RU2822018C1 - Method for rehabilitation of preschool children with spastic diplegia and hemiparetic form of infantile cerebral palsy - Google Patents

Abstract

FIELD: medicine; neurology.

SUBSTANCE: invention relates to rehabilitation and can be used in complex treatment and rehabilitation of preschool children with spastic diplegia and hemiparetic form of infantile cerebral palsy. Following methods of examination are carried out: clinical method: interviewing, examination, assessment of the somatic, neurological status with determination of the degree of spasticity of the involved extremities according to Ashford, muscle strength according to 6-point scale; neuro-orthopedic examination; laboratory methods: CBC, urine analysis, biochemical blood analysis, ECG, neurophysiological methods: ENMG, EEG; X-ray methods: radiography of hip joints; neuro-visual methods: CT and MRI of the brain. Quality of life is assessed by using the parent form of the Russian version of the questionnaire PEDSQL4.0 for children aged 5–7 years. After establishing the diagnosis, infantile cerebral palsy, spastic diplegia or hemiparetic form of cerebral palsy with underlying standard therapy in physical therapy gymnasium 5 times week for 2 weeks at the same time, in morning for 28 minutes, for 10 days with the help of an physical therapy instructor and, if necessary, with the participation of a parent, a complex of dynamic therapy is carried out, consisting of 5 stages: warm-up—5 minutes, lesson on vibration platform "Galileo" (first approach)—4 minutes, frequency range of vibration oscillations—from 8 to 12 Hz, main part (movement therapy)—10 minutes, lesson on vibration platform "Galileo" (second approach)—4 minutes, frequency range of vibration oscillations is from 8 to 12 Hz, relaxation is 5 minutes. Load is controlled by a physiotherapist. Exercises are combined with deep rhythmic breathing.

EFFECT: method provides improved functional abilities, correction of secondary complications, motor rehabilitation, physiotherapy and occupational therapy.

1 cl, 3 tbl, 1 ex

Description

Field of technology to which the invention relates

The invention relates to the field of medicine, namely to neurology, rehabilitation, and can be used in the complex treatment and rehabilitation of preschool children with spastic diplegia and hemiparetic form of cerebral palsy.

State of the art

There is a known method of hippotherapy for patients with cerebral palsy, including therapeutic horse riding, while therapeutic horse riding is carried out in a neuro-orthopedic pneumatic suit by passively-actively mastering poses on a horse without a saddle for a total of 23-27 lessons, and treatment is carried out in three stages: 2-3 classes - initial, then 18-20 classes - rehabilitation and 3-4 classes - consolidating, while at the initial stage the child masters and performs poses in the absence of movement of the horse, the rehabilitation stage includes performing poses in a shorter time in a stationary stance of the horse and with it moving at a slow pace in a circle, and the final stage includes performing poses in a shorter time while the horse moves at a slow pace in a circle, with a gradual increase during the course in the share of the child’s participation in performing each pose and a decrease in the participation of the instructor and parent (see Pat. RU No. 2469694, IPC A61N 1/00, A61N 1/02, A61N 7/00, published 12/20/2012, bulletin.

The disadvantage of this method is its lack of effectiveness.

There is a known method for the complex treatment of motor disorders in children with cerebral palsy, which includes, against the background of standard treatment, exposure to a pulsed low-intensity electromagnetic field using the INFIT apparatus, the duration of exposure is 15 minutes, the course of treatment is 10 daily procedures, with additional daily classes on the coordination platform , balance, strength (KOBS) lasting 25 minutes, the course of treatment is 10 sessions, and this session is carried out 2 hours after exposure to a pulsed low-intensity electromagnetic field (see Pat.RU No. 2525689, IPC A61N 5/02, A61N 1/00, published 08/20/2014, bulletin No. 23).

The disadvantage of this method is the insufficient effectiveness of complex treatment of motor disorders in children with cerebral palsy through the use of a pulsed low-intensity electromagnetic field.

There is a known method for correcting motor disorders in children with spastic forms of cerebral palsy, which includes exposure to low-frequency pulse currents in the electrical stimulation mode, while on the second day after botulinum therapy, 10 procedures of myoelectric stimulation are carried out with the Ionoson-Expert apparatus, with the help of which they are first exposed to amplitude-modulated currents of average frequencies with a frequency range of 100-250 Hz and a carrier frequency of 7 kHz, a current strength of 8 to 20 mA for 4-7 minutes, then a medium-frequency current according to Kots is applied with a frequency of 50 Hz, a pulse and pause duration of 2:6 seconds, respectively, and carrier frequency 7 kHz, for 4-7 minutes; the method according to claim 1, while the effect of each type of current is for a child 2-6 years old - 4 minutes with a current strength of 8 mA, for a child 7-9 years old - 5 minutes with a current strength of 10 mA, for a child 10-15 years old - 7 minutes with a current of 20 mA (see Pat. RU No. 2549012, IPC 32, published 04/20/2015, Bulletin No. Ts).

The disadvantage of this method is the insufficient reduction in the incidence of complications in the form of the formation and progression of joint contractures.

There is a known method for complex rehabilitation of the motor function of the upper limb in patients with cerebral palsy, including the use of a neurotrophic drug against the background of standard sanatorium-resort treatment, with additional training of the paretic limb using the Exohand-2 complex, and Cerebrolysin 2.0 ml intramuscularly is used as a neurotrophic drug a course of 10 injections daily in the morning 30 minutes before the start of training; the method according to claim 1, in which patients aged 14-16 years are given 10 training sessions daily, each of which consists of 3 sessions lasting 5 minutes with rest breaks of 10 minutes; the method according to claim 1, in which patients aged 17-18 years are given 14 training sessions daily, each of which consists of 5 sessions lasting 10 minutes with rest breaks of 5 minutes. (see patent RU No. 2741221, IPC A61N 1/00, published 01.22.2021, bulletin No. 3).

