Spastic Diplegic Cerebral Palsy Health And Social Care Essay

Spastic Diplegic Cerebral Palsy health And Social Cargon EssayCerebral Palsy is a parkland neuro knowledgeal disorder of childhood with prevalence is about 2 per kelvin bloodlines in industrial nations Pameth et al, 1981 and 3 per 100 live births WHO 1999It is defined as a permanent, non progressive defect or lesion present at birth or shortly thereafter.Cerebral refers to judgment and paralyse refers to lack of locomote govern. The childs co ordination of exertion is shamed, making it difficult or unaccepted to form and perfect skills of daily life. Traditionally prenatal etiology, prematurity, total product retardation, perinatal asphyxia and other perinatal ca theatrical roles like trauma shoot all been implicated as risk factors for intellectual palsy. (National collaborative perinatal project NCPP info).Cerebral Palsy (CP) is classified clinically in cost of the part of the be involved,eg., hemiplegia, diplegia, quadraplegia and by the clinical perceptions of caliber and in unpaid movement., eg., Spasti , athetoid , atactic Roberta B.Shepherd 19951.2 SPASTIC DIPLEGIC CEREBRAL PALSYSpasticity affects approximately 75% of all patients with intellectual palsy and when characterized by consistency part. Diplegia is the most communalest part. These disorders are collect to imperfect knowledge damold be on or to labour area in the mental capacity which disrupt the brains business leader to adequately control movement and broadcasture.Tends to affect the legs of a patient much than the arms.Spastic Diplegia rational palsy patients have more result than the upper extremity.This al woefuls most people with spasmodic diplegia intellectual palsy to lastly walk. The gait of a person with convulsive Diplegia cerebral palsy is typically characterized by a crouched gait. Toe walking and flash-frozen genus are common attri scarcelyes.Spasticity is a travel disorder characterized by a velocity aquiline increase in tonic stretch reflex responsees ( go through tone) with exaggerated tendon jerks , resulting from hyper choler of the stretch reflex Lance 1980. Contracture is a acquittance of resist slight telescope of motion assessed by measuring maximum dormant joint dispatch Horsley et al 2007, Harvey et al 2006. Spasticity can lead to contracture Farmer and James 2001, Tardien et al 1982 and some(prenominal) spastcicty and contracture can limit activity Boyd and Ada 2008, Hoffler et al 1987.Two approaches apply for the sermon of children with carnal disabilities are advanced physiotherapy discourse called Neuro developmental therapy (NDT) and tendon energy technique (MET). The aim of Neuro development therapy is through narrow techniques of handling, to give children with cerebral palsy the experience of a greater mix of co ordinated movement fleshs where as muscle energy technique answers by relaxing acute muscle spasm mobilizing the restricted soft interweave and toning the weakened mu sculatures.1.3 NEED OF THE containSince spasticity in the muscles affects the running(a) gait pattern and decreases the childs ambulatory independency, therefore the need for the field of battle is to evaluate the in effect(p)ness of neuro developmental therapy with muscle energy technique for lower extremity to remedy structural ability in children with spastic diplegic cerebral palsy.1.4 STATEMENT OF THE PROBLEM effectivity of Neuro Developmental Therapy with muscle energy technique for lower extremity to improve the serviceable ability in children with spastic diplegic cerebral palsy.1.5 OBJECTIVE intercession of children development neuro developmental therapyTreatment of children using muscle energy technique. compare and contrast Neuro Developmental Therapy in relation to muscle energy Technique.To contain the effectuate of Neuro Developmental Therapy and muscle energy technique that improves the functional ability in children with spastic diplegic cerebral palsy.1.6 HYPOTHESISThe null hypothesis upon which the take aim is designed can be stated as there is no world-shaking improvement in functional ability in children with spastic diplegic cerebral palsy by the exercise of NDT MET.2. REVIEW OF LITERATURERosenbaum palsy2003-Defines cerebral palsy as an umbrella depot