SPASTIC CEREBRAL PALSY (CP)

Description of the situation

• A 15-year-old adolescent with a diagnosis of spastic quadriplegic cerebral palsy, gastrostoma and developmental delay.
• According to the medical opinion of the Vaivari rehabilitation centre in June 2023, the adolescent has GMFCS: V FL and a variable muscle tone with a tendency to markedly increased muscle tone according to the Ashworth scale (4/5). According to the ICD-10 classification, diganosis G 80.0.
• She cannot grasp musical instruments on her own, requires full assistance, and manages with guided movements. The music therapy (MT) part uses sensory stimulation with instruments, passive movement of the joints with guided movements. With guided movements, passively holding bells and maracas, partially makes hand-arm contact. The father lifts the teenager out of the wheelchair and places him on the Vibroacoustic Therapy (VAT) mattress. I observe deformities of the legs and hips while the girl is asleep. The arms are raised upwards, the wrists are clasped. Movement and flexion of the knees is a task for the next part of the VAT.
• During the therapy it is observed that the left side is more flexed than the right. This is in line with the parents' observation and recommendation to start with the left side, because if you start with the right side, the left side shows more spasticity. The left knee, before VAT treatment, has an average flexion angle of 80 degrees as measured by a goniometer, and the right knee has a flexion angle of 100 degrees.

Goal

• To improve the performance of the large motor muscle groups and to relax the muscles.
• Based on the findings of other researchers, it was hypothesised that short-term VAT therapy can influence and improve large motor muscle group performance and relaxation in an adolescent with spastic cerebral palsy. VAT are selected in a 40 Hz program.
• Several researchers have investigated the effects of 20 minutes of VA with stimulation (40 Hz) on spasticity and motor performance in children with cerebral palsy. The results showed a significant improvement in body rotation, including holding the body and head in an upright position, and in various movements (Katušić, Mejaški-Bošnjak, 2011).
• To describe the effects and suitability of short-term vibroacoustic therapy (VAT) and active music therapy (MT) on the performance and relaxation of large motor muscle groups.

• Between November and December 2023, attended 10 vibroacoustic therapy sessions at the "Sound and Music" therapy centre. The therapeutic process uses a Multivib mattress and a pillow with built-in vibration speakers.
• Blood pressure was measured at the beginning and at the end of each session and goniometer measurements were taken to record the dynamics of the VAT process, supplemented by the therapist's observations at intervals.
• During the therapy, the methods initially chosen changed, as patients with CP require different measurements. I had to give up counting pulses during instrument play, as I cannot claim that this is done deliberately. I had to abandon the use of the pulse oximeter due to increased muscle tone.

Results

• Although the change is small, the graph shows the improvement. After VAT treatment, the goniometer measurements show 115 degrees of flexion in the left knee joint and 130 degrees of flexion in the right knee joint. The spasticity had decreased after the VAT treatment programme. It should be mentioned that the wrist and elbow joints were generally much looser than the legs, which is due to the fact that the legs are large muscle groups and require more action.
• In line with the goals of the therapy - improving the performance of the large motor muscle groups and relaxing the muscles, I observed that the girl expresses joy by smiling, making eye contact when the therapist hums a melody, manages to relax the wrist and fingers by sensomotor stimulation with the cabasa.
• It was possible to stimulate the performance of the large motor muscle groups with bells, and to improve the grip performance with drums and a large chicken.
• It was successful to stimulate the wrist (art. radiocarpea) shortened muscle group stretching by passively playing maracas, passively to promote rotational movement with bells.
• With passive, guided, assisting actions, it was partially possible to stimulate wrist positioning with a large shaker and balls.
• At the end of the sessions, the goodbye manages to lift the head off the pillow.

• The results of the case study allow us to conclude that music and vibroacoustic therapy can increase the performance of large motor muscle groups and promote muscle relaxation in an adolescent with spastic cerebral palsy. A case-control analysis does not provide an answer on the long-term durability of the results. This points to a further perspective in a multidisciplinary team. In drawing conclusions, it should be taken into account that the adolescent was already attending music therapy before the vibroacoustic therapy sessions, and the parents were motivated to bring the girl to the therapy. Thus, the results of the case study can be seen as a trend and it would therefore be necessary to continue the therapy in order to assess persistence.
• The VAT method in combination with active music therapy is a good way to promote, maintain and preserve joint range of motion in CP patients, maintain overall functional status, reduce spasticity to the extent possible, and slightly increase joint range of motion.