The disadvantage of this method is that the rehabilitation process does not take into account and does not have a sufficient impact on the development of motor skills of the upper extremities, which does not contribute to increasing the efficiency of social adaptation of patients with cerebral palsy.

There is a known method for complex rehabilitation of patients with cerebral palsy with low self-esteem of the emotional state, which consists in the fact that before the course of rehabilitation, the psycho-emotional status of the patient with cerebral palsy is assessed using the method of self-assessment of emotional states by A. Wesman and D. Ricks, and if low self-esteem of the emotional state is identified - points from 4 to 14 - an additional course of dolphin therapy is prescribed, consisting of a preparatory part, including 4 sessions, and a main part, including 6 sessions; each lesson of the preparatory part is carried out on a platform, introducing the child to a dolphin in a playful way, performing exercises on the platform for muscle relaxation, resistance, improving balance and motor coordination; each lesson of the main part is carried out in water, and the first stage of the main part of the lesson includes getting the patient accustomed to the water for five minutes, while the trainer holds the patient near the handrail, holding him in the thoracic and lumbar spine, and the patient performs movements in the joints of the limbs, then the patient strokes and hugs the dolphin, grabs and holds the dolphin’s fins with his hands, rides the dolphin together with the trainer, holding the dorsal fin with his hands and the tail with his feet; the second stage of the main part of the lesson includes resting in the water for five minutes, stabilizing breathing, while the patient is held by the handrails and is in an upright position, the trainer performs movements in the patient’s limbs aimed at relaxation, the patient exits the water, and removing the wetsuit from the patient and drying the patient; the method according to claim 1, wherein for patients with spastic hemiparesis, the duration of the preparatory part is 15 minutes, and the duration of the main part is 30 minutes; the method according to claim 1, wherein for patients with spastic tetraparesis, the duration of the preparatory part is 25 minutes, and the duration of the main part is 40 minutes; method according to claim 1, while training with a dolphin is carried out in an indoor pool with sea water at a temperature of 25-28 degrees (see patent RU No. 2770986, IPC A61N 1/00, publ. 04/25/2022, bulletin No. 12 ).

The disadvantages of this method are the duration and low efficiency, since a noticeable positive result is achieved only after the 4th session.

The closest in technical essence and achieved positive effect and accepted by the authors as a prototype is the method of using whole body vibration on spasticity and motor activity in children with hemiparetic cerebral palsy, while treatment is carried out using Compex-Winplate™ for whole body vibration for three 15 - minute sessions per week for eight weeks, after whole body vibration training, both general motor function and gait and balance skills were significantly improved, and spasticity in the muscles of the lower and upper limbs was significantly reduced, with improvements maintained after 12 weeks (see Tekin F, Kavlak E. Short and Long-Term Effects of Whole-Body Vibration on Spasticity and Motor Performance in Children with Hemiparetic Cerebral Palsy. 2021 Jun;128(3):l 107-1129. /0031512521991095).

The disadvantage of this method is its insufficient efficiency.

Disclosure of the Invention

The objective of the present invention is to develop a method for the rehabilitation of preschool children with spastic diplegia and hemiparetic form of cerebral palsy, which has efficiency, versatility, accessibility, the ability to improve static-dynamic-motor technique by reducing the pathological tone of the muscles of the trunk and limbs, developing verticalization skills, increasing mobility in the joints of the limbs, increasing the patient’s emotional background, improving motivation for further treatment and rehabilitation measures.

The technical result that can be achieved using the present invention boils down to improving functional abilities, correcting secondary complications, namely motor rehabilitation, physiotherapy and occupational therapy.

The technical result is achieved using a method for the rehabilitation of preschool children with spastic diplegia and hemiparetic form of cerebral palsy, including the combined use of whole body vibration and movement therapy in combination with deep rhythmic breathing, while the rehabilitation of preschool children is carried out in the physical therapy room five times a day a week for two weeks at the same time in the morning with the help of a therapeutic physical education instructor and, if necessary, a parent, for 28 minutes, while the method includes 5 stages: warm-up for five minutes, then a lesson on the Galileo vibration platform "for four minutes, with the frequency range of vibration oscillations being from 8 to 12 Hz, then motor therapy for ten minutes, then the second set of exercises on the Galileo vibration platform for four minutes, with the frequency range of vibration oscillations being from 8 to 12 Hz, relaxation for five minutes, and a combination of exercises with deep rhythmic breathing is carried out using standard therapy for cerebral palsy.

Carrying out the invention

A method of rehabilitation of preschool children with spastic diplegia and hemiparetic form of cerebral palsy is carried out as follows.

When a patient is admitted and a diagnosis of cerebral palsy, spastic diplegia or hemiparetic form is made, the following examination methods are performed:

- clinical method: survey, examination, assessment of somatic and neurological status with determination of the degree of spasticity of the affected limbs according to Ashford, muscle strength on a 6-point scale;

- neuroorthopedic examination;

- laboratory methods: complete blood count (OAK), complete urinalysis (UCA), biochemical blood test, electrocardiogram (ECG),

neurophysiological methods: electroneuromyography (ENMG), electroencephalography (EEG);

- X-ray methods: radiography of the hip joints;

- neuroimaging methods: computed tomography (CT) and magnetic resonance imaging (MRI) of the brain.

To assess the quality of life, the parent form of the Russian version of the PEDSQL4.0 questionnaire is used for children 5-7 years old.

