RU2844244C1 - Method of rehabilitation treatment of sarcopenia muscles of lower extremities in patients with infantile cerebral paralysis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine, namely to restorative medicine, medical rehabilitation, balneology and physiotherapy, and can be used for rehabilitation of motor disorders in patients with infantile cerebral paralysis (ICP). For this purpose, the paretic extremity training is preceded by additionally evaluating the extremity muscle state. Pathological labyrinthine-tonic reflex (LTR) activity or symmetric neck-tonic reflex activity (SNTR) is determined. Severity of secondary sarcopenia is evaluated by ultrasound. Physical performance and the functional state of the muscles are determined by tests of walking speed at 4 m and duration of standing exactly for 10 seconds. If observing a manifested degree of sarcopenia in the ICP patient, the SMC therapeutic procedures are conducted. For children aged 1 year to 7 years, duration of procedure is 15 minutes. For children older than 7 years, duration of procedure is 30 minutes. SMC therapy is followed by ball exercises. For this purpose, the child is placed face down on a ball if the SNTR prevails, or face up if the LTR prevails. Guide assists a child in active horizontal motions. 10-minute therapeutic exercises are performed every second day. If observing the moderate sarcopenia in the patient with ICP, ball trainings with weights 0.5 kg per each extremity are performed.

EFFECT: method provides manifested reduction of pathological symptoms, reduced spasticity of extremity muscles, stimulation of muscle fibre growth, increased muscle strength and range of motions.

2 cl, 2 tbl, 3 ex

Description

The invention relates to the field of medicine, namely, to restorative medicine, medical rehabilitation, balneology and physiotherapy, and can be used for the comprehensive rehabilitation of movement disorders in patients with cerebral palsy (CP).

Currently, methods of restorative treatment of impaired motor, speech and mental functions in children with cerebral palsy have been developed and optimized using physiotherapy, balneotherapy, orthopedic treatment, methods of therapeutic exercise, massage (Demin V.P. Medical and social rehabilitation of children suffering from cerebral palsy. Kurortnye Vedomosti. 2009; (1): 28-29). However, these rehabilitation methods allow only temporary correction of motor disorders, and often do not lead to stable positive results in patients with cerebral palsy, which limits their ability to provide for themselves and socialize.

Muscle growth in cerebral palsy differs from typical development, which is evident as early as 15 months of age. Muscles in cerebral palsy can be reduced in volume by as much as 40%, may be shorter in length, may have longer tendons and fewer sarcomeres in a series that are overstretched compared to normal.

Impaired muscle regeneration in cerebral palsy is associated with an expansion of the extracellular matrix and increased expression of proinflammatory genes, resulting in muscles that are smaller, stiffer, and weaker than normal muscles. These differences contribute to patients with CP engaging in less physical activity, thereby reducing the opportunity for mechanical loading, triggering a vicious cycle of muscle disuse and secondary sarcopenia.

Restorative therapy for movement disorders in patients with cerebral palsy is carried out in several directions: restoration of functions by disinhibition through restoration of synaptic conductivity, increase in the functional activity of muscle tissues, their ability to learn and retain information, restoration of function through activation of muscle tissue regeneration, restoration by restructuring functional systems by means of long-term special training of patients through inclusion of new links in the functional system to replace damaged ones.

Sanatorium and spa treatment is a traditional type of therapy for movement disorders in patients with cerebral palsy and is comprehensive in nature, using various methods aimed at developing active movements in the upper and lower extremities.

When forming the algorithm of the rehabilitation program, it is necessary to take into account the pathomorphological changes of the striated muscle tissue - an increase in myosin type II fibers, occurring against the background of the prevalence of pathologically excessive tone in the muscles. The complexes of rehabilitation measures should include methods that have a reparative effect, manifested in the restoration of the regenerative potential of the muscles of their functional activity, since the formation of new motor capabilities that occurs during rehabilitation is impossible without a certain degree of their preparation.