covering a separate of non progressive, but after changing tug impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of development. He is saying that cerebral palsy refers to a assort of disabilities that will not self correct, which affects children while actually strong and that disrupt the childs movement ability in connection with brain function.Baxm,Goldstein,et al.,(2005) defined cerebral palsy as a group of disorders that affect the development of movement and orderure, causing activity limitation, and are attributed to non progressive breaks that occurred in the developing fetal or infant born.Becker Jg-stated that spa stic paresis is characterized by a canure-and movement dependent tone regulation disorder. The clinical symptoms are the loss or absence of tone in lying, and increases in tone in sitting, standing, walking, or running, depending on the dot of involvement, spastic paresis is the most common take disorder (83%).Janstephan Tecklin (2008)-stated that the child with classic spastic diplegia will typically butt against hypotonia through the neck and trunk while having increased rigor in twain legs.Bernard Dan (2001)-stated that spastic diplegia characterized by limb hypertonia, which is more pronounced distally, predominates the lower limbs and increases active mobilization, hyperactive jerks, extensor plantar responses and varying degree of trunk hypotonia.Felters-1(Phy Therapy 1996)-Did a examine on the effects of Neuro Developmental Therapy versus practice on reaching of children with spastic cerebral palsy. It was imbed that NDT was more usefulIddav Embrey Et Al 1990 Cond ucted a study on effects of neuro -developmental manipulation and inhibitive mortise joint height orthroses on gait with spastic diplegic children with cerebral palsy . The results shows that both methods of treatment can be use to decrease undue knee flexion during gait in a children with spastic diplegic cerebral palsy.Lilly La Powell NJ -Conducted a study regarding measuring the effects of neuro developmental treatment on the daily living skills of two children with cerebral palsy. They examined the short frontier effects of Neuro Developmental Treatment (NDT) was found that improvements were made in the motor fulfilance of daily living skills in two girls with cerebral palsy.Bobath Therapy is a physical technique, principally used with cerebral palsy to inhibit unnatural movement or postures and promote sound patternized movement and muscle tone Early physiotherapy or Bobath technique in infants with suspected neuro motor disturbance 1981.Ketelarr m, et al., Did a study on the effects of functional therapy programe on motor abilities of children with cerebral palsy. They found improvement in both rough-cut motor abilities and functional skills in children who received functional physical therapy programe.(physical therapy 2001).Nikos Tsorlakis Et al 2004 -Conducted a study on effect of Neuro Developmental Treatment on gross motor function of children with cerebral palsy. They found that improvement were made in the gross motor abilities in children who received Neuro Developmental Therapy.Kostidis, Michaei 2009 -The intention of this study was to compare the effect of bodybuilder Energy Technique (MET), to a tranquil stretch of 30 seconds duration for change magnitude the extensibility of the hamstring muscles. The result showed that MET was more effective, compared to static reaching.Mohd.Waseem et al 2009-The purpose of this study was to check into the effectiveness of ponderousness Energy Technique MET on hamstring flexibility in normal INDIAN collegiate males. The result indicates that MET is significantly improving the hamstring flexibility hold of motion in collegiate males.Kmberly Bucham 2007 -In that study to investigate the effectiveness of MET in increasing resistless knee extension. Results showed that a significant increase in range of motion was observe at the knee flexion a use of MET.Wilson E, Donegam Shoafl, et al., 2003-Conducted a study on effects of MET in patients with acute low back pain. The results showed that MET was effective in decreasing disability and improving function in patients with acute low back pain.Ballantyne, Fryer G, et al., 2003-The study was conducted to investigate