Developmental Medicine & Child Neurology Volume 23 Issue Supplement s44 1981 [Doi 10.1111%2Fj.1469-8749.1981.Tb02060.x] Functional Evaluation of Rolfing in Cerebral Palsy; Jacquelin

Develop. Med. Child Neurol. 198 1, 23, 7 17-729

Functional Evaluation of Rolfing in Cerebral Palsy

Jacquelin Perry Margaret H. Jones Lynn Thomas

Introduction Current therapeutic procedures for

cerebral palsy include passive and active stretching, positioning, strengthening, the development of balance and co-ordination of movement, and the use of mobile equipment and orthoses to prevent secondary deformities and to stimulate improvement of function. Surgery is resorted to when deformities occur or when therapy and bracing have not been successful. However, despite these therapeutic measures, many cerebral- palsied children continue to have considerable limitations. Since the known approaches to the motor problems of cerebral palsy are not fully satisfactory, and often are lengthy and expensive, there is a need to explore other techniques. One approach currently under consideration is Rolfing (Rolf 1 9 7 3 ~ b; 1975, 1977).

Rolfing, or ‘structural integration’ as it is formally titled, ‘is a technic which aims to align the body-head, thorax, pelvis, legs-in an optimal position in respect to the gravitational field’ (Rolf ,1977). This alignment allows one to stand erect with less muscular effort. ‘Since the human body is plastic, it succumbs to the unequal torques of everyday life, or to unequal muscle pull about the joint as in cerebral palsy. Because of this same plasticity it can

be repatterned’ (Rolf 1977). In the healthy body the intra- and intermuscular fascia1 layers permit neighbouring structures to slide over one another. As Woo et al. (1975) have demonstrated, chemical changes in the ’ground substance of connective tissue lead to lost collagen fiber mobility, and hence contractures.

Rolfing involves a 10-hour cycle of deep manual manipulation of the myofascial tissues of the body, concentrating on areas in which asymmetries in vertical alignment have been identified. Manual pressure is applied to areas in which muscle tendons are felt to adhere to each other rather than sliding over one another in the normal fashion. The goal is to balance the body optimally in the gravitational field.

General method We developed a protocol to evaluate

lower-extremity passive range of motion, muscle strength and balance, and to provide a comprehensive analysis of gait. Dynamic electromyography, foot-switch, dynamic knee and ankle goniometry and energy-cost evaluations were included in the gait assessment (Table I). All testing was conducted in the Pathokinesiology Laboratory at Rancho Los Amigos Hospital.

The 10 cerebral-palsied patients in this

Correspondence to Jacquelin Perry, M.D., Rancho Los Amigos Hospital, 7601 Imperial Highway, Downey, California 90242.

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study (three male, seven female) ranged in age from 10 to 42 years (Table 11). They were classified into three general clinical categories on the basis of lower-extremity involvement: Mild. Patients in this group had selective motor control, muscle strength of fair plus (F+) to normal (N), no more than mild spasticity in one or two muscle groups, and independent ambulation (patients 1, 2 and 3). Moderate. Patients 4 to 7 exhibited mixed selective and patterned motor control, poor (P) to good (G) muscle strength and moderate spasticity in two or more muscle groups. Two had ambulation and two used crutches. Severe. Limb function in these three patients (8, 9 and 10) was by patterned control, with zero (0) to fair (F) strength, and they had moderate to severe spasticity in three or more muscle groups. They had limited ambulation with crutches, and

TABLE I Testing protocol

Bilateral range of motion and muscle test Hip: flexion

extension abduction adduction internal rotation external rotation straightleg raising

Knee: flexion extension

Ankle: dorsiflexion plantiflexion inversion eversion

Oxygen consumption Sitting Free velocity walking Fast velocity walking

Resting EMG; 8 muscles Manual muscle testing; 8 muscles Quick stretch; 8 muscles Right and left single-limb support Free velocity walking Fast velocity walking

EMG. foor-switch, goniometry, force-plate

used a wheelchair for community ambulat ion.

