Stretching in Children and Adolescents With Spastic Cerebral Palsy
Condition: Cerebral Palsy, Spastic
MeSH terms: Muscle Spasticity; Paralysis; Cerebral Palsy
Study type: Interventional

Summary: 
      The primary aim of this study is to gain knowledge about both the effects of a single bout of
      static and proprioceptive neuromuscular facilitation (PNF) stretching and the effects of
      8-week static and PNF stretching training on the calf muscle-tendon properties in children
      with spastic cerebral palsy (SCP). Furthermore, the effects on joint and muscle function,
      stretch reflexes, gait, and self-reported gait function and functional performance are
      examined to receive a comprehensive picture of potential changes.

      Further aims of this study are to identify which stretching technique might be more efficient
      by comparing the effects of both stretching interventions, and to gain information about the
      influence of foot flexibility on the stretch achieved by the spastic gastrocnemius muscle.
    

Detailed description: 
      Background: Spastic cerebral palsy (SCP) is a non-progressive neuro-muscular disorder in
      children resulting from an injury in the central nervous system. Individuals with SCP present
      with impairments such as hyperreflexia, demonstrate impaired motor control and muscle growth.
      Manual stretching is an important approach in the physical therapy of individuals with SCP
      used to increase muscle extensibility and length, decrease muscle stiffness, and to improve
      functional abilities. However, there are only a few studies that have examined its acute and
      long-term effects in children with SCP and it is still not clear, if it may lead to the
      expected changes, and which method might be the most-effective one. Besides static
      stretching, proprioceptive neuromuscular facilitation (PNF) stretching has been used to aid
      the rehabilitation of, for example, stroke patients by either facilitating muscle elongation
      and/or improving muscle strength. Positive effects were found (e.g., increased dorsiflexion,
      improved gait function, altered tendon properties), which are also clinically relevant for
      individuals with SCP. However, there is no information about the impact of PNF in this
      population.

      Aims: The primary aim of this study is to gain knowledge about both the effects of a single
      bout of static and PNF stretching and the effects of 8-week static and PNF stretching
      training on the calf muscle-tendon properties in children with SCP. Furthermore, the effects
      on joint and muscle function, stretch reflexes, gait, and self-reported gait function and
      functional performance are examined to receive a comprehensive picture of potential changes.
      Further aims of this study are to identify which stretching technique might be more efficient
      by comparing the effects of both stretching interventions, and to gain information about the
      influence of foot flexibility on the stretch achieved by the spastic gastrocnemius
      muscle-tendon unit.

      Methods: A randomized controlled trial with a cross-over design will be performed. Prior to
      the measurements, a familiarization session takes place and both groups will further be
      examined in three separate measurement sessions. Based on a power calculation and in order to
      account for possible dropouts, 30 individuals with SCP (age range: 6 to 15 years) will be
      recruited. The participants will be randomly allocated to either the static stretching or PNF
      stretching intervention after the familiarization session. Passive muscle-tendon
      morphological properties will be examined. A manually controlled instrumented spasticity
      assessment will be performed to test for differences in the reflex responses. Information
      about the lengthening behavior of the tissues throughout the dorsiflexion rotations will also
      be collected by use of ultrasound. Isometric muscle strength and the active torque-angle
      relationship will be investigated using an isokinetic dynamometer. To assess the gait pattern
      of the children, a gait analysis will be performed by use of an 8-camera motion capture
      system. In addition, we will examine the participants' gait function and functional
      performance by use of the Gait Outcomes Assessment List questionnaire.
    

Intervention name(s): Static stretching; Proprioceptive neuromuscular facilitation stretching
Intervention type(s): Other; Other
Intervention description(s): During the static stretching training for the calf muscles, the ankle joint is moved into maximal dorsiflexion until the point of discomfort is reached. The ankle joint is then held in this maximal position for 30 s followed by a rest period of 30 s. Afterwards, the procedure is repeated with the knee in flexed position to stretch the soleus muscle.; During the proprioceptive neuromuscular facilitation stretching, the ankle joint is moved into maximal dorsiflexion. While the foot is kept in this position, the child will perform a (sub-) maximal isometric contraction of the plantar flexors against the resistance of their parents. Afterwards, the ankle joint will be moved further into greater dorsiflexion and is held there for the remaining seconds followed by 30 s of rest. Subsequently, the stretch will be applied with the knee flexed.
Other intervention name(s): PNF
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: Cerebral palsy; Stretching; Muscle-tendon unit; Spasticity; Gait