Shashtika Shali Pinda Sweda in the Management of Cerebral Palsy: A Critical Review

Introduction

Disabled children are of great concern to a family as well as to the society. When disability is discussed, particularly in children, about a quarter of chronic childhood problems are neurological in origin. Cerebral palsy (CP) is the leading cause of chronic disability in children [1], making them physically and mentally handicapped and socially aloof. The worldwide incidence of CP is approximately 2 to 2.5 cases per 1000 live births [2]. In India, it is estimated at around

3 cases per 1000 live births; however, being a developing country the actual figure may be much higher than probable figures. There are about 25 lakh CP children in India as per the last statistical information [3]. It is a symptom complex or syndrome condition rather than a single disease. It is an umbrella term encompassing a group of nonprogressive, noncontagious condition that causes motor impairment syndrome characterized by abnormalities in movement, posture, and tone [4]. In short, it is a group of symptoms occurring due to the involvement of musculature, sense organs (i.e. vision, hearing, speech, etc.), and the mind, including intelligence at variable extents. It can be caused by any of prenatal, natal, and postnatal factors and the primary eventual pathology is any type of injury to the developing brain. Due to the nonprogressive nature of the lesion, historically it is considered as static encephalopathy and excludes all the progressive neurological disorders [5]. No effective treatment for the underlying brain damage has been formulated to date. All the sophisticated technologies and highly expensive and complicated therapies in the medical research field have failed to find a definite cure for this disease. There is no similar disease or symptom complex in Ayurveda that is synonymous to CP. While observing the etiology and clinical features, the predominance of Vata is obvious, and this classifies this disease entity closer to Vatadominant conditions (i.e. Vata Vyadhi). Whereas etiology is concerned, about 75% factors are prenatal in origin [6] Causative factors such as inappropriate Ritu, Kshetra, Ambuand Bija [7]. Dauhrida Avimananat [8, 9], (negligence of pregnancy craving), presence of Garbhopaghatakarabhava [10, 11] incompatible Garbha Vriddhikarabhava [12] and improper following of Garbhini Paricharya [13, 14] may have undesirable effect on the fetus inutero. These hamper the normal growth and development of the child and cause several diseases, deformities, and even death. The mentioned classical references provide an idea about some of the factors or events that result in the occurrence of such comorbid conditions, including CP. Preventive aspects are given more emphasis to limit their occurrence and this can be said to be the only way of coping up with diseases that have a higher prevalence with no definite cure option available. The use of Panchakarma procedures and specific oral medications have been found to improve clinical practices and ongoing researches compared with only oral medication or physiotherapy Considering this, it is planned to study the effect of Abhyanga and Shashtika Sali pinda Sweda (SSPS) with internal administration of medicine.

Method of Administration

Abhyanga should be performed with prescribed Taila for about 15 to 35 minutes before the main procedure. The prepared Pottali are taken and dipped in the mixture of Bala moola Kwatha and cow milk which is simultaneously boiled. This Pottali is rubbed and squeezed mildly on the patient. This is done in 7 postures (2 to 5 Min in each posture). After the procedure is completed the Shashtika is scrapped from the body and Taila applied over the body with mild massage.

After the Shashtika Shali Pinda Sweda treatment, Patient should be advised to take lukewarm water bath. The total duration of the procedure may vary from 45 to 90minutes.The procedure is normally performed for 7 to 21 days according to the condition of the patient and may vary according to the condition of the diseased. Shashtika Shali Pinda Sweda will help to improve circulation, nourishment to the body. It also improve the strength of the tissue of bones and muscles.

Discussion

The medicated oil used in Abhyanga helps in preventing muscular atrophy and improving tone. Generally, Bala Taila is applied for Abhyanga. Bala is Vatashamaka and Balya thus provides nutrition to the muscular tissue and thereby preventing atrophy of muscles. Also the Taila possess Snigdha Guna by virtue of which it performs Snehana, Kledana and Vishyandana of body at cellular level. Also, Abhyanga causes reduction of tone in muscles, which are in a state of excess tension. Stretching of tight fascia and restoration of mobility of soft tissues also occurs.

Pain and stiffness of muscle in Cerebral Palsy mainly occurs due vitiation Vata. Probable mode of action of Abhyanga [22]- The Abhyanga should be done before Shasthika Shali Sweda. The effect of Abhyanga can be supposed by two means i.e. physical manipulations and the effect of medicated oil. Bala is VataShamak and Balya that absorbed locally with the help of oil media gives nourishment to muscle preventing from atrophy of muscle and improving muscular tone. Application of pressure done in correct manner may decrease the alpha motor neuron activity and thus decrease hyper excitability of motor neuron. The mechanism of action is not clearly known and the amount of pressure to be given to stimulate deep tendon receptors or superficial mechanoreceptors is still not properly understood. In a study massage therapy showed good result in the symptoms of Cerebral Palsy of children. In this way Abhynaga acts by the help of the Guna (properties) of Sneha (oil) thus mitigate vitiated Vata. The amount of pressure to be given to stimulate deep tendon receptors or superficial mechanoreceptors is still not properly understood. A study reported that in hemiparetic subjects the H-reflex was depressed during both continuous and intermittent tendon pressure. Intermittent pressure was more effective than continuous.

Probable mode of action of Shashtik Shali Pinda Sweda [22] • Spastic Cerebral Palsy was observed in 75 % patients. Spasticity is characterized by increased resistance by passive stretch,velocity dependent and asymmetric about joints (i.e. greater in flexor muscle at the elbow and the extensor muscle at the knee).

• In Ayurveda this may happen due to Avarana of Vata, wherein, due to Avarana, Vayu cannot perform its normal function i.e. normal movement of joints (Pravartaka Cheshtanam).

• Initially Udvartana might be helped in reduction of vitiated Kapha by its Ruksha and Srotoshodhana property. Once Avarana is removed the aim of treatment is to pacify vitiated Vata. Vayu resides in Sparshnendriya which is located in Tvachya, Abhyanaga is quoted as Tvachya. So, Abhyanga along with Shastika Shali Pinda Sweda might work directly on Vata to bring it back to normalcy. Shshtika Shali rice has the snigdha, laghu etc. Guna and Brihana like Karma, So SSPS nourishes the full body and it is strengthening fomentation which can be very useful in condition like malnutrition of limbs. SSPS enhances physical consistency and increases the muscular strength.

Conclusion

Although Cerebral Palsy is incureable, but Ayurveda can give a better control by enhancing the quality of life of children having Cerebral palsy with better longevity. The effect of Shashitika Shali Pinda Swedana is helpful in reducing the spasticity, joint deformities and prevention of contractures and thus improving muscle tone, gain in muscle strength & proper nourishment of dhatus. From this case study, it can be concluded that Shashtika Shali Pinda Sweda can be used for the management of pain, stiffness in cerebral Palsy. This is Attempt to describe information regarding Shashitika Shali Pinda Sweda in the management of Cerebral Palsy in this Research article.