Treatment Technologies for Cerebral Palsy

 

In the rehabilitation center “Ogonek” an individual rehabilitation program is formed for each child taking into account the peculiarities of his disease. The program is based on the latest technology of motor skills development by special technical means of rehabilitation, trainers, software and hardware equipment. For the correction of muscle tone and intermuscular interactions various types of biofeedback (BFB) are being used effectively, the Partial weight bearing therapy, Underwater vacuum massage, Postural mechanical stimulation therapy, Hi-Top therapy, Wave therapy, Cryotherapy, magnetic, laser, oscillation and other types of physiotherapy, the Kinesiology taping method. To train the vertical posture and balance function – Stabilometric training. For the development of motor skills – Dynamic proprioceptive correction using reflex-loading device “Gravistat” / “Graviton» ® (Professional development of rehabilitation center “Ogonek”), Functional electrical stimulation of the muscles in walking, Transcranial magnetic stimulation (TMS). To improve the adaptive capacity of the child – medical breathing mixtures based on high-purity medical gases, salt chamber, etc.

 DYNAMIC PROPRIOCEPTIVE CORRECTION USING THE DEVICE “GRAVISTAT” / “GRAVITON» ®

The method of dynamic proprioceptive correction (DPC) has been developed at Russian Research and Methodological Center of Rehabilitation of children with cerebral palsy at Scientific Center of Children’s Health   of Russian Medical Sciences Academy under the guidance of professor, honored scientist of Russia, K.A. Semenova, who proposed to use the astronaut suit “Penguin” for the development and recovery of voluntary movement among patients with cerebral palsy. The device “Penguin” of a child size has been called “the Adelie-92“. Experience in using “Adeli-92” required a medical jumpsuit of next generation, especially for the rehabilitation of patients with cerebral palsy.

Reflex-loading device (RLDs) “Gravistat”/”Graviton» ® (Patent RF), developed by rehabilitation center “Ogonek” is a system of elastic straps counter-fixed in the front and in the rear parts of the body surface. The straps arranged along the body provide for a strictly dosed compressive loading acting on muscle antagonists of the body and those of the lower extremities. Besides, the rotation (“rotating”) elastic straps correct the position of the patient’s body locomotive segments. This causes a powerful information flow formed in the receptors of muscles, joints and ligaments to stream to the central nervous system and to form the tracing movement patterns there. Patient’s active movements promote that correct posture and physiologic forms of movement are fixed at the central nervous system level. Brain functional structures activity afferent correction provided by Graviton/Gravistat® brings essential improvements into brain functions in terms of motility, speech, emotion and cognition (mental power, memory).

Graviton/Gravistat® medical suit is assembled of components manufactured in series and individually selected for each patient in strict conformity with the task of correcting his pathologic posture.

Daily 1.5 hour private lessons using the suit “Gravistat” / “Graviton» ® by the child are carried out by an experienced methodist or an instructor of medical gymnastics in a specially equipped room. The course consists of 20 lessons.

Treatment by the DPC method with reflex-loading equipment “Gravistat” / “Graviton» ® is indicated in all clinical forms of cerebral palsy excluding double hemiplegia.

There are contraindications, the most important of which – a luxation of the hip.

  ARTIFICIAL CORRECTION OF MOVEMENTS

 In the literature there are different names for one and the same method: artificial correction of movements (ACM), functional (phase) electrical stimulation of the muscles during walking (FES), a programmable multi-channel electrical stimulation (PMES) of muscles during walking. In our country professor A. S. Vitenzon led the development of technology. The method is based on the principle of muscles management by electrical stimulation of low-frequency pulsed current at the appointed phases of the patient walking process. Stimulation is performed in strict time accordance with the natural  muscles work in the walking process, incorrectly performed movements are being adjusted, gradually the stereotype of walking close to normal is produced. In a relatively short period of time (10-15 procedures) ACMs can significantly reduce the deficit in muscle function.

The use of ACMs is limited by the same contraindications as for other types of electrotherapy.

 BIOFEEDBACK

 The essence of biofeedback (BFB) or functional biofeedback (FBFB) is to organize the training of active movements with visual and audible information regarding its movement in real time. Information about the efforts is switched from proprioceptive channel (deep muscle sense) to visual and auditory analyzers with greater perceived signals recognition. Focusing on such information, the patient is able to adjust the performed movement consciously. The method has a theoretical basis and development in the works of prof. O. Bogdanov and other authors. The principle of biofeedback is used in several software and hardware in rehabilitation center “Ogonek”.

