{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T14:29:10Z","timestamp":1789655350318,"version":"4.0.1"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T00:00:00Z","timestamp":1748476800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004156","name":"Mahidol University","doi-asserted-by":"publisher","award":["Faculty of Medicine Ramathibodi Hospital, Mahidol University"],"award-info":[{"award-number":["Faculty of Medicine Ramathibodi Hospital, Mahidol University"]}],"id":[{"id":"10.13039\/501100004156","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec014\">\n<jats:title>Background<\/jats:title>\n<jats:p>Various types of massage, including the traditional Thai, have not yet provided conclusive evidence to reduce the spasticity and improve walking ability for cerebral palsy (CP).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec015\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>To assess the effect of traditional Thai massage (TM) vs. a standard physical therapy (PT) on gait pattern in spastic CP.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec016\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A cross-over single blinded randomized controlled trial was conducted between October 2022 and October 2023 (Thai Clinical Trials Registry: TCTR20220530007). Individuals with aged 5 years or older, and diagnosed as spastic CP, Gross Motor Function Classification System (GMFCS) I-III were recruited. Participants were randomly assigned into group A (TM followed by PT), and group B (PT followed by TM). Each treatment lasted for 6 weeks (Phase I-II), with a 6-week washout period. Lower extremity range of motion, muscle tone, electromyography, gait profile score (GPS), oxygen consumption was blindly assessed and intention-to-treat analyzed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec017\">\n<jats:title>Results<\/jats:title>\n<jats:p>From 32 eligible patients (16 cases per group), average age was 16.1\u2009\u00b1\u20099.8 years (group A), and 13.6\u2009\u00b1\u20095.8 years (group B). Group B demonstrated higher left ankle dorsiflexion than group A (1.7\u2009\u00b1\u200913.0\u2009degrees vs 12.1\u2009\u00b1\u20096.9\u2009degrees, <jats:italic>P<\/jats:italic>-value\u2009=\u20090.011). GPS slightly improved in Phase I, and contradictory enhanced in TM while deteriorated in PT in Phase II without significant differences between groups. After adjusted for ankle dorsiflexion, TM significantly provided less overall GPS (-1.6 (95% confidence interval (CI) -2.6, -0.6), <jats:italic>P<\/jats:italic>-value\u2009=\u20090.001), and higher peak activity of right rectus femoris (0.132 mV (95%CI 0.001, 0.262), <jats:italic>P<\/jats:italic>-value\u2009=\u20090.030) compared to PT. Other outcomes did not differ significantly between two treatments, and no complication was detected.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec018\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>TM has a positive effect on gait performance, as indicated by GPS and increased activity in the right rectus femoris muscle when compared to PT. A large-scale non-inferiority trial is required to affirm the impact of TM.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0325169","type":"journal-article","created":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T20:08:09Z","timestamp":1748549289000},"page":"e0325169","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["The effect of traditional Thai massage vs routine physical therapy on gait pattern in spastic cerebral palsy: A cross-over randomized controlled trial"],"prefix":"10.1371","volume":"20","author":[{"given":"Peerapat","family":"Lertwiram","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chanika","family":"Angsanuntsukh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krongkaew","family":"Supapitanon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanyaporn","family":"Patathong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apiphan","family":"Iamchaimongkol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suchanont","family":"Baosuwan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2002-970X","authenticated-orcid":true,"given":"Ponsaphat","family":"Ongtanasin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phimpisut","family":"Srinorasit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5975-0998","authenticated-orcid":true,"given":"Patarawan","family":"Woratanarat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,5,29]]},"reference":[{"issue":"6","key":"pone.0325169.ref001","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0003003","article-title":"Magnitude and clinical characteristics of cerebral palsy among children in Africa: A systematic review and meta-analysis","volume":"4","author":"BB Abate","year":"2024","journal-title":"PLOS Glob Public Health"},{"issue":"9","key":"pone.0325169.ref002","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1038\/s41582-018-0043-6","article-title":"The complex aetiology of cerebral palsy","volume":"14","author":"SJ Korzeniewski","year":"2018","journal-title":"Nat Rev Neurol"},{"issue":"6","key":"pone.0325169.ref003","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1016\/j.ajog.2015.05.034","article-title":"Cerebral palsy: causes, pathways, and the role of genetic variants","volume":"213","author":"AH MacLennan","year":"2015","journal-title":"Am J Obstet Gynecol"},{"issue":"8","key":"pone.0325169.ref004","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1017\/S001216220500112X","article-title":"Proposed definition and classification of cerebral palsy, April 2005","volume":"47","author":"M Bax","year":"2005","journal-title":"Dev Med Child Neurol"},{"key":"pone.0325169.ref005","article-title":"Effects of Thai Massage on Spasticity in Young People with Cerebral Palsy","author":"P Malila","year":"2015","journal-title":"J Med Assoc Thai"},{"issue":"4","key":"pone.0325169.ref006","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1177\/0269215509353254","article-title":"Rehabilitation in practice: spasticity management","volume":"24","author":"VL Stevenson","year":"2010","journal-title":"Clin Rehabil"},{"issue":"1","key":"pone.0325169.ref007","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1589\/jpts.28.7","article-title":"Effect of combining passive muscle stretching and whole body vibration on spasticity and physical performance of children and adolescents with cerebral palsy","volume":"28","author":"T Tupimai","year":"2016","journal-title":"J Phys Ther Sci"},{"issue":"6","key":"pone.0325169.ref008","doi-asserted-by":"crossref","first-page":"250","DOI":"10.3390\/medicina55060250","article-title":"Effect of a Combined Stretching and Strength Training Program on Gait Function in Children with Cerebral Palsy, GMFCS Level I & II: A Randomized Controlled Trial","volume":"55","author":"MA Fosdahl","year":"2019","journal-title":"Medicina (Kaunas)"},{"issue":"1","key":"pone.0325169.ref009","first-page":"87","article-title":"The effect of deep cross friction massage on spasticity of children with cerebral palsy: A double-blind randomised controlled trial","volume":"67","author":"F Rasool","year":"2017","journal-title":"J Pak Med Assoc"},{"issue":"3","key":"pone.0325169.ref010","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1111\/j.1469-8749.2007.00187.x","article-title":"Effects of massage on the mechanical behaviour of muscles in adolescents with spastic diplegia: a pilot study","volume":"49","author":"R Macgregor","year":"2007","journal-title":"Dev Med Child Neurol"},{"issue":"11","key":"pone.0325169.ref011","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.1080\/09638288.2019.1671500","article-title":"Effect of physical therapy interventions on spatiotemporal gait parameters in children with cerebral palsy: a systematic review","volume":"43","author":"C Corsi","year":"2021","journal-title":"Disabil Rehabil"},{"key":"pone.0325169.ref012","doi-asserted-by":"crossref","first-page":"1171224","DOI":"10.3389\/fneur.2023.1171224","article-title":"Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review","volume":"14","author":"S Faccioli","year":"2023","journal-title":"Front Neurol"},{"issue":"8","key":"pone.0325169.ref013","article-title":"Physical therapy interventions in children with cerebral palsy: a systematic review","volume":"15","author":"NA Gonzalez","year":"2023","journal-title":"Cureus"},{"issue":"22","key":"pone.0325169.ref014","doi-asserted-by":"crossref","first-page":"4513","DOI":"10.3390\/ijerph16224513","article-title":"Impact of Resistance Therapy on Motor Function in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis","volume":"16","author":"L Collado-Garrido","year":"2019","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0325169.ref015","doi-asserted-by":"crossref","first-page":"20","DOI":"10.4103\/ortho.IJOrtho_241_17","article-title":"Evidence-based Approach to Physical Therapy in Cerebral Palsy","volume":"53","author":"SP Das","year":"2019","journal-title":"Indian J Orthop"},{"issue":"4","key":"pone.0325169.ref016","first-page":"10","article-title":"Survey of the use of massage for children with cerebral palsy","volume":"3","author":"GM Glew","year":"2010","journal-title":"Int J Ther Massage Bodywork"},{"issue":"1","key":"pone.0325169.ref017","first-page":"30","article-title":"Swedish massage and abnormal reflexes of children with spastic cerebral palsy","volume":"5","author":"V Alizad","year":"2007","journal-title":"Iran Rehabil J"},{"issue":"5","key":"pone.0325169.ref018","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1080\/0300443042000230546","article-title":"Cerebral palsy symptoms in children decreased following massage therapy","volume":"175","author":"M Hernandez\u2010Reif","year":"2005","journal-title":"Early Child Development and Care"},{"issue":"5","key":"pone.0325169.ref019","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.12669\/pjms.35.5.478","article-title":"Potential effects of traditional massage on spasticity and gross motor function in children with spastic cerebral palsy: A randomized controlled trial","volume":"35","author":"Q Mahmood","year":"2019","journal-title":"Pak J Med Sci"},{"issue":"2","key":"pone.0325169.ref020","first-page":"4","article-title":"The Effectiveness of Massage for Children With Cerebral Palsy: A Systematic Review","volume":"34","author":"Z G\u00fc\u00e7han Topcu","year":"2020","journal-title":"Adv Mind Body Med"},{"key":"pone.0325169.ref021","unstructured":"Alizad V, Sajedi F, Vameghi R. Muscle tonicity of children with spastic cerebral palsy: How effective is Swedish massage? Iran J Child Neurol. 2009;3(2):25\u20139."},{"key":"pone.0325169.ref022","first-page":"1311","article-title":"The efficacy of traditional Thai massage in decreasing spasticity in elderly stroke patients","volume":"9","author":"T Thanakiatpinyo","year":"2014","journal-title":"Clin Interv Aging"},{"issue":"3","key":"pone.0325169.ref023","first-page":"401","article-title":"A comparison of immediate effect between traditional Thai massage and passive static stretching on alteration of spasticity and walking ability in children with cerebral palsy","volume":"31","author":"P Malila","year":"2019","journal-title":"Arch Allied Health Sci"},{"issue":"2","key":"pone.0325169.ref024","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1002\/pri.1629","article-title":"Capacity of Physiotherapy Workforce Production in Thailand: Public-Private Mix, Secular Trend and Geographic Distribution","volume":"21","author":"S Kaewsawang","year":"2016","journal-title":"Physiother Res Int"},{"issue":"3","key":"pone.0325169.ref025","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1002\/jor.1100080310","article-title":"Measurement of lower extremity kinematics during level walking","volume":"8","author":"MP Kadaba","year":"1990","journal-title":"J Orthop Res"},{"issue":"4","key":"pone.0325169.ref026","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1016\/j.gaitpost.2011.12.008","article-title":"The minimal clinically important difference for the Gait Profile Score","volume":"35","author":"R Baker","year":"2012","journal-title":"Gait Posture"},{"key":"pone.0325169.ref027","doi-asserted-by":"crossref","first-page":"480956","DOI":"10.1155\/2014\/480956","article-title":"Adverse events of massage therapy in pain-related conditions: a systematic review","volume":"2014","author":"P Yin","year":"2014","journal-title":"Evid Based Complement Alternat Med"},{"issue":"2","key":"pone.0325169.ref028","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.gaitpost.2015.04.019","article-title":"Gait Deviation Index, Gait Profile Score and Gait Variable Score in children with spastic cerebral palsy: Intra-rater reliability and agreement across two repeated sessions","volume":"42","author":"HM Rasmussen","year":"2015","journal-title":"Gait Posture"},{"key":"pone.0325169.ref029","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.clinbiomech.2018.08.002","article-title":"Impact of multilevel joint contractures of the hips, knees and ankles on the Gait Profile score in children with cerebral palsy","volume":"59","author":"SJ Holmes","year":"2018","journal-title":"Clin Biomech (Bristol)"},{"key":"pone.0325169.ref030","article-title":"CONSORT 2010 statement: extension to randomised crossover trials","volume":"366","author":"K Dwan","year":"2019","journal-title":"BMJ"},{"issue":"1","key":"pone.0325169.ref031","doi-asserted-by":"crossref","first-page":"29","DOI":"10.33192\/smj.v75i1.260527","article-title":"Comparative Effectiveness of Court-Type Thai Traditional Massage and Ultrasound Therapy in Patients with Neck Pain: A Randomized Controlled Trial","volume":"75","author":"N Watcharasirikul","year":"2023","journal-title":"Siriraj Med J"},{"key":"pone.0325169.ref032","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1186\/s12906-016-1282-y","article-title":"The effects of the court-type Thai traditional massage on anatomical relations, blood flow, and skin temperature of the neck, shoulder, and arm","volume":"16","author":"V Plakornkul","year":"2016","journal-title":"BMC Complement Altern Med"},{"issue":"2","key":"pone.0325169.ref033","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/S2095-4964(17)60323-6","article-title":"The anatomical study of the major signal points of the court-type Thai traditional massage on legs and their effects on blood flow and skin temperature","volume":"15","author":"Y Viravud","year":"2017","journal-title":"J Integr Med"},{"key":"pone.0325169.ref034","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1251\/bpo115","article-title":"Techniques of EMG signal analysis: detection, processing, classification and applications","volume":"8","author":"MBI Raez","year":"2006","journal-title":"Biol Proced Online"},{"issue":"3","key":"pone.0325169.ref035","first-page":"135","article-title":"Effects of functional massage on spasticity and motor functions in children with cerebral palsy: a randomized controlled study","volume":"5","author":"H Bing\u00f6l","year":"2018","journal-title":"J Exerc Ther Rehabil"},{"key":"pone.0325169.ref036","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.ejmhg.2014.02.007","article-title":"Effect of whole-body vibration on muscle strength, spasticity, and motor performance in spastic diplegic cerebral palsy children","volume":"15","author":"MM Ibrahim","year":"2014","journal-title":"Egypt J Med Hum Genet"},{"issue":"1","key":"pone.0325169.ref037","first-page":"97","article-title":"Effectiveness of simple and basic home-based exercise programs including pediatric massage executed by caregivers at their homes in the management of children with spastic cerebral palsy: A randomized controlled trial","volume":"17","author":"Q Mahmood","year":"2024","journal-title":"J Pediatr Rehabil Med"},{"key":"pone.0325169.ref038","doi-asserted-by":"crossref","first-page":"657","DOI":"10.3389\/fneur.2019.00657","article-title":"Effects of Therapeutic Exercise Intensity on Cerebral Palsy Outcomes: A Systematic Review With Meta-Regression of Randomized Clinical Trials","volume":"10","author":"C-W Hsu","year":"2019","journal-title":"Front Neurol"},{"key":"pone.0325169.ref039","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.ridd.2014.12.017","article-title":"Effects of an eight-week whole body vibration on lower extremity muscle tone and function in children with cerebral palsy","volume":"38","author":"H-YK Cheng","year":"2015","journal-title":"Res Dev Disabil"},{"issue":"10","key":"pone.0325169.ref040","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.3109\/02699052.2013.804202","article-title":"Spasticity after stroke: physiology, assessment and treatment","volume":"27","author":"A Thibaut","year":"2013","journal-title":"Brain Inj"},{"key":"pone.0325169.ref041","doi-asserted-by":"crossref","first-page":"673956","DOI":"10.3389\/fped.2021.673956","article-title":"Feasibility of Early Intervention Through Home-Based and Parent-Delivered Infant Massage in Infants at High Risk for Cerebral Palsy","volume":"9","author":"V Menici","year":"2021","journal-title":"Front Pediatr"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0325169","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T20:08:19Z","timestamp":1748549299000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0325169"}},"subtitle":[],"editor":[{"given":"Mshari","family":"Alghadier","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,5,29]]},"references-count":41,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0325169","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,29]]}}}