Cerebral palsy (CP) is a syndrome of motor impairments characterized by non-progressive
disturbances taking place in developing fetal and infant brain(1). The most prevalent motor
disability in children, CP affects 2 to 3 out of every 1,000 live births. The most prevalent
type of CP, spastic CP account for about 80% , especially spastic diplegic, accounts for
between 50% and 60% of all cases(2).The term "cerebral paralysis "was used for the first time
in 1861, by the English orthopedic surgeon named William Little (3). There are four
categories of risk factors for CP: pre-conception, prenatal, perinatal, and postnatal(3, 4).
Traditionally, CP has been categorized according to the type of movement dysfunction and
anatomical distribution. Spastic, dyskinetic, hypotonic, ataxic, and mixed kinds of movement
are among the patterns of movement. Spastic movement is the most prevalent, with dyskinetic,
ataxic, or hypotonic movement patterns making up the minority of cases(5). Hemiplegic,
diplegic, and quadriplegic made up the anatomic distribution. Only one side of the body is
affected in hemiplegic CP, and the upper extremities often show the greatest deficits. Lower
extremities are more commonly affected in Diplegic CP than upper extremities. The axial and
appendicular skeletons are both affected in Quadra plegic cerebral palsy, which affects the
entire body (6).
Damage to the brain occurs in CP patients, most frequently in the region of the brain that
regulates muscle tone and limb movement. As a result, the brain is powerless to control how
flexible a muscle should be. The spinal cord is dominated by the command from the muscle,
which causes the muscle to become too tight or spastic(7). Periventricular leukomalacia
(PVL), the most prevalent abnormality on neuroimaging, is a white matter anomaly located
close to the lateral ventricle. Children with PVL often exhibit spastic diplegia because the
corticospinal tract fibers to the lower limbs are medial to those of the upper extremities in
the periventricular white matter(3, 8).CP child are diagnosed on the basis of history and
physical examination(2). Muscle stiffness and heightened reflexes are side effects of
cerebral palsy, which affects mobility and coordination. Either too loose or too rigid a
muscle tone. Walking difficulty, such as walking on one's toes or crossing one's knees like a
scissor. Inability to use fine motor abilities. Balance and muscle coordination are
noticeably absent. Tremors and jerky involuntary movement also present in children with
athetoid CP(3,9).Spasticity causes irregular movements in the muscles and joints of the
extremities and is particularly damaging to growing youngsters. Any muscle group in the body
might be affected by spasticity. Hip flexion, adduction of the thighs, knee flexion,
equinovarus foot posture, and hyperextension of the big toe are the effects on the lower
limbs.(7). In spastic diplegia the most commonly effected lower limb muscles are
gastrocnemius, soleus, adductors, hamstrings, psoas and rectus femoris(2).
The treatment of a child with CP requires a multidisciplinary approach(7). Physiotherapy
intervention included static and dynamic weight bearing exercises balance training, weight
bearing exercises, sustained stretching exercises, Roods approach, Bobath technique,
exercises on Swiss ball, orthosis, and proper home exercise program(10).Massage is one of the
oldest and most widely used treatments in complementary and alternative medicine, with more
than 75 forms of it practiced today(2).Massage has positive effects on muscle tone
disorder(11, 12).Mocgregor et al conducted a study in this Transverse-friction massage was
applied to the calf muscles of patients with spastic diplegia. They hypothesized that this
resets sarcomere length(8).Tissue flossing was first proposed by Starrett and Cordoza (2015),
who claimed that it can lessen discomfort from various diseases or injuries, increase range
of motion, and/or improve performance (such as strength or leaping performance(13). The
flexibility of muscles can be greatly increased with Floss Band intervention(14, 15).
Generally, muscles of children with CP lack muscular flexibility. Muscular stiffness results
from an increase in muscular tone. Due to muscular stiffness, it was impossible to stretch
the muscle properly, which led to the creation of contractures, reduced range of motion
(ROM), and restricted mobility. Muscular flexibility is a basic element for muscular action
and important milestone in the rehabilitation program for children with CP.
Treatment options provided to improve muscles flexibility, rang of motion and mobility of
children with CP must not be limited to invasive methods which are also financially
expensive. The Tissue flossing is a novice, non-invasive method that depend on an easily
held, safe, cheap and light weighted. The use of tissue flossing is becoming a popular
strategy in rehabilitation program. However the literature on floss band effectiveness in
children with Cp remain sparse. Previously studies have been conducted that support the role
of tissue flossing in athletes and in individuals with various musculoskeletal injuries.
However its role particularly in CP patients is unavailable. In this research we have
incorporated this technique to determine its effects in cerebral palsy children. Therefore,
the purpose of this study is to do comparison between transverse friction massage with tissue
flossing technique and examine the effects on range of motion, muscular flexibility, and
mobility in children with diplegic CP.