Fascial Manipulation in Cerebral Palsy Rehabilitation

NCT06837025 | Recruiting

• 1 other identifier: A2500/511
• Study Type: interventional
• Target: 20
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of the study is to investigate the potential additional benefits of a relatively new physiotherapy method, fascial manipulation, in the rehabilitation of movement difficulties or other problems caused by CP (cerebral palsy). A physiotherapist specialized in fascial manipulation specifically treats the muscle fascia, which plays a central role in the problems associated with CP. Fascial manipulation feels just like a massage but does not hurt. The purpose of the study is to determine how physiotherapeutic rehabilitation methods should be further developed in Finland and elsewhere. Fascial manipulation was originally developed in Italy and is used to treat many musculoskeletal problems. There have been few studies on the effectiveness of fascial manipulation in the context of CP problems. It is important to obtain more research evidence, which is why conducting this study is crucial.

Conditions

Cerebral Palsy (CP)

Keywords

Cerebral Palsy; Fascial manipulation; Flexibility; Spasticity; Walking ability; Interview study; qualitative study

Outcome Measures

Primary Outcomes (1)

• Six-minute walking test

  Distance covered six minutes

  From enrollment to the end of treatment at 8 weeks

Secondary Outcomes (4)

• Walking efficiency

  From enrollment to the end of treatment at 8 weeks

• Ankle joint hyper-resistance

  From enrollment to the end of treatment at 8 weeks

• Gait pattern

  From enrollment to the end of treatment at 8 weeks

• Interview: Parents of a child with cerebral palsy and their physiotherapist

  From enrollment to the end of treatment at 8 weeks

Study Arms (2)

Fascial manipulation

ACTIVE COMPARATOR

In fascia manipulation (FM), the treatment targets the deep fascia related to muscles, including the aponeurotic and epimysial fascia. Treatment points are selected based on a thorough assessment, including the client's history, movement tests and analysis, and palpation tests. Fascia manipulation treatment affects the hyaluronan and viscosity of the muscle fascia. In the treatment of spasticity, the treatment points are in the body parts involved in spastic movement patterns. In this study, fascia manipulation is performed once a week, and the therapist provides instructions for self-exercises to the child with CP. The child's own physiotherapy continues at the same time.

Other: Fascial manipulation

Stretching

ACTIVE COMPARATOR

The stretches are based on the article published 2024 at University of Jyväskylä. Four sets of 45-second manual passive-static guided stretches to the pain threshold are performed for the ankle extensors, hip flexors, hip adductors, and knee flexors.

Other: Fascial manipulation

Interventions

Fascial manipulation OTHER

Fascial manipulation once a week

Also known as: 1

Fascial manipulation; Stretching

Eligibility Criteria

• Age: 7 Years - 14 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Age 7-14 years
• GMFCS level 2-3
• Good cooperation
• Family living in the Helsinki metropolitan area

You may not qualify if:

• The child has previously received fascia manipulation by a Stecco-trained therapist or other fascia treatment (if done within the last 6 months)
• Surgeries on the lower limbs (if done within the last 12 months)
• Electrical stimulation treatments (if done within the last 3 months)
• Botox treatments on the lower limbs (if done within the last 6 months)
• Reduced cognitive level
• Severe visual impairment (unable to perform the walking test)
• Other illnesses: psychological or other serious illness

Sponsors & Collaborators

• Orton Orthopaedic Hospital: lead

Study Sites (1)

Helsinki University Hospital

Helsinki, 00290, Finland

RECRUITING

Related Publications (19)

• Tolvanen 2019 http://www.fascialmanipulation.com/wp-content/uploads/ATTI-2019-PDF.pdf

  RESULT

• Tolvanen 2018, Treatment of neurological pediatric patients in Julia Ann Day, Fascial Manipulation-Stecco -method The practitioner´s perspective, Handspring .

  RESULT

• Tolvanen, Lahtinen-Suopanki, 2022, Fascia Research Congress (poster), The Experiences and Benefits of Applying Fascial Manipulation® Stecco Method in Neurological Physiotherapy for Children and Adults. https://www.fasciaresearchsociety.org/docs/2022_FRC_AbstractBook.pdf

  RESULT

• BOBATH K, BOBATH B. THE FACILITATION OF NORMAL POSTURAL REACTIONS AND MOVEMENTS IN THE TREATMENT OF CEREBRAL PALSY. Physiotherapy. 1964 Aug;50:246-62. No abstract available.

  PMID: 14179895 RESULT

• Stecco L, Basmanjian JV, Day JA. (2004). Fascial manipulation for musculoskeletal pain (pp. 123-130). Padova: Piccin.

  RESULT

• Stecco A, Raghavan P: Peripheral Mechanisms Contributing to Spasticity and Implications for Treatment. Curr Phys Med Rehabil Rep. 2014;2:121-127. DOI 10.1007/s40141-014-0052-3.

  RESULT

• Hansen AB, Price KS, Loi EC, Buysse CA, Jaramillo TM, Pico EL, Feldman HM. Gait changes following myofascial structural integration (Rolfing) observed in 2 children with cerebral palsy. J Evid Based Complementary Altern Med. 2014 Oct;19(4):297-300. doi: 10.1177/2156587214540466. Epub 2014 Jul 2.

