The Efficacy of Fascial Manipulation Compared to Stretching in the Rehabilitation of Children With Cerebral Palsy
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 20
- 试验地点
- 1
- 主要终点
- Six-minute walking test
研究概览
简要总结
The purpose of the study is to investigate the potential additional benefits of a relatively new physiotherapy method, fascial manipulation, in the rehabilitation of movement difficulties or other problems caused by CP (cerebral palsy). A physiotherapist specialized in fascial manipulation specifically treats the muscle fascia, which plays a central role in the problems associated with CP. Fascial manipulation feels just like a massage but does not hurt.
The purpose of the study is to determine how physiotherapeutic rehabilitation methods should be further developed in Finland and elsewhere. Fascial manipulation was originally developed in Italy and is used to treat many musculoskeletal problems. There have been few studies on the effectiveness of fascial manipulation in the context of CP problems. It is important to obtain more research evidence, which is why conducting this study is crucial.
详细描述
Introduction Fascial manipulation (FM) is a manual therapy method developed by physiotherapist Luigi Stecco. It involves the treatment of deep fascia related to muscles or superficial fascia of subcutaneous tissue, which is made up of connective tissue. The goal of FM is to normalize the function of muscle-related fascia, allowing movement to return to normal and overstrained or painful structures to heal. Superficial fascial treatment is needed, for example, in the treatment of surgical scars and swelling The method has been used to treat various musculoskeletal disorders, with evidence supporting its effectiveness.
FM can be used in the rehabilitation of children with CP (cerebral palsy) to treat stiffness caused by the non-neural component of spasticity. Both neural and non-neural factors influence the abnormal movement patterns caused by spasticity in children with CP. Recent research suggests that non-neural factors are functionally more significant.
Spasticity caused by upper motor neuron damage leads to an increase in the extracellular matrix (ECM) of the muscle. The main component of the extracellular matrix is hyaluronan (HA), which facilitates internal muscle and intermuscular sliding and myofascial force transmission.
The mechanical properties of the muscle, such as stiffness and viscosity, often change with spasticity, as the increased concentration of HA associated with spasticity can increase the viscosity of the ECM and the collagen content in the muscle. This affects both active and passive movement and alters the force production and coordination between agonist and antagonist muscles. Increased resistance to active movement causes fatigue and pain. Increased ECM viscosity increases the stretch on the perimysium and the muscle spindle attached to it, sensitizing spindle activation. These non-neural peripheral factors are believed to cause muscle stiffness.
There have been few studies on the effectiveness of FM in the rehabilitation of children with CP. The limited studies and practical observations suggest that treatment targeting muscle-related fascia may be a beneficial addition to the rehabilitation of children with CP. High-quality studies on the effectiveness of FM in general musculoskeletal rehabilitation are scarce. A recent systematic review indicates that the level of evidence for FM is low to moderate. A systematic review on children with CP has recently been published.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 7 Years 至 14 Years（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age 7-14 years
- •GMFCS level 2-3
- •Good cooperation
- •Family living in the Helsinki metropolitan area
排除标准
- •The child has previously received fascia manipulation by a Stecco-trained therapist or other fascia treatment (if done within the last 6 months)
- •Surgeries on the lower limbs (if done within the last 12 months)
- •Electrical stimulation treatments (if done within the last 3 months)
- •Botox treatments on the lower limbs (if done within the last 6 months)
- •Reduced cognitive level
- •Severe visual impairment (unable to perform the walking test)
- •Other illnesses: psychological or other serious illness
研究组 & 干预措施
Fascial manipulation
In fascia manipulation (FM), the treatment targets the deep fascia related to muscles, including the aponeurotic and epimysial fascia. Treatment points are selected based on a thorough assessment, including the client's history, movement tests and analysis, and palpation tests. Fascia manipulation treatment affects the hyaluronan and viscosity of the muscle fascia. In the treatment of spasticity, the treatment points are in the body parts involved in spastic movement patterns. In this study, fascia manipulation is performed once a week, and the therapist provides instructions for self-exercises to the child with CP.
The child's own physiotherapy continues at the same time.
干预措施: Fascial manipulation (Other)
Stretching
The stretches are based on the article published 2024 at University of Jyväskylä. Four sets of 45-second manual passive-static guided stretches to the pain threshold are performed for the ankle extensors, hip flexors, hip adductors, and knee flexors.
干预措施: Fascial manipulation (Other)
结局指标
主要结局
Six-minute walking test
时间窗: From enrollment to the end of treatment at 8 weeks
Distance covered six minutes
次要结局
- Walking efficiency(From enrollment to the end of treatment at 8 weeks)
- Ankle joint hyper-resistance(From enrollment to the end of treatment at 8 weeks)
- Gait pattern(From enrollment to the end of treatment at 8 weeks)
- Interview: Parents of a child with cerebral palsy and their physiotherapist(From enrollment to the end of treatment at 8 weeks)