Spinal Manipulation Therapy May Help Reduce Spasticity in Children with Cerebral Palsy, Trial Finds
Spinal manipulation, a physical therapy focused on realigning and reactivating spinal articulations, may help reduce muscle contractions (spasticity) in the short term in cerebral palsy patients, results of a clinical trial suggest.
Trial results were published in the study, “Influence of Spinal Manipulation on Muscle Spasticity and Manual Dexterity in Participants With Cerebral Palsy: Randomized Controlled Trial,” in the Journal of Chiropractic Medicine.
Muscle spasticity is a symptom of cerebral palsy and other neurological diseases resulting from upper motor neuron lesions. It limits children’s motor development and natural motor functioning, making its reduction a major therapeutic goal for improving motor performance in affected patients.
In the randomized SpiManCP trial (NCT03005938), researchers at the International Clinic of Rehabilitation in Ukraine evaluated the short-term impact of spinal manipulation on wrist muscle spasticity and manual dexterity in children with cerebral palsy.
A total of 79 children, between the ages of 8 and 18 years, were randomly assigned to receive either spinal manipulation or a sham physical therapy. All participants retained hand function up to having some difficulties handling objects, corresponding to levels I to III on the Manual Ability Classification System (MACS).
The trial’s primary outcome measure was muscle spasticity in the wrist muscles measured at the beginning and after therapy. Spasticity was assessed with a NeuroFlexor device, which can quantify the different components of wrist muscle tone response based on the resistance to passive movements of the wrist, performed with different velocity by a computer-controlled step motor.
Total resisting force during passive wrist extension consists of different components: the active neural component, the equivalent of spasticity produced by muscle contractions induced by stretch reflexes; and non-neural components, associated with altered properties of muscle and tendons: the elastic and viscous components.
Spinal manipulation was performed by an orthopedic medical doctor, focusing on the thoracic, lumbar, and cervical regions. This strategy uses applied forced and low-amplitude rapid muscle movement to relieve pressure on the spinal joints and improve nerve function.
The sham therapy was applied by the same practitioner, who used identical body positions and movements performed in the spinal manipulation sessions but without applying substantial force.
Evaluation of the active reaction of wrist muscle tone after 15 minutes of therapy revealed that children who underwent spinal manipulation had less wrist spasticity than before the therapy. They also had less wrist spasticity than the children in the sham therapy group.
In contrast, no changes were reported regarding the non-neural proprieties of muscle and tendon response, in either group or between groups. “Such results were anticipated because structural changes in the muscle are not supposed to occur in such a short period of time,” the researchers wrote.
Next, researchers evaluated hand functionality using the Box and Block test, in which children were asked to move small blocks from one place to another within 60 seconds.
After spinal manipulation, children were able to move a mean of 4.1 blocks more per second than they did before therapy, while in the control group they moved an average of 3.01 blocks more. However, the differences between the treatment and control groups were not statistically significant.
These results did not provide any “evidence about the influence of spinal manipulation on hand dexterity in participants with spasticity.” However they corroborate “the hypothesis that spinal manipulation may decrease muscle spasticity temporarily in participants with disordered muscle tone regulation, specifically in children with cerebral palsy,” according to the researchers.
Additional studies are necessary to explore the long-term effect of spinal manipulation as an alternative strategy to reduce muscle spasticity and improve muscle tone in patients with cerebral palsy, or other spasticity syndrome.
