Use of a Lycra-based Garment in
Facilitating Postural Stability in Children with Cerebral Palsy
Clare CHENG, Senior
Physiotherapist, Superintendent
Iris CHAN, Occupational
Therapist
Jockey Club
Clinical Trial of the Dynamic
Postural Garment (DPG)
CYX showed functions improved immediately after wearing the DPG
NKT also showed improvements in the following functional activities
Truncal, pelvic and shoulder girdle instability is
often a big hurdle to the development of independent mobility and upper limb
functions of children with cerebral palsy. Some years ago, we observed an
unexpected “side-effect” of a pressure garment worn by a schoolboy with spastic
quadriplegia after accidentally scorched his groin region by hot water during
bathing. The pressure garment covering the lower trunk and hips gave some
stability to his “wobbly” pelvis and allowed him to free one hand from support
while standing. This task was impossible for him before wearing the pressure
garment. The “side-effect” aroused our interest in looking into the use of lycra to tackle the problem of
proximal stability in children with cerebral palsy.
In reviewing
the literature, it was found that Blair, et al.1 had
experimented on lycra material to make a lycra-based dynamic total body splint called UPsuit. They reported that the splint provided joint
stability and tone inhibition. The best result was achieved in children with hypotonia or dystonia. This
splint consists of multiple layers of lycra
fitted next to the skin with plastic reinforcement to provide the required
dynamic pull and support. The difference between the UPsuit
and the conventional rigid orthoses is that it
provides support and control whilst allowing movements. Hence, it allows active
learning of more normal functional movements. However, the splint was
complained to associate with significant practical problems such as inconvenience
of putting on and keeping hygiene
Other versions
of dynamic splint based on the concept of UPsuit was
tried by other investigators such as in Hylton and
Allen’s case study3 where they use a thinner lycra
material to make what they called the stabilizing pressure input orthosis (SPIO). It was again a whole body garment.
Gracies, et al.4
investigated the mechanical effect of these lycra-based
garments. Their experimental garment consisted of a series of circumferential lycra segments sewn to form a
sleeve tightly fitted to the whole upper limb with a pull in the direction of supination. They demonstrated that a low-tension sustained
torsion was exerted to the arm and forearm in the desired direction.
Clinical Trial of the Dynamic
Postural Garment (DPG)
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Based on the
literature review and the observation of the child mentioned in our story, we
selected two cases from the Jockey Club Conductive Learning Centre of the
Spastics Association of Hong Kong for a clinical trial on a lycra garment which we called the Dynamic Postural
Garment (DPG) (Figure 1). The garment consisted of a single layer of lycra covering the shoulder region, the trunk, the pelvic
region and the thighs to produce circumferential and compression pressure to
the axial and proximal joints. This is similar to the effect of approximation
given manually to elicit an active cocontraction of
the axial musculature so as to gain truncal and
pelvic stability. |
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One case (CYX)
selected was a four-year-old boy with hypotonic CP and moderate mental
retardation. He demonstrated a generalized hypotonicity
and the tone was only slightly raised in exertion. He
was a supported sitter with good head control but poor truncal
stability and with kyphotic back. Propping with the
upper limbs was weak even with arm gaiters and the grasp was also weak and not
sustained. In supported standing with a ladder frame and manual assistance,
there was a constant sway of the pelvis to either side and locking of the
pelvis in the posterior tilted position showing the poor cocontraction
of the axial musculature. The DPG was expected to elicit more active muscle
work of the axial joints.
The other case
(NKT) was a 3 year-old girl with athetoid CP and
normal to limited intelligence. Her basic muscle tone fluctuated from normal to
slightly hypotonic. She sat with support and occasionally could prop both hands
on floor to maintain sitting balance. However, she got little confidence to sit
independently without adult beside her. She showed little attempt to reach out
with both hands. She tucked her elbows to the side of the body for
stabilization when doing manipulative tasks. This limited her use of the hands
in a more functional position as well as limited her ability to push the ladder
frame (the walking aid she used) in assisted walking. The DPG was expected to
give her more proximal fixation around the shoulder girdle and the trunk giving
her confidence to attempt sitting independently and releasing the fixed posture
of the upper limbs for reaching and pushing.
