Technique to reduce tonus and passive muscle stretching: effects on range of motion in children with spastic cerebral palsy

Introduction: Cerebral palsy (CP) is consequent of brain injury in the maturation phase, causing motor dysfunctions. The decreased mobility is intensified by spasticity, most common form of attack, generating functional impairment. Objective: To analyze the effects of slow passive stretching of triceps sure muscle and technique for decreasing the tonus of Bobath concept on the range of motion (ROM) of ankle dorsiflexion in children with spastic CP. Methods: 18 children seen at Hospital Estadual Mario Covas, in Santo Andre, and Santa Casa, in Diadema, participated in this study. The hypertonia rate of triceps sure muscle was determined by Modified Ashworth Scale and the ROM dorsiflexion by goniometer. Both procedures were realized before and after the following situations: 1) application of a passive muscle stretching protocol; 2) protocol with technique for decreasing the tonus of Bobath concept; and 3) use associated to two protocols. Results: The hypertonia rate did not modify after protocol 1; however, protocols 2 and 3 decreased the spasticity similarly, according to Modified Ashworth Scale. The dorsiflexion angle increased after all protocols: protocol 1 (p=0.176); protocol 2 (p=0.008); and protocol 3, with the most significant increase of ROM (p=0.003). Conclusion: The technique to reduce tonus shows positive effects on decreasing in hypertonia rate and increase of ROM in spastic children. The subsequent execution of muscle stretching increased its effectiveness.