Impact of Craniosacral Treatment on Child Neurodevelopment

Study Overview
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Brief Summary
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Craniosacral exploration and therapy is one of the innovative palpation and treatment techniques in specialized physiotherapy, which can contribute in an efficient, subtle and sudden way to the detection of dysfunctions in the cranial sutures or fontanelles and/or alterations or blockages that may exist in the frontal lobes and other areas of the skull and body. Objective: To demonstrate the need for programs that consider preventive evaluation and specialized physiotherapeutic treatment (craniosacral therapy) in schools and health centers during all stages of child growth (from birth to 12 years of age), maximizing the development of the child's physical, emotional, psychosocial, linguistic and cognitive capacities; avoiding major complications in the long term. Methodology: 120 children were treated without excluding sex divided into three groups: placebo group (n=41), Movement Technique to Inhibit Reflexes group (n=40) and craniosacral therapy group (n=39).

Detailed Description
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The growth of the individual is linked to differentiated medical-scientific stages. Physiology stipulates stages in the development and maturation of the human being, from the moment of fertilization until the day of death, due to the existence of relatively similar patterns in all human beings, produced at specific parallel times. Primitive Reflexes (PR) are one of the patterns that are activated from the moment of birth and remain until a maximum time of 3 years of age. After this period of time, alterations in the Central Nervous System (CNS) are usually considered possible when they persist, inhibiting the maturation of motor neurons causing postural reflexes (coming from PR) to be delayed in their appearance or not to be adequately presented, including the possibility of their complete absence. Child neurology affirms that cortical and spinal control in the newborn (NB) motor system should be the basis for the opening to higher level functions required by the growth and maturation of the CNS. The participation of the frontal lobes is essential in the rapidity of response to a stimulus, since they direct the planning of complex activities, their final conceptualization and the sustained modification of the components to arrive at an efficient motor sequence. In such a way that the frontal lobes provide a kind of synergism with the rest of the CNS, promoting a faster impulse to think, speak and act. That is why, when there is a lesion in such areas, it can cause the reduction of such impulses and generate deterioration and/or delays at neurobehavioral and neuropsychological levels. The cranial sutures or fontanelles are dense fibrous bands that serve as interconnections of the cranial bones. They are critical in the NB, as during delivery they allow the head to pass through the vaginal canal without putting pressure on the baby's brain. After delivery, the sutures remain open for several months of life for the development, growth and protection of the brain. Palpation of the cranial sutures or fontanelles is one of the practices in neurology and physical therapy used to determine the growth and development of the child. Craniosacral exploration and therapy is one of the innovative palpation and treatment techniques in specialized physical therapy, which can contribute in an efficient, subtle and sudden way to the detection of dysfunctions in the cranial sutures or fontanelles and/or in the alterations or blockages that may exist in the frontal lobes and other areas of the skull and body. The manual skill of craniosacral exploration is based on the ability of the craniosacral therapist to feel the state of the fasciae surrounding the brain and spinal cord, as well as their physiological structure. The gentle, non-invasive manual contact, with hardly any pressure, contributes to the detection of tensions in the connective tissue, which could lead to possible disruptions in the treated patient. This is how the specialized therapist assesses the rhythm of mobility of the cranial fasciae, their synchrony, strength, frequency and tenacity. When there are alterations in the structure and state of the cranial membranes diagnosed by the specialized therapist, craniosacral therapy would be initiated to balance the membrane tensions of the bones that make up the skull and normalize the movement, synchrony, strength, frequency and tenacity. Failure to release the existing tensions in the fascial system could lead to different imbalances in the nervous, visceral, endocrine and circulatory systems, both blood and lymphatic; this could cause states of persistent RP or its reactivation, cranial blockages that do not allow the correct neurological and cognitive functioning, and possible mental and learning disorders or alterations. The studies that have been carried out in Physiotherapy at behavioral and neuropsychological level show that there is a high percentage of relationship between persistent RPs and certain disorders, such as attention deficit, hyperactivity, depression, autism and poor concentration, but such dysfunctions are not only described in children with clear pathologies such as those mentioned above, but studies have also been presented in the child population characterized as healthy, with mild patterns of alterations in their cognitive, motor, psychological and social development that show different degrees of activation of RPs. Therefore, it is necessary to evaluate all stages of child development (from gestation to the onset of puberty) to obtain a complete neurological chronological assessment. Other studies show that tensions in the temporo-mandibular joints, in the frontal and parietal areas of the skull, cause problems such as migraines, delayed motor behavior, stress, anxiety, bruxism and lack of concentration, leading to different disorders that occur as the condition progresses, helping to worsen the physical and mental well-being of the child. Thus, craniosacral therapy indicates that all these disorders mentioned in healthy children may be due to a plastic deformation in any of the cranial membranes, which, when generalized to the rest of the body, may influence the degree of fascial tension of the others. With the restructuring of these fasciae by means of craniosacral therapy, the integrity of the organism and thus its well-being would return. This work is based on the previous research presented as Master's Thesis under the name of Early Craniosacral and Primitive Reflex Evaluation in Child Neurodevelopment by Leon et al (2020). Where 14 PR and 6 BC were assessed in a group of 120 children divided into two age ranges: 3 to 6 and 6 to 8 years old, resulting in the following conclusions: Those considered as gestation and/or complicated deliveries suppose risk factors for the active presence of primitive reflexes and existence of craniocranial blocks. The frequency of activation of the primitive reflexes of Moro and cervical symmetric, increases with age (in the studied range) without relation to gender, a result in contrast to that expected according to the normal development of the infant. When the neurodevelopmental assessment measured according to the Battelle scale is shown in low (0-50%) or high (80-100%) ranges, the frequency of activation of the asymmetric and symmetric cervical reflexes and of blocks of the sphenoid bone, dura mater rocking and parietal bones is higher, ordered according to the degree of frequency. The presence of certain activated primitive reflexes (Moro reflex and cervical asymmetric and symmetric) is significantly related to blockages of some areas of the craniosacral system (swaying of the dura mater and sphenoid bone). The main objective of this work is to demonstrate the need for programs that consider preventive evolution and specialized physiotherapeutic treatment (craniosacral therapy) in schools and health centers during all stages of child growth, maximizing the development of the child's physical, emotional, social, linguistic and cognitive abilities; avoiding major complications in the long term.

