Efficacy of Different Types of Mulligan Techniques in Management of Children with Spastic Diplegia with Crouch Gait

Shivangi Trivedi; Snehal Deshpande; Deepak Kumar

doi:doi:10.11648/j.ijnpt.20170301.11

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Efficacy of Different Types of Mulligan Techniques in Management of Children with Spastic Diplegia with Crouch Gait

Shivangi Trivedi, Snehal Deshpande, Deepak Kumar

Published in International Journal of Neurologic Physical Therapy (Volume 3, Issue 1)

Received: 7 January 2017 Accepted: 18 January 2017 Published: 6 March 2017

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Abstract

Mulligan techniques focus on improving the movement, range of motion and reducing pain on movement in adults. The technique is not inadequately studied in children with cerebral palsy. Three Mulligan techniques i.e. adductor elongation, bent leg raise and rectus elongation was applied in children with diplegic spastic cerebral palsy with crouch gait. Four children with diplegic spastic cerebral palsy with crouch gait participated in a prospective study carried out at SNEH RERC over a period of 12 weeks. Adductor elongation, bent leg raise and rectus elongation treatment was given to each child for an average of 1 hour-3 times a week based on the Mulligan techniques. The primary outcome measures included Thomas Test and Duncan Ely Test (hip flexor angle), adductor spread and Tardieu's scale for hamstrings to measure Popliteal angle and secondary outcome measures included Gross Motor Functional Classification Scale (GMFCS), Silfverskiold test, Ashworth's test for iliopsoas, hamstrings, tendo-achilles and selective motor control for hip, knee and ankle respectively. After the completion of 12 weeks, an application of the three Mulligan techniques showed highly significant changes in the range of hip, knee and ankle as seen using the above outcome measures. Mulligan techniques such as adductor elongation, bent leg raise and rectus elongation may significantly improve mobility of the joint and extensibility of the muscle tissue in children with diplegic spastic cerebral palsy with crouch gait. Further research is warranted in this area.

Published in	International Journal of Neurologic Physical Therapy (Volume 3, Issue 1)
DOI	10.11648/j.ijnpt.20170301.11
Page(s)	1-4
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2017. Published by Science Publishing Group

Keywords

Mulligan Techniques, Crouch Gait, Spastic Diplegia, Cerebral Palsy, Adductor Elongation, Bent Leg Raise, Rectus Elongation

References

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[3]	Bell K, Ounpuu S, DeLuca P, Romness M. Natural Progression of Gait in Children with Cerebral Palsy. Journal of Paediatric Orthopaedics. 2002; (27): 677-682.
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[10]	Lee S, Sung K, Chung C et al. Reliability and validity of the Duncan-Ely test for assessing rectus femoris spasticity in patients with cerebral palsy. Developmental Medicine & Child Neurology. 2015; 57 (10): 963-968. doi:10.1111/dmcn.12761.
[11]	Faber I, Nienhuis B, Rijs N, Geurts A, Duysens J. Is the modified Tardieu scale in semi-standing position better associated with knee extension and hamstring activity in terminal swing than the supine Tardieu?. Developmental Medicine & Child Neurology. 2008; 50 (5): 382-387. doi:10.1111/j.1469-8749.2008.02056.x.
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[13]	Mutlu A, Livanelioglu A, Gunel M. Reliability of Ashworth and Modified Ashworth Scales in Children with Spastic Cerebral Palsy. BMC Musculoskeletal Disorders. 2008; 9 (1). doi:10.1186/1471-2474-9-44.
[14]	Smits D, van Groenestijn A, Becher P J et al. Clinical Assessment Of Selective Motor Control In Children Aged 5-7 Years With Cerebral Palsy. 1st ed. Netherlands: Perrin NL; 2016. Available at: http://perrin.nl/oudesite/pdf/Poster_DWSmits_CP0-5_EACD07.pdf. Accessed December 29, 2016.
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[16]	Gerard A. Malanga, Scott Nadler. Thomas test: Musculoskeletal Physical Examination: An Evidence based Approach. p 257.
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APA Style

Shivangi Trivedi, Snehal Deshpande, Deepak Kumar. (2017). Efficacy of Different Types of Mulligan Techniques in Management of Children with Spastic Diplegia with Crouch Gait. International Journal of Neurologic Physical Therapy, 3(1), 1-4. https://doi.org/10.11648/j.ijnpt.20170301.11

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ACS Style

Shivangi Trivedi; Snehal Deshpande; Deepak Kumar. Efficacy of Different Types of Mulligan Techniques in Management of Children with Spastic Diplegia with Crouch Gait. Int. J. Neurol. Phys. Ther. 2017, 3(1), 1-4. doi: 10.11648/j.ijnpt.20170301.11

