Exploiting Neuroplasticity in the Treatment of Neuromuscular Scoliosis in Cerebral Palsy

17Nov '19

Exploiting Neuroplasticity in the Treatment of Neuromuscular Scoliosis in Cerebral Palsy


Cerebral Palsy (CP) is an umbrella term which most commonly refers to subcortical brain damage before the age of 2 years old. The most common presentation involves initial flaccidity followed by spasticity of the muscles of wrist and ankle flexors, and shoulder and hip adductors.

Agonistic/antagonistic muscle imbalances result in a significantly higher prevalence of thoracolumbar scoliosis in CP. Attempts at surgical and non-surgical management have failed to exploit the opportunity to utilized postural therapy as a means towards neurorehabilitaiton. Neuroplastic changes have been reported following courses of sensorimotor stimulations. Treatment of neuromuscular scoliosis through the use of assisted corrective movement, constraint induced movement therapy, somatosensory and vestibulospinal activations, may successfully remediate neuronal functional losses associated with CP.

Neuroplasticity is considered to be fractionated in four categories, Compensatory Masquerade, Functional Map Enlargement, Cross Model Reassignment, and Homologous Region Adoption.

In the case of Compensatory Masquerade, brain injured individuals may experience remediation of a specific skill through compensatory neuronal reorganization of non-injured brain regions. Changes in neurological organization are driven by changes in demand, in other words, when treating neuromuscular scoliosis in CP, if a supportive brace is utilized without putting additional demands on the musculoskeletal system, no remediation could be expected. However, the concept of Compensatory Masquerade is a plausible mechanism of remediation through the use of a dynamic brace which gives some level of support, but also challenges the individual to make attempts to support an upright posture. Compression braces as well as Elastic tension braces, such as Spinecor, provide a model for a neuromuscular rehabilitation brace for the use in Cerebral Palsy.

Functional Map Expansion offers another mechanism of neuroplasticity which can be exploited in treating the causes of neuromuscular scoliosis. Through passive repetitive activation of ascending pathways, healthy areas of the brain can expand and replace areas which have lost function. This is similar to cross model adoption which involves the phenomenon of competing sensory perceptions, such as the competing senses of vestibular and somatosensory function. Vestibular activation of extensor tone may serve to replace gravitational activation of flaccid muscle spindles and golgi tendon organ dysfunction.

Activation of intact brain regions during postural realignment may provide a portal to exploit Homologous Region Adoption. This may occur in adjacent or opposing regions of the brain. The concept of multimodal sensory stimulation during attempted postural correction has been utilized in neurorehabilitation associated with balance disorders, and may serve as a model of therapy in the CP population.

In my experience, postural retraining using corrective movement mobilization, vestibular activation and the flexible spinecor brace is a promising approach to neurological remediation following brain injury in conditions of Cerebral Palsy.

Neurophysiological Remediation associated with the treatment of neuromuscluar scoliosis is a promising alternative to simple rigid bracing and surgical management.


Source by Marc Lamantia