Changes in motor functions in children with cerebral palsy after the course of intensive neurophysiological rehabilitation: a single-blind study
Background. Modern intensive interventions addressing multiple challenges in children with cerebral palsy are attracting clinicians’ and researchers’ attention. One of such methods is the intensive neurophysiological rehabilitation system (INRS) — a combination of interventions focusing on different functional goals, merged into one intensive course. The purpose of the study was to assess changes in gross motor functions, muscle spasticity and passive range of motion (PROM) in children with spastic forms of cerebral palsy (CP) after the twoweek of treatment course with INRS. Materials and methods. A singlearm, singleblind prepost study was conducted among 57 children aged 4 to 12 years with spastic CP, admitted for treatment to the tertiary care center. Patients were examined before and after the twoweek course using INRS, which included multiple interventions totalling 4–5 hours of treatment daily. The Gross Motor Function Measure66 (GMFM66) tasks were videorecorded and evaluated independently by two investigators. The time of recordings (baseline or postintervention) was masked. PROM in the lower extremity joints was assessed with a manual goniometer, muscle spasticity — with the Modified Ashworth scale. Results. GMFM66 scores after INRS use increased statistically significantly from 58.8 to 60.2 points, with a mean difference of 1.4 ± 2.9 points. Substantial improvement in PROM was noted for 5 of 7 movements; the most substantial improvement was observed in hip abduction — an average of 8.0 ± 5.8° and foot dorsiflexion — 8.0 ± 6.1°. Reduction of the muscle tone was observed in all measured muscle groups. Statistically significant decrease of spasticity was noted in hip flexors, with an average reduction of 0.25 scale steps (95% confidence interval (CI) = 0.06–0.44), and hip adductors — 0.30 steps (95% CI = 0.08–0.51). Conclusions. Improvements of gross motor functions, an increase of PROM in the lower extremities and reduction of muscle spasticity have been detected after the twoweek course with INRS. Intensive treatment using INRS requires further studies, including randomized controlled ones.
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