After the diagnosis of cerebral palsy, spastic diplegia or hemiparetic form of cerebral palsy is established against the background of standard therapy in the physical therapy room 5 times a week for 2 weeks at the same time, in the morning for 28 minutes, for 10 days with the help exercise therapy instructor and, if necessary, with the participation of a parent, conduct a complex of dynamic therapy, consisting of 5 stages: warm-up - 5 minutes, exercise on the Galileo vibration platform (first approach) - 4 minutes, frequency range of vibration oscillations - from 8 to 12 Hz, the main part (motor therapy) - 10 minutes, exercise on the Galileo vibration platform (second approach) - 4 minutes, frequency range of vibration oscillations - from 8 to 12 Hz, relaxation - 5 minutes. The load is controlled by a physical therapy doctor. Exercises are combined with deep rhythmic breathing. The training program is developed by a physical therapy doctor after consultation with a neurologist.

Warm up at a slow pace: Starting position: lying on your back

1. Diaphragmatic breathing: on a slow deep inhalation, the stomach is actively protruded, on a slow deep exhalation, the stomach is drawn in, repeat 6 times.

2. Circular movements of the feet outward and inward, repeat 6 times.

3. Alternately strain the muscles of the thighs, mentally try to lift the leg without lifting it from the surface), perform 5 times and the muscles of the lower leg (mentally press the foot on an imaginary obstacle), perform 5 times.

Starting position: sitting on your buttocks with your legs slightly bent at the knees and hips.

1. Perform circular movements with the hands outward and inward, repeat 6 times.

2. Raise your shoulders up to your head, lower them, relax, repeat 6 times.

3. Turn the head to the right side, return to the starting position, then to the left side, return to the starting position, repeat 6 times.

Main part

1. Starting position: lying on your back, arms raised vertically in front of you at an angle of 90° to the body, legs bent at the knee joints at an angle of 45°, feet resting on the floor.

On the count of one, one hand is moved horizontally to ear level, the other hand is lowered down along the body; on the count of two, they return to their original position.

Perform 8 times, alternating with changing hands.

Breathing: at the count of times, when the hands are in opposite positions, exhale; on the count of two, when the hands are in the starting position, inhale. Breathing is deep, measured, smooth.

2. Starting position: lying on your back, arms placed along the body, legs bent at the knees at an angle of 45°, feet resting on the floor. For the first four counts, raise both hands up along the floor, outlining a semicircle; for the next four counts, both hands are lowered down along the floor, returning to the starting position.

Perform 8 times.

Breathing: the first four counts are inhalation, the next four counts are exhalation. Breathing is deep, measured, smooth.

3. Starting position: lying on your back, arms placed along the body, legs bent at the knee joints at an angle of 45°, feet resting on the floor. On the count of one, raise the right arm upward to an angle of 90° with the body, on the count of two, lower the straight arm to the opposite shoulder, on the count of three, grab the opposite straightened arm and hold it for 5 counts, then, on the count of eight, return it to the starting position. Repeat with the left hand. Perform 2 times on each hand. Breathing: count once - inhale; two, three, four - exit; at five, six, seven - inhale; at eight - exhale. While holding, breathing is deep, measured, smooth.

4. Starting position: on four points of support, hands on hands point-blank under the shoulder joints, knees under the hip joints, legs bent at the knee and hip joints 90°, gaze directed forward.

On the count of one, raise the right hand up and forward to a horizontal level, on the count of two, lower the hand down to the starting position. Repeat with the left hand. The exercise is performed alternately with each hand 4 times, a total of 8 times on both hands.

Breathing: on the count of one, when the hand is at the top, exhale, on the count of two, inhale. Breathing is deep, measured, smooth.

5. Starting position: sitting on the buttocks with crossed legs, bent at the knees and hip joints, arms straightened, hands resting on the floor on the sides of the pelvis.

Stepping movements of the arms forward to the count of one, two, three, four, are held for six counts, then walking movements of the arms backward to the count of one, two, three, four, return to the starting position. Repeat this exercise 4 times.

Then they change their legs in the starting position, first the right leg is in front, change it to the left, perform the exercise 4 more times on the left leg. Breathing: walking forward movements with your arms as you exhale, while holding the position - one and a half breathing cycles: one, two - enter, three, four - exhale, five, six - inhale, walking movements backward - exhale, inhale in the starting position. Breathing is deep, measured, smooth.

6. Starting position: lying on your back, arms placed along the body, legs bent at the knee joints at an angle of 45°, feet resting on the floor. On the count of one, straighten the right leg upward to an angle of 90° at the hip and knee joints, on the count of two, lower the leg down to the starting position. Repeat with the left foot. The exercise is performed in turn with each leg 4 times on each leg (8 times in total).

Breathing: when straightening the legs - exhale, in the starting position - inhale. Breathing is deep, measured, smooth.

7. Starting position: lying on your back, arms placed along the body, legs bent at the knees at an angle of 45°, feet resting on the floor. On the count of one, raise the pelvis from the floor due to extension in the hip joints, on the count of two, three, maintain this position, on the count of four, return to the starting position. Perform 6 times.

Breathing: when raising the pelvis up - exhale, while holding the position - inhale, when lowering the pelvis - exhale, in the starting position - inhale.

8. Starting position: lying on your back, arms along the body, legs bent at the knees at an angle of 45°, feet resting on the floor.

On the count of one, bend the right leg at the hip joint until the thigh touches the stomach, while pointing the foot away from you, on the count of two, return to the starting position. Repeat with the left foot. Perform the exercise in turn with each leg 4 times for each leg, 8 times in total.

Breathing: when bending the leg, exhale, in the starting position, inhale.

