Research Article
BibTex RIS Cite

Fonksiyonel masajın serebral palsili çocuklarda spastisite ve motor fonksiyon üzerine etkileri: rastgele kontrollü çalışma

Year 2018, Volume: 5 Issue: 3, 135 - 142, 25.12.2018

Abstract

Amaç: Bu çalışmanın amacı; fonksiyonel masajın serebral palsili (SP) çocukların alt ekstremite spastisite şiddetine ve kaba motor fonksiyonlarına etkilerini araştırmaktı.

Yöntem: Çalışmaya iki farklı rehabilitasyon merkezinden, iletişim becerisi olan (İletişim Becerileri Sınıflandırma Sistemine göre iletişim becerileri I-III arasında), fonksiyonel seviyeleri Kaba Motor Fonksiyon Sınıflandırma Sistemi’ne (KMFS) göre I-IV arasında değişen, hiç ameliyat geçirmemiş ve yaşları 5-12 yaş arasında değişen 20 SP‘li çocuk dahil edildi. Çalışmaya dahil edilen çocuklar kontrol veya araştırma gruplarına sırasıyla sadece Konvansiyonel Fizyoterapi (KF) veya KF’ye ek olarak Fonksiyonel Masaj (FM) almak üzere rastgele dağıtıldı. Uygulamalar gruplara aynı ortamda ve eşit dozlarda verildi (toplam sekiz hafta, haftada 2 gün, günde 45 dk). Spastisite şiddeti Modifiye Ashworth Skalası (MAS), fonksiyonel seviye ve kaba motor fonksiyonlar sırasıyla KMFS ve Kaba Motor Fonksiyon Ölçütü (KMFÖ) ile değerlendirildi.

Bulgular: Her iki gruba ait terapi öncesi ve terapi sonrası KMFÖ, kalça fleksörleri, adduktörleri, hamstringler ve baldır kaslarının spastisite skorlarını kapsayan veriler karşılaştırıldığında, kontrol grubuna ait kalça fleksörleri spastisite skorunda herhangi bir fark bulunmazken (p>0.05); araştırma grubuna ait kalça fleksörleri spastisite skorunda iyileşme saptandı (p<0.05). MAS’daki diğer üç kas grubuna ait spastisite skorunda ve KMFÖ skorundaki değişimler her iki grup için benzerdi.

Sonuç: Sonuç olarak, SP’li çocuklarda FM’nin KF ile kombinasyonu spastisitenin tedavisinde ve motor fonksiyonlarla ilgili bazı parametreleri iyileştirmede etkili olduğu sonucuna varılmıştır.

