One of the most difficult problems in the rehabilitation of children with cerebral palsy (CP) is the limitation of the ability to perform voluntary movements due to spasticity, decreased muscle strength, muscle contractures, dystonia and impaired coordination. Despite the non-progressive nature of neurological disorders in cerebral palsy without proper physical rehabilitation, there is an increase in the severity of motor disorders and, as a consequence, the gradual progression of life limitations with age.
The dissertation research was performed within the research work of the Department of Physical Rehabilitation, Sports Medicine and Valeology of the Dnipro State Medical University "Medical and pedagogical support of physical rehabilitation, sports and health training" (state registration number 0116U004468, 2017-2021).
In the study were included 54 children aged 6 to 12 years with spastic cerebral palsy. Spastic diplegic form of cerebral palsy (SD) was diagnosed in 30 people, spastic hemiplegic form (SH) - in 24 people. All patients within each clinical group were divided into 2 subgroups of the study: I and II subgroups in the group of SD and III and IV subgroups in the group of SH.
It was made "Device for rehabilitation of people with musculoskeletal disorders", which allows the patient to independently or with the help of the operator, performing functional walking using cyclic movements of the lower and/or upper extremities, to move in real conditions environment that promotes the formation of psychomotor skills inherent in healthy people. In addition, the design ability of the Rehabilitation Device to provide fixation of legs, pelvis, torso and head of varying degrees of stability, partial unloading of the patient's body weight, taking into account the length and width of the step, create conditions for tasks and development of static and dynamic skills.
All patients were prescribed a standard set of physical therapy measures and additionally prescribed therapeutic exercises using the developed rehabilitation device according to dynamic (subgroups I and III) and static (subgroups II and IV) methods.
In the process of rehabilitation in both observation groups there was an improvement in spatio-temporal gait: step length (SL), stride length (CL) and step width (SW), improved pattern of walking in terms of the ratio of the SL with one foot and the other, increased the walking speed (WS).
A particularly significant increase in CL was observed during the first two weeks in the group of diabetes. In the SG group, the most positive effect was achieved on the dynamics of the characteristics of walking symmetry. The dynamics of the ratio of SL in subgroups I and II was 0.04±0.02 units. and 0.03±0.02 units, respectively (p<0.05). Statistically significant increase in WS was in the subgroups that performed the load in the dynamic mode. The largest statistically significant increase in WS was achieved in both observation subgroups at 5-6 weeks of the proposed rehabilitation program.
The level of spasticity in the calf muscles of the leg and biceps femoris decreased significantly by an average of 0.43±0.12 points and 0.50±0.14 points in subgroup I, by 0.38±0.09 points and 0.46±0.12 points in subgroup II, 0.36±0.09 points and 0.46±0.13 points in subgroup III and 0.31±0.09 points and 0.54±0,15 points in the IV subgroup of observation (p<0,05). However, after the application of the developed program, a lower level of spasticity was found in the SH group (p<0.05).
The application of the developed rehabilitation program had a positive effect on the amplitude of movements in the joints of the lower extremities, in particular, decreased manifestations of flexion muscle contracture of the hip joint, drive contracture of the muscles of the hip joint, flexion contracture of the knee joint and flexion contracture of ankle joint.
The use of physical rehabilitation program has improved the strength of the lower extremity muscles, including the thigh muscles and the tibia extensor muscles in patients who have been exercising dynamically. In addition, the dynamics of overall endurance indicators was positive.
After the application of the therapeutic program, there was a significant increase in daily activities performed in subgroups I and III (p<0.05), especially during the first two weeks of the program.
Key words: children, cerebral palsy, spastic diplegia, spastic hemiplegia, rehabilitation, physical therapy, movement disorders, restriction of daily activity
