• Online ISSN : 2313-1519
  • Print    ISSN : 1812-2892
Abstract - The effects of massage therapy on symptoms related cerebral palsy in children with cerebral palsy: A systematic review
< Back
Hasan Bingöl, Esedullah Akaras, Hikmet Kocaman


The purpose of this review was to systematically present the effectiveness of massage therapy on cerebral palsy related symptoms in children with cerebral palsy based on existing evidence. A comprehensive systematic literature search was conducted from inception to February 2020 using the following electronic databases: PubMed, Google Scholar, Science Direct, Cochrane Library Database of Reviews of Effectiveness, Physiotherapy Evidence Database. To evaluate the articles concerning eligibility, a screening process was carried out by two reviewers. Summary of the studies including outcomes, measures, and results, and methodological quality of the studies were described according to the American Academy for Cerebral Palsy and Developmental Medicine guidelines. Five studies with different conducting design met inclusion criteria were included to document the current body of evidence of massage therapy in children with cerebral palsy. Almost all of the included articles reported that massage therapy (with or without conventional physiotherapy) is effective to improve spastic/hypertonic muscles and gross motor functions. Besides, it was also found that massage therapy could be effective on comorbidities including pain, sleep disorder, and lower perception of life satisfaction.  Some of the included studies established the effects of massage therapy on comorbidities related to the cerebral palsy, whereas some of the studies directly demonstrated the effects of massage therapy on secondary problems related to The International Classification of Functioning, Disability and Health body structures/functions, and activity. Consequently, performing massage therapy (with or without physical therapy and/or routine therapy), would be effective to improve most of the symptoms related to cerebral palsy.

Key words: cerebral palsy, spasticity, massage therapy, pain, children


Corresponding author: Hasan Bingöl, Teaching Assistant, PT, MSc, Department of Therapy and Rehabilitation, Vocational School of Health Service, Muş Alparslan University, Muş, Turkey. Tel.: +90 04362494949, +90 05072328100. E-mail: h.bingol@alparslan.edu.tr, hesenbingol@gmail.com



1. A. Johnson. Cerebral palsies: epidemiology and causal pathways. Archives of disease in childhood. 2000; 83:279. https://doi.org/10.1136/adc.83.3.279a

2. L. Dimitrijević, H. Čolović, M. Spalević, A. Stanković, D. Zlatanović, B. Cvetković. Assessment and treatment of spasticity in children with cerebral palsy. Acta Facultatis Medicae Naissensis. 2014; 31:163-169. https://doi.org/10.2478/afmnai-2014-0020

3. S. Schiaffino, C. Reggiani. Molecular diversity of myofibrillar proteins: gene regulation and functional significance. Physiological reviews. 1996; 76:371-423. https://doi.org/10.1152/physrev.1996.76.2.371

4. J. Rose, W.L. Haskell, J.G. Gamble, R.L. Hamilton, D.A. Brown, L. Rinsky. Muscle pathology and clinical measures of disability in children with cerebral palsy. Journal of orthopaedic research. 1994; 12:758-768. https://doi.org/10.1002/jor.1100120603

5. W.H. Organization, International Classification of Functioning, Disability and Health: ICF, World Health Organization. 2001.

6. J. Vargus-Adams. Understanding function and other outcomes in cerebral palsy. Physical medicine and rehabilitation clinics of North America. 2009; 20:567-575. https://doi.org/10.1016/j.pmr.2009.04.002

7. K. Klingels, I. Demeyere, E. Jaspers, P. De Cock, G. Molenaers, R. Boyd, H. Feys. Upper limb impairments and their impact on activity measures in children with unilateral cerebral palsy. European Journal of Paediatric Neurology. 2012; 16:475-484. https://doi.org/10.1016/j.ejpn.2011.12.008

8. J. Cooper, A. Majnemer, B. Rosenblatt, R. Birnbaum. The determination of sensory deficits in children with hemiplegic cerebral palsy. Journal of Child Neurology. 1995; 10:300-309. https://doi.org/10.1177/088307389501000412

9. S. Pundik, J. McCabe, M. Skelly, C. Tatsuoka, J.J. Daly. Association of spasticity and motor dysfunction in chronic stroke. Annals of physical and rehabilitation medicine. 2019; 62:397-402.

