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CAM & CP

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dani c

on 15 April 2010

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Transcript of CAM & CP

Complementary & Alternative Medicine
in Cerebral Palsy What is Cerebral Palsy? Most common physical
disability in children Affecting about
2.5/1000 live births A group of permanent
motor disorders Each case may affect the development of
movement and posture differently

Various degrees of activity limitation
May affect different body parts
Accompanied by an array of comorbidities
Caused by neurological impairment
in the fetal or infant brain May be due to:
infection, inflammation,
or hypoxia during pregnancy
complications in the labour process,
e.g.: asphyxiation Types of neurological
impairments: spasticity
hypertonia/hypotonia
hyperreflexia
ataxia
dystonia
choreia
athetosis Anatomical distribution
of motor impairment: hemiplegia
diplegia
triplegia
quadriplegia Different Levels of Severity (Rosenbaum, 2003) (Rosenbaum, 2003) What is CAM? “A group of diverse medical and health care systems, practices, and products that are not generally considered to be part of conventional medicine.” - US National Institues of Health, National Center for CAM "Complementary" used in conjunction with traditional medicine "Alternative" used as a substitute for tradition medicine 5 Domains:
mind-body medicine
biologically based practices
manipulative and body-based practices
(e.g.: osteopathic therapy)
energy medicine (e.g.: acupuncture)
whole medical systems - may include many domains What does this mean in the context of therapy for CP? adding a therapeutic element to everyday activities approaching the disorder with a different idea of biology and physiology Hippotherapy (Sterba, 2002) Hippotherapy, also known as equine-assisted therapy, allows children with CP to enjoy the experience of horseback riding while incorporating stretching and balance exercises. Increases rider's ability to process global sensory and motor information Forces rider to adjust to physical changes and disturbances Enjoyment of recreational activity also bring social benefits - it's fun! Research has demonstrated significant improvements in:
gross motor function measure scores
functional muscle symmetry
head and trunk stability
Caveats:
possibility of trauma from a fall
although studies have included subjects of all levels of CP (I-V), further studies are required to determine gains for more severe disabilities (levels IV & V) Acupuncture According to traditional Chinese medicine, the insertion of thin metal needles into the skin at specific acupoints is said to restore the flow of vital energy (Qi) and the balance of yin-yang. Research of contemporary medical acupuncture postulates that acupuncture may:
stimulate the production of endogenous opioids
trigger gene expression of neuropeptides
exert regional effects on the brain Acupuncture for CP Patients Increase circulation and warm cold limbs

Tongue: Extremities: Shown to decrease drooling Also thought to stimulate hypothalamus, brainstem, and cerebellum to also have an effect on motor function Applied to left and right lateral sides, and to the base of the tongue Both uncontrolled and controlled studies have demonstrated improvements in gross motor function measure scores More studies required to solidify the benefits of acupuncture as therapy for CP patients A promising therapy, but.. Need studies to determine benefits to subgroups (i.e.: different levels of severity) Osteopathic Therapy Osteopaths use their hands to loosen the muscles and fascia allowing for muscle release and the mobilization of tissues. So far, few published studies have investigated the use of osteopathic therapy in CP. One study (Tarsuslu et al., 2009) has investigated the use of osteopathy to relieve constipation in CP patients: Theorized that the neurological damage in CP patients deregulates the pathway between the brain and gut. Applied fascial release, iliopsoas release, sphincter release, and bowel mobilization to patients with level IV and V CP. Significant improvements in constipation, as well as spasticity and gross motor function. Further investigation on its effects on mobility and function is needed before making recommendations. Can complementary & alternative therapies be used for cerebral palsy? All of the above therapies are currently being used for CP, and have been used for many years. They all show promise in improving motor function and other comorbidites, but... Further research is required to determine and quantify the specific benefits.
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