Mouth Opening, Oral Motor Functions, Sialorrhea, Spastic Cerebral Palsy (sCP), Strain Counterstrain Technique
Conditions
Keywords
Strain Counter-Strain, SCS technique, Oromotor Functions, Mouth Opening, Drooling Severity, Masseter Muscle, Pediatric Physical Therapy, Spastic cerebral palsy
Brief summary
This study evaluates the clinical efficacy of the Strain Counter-Strain (SCS) technique on improving oromotor functions in children with spastic cerebral palsy. The intervention specifically targets the masseter, SCM, upper trapezius, scalenes, and suprahyoid muscles to release myofascial tension. The study aims to determine if modulating muscle tone through SCS can provide a stable postural foundation to enhance functional oral motor skills. Outcomes are measured after 4 weeks (one month) of intervention, focusing on mouth opening range, drooling frequency and severity, and overall oral motor functions
Detailed description
This study follows a Randomized Controlled Trial (RCT) design. Children with spastic cerebral palsy are screened for inclusion based on impaired oromotor control and persistent neck muscle tension. The Control Group receives a designed oral motor program aimed at improving oral motor functions, mouth opening, and drooling severity, conducted over 4 weeks (one month). The Study Group receives the same designed oral motor program, preceded by the Strain Counter-Strain (SCS) technique applied to the masseter, sternocleidomastoid (SCM), scalenes, upper trapezius, and suprahyoid muscles. The SCS technique aims to normalize cervical alignment and release restrictive tension in the orofacial region. Outcome Measures: Functional and physical changes are assessed at baseline and after the 4-week period. The primary outcomes include: Mouth opening range (measured in centimeters). Drooling frequency and severity (using standardized scales). Oral motor functions (evaluated through standardized scales). The comparison seeks to demonstrate how stabilizing the proximal postural base through SCS facilitates refined distal oromotor performance
Interventions
PROCEDUREStrain Counter-Strain (SCS)
A manual therapy technique used to release myofascial tightness and muscle tension in the head and neck region to provide a stable postural foundation for oromotor skills
PROCEDUREDesigned Oral Motor Program
A structured exercise program designed to enhance oral motor functions, including feeding efficiency, mouth opening range, and drooling
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Masking description
This is an open-label study where both the participants and the investigator are aware of the assigned interventions. Masking was not feasible due to the nature of the manual therapy technique (Strain Counter-Strain) and the active involvement of the physical therapist in administering the protocol.
Intervention model description
This is a two-arm, randomized controlled trial with a parallel assignment design. Participants are randomly allocated into two groups: the Study Group and the Control Group. Both groups receive the intervention concurrently over a period of 4 weeks. The Study Group receives the Strain Counter-Strain (SCS) technique followed by a designed oral motor program, while the Control Group receives the designed oral motor program alone. Outcomes are assessed for both groups at baseline and immediately following the 4-week intervention period.
Eligibility
Sex/Gender
ALL
Age
4 Years to 8 Years
Healthy volunteers
No
Inclusion criteria
* Chronological age was 4 - 8 years from gender was selected * Their degrees of spasticity were 1, 1+ according to modified Ashworth scale. * They had moderate drooling according to modified drooling questionnaire. * Mouth opening limitation was less than 3 cm. * Their levels of motor function were II - III- IV according to gross motor function classification system. * Their levels of feeding abilities were III on Eating and Drinking Ability Classification System. * Children were able to follow instruction
Exclusion criteria
* Any history of jaw, head, and face trauma. * Facial or dental developmental abnormalities. * Any history of head and neck surgical intervention. * Congenital abnormalities of head and neck
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Oral motor functions | Baseline and after 4 weeks of intervention | Assessment of oral motor skills including feeding, swallowing, and coordination using the Oral Motor Assessment Scale (OMAS). The scale scores range from 0 to 2, where higher scores indicate better function |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mouth Opening Range | Baseline and after 4 weeks of intervention | Measurement of the maximum inter-incisal distance using tape measurement (measured in centimeters) |
| Drooling Frequency and Severity | Baseline and after 4 weeks of intervention | Evaluation of drooling patterns using the Modified Drooling Questionnaire (MDQ). Higher scores indicate more frequent and severe drooling. |
Countries
Egypt
Contacts
STUDY_DIRECTORKamal Shoukry, PhD
Professor of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University
Outcome results
None listed