Stretching- ehhh

Children with Cerebral palsy deserve better.

The biggest deficiency in cerebral palsy rehab is lack of cohesive understanding of why physiotherapy is “given”. In most cases, therapies and rehabilitation techniques are employed without clearly defined objectives. This is often because a significant portion of the medical community operates within the confines of the biomedical model, focusing primarily on addressing observable symptoms, such as spasticity and abnormal movements. This holds true across a wide spectrum of practices, ranging from the Bobath approach to our neighbourhood pediatric clinics, and from neurologists to therapists alike. (o and p kind).

As we have “found” the primary problem we want to correct it. Noble thought. There are many “approaches” developed to reduce or correct the abnormal movements and underlying spasticity.

Stretching the panacea

One common technique employed in these approaches is stretching. Stretching is a practice that spans across various populations, from athletes to individuals with Parkinson's disease. Many healthcare professionals, including physical therapists (PTs) and occupational therapists (OTs), commonly incorporate stretching into their treatment regimens, emphasizing the importance of patients and caregivers diligently following these stretching routines. The underlying belief is that through stretching, it is assumed that abnormal movements in patients can be improved, and the onset of deformities can potentially be prevented.

During pediatric physical therapy sessions, each session typically lasts anywhere from 10 to 45 minutes. In these sessions, stretching and passive movements occupy approximately 20 to 30 percent of the time. However, the stretching can sometimes be quite forceful, leading some children to cry. Many children along with other circus treatment methods like rolling the child like a rag doll on a ball and other such nonsense.

As tightness or contracture gets worse- the stretching gets more aggressive and the crying becomes worse. The crying makes the whole therapy completely useless. Screams coming from some paediatric therapy department is heartbreaking. Its not new, it was always like that (well at least from the 90s.) The child screaming when the muscles are stretched is not only bad, its completely useless. No dear, you are not preventing contracture. Along with that we know if the child is crying it is hardly learning or forming an alliance with the therapist. The whole therapy becomes waste of time.

What’s the alternative

People usually complain i only talk about what’s wrong and never point out what should be done. I think that is just childish, but i will bite.

The first thing is- you cannot prevent contracture, reduce spasticity or abnormal movement by stretching or any passive method. So stop. no, the world will not collapse.

If we stop, then we will think what do to in the session. The ideas are fairly simple- make the child learn- not cry.