MOJ Orthopedics & Rheumatology

Deep Flexor Exercise to Improve Physical Performance for People with Cerebral Palsy

Introduction Mini Review posture that develops from non-progressive lesions that can be Volume 7 Issue 4 - 2017 causedCerebral by injury palsy to is the defined developing as a disorderfetus and of infant’s movement brain; and it is not a disease, so its clinical features are similar to a common Yong-Gu Han* and Chang-Kyo Yun syndrome [1]. The immature brain’s development triggers Department of Physical Therapy, Daegu University constraints on their activities, and permanent obstacles to Rehabilitation Clinic, Republic of Korea attitude development and movement. In addition, palsy *Corresponding author: Chang Kyo Yun, Department of at the injured site can create problems with sensation, language, Physical Therapy, Daegu University Rehabilitation Clinic, cognition, behavior, musculoskeletal system disturbances in 70 Myeongdeok-ro 8-gil, Nam-gu, Daegu, Republic of Korea, the coordination between different muscles, and sensory organ Email: coordination [2]. Thus, sufferers often lack the ability to maintain Received: February 17, 2017 | Published: February 27, 2017 postureIn the through normal normal development movement process, [3,4]. the baby can pull their chin and head up, in a lying posture at six months of age. This control have developed [5]. However, children with cerebral palsy this induces excessive neck extension, which reduces its stability whosignified have thatnot anti-gravityexperienced flexornormal muscles development that regulateshow a headpoor [12]. Therefore, the longus colli and longus capitis muscles acting ability to control their head, and head control is essential during as antagonists of the neck extensor muscles are emphasized the young children’s development, in this way, it will not permit [8]. These muscles perform a similar dynamic function, provide effective posture adjustment, and children cannot perform normal vertical stability for the neck, and serve to support the anterior movements in all postures [6]. Moreover, excessive extension posture in the neck and stooped trunk posture shortens sufferers’ posterior neck muscles, sustained posture creates weakness in cooperateof the base effectively of the neck to andgenerate support strong and musclefix each contraction joint [13,14]. force In toparticular, support the weight deep cervical of the head flexion while muscles maintaining are lower the thancorrect to space, the arms are too heavy for movement, and the hands and posture of the neck and moving the head. They play a role in eyesthe posterior move separately neck muscles, [6]. Therefore, it is difficult maintaining to keep thebalance head inand a endurance and stability [15]. Recently, the activation of the supporting and fixing the neck by providing strong static muscle Head regulation intervention is indispensable for improving posture is very difficult for children with cerebral palsy [7]. on the improvement of the abdominal muscle thickness, dynamic posture control with cerebral palsy, and the role of the deep neck andcervical static flexor balance muscles ability, have and been Proprioceptive proven to have function a positive of children effect with cerebral palsy [16]. showsflexor musclesa relatively to large maintain amount posture of muscle control spindle and neck distributions stability Balance comparedhave been withemphasized other muscles, recently and [8]. can The require deep high neck Proprioceptive flexor muscle function [9]. Proprioceptive sensation plays an important role in Posture control gains stabilization with the ability to adjust maintaining posture to teach information about position sense the position of the body in space, and balance adjustment means and relative body orientation with regard to the ground, and the ability to maintain the center of gravity of the body at the intervention for that is positive for the maintenance of posture in cerebral palsy children [10]. particular, in the course of normal development, the development ofminimum the ability posture to locate fluctuation the head ofon a the child support in space surface is very [17,18]. important In Deep Neck Flexor Muscle Exercise [19,20]. However, the head-regulating ability of children with cerebral palsy is lowered due to the congenital disease, and The deep muscles of the neck include the cervical muscles the stabilization movement of the neck is applied through longus colli, longus capitis, rectus capitis anterior, and rectus intervention against this. When stabilizing the neck, improving capitis lateralis, and other muscles in the anterior, and the spinalis the stability and control ability of the head through strengthening the posterior; these muscles are involved in stabilizing and to improve the stability of the neck in a static balance will have cervicis, multifidus, suboccipitalis, and others are involved in supporting the neck [11]. Most children with cerebral palsy show the deep cervical flexor muscles and continuing sensory feedback of Soh et al. [22], the stabilization movement of the neck showed the lack of trunk stability. In particular, it is observed from the improvemetsa positive influence in the [21].functional As well reaching as looking test(FRT), in another timed research up and posturea posture when side bendingflexion posture forward or from forward a body flexion sitting posture position due that to