A method is known for the restorative treatment of muscle sarcopenia in patients with cerebral palsy (Patent 2260417, published on 20.09.2005), including massage, fixation of body parts, vestibular passive and active exercises on a ball with a diameter of at least 45 cm, gymnastic exercises, teaching the patient motor skills, wherein the fixation of body parts is maintained during the entire massage, alternately removing the fixation for the duration of the massage only from that part of the body that is being massaged, the fixed body during the massage is maintained in the "lying on the back" and "lying on the stomach" positions with the maximum possible extension of the joints of the arms and legs with the maximum possible spreading of the buttocks, and also the fixation of these positions is reinforced by placing sandbags weighing 1-5 kg on the arms and legs, depending on age.

The disadvantages of this method are the low efficiency of rehabilitation and the impossibility of obtaining a long-term positive result in patients with various spastic forms of cerebral palsy, and the static nature of the procedure in one place.

A method for the rehabilitation treatment of muscle sarcopenia in patients with cerebral palsy is known (Patent RU 2214209, published 20.10.2003), which consists in the fact that for each muscle with a pronounced high tone, the presence of its response to the force impact by the hands of a rehabilitation therapist is diagnosed, expressed in the occurrence of a sharp mechanical resistance at a certain value of impact and tactilely felt by the rehabilitation therapist, the established value is taken as the upper limit of impact, then in the process of carrying out manipulations, multiple, random in direction force impacts are carried out, in magnitude not exceeding the previously established mentioned upper limit of impact, and the manipulations are carried out in sessions lasting 90-120 minutes each, while affecting each affected muscle in turn for 3-5 minutes.

The disadvantages of this method are the following: static nature and duration of the procedure in one place, short-term correction of disorders, limited use in patients with spastic forms of cerebral palsy in school and senior school age, when the risk of developing joint contractures that can only be eliminated surgically is greatest, and insufficiently stable rehabilitation results.

A method of rehabilitation treatment of patients with cerebral palsy is known (M. Weiss, A. Zembaty. Physiotherapy. Moscow: Medicine. 1986: 114-131), according to which the patient with cerebral palsy is rocked from side to side, forward and backward on a ball or a sphere of large diameter, and the child's body is manipulated, transferred from the initial positions on the back and stomach to positions on all fours, sitting, with support on the hands, and also rocking the ball and directing it accordingly, they train support on the hands, on the legs, turns of the child's body for the patient to master the stages of physical development.

The disadvantages of this method are low efficiency, lack of combination of exercises performed with muscle stretching exercises that help normalize muscle tone, which does not ensure the achievement of a stable result.

The prototype chosen is a method of complex rehabilitation of patients with cerebral palsy (Patent RU 2289381, published 20.12.2006), which consists in the fact that with the help of methodologists, the child is relaxed on a not fully inflated ball with a diameter of 120 cm, for which the child is laid face down on the ball, while one methodologist fixes his shoulders on the surface of the ball, arms - symmetrically along the body, another methodologist fixes the lower limbs on the surface of the ball and, as relaxation is achieved, spreads them, performing slow swings back and forth, right and left and in a circle, while the child's head is turned after several swings first to one side, then to the other, then exercises are performed to stretch the limbs and torso of the child symmetrically, with the same effort, in one horizontal plane, sequentially, starting with the upper limbs and shoulder girdle, for 3-5 seconds, with an effort of 3-5 kg for children of primary school age or 6-8 kg - senior, followed by stretching of the lower limbs and in the initial position on the back, with normalization of muscle tone carried out 2-3 times a week, in courses of 10-12 procedures, lasting 5-10 minutes.

The disadvantages of this method are as follows: low efficiency due to the fact that before conducting classes, preliminary individual preparation of the neuromuscular system is not carried out taking into account the degree of readiness of the state of the muscular system of the limbs of a patient with cerebral palsy, the degree of severity of muscle degeneration is not taken into account in the rehabilitation process, which reduces the process of restoring muscle activity, and the influence of the pathological labyrinthine-tonic reflex is not taken into account, the main clinical manifestation of which is the flexion posture of a child with cerebral palsy, in connection with which the position of the child on the stomach with a bent head can increase the activity of the pathological reflex and stimulate the formation of flexion pathological positions of the limbs, which makes it impossible to form independent walking.

The conducted patent information search did not reveal methods for the restorative treatment of sarcopenia of the muscles of the lower extremities in patients with cerebral palsy with the essential features of the claimed method.

