Cerebral Palsy: An Osteopathic Approach to Muscle Spascity

Cerebral Palsy

What Causes Cerebral Palsy?

Cerebral palsy (CP) is caused by an injury to an infants brain that interrupts normal development. People with CP have reduced muscle strength and aerobic fitness, which may impact their ability to perform activities such as standing, walking, running and to participate in everyday life. Exercise is defined as a planned, structured and repetitive activity that aims to improve fitness. Aerobic exercise aims to improve aerobic fitness, while strength training aims to improve muscle strength. Health professionals often prescribe exercise to people with CP, primarily to improve function, but there has been no comprehensive evaluation of the evidence for th e effe ctiveness of these interventions in people with CP (Ryan et al, 2017).

Types of Cerebral Palsy

Exercise Prescription

aerobic exercise

resistance training

Mixed training

Passive muscle stretching

6 weeks of combined passive muscle stretching and whole body vibration could decrease the spasticity and increase the muscle strength and balance of children and adolescents with CP. Whole body vibration could be an alternative additional treatment to passive muscle stretching for both clinical and home therapy programs for children and adolescents with CP (Tupimai et al. 2016).

Effect of Massage Treatment on Microcirculation and musculoskeletal soft tissues

Massage is one of the oldest and most widely used treatments in complementary and alternative medicine, with more than 75 forms of it practised today.
Deepfriction massage (DFM), which was introduced by James Cyriax for treating tendon disorders, involves application of forces perpendicular to the fibres as to separate each fibre and align the newly formed collagen. It helps to promote analgesia, local hyperaemia, and reduce adherence of scar tissue to muscles, tendons and ligaments. Moreover, it helps to break subcutaneous adhesion and prevent fibrosis, leading to improved sensory feedback and decreased pain  (Rasool et al. 2017).

Massage has been used to improve blood and lymphatic circulation, enhance inelastic and elastic properties of muscles and connective tissue, alleviate muscle pain and promote relaxation. 9 It has been reported that mechanical properties and stretch reflex of spastic muscle differ from normal muscles. Stretch reflex is responsible for regulation of muscle stiffness and exaggerated response as this is responsible for hypertonia (Rasool et al. 2017).

Consequently, treatment is directed towards reducing stretch reflex which has been demonstrated by O’Dwyer et al. in young people with CP through the use of visual feedback.Deep cross-friction massage is used to stretch spasticmuscles and bring the sacromere length to an optimal level. Physical contact in this technique aids in decreasing the pain and benefiting the patient through psychological effects and by acting on the gate control theory.  M Hernandez Reif et al. found that children receiving massage therapy showed fewer cerebral palsy symptoms, including overall less rigid muscle tone reduced spasticity, and improvement in gross and fine motor functioning  (Rasool et al. 2017).

Effectiveness of Deep Friction Massage on Spascity associated with Cerebral Palsy

Deep Friction Massage was found to be a better and efficacious treatment option for management of spasticity in children with cerebral palsy than the traditional physical therapy alone. However, its role in improving function could not be established but it is speculated that reducing the spasticity
may help benefit in functional level and performance (Rasool et al. 2017).

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Reference List

Rasool F, Memon AR, Kiyani MM, Sajjad AG (2017). The effect of deep cross friction massage on spasticity of children with cerebral palsy: A double-blind randomised controlled trial. J Pak Med Assoc. Jan;67(1):87-91.

Ryan JM, Cassidy EE, Noorduyn SG, O’Connell NE (2017). Exercise interventions for cerebral palsyCochrane Database Syst Rev. Jun 11;6:CD011660

Tupimai T, Peungsuwan P, Prasertnoo J, Yamauchi J (2016). Effect of combining passive muscle stretching and whole body vibration on spasticity and physical performance of children and adolescents with cerebral palsyJ Phys Ther Sci. Jan;28(1):7-13.

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