Rolfing therapy was performed independently of our laboratory. The ‘Rolfers’ were selected by Dr. Rolf from those she had trained previously. Each patient underwent a 10-session course of treatment, for one hour each week for 10 consecutive weeks. The patients were asked to discontinue any other treatment for the duration of this study, and no new treatment other than Rolfing was begun.

The testing sequence consisted of three identical evaluations. Pre-treatment testing, which established baseline values, was followed by the prescribed course of Rolfing. The patients returned for post- treatment testing within one month of their last Rolfing session, and again for follow- up after four to six months.

Because of the extensive testing procedures, evaluation details and results will be described separately for each area of, investigation.

Passive range of motion Method

Initial passive range of motion was recorded for hip, knee and ankle joints, bilaterally. Changes of 10” or more on subsequent tests were considered to be clinically significant.

Results Significant changes were seen in 46 per

cent of all post-treatment range measure- ments, of which half were increases and half were decreases in range of motion. Each patient exhibited both gains and losses among the 14 motions tested. No correlation was found between these changes and the patient’s disability classification.

Hips (Table 111). Immediate post- Rolfing gains in the hip flexion-extension arc were seen in 10 hips, and this improvement was maintained at follow-

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JACQUELIN PERRY MARGARET H . JONES LYNN THOMAS

TABLE I 1 Study participants

Clinical Patient Sex Age Ambularion Medical Previous grouping no. (yrs.) diagnosis treaimen I

Mild I

2

3

10 Independent Spastic quadriplegia

12 Independent Spastic paraplegia*

Physical therapy, casts, motor end-point injection Physical therapy, surgery, bilateral achilles teriotorny Physical therapy 15 Independent Spastic

paraplegia, tremor**

14 Crutches Spastic diplegia*

Moderate F

M

Physical therapy, surgery, posterior tibia1 transplants Physical therapy. rectus release, adductor myotomy, gracilis tenotomy, semi-tendenosis transfer Physical therapy

25 Independent Spastic diplegia

F

F

21 Independent Spastic

25 Crutches Spastic quadriplegia

quadriplegia

6

7 Physical therapy, surgery, adductor-hamstring release

Physical therapy, surgery, adductor-hamstring release, femoral osteotomy Physical therapy, adductor tenotomy Physical therapy, surgery, derotation osteotomy

Severe 8 F 31 Crutches Spastic quadriplegia

F

M

32 Crutches Spastic

10 Crutches Spastic quadriplegia

diplegia*

9

10

*Premature. **Congenital aqueductal stenosis. Etiology in other cases not known, but present from birth.

TABLE 111 Changes in hip range of motion

Gains Immediate Follow-up

Losses Immediate Follo~twp

7 4 2 6 7 8

Saggital Flexion Extension Arc

Coronal Abduction Adduction Arc

Internal rotation External rotation Arc

Transverse

7 6 4 7

10 10

1 2 6 5 6 8

8 5 3 2 8 5

6 6 6 5 6 5

9 6 4 8 9 7

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ROLFING IN CEREBRAL PALSY

up. The arc showed post-Rolfing loss in seven hips initially, and in eight hips at follow-up. In most cases this loss was an increase in hip flexion contracture.

Gains in the hip adbuction-adduction arc, mainly in range of adduction, were seen in six of the joints immediately after treatment, and in eight at follow-up. Post- Rolfing lbsses in this arc were found in another eight hips. Some recovery of lost motion had occured at follow-up, with only five hips demonstrating sustained loss.

Six hips had a greater range of rotation immediately after Rolfing, and five maintained this gain at follow-up. Range of rotation was lessened in nine hips after Rolfing, and remained so in seven hips at follow-up. Loss of external rotation was the contributing factor in every case.

Knees (Table IV). Range of flexion improved in six knees immediately after Rolfing, but with concommitant increase in knee flexion contracture in two joints. Increased flexion-extension arc was maintained in four knees at follow-up. Post-Rolfing losses in the knee arc during motion were recorded in five knees. At follow-up the range of flexion had improved in two of these, so loss was limited to three knees, all with increased flexion contracture.