Based on the above-mentioned level of technology, in the rehabilitation treatment of patients with cerebral palsy, the problem is to achieve long-term and stable improvement in the functional activity of muscles, increase muscle strength, reduce spasticity, and consolidate the correct pattern of support and walking in the form of functional connections in the structures of the brain, leading to improved motor skills in this group of patients.

The development of a more effective method of restorative treatment of sarcopenia of the lower limb muscles in patients with cerebral palsy based on an individual approach by preliminary assessment of the condition of the muscular apparatus of the limbs and the motor status of the patient with cerebral palsy by determining the degree of expression of secondary sarcopenia using ultrasound examination, clinical testing of the activity of unreduced pathological tonic reflexes, and subsequent combined use of sinusoidal-modulated current therapy on the muscles of the lower limbs and training of paretic limbs using exercises on a ball against the background of standard spa treatment will improve the effectiveness of exercises and intensify active targeted movements, as well as achieve a lasting positive effect and, therefore, solve the above problem.

The technical result consists in increasing the effectiveness of rehabilitation of motor functions of the lower extremities in patients with cerebral palsy, reducing spasticity of the muscles of the extremities, stimulating the growth of muscle fibers, increasing muscle strength and range of motion.

It is proposed, as in the prototype, to use therapeutic gymnastics in the form of exercises on a ball in order to stretch the muscular-ligamentous apparatus.

The claimed method has been developed for the first time.

The essence of the claimed invention is that in the method of restorative treatment of sarcopenia of the lower limb muscles in patients with cerebral palsy, including the use of therapeutic gymnastics in the form of exercises on a ball against the background of standard spa treatment, according to the invention, the severity of secondary sarcopenia is preliminarily assessed using ultrasound examination (US), the activity of the pathological labyrinthine-tonic reflex (LTR), the activity of the symmetrical cervical-tonic reflex (SCTR), physical performance and the functional state of the muscles are determined using a 4 m walking speed test, a 10-second standing test and, if a severe degree of sarcopenia is detected in a patient with cerebral palsy, a preliminary stage of rehabilitation is carried out in the form of a set of procedures for sinusoidal-modulated current (SMC) therapy using the Amplipulse-7 device, and for children aged 1 to 7 years, the duration of the procedure is 15 minutes, at 10-15 mA, modulation frequency of 50 Hz, current modulation depth of no more than 75%; for children over 7 years old, the procedure duration is 30 minutes, at 20-25 mA, with a modulation frequency of 100 Hz, current modulation depth of no more than 75%; after the SMT procedure, exercises are performed on the ball, for which the child is laid on the ball face down if SSTR prevails, or face up if LTR prevails in the clinical picture of the disease, then, with the help of a methodologist, the child makes active horizontal movements, and all movements are performed with extension in the joints and stretching of spastic muscles, fixation of the achieved range of motion for up to 1 minute, exercises are held every other day, lasting 10 minutes, in a course of 10; if a moderate degree of sarcopenia is detected in a patient with cerebral palsy, a set of SMT therapy procedures is carried out, the patient with cerebral palsy performs exercises on the ball with weights of 0.5 kg for each limb.

The cause-and-effect relationship between the set of essential features and the technical result provided by the invention is as follows: a preliminary study of the degree of secondary sarcopenia in a patient with cerebral palsy using ultrasound, determining the activity of the LTR or the activity of the SSTR, assessing physical performance and the functional state of the muscles using walking speed and standing still duration tests, followed by a preparatory stage of rehabilitation in the form of a set of SMT therapy procedures when detecting a severe or moderate degree of sarcopenia of the lower extremities, the predominant activity of the unreduced pathological tonic reflex, allows to effectively prepare a patient with cerebral palsy for the subsequent stage of rehabilitation with the inclusion of exercises on a ball with or without weights, aimed at restoring joint mobility, eliminating contractures, developing movement and self-care skills, which contributes to a pronounced reduction in pathological symptoms, increasing the activity of weakened muscles, leads to an increase in motor activity and, therefore, allows to achieve the expected technical result.

