Macgregor Russell, Campbell Ross, Gladden Margaret H, Tennant Nicola, Young David
Institute of Biomedical and Life Sciences, University of Glasgow, Glasgow, UK.
Dev Med Child Neurol. 2007 Mar;49(3):187-91. doi: 10.1111/j.1469-8749.2007.00187.x.
Calf muscles of five adolescents aged 12 to 15 years (three males, two females) with spastic diplegia were massaged for 14 minutes twice a week for 5 weeks in a controlled sequence, stretching the muscles transversely rather than longitudinally, without eliciting pain. Slow, passive test stretches were applied before and after massage. After massage, the range of movement was not consistently increased but, on average, greater force was needed to stretch the muscle than before massage. However, after massage the resting ankle angle sometimes changed so that the calf muscles were either shorter or longer. We suggest that these phenomena could be explained if massage resets sarcomere lengths which corrects for thixotropic effects (i.e. previous use modifies a muscle's mechanical behaviour). A redistribution on sarcomere lengths within muscles could also have reset proprioceptive feedback. The incidence of abnormal stretch reflexes during test stretches fell from 40 to 22%, comparing the first five sessions with the last five sessions. The amplitude of voluntary alternating ankle rotation increased in three participants. Motor skills were assessed with the Gross Motor Function Measure-66 (GMFM-66) 1 week before the test period, during the 5th week, and 12 weeks later. Our participants in Gross Motor Function Classification System (GMFCS) Levels I and II made sustained improvements in GMFM-66 scores (6.4% at 5 weeks falling to 5.5% at 17 weeks), one increase being significant. One participant in GMFCS Level III improved significantly only after massage of all leg muscles for 30 weeks.
对5名年龄在12至15岁之间（3名男性，2名女性）患有痉挛性双侧瘫的青少年的小腿肌肉进行按摩，每周两次，每次14分钟，共进行5周，按摩按特定顺序进行，横向而非纵向拉伸肌肉，且不引起疼痛。在按摩前后进行缓慢的被动测试拉伸。按摩后，活动范围并非持续增加，但平均而言，拉伸肌肉需要比按摩前更大的力量。然而，按摩后静息踝关节角度有时会发生变化，导致小腿肌肉要么变短要么变长。我们认为，如果按摩重置肌节长度以纠正触变效应（即先前的使用会改变肌肉的力学行为），这些现象就可以得到解释。肌肉内肌节长度的重新分布也可能重置了本体感觉反馈。将前五次测试与后五次测试相比，测试拉伸期间异常拉伸反射的发生率从40%降至22%。三名参与者的自愿交替踝关节旋转幅度增加。在测试期前1周、第5周和12周后，使用粗大运动功能测量量表66（GMFM - 66）评估运动技能。我们的粗大运动功能分类系统（GMFCS）I级和II级参与者的GMFM - 66分数持续改善（5周时提高6.4%，17周时降至5.5%），其中一次提高具有显著性。一名GMFCS III级参与者仅在对所有腿部肌肉进行30周按摩后有显著改善。
