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.

Keywords: Cerebral Palsy; Muscle Spasticity; Spinal Manipulation.

Figures

Fig 1

The Neuroflexor device for measuring muscle tone components.

Fig 2

Neural component values before intervention (NC-1), after 1 spinal manipulation (NC-2), and after the 2-week course of treatment (NC-3). Data presented for the whole group, for patients with minimal spasticity (“1” by the Modified Ashworth scale), for patients with mild spasticity (“1+” by the Modified Ashworth scale), and for patients with moderate spasticity (“2” by the Modified Ashworth scale). The NC values are given in newtons on the vertical axis.