Changes in Muscle Spasticity in Patients With Cerebral Palsy After Spinal Manipulation: Case Series

Abstract

Objective: The purpose of this case series was to report quantitative changes in wrist muscle spasticity in children with cerebral palsy after 1 spinal manipulation (SM) and a 2-week course of treatment. Methods: Twenty-nine patients, aged 7 to 18 years, with spastic forms of cerebral palsy and without fixed contracture of the wrist, were evaluated before initiation of treatment, after 1 SM, and at the end of a 2-week course of treatment. Along with daily SM, the program included physical therapy, massage, reflexotherapy, extremity joint mobilization, mechanotherapy, and rehabilitation computer games for 3 to 4 hours' duration. Spasticity of the wrist flexor was measured quantitatively using a Neuroflexor device, which calculates the neural component (NC) of muscle tone, representing true spasticity, and excluding nonneural components, caused by altered muscle properties: elasticity and viscosity. Results: Substantial decrease in spasticity was noted in all patient groups after SM. The average NC values decreased by 1.65 newtons (from 7.6 ± 6.2 to 5.9 ± 6.5) after 1 SM. Another slight decrease of 0.5 newtons was noted after a 2-week course of treatment. In the group of patients with minimal spasticity, the decrease in NC after the first SM was almost twofold-from 3.93 ± 2.9 to 2.01 ± 1.0. In cases of moderate spasticity, NC reduction was noted only after the 2-week course of intensive treatment. Conclusions: In this sample of patients with cerebral palsy, a decrease in wrist muscle spasticity was noted after SM. Spasticity reduction was potentiated during the 2-week course of treatment. (J Chiropr Med 2016;15:299-304)

Influence of Spinal Manipulation on Muscle Spasticity and Manual Dexterity in Participants With Cerebral Palsy: Randomized Controlled Trial

“…6,7,8,9,11,12 Previous studies conducted on stroke patients and CP children provided only descriptive information about such influence. 13,14,15 Muscle spasticity was the primary outcome measure of the study. It was measured quantitatively with a Neuro-Flexor device, a valid and reliable tool.…”

“…Sample size was calculated based on data from the preliminary research on the influence of SM on muscle spasticity, 15 with confidence level of 95% and power of 80%. Aimed at detecting the size effect of 1.92 newton in the mild spasticity group, with an SD of 2.92, the estimated sample size was calculated to be at least 37 participants in each group.…”

“…13 Reduction in wrist muscle spasticity after SM was also reported in patients with CP. 14,15 In addition, there is growing body of research on the effects of SM on sensory processing, motor output, and functional performance, including hand function. 8,16 Studies suggest possible changes of muscle strength after a single session of manual therapy (MT).…”

Changes in Ankle Range of Motion, Gait Function and Standing Balance in Children with Bilateral Spastic Cerebral Palsy after Ankle Mobilization by Manual Therapy

“…Joint mobilization provides a well-suited intervention for ankle rehabilitation, but the effectiveness of a randomized control trial study in children with CP has not been confirmed. As part of manual therapy, there are spine manipulation studies for cerebral palsy [ 26 , 27 ]. Manipulation is a high-velocity (thrust) technique, while joint mobilization is a relatively safe technique with low-velocity techniques [ 28 ].…”

Effect of Intermittent Serial Casting on Equinus Ankle Deformity in Children with Hemiplegic Cerebral Palsy

“…As the child grows, the progressive shortening of the calf muscles secondary to spasticity develop to such a significant degree that the contracture may require surgical lengthening of the muscle but since children's feet are relatively flexible and adaptable, The treatment program for a child with HCP may include different options: Exercises, bracing, casting, oral medications and orthopedic surgery. Because of the limited efficiency of "traditional" treatments as exercises and bracing, a wide range of complementary and alternative therapies are used for muscle tone and Range of Motion (ROM) management [6,7] . Serial casting is the use of a series of progressive muscle stretching casts to increase muscle length using prolonged low load stress to contracted tissue [8] .…”