Tarsuslu Tülay, Bol Hüseyin, Simşek Ibrahim Engin, Toylan Imran Erkanat, Cam Sabahat
University of Abant Izzet Baysal, KD School of Physical Therapy and Rehabilitation, Bolu, Turkey.
J Manipulative Physiol Ther. 2009 Oct;32(8):648-53. doi: 10.1016/j.jmpt.2009.08.016.
This pilot study was designed to investigate the effectiveness of osteopathic treatment in children with cerebral palsy and chronic constipation.
This study included 13 children with cerebral palsy diagnosed as having chronic constipation by a gastroenterologist. The subjects were separated into 2 groups. Group 1 was treated with osteopathic methods and group 2 underwent both medical and exactly the same osteopathic treatments of group 1. Osteopathic treatments included fascial release, iliopsoas muscle release, sphincter release, and bowel mobilizations. Gross Motor Functional Classification System, Functional Independence Measure for Children, and Modified Ashworth Scale were used to determine the level of disability, functional independence, and muscle tonus, respectively. In addition, Constipation Assessment Scale was administered to the subjects to determine the severity of constipation. The satisfaction from the treatment was measured using a Visual Analogue Scale at 3 and 6 months.
Most of the children included in this study were determined as level IV or V according to Gross Motor Functional Classification System. The satisfaction of the subjects or the families with the treatments was not different when the groups were compared (P > .05). Constipation Assessment Scale scores decreased significantly in both groups (P < .05). Pretreatment (initial evaluation) and posttreatment (follow-ups at 3 and 6 months) results revealed no difference between the groups in either aspects (P > .05). However, both groups showed significant improvements compared with baseline evaluations (P < .05).
Osteopathic methods were as effective as osteopathic methods in addition to medical care for both treatment groups. The results of this study suggest that osteopathic methods may be helpful as an alternative treatment in constipation. Additional advanced studies should be conducted.
本初步研究旨在调查整骨疗法对脑瘫合并慢性便秘儿童的疗效。
本研究纳入了13名经胃肠病学家诊断为慢性便秘的脑瘫儿童。受试者被分为两组。第1组接受整骨疗法，第2组除接受与第1组完全相同的整骨疗法外，还接受药物治疗。整骨疗法包括筋膜松解、髂腰肌松解、括约肌松解和肠道松动术。分别使用粗大运动功能分类系统、儿童功能独立性测量和改良Ashworth量表来确定残疾程度、功能独立性和肌肉张力。此外，对受试者进行便秘评估量表测试以确定便秘的严重程度。在3个月和6个月时使用视觉模拟量表测量对治疗的满意度。
根据粗大运动功能分类系统，本研究中的大多数儿童被确定为IV级或V级。比较两组时，受试者或其家庭对治疗的满意度没有差异（P>0.05）。两组的便秘评估量表评分均显著降低（P<0.05）。治疗前（初始评估）和治疗后（3个月和6个月随访）结果显示，两组在任何方面均无差异（P>0.05）。然而，与基线评估相比，两组均显示出显著改善（P<0.05）。
对于两个治疗组，整骨疗法与整骨疗法加药物治疗一样有效。本研究结果表明，整骨疗法可能作为便秘的替代治疗方法有帮助。应进行更多的深入研究。
