THE INFLUENCE OF COMBINATION NON-MEDICAL TREATMENT INCLUDING FUNCTIONAL PROGRAMMED ELECTRICAL STIMULATION ON THE CLINICAL AND INSTRUMENTAL PARAMETERS IN PATIENTS WITH CEREBRAL PALSY WITH SPASTIC DIPLEGIA

Abstract

Background: Cerebral palsy is the leading cause of physical disability in pediatric age. The search for new methods and improvement of old rehabil- itation techniques is ongoing, due to low efficacy of the latter. Aim: To assess the efficacy of a func- tional programmed electrical muscle stimulation as a part of combination treatment of patients with cerebral palsy in the form of spastic diplegia. Materials and methods: We analyzed the results of treatment of 71 children with cerebral palsy and spastic diplegia, who had been randomized into two groups depending on the type of treatment. In the first group, the patients (n = 38) received a course of functional programmed electric stim- ulation in combination with other non-medical treatment methods. The second group (n = 33) underwent a usual course of electrical stimula- tion in combination with non-medical treatment, similar to that in the first group. The third group (control) included 41 children without cere- bral palsy. Clinical and instrumental parameters were assessed in all study participants. Results: After the course of combination treatment in the group 1, the tonus of m. gastrocnemius was de- creased significantly by 41%, that of the posterior group of femur muscles by 43%, adductor group of femur muscles by 36%. In the group 2, the re- spective parameters decreased by 24, 21 and 21%. Muscle power endurance was increased signifi- cantly in patients of both groups: that of long back extensors by 12.5 and 6.2 sec, of m. rectus abdomi- nis by 10.6 sec and 5.2 sec, of gluteal muscles by 9.3 and 4.6 sec, of m. quadriceps by 19.8 and 7.2 sec, of m. anterior tibialis by 12.1 and 4.6 sec, respec- tively. After the treatment, the active movement volume in the large joints of lower extremities in the group 1 patients improved as follows: by 15.6° in hip joints, by 11.1° in knee joints and by 10.6° in ankle joints. In the second group the correspond- ing values were 7.4° in hip joints, 5.1° in knee joints and 4.8° in ankle joints. The differences for all pa- rameters were statistically significant (p < 0.05), be- ing significantly better in the group 1. Conclusion: The course of the functional programmed electri- cal muscle stimulation at walking, compared to the usual electrical stimulation in spastic diplegia patients is significantly more effective in reduction of the spastic muscle tonus of the lower extremi- ties. It improves power endurance of the weak legs and trunk muscles, increases the volume of active movements in big joints of the lower extremities.