Ankles (Table V). Immediate improve- ment in the dorsiflexion-plantiflexion arc in five ankles was matched by losses in another five. Although 10 ankles had increased range of dorsiflexion at follow- up, half of these also had decreased range

of plantiflexion, so only five ankles had an improved arc at follow-up. The decreased arc at follow-up in another six ankles was distributed evenly between loss of dorsiflexion and loss of plantiflexion.

Immediate post-Rolfing gain in the inversion-eversion arc in six ankles was maintained in four at follow-up. Post- Rolfing losses in five ankles, particularly in range of inversion, increased to nine ankles at follow-up.

Muscle strength Method

Manual muscle testing (Daniels et al. 1956) was completed for all major muscle groups in the lower extremities. Grades for patterns of flexion and extension were given when there was no selective control. A change of one full muscle grade above or below the initial test score was considered to be clinically significant.

Results No consistent trend in changed muscle

strength could be found in either the immediate post-Rolfing test or the follow- up test. When changes did occur they were usually of only one grade. At follow-up, three patients exhibited a slight over-all increased strength, three a small decrease, and four showed no change. There was no correlation between extent of disability and change of muscle strength.

Gait analysis Simultaneous foot-switch, EMG and

goniometric recordings were made as each

TABLE IV Changes in passive knee range of motion

Flexion Extension Arc

Gains Losses Immediate Follow-up Immediate Follow-up

6 6 2 1 2 3 3 3 4 4 5 3

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JACQUELIN PERRY MARGARET H. JONES LYNN THOMAS

patient walked, first at natural walking speed and then at a fast velocity, along a level IS-meter walkway. Photo-electric cells along the middle six meters of walkway superimposed a signal on the recorded data. Only the information collected within this six-meter section was analysed, so normal acceleration and deceleration of walking took place outside the recording zone.

The foot-switch, EMG and goniometry signals were recorded simulataneously on video and analog tapes. Subsequently, a paper print-out was produced on a light- sensitive strip chart (Honeywell Visicorder 2106).

Stride characteristics Method

The foot-switch system consisted of bilateral, insole sensors and a telemetry package. The insoles contained a cluster of' compression-closing modules at the heel, first and fifth metatarsal heads, and the great toe. The modules were sensitive to a minimum of 0.8kg. The insoles were available in 10 sizes, and foot-switches of an appropriate size were secured to each foot. The patients then walked the length of the walkway, using their usual walking aids, if any.

Measurements of three consecutive strides were taken from the foot-switch records and processed by computer. The resulting gait profile included velocity, stride length, cadence, duration of gait

cycle, single- and double-limb support times, and swingstance ratio. Final free- walking velocity, cadence and stride length were compared with initial test values for each patient. Changes were considered to be functionally significant if they were greater than or equal to 5 per cent of established normal values (Lerch 1973, Blessey et a/. 1976, Stewart 1976). The foot-switch signals were also used to define successive gait cycles as event guidelines in EMG and goniometry analysis.

A foot-floor contact pattern was obtained by averaging the duration of each component of support sta4.d ?or three consecutive gait cycles and expressing the profile as a percentage of total gait cycle.

Results Six patients significantly increased their

free-walking velocity (Table VI). All three mildly involved patients made substantial gains over their pre-Rolfing velocities, and at follow-up patients 2 and 3 achieved a walking speed within normal limits for their age. Three of the four moderately involved patients achieved smaller gains in velocity and remained below normal limits: the fourth patient in this group, and all three severely involved patients, had non-significant gains or actual losses in walking velocity.

Nine of the 10 patients were able to increase their walking velocity on request. Changes in fast velocity after treatment were smaller than those in speed of free

TABLE V Changes in passive ankle range of motion

Gains Immedia te Follow-up

Losses Immediate Follow-up

Dorsiflexion Plantiflexion Arc Inversion Eversion Arc

5 10 3 5 5 5 6 5 3 3 6 4

4 5 2 5 5 6 5 9 2 4 5 9

ROLFING IN CEREBRAL PALSY

walking, significant increases being seen in only four patients at follow-up. Neither the ability to walk faster, nor the magnitudeof increase over free-walking speed, were correlated with clinical category.

