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Serial casting has been used for over a decade to manage soft tissue contractures in patients with traumatic head injuries. Its use has also extended to the prevention of contractures in extremities exhibiting potentially deforming spasticity. This article will review the causes of soft tissue contractures and discuss how serial casting can manage such deformities. It will also identify how a serial casting program can be modified and integrated with other therapeutic efforts as the head-injured patient progresses physically and cognitively. Finally, it will address the timing and priority of casting in the patient's overall program.