According to the literature, the efficacy of reflexology modality has been confirmed as an effective method for improving motor function in children with CP, normalizing the muscular tonus, improving walking, speech skills, and quality of life by expanding the functionality, as well as possessing positive effects on sleep, constipation, and saliva (Özkan & Zincir, 2018; Ukhanova & Gorbunov, 2012; Ukhanova, Gorbunov, Dement'eva, Volkova, & Novikova, 2012; Ukhanova, Noivikova, & Dement'eva, 2012; Wang, Tsai, Lee, Chang, & Yang, 2008; Whatley et al., 2022).
The current study showed that receiving foot reflexology did not affect motor functions in children with CP between the ages of 2 and 6. There are no reports for comparing the current investigation's outcomes within the same age group. However, more than half of the participants had quadriplegia. Children with this type of CP showed severe motor impairments. Additionally, children's mobility levels in GMFCS fall in levels III and IV.
Children with CP can have mild symptoms, from one leg affected by motor dysfunction to more severe cases, like one cannot even sit without support (da Costa Cunha et al., 2017). Therefore, reflexology as complementary and alternative medicine could help reduce spasticity, improve joint mobility, and enhance functional independence (Elbasan & Bezgin, 2018; Ukhanova, Gorbunov, et al., 2012).
Moreover, nearly two-thirds of children suffered from muscle stiffness & exaggerated reflexes. Such symptoms could interfere with the mechanism of reflexology actions that depends on the act of nerve theory. Therefore, the GMFCS method is widely accepted as the diagnostic tool to predict motor development in children with CP (Piscitelli et al., 2021). The current study found that children with CP aged 4–6 years exhibited modest improvement in their motor abilities. A similar study conducted by Elbasan and Bezgin et al. to evaluate the effects of reflexology on motor skills in CP patients with GMFCS levels of 3/4/5 showed that reflexology has a contradictory impact on motor development (Elbasan & Bezgin, 2018). In another study, Özkan and Zincir et al. conducted 24 physiotherapy sessions, revealing that reflexology with physiotherapy improved gross motor functions but did not improve children's quality of life (Özkan & Zincir, 2017). Shailaja et al. showed that massage therapy improved gross motor functioning in individuals with CP (Shailaja, Rao, Debnath, & Adhikari, 2014).
The current study suggests that combining reflexology and physiotherapy can improve motor functions by reducing leg spasticity if followed for more duration. In addition, this procedure can activate brain and spinal reflex points on the foot, which may unclog neural pathways, ultimately enhancing spastic muscle nerve function and allowing nerve impulses to more effectively. Another possible explanation is that improving their microcirculation improves children's motor impairment.
Regarding limitations, the current study was conducted in all outpatient clinics in the region; however, due to constraints on obtaining approval. In addition, this study was limited to only two hospitals. Due to the sample size and convenience, it is conceivable that the participants do not represent all children with CP. Therefore, generalizations should be made with caution.