10. J.P. Lin, J.K. Brown, E.G. Walsh. Continuum of reflex excitability in hemiplegia: influence of muscle length and muscular transformation after heel-cord lengthening and immobilization on the pathophysiology of spasticity and clonus. Developmental medicine and child neurology. 1999; 41:534-548. https://doi.org/10.1017/S0012162299001152

11. M. Flanigan, D. Gaebler-Spira, M. Kocherginsky, A. Garrett, C. Marciniak. Spasticity and pain in adults with cerebral palsy. Developmental Medicine & Child Neurology. 2019. https://doi.org/10.1111/dmcn.14368

12. B. Findlay, L. Switzer, U. Narayanan, S. Chen, D. Fehlings. Investigating the impact of pain, age, Gross Motor Function Classification System, and sex on health-related quality of life in children with cerebral palsy. Developmental Medicine & Child Neurology. 2016; 58:292-297. https://doi.org/10.1111/dmcn.12936

13. L.B. Hohman, L. Baker, R. Reed. sensory disturbances in children with infantile hemiplegia, triplegia, and quadriplegia. American Journal of Physical Medicine & Rehabilitation. 1958; 37:1-6.

14. A.A. Bolanos, E.E. Bleck, P. Firestone, L. Young. Comparison of stereognosis and two-point discrimination testing of the hands of children with cerebral palsy. Developmental Medicine & Child Neurology. 1989; 31:371-376. https://doi.org/10.1111/j.1469-8749.1989.tb04006.x

15. I. Novak. Evidence-based diagnosis, health care, and rehabilitation for children with cerebral palsy. Journal of child neurology. 2014; 29:1141-1156. https://doi.org/10.1177/0883073814535503

16. V. Dietz, W. Berger. Normal and impaired regulation of muscle stiffness in gait: a new hypothesis about muscle hypertonia. Experimental neurology. 1983; 79:680-687. https://doi.org/10.1016/0014-4886(83)90032-8

17. Y.J. Yang, J. Zhang, Y. Hou, B.Y. Jiang, H.F Pan, J. Wang, D.Y. Zhong, H.Y. Guo, Y. Zhu, J. Cheng. Effectiveness and safety of Chinese massage therapy (Tui Na) on post-stroke spasticity: A prospective multicenter randomized controlled trial. Clinical rehabilitation. 2017; 31:904-912. https://doi.org/10.1177/0269215516663009

18. J. Lexell, D. Downham, M. Sjöström. Distribution of different fibre types in human skeletal muscles. Journal of the neurological sciences. 1983; 61:301-314. https://doi.org/10.1016/0022-510X(83)90164-8

19. G.S. Liptak. Complementary and alternative therapies for cerebral palsy. Developmental Disabilities Research Reviews. 2005; 11:156-163. https://doi.org/10.1002/mrdd.20066

20. T. Field, M. Diego, M. Hernandez-Reif. Massage therapy research. Developmental Review. 2007; 27:75-89. https://doi.org/10.1016/j.dr.2005.12.002

21. R. Dewar, S. Love, L.M. Johnston. Exercise interventions improve postural control in children with cerebral palsy: a systematic review. Developmental Medicine & Child Neurology. 2015; 57:504-520. https://doi.org/10.1111/dmcn.12660

22. J. Darrah, R. Hickman, M. O'Donnnell, L. Vogde, L. Wiart. AACPDM methodology for developing systematic reviews of treatment interventions (Revison 1.2). 2008.

23. D. Moher, L. Shamseer, M. Clarke, D. Ghersi, A. Liberati, M. Petticrew, P. Shekelle, L.A. Stewart. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). Systematic reviews. 2015; 4:1. https://doi.org/10.1186/2046-4053-4-1

24. S.V. Philbois, J. Martins, C.S. Souza, R.F. Sampaio, A.S. Oliveira. Health professionals identify components of the International Classification of Functioning, Disability and Health (ICF) in questionnaires for the upper limb. Brazilian journal of physical therapy. 2016; 20:15-25. https://doi.org/10.1590/bjpt-rbf.2014.0135

25. Treatment Outcomes Committee AACPDM. AACPDM Methodology to Develop Systematic Reviews of Treatment Interventions (Revision 1.2). 2008.

