Effects of Biomechanical Regulators on Standing: Postural Capacity/Capability in the Transverse and Coronal Planes
Author: Scooter LeBleu
Abstract: The patient is an eight year old female with quadriplegic hypertonicity\ synergic pattern since birth. From 1993-1997, she received physical therapy based on an NDT (Neurodevelopmental Technique)/functional approach, which allowed assisted ambulation with a walker. Since 1997, treatment has been comprised of techniques developed by Integrative Manual Practitioners.1 With Integrative Manual Therapy, the patient has progressed from assisted to independent ambulation. (She also wears in-shoe orthotics.) This case study documents postural and other changes after a one hour session of Integrative Manual Therapy treatment.
Key Words: Biomechanical Regulators, pediatric, quadriplegia
History
The patient is an eight year old female with quadriplegic hypertonicity/synergic pattern since birth. From 1993-1997, she received physical therapy based on an NDT (Neurodevelopmental Technique)\functional approach, which allowed assisted ambulation with a walker. Since 1997, treatment has been comprised of techniques developed by Integrative Manual Practitioners.1 With Integrative Manual Therapy, the patient has progressed from assisted to independent ambulation. (She also wears in-shoe orthotics.) This case study documents postural and other changes after a one hour session of Integrative Manual Therapy treatment.
Treatment Goals and Techniques
The goals included:
1. improved biomechanics, range of motion, and function at all joints
2. increased balance, coordination, control in standing, gait, and all functional activities\ play through elimination of synergic patterns, hypertonicity, and associated reactions throughout the body.
Treatment techniques were bilateral. Integrative Manual Therapy techniques utilized included biomechanical regulators, especially #4 superior glide of fibula, #38 transmission of arch of foot through the leg, #37 cruciate ligaments of knee for internal\ external rotation of tibia, #32 anterior\ posterior glide of femur in acetabulum, and #30 external\internal rotation of femur. 2
In addition, the parents were given a home program consisting of neurofascial process to the body areas treated. 3
Results
Pre- and post-treatment photographs are included as a postural assessment tool and reference. The first photo was taken prior to a one hour treatment session and the second photo was taken immediately following treatment. Post-treatment, note the following improvements in the sagittal plane:
1. heel contact with the floor
2. tibia no longer posterior but parallel to sagittal plane and perpendicular to the foot
3. increased hip\knee\trunk extension
4. head and trunk less forward
5. decreased associated reactions throughout the body
In the transverse and coronal planes, note the following improvements:
1. decreased femoral adduction bilateral-coronal
2 .decreased rear foot varus bilateral-coronal
3. decreased forefoot varus bilateral-coronal
4. decreased pelvic rotation-transverse
5. decreased internal rotation of hips bilateral-transverse
6. decreased internal rotation of tibia bilateral-transverse
7. decreased rotation of trunk-transverse
8. decreased associated reactions throughout the body
Conclusion
Integrative Manual Therapy facilitated observable structural and functional changes for the patient within this one hour session.
References