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AMA Style

Shivangi Trivedi, Snehal Deshpande, Deepak Kumar. Efficacy of Different Types of Mulligan Techniques in Management of Children with Spastic Diplegia with Crouch Gait. Int J Neurol Phys Ther. 2017;3(1):1-4. doi: 10.11648/j.ijnpt.20170301.11

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@article{10.11648/j.ijnpt.20170301.11,
  author = {Shivangi Trivedi and Snehal Deshpande and Deepak Kumar},
  title = {Efficacy of Different Types of Mulligan Techniques in Management of Children with Spastic Diplegia with Crouch Gait},
  journal = {International Journal of Neurologic Physical Therapy},
  volume = {3},
  number = {1},
  pages = {1-4},
  doi = {10.11648/j.ijnpt.20170301.11},
  url = {https://doi.org/10.11648/j.ijnpt.20170301.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijnpt.20170301.11},
  abstract = {Mulligan techniques focus on improving the movement, range of motion and reducing pain on movement in adults. The technique is not inadequately studied in children with cerebral palsy. Three Mulligan techniques i.e. adductor elongation, bent leg raise and rectus elongation was applied in children with diplegic spastic cerebral palsy with crouch gait. Four children with diplegic spastic cerebral palsy with crouch gait participated in a prospective study carried out at SNEH RERC over a period of 12 weeks. Adductor elongation, bent leg raise and rectus elongation treatment was given to each child for an average of 1 hour-3 times a week based on the Mulligan techniques. The primary outcome measures included Thomas Test and Duncan Ely Test (hip flexor angle), adductor spread and Tardieu's scale for hamstrings to measure Popliteal angle and secondary outcome measures included Gross Motor Functional Classification Scale (GMFCS), Silfverskiold test, Ashworth's test for iliopsoas, hamstrings, tendo-achilles and selective motor control for hip, knee and ankle respectively. After the completion of 12 weeks, an application of the three Mulligan techniques showed highly significant changes in the range of hip, knee and ankle as seen using the above outcome measures. Mulligan techniques such as adductor elongation, bent leg raise and rectus elongation may significantly improve mobility of the joint and extensibility of the muscle tissue in children with diplegic spastic cerebral palsy with crouch gait. Further research is warranted in this area.},
 year = {2017}
}

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TY  - JOUR
T1  - Efficacy of Different Types of Mulligan Techniques in Management of Children with Spastic Diplegia with Crouch Gait
AU  - Shivangi Trivedi
AU  - Snehal Deshpande
AU  - Deepak Kumar
Y1  - 2017/03/06
PY  - 2017
N1  - https://doi.org/10.11648/j.ijnpt.20170301.11
DO  - 10.11648/j.ijnpt.20170301.11
T2  - International Journal of Neurologic Physical Therapy
JF  - International Journal of Neurologic Physical Therapy
JO  - International Journal of Neurologic Physical Therapy
SP  - 1
EP  - 4
PB  - Science Publishing Group
SN  - 2575-1778
UR  - https://doi.org/10.11648/j.ijnpt.20170301.11
AB  - Mulligan techniques focus on improving the movement, range of motion and reducing pain on movement in adults. The technique is not inadequately studied in children with cerebral palsy. Three Mulligan techniques i.e. adductor elongation, bent leg raise and rectus elongation was applied in children with diplegic spastic cerebral palsy with crouch gait. Four children with diplegic spastic cerebral palsy with crouch gait participated in a prospective study carried out at SNEH RERC over a period of 12 weeks. Adductor elongation, bent leg raise and rectus elongation treatment was given to each child for an average of 1 hour-3 times a week based on the Mulligan techniques. The primary outcome measures included Thomas Test and Duncan Ely Test (hip flexor angle), adductor spread and Tardieu's scale for hamstrings to measure Popliteal angle and secondary outcome measures included Gross Motor Functional Classification Scale (GMFCS), Silfverskiold test, Ashworth's test for iliopsoas, hamstrings, tendo-achilles and selective motor control for hip, knee and ankle respectively. After the completion of 12 weeks, an application of the three Mulligan techniques showed highly significant changes in the range of hip, knee and ankle as seen using the above outcome measures. Mulligan techniques such as adductor elongation, bent leg raise and rectus elongation may significantly improve mobility of the joint and extensibility of the muscle tissue in children with diplegic spastic cerebral palsy with crouch gait. Further research is warranted in this area.
VL  - 3
IS  - 1
ER  -

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Author Information

Shivangi Trivedi

SNEH RERC (Rehabilitation, Educational and Research Centre), Mumbai, India
Snehal Deshpande

SNEH RERC (Rehabilitation, Educational and Research Centre), Mumbai, India
Deepak Kumar

Capri Institute of Manual Therapy, New Delhi, India

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APA Style

Shivangi Trivedi, Snehal Deshpande, Deepak Kumar. (2017). Efficacy of Different Types of Mulligan Techniques in Management of Children with Spastic Diplegia with Crouch Gait. International Journal of Neurologic Physical Therapy, 3(1), 1-4. https://doi.org/10.11648/j.ijnpt.20170301.11