The study of the presence of sarcopenia in children with cerebral palsy using ultrasound has a number of advantages compared to other methods of diagnosing sarcopenia, such as the absence of ionizing radiation, reproducibility and repeatability, ease of implementation, which allows for early diagnosis of the severity of sarcopenia in children with cerebral palsy and the most effective further rehabilitation treatment taking into account the results obtained (Vlasenko S.V., Nenko A.M. Possibilities of ultrasound diagnostics in the rehabilitation of motor functions in patients with cerebral palsy. Bulletin of Physiotherapy and Balneology. 2013; (2): 17-21). Sarcopenia is diagnosed using ultrasound by studying the qualitative and quantitative parameters measured in various muscle groups, namely, in the muscles of the lower extremities (Kurganskaya O.N., Tselih Zh.R. Diagnostics of sarcopenia using ultrasound imaging. Gerontology. 2022; 10 (1): 34-42).

Physical performance and muscle function are assessed using a 4 m walking speed test; gait speed below 0.8 m/s is considered reduced and the presence of sarcopenia is determined (Alfonso J.C.J., Gülistan B., Juergen M.B. et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019; 48 (1): 16-31). Walking speed can have a significant impact on biomechanical gait parameters in children with cerebral palsy (Kane K.J., Lanovaz J., Bisaro D. et al. Preliminary study of novel, timed walking tests for children with spina bifida or cerebral palsy. SAGE Open Med. 2016; 4: 2050312116658908). Evaluation of gait biomechanics allows us to objectify the degree and nature of the severity of motor disorders in cerebral palsy, and also helps to evaluate the results of rehabilitation interventions.

Sinusoidal modulated current therapy activates the blood supply process in tissues, supplies the affected tissues with oxygen, accelerates the regeneration of soft tissues, improves muscle tone function, helping to eliminate muscle spasms and prevent muscle atrophy, and allows you to prepare muscles for subsequent training. SMT therapy has a gentle effect on tissues; patients do not experience tingling or burning. The accumulation of the therapeutic effect occurs after several sessions and is steadily formed closer to the end of the course.

Conducting training of paretic lower limbs in patients with cerebral palsy using exercises on a ball with or without weights according to an individually selected regimen contributes to a more effective restoration of impaired functions, which is clinically expressed in an improvement in the patient's motor activity, effective training in independently performing simple everyday skills, and increased activity of weakened leg muscles.

The inclusion of a preparatory stage in the rehabilitation algorithm in the form of SMT therapy in the declared modes, aimed at developing a certain degree of readiness of the muscles of the lower extremities against the background of standard spa treatment, is justified, since it allows for the formation of a full-fledged neuroreflexive relationship between the central and peripheral analyzers, which in combination with subsequent training leads to the stable formation of new stereotypes of limb movement, the development of muscle strength necessary for learning new motor skills, and muscle regeneration in patients with cerebral palsy.

The choice of the declared modes of the components of the rehabilitation course for patients with cerebral palsy depending on age characteristics, neurological status, results of preliminary testing of muscle tone and muscle strength of the patient's lower limbs, and the severity of sarcopenia, allows for the effective development of motor skills and promotes their consolidation in the form of functional connections in the structures of the brain, the formation of which occurs under conditions of a structural defect, and reduces motor deficit.

The sequence of implementation of the components of the rehabilitation algorithm and the proposed modes of their implementation allow to increase the effectiveness of rehabilitation of the motor function of the lower extremities by stimulating the process of muscle fiber regeneration in patients with cerebral palsy and at the same time develop the most acceptable conditions for neuroplastic changes in the motor cortex and consolidation of the motor stereotype, which allows to obtain a synergistic effect in the process of rehabilitation treatment of patients with cerebral palsy at the sanatorium-resort stage.

The method is as follows.

When carrying out complex rehabilitation of children with cerebral palsy at the sanatorium-resort stage, a clinical examination of the patient is carried out first. The activity of the pathological labyrinthine-tonic reflex (LTR), clinically manifested in the form of a flexion posture of the child, the activity of the symmetrical cervical-tonic reflex (SSTR), clinically manifested in the form of the child's position on the stomach with a bent head - an extension posture, is determined.

The severity of secondary sarcopenia is assessed using ultrasound - the predominance of connective tissue over muscle (Changes in spastic muscles in patients with cerebral palsy according to ultrasound data. Vlasenko S.V., Kushnir G.M., Golubeva T.F., Osmanov E.A., Strashko E.V. Neurology, neuropsychiatry, psychosomatics. 2016; 8 (1): 39-42). As hardware, they use, for example, the SSD-1700 ultrasound system (Aloca, Japan), linear ultrasound sensors with a frequency of 5-7.5 MHz. The sonogram description includes a visual assessment of the muscle structure - striation, homogeneity, as well as the localization and type of changes, the presence of fasciculations. Ultrasound indices are calculated in conventional units: connective tissue index (CTI) and the degree of preservation of the characteristic striation of the CTI.

