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Changes in Muscle Spasticity in Patients With Cerebral Palsy After Spinal Manipulation

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

The Chiro.Org Blog


SOURCE:   J Chiropractic Medicine 2016 (Dec); 15 (4): 299—304

Oleh Kachmar, MD, PhD, Taras Voloshyn, MD,
and Mykhailo Hordiyevych, MD

Innovative Technologies Department,
International Clinic of Rehabilitation,
Truskavets, Ukraine.


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.

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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.

KEYWORDS:   Cerebral Palsy; Muscle Spasticity; Spinal Manipulation


From the FULL TEXT Article:

Introduction

The term cerebral palsy (CP) refers to a group of permanent disorders of the development of movement and posture, which cause activity limitations and are attributed to nonprogressive disturbances of a developing brain. [1] It is the most common motor disorder among children, affecting approximately 2 children per 1000 births. One in 5 children with CP (20%) has a severe intellectual deficit and is unable to walk. [2]

Muscle spasticity is a clinical syndrome of CP resulting from upper motor neuron lesions, and the reduction of these lesions is an important therapeutic target for optimizing motor performance. The treatment program for a child with spasticity may include different options: exercises, casting, constraint-induced therapy, oral medications, chemodenervation, intrathecal baclofen, selective dorsal rhizotomy, and orthopedic surgery. [3] Because of the limited efficiency of “traditional” treatments, a wide range of complementary and alternative therapies are used for muscle tone management in patients with CP, including spinal manipulation (SM). [4, 5]


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