 

TRANSCRANIAL AND TRANSVERTEBRAL MIKROPOLARIZATION

 Mikropolarization – the impact of a weak constant current to the scalp areas, which are a projection of certain cortical structures or areas of skin projections of the spinal cord segments to directional changes in the functional state of the central nervous system formations. Current parameters during transcranial mikropolarization usually stay within tens or hundreds of mkA, which is much smaller than used in conventional physiotherapy. The direction of effect provided by the use of small areas of the electrodes (about 300 square millimeters) and their location. Mikropolarization improves cognitive brain functions, attention span, memory, vision, and emotional state of patients, normalizes a sleep, contributes to the development of motor skills and speech functions.

 DYNAMIC HIP ORTHOTICS

 With cerebral palsy, especially the spastic forms, many children have got a subluxation of the hip. The progression of hip subluxation in cerebral palsy limits the choice of strategy for rehabilitation of the child, as excludes the possibility of applying the most efficient physiotherapeutical methods in terms of active movement’s development, including dynamic proprioceptive correction (DPC). This is because the axial load may further worsen the position of the hip in the acetabulum. Currently, the application of “Graviton” for the active motor skills development is possible even with subluxation, but only in case of simultaneous use of the adjustable hip abduction brace orthosis (developed by research and production center “Ogonek”) – the method of dynamic orthotics. This one is required for the treatment of children from 2.5-3 to 15-16 years old, suffering from spastic or atonic paralytic subluxation of the hip, or in case pathological hip’s position (when the risk of subluxation is high). With the help of an adjustable hip abduction brace orthosis, the correction of the position of the femoral head in the acetabulum is performed, while retaining the possibility of active movements in the hip joint within the required volumes. With the hip abduction brace orthosis a child can sit, stand and walk, without damage to the position of the femoral head in the acetabulum. Thereby in most cases an application of this one can be an alternative method of gypsuming. Prolonged use of the orthosis (usually one year) helps to reduce spasticity in the thigh adductors and power imbalance of muscles, which motion the hip joint.

Mode of the adjustable hip abduction brace orthosis application – to wear when awake. With prolonged use of this one it is necessary to correct the settings, as a rule once in 4 months.

MEDICAL RESPIRATORY GAS MIXTURES

 The use of therapeutic breathing gas mixtures according to the methods of the Institute of Biomedical Problems (inhalation therapy warmed with gas mixtures, based on high-purity inert gas-oxygen cutting agents) can improve the body’s defenses, resistance (tolerance) to physical activity, reduces pain in spasticity. Therapy with a mixture based on xenon is effective for medical emotional disorders. The heated oxygen-helium mixture improves the adaptive ability of the organism, is used to prevent colds, as well as in treatment of diseases of the respiratory and cardiovascular systems. The use of therapeutic gas mixtures – treatment of XXI century!

  POSTURAL MECHANICAL STIMULATION THERAPY

The dosage vibratory stimulation of the human body (postural mechanical stimulation) is a method of the biological activity stimulation of the organism of athletes and individuals of extreme professions, adapted to the regenerative treatment of children with central nervous system and musculoskeletal system disorder. Method has been successfully used during the training of professional athletes, astronauts, divers and others and is based on a holistic impact on the quality of the motor act of simultaneous exposure of the active muscle contraction (exercise) and mechanical stimulation of working in different physiological modes of the muscles. With the simultaneous effects of dosage and the active muscle vibration (mainly static, ie, long-term, but a little on the intensity of muscle contraction) of the stimulated muscles information flow that is characteristic of the more powerful and prolonged muscle contraction is received to the structures of the central nervous system. This information can purposefully change throughout the chain of command physical activity. To achieve the desired physiological effects, such as increased resistance to stress, physical activity, adaptive resource expansion, improvement of muscle power and normalization of muscle tone, the method of generation and characteristics of the mechanical vibrations is very useful. The method has been used successfully in the rehabilitation center “Ogonek” (as indicated) in a comprehensive program of rehabilitation of children with different clinical forms of cerebral palsy.

DIAGNOSTIC TECHNOLOGIES

CLINICAL VIDEO

 For an objective assessment of motor ability of each child in the rehabilitation center “Ogonek” before and after the treatment videoregistration of the movement skills is produced. Hand movements, posture, an opportunity to sit and stand without assistance, walk (independently, with support for one or two hands, with a high support, with additional support on a cane, etc.) are being estimated.

VIDEOREGISTRATION AND ANALYSIS OF MOTIONS

Walking of patient is recording by high-speed cameras in order to objectively estimate the quality of movements of children able to walk without support. For this purpose, StarTrace® a video-based motion capture and analysis system is used in rehabilitation center “Ogonek”. The video recording is processed by the evaluation software automatically or manually. The method allows the doctor to make an informed choice of specific rehabilitation techniques for each patient and subsequently estimate the effectiveness of treatment..