9. Starting position: sitting on the sit bones, legs shoulder-width apart, extended forward, slightly bent at the knee joints at an angle of 130-140°.

On the count of one, reach with the right hand to the right leg, and on the count of two, return to the starting position. They change arms and legs: they reach with their left hand towards their left leg. Perform 4 times on each side, alternating them, 8 times in total. Breathing: when stretching your hand towards your leg, exhale, in the starting position, inhale.

10. Starting position: sitting on the buttocks with crossed legs, bent at the knees and hip joints, arms raised in front of you horizontally at an angle of 90° to the body, hands pointing down. On the count of one, straight arms are spread to the sides at an angle of 90° from the body, squeezing the shoulder blades and directing the chest forward; on the count of two, they bring their arms together in front of them, while rounding the thoracic spine. Perform 8 times. Breathing: on the count of one - inhale, on the count of two - exhale. Relaxation:

Starting position: lying on your back, hands at a distance of 20-30 cm from the body, palms pointing upward. Feet shoulder width apart. The legs are slightly bent at the knee and hip joints.

Close your eyes and focus on breathing. Do three deep breathing cycles. Completely relax gradually from the lower extremities to the head. Make sure that the lower jaw is relaxed and the tongue does not move. Then breathe slowly and easily. Perform 8 breathing cycles.

Breathing is measured and smooth.

Exercises on a vibration platform are carried out in 2 sets of 4 minutes after warming up before the main part of movement therapy and after it before relaxation. During a whole body vibration session, the patient stands on the Galileo® vibration platform in a vertical position, positioned on the vibration platform with the help of a physical therapy instructor and, if necessary, with the help of parents.

The frequency range of vibration oscillations for a patient aged 4 to 5 years is 8-9 Hz, for a patient aged 6-7 years - 10-12 Hz. Through three-dimensional vibration of the whole body in a given frequency range, an impulse effect is exerted on various parts of the neuromuscular system: proprioceptors, Golgi tendon organs, remodeling of the neuromuscular system occurs, which leads to reflex relaxation of skeletal muscles, that is, an antispastic effect against the background of increased intramuscular blood flow, that is, improvement tissue trophism. Clinical examples. Main group

Example 1. Patient Sh., 5 years old, complains (according to his mother) of delayed motor development, walks with his legs wide apart, weakness in the lower extremities, unsteadiness when walking, frequent falls.

History of the disease: according to the parents, a child from the 1st pregnancy, progressing physiologically, 1st birth, emergency at 34 weeks. The condition at birth was assessed as severe, on the Apgar scale 6-7 points, she screamed immediately. Birth weight: 2038 g, height: 45 cm, on mechanical ventilation for up to 3 days, was transferred to the neonatal pathology department, discharged at 1 month and 3 days, with a diagnosis of prematurity 33-34 weeks. Low body weight. Late anemia of prematurity. Asphyxia at birth. Cerebral ischemia in a newborn, grade 2. Registered with a neurologist since birth, he constantly receives courses of drug therapy on an outpatient basis.

General somatic status. Level of consciousness on the Glasgow scale: 15 points. The skin is clean. Edema is not detected. The mucous membranes are clean pink, the pharynx is calm, nasal breathing is free. Results of auscultation of the lungs: breathing is carried out in all parts, there is no wheezing. Results of percussion and auscultation of the heart: auscultation of the heart sounds is clear, rhythmic.

Neurological status: Available to contact, reacts positively to examination. The head shape is round. The large fontanel is closed. There are no seizures at the time of examination. The cranial nerves are without pathology. Motor sphere: active position, physiological posture, gait is changed due to the equino-plano-valgus position of the feet. The shape of the spine is not disturbed. The range of active and passive movements is preserved. Muscle strength in the upper extremities 5 points, D=S. Muscle strength in the lower extremities 4 points, D=S. Muscle tone in the hands is satisfactory D=S. Muscle tone in the legs is increased D=S, Ashford scale 3 points. Physiological reflexes from the hands, flexion-elbow reflexes D=S, live. Extensor-elbow reflexes D=S, live. Carpo-radial reflexes D=S, live. Knee reflexes D=S, animated. Achilles reflexes D=S, alive. Plantar reflexes D=S, animated. Abdominal reflexes upper, middle, lower D=S. Carpal pathological reflexes are negative. Pathological foot reflexes: Babinski's sign is positive on both sides. Oral automatism reflexes are negative. Sensitivity is not impaired. Meningeal symptoms were not detected at the time of examination. Urination is not impaired. Higher mental functions: reduced intelligence, hyperactive.

Additional examination: according to general clinical examinations: OAK, OAM, biochemical blood test, ECG, no pathological changes were noted. X-ray of the hip joints without pathology. CT scan of the brain: CT signs of brain space-occupying lesions were not identified. Fragmentary expansion of the subarachnoid space without signs of atrophic changes. CT signs of initial dilatation of the ventricular system of the brain (posterior horns). EEG - general cerebral changes in the bioelectrical activity of the brain. According to stimulation ENMG and surface EMG, no significant pathological changes were noted.

Quality of life, according to the parent form of the Russian version of the PEDSQ14.0 questionnaire for children 5-7 years old, initially averaged: on the physical functioning scale 19 points, on the emotional functioning scale 30 points, on the social functioning scale 25 points.

A diagnosis has been made. Residual organic damage to the central nervous system, cerebral palsy, spastic diplegia, GMFCS level II, MACS level II, final residual stage.

