Heat therapy helps to relax the spastic muscles and thus helps in attaining more range of motion.
Ultrasound therapy can be used to break the adhesions, increase circulation, and thus helps increase joint movement.
Neuromuscular Electrical Stimulation (NMES):
This involves the application of transcutaneous electrical currents that causes muscle contraction. NMES helps to increase muscle strength by increasing the cross-sectional area of the muscle and by increasing the recruitment of type 2 muscle fibers.
Functional Electrical Stimulation:
It is the application of electrical stimulation during a given task or activity when a specific muscle is expected to be contracting.
Soft tissue mobilization and joint mobilization:
Soft tissue mobilization like kneading of the muscles relaxes the muscles increases blood circulation, breaks the contractures, and thus increases the flexibility of the joints. Joint mobilization breaks the adhesion in fused joints and thus improves the range of motion.
Range of Motion Exercises:
A cerebral palsy patient can benefit from the range of motion exercises. Passive range of motion exercises can be done by the physiotherapist, the therapist moves the patient's body, helping the patient to stretch the muscles, gain motion in their joints, and promote flexibility and circulation. The patient with more muscle control is encouraged to practice range of motion exercises actively, on their own. This may help in strengthening. Even active assistive range of motion exercises are done to help the individual with cerebral palsy to complete the targeted motion. This technique allows the individual to do the movement as much as they can, while the physiotherapist helps them move farther than they can independently to gain more active motion.
Strengthening exercises are essential for cerebral palsy because they help to increase muscle power, flexibility, posture, and balance. When these functions are attained, individuals are more likely to be active and perform daily activities on their own.
Constraint-Induced Movement Therapy:
Constraint-Induced Movement Therapy (CIMT) is used in individuals with hemiplegic cerebral palsy to improve the use of an affected upper limb.
Passive stretching is a manual application to spastic muscles to relieve soft tissue tightness. Manual stretching may reduce spasticity, increase the range of movements, or improve walking efficiency in children with spasticity. Types of stretching techniques include fast/quick, prolonged, and maintained.
This type of stretching is used for facilitation, by producing a short-lived contraction of the agonist's muscle and short-lived inhibition of the antagonist muscle which facilitates a muscle contraction.
Prolonged stretching normalizes the tone and maintains soft tissue length. This stretching technique may be achieved through several methods which include:
Prolonged manual stretch may be applied manually by using machines or splints or by using the effect of body weight and gravity or mechanically.
Weight-bearing helps to reduce the contracture in the lower limb by the use of tilt-tables and standing frames through a prolonged stretch.
Splints and casts are external devices, which are designed to apply, distribute or remove forces to or from the body in a controlled manner.
Serial casting is a common technique, most effective in managing spasticity-related contractures and increase the range of joint motion.
Functional training programs on a treadmill or static bicycles are beneficial for gait and gross motor development but have not been found to have any effect on spasticity.
Gait training focuses specifically on improving walking functions. Many patients with CP may walk with an abnormal gait due to spasticity in the legs. During gait training, the physiotherapist focuses on increasing walking speed or correcting walking patterns. Correcting abnormal gait patterns is essential because the poor form can compromise function and lead to the development of chronic pain. Types of equipment such as walkers, bodyweight supporting treadmills, and parallel bars can be used to help patients practice walking without losing stability. Even orthotics such as a leg brace to support correct musculoskeletal alignment and gently stretch spastic muscles can be recommended.
Hydrotherapy is a form of physiotherapy that takes place in a pool. The patient is submerged in water so that the person feels weightless, which enables the person to focus on developing the form without straining the joints, also moving against the resistance of the water helps to strengthen the muscles.