Massage Therapy and Chiropractic Adjustments for Hemiplegic Cerebral Palsy

Now that E is older, we have again broached massage therapy and chiropractic as treatment options for her spasticity.  E had several chiropractic adjustments when she was an infant after her traumatic birth, and we tried myofascial release massage therapy when she was around 3 years old but she HATED it, so we haven’t done either for a number of years now.

E has become very resistant to wearing her TLSO trunk support vest – she is embarrassed by it and complains that it is hot and sweaty (she is currently overweight which contributes to the hot body temperature).  So, this year, I gave her the option of trying massage therapy and chiropractic instead of wearing the TLSO vest.  The massage therapist targets her tight muscles and tries to release built up tension. The chiropractor checks her spinal alignment, arm and leg length discrepancies, and muscle tone.  We have found these both to be very helpful modalities in her overall spasticity/tone maintenance.  Note that the benefit is in controlling muscle pain and tension, which in turn can promote normal growth (preventing bone growth complications, particularly scoliosis).  We have no anticipation that these treatments will assist with functional ability.

Massage Therapy:

E tends to have tightness all along her right (affected) side.  It is in her shoulder girdle, arm, wrist, fingers.  It is along her trunk, trying to pull her spine out of alignment.  It is to a lesser extent in her hamstrings, gluteus, calves, and other ankle/lower leg muscles.  Massage is able to loosen this tension quite significantly.  Unfortunately, the effects only last several days.  Ideally, I would think E should have massage therapy 3+ times a week – but this isn’t in our financial capabilities.  We tried every 3 weeks for about 6 months (1/2 hour session, which was as long as E would tolerate – she watched movies on the iPad during her sessions).

The studies I had read on massage therapy for cerebral palsy had all talked specifically about “myofascial release”.  So initially I had sought out a massage therapist who was trained in “myofascial release massage therapy” (which some advertise).  Our chiropractor has explained to me that the term is kind of a gimmick – ALL massage therapy affects the myofascia and intends to release the tension in it.  So, basically, all therapeutic massage therapy (as opposed to relaxation massage) should work similarly, based on the experience and skill of your practitioner.

Here’s one study, showing benefit in reduced spasticity, but no associated functional improvement:

The effect of deep cross friction massage on spasticity of children with cerebral palsy: A double-blind randomised controlled trial.

RESULTS:  Of the 60 patients, there were 30(50%) in each group. The control group consisted of 14(46.7%) males and 16(53.3%) females compared to 16(53.3%) males and 14(46.7%) females in the experimental group (p=0.72). The overall mean age was 6.03±1.73 years. All patients (100%) were followed up for a period of 6 weeks and there was not a significant (p=0.26) improvement in experimental group compared to control group evident on Modified Ashworth Scale. The experimental group, however, had significant improvement after 6 weeks compared to the baseline values (p<0.001). However, functional level did not improve (p=0.55) by the end of study.

Massage therapy can assist with:

  • promoting relaxation
  • releasing muscle tension
  • decreasing tone in spastic muscles / increasing tone in flaccid muscles
  • encouraging muscle growth
  • improving circulation
  • body awareness

You can ask your practitioner to show you some massage strokes to do at home, going from proximal to distal (truck to tips direction).  It would be most beneficial to your child to do this at home massage on a daily basis, if possible.

It is also helpful to incorporate gentle stretches into your child’s daily routine.  You can consult with a PT, OT, RMT, and Chiropractor for appropriate stretches.  When done consistently, these can make a big difference in your child’s range of motion.

Chiropractic Adjustment:

I found the following information on Chiropractic treatment helpful:

Chiropractic care is technically considered a manipulative and body-based therapeutic method that affects the body systems and structures – bones, joints, soft tissues, and neuromuscular system – that are manipulated beyond their passive range of motion and with appropriate use of force. It is a therapy that uses the manipulation of the spine and joints to relieve pain. The spinal manipulations are made using the chiropractor’s hands, and are referred to as “adjustments.”

Simply explained, the brain communicates with the body through nerves. Chiropractic care is based in improving the way brain control and muscles work together. The neuromuscular system sends messages from the brain, down the spine and into the nerves. If there is interference, the body is not able to function as effectively.

Chiropractic intervention aims to improve the structural aspects of the body to clear the pathway for the brain to communicate with the nerves. This can result in improved strength, balance, flexibility and coordination skills, especially in the limbs. One intervention doesn’t fix all, rather the intervention chosen and the location of treatment are relative to the symptom being addressed. Since Cerebral Palsy affects people differently, differing chiropractic modalities are used to address specific issues.

There is evidence that the chiropractic care can be helpful to children with Cerebral Palsy. A handful of studies indicates that children that underwent spinal manipulation could sit and stand with more ease. Also, the studies indicated that some children became more active, digested food more efficiently, slept more peacefully, and enjoyed improved coordination after undergoing chiropractic care.

  • Adjustment of the atlanto-occipital subluxations helped with children who had difficulty with sleeping,personality disturbances, and hypertonic musculature.
  • Myofascial release may be used to assist in decreasing the severity of spinal distortion and aid in stabilizing gait patterns in children with spastic Cerebral Palsy who have muscle contractures in the paraspinals, lateral thigh muscles, lower extremity abductors, Achilles tendons, and wrist extensors.

From www.cerebralpalsy.org

In reviewing the literature, there are not many formal studies on the benefits of chiropractic care for hemiplegic cerebral palsy.  However, it is suggested that chiropractic care can assist with:

  • gait patterns
  • hypertonic muscles (spasticity)
  • joint pain or stiffness
  • muscle contractures
  • neck pain and tension
  • scoliosis (curvature of the spine) prevention or treatment
  • sleep difficulties

E started regular chiropractic adjustments about 9 months ago.  At first she was going every 4-6 weeks, but in the last few months we have been taking her every 2-3 weeks.  We have actually stopped massage therapy (appointment overload!) and are just doing the chiropractic for now, and are finding similar benefit.  The best combination would be daily at-home massage therapy, occasional therapeutic massage therapy (unsure ideal timing for E), plus regular chiropractic (every 2 weeks for E is what we have found).  I just haven’t gotten into a routine of trying massage at home yet…

It took several tries to find a good match for a chiropractor.  The one we have found is very proactive and researches things that may help E in between our appointments.  At each appointment, he:

  • Assesses E’s spine for straightness
  • Assesses her muscle tone (spasticity)
  • Provides some myofascial release to high tone muscles
  • Applies vibrational treatment using a vibrocussor (sp?) to spastic muscles
  • Works on loosening her hip flexors and shoulder girdle
  • Sometimes provides adjustments to her ribs or T spine or L/S spine
  • Assigns exercises and stretches he wants her to do at home

We have found that going regularly to the chiropractor has decreased E’s tone in her arm and leg and improves her apparent arm and leg length discrepancies.  Going from 2 to 3 weeks in between appointments we notice a definite increase in tone.  It is also reassuring to me that her spinal alignment is being closely monitored.  Before writing this post, I was not aware that chiropractic can improve sleep – but E’s sleep has improved since having regular adjustments (from never sleeping through the night to sleeping through the night 1-2x a week).

I strongly believe that in this life, nothing happens by accident or coincidence – things aren’t determined by fate or luck (good or bad).  I believe there is an overarching story – a beautiful picture of love, loss, and redemption – and that there is Someone who cares and is in control.  You are already a part of this story, whether you know or believe it or not.  While the end of the story has already been written, your own part lays open before you for you to choose your ultimate destiny.  Maybe all your life has been leading to this one moment: The Bridge to God.

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