On the 1st day, the patient was prescribed: drug therapy: mydocalm, individual lessons with a defectologist, a correctional teacher, general massage, magnetic therapy, electrophoresis with a solution of aminophylline 2.4% - 5 ml. A complex of dynamic therapy was prescribed, which was carried out in the exercise therapy room in the morning under the supervision of an exercise therapy instructor, included a warm-up - 5 minutes, a lesson on the Galileo® vibration platform - 4 minutes, the frequency range of vibration vibrations - 8 Hz, the main part (motor therapy) - 10 minutes , exercise on the Galileo® vibration platform (second approach) - 4 minutes, frequency range of vibrations - 8 Hz, relaxation - 5 minutes.

On the 5th day, therapy was continued in the specified volume. Positive dynamics were noted in the form of improvement in locomotor functions: the gait became more confident, and upon examination, spasticity on the Ashford scale was 3 points. Muscle strength in the legs - 4 points. Quality of life, according to the parent form of the Russian version of the PEDSQ14.0 questionnaire for children 5-7 years old, was: on the physical functioning scale 31 points, on the emotional functioning scale 40 points, on the social functioning scale 35 points.

On the 10th day I completed the course of prescribed therapy. There was a significant improvement in locomotor functions: the frequency of falls when walking decreased; on examination, spasticity on the Ashward scale was 2 points, muscle strength in the legs was up to 4.5 points. Quality of life, according to the parent form of the Russian version of the PEDSQ1 4.0 questionnaire for children 5-7 years old, was: on the physical functioning scale 34 points, on the emotional functioning scale 45 points, on the social functioning scale 35 points. Recommendations for further rehabilitation were given, and dynamic monitoring of the patient was continued.

Example 2. Patient A., 6 years old, complaints (according to his mother) of limited active movements in the right limbs, gait disturbance, frequent falls, impaired fine motor skills in the right hand.

History of the disease: the parents noticed weakness and decreased motor activity in the right hand from the age of 3 months of the child’s life. From 4 months (refusal of breastfeeding) - frequent regurgitation. A CT scan of the brain was performed: signs of monoventricular internal hydrocephalus. Consulted by a neurosurgeon: left-sided monoventricular hydrocephalus (porencephalic cyst), compensated. Right-sided spastic hemiparesis. No surgical treatment is required. Completed a course of outpatient treatment: nootropic therapy, physiotherapy. According to my mother, with short-term positive dynamics.

Life history: a child from the 2nd pregnancy, which, according to words, was without any peculiarities. Childbirth 2nd, urgent, physiological. Umbilical cord entanglement around the neck, birth asphyxia. The Apgar score is 5-6 points. He screamed right away. Birth weight: 2830 g. Height: 53 cm. Attached to the chest on the 1st day. Feeding: artificial from 4 months. Growing and developing with delay. General somatic status. Level of consciousness on the Glasgow scale: 15 points. The skin is clean. Edema is not detected. The mucous membranes are clean pink, the pharynx is calm, nasal breathing is free. Results of auscultation of the lungs: breathing is carried out in all parts, there are no wheezes. Results of percussion and auscultation of the heart: auscultation of the heart sounds is clear, rhythmic.

Neurological status: General condition of moderate severity. Consciousness is clear. The head shape is round. Cranial nerves: movement of the eyeballs is limited in the extreme abductions. Convergent strabismus of both eyes. Motor sphere: active position, hemiparetic gait, muscle strength reduced in the right limbs to 3 points. Muscle tone in the arms and legs is increased according to the spastic type on the right, D>S, Ashford scale 3 points. Physiological reflexes from the hands D>S, increased on the right. Foot pathological reflexes Babinski's symptom is positive. Oral automatism reflexes are negative. Superficial sensitivity is preserved. Speech: a set of simple words, understands spoken speech. Additional examination: according to general clinical examinations: OAK, OAM, biochemical blood test, ECG, no pathological changes were noted. X-ray of the hip joints: without pathology. EEG: sleep phase 2-3 recorded. Signs of delayed rhythm formation. No epiactivity was recorded. CT scan of the brain: CT picture of severe left-sided monoventricular hydrocephalus, porencephalic cyst. Slight displacement of the midline structures to the left. According to stimulation ENMG and surface EMG, no significant pathological changes were noted.

Quality of life, according to the parent form of the Russian version of the PEDSQ14.0 questionnaire for children 5-7 years old, initially averaged: on the physical functioning scale 19 points, on the emotional functioning scale 30 points, on the social functioning scale 25 points.

A diagnosis has been made. Consequences of early organic damage to the central nervous system. Left-sided monoventricular hydrocephalus (porencephalic cyst). Cerebral palsy, right-sided spastic hemiparesis, GMFCS level II, MACS level III-IV. Delayed psychomotor and speech development.

On the 1st day, the patient was prescribed: drug therapy: mydocalm, individual lessons with a defectologist, a correctional teacher, general massage, magnetic therapy, electrophoresis with a solution of aminophylline 2.4% - 5 ml. A complex of dynamic therapy was prescribed, which was carried out in the exercise therapy room in the morning under the supervision of an exercise therapy instructor, included a warm-up - 5 minutes, a lesson on the Galileo® vibration platform - 4 minutes, the frequency range of vibration vibrations - 8 Hz, the main part (motor therapy) - 10 minutes , exercise on the Galileo® vibration platform (second approach) - 4 minutes, frequency range of vibration oscillations - 8 Hz, relaxation - 5 minutes. On the 5th day, therapy was continued in the specified volume. Positive dynamics were noted in the form of improvement in locomotor functions: the gait became more confident, and upon examination, spasticity on the Ashford scale was 3 points. Muscle strength in the farts and legs - 3.5 points. Quality of life, according to the parent form of the Russian version of the PEDSQ14.0 questionnaire for children 5-7 years old, was: on the physical functioning scale 34 points, on the emotional functioning scale 40 points, on the social functioning scale 35 points.