Official Title
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Impact of Early Craniosacral Evaluation and Treatment on the Optimization of Infant Neurodevelopment

Conditions
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Child Development Disorder

Intervention / Treatment
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* Diagnostic Test: Online questionnaire of children's backgrounds
* Other: Academic behavioral intervention of teachers
* Procedure: Therapy sessions


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Apparently healthy children School group Within age range Exclusion Criteria: Children with possible pathologies Older than the established age

Ages Eligible for Study
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Minimum Age: 3 Years
Maximum Age: 8 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: 120 pupils aged 3-8 years were divided into three treatment groups set as follows: Placebo group (n=41) Rhythmic Movement Therapy Group (n=40) Craniosacral Therapy Group (n=39) Such participants were included according to the number of Active Primitive Reflexes (Moro, asymmetric and symmetric cervical) and/or Cranial Blocks (swaying of the dura mater, sphenoid bone and cranial parietal areas) presented by each of them
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Primary Group Control<br>41 patients of the total sample are part of the placebo group, being these patients without active primitive reflexes and/or cranial blocks, or in smaller quantities than the other participants of the study | Diagnostic Test: Online questionnaire of children's backgrounds<br>* A series of questions were asked to the children's parents in a virtual questionnaire on physical characteristics, previous health assessments and observations of their balance and coordination in front of their children.<br>Other: Academic behavioral intervention of teachers<br>* the school teachers examined neurobehavioral aspects of the students using the Battelle Developmental Inventory (BDI), which evaluates five areas of development (personal/social, adaptive, motor, communicative and cognitive) between 2 and 8 years of age. The results are assigned in age-adjusted percentages, classified as: low (0-49%), normal (50-79%) and high (80-100%). Low and high values are considered impairments in one or more of the areas evaluated. Evaluation of the Battelle scale was carried out before and after the therapy sessions.<br>Procedure: Therapy sessions<br>* Seven sessions were given to each of the three groups according to their classification (placebo, TMR, TCS), being able to obtain a stable value in each of the treatments carried out. Before each session, the effect of the previous session was explored in order to evaluate its efficacy (from the second session onwards). Each of the therapies had the same number of sessions (1 per week for 7 weeks) in order to have equality in all the parameters evaluated. The effectiveness values of the therapies were expressed as percentages of satisfaction with the classifications of 25% (apparent changes less than half of the sample in each therapy group), 50% (apparent changes in half of the sample plus one in each therapy group) and 75-100% (apparent changes in all or almost all of the sample in each therapy group).<br>|
| Active Comparator: Secondary group Rhythmic Movement Therapy<br>40 patients of the total sample are part of the rhythmic movement therapy group, having 1 or all of the primitive reflexes active and/or cranial blocks studied. | Diagnostic Test: Online questionnaire of children's backgrounds<br>* A series of questions were asked to the children's parents in a virtual questionnaire on physical characteristics, previous health assessments and observations of their balance and coordination in front of their children.<br>Other: Academic behavioral intervention of teachers<br>* the school teachers examined neurobehavioral aspects of the students using the Battelle Developmental Inventory (BDI), which evaluates five areas of development (personal/social, adaptive, motor, communicative and cognitive) between 2 and 8 years of age. The results are assigned in age-adjusted percentages, classified as: low (0-49%), normal (50-79%) and high (80-100%). Low and high values are considered impairments in one or more of the areas evaluated. Evaluation of the Battelle scale was carried out before and after the therapy sessions.