EFFECTIVENESS OF THE COMBINED USE OF ROBOTIC KINESIOTHERAPY AND BOTULINUM THERAPY IN THE COMPLEX REHABILITATION OF CHILDREN WITH CEREBRAL PALSY
DOI:
https://doi.org/10.22159/ajpcr.2018.v11i9.26541Keywords:
Cerebral palsy, Multidisciplinary rehabilitation, Robotic walking, Botulinum therapyAbstract
Objective: The objective of this study is to evaluate the effectiveness of combined use of robotic kinesiotherapy and botulinum therapy in the complex rehabilitation of children with spastic diplegia.
Methods: In the research, 162 children were participated in the age from 4 to 6 years with spastic diplegia. The main group was carried out using robotic kinesiotherapy with the help of the Lokomat complex and intramuscular injection of botulinum toxin type A (BtA), as a part of complex rehabilitation. Children from the control group received rehabilitative treatment with traditional methods.
Results: During the comparative study of groups, higher results were obtained in the main group, where average according to Gross Motor Function Measure 88 increased from 69.99 to 76.41 with a difference of 6.42 points (p=0.0001). In the control group, this indicator increased from 67.01 to 69.41 with a difference of 2.4 points. In the main group, a moderate coupling was noticed between overall motor activity improvement and muscle tone improvement (rs=0.411, p=0.001). Herewith, the correlation was pronounced more with children of the III level in Gross Motor Function Classification System (rs=0.483, p=0.002) in comparison with the II development level (rs=0.304, p=0.042).
Conclusion: Research results indicated that the children with spastic diplegia have significant improvement in motor characteristics when the combined applying of robotic walking and botulinum therapy compared with conventional therapy. In our opinion, the data obtained allow to recommend this method as one of the perspective methods of rehabilitation treatment for children with spastic forms of cerebral palsy.
Downloads
References
Oskoui M, Coutinho F, Dykeman J, Jetté N, Pringsheim T. An update on the prevalence of cerebral palsy: A systematic review and meta-analysis. Dev Med Child Neurol 2013;55:509-19.
Health of the population of the Republic of Kazakhstan and the activities of health organizations: Statistical compilations for 2005- 2016. Available from: http://www.rcrz.kz/index.php/ru/?option=com_ content&view=article&id=973.
Bulekbayeva S, Daribayev Z, Ospanova S, Vento S. Cerebral palsy: A multidisciplinary, integrated approach is essential. Lancet Glob Health 2017;5:e401.
Bulekbayeva S, Abdrakhmanova A, Ospanova S, Rizvanova A, Shalbarbaeva G, Kharina YU. Innovative technologies in the rehabilitation of children with neurological pathology in the republican children’s rehabilitation center. Vestnik AGIUV 2011;43-4.
Nam KY, Kim HJ, Kwon BS, Park J-W, Lee HJ, Yoo A. Robot-assisted gait training (Lokomat) improves walking function and activity in people with spinal cord injury: A systematic review. J Neuroeng Rehabil 2017;14:24.
Bruni MF, Melegari C, De Cola MC, Bramanti A, Bramanti P, Calabrò RS. What does best evidence tell us about robotic gait rehabilitation in stroke patients: A systematic review and meta-analysis. J Clin Neurosci 2018;48:11-7.
Hidler J, Nichols D, Pelliccio M, Brady K. Campbell DD, Kahn JH, et al. Multicentre randomized clinical trial evaluating the effectiveness of the Lokomat in subacute stroke. Neurorehabil Neural Repair 2009;23:5 13.
Castelli E. Robotic movement therapy in cerebral palsy. Dev Med Child Neurol 2011;53:481.
Drużbicki M, Rusek W, Szczepanik M, Dudek J, Snela S. Assessment of the impact of orthotic gait training on balance in children with cerebral palsy. Acta Bioeng Biomech 2010;12:53-8.
Wallard L, Dietrich G, Kerlirzin Y, Bredin J. Effect of robotic-assisted gait rehabilitation on dynamic equilibrium control in the gait of children with cerebral palsy. Gait Posture 2018;60:55-60.
Borggraefe I, Schaefer JS, Klaiber M, Dabrowski E, Ammann- Reiffer C, Knecht B, et al. Robotic-assisted treadmill therapy improves walking and standing performance in children and adolescents with cerebral palsy. Eur J Paediatr Neurol 2010;14:496-502.
Schroeder AS, Homburg M, Warken B, Auffermann H, Koerte I, Berweck S, et al. Prospective controlled cohort study to evaluate changes of function, activity and participation in patients with bilateral spastic cerebral palsy after Robot-enhanced repetitive treadmill therapy. Eur J Paediatr Neurol 2014;18:502-10.
Drużbicki M, Rusek W, Snela S, Dudek J, Szczepanik M, Zak E, et al. Functional effects of robotic-assisted locomotor treadmill therapy in children with cerebral palsy. J Rehabil Med 2013;45:358-63.
Peri E, Turconi AC, Biffi E, Maghini C, Panzeri D, Morganti R, et al. Effects of dose and duration of robot-assisted gait training on walking ability of children affected by cerebral palsy. Technol Health Care 2017;25:671-81.
Calabrò RS, Cacciola A, Bertè F, Manuli A, Leo A, Bramanti A, et al. Robotic gait rehabilitation and substitution devices in neurological disorders: Where are we now? Neurol Sci 2016;37:503-14.
Aurich-Schuler A, Warken B, Graser JV, Ulrich T, Borggraefe I, Heinen F, et al. Practical recommendations for robot-assisted treadmill therapy (Lokomat) in children with cerebral palsy: Indications, goal setting, and clinical implementation within the WHO-ICF framework. Neuropediatrics 2015;46:248-60.
Alodeani EA. Botulinum toxin type A: An effective, safe and minimally invasive treatment option of axillary and palmar hyperhidrosis. Int J Pharm Pharm Sci 2016;8:237-40.
Vidya VS, Felicita AS. Efficacy of pharmacological agents in the treatment of temporomandibular joint disorder: A systematic review. Int J Pharm Pharm Sci 2015;7:54-8.
Kumar S. The emerging role of botulinum toxin in the treatment of orofacial disorders: Literature update. Asian J Pharm Clin Res 2017;10:21-9.
Fonseca PR Jr. Franco de Moura RC, Galli M, Santos Oliveira C. Effect of physiotherapeutic intervention on the gait after the application of botulinum toxin in children with cerebral palsy: Systematic review. Eur J Phys Rehabil Med 2017; doi: 10.23736/S1973-9087.
Wang HY, Yang YH. Evaluating the responsiveness of 2 versions of the gross motor function measure for children with cerebral palsy. Arch Phys Med Rehabil 2006;87:51-6.
Van Hedel HJ, Meyer-Heim A, Rüsch-Bohtz C. Robot-assisted gait training might be beneficial for more severely affected children with cerebral palsy. Dev Neurorehabil 2016;19:410-5.
Willoughby KL, Dodd KJ, Shields N. A systematic review of the effectiveness of treadmill training for children with cerebral palsy. Disabil Rehabil 2009;31:1971-9.
Lee BH. Relationship between gross motor function and the function, activity and participation components of the international classification of functioning in children with spastic cerebral palsy. J Phys Ther Sci 2017;29:1732-6.
Published
How to Cite
Issue
Section
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.