No matter how hard you try, you cannot pull apart creativity and innovation from the field of physical therapy. While it may not be immediately apparent, creativity and innovation are essential components of the field. Physiotherapists are often required to come up with unique and individualized treatment plans that take into account the specific needs and challenges of each patient. This requires a great deal of creativity and innovation, as well as the ability to think outside the box and adapt to new situations as they arise.
It is our job to introduce you and therapists around the world to new and improved, evidence-based, innovations in physiotherapy. Here we are with another unique strategy that may improve patient prognosis, this time for those suffering from Cerebral Palsy.
Cerebral palsy (CP) is defined as a group of permanent disorders in the development of movements and postures, provoking limitations on activity, attributed to non-progressive disturbances that occurred in the development of the foetal or infant brain. Motor disorders of cerebral palsy are often accompanied by alterations to sensation, perception, cognition, communication, and behaviour due to epilepsy and secondary musculoskeletal problems. According to Graham et al, CP affects approximately 1 out of 500 newborns, with an estimated prevalence of 17 million people worldwide, which establishes it as the most common motor disability during childhood.
People with CP can be very bright, but because it is visible, and the way they walk is different, people think they can’t do some things on their own
- Dr. Gary Edwards
Physical therapy plays a key role in its treatment through several therapeutic interventions that achieve improved physiological and functional outcomes. Based on recent evidence, current goal-oriented functional approaches are considered effective, although more research is needed to determine the best ways to achieve even more improved functional outcomes in children with CP. Physiotherapy sessions for managing cerebral palsy are often up to 6 or 7 hours long, where the therapist solely concentrates on motor function and goal-oriented activities. According to Hasanah and Nasuruddin et al, Music therapy might be a new avenue that, in combination with PT, would help to improve motor function in patients with CP.
Jackson et al state that – Music therapy is a paramedical specialization based scientifically on clinical–therapeutic methods and establishes a working methodology and a series of techniques with the objective of promoting positive cognitive, physical, mental, and social changes in individuals with health or behaviour disorders.
Through the use of rhythmic, harmonic, and melodic sounds by means of improvisations, musical compositions, reproduction of sounds, and other techniques, an improvement in communication, expression, organization, learning, and mobilization is achieved by also obtaining a rehabilitative effect.
Our children may never be ‘normal’ in the world’s eyes but they can be better than normal — they can be extraordinary. I’m not going to lie to you, there will be times when you get discouraged and afraid for the future but don’t ever give up!
- David Juliano,
father of a child with cerebral palsy
Music therapy has been proven to be a powerful tool in treating a wide range of conditions, from cancer to burns, as well as cognitive deterioration. This incredible therapy can impact a range of factors, including breathing, blood flow, heart rate, blood pressure, metabolism, and oxygenation. But that’s not all – MT can also have a significant impact on emotional well-being, helping to alleviate feelings of anguish, anxiety, tension, stress, and fear. With such a diverse range of benefits, it’s no surprise that MT has also been explored as a potential treatment for individuals with cerebral palsy, with researchers examining its effects on muscle tone.
Bean and Oldfield (2001) performed a series of exercises for the development of specific movements in children with CP, creating musical activities for the development of functional skills. This active work was also used by Lasse Hjelm, the author of the functionally oriented music therapy method, who commented that Music therapy focused on human body functions is often indicated in motor impairments and is highly applicable in people with CP.
When it comes to functional capacity, music and education can have a significant impact, as demonstrated by Richardson, who adapted Zoltán Kodály’s methodology to help children with disabilities. Concrete techniques, such as manual signal tests and an adaptation of Orff Schulwerk’s methodology, were used to aid the development of motor skills. Similarly, the Suzuki method has shown promising results in this area. In addition, music has been used to motivate patients during physiotherapy sessions with great success.
As a person with cerebral palsy who walks with crutches, people have the assumption that I’ve had to overcome a lot of obstacles in my life because of it, and to some degree, I have. However, the most difficult obstacle to overcome is other people’s perception of who a person with a disability is.
- Greg Walloch
In the early 1990s, music therapists and physiotherapists began collaborating clinically, which led to the development of neurological music therapy (NMT). NMT is an evidence-based system of clinical interventions that can retrain the sensory-motor area, speech and language, and cognitive functions that may be impaired following a neurological injury. Furthermore, it can promote neuroplasticity through therapeutic instrumental music performance, aiding motor control learning.
Other music therapy techniques have also been used with positive results, such as patterned sensory enhancement, which translates movement components into sound patterns to provide temporal, spatial, and force cues for improved execution. Rhythmic auditory stimulation is another technique that uses rhythmic sensory stimuli to improve motor control during rehabilitation. With the growing body of evidence supporting the effectiveness of music therapy techniques, it’s an exciting time for the field and the potential to revolutionize healthcare is promising.
People with CP have affected gross motor function and manual function but may be able to integrate rhythm and movement and use musical instruments in their therapy, taking advantage of all the benefits of this technique for neuroplasticity and motor control.
Based on the results obtained in a review and meta-analysis conducted by Maria Jesus et al, physiotherapy in combination with music therapy can be effective in subjects with cerebral palsy to improve motor function in a general way, allowing them to perform voluntary movements more easily. This multivariate intervention improved stride length, velocity, symmetry, cadence, step length, knee extension power, balance, upper limb position, and locomotor stages. However, it was not effective on walking velocity. Although, due to the diversity of studies analysed and the number of articles included in this study, no firm conclusions can be drawn.
In general, a positive impact of physiotherapy and music therapy on cerebral palsy is expected, but future clinical trials are needed that use larger sample sizes and present greater homogeneity in terms of the types of CP, devices used, and intervention protocols of MT and PT, as well as unify criteria in terms of how to measure motor function.
It would be relevant to combine both therapies in the treatment of CP. However, we need more standard interpretation models to measure functionality and additional standardized data to validate the existing literature and thus be capable of achieving a treatment protocol. This will allow us to achieve an optimal therapeutic treatment.
To conclude, cerebral palsy is a condition that constantly challenges patients suffering form it and physios alike, for formulating effective treatment protocols. We need to be open to any innovative or out of the box thinking when we deal with conditions such CP. Music therapy seems to have the right tools which traditional methods do not have, and as may actually be the missing key to therapy.