Stretching
Techniques 
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Historically, mobility problems have been aggressively treated with pulling and stretching techniques known as dynamic stretching. If a limb is spastic and won't extend completely, the therapist uses force to pull the limb straight. This kind of stretching has proven to be significantly ineffective as a treatment for spasticity. It is known to cause hyperextension of joints, which ultimately interferes with limb mobility and does little, if anything, to decrease spasticity itself.
Another historic form of stretching is static stretching,
which is achieved by immobilizing the limbs in the extended position through
the use of casts, braces, or binds (i.e., standing tables). These static stretching
approaches are also significantly ineffective in decreasing spasticity. Indeed,
because these forms of stretching can provide isometric exercise to the flexors
of the limbs, they can actually worsen spasticity when static stretching is
stopped.
Pharmacologics
and Surgery back
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The limited success of stretching techniques and the knowledge that spasticity increases with age has increased the use of more radical medical treatments using pharmacologic agents and surgery. Muscle relaxants are the primary pharmacologics used to treat various levels of the nervous system. Generally, there is no significant lasting improvement from these drugs, and there can be severe side effects.
Surgical interventions have been attempted at two levels. First is surgery on the actual muscles, tendons, and bones involved. Second is surgery on the efferent nerve fibers that control the muscles involved (rhizotomy). Results of surgery have been disappointing at best. Significant lasting improvements in patient mobility have rarely been reported.
Sensory
Treatment back
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Preliminary Testing of the Delacato Method
Ten years ago at Delacato treatment centers, we began a thorough reevaluation of our approach to spasticity. We concluded that stretching gave little if any progress, even though motor activities are the most commonly used approach today. Our teams also tried muscle relaxants and surgery. We did not achieve, nor have we seen reported, significant improvements with any of these systems.
After much searching for an alternative approach we decided to experiment with a sensory approach. Our initial attempts to relax spastic limbs used heat and gentle massage only. We kept patients warm at all times and taught this approach to parents who carried it out at home. We noted improvements within the first month; spasticity was improving more than it had through stretching, but it was not significant enough to satisfy our team. Next, we decided to evaluate the muscles involved and to incorporate unlocking and toning activities.
To evaluate spastic children we examined muscle groups rather than individual muscles. Most spasticity occurs in the muscle groups of the arms and legs, making it easy to determine spasticity by observation—is the limb contracted or extended? We determined whether each group was:
- hypertonic (overly contracted) or
- hypotonic (overly extended).
If the muscles were hypertonic, our unlocking activities relaxed and extended muscles. If the muscles were hypotonic, our sensory activities increased muscle tone.
The Delaclato Method for spasticity uses heat, massage, and other sensory activities—to unlock hypertonic muscles and stimulate hypotonic muscles. The program progresses through four stages that take approximately eight months to complete. Prior to any unlocking activities (which occur in the later stages), we use four weeks of sensory programming only—relaxation activities for hypertonic muscle groups, and tone-increasing activities for hypotonic muscle groups. Throughout treatment, children are kept warm at all times, both while awake and asleep; sleeping bags are useful in this regard.
Results of Preliminary Testing
In our initial research we treated 48 children who had
been previously treated for spasticity without success. Eighteen had received
static treatment (i.e., bracing, standing tables, etc.), four had received
muscle relaxant medications, eight had undergone surgical procedures, and
eighteen had received dynamic stretching at least two times per week from
a therapist or parent. All of these children came to us because their primary
problem of spasticity was not improving. We explained to the parents and children
that we were experimenting with a sensory approach to spasticity. We also
explained that our experiment would take a minimum of eight months of work.
In recent months, we have seen two new developments in the problem of spasticity.
First, there is sometimes a tendency for the legs to rotate inward giving
the child the appearance of a severe pigeon-toed stance. This does not occur
with all children, and can be treated by rotating the axis of relaxation/tone
increasing along the leg. The primary problem exists in the hips of these
children, and thus we concentrate here. We perform relaxation techniques on
the inside of the leg, especially the inner thigh, and tone-increasing activities
on the outside of the leg, especially the outer thigh and buttocks.
Second, we have seen that when stretching exercises are done in conjunction
with this program, these children make much less progress than do those children
who perform no such exercises. We suggest that children not be given any form
of stretching exercises or passive-range-of-motion exercises during this program.
