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Physiotherapy Management of Cerebral Palsy Patient:-: Manual Stretching

The physiotherapy management of cerebral palsy patients has several goals: to improve coordination, build strength, enhance balance and flexibility, optimize functioning, and maximize independence. Techniques used include manual stretching, weight bearing, splinting, static and functional exercises, and different types of stretching. Additional approaches are neurodevelopmental treatment, constraint-induced movement therapy, serial casting, electrical stimulation, and hippotherapy.

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Md Sherajul Haque
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94 views

Physiotherapy Management of Cerebral Palsy Patient:-: Manual Stretching

The physiotherapy management of cerebral palsy patients has several goals: to improve coordination, build strength, enhance balance and flexibility, optimize functioning, and maximize independence. Techniques used include manual stretching, weight bearing, splinting, static and functional exercises, and different types of stretching. Additional approaches are neurodevelopmental treatment, constraint-induced movement therapy, serial casting, electrical stimulation, and hippotherapy.

Uploaded by

Md Sherajul Haque
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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PHYSIOTHERAPY MANAGEMENT OF CEREBRAL

PALSY PATIENT :-
The goal of physical therapy is to help individuals:

 develop coordination
 build strength
 improve balance
 maintain flexibility
 optimize physical functioning levels
 maximize independence

Manual Stretching 

Prolonged manual stretch may be applied manually, using the effect of


body weight and gravity or mechanically, using machine or splints. Stretch
should provide sufficient force to overcome hyper tonicity and passively
lengthen the muscle. Unlikely to provide sufficient stretch to cause change
in a joint that already has contracture.

Weight Bearing

 
Weight bearing has been reported to reduce contracture in the lower limb
through use of Tilt-tables, and standing frames through a prolonged
stretch. Angles are key to ensure the knees remain extend during the
prolonged stretch as the force exerted on the knee can be quite high. Some
research also challenges the assumption of the benefits of prolonged
standing.

Splinting

Splints and casts are external devices “Splints and casts are external
devices designed to apply, distribute or remove forces to or from the body
in a controlled manner to perform one or both basic functions of control of
body motion and alteration or prevention in the shape of body tissue.”
Splinting can be used to produce low-force, long duration stretching
although there is a dearth of evidence to support this. 

Static Weight-bearing Exercises

Stimulation of antigravity muscle strength, prevention of hip dislocation,


reduction in spasticity and improvements in bone mineral density, self-
confidence and motor function have all been achieved through the use of
Static Weight-Bearing exercises such as Tilt-Table and Standing Frame. [5]

Muscle Strengthening Exercises

It aims to increase the power of weak antagonist muscles and of the


corresponding spastic agonists and to provide the functional benefits of
strengthening in children with CP. 

Functional Exercises

Training related to specific functional activities combining aerobic and


anaerobic capacity and strength training in ambulatory children, has been
shown to significantly improve overall physical fitness, the intensity of
activities, and quality of life.
Passive Stretching

It is a manual application for spastic muscles to relieve soft tissue


tightness. Manual stretching may increase range of movements, reduce
spasticity, or improve walking efficiency in children with spasticity. 
Stretch may be applied in a number of ways during neurological
rehabilitation to achieve different effects. The types of stretching used
include;

1. Fast / Quick
2. Prolonged
3. Maintained
Neurodevelopmental Treatment (NDT) 
One of the more popular approaches utilized in the management of
cerebral palsy, the NDT Approach also know as Bo bath Approach, was
developed in the 1940's by Berta and Karl Bo bath, based on their personal
observations working with children with cerebral palsy. The basis of this
approach is that motor abnormalities seen in children with Cerebral Palsy
are due to atypical development in relation to postural control and reflexes
because of the underlying dysfunction of the central nervous system.

Constraint-Induced Movement Therapy (CIMT)

Constraint-induced Movement therapy  is used predominantly in the


individual with Hemiplegic Cerebral Palsy to improve the use of the
affected upper limb. The stronger or non-impaired upper limb is
immobilized for a variable duration in order to Force Use of the impaired
upper limb over time .Antilla et al (2008) ] identified one high and one
lower-quality trials which measured both body functions and structures,
and activity and participation outcomes through use of CIMT.
Serial Casting 

Serial casting is a common technique that is used and most effective in


managing spasticity related contracture. Serial casting is a specialized
technique to provide an increased range of joint motion. The process
involves a joint or joints that are tight, which are immobilized with a semi-
rigid, well-padded cast. Serial casting involves repeated applications of
casts, typically every one to two weeks as range of motion is restored. 

Electrical Stimulation

The goal of the electrical stimulation is to increase muscle strength and


motor function. Electrical stimulation is provided by Transcutaneous
Electrical Nerve Stimulation (TENS) Unit which is portable, non-invasive
and can be used in the home-setting by parents or the
patient. Neuromuscular Electrical Stimulation (NMES) involves
application of transcutaneous electrical current that results in muscle
contraction. NMES has been postulated to increase muscle strength by
increasing the cross-sectional area of the muscle and by increased
recruitment of type 2 muscle fibres.

Hippo therapy

Gross Motor Function including Muscle tone, Range of Movement,


Balance, Coordination and Postural Control in children with CP have been
shown to improve with Hippo therapy - Therapeutic horse-back riding
which may reduce the degree of motor disability. Many none physical
benefits may also be developed through enjoyment and providing a setting
for increased social interaction, cognitive and psychosocial development .

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