Changes in motor functions in children with cerebral palsy after the course of intensive neurophysiological rehabilitation: a single-blind study

O. Kachmar, I. Mysula, A. Kushnir, T. Voloshyn, O. Matiushenko, M. Hasiuk, M. Hordiyevych


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.


cerebral palsy; rehabilitation; physical therapy; motor disorders; muscle spasticity

Full Text:



Rosenbaum P., Paneth N., Leviton A., Goldstein M., Bax M., Damiano D., Dan B., Jacobsson B. A report: the definition and classification of cere-bral palsy. Dev. Med. Child Neurol. 2007, Suppl. Feb. 109. 8­14.

Schiariti V., Selb M., Cieza A., O’Donnell M. International Classification of Functioning, Disability and Health Core Sets for children and youth with cerebral palsy: a consensus meeting. Dev. Med. Child Neurol. 2015. 57(2). 149­158.

World Health Organization. International classification of functioning, disability and health: ICF. Geneva: World Health Organization, 2001.

Novak I., McIntyre S., Morgan C., Campbell L., Dark L., Morton N., Goldsmith S. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev. Med. Child Neurol. 2013. 55(10). 885­910.

Hoare B.J., Wallen M.A., Thorley M.N., Jackman M.L., Ca­rey L.M., Imms C. Constraint-induced movement therapy in children with unilateral cerebral palsy. Cochrane Database of Systematic Reviews. 2019. 4.

Bleyenheuft Y., Ebner­Karestinos D., Surana B., Paradis J., Sidiropoulos A., Renders A., Gordon A.M. Intensive upper- and lower-extremity train-ing for children with bilateral cerebral palsy: a quasi-randomized trial. Dev. Med. Child Neurol. 2017. 59(6). 625­633.

Størvold G.V., Jahnsen R.B., Evensen K.A.I., Bratberg G.H. Is more frequent physical therapy associated with increased gross motor improvement in children with cerebral palsy? A national prospective cohort study. Disability and Rehabilitation. 2018. 1­9.

Kozyavkin V.I., Babadagly M.O., Lun G.P., Kachmar O.O., Hordievych S.M., Lysovych V.I., Voloshyn B.D. Intensive Neurophy­siological Reha-bilitation System — the Kozyavkin method. A manual for rehabilitation specialists. Lviv: Design studio Papuga, 2012.

Kozyavkin V.I., Kachmar O.O., Lysovych V.I. A retrospective analysis of the results of treatment with Intensive Neurophysiological Rehabilitation System. International Neurological Journal. 2018. 3(97). 13­22.

Russell D.J., Rosenbaum P.L., