ADHD is a neurodevelopmental disorder with attention deficit, hyperactivity, impulsivity, poor emotional self-regulation and motor problems. It carries a psychosocial functional impairment that should be considered. Somatic features such as joint-hypermobility, dysautonomia and somatology have been shown to be characteristic, not being included in the diagnostic criteria._x000D_ _x000D_ Although pharmacotherapy remains the treatment of choice, benefits of non-pharmacological treatments have been observed, representing Physiotherapy (PT) an opportunity in a multidisciplinary approach._x000D_ _x000D_ Autonomic imbalances involved in mental pathologies provide an opportunity to study the neurophysiological effects of PT, representing heart-rate-variability (HRV) a marker of the autonomic activity, of self-regulation and psychiatric illness._x000D_ _x000D_ Purpose: To analyze short, medium/long-term neurophysiological effects of two manual-therapy (MT) programs in a group of ADHD children, based on time/frequency domain parameters of HRV, and the relationship between somatic features with the autonomic response._x000D_ _x000D_ To analyze-compare the neuropsychological efficacy of two MT programs in the medium/long-term, on the core symptoms of ADHD, on psychosocial development, quality of life, health self-perception and on methylphenidate side effects._x000D_ _x000D_ The medium/long-term relationship between neurophysiological-neuropsychological-psychosocial dimensions was investigated to study the influence of neurovegetative changes on behavior._x000D_ _x000D_ Material-methods: A double-blind, clinical trial was conducted in 48 children with ADHD randomized into two intervention groups (IG’s). Both groups received multimodal treatment and 4 sessions of two MT programs: a massage (IG1) or a manual cranial-therapy (MCT) program (IG2). Variables: vital signs, time/frequency domain HRV parameters, joint-hypermobility, somatotype, coordination, motor-control, fine motor skills, methylphenidate side effects (biological-dimension). Neuropsychological-dimension: oppositionism, inattention, hyperactivity, ADHD-index, selective attention, severity-improvement. Psychosocial-dimension: psychosocial development, quality of life, health self-perception._x000D_ _x000D_ _x000D_ _x000D_ Results-Conclusions: Baseline levels of joint-hypermobility, ectomorphism, psychomotor-impairment, impairment of psychosocial development, of quality of life, of health self-perception and basal sympathetic activity (reflecting a worse cardiac vagal control and self-regulation)._x000D_ _x000D_ The MCT program may be included in the management of ADHD, due to the effects in motor skills and its autonomic action (parasympathetic predominance). It also increased cardiac vagal control and the state of relaxation, improving both emotional self-regulation and self-control. The effects of the MCT program revealed a significant interrelation between the LF/HF ratio, methylphenidate side effects and psychosocial development. As HRV moved towards a predominance of parasympathetic activity, methylphenidate side effects decreased and quality of life increased._x000D_ _x000D_ Both programs showed significant neuropsychological effects on ADHD core symptoms in the medium/long-term. The MCT program showed significant effects in the medium/long-term on satisfaction and self-esteem, physical well-being, emotional, family participation, problem solving and physical activity._x000D_ _x000D_ These findings support that the MCT program may exert effects on vagal functions since the applied techniques had a direct/indirect influence on the vagus nerve pathways._x000D_ _x000D_ The evaluation of somatic and neurophysiological features should be included in the diagnosis process, requiring an approach, combining psychopharmacology, psychotherapy and Physiotherapy to treat the somatic and clinical manifestations._x000D_ _x000D_ Manual-therapy is a safe technique which may reduce pharmacotherapy side effects, improving the symptomatology of this condition, quality of life, physical-emotional well-being and interpersonal relationships.
| Date of Award | 22 Oct 2020 |
|---|
| Original language | Spanish |
|---|
| Supervisor | Jorge Ramón Esquirol Caussa (Director) & Diego Jose Palao Vidal (Director) |
|---|