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ACS Style

Shivangi Trivedi; Snehal Deshpande; Deepak Kumar. Efficacy of Different Types of Mulligan Techniques in Management of Children with Spastic Diplegia with Crouch Gait. Int. J. Neurol. Phys. Ther. 2017, 3(1), 1-4. doi: 10.11648/j.ijnpt.20170301.11

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AMA Style

Shivangi Trivedi, Snehal Deshpande, Deepak Kumar. Efficacy of Different Types of Mulligan Techniques in Management of Children with Spastic Diplegia with Crouch Gait. Int J Neurol Phys Ther. 2017;3(1):1-4. doi: 10.11648/j.ijnpt.20170301.11

Copy | Download

@article{10.11648/j.ijnpt.20170301.11,
  author = {Shivangi Trivedi and Snehal Deshpande and Deepak Kumar},
  title = {Efficacy of Different Types of Mulligan Techniques in Management of Children with Spastic Diplegia with Crouch Gait},
  journal = {International Journal of Neurologic Physical Therapy},
  volume = {3},
  number = {1},
  pages = {1-4},
  doi = {10.11648/j.ijnpt.20170301.11},
  url = {https://doi.org/10.11648/j.ijnpt.20170301.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijnpt.20170301.11},
  abstract = {Mulligan techniques focus on improving the movement, range of motion and reducing pain on movement in adults. The technique is not inadequately studied in children with cerebral palsy. Three Mulligan techniques i.e. adductor elongation, bent leg raise and rectus elongation was applied in children with diplegic spastic cerebral palsy with crouch gait. Four children with diplegic spastic cerebral palsy with crouch gait participated in a prospective study carried out at SNEH RERC over a period of 12 weeks. Adductor elongation, bent leg raise and rectus elongation treatment was given to each child for an average of 1 hour-3 times a week based on the Mulligan techniques. The primary outcome measures included Thomas Test and Duncan Ely Test (hip flexor angle), adductor spread and Tardieu's scale for hamstrings to measure Popliteal angle and secondary outcome measures included Gross Motor Functional Classification Scale (GMFCS), Silfverskiold test, Ashworth's test for iliopsoas, hamstrings, tendo-achilles and selective motor control for hip, knee and ankle respectively. After the completion of 12 weeks, an application of the three Mulligan techniques showed highly significant changes in the range of hip, knee and ankle as seen using the above outcome measures. Mulligan techniques such as adductor elongation, bent leg raise and rectus elongation may significantly improve mobility of the joint and extensibility of the muscle tissue in children with diplegic spastic cerebral palsy with crouch gait. Further research is warranted in this area.},
 year = {2017}
}

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TY  - JOUR
T1  - Efficacy of Different Types of Mulligan Techniques in Management of Children with Spastic Diplegia with Crouch Gait
AU  - Shivangi Trivedi
AU  - Snehal Deshpande
AU  - Deepak Kumar
Y1  - 2017/03/06
PY  - 2017
N1  - https://doi.org/10.11648/j.ijnpt.20170301.11
DO  - 10.11648/j.ijnpt.20170301.11
T2  - International Journal of Neurologic Physical Therapy
JF  - International Journal of Neurologic Physical Therapy
JO  - International Journal of Neurologic Physical Therapy
SP  - 1
EP  - 4
PB  - Science Publishing Group
SN  - 2575-1778
UR  - https://doi.org/10.11648/j.ijnpt.20170301.11
AB  - Mulligan techniques focus on improving the movement, range of motion and reducing pain on movement in adults. The technique is not inadequately studied in children with cerebral palsy. Three Mulligan techniques i.e. adductor elongation, bent leg raise and rectus elongation was applied in children with diplegic spastic cerebral palsy with crouch gait. Four children with diplegic spastic cerebral palsy with crouch gait participated in a prospective study carried out at SNEH RERC over a period of 12 weeks. Adductor elongation, bent leg raise and rectus elongation treatment was given to each child for an average of 1 hour-3 times a week based on the Mulligan techniques. The primary outcome measures included Thomas Test and Duncan Ely Test (hip flexor angle), adductor spread and Tardieu's scale for hamstrings to measure Popliteal angle and secondary outcome measures included Gross Motor Functional Classification Scale (GMFCS), Silfverskiold test, Ashworth's test for iliopsoas, hamstrings, tendo-achilles and selective motor control for hip, knee and ankle respectively. After the completion of 12 weeks, an application of the three Mulligan techniques showed highly significant changes in the range of hip, knee and ankle as seen using the above outcome measures. Mulligan techniques such as adductor elongation, bent leg raise and rectus elongation may significantly improve mobility of the joint and extensibility of the muscle tissue in children with diplegic spastic cerebral palsy with crouch gait. Further research is warranted in this area.
VL  - 3
IS  - 1
ER  -

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