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Effect of position on gross motor function and spasticity in spastic cerebral palsy children
Wardah Rauf1, Samia Sarmad1, Iqra Khan2
1Paediatric Physical Therapy, and Rehabilitation Center, University of Lahore Teaching Hospital, Lahore, Pakistan.
Insights
Proper 24-hour positioning significantly improved gross motor function and reduced spasticity in children with severe spastic quadriplegic cerebral palsy. This intervention benefits children classified at Gross Motor Function Classification System levels IV and V.
Area of Science:
- Pediatric Physical Therapy
- Neurology
- Rehabilitation Medicine
Background:
- Spastic quadriplegic cerebral palsy (CP) significantly impacts gross motor function and spasticity.
- Children with Gross Motor Function Classification System (GMFCS) levels IV and V experience severe motor impairments.
- Effective positioning strategies are crucial for managing spasticity and enhancing function in CP.
Purpose of the Study:
- To investigate the impact of comprehensive 24-hour positioning on gross motor function.
- To assess the effect of positioning interventions on spasticity levels.
- To evaluate outcomes in children with severe spastic quadriplegic CP (GMFCS IV-V).
Main Methods:
- A quasi-experimental study involving 74 children (3-8 years) with quadriplegic CP.
- Intervention included 24-hour positioning (specific seats, night positioning, standing frames) for six months.
- Gross motor function (GMFM-88) and spasticity (Modified Ashworth Scale) were assessed pre- and post-intervention.
Main Results:
- Significant improvements were observed in all gross motor function domains, including lying, rolling, sitting, crawling, kneeling, and standing.
- Fifty-nine participants showed reduced spasticity post-intervention.
- No improvement in spasticity was noted in 15 participants (p<0.05).
Conclusions:
- Twenty-four-hour positioning and postural techniques are effective in enhancing gross motor functioning across all GMFCS levels.
- Appropriate positioning strategies lead to a reduction in overall spasticity in children with quadriplegic CP.
- This approach offers a viable therapeutic option for improving functional outcomes in severe CP.
Objectives:
To evaluate the effect of positioning on gross motor function and spasticity in spastic quadriplegic cerebral palsy children with Gross Motor Function Classification System level IV and V.
Methods:
A quasi-experimental study was conducted at two Paediatric Physical Therapy Centres from November 2018 to July 2019. The study comprised of seventy four children with quadriplegic cerebral palsy aged between 3 to 8 years. Data was obtained and gross motor functional abilities and spasticity were assessed by GMFM-88 and Modified Ashworth Scale, respectively. Twenty four-hour positioning in specific seats, night positioning and standing frames for six months. The child was being positioned 24 hours according to his challenges for the period of six months. Semi reclined positioning was performed to manage aspiration, oral leak and to develop retention. Prone positioning was done to develop righting reactions, functional sitting position was used in the treatment regime to attain better upright position and neutral pelvic standing using standing frames. SPSS 24 was used to analyse the data.
Results:
Paired t-test reported significant improvement in the test scores in lying position, rolling, sitting position, crawling, kneeling, standing, walking or running. Fifty-nine subjects exhibited improvement in spasticity before and after interventional procedures, while 15 showed no improvement (p<0.05).
Conclusions:
Twenty-Four-hour proper body positioning and postural techniques improved gross motor functioning in all five dimensions of functioning. The overall spasticity in quadriplegic cerebral palsy children was also reduced due to appropriate positioning techniques.