On the 10th day I completed the course of prescribed therapy. There was an improvement in locomotor functions: the frequency of falls when walking decreased; on examination, spasticity on the Ashward scale was 2 points, muscle strength in the extremities on the right was up to 4.0 points. The quality of life according to the parent form of the Russian version of the PEDSQ1 4.0 questionnaire for children 5-7 years old was: on the physical functioning scale 37 points, on the emotional functioning scale 45 points, on the social functioning scale 35 points. Recommendations for further rehabilitation were given, and dynamic monitoring of the patient was continued.

Control group

Example 1. Patient M., 5 years old, complains (according to his mother) of strabismus, walks with support, legs wide apart, weakness in the lower extremities. History: child from the 5th pregnancy, which occurred against the background of a threatened miscarriage. Childbirth 2, Apgar score 4-5, was in the intensive care unit. Discharged with a clinical diagnosis: prematurity 31 weeks. Congenital pneumonia. Perinatal hypoxic damage to the central nervous system, central nervous system depression syndrome. He didn’t scream right away. Birth weight: 1600 g. Height: 41 cm. Feeding: breastfeeding - 6 months. Growing and developing at a slow rate.

General somatic status. Level of consciousness on the Glasgow scale: 15 points. The skin is clean. Edema is not detected. The mucous membranes are clean pink, the pharynx is calm, nasal breathing is free. Results of auscultation of the lungs: breathing is carried out in all parts, there are no wheezes. Results of percussion and auscultation of the heart: auscultation of the heart sounds is clear, rhythmic.

Neurological status. Head shape: somewhat hydrocephalic. Cranial nerves: bilateral convergent strabismus. Motor sphere: spastic gait. Muscle strength in the upper extremities: D=S - 4.5 points, in the lower extremities D=S - 3 points. Muscle tone in the arms: normal D=S. Muscle tone in the legs is increased D=S, Ashford scale 3 points. Physiological reflexes. Flexion-elbow reflexes D=S, animated. Extensor-elbow reflexes D=S, live. Carporadial reflexes D=S, high. Knee reflexes D=S, high. Achilles reflexes D=S, high. Plantar reflexes D=S, high. Foot pathological reflexes: Babinski's sign is positive, on both sides. Sensitivity is not impaired. Walks with support. Speech at the level of syllables. Phrasal speech is not formed.

Additional examination: X-ray signs of hip dysplasia: bilateral coxa valga. EEG: pronounced cerebral changes in the bioelectrical activity of the brain. CT scan of the brain: CT signs of moderate internal hydrocephalus. Atrophic changes in brain tissue in the fronto-parietal-occipital region, cyst-like expansion of the subarachnoid space of the cerebellum. According to stimulation ENMG and surface EMG, no significant pathological changes were noted.

Quality of life, according to the parent form of the Russian version of the PEDSQ14.0 questionnaire for children 5-7 years old, initially averaged: on the physical functioning scale 19 points, on the emotional functioning scale 30 points, on the social functioning scale 25 points.

A diagnosis has been made. Cerebral palsy, spastic diplegia, GMFCS level II. MACS II level. Severe delay in psycho-speech and motor development. On the 1st day, the patient was prescribed: drug therapy: mydocalm, individual lessons with a speech pathologist, correctional teacher, general massage, magnetic therapy, electrophoresis with a solution of aminophylline 2.4% - 5 ml. On the 5th day, therapy was continued in the specified volume. There was a slight positive trend in the form of improvement in locomotor functions: the gait became more confident. On examination, spasticity on the Ashford scale was 3 points. Muscle strength in the legs - 3 points. Quality of life, according to the parent form of the Russian version of the PEDSQ14.0 questionnaire for children 5-7 years old, was: on the physical functioning scale 25 points, on the emotional functioning scale 35 points, on the social functioning scale 30 points.

On the 10th day I completed the course of prescribed therapy. There was an improvement in locomotor functions. On examination, spasticity on the Ashward scale was 3 points, muscle strength in the legs was up to 3.5 points. Quality of life, according to the parent form of the Russian version of the PEDSQ1 4.0 questionnaire for children 5-7 years old, was: on the physical functioning scale 31 points, on the emotional functioning scale 40 points, on the social functioning scale 30 points. Recommendations for further rehabilitation were given, and dynamic monitoring of the patient was continued.

Example 2. Patient R., 5 years old, complaints (according to his mother) of limited movements in the left limbs, gait disturbances, poor memory, shortening of the left arm.

History: child from the 1st pregnancy, which proceeded without any special features. 1st birth, urgent, weight 3600, breech presentation. Discharged on the 7th day. Parents noticed asymmetry in the limbs after the child was one year old. He was observed by a neurologist at his place of residence. A CT scan of the brain was performed: a cerebrospinal fluid cyst in the frontal-temporo-parietal region on the left. Physical and psychomotor development at 1 year: sat down at 1.5 years, walked at 2 years 3 months. Past diseases: ARVI. Preventive vaccinations - according to an individual schedule.

General somatic status. Level of consciousness on the Glasgow scale: 15 points. The skin is clean. Edema is not detected. The mucous membranes are clean pink, the pharynx is calm, nasal breathing is free. Results of auscultation of the lungs: breathing is carried out in all parts, there are no wheezes. Results of percussion and auscultation of the heart: auscultation of the heart sounds is clear, rhythmic.