References

  • 1. Smithers-Sheedy H, Badawi N, Blair E, et al. What constitutes cerebral palsy in the twentyfirst century? Dev Med Chil Neurol. 2014;56:323-328.
  • 2. Ohata K, Tsuboyama T, Haruta T, et al. Relation between muscle thickness, spasticity, and activity limitations in children and adolescents with cerebral palsy. Dev Med Child Neurol. 2008;50:152-156.
  • 3. Aymard C, Katz R, Lafitte C, et al. Presynaptic inhibition and homosynaptic depression: a comparison between lower and upper limbs in normal human subjects and patients with hemiplegia. Brain. 2000;123:1688-1702.
  • 4. Calancie B, Broton JG, Klose KJ, et al. Evidence that alterations in presynaptic inhibition contribute to segmental hypo-and hyperexcitability after spinal cord injury in man. Electroencephalogr and Clin Neurophysiol. 1993;89:177-186.
  • 5. Damiano DL, Vaughan CL, Abel ME. Muscle response to heavy resistance exercise in children with spastic cerebral palsy. Dev Med Child Neurol. 1995;37:731-9.
  • 6. Carter R, Crago P, Keith M. Stiffness regulation by reflex action in the normal human hand. J Neurophysiol. 1990;64:105-118.
  • 7. Cody F, Richardson Hc, MacDermott N, et al. Stretch and vibration reflexes of wrist flexor muscles in spasticity. Brain. 1987;110:433-450.
  • 8. Dietz V, Quintern J, Berger W. Electrophysiological studies of gait in spasticity and rigidity. Evidence that altered mechanical properties of muscle contribute to hypertonia. J Neurol. 1981;104:431-449.
  • 9. Dietz V, Ketelsen U-P, Berger W, et al. Motor unit involvement in spastic paresis: relationship between leg muscle activation and histochemistry. J Neurological Sci. 1986;75:89-103.
  • 10. Little JW, Powers RK, Michelson P, et al. Electrodiagnosis of upper limb weakness in acute quadriplegia. Am J Phys Med Rehabil. 1994;73:15-22.
  • 11. Meinders M, Price R, Lehmann JF, et al. The stretch reflex response in the normal and spastic ankle: effect of ankle position. Arch Phys Med Rehabil. 1996;77:487-492.
  • 12. Rantanen T, Avlund K, Suominen H, et al. Muscle strength as a predictor of onset of ADL dependence in people aged 75 years. Aging Clin Exp Res. 2002;14(Suppl):10-15.
  • 13. Rantanen T, Sakari‐Rantala R, Heikkinen E. Muscle strength before and mortality after a bone fracture in older people. Scand J Med Sci Sports. 2002;12:296-300.
  • 14. Gallagher D, Visser M, De Meersman RE, et al. Appendicular skeletal muscle mass: effects of age, gender, and ethnicity. J Appl Physiol. 1997;83:229-239.
  • 15. Lexell J, Downham D, Sjöström M. Distribution of different fibre types in human skeletal muscles: fibre type arrangement in m. vastus lateralis from three groups of healthy men between 15 and 83 years. J Neurol Sci. 1986;72:211-222.
  • 16. McCrea PH, Eng JJ, Hodgson AJ. Time and magnitude of torque generation is impaired in both arms following stroke. Muscle Nerve. 2003;28:46-53.
  • 17. Powers R, Campbell D, Rymer W. Stretch reflex dynamics in spastic elbow flexor muscles. Ann Neurol. 1989;25:32-42.
  • 18. Novak I, McIntyre S, Morgan C, et al. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol. 2013;55:885-910.
  • 19. Novak I, McIntyre S. The effect of Education with workplace supports on practitioners’ evidence-based practice knowledge and implementation behaviours. Aust Occup Ther J 2010;57:386-393.
  • 20. Thanakiatpinyo T, Suwannatrai S, Suwannatrai U, et al. The efficacy of traditional thai massage in decreasing spasticity in elderly stroke patients. Clin Interv Aging. 2014;9:1311-1319.
  • 21. Barlow J, Powell L, Cheshire A. The training and support programme (involving basic massage) for parents of children with cerebral palsy. J Bodyw Mov Ther. 2007;11:44-53.
  • 22. Malila P, Seeda K, Machom S, et al. Effects of thai massage on spasticity in young people with cerebral palsy. J Med Assoc Thai. 2015;98(Suppl 5):S92-S96.
  • 23. Standley RA, Miller MG, Binkley H. Massage’s effect on injury, recovery, and performance: a review of techniques and treatment parameters. Strength Cond J. 2010;32:64-67.
  • 24. Yang YJ, Zhang J, Hou Y, et al. Effectiveness and safety of Chinese massage therapy (Tui Na) on post-stroke spasticity: a prospective multicenter randomized controlled trial. Clin Rehabil. 2017;31:904-912.
  • 25. Krauss JR, Creighton DS, Pociask FD. Extremity orthopedics: a laboratory manual. Rochester Hills, MI: Lakeview Media LLC; 2004.
  • 26. Van den Doler P, Ferreira P, Refshauge K. Effectiveness of soft tissue massage and exercise for the treatment of non-specific shoulder pain: a systematic review with metaanalysis. Br J Sports Med. 2014;48:1216-1226.
  • 27. Weerapong P, Hume PA, Kolt GS. The mechanisms of massage and effects on performance, muscle recovery and injury prevention. Sports Med. 2005;35:235-256.
  • 28. Cortés Godoy V, Gallego Izquierdo T, Lázaro Navas I, et al. Effectiveness of massage therapy as co-adjuvant treatment to exercise in osteoarthritis of the knee: a randomized control trial. J Back Musculoskelet Rehabil. 2014;27:521-529.
  • 29. Wallen M, Stewart K. The evidence for abandoning upper limb stretch interventions in paediatric practice. Dev Med Child Neurol. 2013;55:208-209.
  • 30. Moyer CA, Rounds J, Hannum JW. A metaanalysis of massage therapy research. Psychol Bull. 2004;130:3-18.
  • 31. Sobeck C, Lenk L, Knipper S, et al. The effectiveness of functional massage on pain and range of motion measurements in patients with orthopedic impairments of the extremities. Int Musculoskelet Med. 2016;38:21-25.
  • 32. Wiktorsson-Moller M, Öberg B, Ekstrand J, et al. Effects of warming up, massage, and stretching on range of motion and muscle strength in the lower extremity. Am J Sports Med. 1983;11:249-252.
  • 33. Alhusaini AA, Crosbie J, Shepherd RB, et al. No change in calf muscle passive stiffness after botulinum toxin injection in children with cerebral palsy. Dev Med Child Neurol. 2011;53:553-558.
  • 34. Field T, Diego M, Gonzalez G, et al. Neck arthritis pain is reduced and range of motion is increased by massage therapy. Complement Ther Clin Pract. 2014;20:219-223.
  • 35. Goldberg J, Seaborne DE, Sullivan SJ, et al. The effect of therapeutic massage on H-reflex amplitude in persons with a spinal cord injury. Phys Ther. 1994;74:728-737.
  • 36. Gracies JM. Physical modalities other than stretch in spastic hypertonia. Phys Med Rehabil Clin N Am. 2001;12:769-792.
  • 37. Hernandez-Reif M, Field T, Field T, et al. Multiple sclerosis patients benefit from massage therapy. J Bodyw Mov Ther. 1998;2:168-174.
  • 38. Hernandez-Reif M, Field T, Largie S, et al. Cerebral palsy symptoms in children decreased following massage therapy. Early Child Development and Care. 2005;175:445-456.
  • 39. Sanders H, Davis MF, Duncan B, et al. Use of complementary and alternative medical therapies among children with special health care needs in southern Arizona. Pediatrics. 2003;111:584-587.
  • 40. Macgregor R, Campbell R, Gladden MH, et al. Effects of massage on the mechanical behaviour of muscles in adolescents with spastic diplegia: a pilot study. Dev Med Child Neurol. 2007;49:187-191.