  PMID: 24989994 RESULT

• Pintucci M, Simis M, Imamura M, Pratelli E, Stecco A, Ozcakar L, Battistella LR. Successful treatment of rotator cuff tear using Fascial Manipulation(R) in a stroke patient. J Bodyw Mov Ther. 2017 Jul;21(3):653-657. doi: 10.1016/j.jbmt.2016.12.007. Epub 2016 Dec 22.

  PMID: 28750980 RESULT

• Faccioli S, Pagliano E, Ferrari A, Maghini C, Siani MF, Sgherri G, Cappetta G, Borelli G, Farella GM, Foscan M, Vigano M, Sghedoni S, Perazza S, Sassi S. Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review. Front Neurol. 2023 May 25;14:1171224. doi: 10.3389/fneur.2023.1171224. eCollection 2023.

  PMID: 37305763 RESULT

• Amir A, Kim S, Stecco A, Jankowski MP, Raghavan P. Hyaluronan homeostasis and its role in pain and muscle stiffness. PM R. 2022 Dec;14(12):1490-1496. doi: 10.1002/pmrj.12771. Epub 2022 Feb 25.

  PMID: 35077007 RESULT

• Cowman MK, Schmidt TA, Raghavan P, Stecco A. Viscoelastic Properties of Hyaluronan in Physiological Conditions. F1000Res. 2015 Aug 25;4:622. doi: 10.12688/f1000research.6885.1. eCollection 2015.

  PMID: 26594344 RESULT

• Smith LR, Lee KS, Ward SR, Chambers HG, Lieber RL. Hamstring contractures in children with spastic cerebral palsy result from a stiffer extracellular matrix and increased in vivo sarcomere length. J Physiol. 2011 May 15;589(Pt 10):2625-39. doi: 10.1113/jphysiol.2010.203364. Epub 2011 Mar 21.

  PMID: 21486759 RESULT

• Menon RG, Oswald SF, Raghavan P, Regatte RR, Stecco A. T1rho-Mapping for Musculoskeletal Pain Diagnosis: Case Series of Variation of Water Bound Glycosaminoglycans Quantification before and after Fascial Manipulation(R) in Subjects with Elbow Pain. Int J Environ Res Public Health. 2020 Jan 22;17(3):708. doi: 10.3390/ijerph17030708.

  PMID: 31979044 RESULT

• Valadao P, Cenni F, Piitulainen H, Avela J, Finni T. Effects of the EXECP Intervention on Motor Function, Muscle Strength, and Joint Flexibility in Individuals with Cerebral Palsy. Med Sci Sports Exerc. 2024 Jan 1;56(1):1-12. doi: 10.1249/MSS.0000000000003273. Epub 2023 Aug 7.

  PMID: 37565430 RESULT

• Te Velde A, Morgan C, Finch-Edmondson M, McNamara L, McNamara M, Paton MCB, Stanton E, Webb A, Badawi N, Novak I. Neurodevelopmental Therapy for Cerebral Palsy: A Meta-analysis. Pediatrics. 2022 Jun 1;149(6):e2021055061. doi: 10.1542/peds.2021-055061.

  PMID: 35607928 RESULT

• Arumugam K, Harikesavan K. Effectiveness of fascial manipulation on pain and disability in musculoskeletal conditions. A systematic review. J Bodyw Mov Ther. 2021 Jan;25:230-239. doi: 10.1016/j.jbmt.2020.11.005. Epub 2020 Nov 11.

  PMID: 33714501 RESULT

• Raghavan P, Lu Y, Mirchandani M, Stecco A. Human Recombinant Hyaluronidase Injections For Upper Limb Muscle Stiffness in Individuals With Cerebral Injury: A Case Series. EBioMedicine. 2016 Jul;9:306-313. doi: 10.1016/j.ebiom.2016.05.014. Epub 2016 May 13.

  PMID: 27333050 RESULT

• Nielsen JB, Christensen MS, Farmer SF, Lorentzen J. Spastic movement disorder: should we forget hyperexcitable stretch reflexes and start talking about inappropriate prediction of sensory consequences of movement? Exp Brain Res. 2020 Aug;238(7-8):1627-1636. doi: 10.1007/s00221-020-05792-0. Epub 2020 May 7.

  PMID: 32382862 RESULT

• Stecco A, Stern R, Fantoni I, De Caro R, Stecco C. Fascial Disorders: Implications for Treatment. PM R. 2016 Feb;8(2):161-8. doi: 10.1016/j.pmrj.2015.06.006. Epub 2015 Jun 14.

  PMID: 26079868 RESULT

MeSH Terms

Conditions

Cerebral Palsy; Muscle Spasticity

Condition Hierarchy (Ancestors)

Brain Damage, Chronic; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Muscular Diseases; Musculoskeletal Diseases; Muscle Hypertonia; Neuromuscular Manifestations; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Central Study Contacts

Juha-Pekka Kulmala, PhD

CONTACT

+358404863595; juha-pekka.kulmala@hus.fi

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 31, 2025
• First Posted: February 20, 2025
• Study Start: October 4, 2024
• Primary Completion (Estimated): December 31, 2027
• Study Completion (Estimated): December 31, 2027
• Last Updated: February 24, 2025

Record last verified: 2025-02

Locations

FI (1)