CYX started the
trial in September 2000 and off the garment in June 2001. In the first week,
the garment was worn for one hour as an adjustment period. The duration was
gradually increased to 2.5 hours per day thereafter. The garment was off during
mealtime and sleeping time.
NKT started the
trial in June 2001 and off in August 2001. The DPG has been worn for 5 weeks.
The duration of wearing the garment was increased gradually from one hour per
day to 2.5 hours per day. The much shorter duration compared with CYX was due
to less skin tolerance in NKT.
Both cases
continued their training in Conductive Education programmes
which include learning in transfer skills, hand tasks, play skills, self-care
skills and daily routine of walking, toileting and feeding. All the activities
emphasized active movements and participation as well as understanding of the
task and good postural requirements. The flexibility of the DPG material
allowed movements and it did not hinder the active learning part of the programmes.
Video on gross
and fine motor activities was taken in the natural environment during the
training programmes and daily routine. Video was
taken before wearing DPG, immediately wearing it and at the end of the trial
period. The content was analyzed according to activities including rolling,
prone on elbows, 4-point kneeling, sitting on floor, sitting on stool,
standing, sitting on stool to standing, walking, reaching with the upper limbs
and basic grasp and release of the hands.
CYX showed
functions improved immediately after wearing the DPG:
1. The frog position of the legs in
lying was reduced;
2. The upper limb actively took part
in the assisted rolling with the shoulder showing more self- controlled
movement;
3. The head could maintain in the
upright position in the forearm-supported prone position for a longer time and
the head could turn from side to side to follow toys with sound;
4. Hands could prop on the floor
without arm gaiters to maintain sitting for a second and with arm gaiters,
sitting balance could be maintained up to 2 minutes;
5. In
sitting, the trunk maintained in the upright position more frequently;
6. Sideways and forward sway of the
pelvis was reduced in supported standing.
NKT also
showed improvements in the following functional activities:
1. She could sit on the floor on her
own without support for an increased period of time;
2. She showed confident to sit on a
stool without adult beside her;
3. She could reach out with both hands
in different directions in the sitting position;
4. She could maintained
a 4-point position which was not achieved before;
5. Her shoulders were more forward
with elbows extended in standing pushing onto a ladder frame;
6. “Athetoid
dancing” of the legs was reduced in standing position;
7. Walking was improved with better
pushing of the ladder frame and weight shifting between the two legs.
The project was
a very preliminary trial of two cases on the lycra-based
garment. Encouraging results were seen in both cases indicating an improvement
of proximal stability on wearing the garment. The investigation will be
continued to work for a more systematic assessment for correlating the
findings. Colleagues who are interested to try this garment out are reminded to
some contraindications. Subjects with uncontrolled epilepsy and poor
respiratory function should be excluded. Skin sensitivity to the lycra material should be observed
before a longer wearing regime is adopted. Reduced muscle strength in prolonged
wearing is also theoretically possible. Constipation and urinary frequency is
also some complications mentioned in some investigations.
1. Blair
E, Ballantyne J, Horsman S,
Chauvel P. A study of a dynamic
proximal stability splint in the management of children with cerebral palsy.
Dev Med Child Neurol 1995;37:544-54.
2. Hanson
C. How effective are lycra
suits in the management of children in cerebral palsy. J Assoc Paediatr Chart Physiotherapists 1999;90:49-57.
3. Hylton N, Allen C. The development and
use of SPIO Lycra compression bracing in children with neuromotor
deficits. Pediatr Rehabil 1997; 1:109-16.
4. Gracies JM, Fitzpatrick R, Wilson L, Burke D, Gandevia SC. lycra garments designed for patients with upperlimb spasticity: mechanical effects in normal subjects. Arch Phys Med Rehabil 1997 Oct;78 (10):1066-71.