The Effect of Stretching and Propiroceptive Neuromuscular Facilitation in Spastic Diplegic Cerebral Palsy: A Comparative study

INTRODUCTION: Cerebral palsy (CP) is a common developmental disability first described by WILLAM LITTLE in 1940. Cerebral palsy is a common problem, worldwide incidence being 2-2.5/1000 live birth. As much as 75-80% of the cases are due to prenatal injury with less than 10% being due to significant birth trauma or asphyxia. The most important risk factor seems to be prematurity and low birth weight. PREVALANCE AND TYPES OF CP: Diplegia 30 - 40%, Hemiplegia 20 - 30%, Quadriplegia 10 – 15%. COMMON CAUSES: Neonatal asphyxia, Infants born prematurely with low birth weight, maternal infections such as high grade fever or rubella during pregnancy. In an analysis of 1000 cases of CP from India, it was found spastic quadriplegia constituted 61% cases followed by diplegia 22%. Cerebral palsy – It is an umbrella term covering a group of non-progressive, but often changing, motor impairment syndromes secondary to lesion or anomalies of the brain arising in the early stages of its development. Tightness in one or more muscle group affects 70-80% of individual with CP. Hamstring tightness is most common of all. Significant effects were only observed when the popliteal angle exceeds 85 degree (p<0.001) and included increased effort of walking, decreased speed, stride and step length, decreased hip flexion and increased knee flexion instance, increased posterior pelvic tilt, decreased pelvic obliquity and rotation and premature ankle dorsi- and plantar- flexion in stance. OBJECTIVES: 1. To find out the effectiveness of the PNF technique for the tightness of lower limb muscles in spastic diplegic CP. 2. To find out the effectiveness of stretching for the tightness of lower limb muscles in spastic diplegic CP. 3. To compare the effectiveness of PNF versus stretching, for the tightness of lower limb muscles in spastic diplegic CP. DESIGN AND METHODOLGY: STUDY DESIGN: A Comparative Experimental Study. STUDY SETUP: Madha medical college hospital and research institute. SAMPLE SIZE: 30 subjects (Group A -15 and Group B -15 Patients). INCLUSION CRITERIA: 1. Spastic Diplegic cerebral palsy. 2. Both the sex was considered. 3. Age group of patients ranged between 5 years to 10 years. 4. Muscle tightness. 5. Subject who is able to follow the instruction. 6. Willing to participate in study. EXLUSION CRITERIA: 1. Patients with medical co-morbid. 2. Patients with mental retardation. 3. Patients with contractures. 4. Gross deformity of lower limb. RESULTS: This study compares the effects and uses of stretching and PNF techniques for the functional re-education of patients following spasticity. In case of unpaired ‘t’ test the result obtained at 5% level of significance is the accepting the alternative hypothesis because the ‘t’ value remain less than that of table value. In a former study by Dyek and associates, concluded that patients who were treated with stretching as well as patients treated with PNF technique. Another study conducted by Harris and colleagues compared PNF and Stretching technique found that there is significant difference in outcome. In the same way the current study also shows that there is statistical significance in outcome. But when pre test and post test data of individual techniques were analysed using coefficient of variation, Paired ‘t’ test. The result obtained at 5% level f significant shows that stretching concept as significant difference in the outcome then that of PNF. The difference between the two techniques is significant. It really emphasis that patients who belong to group receiving stretching showed slower improvement than the PNF for a given period of time. The time or early regaining of functional independence is very much useful during the management of spasticity patients. CONCLUSION: Thus this study conclusively emphasis that proprioceptive neuromuscular facilitation is more valid for the recovery of functional activities in the patients following spasticity than the stretching.