Five patients had improvedstride length. All three mildly involved patients made significant gains, and one (patient 2) was within normal limits at follow-up. Two of the moderately involved patients also made significant gains but did not reach 11 o r ma I I i m i t s.

Cadence also improved i n five patients. Again, the mildly involved patients all made significant gains, with cadence values at the upper end of normal limits at follow-up. Improvement noted i n the other two patients, one moderately and one severely involved, did not approach normal values.

Three patients demonstrated definite improvement i n their stance support pattern after treatment. The first, patient 2, had no weight-bearing over the lateral border (fif th metatarsal head) of the foot on initial and immediate post-Rolfing tests, but had achieved a more normal foot-flat segment i n stance at follow-up testing. Patient 7 had no heel or fifth metatarsal-head contact with the left foot and late heel contact with the right foot, following initial contact over the first metatarsal head. On subsequent testing, initial heel-strike had been achieved

bilaterally and weight-bearing included contact along the lateral border of the left foot. Patient 8 had a predominant pattern of heel and first metatarsal-head support when tested initially, arid subsequent tests showed improvement in mid-stance, with some weight-bearing over the lateral border of the foot. Heel contact was completely lost, however, because of increased plantar flexion of the ankle on initial contact.

Dynamic EMG Method

At the initial visit, each patierit was examined in order t o select eight leg muscles which were representative of their particular gait pattern for EMG analysis. For each individual, the same muscles were studied on all subsequent tests.

Dual intramuscular electrodes of 5Opm teflon-coated stainless steel wire were used to record myoelectric activity. Placement accuracy was confirmed by stimulation through the wires. An FM-FM V H F telemetry system (Biosentry model 2600S), worn at the waist, transmitted the EM(; signal to the receiver for decoding, amplification and recording.

Data from the EMG were recorded simultaneously with the foot-switch information whilst the patient was walking. The foot-switch record was used as a time base for E M G analysis. Duration

TABLE VI Stride characteristics of patients with significant velocity increase

Pntient Age Ambulation Velocity Stride Cudenre no. (jirs.) ( d m i n ) length (rm)* (steps/nrin)*

I 10 Independent + 15 + 7 t 24 2 12 Independent + 26 + 26 t LO 3 15 Independent t I5 t 16 + I 1 6 21 Independent t 4 - 8 t I3 4 14 Crutches + 5 t 7 NS 7 25 Crutches t 6.5 + 17 NS

*Stride length and cadence changes at follow-up which contribute to significant increase in velocity. t indicates increase, - indicates decrease over pre-test values.

722

of muscle activity over three consecutive gait cycles was averaged for each muscle and recorded as a percentage of gait cycle, thus producing a display of phasic muscle activity. Phase changes from pre-treatment patterns needed to be at least 10 per cent of the gait cycle to be considered functionally significant.

Results Only scattered changes i n muscle

activity were found after the Rolfing treatment. Some were seen immediately after treatment but were not necessarily the same at follow-up. Other changes did not appear until the follow-up testing. When all post-Rolfing test results were combined, 18 per cent of the muscles showed improvement towards the normal phasic pattern, but 9 per cent had departed further from the norm (i.e. were worse). No consistent trends were seen.

Range of motion in gait Method

Single-plane parallelogram-type knee and ankle electrogoniometers were used. These respond to motion in the sagittal plane while remaining insensitive to movement in all other directions.

The goniometers were placed on the same limb as had been selected for EMG analysis. They were calibrated to a known joint position which had been documented by manual goniometry. The goniometry signals were transmitted by an overhead cable and were recorded simultaneously with the foot-switch and EMG data during walking.

Again, the foot-switch data were used as a time base for analysis of the goniometry recordings. Knee- and ankle-joint positions were averaged over three consecutive gait cycles. Particular note was made of knee position at the points of initial contact, maximum stance extension and peak swing flexion. Ankle position

was noted at initial contact, maximum dorsiflexion, maximum plantiflexion, toe- off and contralateral initial contact. Changes from initial values of 5 per cent or more were considered to be clinically significant.

