Rehabilitation for children suffering from various forms of spinal dysraphism

The success of post-operative rehabilitation of children with various forms of spinal dysraphism depends not only on the degree of spinal cord and its roots tissue preservation, but also on the timeliness and adequacy of treatment.

The success of medical rehabilitation depends not only on the extent of intactness of the tissue of spinal cord and its roots, but also the timeliness and adequacy of treatment.

A proper orthopedic care of a sick child is an important component of rehab process and a difficult medical problem in flail legs caused by different forms of spinal dysraphism. On the one hand, an orthopedic appliance should provide a support ability of the lower extremities. On the other, this appliance should not impede making steps by a child, who retains minimum motor function of his leg muscles. Traditionally, a fixing locking device for a whole leg with a semi-brace is used for orthotics in the children with flail legs. It is usually manufactured according to individual moulds, contains hip and knee hinges providing fixation of hip and shin extension at an angle of 180° in hip and knee joint, respectively. However, a locking device firstly hampers complete walking, and secondly fails to provide improvement in the position of a whirlbone in the acetabulum in the paralytic instability of hip joints.

Unfortunately, the instability of hip joints of different extent, right up to the onset of paralytic hip dislocation, occurs in most patients suffering from flail legs due to spinal dysraphism. Paralytic instability of hip joints is treated surgically, but this treatment as a rule needs long-term postoperative immobilization, in many cases resulting in a partial loss of motor skill of a sick child.

Recently, a biomechanical rotation-correcting apparatus for a lower extremity® (a dynamic orthotics technique), an innovative product of Scientific Production Center “Ogonyok”, has been applied with success for orthotics in the children of 2 to 3 years old suffering from flail legs. This orthopedic device not only improves a support ability of the lower extremities without hindering step movements, but also provides a controlled extent of hip abduction aimed at improvement of whirlbones position in the respective acetabulums

The apparatus has a module construction and is assembled individually for each patient out of serial components. Depending on orthopedic-neurologic disorders in a child, the apparatus can be assembled for one or both lower extremities.

An important advantage of dynamic orthotics technique for paralytic hip joints instability is a possibility of simultaneous application of kinesitherapeutic methods including the application to a child of a thrust compression load aimed at the development of active motor skill. The application of a thrust load without dynamic hip orthotics could provoke worsening of a femoral head position in acetabulum, leading to aggravation of paralytic hip joint instability.

On the contrary, a permanent abduction position of each (left and right) hip provided by the apparatus, allows inhibiting an unfavorable effect of a thrust load on a femoral head position in acetabulum. Thus, incorporating the biomechanical apparatus in a construction of a reflex-load device “Gravistat”/”Graviton” ® enables medical rehabilitation of children suffering from different forms of spinal dysraphism by means of dynamic proprioceptive correction (DPC)

In addition to dynamic orthotics and DPC technique, medical rehabilitation of children with orthopedic-neurological signs of spinal dysraphism at the Scientific Production Center “Ogonyok” includes (by the indications): kinesiology taping, artificial motor correction (AMC), oscillatory therapy, exterior pneumocompression, transcranial magnetic stimulation (TMS),  postural mechanostimulation, underwater vacuum massage as well as the other techniques and methods of modern physiotherapy..