Physical performance and muscle function are assessed using a 4-m walking speed test (Kane K.J., Lanovaz J., Bisaro D. et al. Preliminary study of novel, timed walking tests for children with spina bifida or cerebral palsy. SAGE Open Med. 2016;4:2050312116658908).

They conduct a test of the duration of standing, for this they ask the patient with cerebral palsy to maintain balance for 10 seconds, standing straight on two legs, without raising their arms (Gregory Reychler, Nicolas Audag, Sophie Dewulf, Natalia Morale Mestre, Gilles CatyValidation of 6 min step test and 4-m gait speed in children: A randomized cross-over study. Gait Posture. 2018 Mar: 61: 19-24) .

A neurological examination is carried out.

If a patient with cerebral palsy is found to have a pronounced degree of sarcopenia, a 4-meter walk time of more than 50 seconds, and a standing time of less than 5 seconds, they are offered a preliminary stage of rehabilitation in the form of a set of SMT therapy procedures.

Physiotherapy procedures are carried out on the Amplipulse-7 device. According to the SMT-5 method. For children aged 1 to 7 years, the procedure lasts 15 minutes, at 10-15 mA, modulation frequency of 50 Hz, current modulation depth of no more than 75%. For children over 7 years old, the procedure lasts 30 minutes, at 20-25 mA, with a modulation frequency of 100 Hz, current modulation depth of no more than 75%. The procedures are carried out on the patient under conditions of maximum muscle relaxation. Electrodes are applied to the treated areas of the patient's body and fixed with elastic bandages, dressings, sandbags, or placed under the patient's body. The physiotherapy course includes 10 procedures every other day.

Then, after the SMT therapy procedure, exercises are performed on a ball to stretch the muscular-ligamentous apparatus. An individual diameter of the ball is selected so that in the horizontal position of the child on the ball, his upper and lower limbs do not hang freely, but touch the surface without pressure on it. The child is placed on the ball face down if the clinical picture of the disease is dominated by SSTR - the child's position on the stomach with a bent head, or placed on the ball face up if the clinical picture of the disease is dominated by LTR - the child's position on the back with an unbent head.

Then, with the help of the methodologist, the child tries to make active movements horizontally. All movements are performed with extension in the joints and stretching of spastic muscles, fixation of the achieved range of motion for up to 1 minute. With the activity of the SSTR, it is necessary to activate the forward flexion of the head and lower limbs, and with the activity of the LTR, the instructor stimulates the child to straighten the head and lower limbs. When turning the head, the instructor must ensure that the child does not automatically bend the limbs, thereby suppressing the activity of pathological reflexes.

Classes are held every other day, lasting 10 minutes, in a course of 10 procedures.

If a patient with cerebral palsy is found to have moderate sarcopenia, a 4-meter walk time of less than 50 seconds, or raising arms while standing on two legs for more than 5 seconds, they are offered a preliminary stage of rehabilitation in the form of a set of SMT therapy procedures.

Then, after the SMT therapy procedure, exercises are performed on a ball with weights of 0.5 kg for each limb. At the beginning of the exercise, cuffs weighing 0.5 kg are put on the distal parts of the upper and lower limbs. Exercises are performed every other day, lasting 10 minutes, in a course of 10 procedures.

The stated rehabilitation course is carried out against the background of standard spa treatment.

The standard course of spa treatment for patients with cerebral palsy is aimed at developing motor abilities (Order of the Ministry of Health of the Russian Federation of June 16, 2015 No. 349n "On approval of the standard of specialized medical care for cerebral palsy (medical rehabilitation phase)", Order of the Ministry of Health and Social Development of the Russian Federation No. 213 of November 22, 2004 "On approval of the standard of spa care for patients with cerebral palsy").

A rehabilitation course was completed using the claimed method for 55 patients with spastic forms of cerebral palsy aged from 7 to 18 years.

Before treatment, patients were divided into 2 groups.