Results During free walking, knee extension at

initial contact improved immediately after treatment in three patients (3,4,8), and in another four at follow-up (1,2,5,7). Mid- stance knee extension increased in five patients (2, 3, 6, 7, 10) immediately after treatment and was maintained at follow- up. For patients 6 and 7, however, this resulted in hyperextension of the knee, and to 8" and9" increases in ankle plantiflexion on initial contact.

Immediately after Rolfing, five ankles had greater relative plantar flexion at initial contact, and these increased to eight at follow-up. However, it was of actual benefit in only three cases (1,4,9), who had had excessive dorsiflexion prior to treatment. Furthermore, increased plantar flexion was no longer of benefit in these cases when full bodyweight was trans- ferred to the stance limb. At the moment of contralateral initial contact, ankle position was not altered in any of the patients after treatment: those who were in excessive dorsiflexion at that point remained so both immediately after treatment and at follow- UP.

Six patients (1,3,4,6,7,9) demonstrated increased plantar flexion at toe-off immediately after Rolfing and at follow- up. For patients I , 3 , 4 and 9 this was an improvement in posture (shift from dorsiflexion or limited plantar flexion towards 20" of plantar flexion).

In 55 per cent of all dorsiflexion measurements made in this .study, maximum stance dorsiflexion was found to exceed by at least 5" the maximum dorsiflexion obtained passively. In 25 per

JACQUELIN PERRY MARGARET H. JONES LYNN THOMAS

723

cent of the tests on the mildly involved patients there was an average discrepancy of 12"; in 58 per cent of tests on the moderately involved patients it was 13"; and in 75 per cent of tests on the severely involved group it was 18".

Energy-cost evaluations Method

All evaluations of: energy costs during walking were made outdoors, on a level concrete track 65m in circumference. A modified Douglas bag technique and self- contained telemetry package allowed the patients to walk without restraint during this testing.

Gas analysis was made by means of a paramagnetic oxygen analyser (Serromex type OA 250) and an infra-red carbon- dioxide analyser (Capnograph-Godart type 146). Expired air volumes were measured by a dry gas flow-meter (American Meter Company).

Five-minute tests were made with the patients sitting, walking at their usual speed, and walking at a fast velocity (if able). The first three minutes of each test were monitored to allow the patient to reach a physiologically steady state. Expired air samples and all related data were collected during the final two minutes of each test, when constant heart and respiratory rates indicated a steady state.

Expired air samples were measured after each test condition for percentages of oxygen and carbon dioxide, and for total volume. These values were then processed by computer to produce a complete energy profile. Because of the interdependence of velocity of walking and oxygen uptake, and the wide variation in walking velocity among the patients, oxygen uptake per meter (ml O,/kg-m) was chosen as a basis of comparison among the patients and against normal values for age (Lerch 1973, Blessey et at. 1976, Stewart 1976). In considering this unit as a measure of

ROLFING IN CEREBRAL PALSY

724

walking efficiency, its reciprocal (meters/ kg-ml 0,) was also calculated. (This may be considered the physiological parallel of the automobile's efficiency rating of miles per gallon.)

Results The three mildly involved patients were

within normal limits for their ages on pre- treatment testing. At follow-up, one had achieved a 46 per cent increase in velocity and a 19 per cent improvement in energy cost; in the other two there were non- significant changes in walking velocity and energy cost.

Three of the four with moderate involvement had pre-Rolfing energy cost values well above normal limits. At follow- up, one had achieved a I7 per cent increase in both velocity and efficiency, and two had non-significant velocity changes but 11 per cent and 14 per cent improvements in energy cost. However, they all remained more than 200 per cent above normal values. (The fourth patient in this group was excluded because of inconsistent test performance.)

None of the three patients with severe involvement had a significant change in walking velocity. At follow-up, one had a 19 per cent improvement in energy cost but remained almost 500 per cent above normal. The other two demonstrated a loss of efficiency, because energy cost in walking had increased by 12 per cent.

These results are summarised in Table VII.