Effects of functional massage on spasticity and motor functions in children with cerebral palsy: a randomized controlled study

Year 2018, Volume: 5 Issue: 3, 135 - 142, 25.12.2018

Abstract

Purpose: The purpose of this study was to investigate the effects of functional massage on the severity of lower limb spasticity and gross motor function of children with cerebral palsy (CP).

Methods: In this study, 20 children who were classified as level I-IV according to Gross Motor Classification System (GMFCS), who had communication skills (according to Communication Function Classification System, level I-III), who had never undergone surgery and who were between the ages of 5-12 years, were recruited from two rehabilitation centers. Children were randomized to control or experimental groups to receive either only Traditional Physiotherapy (TP) or TP combined with Functional Massage (FM). Interventions were delivered at equal dosage (total eight weeks, 2 days per week, 45 minutes/day) in the same environment. The severity of spasticity was measured with Modified Ashworth Scale (MAS), and functional level and gross motor function were quantified according to GMFCS and Gross Motor Function Measure (GMFM), respectively.

Results: When the pre-therapy and post-therapy data covering GMFM and hip adductors, hip flexors, hamstrings and calf muscles spasticity score of the both groups were compared, no statistically significant difference was determined in the hip flexor spasticity score of the control group (p>0.05), while considerable differences were defined in the hip flexors spasticity score of the experimental group (p<0.05). Improvements on MAS belonging to other three muscle groups and on GMFM score were similar in both groups (p>0.05).

Conclusion: In conclusion, it was identified that FM combined with TP is effective in treating spasticity and in improving some parameters related to motor function in children with CP.