The first group included 55 people, the rehabilitation course was carried out according to the declared method.

The second group, which included 20 people, underwent a course of standard spa treatment for patients with cerebral palsy.

According to the clinical examination data, all patients were found to have activity of unreduced pathological tonic reflexes - cervical tonic and labyrinthine, which was clinically manifested in the form of extension or flexion postures with pathological activity in one or another muscle group.

All patients underwent a neurological examination. The level of lower limb spasticity was assessed using the 4-meter walking scale and the standing stillness scale.

Table 1 shows the results of ultrasound examination of muscles in patients with cerebral palsy. Distribution of patients with cerebral palsy into clinical rehabilitation groups depending on the severity of pathological changes in muscles according to the combined data of various types of studies (M±m).

Table 1

Patient groups
(n=75) Ultrasound indices Clinical tests SI (cu)
adduct
triceps SSCHI (u.e.)
adduct
triceps 4m Walk Test, seconds Standing still test, seconds I mild degree of sarcopenia (n=25) 2.88 ± 0.29
3.30±0.20 688.16 ± 18.06
627.78±13.42 32 8 II moderate sarcopenia (n=25) 2.17 ± 0.18
2.89±0.16 613.74 ± 10.87
513.22±10.23 44 5 III gross structural changes, severe sarcopenia (n=25) 1.79 ± 0.25
2.19±0.25 451.19 ± 17.39
421.19±17.39 58 2

The dynamics of restoration of motor functions of the limbs was assessed by the increase in points on the scales used.

After completion of the rehabilitation course, patients in the first group showed a statistically significant decrease in walking time by 4 meters (p<0.001), and testing the duration of standing still without using hands showed a significant increase in the indicator (p<0.001).

Table 2 shows the indicators of changes in motor functions in patients with cerebral palsy of the first group before and after rehabilitation using the claimed method.

Table 2

Patient groups
(n=55) Clinical tests 4m Walk Test, seconds Standing still test, seconds I mild degree of sarcopenia (n=15) 32.88 ± 0.29
13.30±0.20** ^Δ 8.16 ± 18.06
10.78±13.42** ^Δ II moderate degree of sarcopenia (n=25) 48.17 ± 0.18
22.89±0.16* ^Δ 5.74 ± 10.87
8.22±10.23* ^Δ III severe degree of sarcopenia (n=15) 58.79 ± 0.25
42.19±0.25 2.19 ± 17.39
4.19±17.39

In Table 2, the numerator shows the indicators before treatment, the denominator shows the indicators after treatment, the reliability of differences in indicators: * - p<0.05; ** - p<0.01; indicators of the first and second groups after treatment: ^Δ - p<0.05, ^ΔΔ - p<0.01.

The obtained results show that the claimed method is effective in the rehabilitation process of motor functions of the lower extremities in patients with cerebral palsy and does not cause negative consequences.

The use of the claimed method ensures the achievement of effective activation of the motor regime in patients with cerebral palsy, consolidation of stable motor skills, reduction of negative reactions of the body and increase of social adaptive capabilities, stimulation of muscle regeneration, reduction of secondary sarcopenia phenomena.

Examples of implementation of the claimed method

Example 1

Patient V., 14 years old. Diagnosis: cerebral palsy, spastic diplegia of moderate severity, flexion-pronation positions of the forearms, adduction positions of the hips, LTR prevailed. The clinical picture of the disease shows severe sarcopenia, the following ultrasound indices were calculated - SI adduct 1 c.u., triceps 2 c.u., SSCHI adduct 451 c.u., triceps 421 c.u., according to the scale, walking 4 m - 58 seconds, according to the scale, standing straight - 2 seconds, which was characterized as a pronounced degree of sarcopenia.

The patient underwent a rehabilitation course using the stated method.

The patient underwent a course of SMT therapy 20-25 mA, with a modulation frequency of 100 Hz, a current modulation depth of no more than 75%, a procedure duration of 30 minutes, in the amount of 10 procedures every other day. After each SMT procedure, exercises were performed on a ball without weights. The patient was positioned on his back, with his head in an extended position.

After the course of complex rehabilitation, the clinical picture of the disease showed the extinction of the pathological tonic reflex. A decrease in the duration of walking by 4 meters to 42 seconds was noted. An increase in the duration of standing still without balancing with hands to 4 seconds.