Discussion There is no doubt that a person with

cerebral palsy is both physiologically and functionally handicapped by the physical disability. In an energy cost study of 22 children with spastic diplegia, Campbell and Ball (1978) found that energy expenditure per distance travelled (ml O,/kg-m) was 350 per cent above normal

JACQUELIN PERRY MARGARET H. JONES LYNN THOMAS

when the children walked at their usual speed. Using bicycle ergometry, Lundberg (1978) found that the physical work capacity of patients with spastic cerebral palsy was 50 per cent lower than the normal controls. In the present study, both locomotion before treatment and im- proved function after Rolfing appeared to be directly related to whether impairment was mild, moderate or severe.

Patients in the first category, who were also the youngest group tested, all walked at energy cost levels which were within normal limits prior to treatment. They were all able to increase their gait velocity by making significant gains in stride length and cadence. The ability to achieve a particularly rapid step frequency appeared to be unique to this group, and was instrumental in enabling two of the three patients to achieve normal gait velocity. All three patients in this group displayed some improvement in ambulation after Rolfing.

Three of the four patients with moderate impairment showed improvement in gait velocity, with an associated gain in either cadence or stride length. Comparison of immediate post-treatment and follow-up results showed this group to be vulnerable to early post-Rolfing losses, which improved spontaneously duringthe follow- up period. Three patients in this group achieved measureable improvement in walking efficiency, though there was no change in previous walking status and all remained at least 200 per cent above normal energy cost values.

Two of the three severely impaired patients had substantial losses in all stride characteristics immediately after Rolfing. While the third patient was able to increase his cadence, none of the three had improved functionally at follow-up.

Changes in range of motion were independent of the extent of physical involvement. Studies of functional range

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ROLFING IN CEREBRAL PALSY

of motion commonly revealed increased arcs at the knee and ankleafter Rolfing. At the ankle, most ofthe motion wasgained i n plantar flexion, which appeared to offer only limited functional benefit to patients who previously had had excessive dorsiflexion. and could be detrimental to those for whom equinus was the initial problem. I n fact, increased ankle plantar flexion on initial contact led to loss of heel- strike in one patient and to undesirable knee hyperextension in two others.

Increased ankle plantar flexion also tailed to improve joint position later i n stance. at the moment of contralateral heel-strike. At this point in the gait cycle, controlled tibia1 advancement by the plantar flexors should allow limited dorsiflexion (approximately 6") as bodyweight advances i n front of the supporting limb. Three patients displayed this desired posture before treatment, and retained it at follow-up. However, the five patients with excessive ankle dorsiflexion and the two with excessive plantiflexion retained those same stance postures after Rolfi rig.

The effects of Rolfing on passive range of motion were highly variable, both within the same patient and between patients. The most commonly occurring motion loss could result in hip flexion, adduction and/or internal rotation contractures, knee flexion contractures and increased ankle plantar flexion. Changes occurred in these arcs independ- ently of muscle spasticity. However, it was interesting that the muscle groups most likely to exhibit spasticity, and which contribute to many of the more difficult problems with gait, were also those most susceptible to increased tightening after Rolfing.

There was a lack of correlation between measurement of passive and active ranges of motion at the ankle. The effect of bodyweight and position on motion of the

joint, particularly in the presence of spasticity, was illustrated by the fact that 75 per cent of all tests on the severely involved patients had an average discrepancy of 18" i n ankle dorsiflexion. The finding of a greater range in gait vs passive movements in 55 per cent of all measurements made in this study suggests that passive range of motion is a poor test for cerebral-palsied patients.

Conclusions The number of patients evaluated i n this

study was small. Various factors relating to locomotion were evaluated, but interpret- ation of the trends seen after Rolfing in a group this size must be guarded. However, the extent of the patients' neurological involvement and their individual limit- ations on range of movement may serve as guidelines to the expected outcome of Rolfing treatment.

Muscle groups which commonly exhibit spasticity in cerebral palsy were the most susceptible to increased tightness after Rolfing. Particular care should be taken to avoid increased plantar flexion tightness, as this caused undesirable knee and ankle postures during walking in some patients. While it could benefit patients with excessive dorsiflexion during gait, calf musculature should not be included in the Rolfing procedure if increased ankle plantar flexion would be functionally detrimental.