References

  • 1. Smithers-Sheedy H, Badawi N, Blair E, et al. What constitutes cerebral palsy in the twentyfirst century? Dev Med Chil Neurol. 2014;56:323-328.
  • 2. Ohata K, Tsuboyama T, Haruta T, et al. Relation between muscle thickness, spasticity, and activity limitations in children and adolescents with cerebral palsy. Dev Med Child Neurol. 2008;50:152-156.
  • 3. Aymard C, Katz R, Lafitte C, et al. Presynaptic inhibition and homosynaptic depression: a comparison between lower and upper limbs in normal human subjects and patients with hemiplegia. Brain. 2000;123:1688-1702.
  • 4. Calancie B, Broton JG, Klose KJ, et al. Evidence that alterations in presynaptic inhibition contribute to segmental hypo-and hyperexcitability after spinal cord injury in man. Electroencephalogr and Clin Neurophysiol. 1993;89:177-186.
  • 5. Damiano DL, Vaughan CL, Abel ME. Muscle response to heavy resistance exercise in children with spastic cerebral palsy. Dev Med Child Neurol. 1995;37:731-9.
  • 6. Carter R, Crago P, Keith M. Stiffness regulation by reflex action in the normal human hand. J Neurophysiol. 1990;64:105-118.
  • 7. Cody F, Richardson Hc, MacDermott N, et al. Stretch and vibration reflexes of wrist flexor muscles in spasticity. Brain. 1987;110:433-450.
  • 8. Dietz V, Quintern J, Berger W. Electrophysiological studies of gait in spasticity and rigidity. Evidence that altered mechanical properties of muscle contribute to hypertonia. J Neurol. 1981;104:431-449.
  • 9. Dietz V, Ketelsen U-P, Berger W, et al. Motor unit involvement in spastic paresis: relationship between leg muscle activation and histochemistry. J Neurological Sci. 1986;75:89-103.
  • 10. Little JW, Powers RK, Michelson P, et al. Electrodiagnosis of upper limb weakness in acute quadriplegia. Am J Phys Med Rehabil. 1994;73:15-22.
  • 11. Meinders M, Price R, Lehmann JF, et al. The stretch reflex response in the normal and spastic ankle: effect of ankle position. Arch Phys Med Rehabil. 1996;77:487-492.
  • 12. Rantanen T, Avlund K, Suominen H, et al. Muscle strength as a predictor of onset of ADL dependence in people aged 75 years. Aging Clin Exp Res. 2002;14(Suppl):10-15.
  • 13. Rantanen T, Sakari‐Rantala R, Heikkinen E. Muscle strength before and mortality after a bone fracture in older people. Scand J Med Sci Sports. 2002;12:296-300.
  • 14. Gallagher D, Visser M, De Meersman RE, et al. Appendicular skeletal muscle mass: effects of age, gender, and ethnicity. J Appl Physiol. 1997;83:229-239.
  • 15. Lexell J, Downham D, Sjöström M. Distribution of different fibre types in human skeletal muscles: fibre type arrangement in m. vastus lateralis from three groups of healthy men between 15 and 83 years. J Neurol Sci. 1986;72:211-222.
  • 16. McCrea PH, Eng JJ, Hodgson AJ. Time and magnitude of torque generation is impaired in both arms following stroke. Muscle Nerve. 2003;28:46-53.
  • 17. Powers R, Campbell D, Rymer W. Stretch reflex dynamics in spastic elbow flexor muscles. Ann Neurol. 1989;25:32-42.
  • 18. Novak I, McIntyre S, Morgan C, et al. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol. 2013;55:885-910.
  • 19. Novak I, McIntyre S. The effect of Education with workplace supports on practitioners’ evidence-based practice knowledge and implementation behaviours. Aust Occup Ther J 2010;57:386-393.
  • 20. Thanakiatpinyo T, Suwannatrai S, Suwannatrai U, et al. The efficacy of traditional thai massage in decreasing spasticity in elderly stroke patients. Clin Interv Aging. 2014;9:1311-1319.
  • 21. Barlow J, Powell L, Cheshire A. The training and support programme (involving basic massage) for parents of children with cerebral palsy. J Bodyw Mov Ther. 2007;11:44-53.
