Stretching in children with Cerebral palsy

How does stretching children with Cerebral palsy influence muscle tendon unit length?

Cerebral palsy (CP) is a non-progressive disorder caused by a brain lesion during or soon after birth. This can lead to changes in the muscle, including muscle atrophy, fibrosis, shortening, overstretched sarcomeres and a lack of muscle growth.

Muscle shortening in children with CP is commonly treated with stretching exercises, casting, ankle-foot orthoses or botulinum toxin injections. This review discusses the current evidence of stretching treatments, provides a mechanistic explanation, and offers potential approaches of how muscle shortening can be tackled more successfully.

To date isolated stretching treatments do not promote muscle length growth or improve function in children with CP. This emphasises that alternative treatments are needed.

The combination of stretching with botox injections and electrical stimulation appears to have a beneficial effect. Also increasing tendon stiffness to increase fascicle length might be a promising approach.

Nevertheless, more research is needed to understand whether improved fascicle length can result in improved force production across the increased ROM and whether this can lead to improved function and gait.  

> From: Kalkman et al., Front Physiol 11 (2020) 131 . All rights reserved to The Author(s). Click here for the online summary.

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Expert opinion

Stretching interventions in children with CP should not only aim to improve ROM and function, but should ideally ensure that the muscle fascicle length improves over the tendon length.

This review was the first review that gave an insight of the influence of stretching treatments on the tendon and muscle length. These insights are crucial for physiotherapists to be able to understand the underlying mechanism of applied stretching interventions and why these interventions commonly fail to improve muscle length.

Furthermore, this study provides a crucial outlook on potential combined stretching interventions that might be more beneficial.

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