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Does fascial manipulation and myofascial surgery reduce spasticity and improve
function of upper limb in cerebral palsy?
Article in Journal of Bodywork and Movement Therapies · October 2018
DOI: 10.1016/j.jbmt.2018.09.045
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Joshua Samuel Rajkumar Deepak Sharan
JOSH Clinic - Physiotherapy & Rehabilitation RECOUP Health
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Does fascial manipulation and myofascial surgery reduce spasticity and improve function of upper limb in
cerebral palsy?
• JOSHUA SAMUEL RAJKUMAR (RECOUP Neuromusculoskeletal Rehabilitation Centre)
• Deepak Sharan (RECOUP Neuromusculoskeletal Rehabilitation Centre)
• Annie Linda (RECOUP Neuromusculoskeletal Rehabilitation Centre)
• Rajini Gorantla (RECOUP Neuromusculoskeletal Rehabilitation Centre)
• Jeena Jose (RECOUP Neuromusculoskeletal Rehabilitation Centre)
Introduction/Background
A generalized increase in extracellular connective tissue has been demonstrated in spastic muscles.
Increased connective tissue in a contracted muscle is known to reduce its compliance and could reduce
the threshold for stimulation of spindle receptors in the muscle. Increased stretch-induced stimulation of
spindles in muscles with stiffer connective tissue has been postulated to contribute to spasticity. Hence,
the objectives of this study were to evaluate the effectiveness of Fascial Manipulation (Stecco Method)
and Myofascial Surgery on Spasticity, Range of Motion, Strength and Function of the upper limb in
children with cerebral palsy (CP).
Methods
30 children with CP, aged between 6 to 16 years were recruited for the study and were conveniently
divided into 3 groups. Group A, underwent Fascial Manipulation which involved releasing specific
centres of coordination (CCs) and centres of fusion (CFs) of some of the major segments based on the
specific local findings during the examination by a Fascial Manipulation trained Physiotherapist.
Conventional rehabilitation (CR) designed specifically for CP was also performed. Group B, underwent
modified Orthopaedic Selective Spasticity Control Surgery (OSSCS), comprising of intramuscular tendon
lengthening, controlled sliding tendon lengthening, release of deep fascia, myofascia and inter-tendinous
fascia, followed by CR. Group C underwent CR alone. Tardieu scale, Functional Spasticity Scale,
Goniometer, Dynamometer and Melbourne Assessment of Unilateral Upper Limb Function (MAUULF)
were measured.
Results
The reduction of spasticity by Tardieu (P<0.05), Functional Spasticity Scale (p<0.05) and Goniometer –
wrist extension (p<0.05) and elbow extension (p<0.05) were statistically significant in the Group A and B
compared to Group C. The strength (grip) and hand function scores measured using Dynamometer
(p<0.05) and MAUULF (P<0.05) respectively were statistically significant in Group B, compared to
Group A and C. In the follow-up evaluation, the obtained outcomes were maintained for the Group B. For
Group A, except the parameter of ROM, the other parameters for spasticity were maintained.
Conclusion
OSSCS and Fascial Manipulation was effective in reducing spasticity and improving range of motion,
strength and function of the upper limb in children with CP, compared to conventional rehabilitation
alone.
Topics
• Fascial Pathologies
• Clinical studies
Additional Info
Illustrations, Graphs, Figures, and Photographs: —
References: 1. Stecco A, Stecco C, Raghavan P. (2014) Peripheral Mechanisms Contributing to
Spasticity and Implications for Treatment. Curr Phys Med Rehabil Rep 2:121–127.
2. Sharan D. (2017) Orthopaedic Surgery in Cerebral Palsy. Instructional Course Lecture. Indian J Orthop
May-June;51(3): 240-255.
3. Sharan D, Rajkumar JS, Balakrishnan R, Kulkarni A. (2016) Neuromusculoskeletal rehabilitation of
severe cerebral palsy. In: Mintaze Kerem Gunel (ed.): Cerebral Palsy- Current Steps, Intech, Rijeka,
Croatia, Chapter 7: 141-172.
4. Sharan D. (2014) Neuromusculoskeletal Rehabilitation of Cerebral Palsy using SEMLARASS. In
Emira Svraka (ed.): Cerebral Palsy- Challenges for the Future, Intech, Rijeka, Croatia, Chapter 6: 193-
215.
Other Properties
Presentation Format: Oral
Student Submission: No
Submission ID: 237
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