the effectiveness of musculus Energy Technique in increasing passive knee extension and to explore the mechanism behind any observed change. go across Energy Technique produced an warm increase in passive knee extension. This observed change in range of motion is passive due to an increased tolerance to stre tch.Ching Shag Anita,et al., 2004-The study was conducted to compare the immediate effects and lasting effects amidst passive stretch and bodybuilder Energy Technique on Hamstring Muscle Extensibility. The result suggested that Muscle Energy Technique appeared to be more effective than passive stretching for increasing Hamstring Extensibility immediately post treatment and still at one hour.Msalle me et al-WEE FIM is a valid measure for tracking disability in preschool age and middle childhood and this allows the paediatrician to prioritize preventives for enhancing comprehensive functional outcomes and supporting families.Yung a, wong v et al., WEE FIM could be used to assist neuro refilling clinicians in the selection of short term realistic goals and long term rehabilitation strategies for children with respective(a) Neuro Developmental disabilities.Dr.Fayetteville,ms.smith et al.,- to determine the inter rater reliability of manual tallys of elbow flexor muscle spasticity graded on a limited Ashworth Scale was significant and the reliability was good and believe them to be verificatory abundant to encourage further trials of the special Ashworth Scale for grading spasticity.3. MATERIALS AND methodological abbreviationThe cerebral palsy children were selected on an initial baseline assessment and tab of their diagnosis.3.1 SUBJECTSMale and female cerebral palsy children betwixt age group of four to fourteen historic period were taken. The children were primarily diagnosed and evaluated by a neurologist and a pediatrician and were referred to physical therapy.3.2 ASSESSMENT TOOL USEDModified Ashworth ScaleWeefim Scale3.3 MATERIALS USEDFloor Smooth non slippery Surface.A large firm exercise mat (minimum 4 or 6) with a maximum thickness of 1 for proprioception and tactile feedback. So the child has wear out sensory information regarding movement.Small interesting toys that can be fey with one or both hands for head control, reaching, eye fixa tion.Pillows.Therapy clunk and Bolsters provides mobile surface and facilitate automatic reactions.Small wooden chair, terrace and couch of various heights for short sitting , table natural elevation activities , stepping , climbing and so on.A rail or parallel bars. keel boards and equilibrium boards for the child may lie, sit, kneel, stand or maintain a quadruped position, while being rocked in mediolateral or anteroposterior educations and to elicit rightening reactions. reconciling equipment to offer postural support or may aid functional skills and mobility.Soft soothing music to motivate the child.Stop watch.3.4 METHODOLOGY3.4.1. STUDY DESIGNThis will be an experienced study with two groups having pretest and post test groups.3.4.2. STUDY SETTINGThis study was done in Families for children podanur, Amrit orthopedics rehablitation centre, Coimbatore and in patients who were referred for physical therapy from department of pediatrics and neurology, SRI RAMAKRISHNA HOSPITAL, COIMBATORE.3.4.3. TOTAL STUDY succession6 Months.3.4.4. TREATMENT TIME45 Minutes duration per day for three weeks.3.5. SELECTION CRITERIA3.5.1. INCLUSION CRITERIAChildren with mild to moderate spastic diplegic type of cerebral palsy.Ability to down the stairsstand and respond to verbal instructions.Gross motor usage Classification level and II and III.Cognitively Sound.Children within the age group of 4-14 years.Both male and female.3.5.2. EXCLUSION CRITERIAGross Motor Function Classification level IV and V.Mental retardation.Uncontrolled Epilepsy.Children with Athetoid and Mixed type of cerebral palsy.Visual and hearing impairment.Respiratory distress.Congenital heart problems.Children with fixed skeletal or hip deformities.Difficulty to understand command.3.6. SAMPLING20 Children were selected based on inclusion criteria. They were further divided into control and data-based group containing 10 children in each group based on convenient sampling.Control group ( host A ) Chi ldren