Suppression of Myotonia in Cerebral Palsy and Adjuctive Effect of Low-Level Laser Therapy on Intensive Functional Training
Yoshimi Asagai, Yasutaka Watanabe, Toshio Ohshiro, Kengo Yamamoto
Shinano Handicapped Children’s Hospital, Shimosuwa, Nagano
Department of Orthopaedic Surgery, Tokyo Medical College, Shinjuku, Tokyo
Japan Medical Laser Laboratory, Shinanomachi, Tokyo Japan
Abstract
This study assesses successively the changes in gross movement by hospital treatment with intensive functional training for 1-2 months according to the objective assessment criteria, the gross motor function measure (GMFM), which is commonly accepted as the global standard. Intensive functional training was carried out on its own in institutions other than the principal author’s, or together with low reactive-level IR diode laser therapy (LLLT) in the Shinano Handicapped Children’s Hospital, and the efficacy of the two approaches was compared. The severity of the disease was classified according to the gross motor function classification system (GMFCS). When the development of motor function was compared separately by disease severity with the cross-sectional motor growth curve, in the cases of the GMFCS level III a significant improvement was observed in patients of up to around age 8 . A significant improvement was observed inpatients of up to around 8 years old, especially up to 3 years old, when compared with the cross-sectional motor growth curve even when the GMFCS level was IV. When compared with patients at other rehabilitation and training sites, where only functional training therapy was applied without LLLT, the efficacy of intensive functional training was clearly enhanced in combination with LLLT.
Low-Level Laser Therapy (LLLT) For Cerebral Palsy
Kazuaki Tsuchiya MD, Takashi Harada MD, Nobuyuki Ushigome MD, Ikuko Ohkuni MD, Toshio Ohshiro MD PhD, Yoshiro Musya MD, Kazuhiro Mizutani MD, Yu Maruyama MD, Toru Suguro MD
Rehabilitation Medicine and Orthopaedic Surgery Toho University, Tokyo
Japan Medical Laser laboratory, Shinanomachi, Tokyo, Japan
Departments of Orthopedic Surgery, Ohhashi Hospital and Plastic Surgery, Toho University, Tokyo Japan
Abstract
Spasticity in cerebral palsy (CP) patients is a critical factor preventing voluntary movement, and can also be associated with involuntary clonus. Low reactive-level laser therapy (LLLT) has been reported as having good overall efficacy in CP patients and also in controlling clonus. The present study was designed to evaluate LLLT in the clinical setting to attenuate spasticity in severely handicapped CP patients. We treated 20 CP patients with near infrared (830 nm) LLLT (16.2J/cm2/point, once/week over 10 weeks) as a clinical study at our university hospital and a hospital connected with our university. For spasticity of the hip adductor muscle, the obturator nerve was the target for LLLT, and the tibial nerve was irradiated in the case of triceps surae muscle spasticity. LLLT was indicated for the 10 sessions and the degree of attenuation of spasticity was assessed after the final session. Some degree of efficacy and treatment latency was seen in 14 (70%) of the 20 patients, 5 evaluated as excellent, 6 as very good and 3 as fair. Little or no change was seen in the remaining 6 patients, and in no patient did the symptoms worsen. We concluded that LLLT was an efficacious treatment option in the conservative treatment of CP patients, that it was easilyapplied, non-invasive and pain-free, and that it did not have any adverse side effects.
Application of Low Reactive-Level Laser Therapy (LLLT) in Patients with Cerebral Palsy of the Adult Tension Athetosis Type
Yoshimi Asagai, Ryuichi Ueno, Yukio Miura, Toshio Ohshiro MD PhD
Shinano Handicapped Children’s Hospital, Shimosuwa, Nagano
Department of Orthopaedic Surgery, Tokyo Medical College, Shinjuku, Tokyo
Japan Medical Laser Laboratory, Shinanomachi, Tokyo Japan
Abstract
In patients with cerebral palsy of the tension athetosis type, a number of symptoms may be observed, including not only the fairly constant involuntary athetotic movements but also myotonic disorders of the motor function of all four limbs and trunk, vocalization and motions associated with eating such as mastication and swallowing. Aggravation of involuntary movements and pain in the neck and back are also seen in many cases. Existing conservative treatment methodologies have proved to be more or less ineffective, and limitations in functional training in adults have made treatment extremely difficult. We first employed low reactive-level laser therapy (LLLT) in a case of spastic cerebral palsy in 1994 with good results. In the present study, we applied laser irradiation (830 nm. 60 mW continuous wave) to all myotonic sites around the face and neck region where myotonia was severe in 20 patients with cerebral palsy of the adult tension athetosis type for which there was no effective treatment for their neck and back pain. Improvement of myotonia was seen in 19 patients while improvement of pain in the neck and back was seen in all the 16 patients who had pain in these regions. Suppression of myotonia reduced tonic vocalization making words easily heard; moreover, suppression of myotonia and involuntary movements improved working efficiency enabling the patient to perform fairly complex tasks such as word processing. Insomnia and dysuria also improved. Even in the most severe cases, assisting the patient became easier and breathing improved. LLLT with the 830 nm diode laser provides a new and effective treatment modality in this extremely problematic condition, has no serious side effects, and has the potential to improve these patients’ quality of life.