Abstract
Mulligan techniques focus on improving the movement, range of motion and reducing pain on movement in adults. The technique is not inadequately studied in children with cerebral palsy. Three Mulligan techniques i.e. adductor elongation, bent leg raise and rectus elongation was applied in children with diplegic spastic cerebral palsy with crouch gait. Four children with diplegic spastic cerebral palsy with crouch gait participated in a prospective study carried out at SNEH RERC over a period of 12 weeks. Adductor elongation, bent leg raise and rectus elongation treatment was given to each child for an average of 1 hour-3 times a week based on the Mulligan techniques. The primary outcome measures included Thomas Test and Duncan Ely Test (hip flexor angle), adductor spread and Tardieu's scale for hamstrings to measure Popliteal angle and secondary outcome measures included Gross Motor Functional Classification Scale (GMFCS), Silfverskiold test, Ashworth's test for iliopsoas, hamstrings, tendo-achilles and selective motor control for hip, knee and ankle respectively. After the completion of 12 weeks, an application of the three Mulligan techniques showed highly significant changes in the range of hip, knee and ankle as seen using the above outcome measures. Mulligan techniques such as adductor elongation, bent leg raise and rectus elongation may significantly improve mobility of the joint and extensibility of the muscle tissue in children with diplegic spastic cerebral palsy with crouch gait. Further research is warranted in this area.
Highlights
Cerebral palsy (CP) is a spectrum of permanent disorders affecting the movement and posture, causing activity limitation, caused due to non-progressive disturbances that occurred in the developing foetal or infant brain during the pre, peri or post-natal stage
The purpose of the study is to evaluate the effect of three Mulligan techniques adductor elongation, bent leg raise and rectus elongation on mobility of the joint and extensibility of the muscle tissue in children with diplegic spastic cerebral palsy with crouch gait
All 4 subjects with Gross Motor Functional Classification Scale (GMFCS) level 1⁄2 and their parents were explained about the study and the techniques to be administered as part of therapy and informed consent was taken from the parents
Summary
Cerebral palsy (CP) is a spectrum of permanent disorders affecting the movement and posture, causing activity limitation, caused due to non-progressive disturbances that occurred in the developing foetal or infant brain during the pre, peri or post-natal stage. Crouch gait is generally seen as child grows older into teenage years and it has specific clinical and biomechanical manifestations [2]. These children generally demonstrate tightness in hamstrings especially the medial hamstrings, hip flexors and adductors, muscle tightness, weakness and spasticity, skeletal deformities, and motor control deficits [3]. The purpose of the study is to evaluate the effect of three Mulligan techniques adductor elongation, bent leg raise and rectus elongation on mobility of the joint and extensibility of the muscle tissue in children with diplegic spastic cerebral palsy with crouch gait
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