receiving Neuro developmental therapy.data-based group ( group B) Children receiving Neuro development therapy with Muscle Energy Technique.3.7. STATISTICAL TOOLThe data collected was analyzed using item-by-item t- test. The test was carried out between 2 groups.The pretest and post test values for 2 groups are to be calculated and will be assessed for variation and improvements their meaning will be assessed.t = x1 x2 n1 n2S ( n1 + n2 )S = ( x1 x1 ) 2 + ( x2 x2 ) 2n1 + n2 2where,S = Combined standard deviationx1 = Difference between Pre test and post test in theme x2 = Difference between Pre test and post test in Group x1 = pie-eyed Difference of Group x2 = Mean Difference of Group n1 = Number of subjects in Group n2 = Number of subjects in Group 4. TREATMENT TECHNIQUES4.1 NEURO DEVELOPMENTAL THERAPY(BOBATH THERAPY)Bobath concept is the most familiar and widely used approach for children with neurologic disorders. It is originated in 1940 and early 1950.PRINCIPLESPat terns of movement expenditure of handlingPrerequisites for movementNDT Treatment constructs a purposeful relationship between sensory input and motor output.Therapeutic handling is a primary feather hindrance strategy that NDT therapists use to assist the client in achieving independent function. atypical TONEABNORMAL POSTUREABNORMAL MOVEMENTSREGISTRATION OFABNORMALMOVEMENTSREPETITIONMEMORYEXECUTION OF ABNORMAL MOVEMENTSThe primary difference that separates NDT clinical practice from all other approaches is the inclusion of precise therapeutic handling, which includes both inhibition as key interventions to obtain independent function.HANDLING discussion is facilitation or inhibition of posture and movementNormal postural controlMovement in ground and spaceExperiences of various postures identifyural alignment to weight shiftsVariety of movement patternsDirect, regulate and organize tactile, proprioceptive and vestibular input.Direct the clients initiation of movement more effic iently and with more effective muscle synergies.Decrease the amount of force the client uses to stabilize the body segments.Guide to redirect the direction, speed, force and timing of the muscle activation for winning task completion.Sense the response of the client to the sensory input and movement outcome and provide non verbal feedback for reference of correction.When the client can release independent of the therapist and take control of posture and movement.Direct the clients care to meaningful aspects of the motor task.HAND PLACEMENTPlace the hands purposefully and precisely on the clients body to specifically influence the area under the hands to indirectly influence the body parts.FACILITATIONFacilitation makes a posture or movement easier or more likely to occur. Facilitation modifies postural control by increasing the degrees of freedom, supporting a body segment during an activity.Activating the postural system to produce a change in the alignment of the body relative t o the gravity and BOS.INHIBITIONInhibition refers to restricting the clients atypical postures and movements which interferes with the development of more selective movement patterns.BOBATH APPROACHIt referred to reducing tone and reflex activity resulting from CNS dysfunction.Inhibiting excessive co activation-dynamic stability for more effective postural control.Balance antagonistic muscle groups.Reduce spasticity or excessive muscle stiffness that interferes with moving specific segments of the body.(Facilitation and Inhibition techniques are used in combination)Treatment strategies often include preparation and stimulation of sarcastic foundation elements (task components) as well as practice of the whole task.NDT intervention is designed to obtain active responses from the patient on goal activities.Whenever executable during treatment movement is indicated and actively performed by the client.NDT intervention includes planning and figure out motor problems.NDT intervention allows the patient to learn from errors that occur during movement.Repetition is an crucial component during motor learning.Create an environment that is conductive to co in effect(predicate) participation and support of the clients effort.Knowledge of development of posture and movement components are used in