Basics of Massage for Cerebral Palsy

Nowadays, children who have suffered from hypoxic, traumatic, and ischemic damage to the nervous system are no longer a rarity. Children are extremely vulnerable during their perinatal period, which is why there are many causes for such damage. These include birth trauma, oxygen deprivation, maternal infectious diseases, pregnancy complications, external factors, etc. The consequences of such damage are also varied. Examples include hypertensive-hydrocephalic syndrome, vegetative-visceral dysfunction syndrome, convulsive syndrome, motor disorders syndrome, and cerebral palsy. Let’s examine the latter in more detail.

Cerebral palsy (CP) is not a specific disease with characteristic symptoms, but rather a group of chronic motor disorders secondary to brain damage that occurs during the perinatal period. In Russia, the most commonly used classification of CP is by Semenova K.A., which includes: spastic diplegia; double hemiplegia; hemiparetic; hyperkinetic; atonic-asthenic. However, there is also an international classification, ICD-10, which includes: spastic tetraplegia; spastic diplegia; hemiplegic form; dyskinetic form; ataxic form; mixed forms; unspecified form. CP is a non-progressive condition, although a false progression may occur as the child grows. It is characterized by unnatural postures and incomplete movements. To restore and maintain impaired functions, a comprehensive treatment plan is prescribed, which includes physical therapy (LFC) and massage. Due to the brain damage, all areas of the brain may be affected, and often, alongside motor functions, speech is also impaired. Therefore, for CP, massage can be divided into general and speech therapy (logopedic) types.

Speech therapy massage has a positive effect on the trophism of facial tissues, normalizes the tone and motor function of the articulatory apparatus. It can be divided into two parts: face and tongue massage. Before the procedure, it is important to ensure that the child is in a comfortable position. Proper posture helps normalize muscle tone. When performing massage of the facial and chewing muscles, the specialist selects techniques individually. The main techniques are: stroking, rubbing, kneading, and vibration. The sequence of movements is from bottom to top – from the neck to the forehead. The direction of movements should be from the center to the periphery along the muscle fibers, following the muscle attachment points. Movements vary in strength: deep and slow movements are sedative, while superficial and fast movements are tonic. Tongue massage should not be performed immediately after feeding. Before the procedure, the specialist determines the degree and boundary of the gag (vomiting) reflex. During the procedure, the massage therapist holds the child by the tip of the tongue using a napkin. The techniques can be performed with fingers or speech therapy probes. The direction of movements is from the center of the tongue to the periphery, from the tip to the root and back. Different methods of tongue massage exist, and these should also be selected individually.

General massage plays an important role in the treatment of CP. By applying mechanical pressure to the child's body, it is possible to:

• normalize muscle tone,
• improve blood and lymph circulation,
• prevent the development of contractures,
• enhance tissue metabolism.

The procedure should be performed in a warm room. Before starting, the massage therapist conducts an examination to determine which technique should be applied.

CP is characterized by asymmetry in muscle tone in the torso and limbs. Therefore, the technique may be structured as follows:

• Relaxing the flexor muscles on the affected side: neck muscles, large pectoral muscle, trapezius, latissimus dorsi, iliopsoas, gluteal muscles, adductors of the thighs, calf muscles. The massage techniques to be used include stroking, light rubbing, vibration, rolling, as well as acupressure for relaxation.
• Strengthening the extensor muscles of the back (classical techniques and acupressure – a tonic method), which should be done more intensively on the healthy side.

It is important to note: The air temperature in the room should be comfortable for the child, approximately 23 degrees Celsius. The child’s position during the procedure should be such that pathological tonic reflexes are minimally manifested. Movements should be directed along the flow of blood and lymph. Techniques such as chopping, tapping, and squeezing should not be used for CP. Failing to follow these simple rules may lead to an increase in spasticity.