a serious danger of falling if the patient in a hip spica cast tries to get upright to walk without assistance because they lack the ability to control their balance. Patients normally remain in a bed or rely on a reclining wheelchair or children's stroller. Children in spica casts can sometimes learn to get mobile by scooting around on skateboards, or pulling themselves across the floor. Some children even learn to walk by holding themselves up against furniture. A child in a spica cast must always be supervised and safety must always be considered when they are at a mobile phase of their healing to prevent reinjury or damage to the cast. Many spica casts have a spreader bar between the legs to help strengthen the cast and support the legs in the proper positions. It is important when moving the casted patient to not lift them by this spreader bar, as it may break and this could cause injury to the patient. To facilitate toileting or diaper changing and hygienic cleaning, an opening is created in the cast at the groin. The opening is normally referred to as the "perineal opening". It is formed either during cast application or after cast application by cutting the hole with the cast saw. The opening must then be petalled or lined to keep this area of the cast clean and dry. Because the hips cannot bend, using a toilet is difficult, if not impossible. It is therefore necessary for the patient to either use a diaper, bedpan, or catheters to manage bodily waste eliminations. Bathing must be done by sponge baths. Hair may be shampooed by using plastic wash basins under the head. To shampoo wash the hair of a child, the child can be lifted and placed on a kitchen counter top and their head held over the kitchen sink. Other casts The Minerva cast and the Risser cast were formerly used to protect an injured spine or as part of the treatment for a spinal deformity (see scoliosis), but are seldom seen today. The Minerva cast includes the trunk of the body (sometimes extending down only so far as the rib cage) as well as the patient's head, with openings provided for the patient's face, ears, and usually the top of the head and hair. The Risser cast was similar, extending from the patient's hips to the neck and sometimes