Article Text
PDF
Abstract
Movement disorders are determining clinical syndrome of cerebral palsy (CP). The prevalence of CP in Russia is 2.2–3.3 cases per 1000 newborns; 85–90% of them are spastic forms. Complex treatment of children with spastic CP includes Botulinum toxin type A as the main component - it reduces spasticity, which optimizes the subsequent rehabilitation. Combination of botulinum therapy with physiotherapy increases the effectiveness of management CP in children. Transcranial magnetic stimulation was carried out on the ‘Amo Atos’ device using the add-on device ‘OGOLOVYE’, according to our own method with a bitemporal arrangement of emitters, with increasing frequency in subsequent procedures from 5 Hz to 10 Hz, for 10 minutes. Transcranial magnetic stimulation was combined with physical exercise on the device with biofeedback ‘MOTOmed gracile’ according to an individual scheme after botulinotherapy.
Aim To evaluate the effectiveness of combined use of transcranial magnetic stimulation and physical exercise using the biofeedback device with simultaneous neurometabolic medical therapy, exercise therapy, massage after administration of botulinum toxin type A.
Materials and methods The case-control study included 30 patients 2–14 years old with spastic and dyskinetic CP, comparable by sex, age, degree of motor disorder. The degree of motor disorders was determined by Gross Motor Function Classification System. Evaluation of effectiveness – according to muscle strength scale; tone was estimated by Modified Ashworth Scale; detailed assessment of motor skills according to GMFM-66/88 table, considering the quantitative indicator of motor development. Patients of both groups received botulinum therapy, nicotinic acid, massage, exercise therapy. The main group received physical load on the device ‘MOTOmed gracile’, transcranial magnetic stimulation; the control group underwent sinusoidal magnetic fields.
Results A 1 point decrease in muscle tone by 10 days was significantly achieved in 92% of children of the main group and in 75% of the children in the control group; change in strength was found in 25% of children in the main and 12% of the control group; improvement in motor skills was observed in all patients, in the main group by 5.5%, in the control group - by 3%.
Conclusions The study shows high efficacy of botulinum toxin, a good antispastic effect in both groups. Improvement of motor skills and new motor patterns occurs in a fairly short time only with an active rehabilitation program. It confirms the effectiveness of transcranial magnetic therapy and physical activity on the device with biofeedback ‘MOTOmed gracile’.