Influence of the Spinal Manipulation on Muscle Spasticity and Manual Dexterity in Cerebral Palsy.
Condition: Cerebral Palsy, Spastic
MeSH terms: Muscle Spasticity; Paralysis; Cerebral Palsy
Study type: Interventional

Summary: 
      The aim of the study is to evaluate a short term influence of the Spinal Manipulation (SM) on
      the wrist muscles spasticity and manual dexterity in children with spastic Cerebral Palsy.

      Effect of SM and imitation of the SM has to be compared in the double-blinded randomized
      clinical trial.
    

Detailed description: 
      Muscle spasticity is an important clinical syndrome of Cerebral Palsy (CP) resulting from
      upper motor neuron lesion, and its reduction is a significant therapeutic target for
      optimizing motor performance.

      Investigator's recent study describes decrease in spasticity after SM in a group of children
      with CP. But that case series has no control group and the sample size was small so it does
      not prove the influence of the SM on the muscle spasticity.

      The purpose of the present study is to evaluate influence of the SM on muscle spasticity and
      on manual dexterity of the child with CP in a double-blind randomized clinical trial with two
      arms: SM (experimental group) and imitation of SM (control group).

      Children admitted to the International Clinic of Rehabilitation are selected according to
      inclusion-exclusion criteria and invited to participate. After getting the permission the
      baseline assessment is performed.

      Patients are allocated to the experimental or control group using stratified randomization.
      Medical doctor certified in Manual Therapy performs the intervention (SM in the experimental
      group and imitation in the control group) and in 15 minutes the second assessment is
      performed. Investigators, children and parents are blinded to group allocation.
    

Intervention name(s): Spinal manipulation; Imitation of the spinal manipulation
Intervention type(s): Procedure; Procedure
Intervention description(s): Spinal manipulation (SM) is a therapeutic intervention performed on spinal articulations in which force is applied to the spine. The selected joint is moved to its end range of motion, followed by application of an rapid impulse or thrust to achieve a gapping of the target joint.
SM is performed by an orthopedic medical doctor certified in Manual Therapy. After manual evaluation, high-velocity low-amplitude SM is carried out in all regions of the spine, including thoracic adjustments in the prone position, lumbar manipulation in lateral recumbent position, and cervical manipulation in sitting position.; Imitation of the SM physically and visually resembles the act of SM. It comprises placing the patient in the same positions and performing the same movements as during SM but without applying the force in the end range of motion.
Other intervention name(s): Biomechanical correction of the spine; Sham manipulation
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Basic Science
Keywords: Cerebral Palsy; Spinal Manipulation; Muscle Spasticity; Manual Dexterity