Comprehensive rehabilitation of patients with movement disorders with spastic forms of cerebral palsy

Until now, there is no radical method of treating children with cerebral palsy, which allows us to consider scientific research in this direction reasonable and promising.The aim of the research: to study the effect of exercises on the mini-simulator “Kinesioplatform-swing” with biofeedback on the indicators of motor skills in children with spastic cerebral palsy.Materials and methods. We conducted an open, non-randomized, prospective, comparative, controlled study in pairs (each participant in the main group corresponds to a participant in the control group). The study involved 53 patients aged 4–12 years with cerebral palsy: the intervention group (group 1: n = 27 (13 boys, 14 girls)) and the control group (group 2: n = 26 (11 boys, 15 girls)), comparable in terms of gender, age and severity of movement disorders. Characteristics of the medical intervention: group 1 – botulinum toxin type A (BTA, for exercising against the background of relative muscular normotonus) + exercise therapy + exercises on the mini-simulator “Kinesioplatform-swing” with biofeedback (BFB); group 2 – BTA + exercise therapy. Duration of the study: 2019–2020. The difference between groups in terms of motor skills on the day of hospitalization and after completion of the training program (10 sessions each) was determined. Motor skills were assessed according to the GMFM-66/88 (Gross Motor Function Measure) table using the “Scales for measuring global motor functions”.Results. The inclusion of additional exercises on the mini-simulator “Kinesioplatformswing” with biofeedback in the rehabilitation of patients with movement disorders with spastic cerebral palsy (BTA + exercise therapy) in comparison with the control group. However, the question of the long-term effects of such training remains open and requires further study.

[Multilevel botulinum toxin treatment in severe spastic forms of cerebral palsy (GMFCS IV-V)]

OBJECTIVE

To evaluate the most typical target muscles and dosages for the first and repeated botulinum toxin A (BTA) injections in cerebral palsy (CP) patients with severe motor deficit - GMFCS IV-V.

MATERIAL AND METHODS

A retrospective analysis of 677 protocols of the first and repeated Abobotulinumtoxin A (AboA) injections in 333 patients with CP GMFCS IV and V, aged 1 to 18 years, was carried out.

RESULTS

Ninety-seven percent of patients received multilevel injections. In the lower extremities the most typical target muscles were: m.gracilis - 221 (66.4%) patients, hip adductors - 164 (49.2%), medial hamstring - 144 (43.2%). In the upper extremities the most typical muscles were: m.pronator teres - 237 (71.2%) patients, m.biceps brachii+m.brachialis - 197 (59.2%). The total dosages of AboA and dosages for every target muscle were calculated. Several patients required high dosages (more than 30 U/kg of AboA). Higher dosages per kg were used in younger children and for repeated injections. The age-related evolution of spastic patterns was described. Adverse events were observed in 36 cases (5.3% of all injections).

CONCLUSION

The majority of patients with GMFCS IV-V required multilevel BTA injections in high dosages, especially in young age. Described selection of target muscles and dosages of AboA could be taken into account as a practical experience and reference for the BTA therapy in GMFCS IV-V patients.

Objective Signs of Foot Deformities in Children with Spastic Form of Cerebral Paralysis: Justification of Individual Approach to Footwear Support

Relevance. Foot deformities are the most common locomotor pathology in children with infantile cerebral paralysis. At the same time many children suffering from this pathology wear standard shoes that do not take into account the individual foot anatomy. Purpose of the study — to justify the expedience of individual approach to orthopaedic support for children with infantile cerebral paralysis. Materials and methods. The authors examined 220 feet in 110 patients aging from 3 to 18 years: 62 patients with spastic form of infantile cerebral paralysis and 48 children who were examined during periodic screening at general education institutions (control group). Clinical examination methods, computerized plantography and podometry by flatbed foot scanning (ventrally, posteriorly, medially) in standing position were used in the present study. Results. Statistically significant variances (p*0.005) were obtained for 8 indicators of foot deformity in three planes in children with infantile cerebral paralysis as compared to the norm, as well as differences between the groups of patients with varying degree of disorders in gross motor functions. The authors established pathological foot deformities in children with infantile cerebral paralysis; statistically significant variances in types and degrees of these disorders for patient groups with different levels of gross motor functions disorders; distinctiveness of foot deformities within each of the groups. Conclusion. Objectively instrumental method was used to identify the main components of foot deformities in patients with infantile cerebral paralysis with preservation and realization of walking capability: loss of height of longitudinal arches, midfoot pronation and hindfoot valgus, hallux valgus. Increased elevation of longitudinal arches (cavus foot), midfoot supination and hindfoot varus are rarer components of deformities occurring more often in patients with severer forms of the pathology. Strong variation in the spread of foot anatomy parameters observed within different groups of motor dysfunctions indicates the expediency of individual approach to footwear recommendations: standard, less or more complex orthopaedic shoes. Implementation of obtained data into the clinical practice requires additional series of biomechanical trials aimed at elaboration of criteria for recommendations and efficiency evaluation of various footwear types that take into account not only specifics of foot anatomy but also its statodynamic function as well as the level of gross motor functions of a particular patient.