Joint mobilization for children with central nervous system disorders: indications and precautions.

Because clinicians are introducing joint mobilization into treatment programs for children with cerebral palsy, we felt that a review of the procedure and its scientific basis would be timely. The goals of the introductory section of this article are to define joint mobilization as it has been used for adults with musculoskeletal disabilities, to discuss various rationales for its effects, to describe contraindications and precautions for its use, and to discuss its efficacy as reported in the research literature. The latter part of the article deals with the use of joint mobilization for children with central nervous system (CNS) disorders. In an effort to understand precautions for the use of joint mobilization in children, musculoskeletal development will be described both for typically developing children and for children with spastic cerebral palsy. Indications for using joint mobilization techniques in children with spasticity will be outlined. Specific neurodevelopmental disabilities for which joint mobilization would be strongly contraindicated will be listed. Finally, future research directions in evaluating reliability of assessment of joint dysfunction and efficacy of joint mobilization in children will be discussed.