  • 22. Malila P, Seeda K, Machom S, et al. Effects of thai massage on spasticity in young people with cerebral palsy. J Med Assoc Thai. 2015;98(Suppl 5):S92-S96.
  • 23. Standley RA, Miller MG, Binkley H. Massage’s effect on injury, recovery, and performance: a review of techniques and treatment parameters. Strength Cond J. 2010;32:64-67.
  • 24. Yang YJ, Zhang J, Hou Y, et al. Effectiveness and safety of Chinese massage therapy (Tui Na) on post-stroke spasticity: a prospective multicenter randomized controlled trial. Clin Rehabil. 2017;31:904-912.
  • 25. Krauss JR, Creighton DS, Pociask FD. Extremity orthopedics: a laboratory manual. Rochester Hills, MI: Lakeview Media LLC; 2004.
  • 26. Van den Doler P, Ferreira P, Refshauge K. Effectiveness of soft tissue massage and exercise for the treatment of non-specific shoulder pain: a systematic review with metaanalysis. Br J Sports Med. 2014;48:1216-1226.
  • 27. Weerapong P, Hume PA, Kolt GS. The mechanisms of massage and effects on performance, muscle recovery and injury prevention. Sports Med. 2005;35:235-256.
  • 28. Cortés Godoy V, Gallego Izquierdo T, Lázaro Navas I, et al. Effectiveness of massage therapy as co-adjuvant treatment to exercise in osteoarthritis of the knee: a randomized control trial. J Back Musculoskelet Rehabil. 2014;27:521-529.
  • 29. Wallen M, Stewart K. The evidence for abandoning upper limb stretch interventions in paediatric practice. Dev Med Child Neurol. 2013;55:208-209.
  • 30. Moyer CA, Rounds J, Hannum JW. A metaanalysis of massage therapy research. Psychol Bull. 2004;130:3-18.
  • 31. Sobeck C, Lenk L, Knipper S, et al. The effectiveness of functional massage on pain and range of motion measurements in patients with orthopedic impairments of the extremities. Int Musculoskelet Med. 2016;38:21-25.
  • 32. Wiktorsson-Moller M, Öberg B, Ekstrand J, et al. Effects of warming up, massage, and stretching on range of motion and muscle strength in the lower extremity. Am J Sports Med. 1983;11:249-252.
  • 33. Alhusaini AA, Crosbie J, Shepherd RB, et al. No change in calf muscle passive stiffness after botulinum toxin injection in children with cerebral palsy. Dev Med Child Neurol. 2011;53:553-558.
  • 34. Field T, Diego M, Gonzalez G, et al. Neck arthritis pain is reduced and range of motion is increased by massage therapy. Complement Ther Clin Pract. 2014;20:219-223.
  • 35. Goldberg J, Seaborne DE, Sullivan SJ, et al. The effect of therapeutic massage on H-reflex amplitude in persons with a spinal cord injury. Phys Ther. 1994;74:728-737.
  • 36. Gracies JM. Physical modalities other than stretch in spastic hypertonia. Phys Med Rehabil Clin N Am. 2001;12:769-792.
  • 37. Hernandez-Reif M, Field T, Field T, et al. Multiple sclerosis patients benefit from massage therapy. J Bodyw Mov Ther. 1998;2:168-174.
  • 38. Hernandez-Reif M, Field T, Largie S, et al. Cerebral palsy symptoms in children decreased following massage therapy. Early Child Development and Care. 2005;175:445-456.
  • 39. Sanders H, Davis MF, Duncan B, et al. Use of complementary and alternative medical therapies among children with special health care needs in southern Arizona. Pediatrics. 2003;111:584-587.
  • 40. Macgregor R, Campbell R, Gladden MH, et al. Effects of massage on the mechanical behaviour of muscles in adolescents with spastic diplegia: a pilot study. Dev Med Child Neurol. 2007;49:187-191.
There are 40 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Hasan Bingöl 0000-0003-3185-866X

Özlem Yılmaz This is me

Publication Date December 25, 2018
Submission Date July 31, 2018
Published in Issue Year 2018 Volume: 5 Issue: 3

Cite

Vancouver Bingöl H, Yılmaz Ö. Effects of functional massage on spasticity and motor functions in children with cerebral palsy: a randomized controlled study. JETR. 2018;5(3):135-42.