Neurological status: general condition: moderate. Consciousness: clear. Head shape: round. Cranial nerves - without pathology. Motor sphere: active position, hemiparetic gait, muscle strength in the upper extremities is reduced on the left to 3.5 points. Muscle strength in the lower extremities is reduced to 3 points on the left. Muscle tone in the arms and legs is increased according to the spastic type on the left, D<S, Ashford scale 3 points. Physiological reflexes from the hands D<S, increased on the left. Foot pathological reflexes: Babinski's sign is positive. Oral automatism reflexes are negative. Superficial sensitivity is preserved. Speech: a set of simple words, phrasal speech is not formed, memory is reduced.

Additional examination: EEG: pronounced cerebral changes in the bioelectrical activity of the brain. According to stimulation ENMG and surface EMG, no significant pathological changes were noted. X-ray of the hip joints: X-ray signs of hip dysplasia - bilateral Coxa valga, decentration. Initial manifestations of coxarthrosis. CT scan of the brain: cerebrospinal fluid cyst of the frontal-temporo-parietal region on the left.

Quality of life, according to the parent form of the Russian version of the PEDSQ14.0 questionnaire for children 5-7 years old, initially averaged: on the physical functioning scale 19 points, on the emotional functioning scale 30 points, on the social functioning scale 25 points.

A diagnosis has been made. Consequences of early organic damage to the central nervous system. Post-trophic non-tense cyst of the right fronto-parietal-temporal region. Cerebral palsy, left-sided hemiparesis, GMFCS level II. MACS III level Delayed psychomotor and speech development.

On the 1st day, the patient was prescribed: drug therapy: mydocalm, individual lessons with a defectologist, a correctional teacher, general massage, magnetic therapy, electrophoresis with a solution of aminophylline 2.4% - 5 ml. On the 5th day, therapy was continued in the specified volume. There was a slight positive trend in the form of improvement in locomotor functions: the gait became more confident. On examination, spasticity on the Ashford scale was 3 points. Muscle strength in the legs - 3 points. Quality of life, according to the parent form of the Russian version of the PEDSQ14.0 questionnaire for children 5-7 years old, was: on the physical functioning scale 25 points, on the emotional functioning scale 35 points, on the social functioning scale 30 points.

On the 10th day I completed the course of prescribed therapy. There was an improvement in locomotor functions. On examination, spasticity on the Ashward scale was 3 points, muscle strength in the legs was up to 3.5 points. Quality of life, according to the parent form of the Russian version of the PEDSQ1 4.0 questionnaire for children 5-7 years old, was: on the physical functioning scale 34 points, on the emotional functioning scale 40 points, on the social functioning scale 30 points. Recommendations for further rehabilitation and dynamic monitoring of the patient were given.

The proposed invention, in comparison with the prototype and other known technical solutions, has the following advantages:

- the proposed method allows you to successfully form statokinetic reactions of patients suffering from cerebral palsy through a combination of movement therapy with relaxation, as well as through the use of whole body vibration on the Galileo® vibration platform;

- helps to activate skeletal muscles, increase muscle strength, as a result, muscle tone and spasticity decrease, blood flow improves, due to movement on the vibration platform, reflex excitability decreases;

- due to the inclusion of an involuntary tendon reflex due to vibration of the whole body due to movement on the vibration platform, a return signal passes from the limbs to the brain, which contributes to the formation of a direct signal from the brain to the limbs and the formation of conscious movements;

- carrying out movement therapy contributes to the best results in terms of improving strength and reducing spasticity of the muscles involved;

- the combination of motor therapy exercises with deep rhythmic breathing influences the regulation of the function of the diaphragm, which, in turn, affects the static-locomotor regulation of the spinal motion segments, improving the biomechanics of the musculoskeletal system;

- the use of vibration of the whole body through movement on a vibration platform, motor therapy exercises in combination with deep rhythmic breathing in a developed sequence leads to the achievement of stable remission due to the normalization of the function of both peripheral and central structures of the central nervous system, through influence at various levels of regulation of the nervous system ;

- combining vibration and kinesthetic components makes it possible to improve static-dynamic functions in patients with cerebral palsy: reduce the pathological tone of the muscles of the trunk and limbs, increase mobility in the joints of the limbs, develop verticalization skills, improve balance, walking stability, coordination and physical endurance;

- allows you to increase the emotional background of the child, improve motivation for further treatment and rehabilitation measures, that is, it has an indirect beneficial effect on psychological health;

- the benefits of whole body vibration include less stress and risk of injury, more passive training activity and reduced time for an effective therapeutic session, which is significant for patients with cerebral palsy who have physiological impairments;

- allows you to achieve an improvement in the main indicators of quality of life: physical, emotional and social functioning, reduce emotional and cognitive sensitization, preventing further progression of the pathological process;

allows you to qualitatively increase the effectiveness of treatment of cerebral palsy, reduce the degree of physical impact on the child’s body, the proposed method reduces the complexity of the therapeutic effect.

- allows you to improve static-dynamic functions in preschool children by reducing the pathological tone of the muscles of the trunk and limbs;

- the proposed method reduces the number of side effects from standard drug therapy, which contributes to an earlier recovery of motor functions and psychophysiological processes.