26. W.H. Organization, International Classification of Functioning, Disability, and Health: Children & Youth Version: ICF-CY, World Health Organization. 2007.

27. M. Hernandez-Reif, T. Field, S. Largie, M. Diego, N. Manigat, J. Seoanes, J. Bornstein. Cerebral palsy symptoms in children decreased following massage therapy. Early Child Development and Care. 2005; 175:445-456. https://doi.org/10.1080/0300443042000230546

28. R. Macgregor, R. Campbell, M.H. Gladden, N. Tennant, D. Young. Effects of massage on the mechanical behaviour of muscles in adolescents with spastic diplegia: a pilot study. Developmental Medicine & Child Neurology. 2007; 49:187-191. https://doi.org/10.1111/j.1469-8749.2007.00187.x

29. S. Nilsson, G. Johansson, K. Enskär, K. Himmelmann. Massage therapy in post-operative rehabilitation of children and adolescents with cerebral palsy-a pilot study. Complementary therapies in clinical practice. 2011; 17:127-131. https://doi.org/10.1016/j.ctcp.2010.11.003

30. F. Rasool, A.R. Memon, M.M. Kiyani, A.G. Sajjad. The effect of deep cross friction massage on spasticity of children with cerebral palsy: A double-blind randomised controlled trial. J Pak Med Assoc. 2017; 67(1):87-91.

31. H. Bingöl, Ö. Yılmaz. Effects of functional massage on spasticity and motor functions in children with cerebral palsy: a randomized controlled study. Journal of Exercise Therapy and Rehabilitation. 2018; 5:135-142.

32. F. Rasool, A.R. Memon, M.M. Kiyani, A.G. Sajjad. The effect of deep cross friction massage on spasticity of children with cerebral palsy: A double-blind randomised controlled trial. JPMA. The Journal of the Pakistan Medical Association. 2017; 67:87-91.

33. P. Morgan, J.L. McGinley. Chapter 20 - Cerebral palsy, in: B.L. Day, S.R. Lord (Eds.) Handbook of Clinical Neurology. 2018; 323-336. https://doi.org/10.1016/B978-0-444-63916-5.00020-3

34. I. Novak, S. Mcintyre, C. Morgan, L. Campbell, L. Dark, N. Morton, E. Stumbles, S.A. Wilson, S. Goldsmith. A systematic review of interventions for children with cerebral palsy: state of the evidence. Developmental Medicine & Child Neurology. 2013; 55:885-910. https://doi.org/10.1111/dmcn.12246

35. A. Shamsoddini. Comparison between the effect of neurodevelopmental treatment and sensory integration therapy on gross motor function in children with cerebral palsy. Iranian Journal of Child Neurology. 2010; 4:31-38.

36. L.A. Graham. Management of spasticity revisited. Age and ageing. 2013; 42:435-441. https://doi.org/10.1093/ageing/aft064

37. T.D. Sanger, M.R. Delgado, D. Gaebler-Spira, M. Hallett, J.W. Mink. Classification and definition of disorders causing hypertonia in childhood. Pediatrics. 2003; 111:e89-e97. https://doi.org/10.1542/peds.111.1.e89

38. H. SA. The efficacy of botulinum toxin type A injection in the hamstring and calf muscles with and without serial foot casting in gait improvement in children with cerebral palsy. Tehran University Medical Journal TUMS Publications. 2011; 69:509-517.

39. L.R. Logan. Rehabilitation techniques to maximize spasticity management. Topics in stroke rehabilitation. 2011; 18:203-211. https://doi.org/10.1310/tsr1803-203

40. M. Cigales, T. Field, B. Lundy, A. Cuadra, S. Hart. Massage enhances recovery from habituation in normal infants. Infant Behavior and Development. 1997; 20:29-34. https://doi.org/10.1016/S0163-6383(97)90058-8

41. R. MacGregor. Effects of specifically sequenced massage on spastic muscle properties and motor skills in adolescents with cerebral palsy, University of Glasgow. 2009.

42. J. Barlow, L. Powell, A. Cheshire. The Training and Support Programme (involving basic massage) for parents of children with cerebral palsy: an implementation study. Journal of Bodywork and Movement Therapies. 2007; 11:44-53. https://doi.org/10.1016/j.jbmt.2006.03.002


Volume 4, Number 58 (2020)