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Saturday, May 25, 2013
Frequency of passive range of motion
What frequency of passive range of motion (to extremities) is recommended for children who have no active range of motion? What evidence is this based on?
A child with Aicardia syndrome has fluxuating hypertonicity and hypotonicity. She has no volitional active range of motion. She has between 3-20 seizures daily. She has difficulty with any position other than supine (with slight elevation of her head).
Dr. Jilda Vargus Adams, pediatric physiatrist, provides the following answer: "There is no specific evidence to guide us in terms of physical therapy in Aicardi syndrome. If your goal is to maintain your child`s range of motion, I believe stretching is a good idea. Limited data are available on the use of stretching for range of motion in healthy adults, and even less on stretching in children with cerebral palsy. The available studies would suggest that, if your daughter does not have a great deal of spasticity, daily stretches that last 30 seconds per muscle group stretched would be sufficient. If she has significant spasticity/hypertonicity it is possible that a greater duration or frequency of stretching would be beneficial. It may be worth considering the cost/benefit analysis of frequent stretching vs tolerating some loss of range of motion. If passive stretches are difficult for her, you may choose to accept some loss of range as long as your daughter has adequate range of motion to be comfortably positioned and does not have contractures that interfere with her care. These are decisions you should discuss with her therapists and physicians. Good luck."
Stephen J Page, PhD
Director of Research, Associate Professor
University of Cincinnati