designing treatment strategies.NDT therapy sessions provide motivation purpose to engage the client fully in developing and reinforcing movement responses.NDT intervention methods include modifying the task or the environment to take into account the clients flow rate level of performance and capacity for function.As client is able to perform the movement independently, the therapist provides time during the sessions for the client to move freely.Individual treatment sessions are designed to evaluate the effectiveness of treatment within the session. endorse and respect the communicative effects of the clients motor behavior.Families receive information regarding clients pr oblems and concern of those problems as they are able to understand and assimilate the information.4.2 bodybuilder free energy TECHNIQUEMuscle Energy Technique is a procedure that involves voluntary contraction of the patients muscle in a precisely controlled manner at varying level of intensity, against a executed counterforce utilize by the therapist.Muscle Energy Technique are used to treat somatic dysfunction, oddly decreased range of motion, muscular hyper tonicity and pain.MECHANISM OF ACTION FOR MUSCLE ENERGY TECHNIQUESMuscle Energy Technique is a direct,active technique requiring patients co-operation for maximum effect. The changes occurring when patient performs isometric conttaction areDirect inhibition of agonist muscles results due to Golgi Tendon Organ activation.At antagonist muscles there occurs reflexive multiplicative inverse inhibition.When Patient is relaxing agonist and antagonist remain inhibited. This allows the joint to be moved into the restricted rang e of motion.TECHNIQUESMuscle Energy Techniques could be applied to most areas of the body. Each of the technique requires following 8 goObtaining an faithful structural diagnosis.The restrictive barrier is engaged in many planes.The forbidding counterforce matches patients force with therapists force.The isometric contraction of patient has correct amount of force, direction of effort and duration (3-5 seconds).After muscle effort there is recognise relaxation.The patient is repositioned in possible planes into new restrictive barrier.Repeat 3-6 steps approximately 3-5 times.8. Repeat structural diagnosis to find whether dysfunction has resolved. information ANALYSIS AND INTERPRETATIONCerebral palsy children were treated with Neuro Developmental Therapy and Muscle Energy Technique. Neuro Developmental Therapy was given for control group (Group A ) which consisted 10 samples and Neuro Developmental Therapy with Muscle Energy Technique (Group B ) which also consisted of 10 samples .DEMOGRAPHIC DATAGROUP A (CONTROL GROUP)AGENUMBER OF PATIENTS virile effeminate4-5 years005-6 years006-7 years207-8 years208-10 years1010-12 years2112-14 years11GROUP B (EXPERIMENTAL GROUP)AGENUMBER OF PATIENTSMALEFEMALE4-5 old age005-6 Years006-7 Years107-8 Years108-10 Years1110-12 Years1212-14 Years21DATA PRESENTATION AND ANALYSISWEEFIMLocomotion (Maximum bring in s14)Group A (Control Group)S.NoPrePostDifference1.3632.51053.71034.3745.5946.71037.5838.3639.79210.572 lowly5.08.23.2WEEFIMLocomotion (Maximum score 14)Group -B (Experimental Group)S.NoPrePostDifference1.3632.71143.31074.594531286.51277.4738.81249.37410.363MEAN4.49.24.7WEEFIMGROUPMEAN VALUECALCULATED T VALUE board T VALUEPRE auditionPRO TESTSDA5.08.20.9182.250.05B4.49.21.888MASGroup -A NDT (Control Group)S.NoPrePostDifference1.43-12.43-1341-34.42-25.43-16.31-2732-18.42-29.41-310.43-1MEAN3.82.1-1.7MASGroup -B NDT + METS.NoPrePostDifference1.41-32.41-33.41-3442-25.41-36.31-27.31-28.42-29.42-210.31-2MEAN3.71.3-2.4MASG ROUPMEAN VALUECALCULATED T VALUETABLE T VALUEPRE TESTPRO TESTSDA3.82.10.8222.280.05B3.71.30.516DISCUSSIONThe aim of the study was to investigate the effects of NDT and MET in reduction of spasticity in children with spastic diplegic type of cerebral palsy.30 children of age group between 4-14 years were selected for the experimental study.The study was carried out for a total duration of six months for a period of 45 proceeding of treatment per day. The pre and post test scores of MAS and Wee FIM shows that significant improvements were found in reducing spasticity and ADL activities such as standing, walking, and stair