Fysioterapeutti Nita Tolvasen abstrakti 2019 AMF kongressiin: Kokemuksia Faskiamanipulaatiosta lasten ja aikuisten neurologisessa fysioterapiassa
Experiences of Fascial Manipulation Stecco in neurological physiotherapy for children and adults
Nita Tolvanen, april 2019
The use of Fascial Manipulation (FM) for patients with neurological disorders has not been a topic for research yet. There have been some ambivalence regarding how to apply FM to neurological patients, indications and benefits. In Finland there are separately working therapists with quite a lot of clinical experience regarding the use of FM for patients with neurological disorders of different ages. No one has before tried to collect these very important clinical experiences. Therefor for example teachers of FM have found it difficult to explain how to adapt this method in neurology. This qualitative study based on group interviews was made to collect and identify data that answers these questions and to get an answer if FM can be used for neurological patients.
In Finland there have been 4 FM courses ( 2 x level 1, 2x level 2) where the participants have been therapists working with neurological children. Teaching was made by our teacher Tiina Lahtinen-Suopanki assisted by Nita Tolvanen with experience of using FM with neurological patients. Of these participants who all had completed level 2 twelve (12) participated in the interviews. They had a work experience of 10-40 years. The fact that they have a long experience of working without FM makes the results even more important. Together they had experiences from 135 different cases with a age range from one month old babies to adults. Through their experiences it has become clear that it is possible to apply FM to neurological patients but it requires some adaptation of evaluation and of course some other method that promotes motor learning and functional skills.
Evaluation and reasoning where to start palpating has been based on knowledge regarding the effects of movement patterns, importance of alignment and observation of compensations (on which plane or in which segment) that are similar in the NDT/Bobath approach (of these 12 therapists 10 were NDT/Bobath therapists which might be of importance). Evaluating have included analysis of changes in movement patterns, range of motion or quality of movement before and after treatment. These changes have been evaluated by observation, by taking photos or videos before and after. Often therapists have evaluated a certain movement/part of movement or the change in performance and when possible patients own experiences. Patients tell moving gets “easier”( requiring less effort and concentration), they can “feel their muscles” better.
All therapists have taken a more indirect approach the first time they treated, but in the future they all have used a more direct approach because all patients have some kind of problems with central output and/or muscle tone and incorrect movement patterns which as repetitive movement patterns cause densifications over and over again in quite the same manner.
Neurological patients have clearly benefited from this method when it is combined with other approaches that promote active motor skills. All participants have had the experience that it is possible to affect proprioception by using FM, for example decreasing sensitivity to touch, increasing awareness of unused muscles, increasing peripheral awareness that makes it easier to find difficult movements or to move on uneven surfaces.
Balance and body awareness has improved. Some of these
effects have been seen immediately, some have come during time and repeated
Treatment of scars, both very old and new, has made it easier to recruit muscles and it has increased sensory feedback.
For increasing range of motion (ROM) FM has been very effective and most therapists have started to use FM first and then stretch if needed and usually only end range of motion. It has been possible in some cases to decrease contractures by FM, which have not released by passive stretch. These experiences have regarded; CP, MMC, Erb´s palsy.
Selective movements have been easier
to learn when agonist-antagonist coordination has become easier.
Clonus and spasms have decreased or disappeared, even though these are generally thought to be of central origin.
The impact of incorrect movement patterns has become less severe. This has to do with the cumulative effects of FM.
The ability to produce selective movements in tongue and jaw have made closing of lips, sucking and feeding easier. Also phonation/ speech has become better and drooling lessened. More effective breathing has had a big effect on so many things from feeding, to speech and moving.
Fascial manipulation has been used as the only method only when treating pain. As a way of understanding and treating pain in individuals with hypertonia it has been a new and very powerful method. Some young adults tell that FM affects pain more effectively than medicine.
FM has become an important method providing new understanding how everything is connected and explaining the importance of fascial tissue adaptation for movement and proprioception and when manually produced gliding is needed to get adaptation to movement and better results than before. FM has been used repetitively since spasticity continuously affects ECM and incorrect movement patterns causes densification as repetitive movements with small variations. How often FM has to be used seems to correlate with the degree of muscle tone and the ability to produce active, selective movements. The more/better the person could adapt to change in gliding the longer the pauses can be held between treatments.
This is a field of application of Fascial Manipulation that needs further clinical experiences, case-studies and research for the benefit of neurological patients of all ages who definitely benefit from this method when applied according to their needs. According to these experiences is likely that also patients with MS, stroke and Familiar ALS (FALS) could benefit from FM, since there are good clinical experiences also among these patients. This requires further case-studies and research.