To help kids move, docs try Rolfing

For the umpteenth time on a recent afternoon, Ethan Todd sprang to his feet and reached for a toy truck. And for the umpteenth time, the 5-year-old boy’s thin legs buckled and collapsed.

The San Mateo boy then allowed Karen Price to sit behind him in the Palo Alto studio and knead his calves and thighs. «Look how high your feet can go!» she said, lifting his right leg into the air.

To the casual eye, what Price did may have looked like a massage. In fact, it was a session of what’s known as Rolfing — a novel technique that experts increasingly believe could help kids who, like Ethan, have cerebral palsy.

Cerebral palsy, the most common physical disability among children in the United States, is the name for a group of neurological disorders that develop early in life and permanently disrupt the brain’s control over movement and posture. There are many possible causes — such as genetic conditions, infections, bleeding in the brain, lack of oxygen or head injury — but doctors don’t really know.

There is no cure, so youths traditionally undergo physical and occupational therapy to work on performing basic functions, such as walking and standing, and fine-motor tasks, like handwriting. More invasive procedures involve medicine and surgery.

But at Stanford University School of Medicine, researchers say Rolfing is producing early and promising improvements in such children.

How Rolfing works

Rolfing deals with a web of white tissue called fascia, which lies beneath the skin and covers and connects the underlying muscles, bones and organs. The fascia plays a large role in holding together the body’s structure and supporting its posture.

But the fascia can cause pain when pulled out of its natural position by injuries, stress, inflammation, trauma, scoliosis or poor posture, according to Dr. Ida Rolf, who made the technique popular in the 1970s. It can also be thrown off-kilter in those with cerebral palsy, when brain injuries cause some muscles to work too hard and others not enough, researchers say.

Rolfers, as the practitioners are called, use their hands to administer a slow, intense massage that evens out muscle tensions and contractures and restores the connective tissue’s flexibility.

Rolfing is traditionally practiced on adults, some of whom find the process painful.

But children with cerebral palsy do not feel pain when it is used on them, said Stanford researchers in a paper published in April in the Journal of Evidence-Based Complementary and Alternative Medicine.

Dr. Heidi Feldman, a developmental and behavioral pediatrician at Stanford and a co-lead investigator in the study, learned of Rolfing about four years ago, when she and a medical student went looking for a treatment that would relieve the muscles weakened by cerebral palsy.

Children under study

Their preliminary study involved eight children between ages 2 and 7 with spastic cerebral palsy, which, as the most common form of the condition, involves stiff, tight and movement-resistant muscles.

«We wanted to look at the youngest children who are still in the process of developing their motor skills,» Feldman said. «That is helpful to the children because if they can get a jump start on moving along more effectively, there may be a cumulative effort over time that will be helpful to them.»

On top of their ongoing physical and occupational therapy, each child went to 10 weekly Rolfing sessions and 10 weekly play sessions, which served as a control activity for the purposes of the study. Their motor skills were tested before and after each phase.

On average, the children’s movements improved more after Rolfing, when their muscles and joints were loosened and realigned, than after the play sessions, the researchers said.

Six of the eight toddlers showed major improvements in their motor skills after Rolfing. They included a cognitively impaired 6-year-old who began crawling and climbing independently, a visually impaired 6-year-old who stopped needing a brace on his right leg, and a 3-year-old who learned to run and jump. While the researchers did not track them all formally after the study, a few participants continued to attend Rolfing sessions and appeared to progress, researchers said.

All the parents reported improvements in their children’s appetite, bowel function, speech and maturity. Rolfing, the researchers concluded, «holds promise as a novel complementary treatment for spastic cerebral palsy.»

Now, the researchers are conducting a similar study with a larger group — the goal is 24 children — to get more expansive data on Rolfing’s effects.

«This is not a cure,» said Price, the Rolfer who has performed the therapy sessions. «This is giving kids the best use of what they have.»

Benefits seen

Dr. Wolf Mehling, associate professor of clinical family and community medicine at UCSF, said Stanford’s results looks promising. «It’s kind of a deep massage, and I can imagine that it might be beneficial,» he said.

When combined with traditional therapy, Rolfing could help reduce the need for more invasive treatments of cerebral palsy, said Farhad Sahebkar, director of California Pacific Medical Center’s child neurology division.

Those include injections of botulinum toxin, commonly known as Botox, to relax the muscles. The American Academy of Neurology recommends it as an effective treatment for spasticity.

Another medication, intrathecal baclofen, also relaxes the muscles and can be taken as a pill or through a pump. But both forms have some undesirable side effects, Sahebkar said, and their effectiveness and safety have not been determined.

Other options include orthopedic surgery, which can help children with a severe lack of mobility and muscle function, and dorsal rhizotomy, which cuts certain nerve roots in the spinal cord to relieve targeted spastic muscles.

The bottom line is that «caregiving can be very challenging in a child who has severe spasticity affecting the hips. … Simple things such as changing diapers can be challenging,» Sahebkar said. «Complementary services like (Rolfing) could be very helpful.»

Ethan’s progress

For now, Rolfing seems to be working for Ethan, the San Mateo preschooler.

Diagnosed with spastic cerebral palsy around age 2, he has never stood on his own, said his mother, Winnie Todd. His leg muscles are stiff, and he has trouble articulating words, another symptom of the condition, she said.

Before Todd enrolled her son in Stanford’s latest study, she said he had so little control over his posture that he would slide out of a dining chair. Now, he can sit in one, and Todd credits Rolfing.

«I would see him straighten sitting up and also standing up,» she said. «When he’s holding on to furniture, he’s starting to stand up.»

She added that he’s also more talkative. «He always talks, but he’s using more complete sentences,» she said.

In a recent session, Ethan enthusiastically bounded after balls and toy cars, even though he was mostly on his hands and knees. At one point, as he held Price and Todd’s hands, he even took a few wobbly steps.

No one therapy, not even Rolfing, will ever cure Ethan, but Todd is hopeful that he will eventually become independent.

«I’d do whatever it takes for him to get better,» she said.