SPASTICITY MANAGEMENT ANDNEUROPHYSIOLOGIC CHANGES IN CEREBRAL PALSY CHILDREN

Abstract

SUMMARY C erebral palsy (CP) is the most common chronic disability of childhood today. It is ubiquitous and it occurs all around the world. In developed nations, the incidence is about 1 to 2 per 1000 births. Spasticity is a hallmark of neurological diseases that affect the central nervous system. It can cause discomfort and stiffness, while spasms can be annoying and painful and may interfere with function. This study was conducted to investigate the effect of skeletal muscle relaxant and physiotherapy on spasticity. This study Included 20 children with spastic CP. They were 16 males and 4 female There were 15 quadriplegic and 5 diplegic spastic CP who were classified in two groups: Group1: Ten children received skeletal muscle relaxants(Baclofen), 0.5 to 2 mg/kg,for 21 days. Group 2: Ten children were subjected to massage therapy for 15 minutes passive movement of ankle joint dorsi-flexion, knee joint extension, abduction and external rotation of hip joint which is known as the reflex inhibitory pattern. Daily session was applied for 21 days. All children were subjected to the following before and after the 21 days of intervention: (a) Muscle tone evaluation by Modified Ashworth Index(MAS) (b) Ankle joint dorsiflexion range of motion (ROM) by hand-held goniometer, (c) Ankledorsiflexor muscle manual strength test (d) Evaluation of soleus muscle H-reflex amplitude (e) Gross motor functional classification system for CP(GMFCS) In the present study, both groups showed statistically significant reduction in spasticity and improvement in motor function after the 21 days of intervention with no statistically significant difference between them either before or after the intervention. In the muscle relaxant group:Statistically significant improvement were found in all the parameters, there were statistically significant increase in Ankle DorsiFlexormuscle manual strength test mean + SD (2.70+0.48); t(-2.449),P= (0.04), and in Ankle Joint DorsiFlexion range of motion (ROM)by hand held goniometer mean + SD (20.50+1.27);t (-4.392),P=(0.02)., and therewere statistically significant decrease inGMFCSmean +SD (2.10+0.57);t (2.449),P=(0.04). MASmean + SD (2.00+0.67);t(2.449),P-value(0.0037)., H/M ratio mean +SD (16.02+1.18);t(6.936),P-value(<0.001). H-reflex mean + SD (20.57+0.93);t(3.994),P=(0.04). In the physiotherapy group: There were statistically significant increase in both Ankle DorsiFlexor muscle manual strength test mean + SD (2.60+1.17); t(-3.000), P=(0.01), Ankle Joint DorsiFlexion range of motion (ROM)by hand held goniometer mean + SD (18.90+3.25); t(-2.753), P=(0.02),and there were statistically significant decrease in H/M ratio mean + SD (24.08+12.67); t(4.026), P=(0.003). and H-reflex mean + SD (28.72+12.83); t(3.036), P= (0.01).