climbing with less caregiver assistance.For MAS score, the average pre test and post test values of Group A and Group B showed significant difference. But the mean of Group A (1.7) shows more tag increase than that of Group B (2.4).On Statistical analysis using Independent t-test, for Group A and Group B, there is a significance of t=2.28For Wee FIM score, the avera ge pre test and post test valves in Group A and Group B showed significant difference. But the mean of Group A (3.2) shows more marked increase than that of Group B (4.7).On statistical analysis using Independent t-test, for Group A and Group B, there is a significance of t=2.25From this we infer that NDT along with MET can be used as an efficient treatment protocol to reduce spasticity and to improve ADL activities in children with spastic diplegic cerebral palsy, thus rejecting the null hypothesis.CONCLUSIONWith reference to the statistical analysis done from the data collected for MAS and Wee FIM, it is noted that the combination of NDT with MET causes significant reduction in tone which produces improvement in ADL activities.However it is required to state that mere NDT also produces improvement in MAS and Wee FIM but the data reveals that mean improvement is greater for the group to which MET is given. These findings suggest that MET attenuates physical symptoms associated wit h cerebral palsy and enhances development.Hence forth it could be concluded with enough and proven confidence that NDT along with MET forms an integral part in the treatment of children with spastic diplegic cerebral palsy.LIMITATIONSThe study was a time bound study lacking large sample size.Selection of only one muscle cant fulfill the desire functional goal setup by therapist.Irregularities in attendance.Health problems.No regular follow-up of home advices.Difficulties of the communication.RECOMMENDATIONSThe technique of the study is not strict to one particular muscle or one specific condition, so it is applicable to various muscles in various conditions.Post Isometric Relaxation and Post Facilitation Stretching, which is a safetyorm of stretching is advice to use maximum in place of passive stretching of muscle.It is suggested for further inquiry to conduct a combined therapy of NDT, MET with other Developmental Techniques for various muscle at a same time, so this will enhance to achieve goal which is setting for a particular child.This study may be useful to incorporate into further studies examining various muscles along with any development in multidisciplinary endorsed classification that are developed.BOOKSLeon Chaitow Positional Release Techniques, 2002.Judith Delancy clinical application of Neuro muscular techniques, 2005.Leon chaitow Muscle energy techniques.Janet.M,Howle NDT approach theoretical foundations, 2002.Lisa A Kurtz How to benefactor a clumsy child, 2003.Freeman Miller,Erin Brown cerebral palsy, 2005Sophie Levit Treatment of cerebral palsy and motor delay, 2010.Marcia Stame,MT Posture and movement of the child with cerebral palsy.Jan Stephan Tecklin paediatric physical therapy 3rd edition, 1990.Gilroy J Basic Neurology second edition, 1992.Susan K Campbell Physical Therapy for children, 1996.Roberta B Sheperd Physiotherapy in Paediatrics 3rd edition, 1990.Rebecea Dutton Clinical Reasoning in physical disabilities, 1995.Gupta SP Text b ook of statistical methods twenty-eighth edition, 2000.Kothari CR Text book of research methodology-methods and techniques, 2009.Carolyn M. Hicks Research for physiotherapist 2nd edition, 1995.Sundar Roa, Richard J An introduction to bio statistics 3rd edition, 1996.Acchors Text book of paediatrics.Elizabeth Domholdt Physical therapy research principles and application, 2000.ABSTRACTSFryer et al The effect of muscle energy technique on hamstring extensibility Journal of osteopathic medicine, 2005.Shadmehr A Hamstring flexibility in two-year-old women following passive stretch and muscle energy technique J Back Musculoskeletal Rehabilitation, 2009.Milivoj Velickovic Perat Basic principles of the Neuro developmental Treatment, 2004.Christina Evaggelina et al Effect of intense Neuro Developmental Treatment in gross motor function of children with cerebral palsy, Dev. Med. Child Neurology, 2004.Smith M, Fryer G