<br>Procedure: Therapy sessions<br>* Seven sessions were given to each of the three groups according to their classification (placebo, TMR, TCS), being able to obtain a stable value in each of the treatments carried out. Before each session, the effect of the previous session was explored in order to evaluate its efficacy (from the second session onwards). Each of the therapies had the same number of sessions (1 per week for 7 weeks) in order to have equality in all the parameters evaluated. The effectiveness values of the therapies were expressed as percentages of satisfaction with the classifications of 25% (apparent changes less than half of the sample in each therapy group), 50% (apparent changes in half of the sample plus one in each therapy group) and 75-100% (apparent changes in all or almost all of the sample in each therapy group).<br>|
| Experimental: Tertiary group Craniosacral Therapy<br>39 patients of the total sample are part of the rhythmic movement therapy group, having 1 or all of the primitive reflexes active and/or cranial blocks studied. | Diagnostic Test: Online questionnaire of children's backgrounds<br>* A series of questions were asked to the children's parents in a virtual questionnaire on physical characteristics, previous health assessments and observations of their balance and coordination in front of their children.<br>Other: Academic behavioral intervention of teachers<br>* the school teachers examined neurobehavioral aspects of the students using the Battelle Developmental Inventory (BDI), which evaluates five areas of development (personal/social, adaptive, motor, communicative and cognitive) between 2 and 8 years of age. The results are assigned in age-adjusted percentages, classified as: low (0-49%), normal (50-79%) and high (80-100%). Low and high values are considered impairments in one or more of the areas evaluated. Evaluation of the Battelle scale was carried out before and after the therapy sessions.<br>Procedure: Therapy sessions<br>* Seven sessions were given to each of the three groups according to their classification (placebo, TMR, TCS), being able to obtain a stable value in each of the treatments carried out. Before each session, the effect of the previous session was explored in order to evaluate its efficacy (from the second session onwards). Each of the therapies had the same number of sessions (1 per week for 7 weeks) in order to have equality in all the parameters evaluated. The effectiveness values of the therapies were expressed as percentages of satisfaction with the classifications of 25% (apparent changes less than half of the sample in each therapy group), 50% (apparent changes in half of the sample plus one in each therapy group) and 75-100% (apparent changes in all or almost all of the sample in each therapy group).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Series of questions to the children's parents | A questionnaire of 5 questions in an online format was sent to the parents or legal representatives of each child related to behavioral, psychomotor and cognitive aspects, pregnancy and childbirth. | three months | 
| Previous teachers' test by means of the Battelle Development Inventory (BDI). | The school teachers examined neurobehavioral aspects of the students using the Battelle Developmental Inventory (BDI), which assesses five areas of development (personal/social, adaptive, motor, communicative and cognitive) between 2 and 8 years of age. The results are assigned in age-adjusted percentages, classified as: low (0-50%), normal (50-80%) and high (80-100%). Low and high values are considered impairments in one or more of the evaluated areas. The minimum and maximum values are 0-341. 170.5-272.8 in item scores are ideal values that indicate normal behavior according to their age. | five months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Comparison before and after the therapeutic intervention by means of the Battelle Developmental Inventory (BDI) | The investigators compare the previous and subsequent results in each of the participants of the three groups established for the study by means of the Battelle scale, which identifies the absolute values for optimal growth in the stages of neurobehavioral growth during childhood. This is intended to demonstrate the efficacy of each of the therapeutic protocols used. | two months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Craniosacral treatment, primitive reflexes, cranial blocks, childhood, physiotherapy