Original research
Influence of Spinal Manipulation on Muscle Spasticity and Manual Dexterity in Participants With Cerebral Palsy: Randomized Controlled Trial

https://doi.org/10.1016/j.jcm.2018.03.004Get rights and content

Abstract

Objectives

The aim of this study was to investigate the short-term effects of spinal manipulation (SM) on wrist muscle spasticity and manual dexterity in participants with cerebral palsy (CP).

Methods

After baseline examination, 78 participants with spastic CP (7-18 years) without contractures or hyperkinetic syndrome were randomly allocated into 2 groups. The experimental group underwent SM to the cervical, thoracic, and lumbar spine, and the control group received sham SM. A second evaluation was performed 5 minutes postintervention. Wrist muscle spasticity was measured quantitatively with NeuroFlexor (Aggero MedTech AB, Solna, Sweden), a device assessing resistance to passive movements of different velocities. Between-group difference was calculated using the Mann-Whitney U test. Manual dexterity was evaluated by the Box and Block test.

Results

In the experimental group, muscle spasticity was reduced by 2.18 newton from median 5.53 with interquartile range 8.66 to median 3.35 newton with interquartile range 7.19; the difference was statistically significant (P = .002). In the control group, reduction in spasticity was negligible. The between-group difference in change of muscle spasticity was statistically significant (P = .034). Improvement of manual dexterity was not statistically significant (P = .28).

Conclusions

These findings suggest that SM may, in the short term, help to reduce spasticity in participants with CP. Long-term effects of SM on muscle spasticity have yet to be studied.

Introduction

Muscle spasticity is an important clinical syndrome in people with cerebral palsy (CP) and other neurologic diseases resulting from upper motor neuron lesions.1 It manifests with an increased stretch reflex, which intensifies with movement velocity.2

Spasticity affects motor development and functioning of a child, and its reduction is an important therapeutic target for optimizing motor performance. The range of treatments for excess muscle tone is vast: from simple stretching exercises or pharmacotherapy to surgery.3 However, because of limited effectiveness of conventional treatments, a wide range of complementary and alternative therapies are used for muscle tone management in patients with CP, including spinal manipulation (SM).4, 5

Resent research indicates possible influence of SM on muscle spasticity. The literature points to the effect of SM on spinal cord neural circuits as a factor that possibly modifies stretch reflexes.6, 7 Neural responses to SM have been reported in studies on animal models.8, 9 There is preliminary evidence that SM is followed by a short-term reduction in local spinal muscle electromyographic activity in hypertonic muscles.10 Decrease in motoneuron excitability (H-reflex) after sacroiliac joint manipulation was observed in patients with low back pain.11, 12 There are several clinical studies suggesting the influence of SM on spasticity. Decrease of spasticity after SM was noted in post-stroke patients.13 Reduction in wrist muscle spasticity after SM was also reported in patients with CP.14, 15

In addition, there is growing body of research on the effects of SM on sensory processing, motor output, and functional performance, including hand function.8, 16 Studies suggest possible changes of muscle strength after a single session of manual therapy (MT).17 Improvement of manual dexterity after SM was also noted in patients with CP.18

However, there are no studies directly measuring the relationship between SM and reduction of muscle spasticity. Therefore, the primary aim of this study was to evaluate the effect of SM on muscle spasticity in participants with CP. A secondary aim of this study was to test the hypothesis that SM influences manual dexterity in participants with reduced hand function due to CP.

Section snippets

Study Design

This was a prospective, randomized controlled trial with 2 groups: experimental (receiving SM) and control (receiving sham of SM).

After the baseline examination, participants were randomized into 2 equal arms (1:1): the SM group (experimental) and the sham group (control). We used stratified block randomization with a block size of 4 by the form of CP (unilateral or bilateral) and level of wrist spasticity (low or high). Stratified block randomization helped to achieve balance between the

Results

Participants’ demographic and baseline assessment data are summarized in Table 1. Values of each variable for experimental and control group, as well as between-group difference, are presented. Between-group difference probability (P value) was calculated using the independent samples t test for normally distributed data, χ2 test for binary data, and the Mann-Whitney U test for nonparametric variables.

There was no significant difference between experimental and control groups in any of the

Discussion

To our knowledge, this is the first trial to measure the immediate effect of SM on muscle spasticity and hand dexterity in participants with spastic forms of CP. The contribution of this study is that it corroborates the hypothesis that SM may decrease muscle spasticity temporarily in participants with disordered muscle tone regulation, specifically in children with CP.

At present, the mechanisms through which SM alters muscle spasticity are not fully understood. Experimental evidence

Conclusion

These findings suggest that SM may, in the short term, help to reduce spasticity in participants with CP. Long-term effects of this influence were beyond the scope of the study and will have to be studied in the future. No evidence about the influence of SM on hand dexterity in participants with spasticity was obtained.

Funding Sources and Conflicts of Interest

Research was supported by a grant from the Institute of Medical Rehabilitation, Ukraine (state registration number: 23272758). No conflicts of interest were reported for this study.

Contributorship Information

  • Concept development (provided idea for the research): O.K.

  • Design (planned the methods to generate the results): O.K., A.K.

  • Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): O.K.

  • Data collection/processing (responsible for experiments, patient management, organization, or reporting data): A.K., O.M., M.H.

  • Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results): O.K., A.K.

  • Literature search

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