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go(TUG) expressing dynamic balance ability and Berg balance 5. scale(BBS) [16,22]. Therefore, the exercise of neck stabilization is positive, and it can be applied to the intervention method for Bly L (1991) A Historical and Current View of the Basis of NDT. 6. Pediatric Hong JS (2009) physical The therapy normal 3(3): development 131-136. for cerebral palsy treatment. improving the dynamic balance ability. Gunja publisher, South Korea. Trunk Stability 7. control synergies during quiet standing in healthy children and Stability of the trunk is the ability of the musculoskeletal Ferdjallah M, Harris GF, Smith P, Wertsch JJ (2002) Analysis of postural system to maintain a balance that is displayed as a small exercise 8. children with cerebral palsy. Clinical Biomechanics 17(3): 203-10. have undergone an abdominal development process and the MusclesBoyd-Clark of the LC, Cervical Briggs Spine. CA, Spine Galea 27(7): MP 694-701. (2002) Muscle Spindle stabilityor a distraction of the trunkof movement will be [23].reduced Children [24], withincluding cerebral not palsyonly Distribution, Morphology, and Density in Longus Colli and Multifidus the balance while sitting, but also decreased walking ability and 9. Hunt CC (1990) Mammalian muscle spindle: peripheral mechanism. upper-limb function. Therefore, the medial muscle of the body 10. PhysiolMatthews Rev PB 70(3): (1998) 643-663. Proprioceptors and their contribution to cerebral palsy and also has a positive effect on the stability of the somatosensory mapping: complex messages require complex requires mediation of the neck flexion movement of a child with contraction for the stabilization of the ventral trunk muscles and 11. processing.Kim SY, Lee CanHJ (2006) J PhysioI Literature Pharmacol review 66(4): on the430-438. association between a contributestrunk. The neck to the flexion automatic exercise adjustment secondarily of the activates trunk [25]. the muscle cervical dysfunction and the change of neuromuscular control activity.

Body Alignment 67. Korean Academy of Orthopedic Manual Physical Therapy 12(1): 57- Regarding the posture of those with cerebral palsy, the trunk 12. Kim JC, Jeon HS, Yi CH, Kwon HY, Oh DW (2007) Strength and is bent forward and the head is excessively stretched; thus, the forward movement posture of the head due to the changes in endurance of the deep neck flexors of industrial workers with and without neck pain. Ergonomics Society of Korea 26(4): 25-31. changes, such as the longus colli muscle [26]. In particular, if head position can result in deep cervical flexor muscles thickness 13. 2505-2512.Conley MS, Meyer RA, Bloomberg JJ, Feeback DL, Dudley GA (1995) are weakened and the ability to adjust the head decreases, Noninvasive analysis of human neck muscle function. Spine 20(23): the deep flexor muscles, the longus colli and longus capitis, 14. Mayoux Benhamou M, Revel M, Vallee C, Roudier R, Barbet J, et al. (1994) Longus colli has a postural function on cervical curvature. Surg anterior scalene, are activated early and excessive chin and head movementsthe superficial are displayed, muscles, causing the sternocleidomastoid hyperextension in the muscle superior and [27]. If these incorrect posture behaviors 15. Radiol Anat 16(4): 367-71. muscle responses during postural perturbations in humans. Exp persist chronically, the disc of the cervical spine will be pushed Keshner EA, Woollacott MH, Debu B (1988) Neck, trunk and limb and muscle shortening between the and will occur, resulting in permanent deformation of the posture. Therefore, it is 16. BrainYun CK Res (2016) 71(3): The455-466. effect of neck stabilization exercise in sitting important to maintain proper alignment, and stabilization of the neck may be an effective intervention for this. with cerebral palsy. Department of Rehabilitation Science Graduate School,posture Deagu on deep University, neck flexor South muscle Korea. thinkness, gait, balance of children Conclusion 17.

Shumway Cook A, Woollacott MH (2007) Motor control: translating 18. research into clinical practice. Lippincott Williams & Wilkins, USA. hasAccording a positive toeffect the on above the researchstatic and results, dynamic it balance can be seenability that of on slinical balance score and quantitative assessment of postural sway cerebralstrengthening palsy thechildren, motion contributing of the deep to the cervical stabilization flexor muscleof the usingKim YH, force Kim platform NG, Kim anals HL, Sin of rehabilitation Yl, Lee KM (1995) Medicine A Comparative 19(4): 782-792. study trunk. Therefore, it is concluded that it is necessary to verify the 19. intervention effect in various environments through continuous locomotor tasks in humans. Exp Brain Res 82(1): 97-106. research. Pozzo T, Berthoz A, Lefort L (1990) Head stabilization during various 20. References upper body balance during human locomotion. Gait & Posture 2(1): 19-25.Prince F, Winter D, Stergiou P, Walt S (1994) Anticipatory control of 1. Bass N (1999) Cerebral palsy and neurodegenerative disease. Curr Opin Pediatr 11(6): 504-507. 21.

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Citation: Han YG, Yun CK (2017) Deep Neck Flexor Exercise to Improve Physical Performance for People with Cerebral Palsy. MOJ Orthop Rheumatol 7(4): 00279. DOI: 10.15406/mojor.2017.07.00279 Deep Neck Flexor Exercise to Improve Physical Performance for People with Cerebral Copyright: 3/3 Palsy ©2017 Yong Gu et al.

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Citation: Han YG, Yun CK (2017) Deep Neck Flexor Exercise to Improve Physical Performance for People with Cerebral Palsy. MOJ Orthop Rheumatol 7(4): 00279. DOI: 10.15406/mojor.2017.07.00279