By Lee Vanderloop
Range of motion is the measurement used to describe the degree of flexion in a joint (how far it can be bent) and extension (how far it can be stretched or extended out). Many children, especially children with spastic cerebral palsy experience limited range of motion. Children with hemiplegia cerebral palsy may experience limited range of motion involving the extremities on one side of their body while children with quadrapalegia may experience range of motion issues with all extremities including the trunk, putting them at risk for spinal scoliosis.
If you’ve ever had an injury resulting in casting or any form of immobilization for a period of time, you probably experienced limited range of motion when the cast was removed. You may even have needed physical therapy to regain normal range of motion in that extremity.
Children with spastic cerebral palsy who are non-ambulatory often require daily range-of-motion exercises. This is because spacticity issues left untreated can lead to spinal scoliosis and deforming contractures , especially to joints such as the knee, ankle, elbow and wrist. The absence of range-of-motion exercises also can seriously compromise benefits from physical therapy.
My daughter suffers from severe spastic quadrapalegia cerebral palsy and medications did little to reduce the spasticity. The chronic spasticity made physical therapy and range-of-motion exercises, though necessary, unproductive and all but useless in our attempts to prevent contractures of her extremities. It would take 30 minutes of relaxation techniques just to relax her enough to do any type of range-of-motion exercises.
By age 12, in spite of our best efforts, the constant hypertonia/spasticity resulted in severe contractions. Her right knee had contracted to the point where she was literally almost sitting on her right foot. Her upper extremities also showed the consequences. With the spasticity causing her to constantly pull her arms into her chest (fists under her chin), her arms had contracted at the elbow, and any attempts to range her resulted in her pulling her arms in even tighter. These contractures impacted her quality of life and made dressing and positioning her all but impossible.
The contracture in her right leg was partially resolved with tendon release surgery, but with her chronic hypertonia still not resolved, this was a temporary fix.
It wasn’t until we reduced the level of hypertonia with intrathecal baclofen that we realized any benefits from physical therapy or range-of-motion exercises. Within two years of the baclofen surgery we were witnessing an incredible 60-80% improvement in her range-of-motion for both upper and lower extremities.
It is imperative that every attempt be made to alleviate excess tone and spasticity to the extent possible, in order to achieve the maximum benefit from physical therapy and range-of-motion exercises, and to deter contractures.
Children who suffer with hypotonia are not at the same risk of contractures as children with spastic CP, but still require physical therapy and range-of-motion exercises to prevent muscle atrophy and maintain joint mobility.
Mayo Clinic, Cerebral palsy, Complications, Contractures
WebMD, Children’s Health, Cerebral Palsy - Surgery
WebMD, Contractures in people with cerebral palsy
WebMD, Orthopedic surgery for cerebral palsy
WebMD, Physical Therapy – Topic Overview