Neurodevelopmental physical therapy improves spasticity in children with CP

A physical therapy approach known as neurodevelopmental treatment can improve shaking but not movement in children with cerebral palsy, according to a South Korean study in the Journal of Physical Therapy Science.

Neurodevelopmental physical therapy is shown to improve spasticity, but not movement, in some children with CP. CP Family Network‏ @cpfamilies August 1, 2017

By Stacy Grieve, Cerebral Palsy News Today July 5, 2017

Children with CP often experience movement-related problems. These include muscle weakness, spasticity, a limited range of motion, and loss of some movement functioning. Spasticity is stiffness or tightening of muscles that leads to involuntary movements.

Physical therapy is often necessary to address movement problems, but researchers have disagreed on the best approach.

Neurodevelopmental treatment, or NDT, is a hands-on approach to improving movement in patients with CP, stroke, or head injury. It involves guiding a patient’s movements. Proponents say it allows a physical therapist to assess and analyze movements while training patients.

South Korean researchers decided to investigate the effects of a year of NDT physical therapy on the muscle strength, spasticity, and movement of children with CP.

The study included 175 children with spastic cerebral palsy, aged 3 to 18. The children had NDT physical therapy 35 minutes a day, two to three times a week, for a year. The research team measured muscle strength, spasticity and movement abilities before and after the therapy.

Researchers used the Gross Motor Functional Classification System (GMFCS) to categorize patients’ movement functioning. Under this system, the higher the category, the worse the patient’s disability.

The majority of patients – 112 – were classified as level III-V. Sixty-three patients were categorized as level I-II.

After a year of the therapy, researchers discovered that only changes in patients’ spasticity were significantly different: It decreased. There were no changes in their muscle strength or movement abilities.

Spasticity differed between the GMFCS levels, researchers added. It decreased more among children classified as GMFCS III-IV than in those classified as I-II. In contrast, muscle strength in children at GMFCS levels I–II improved more than in levels III–V. No significant improvement in movement ability was seen in either group.

“Neurodevelopmental treatment-based physical therapy in children with cerebral palsy seems to be effective in reducing spasticity, but does not improve gross motor function,” the team wrote. “Therefore, other interventional approaches are needed to improve gross motor function [movement ability] in children with cerebral palsy.”

Source Cerebral Palsy News Today

Effect of neurodevelopmental treatment-based physical therapy on the change of muscle strength, spasticity, and gross motor function in children with spastic cerebral palsy, Eun-Young Park, PT, PhD and Won-Ho Kim, PT, PhD. J Phys Ther Sci. 2017 Jun; 29(6): 966–969. Published online 2017 Jun 7. doi: 10.1589/jpts.29.966

  Further reading
Systematic review of the relationship between habitual physical activity and motor capacity in children with cerebral palsy, Keawutan P, Bell K, Davies PS, Boyd RN. Res Dev Disabil. 2014 Jun;35(6):1301-9. doi: 10.1016/j.ridd.2014.03.028. Epub 2014 Mar 30.

The relationship between spasticity and gross motor capability in nonambulatory children with spastic cerebral palsy, Katusic A, Alimovic S. Int J Rehabil Res. 2013 Sep;36(3):205-10. doi: 10.1097/MRR.0b013e32835d0b11.

The relationship between spasticity in young children (18 months of age) with cerebral palsy and their gross motor function development, Gorter JW, Verschuren O, van Riel L, Ketelaar M. BMC Musculoskelet Disord. 2009 Sep 4;10:108. doi: 10.1186/1471-2474-10-108.

Relationships between spasticity, strength, gait, and the GMFM-66 in persons with spastic diplegia cerebral palsy, Ross SA, Engsberg JR. Arch Phys Med Rehabil. 2007 Sep;88(9):1114-20.

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