Example 2

Patient S., 6 years old. Cerebral palsy, adductor positions in the joints of the limbs, with decussation at the level of the knee joints, equinus position in the ankle joints, prevalence of SSTR. The clinical picture of the disease shows moderate sarcopenia, the following ultrasound indices were calculated - SI adduct 2 c.u., triceps 2 c.u., SSCHI adduct 613 c.u., triceps 513 c.u., according to the scale, walking 4 m - 44 seconds, according to the scale, standing straight - 5 seconds, which was characterized as a moderate degree of sarcopenia.

The patient underwent a rehabilitation course using the stated method.

The patient underwent a course of SMT therapy procedures at 10-15 mA, modulation frequency of 50 Hz, current modulation depth of no more than 75%, procedure duration of 15 minutes, in the amount of 10 procedures every other day. After each SMT procedure, exercises were performed on a ball with a 0.5 kg weight.

From the third day of training, the patient noted an increase in the volume of active and passive movements.

Example 3

Patient S., 4 years old. Cerebral palsy, adductor positions in the joints of the limbs, equinus position in the ankle joints, prevalence of SSTR. The clinical picture of the disease shows mild sarcopenia, the following ultrasound indices were calculated: SI adduct 3 c.u., triceps 3 c.u., SSCHI adduct 690 c.u., triceps 650 c.u., according to the scale, walking 4 m - 30 seconds, according to the scale, standing straight - 8 seconds.

The patient underwent a rehabilitation course using the stated method.

SMT therapy was not performed. From the first day, training was started taking into account the activity of the unreduced reflex on a ball with weights of 0.5 kg per limb. The patient noted an increase in the volume of active, passive movements from the third day of training.

The examples provided confirm the high efficiency of the proposed rehabilitation method for patients with cerebral palsy.

The use of the claimed method of restorative treatment of sarcopenia of the muscles of the lower extremities in patients with cerebral palsy, due to the possibility of a deeper impact on the entire musculoskeletal system of the child, contributes to obtaining a stable rehabilitation effect without the use of complex auxiliary technical means while simplifying the method, allows for a reduction in complications, which ensures the achievement of a stable result.

The claimed rehabilitation method complements existing methods and allows for an expansion of the range of therapeutic effects, and is distinguished by the safety of the rehabilitation process.

The method can be used for the rehabilitation of patients aged 4-18 years with various spastic forms of cerebral palsy in the context of spa treatment.

Claims (2)

1. A method for the restorative treatment of sarcopenia of the lower limb muscles in patients with cerebral palsy, including the use of therapeutic gymnastics in the form of exercises on a ball against the background of spa treatment, characterized in that an ultrasound examination of the lower limb muscles is preliminary performed, a 4 m walking speed test is performed, a 10-second standing duration test is performed, the activity of the pathological labyrinthine-tonic reflex (LTR) is determined, the activity of the symmetrical cervical-tonic reflex (SCTR) is determined, and if the duration of walking for 4 meters is more than 50 seconds and the duration of standing is less than 5 seconds, a preliminary stage of rehabilitation is performed in the form of sinusoidal-modulated current (SMC) therapy procedures on the muscles of the lower limbs using the Amplipulse-7 device, and for children aged 1 to 7 years, the duration of the procedure is 15 minutes, at 10-15 mA, a modulation frequency of 50 Hz, the depth of current modulation is no more than 75%; for children over 7 years old, the duration of the SMT procedure is 30 minutes, at 20-25 mA, with a modulation frequency of 100 Hz, the depth of current modulation is no more than 75%; the course of SMT therapy includes 10 procedures every other day, after each SMT therapy procedure, an exercise is carried out on a ball with a diameter that allows, when the child is lying on the ball, to touch the surface without pressing on it with his upper and lower limbs, while the child is placed on the ball face down, if SSTR prevails, or face up, if LTR prevails, then, with the help of a methodologist, the child makes active movements with extension in the joints and stretching of spastic muscles and fixation of the achieved range of motion for up to 1 minute, the lesson is carried out for 10 minutes, a course of 10. 2. The method according to paragraph 1, characterized in that the patient performs exercises on the ball with weights of 0.5 kg for each limb.