Claims (20)

A method for the rehabilitation of preschool children with spastic diplegia and hemiparetic form of cerebral palsy, including the combined use of whole body vibration and movement therapy in combination with rhythmic breathing, characterized in that the rehabilitation of preschool children is carried out in the physical therapy room five times a week for two weeks at the same time in the morning with the help of a therapeutic physical education instructor, for 28 minutes, while the method includes 5 stages: warm-up for five minutes, which includes: in the starting position lying on your back: 1) diaphragmatic breathing: while inhaling, the stomach is protruded, while exhaling, the stomach is drawn in, repeat 6 times; 2) circular movements of the feet outward and inward, repeat 6 times. 3) alternately strain the muscles of the thighs, while mentally trying to lift the leg without lifting it from the surface, do this 5 times; and lower leg muscles, while mentally pressing the foot on an imaginary obstacle, perform 5 times; then in the starting position: sitting on the buttocks with legs bent at the knees and hip joints: 1) perform circular movements with the hands outward and inward, repeat 6 times; 2) raise their shoulders up to their head, lower them, relax, repeat 6 times; 3) turn the head to the right side, return to the starting position, then to the left side, return to the starting position, repeat 6 times; then a lesson on the Galileo vibration platform for four minutes, with the frequency range of vibration oscillations being from 8 to 12 Hz, then motor therapy for ten minutes, which includes exercises: 1) starting position: lying on your back, arms raised vertically in front of you at an angle of 90° to the body, legs bent at the knee joints at an angle of 45°, feet resting on the floor, while counting once, one arm is moved horizontally to ear level, the other the hand is lowered down along the body; on the count of two - return to the starting position, perform 8 times, alternately with changing hands, breathing: on the count of one, when the hands are in opposite positions, exhale; on the count of two, when the hands are in the starting position, inhale; 2) starting position: lying on your back, arms placed along the body, legs bent at the knees at an angle of 45°, feet resting on the floor, for the first four counts, raise both arms up along the floor, outlining a semicircle, for the next four counts, lower both arms floor down, return to the starting position, perform 8 times, breathing: the first four counts - inhale, the next four counts - exhale; 3) starting position: lying on your back, arms placed along the body, legs bent at the knee joints at an angle of 45°, feet resting on the floor, for a count of one, raise the right arm up to an angle of 90° with the body, for a count of two, lower the straight arm to to the opposite shoulder, on the count of three, grab the opposite straightened arm and hold it for 5 counts, then, on the count of eight, return to the starting position, repeat with the left hand, perform 2 times on each hand, breathing: on the count of one - inhale; two, three, four - exit; at five, six, seven - inhale; at eight - exhale; 4) starting position: at four points of support, hands on hands point-blank under the shoulder joints, knees under the hip joints, legs bent at the knee and hip joints 90°, gaze directed forward; on the count of one, raise the right hand up and forward to a horizontal level, on the count of two, lower the hand down to its original position, repeat with the left hand, the exercise is performed alternately with each hand 4 times, a total of 8 times on two hands; breathing: on the count of one, when the hand is at the top, exhale, on the count of two - inhale; 5) starting position: sitting on the buttocks with crossed legs, bent at the knees and hip joints, arms straightened, hands resting on the floor on the sides of the pelvis, walking forward movements of the arms for a count of one, two, three, four, held for six counts, then walking movements with the hands back to the count of one, two, three, four, return to the starting position, repeat this exercise 4 times, then change legs in the starting position, first the right leg is in front, change it to the left, perform the exercise 4 more times on the left leg, breathing: walking movements of the arms forward as you exhale, while holding the position - one and a half respiratory cycles: one, two - entry, three, four - exhale, five, six - inhale, walking movements back - exhale, in the original inhale; 6) starting position: lying on your back, arms placed along the body, legs bent at the knee joints at an angle of 45°, feet resting on the floor, on the count of one, straighten the right leg upward to an angle of 90° at the hip and knee joints, on the count of two - lower the leg down to the starting position, repeat with the left leg, perform the exercise in turn with each leg 4 times for each leg, 8 times in total, breathing: when straightening the leg - exhale, in the starting position - inhale; 7) starting position: lying on your back, arms placed along the body, legs bent at the knees at an angle of 45°, feet resting on the floor, for a count of one, raise the pelvis from the floor due to extension in the hip joints, for a count of two, three, maintain this position , on the count of four, return to the starting position, perform 6 times, breathing: when raising the pelvis up - exhale, while holding the position - inhale, when lowering the pelvis - exhale, in the starting position - inhale; 8) starting position: lying on your back, arms along the body, legs bent at the knees at an angle of 45°, feet resting on the floor; on the count of one - bend the right leg at the hip joint until the thigh touches the stomach, while pointing the foot away from you, on the count of two return to the starting position, repeat with the left leg, perform the exercise in turn with each leg 4 times on each leg, 8 times in total , breathing: when bending the leg - exhale, in the starting position - inhale; 9) starting position: sitting on the sit bones, legs shoulder-width apart, stretched forward, bend at the knee joints at an angle of 130-140°, on a count of one, reach with the right hand to the right leg, on a count of two, return to the starting position, change arms and legs : reach with the left hand to the left leg, perform 4 times on each side, alternating them, 8 times in total, breathing: when stretching the hand to the leg - exhale, in the starting position - inhale; 10) starting position: sitting on the buttocks with crossed legs, bent at the knees and hip joints, arms raised horizontally in front of you at an angle of 90° to the body, hands pointing down; for a count of one, straight arms are spread to the sides at an angle of 90° from the body, squeezing the shoulder blades and directing the chest forward; for a count of two, they bring their arms in front of them, while rounding the thoracic spine, perform 8 times, breathing: for a count of one, inhale, count two - exhale; then - the second approach of training on the Galileo vibration platform for four minutes, with the frequency range of vibration oscillations being from 8 to 12 Hz, relaxation for five minutes, which includes: in the starting position: lying on your back, hands at a distance of 20 -30 cm from the body, palms point upward, feet shoulder-width apart, legs bent at the knees, hip joints, close your eyes, focus on breathing, do three breathing cycles, completely relax gradually from the lower extremities to the head, make sure that the lower jaw was relaxed, but the tongue did not move, perform 8 breathing cycles.