Effectiveness of the manual diaphragmatic stretching technique on respiratory function in cerebral palsy: A randomised controlled trial.

BACKGROUND: Respiratory failure resulting from diaphragmatic muscle weakness is a major cause of long-term hospitalization in children with cerebral palsy (CP). Manual diaphragmatic stretching technique (MDST) can be directly applied to stretch diaphragmatic muscle and has been reported to improve respiratory function in patients with asthma and COPD. However, there have been no studies among CP. This study aimed to examine the effects of a six-week MDST course on respiratory function among CP. METHODS: Fifty-three children with spastic CP were randomly assigned to experimental (n = 27) and control (n = 26) groups. The experimental group received MDST on non-consecutive days, three days per week for six weeks alongside standard physiotherapy (SDPT), while the control group received only SDPT. The outcome variables were diaphragmatic mobility, pulmonary function and chest wall expansion. RESULTS: MDST significantly improved diaphragmatic mobility on both sides of the body, with a between-group difference of 0.97 cm (95% CI 0.55-1.39 cm, p < 0.001) for the right side and 0.82 cm (95% CI 0.35-1.29 cm, p = 0.001) for the left side. MDST significantly improved chest wall expansion at the xiphoid process and umbilical levels, with between-group differences of 0.57 cm (95% CI 0.12-1.20 cm, p = 0.013) and 0.87 cm (95% CI 0.31-1.43 cm, p = 0.003), respectively. There was no significant difference in pulmonary function testing between the groups. CONCLUSION: MDST could significantly improve diaphragmatic mobility, and lower and abdominal chest wall expansion, among children with CP. Therefore, MDST could be considered as an additional technique for physiotherapy programmes, to improve diaphragmatic function in spastic CP.

Diaphragmatic mobility in children with spastic cerebral palsy and differing motor performance levels.

The aim of this study was to compare diaphragmatic mobility (DM) and respiratory function between children with cerebral palsy (CP) and healthy controls (HC). CP was divided into non-ambulatory CP (NACP) and ambulatory CP (ACP). Eighteen children with NACP, 18 with ACP and 18 HC age between 8 and 18 years were recruited. Ultrasound was used to measure DM on both sides. Respiratory muscle strength (RMS), pulmonary function (PF) and chest expansion (CE) were also measured. The results showed that there was significantly lower right DM in CP than HC group. The NACP group had significantly lower DM than the ACP group. There were also significantly lower values of RMS, PF and CE in CP, compared to the HC group. There are significant impairments of diaphragmatic and respiratory function in CP, relative to HC. Thus, appropriate interventions to improve diaphragmatic muscle strength are necessary for children with CP, especially in the NACP.