Measureable locomotor gain occured only in the younger, mildly involved patients. Those with severe impairment registered no gains. When the disability was moderate, improvements were not sufficient to change functional levels of ambulation.

I t appears, then, that appropriate candidates for Rolfing must have the neurological capacity to use increased tissue mobility to avoid contractures. Since programs of treatment for the cerebral-

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JACQUELIN PERRY MARGARET H . JONES LYNN THOMAS

palsied patient tend to concentrate on those with significant disability, it is difficult to know whether mildly involved patients might benefit from conventional therapy given in 10 one-hour sessions at weekly intervals. Perhaps there are benefits for these patients which are unique to Rolfing: if SO, it may be appropriate to use Rolfing as an adjunct to conventional

mildly involved cerebral-palsied patients.

Acknowledgemenfs: An adaptation of this paper was presented at the 33rd Annual Meeting of the American Academy for Cerebral Palsy and Developmental Medicine in September 1979.

AUTHORS’ APPOINTMENTS Jacquelin Perry, M.D. , Chief, Pathokinesiology Unit; Margaret H. Jones, M.D. , Pediatric Consultant; Lynn Thomas, M.S., R.P.T., Research Physical Therapist;

California 90242. techniques in the treatment Of young, Rancho Los A m i g o s Hospital , D o w n e y .

SUMMARY Rolfing is a technique which involves the use of pressure on areas of the body in which

muscle tendons adhere to each other rather than sliding over one another in the normal way. In this study, a series of 10 patients with mild, moderate or severe cerebral palsy

underwent Rolfing Treatment, and the results were evaluated. Mildly impaired patients made gains in velocity, stride length and cadence; the moderately impaired group made only minor gains in velocity; and the severely impaired did not improve by any of the criteria used in this study. Muscle strength and electromyography were not altered appreciably in any of the patients. While the effects of treatment on range of motion were highly variable, increased muscle tightness in the hip and knee flexors, hip internal rotators, hip adductors and plantar flexors was noted.

These results indicate that Rolfing can lead to improved performance in mildly affected patients because they possess the neurological capacity to make use of increased tissue mobility, and thus avoid contractures. However, the increased muscle tightness which can occur probably outweighs any benefit which moderately or severely impaired patients may derive from the treatment.

RBSUMB Evaluation fonctionelle du ‘Rolfing’ dans tinfirmitt! motrice ckrkbrale

Le Rolfing est une technique utilisCe avec les IMC, qui a pour but d‘kquilibrer le corps dans le champ gravifique de facon optimale. Cela implique l’utilisation de pression sur les zones du corps au niveau desquelles les tendons des muscles adhkrent I’un h I’autre au lieu de glisser normalement l’un sur I’autre.

Au cours de cette Ctude, dix sujets prksentant des formes ltgkres, moyennes ou graves d’infirmitk motrice cCrCbrale ont bCnCficiC d’un traitement de Rolfing et les rCsultats ont CtC CvaluQ. I1 a pu Ctre not6 que les sujets faiblement atteints prksentaient seulement des gains minimes en vitesse, angle de sustentation et cadence; les sujets moyennement atteints ont prCsentC seulement des gains mineurs de rapiditk et les plus gravement atteints n’ont prtsent6 aucune amklioration en fonction des critkres utilisks dans cette Ctude. Les forces musculaire et tlectromyographique n’ont CtC modifikes de faqon apprkciable chez aucun des sujets. Tandis que les effets du traitement sur 1’Ctendue de mouvement Ctaient hautement variables, il a CtC not6 un accroissement de la raideur musculaire au niveau des flkchisseurs de la hanche et des genoux, des rotateurs internes de hanches, des adducteurs de hanche et des flkchisseurs plantaires.

