Casting is a fairly well-established option for the reduction of contractures due to spasticity, as well as a method for reducing tone. Some research suggests that casting is more effective than traditional therapy techniques in reducing contracture and is inconsistently better at decreasing hypertonicity. Traumatic brain injury and cerebral palsy are the most common diagnostic groups that are identified in the literature as benefiting from casting, but severe spasticity resulting from a stroke may also be positively affected by this technique. Several forms of casting are mentioned in the literature, including serial casting, inhibitive casting, drop-out casts, and bivalve casts. The purpose of this article is to review the differences and similarities between these kinds of casting and offer guidelines for their use in individuals who have suffered a stroke.