Punctual mechanical oscillation in modulation of muscular tonus in children with spasticity

Stéphani De Pol,Eddy Krueger,André Eugenio Lazzaretti,Eduardo Borba Neves,Suhaila Mahmoud Smaili

doi:10.14393/bj-v37n0a2021-53574

Abstract

Spasticity is a motor condition present in 75 to 88% of children with Cerebral Palsy (CP). One form of treatment is called punctual mechanical oscillation (PO). The current study aimed to study different protocols for the application of PO and the magnitude of their effects. In total, 7children with medical diagnosis of CP and ICD (International Classification of Diseases) were included. The first intervention protocol (Int1) consisted of the application of PO to the spastic muscle tendon and the second intervention protocol (Int2) to the muscle belly ofthe spastic antagonist muscle. For evaluation, the Modified Ashworth Scale (MAS) was used, while simultaneously capturing the mechanomyography (MMG) signals. Data were collected pre-intervention and 1 (Post1), 15 (Post15), 30 (Post30), 45 (Post45), and60 (Post60) minutes after the interventions. The MAS values (median ± interquartile range) post intervention were statistically lower when compared to the pre values in the 2 protocols studied; in Int1between Pre (2 ± 0) andPost15 (0 ± 1.75), Post30 (0 ± 1), Post45 (1 ± 1),and Post60 (1 ± 1), and in Int2only between Pre (2 ± 1) and Post1 (0 ± 1).The values found in the MMG in both its temporal and spectral domains did not follow a pattern (p>0.05). The comparison between the protocols did not demonstrate statistical differences in any characteristics (MAS, MMGMF, and MMGRMS). However, PO was shown to be a therapeutic resource that modulated spasticity for up to 60 minutes after its application, and PO could contribute as a tool to aid the treatment of spasticity.

Highlights

Cerebral Palsy (CP) describes a group of disorders that compromise movement and posture, causing limitations in the functional activities of the individual
The objective of this study was to verify the effectiveness of punctual mechanical oscillation in the modulation of spasticity, to verify the modulation permanence time, as well as to compare the two application protocols using the Modified Ashworth Scale and Mechanomyography
The values found by the MMG did not follow a pattern when compared to the Modified Ashworth Scale (MAS), due to the possible associated limb movement when performing the stretching reflex in the MAS evaluation, as the signals of this movement were possibly captured by the accelerometer

Summary

Introduction

Cerebral Palsy (CP) describes a group of disorders that compromise movement and posture, causing limitations in the functional activities of the individual. Punctual mechanical oscillation in modulation of muscular tonus in children with spasticity. It is estimated that 75 to 88% of patients present, as part of their clinical characteristic, alteration in muscle tone, defined as spasticity, which can cause secondary damage such as reduction in muscle length, deformities, and loss of function (Dias et al 2015). This increase in muscle tone may contribute to joint stabilization, and assist in postural control, facilitating changes in decubitus and transfers. Spasticity is a condition to be modulated and not completely eliminated (O’shea 2008; Brasil 2009). Vibration refers to mechanical oscillations around a reference point, which are defined by the evaluated frequency and amplitude (Batista et al 2007). Vibratory stimulation results in neurophysiological alterations through muscle and tendon mechanoreceptors, such as the muscle spindle (MS) and Golgi tendon organ (GTO) (Fallon and Macefield 2007)

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