Ces rtsultats montrent que le Rolfing peut ambliorer les performances de sujets lkgkrement atteints parce qu’ils posskdent la capacitk neurologique d’utiliser la mobilitC

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ROLFING IN CEREBRAL PALSY

tissulaire accrue, Cvitant ainsi les contractures. Cependant, la raideur accrue des muscles qui peut se produire outrepasse les bCnCfices limit& que les sujets moyennement atteints peuvent tirer du traitement.

ZUSAMMENFASSUNG Funktionelle Beurteilung des ‘Rolfing’ bei Cerebralparese

Rolfing ist eine Technik, die bei Patienten mit Cerebralparese angewandt wird und deren Ziel es ist, den Korper im Schwerkraftfeld optimal auszubalancieren. Hierbei wird auf die Korperregionen, in denen Muskelsehnen verklebt sind und nicht wie im Normalfall ii bereinander gleiten, ein Druck ausgeiibt.

Bei dieser Untersuchung wurden 10 Patienten mit leichter, mittelschwerer und schwerer Cerebralparese mit der Rolfing Methode behandelt und die Ergebnisse ausgewertet. Die gering betroffenen Patienten verbesserten sich hinsichtlich Geschwindigkeit, Schrittllnge und Kadenz, die mittelschwer betroffenen erzielten nur geringe Erfolge bei der Geschwindigkeit und die schwer betroffenen verbesserten sich nach den hier angewandten Kriterien iiberhaupt nicht. Muskelkraft und elektromyographische Befunde waren bei keinem Patienten zufriedenstellend verandert. Wahrend der Behandlungserfolg beim Bewegungsspielraum sehr unterschiedlich war, wurde in den Hiift- und Knieflexoren, inneren Hiiftrotatoren, Hiiftadduktoren und Plantarflexoren ein erhohter Muskeltonus festgestellt.

Diese Ergebnisse zeigen, daR die Rolfing Methode bei leicht betroffenen Patienten eine Verbesserung bringen kann, da sie neurologisch die Fahigkeit haben, vermehrte Gewebemobilitat zu nutzen und dadurch Kontrakturen zu vermieden; der vermehrte Muskeltonus aber, der auftreten kann, macht die begrenzten Erfolge, die mittelschwer und schwer betroffene Patienten von der Behandlung haben, zunichte.

RESUMEN Evaluacidn funcional del ‘Ro fjing’ en la paralisis cerebral

El Rolfing es una tCcnica utilizada en pacientes con paralisis cerebral y cuya finalidad es conseguir el equilibrio corporal de forma 6ptima en el campo gravitatorio. Incluye la utilizaci6n de presi6n sobre areas del cuerpo en las cuales 10s tendones musculares estln adheridos unos con otros en vez de deslizarse uno a lo largo del otro como 6s lo normal.

En este estudio, se aplic6 el tratamiento de Rolfing a series de 10 pacientes con paralisis cerebral de tipo ligero, moderado o grave, y se evaluaron 10s resultados. Se observd que 10s pacientes moderadamente afectados solamente conseguian mejorias pequeiias en la velocidad, y en la cadencia y longitud del paso; 10s afectados moderadamente conseguian s610 unas mejorias pequefias en la velocidad; y que 10s afectados gravemente no mejoraban bajo ninguno de 10s criterios usados en este estudio. La fuerza muscular y 10s trazados electromiogrhficos no se alteraron apreciablemente en ninguno de 10s pacientes. Mientras que 10s efectos del tratamiento sobre la amplitud del movimiento eran altamente variables, se observ6 un aumento en la tirantez muscular a nivel de 10s flexores de cadera y rodilla, en 10s rotadores internos de la cadera, en 10s adductores de la cadera y en 10s flexores plantares.

Estos resultados indican que el Rolfing puede conducir a mejorias en pacientes con afectaciones ligeras porque poseen la capacidad neurolbgica que les permite utilizar el aumento de la mobilidad tisular, y con ello evitar las contracturas. Sin embargo, el aumento en la tirantez muscular que puede ocasionarse, probablemente sobrepasa 10s limitados beneficios que 10s pacientes con alteraciones moderadas o graves puedan obtener.

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JACQUELIN PERRY MARGARET H . JONES LYNN THOMAS

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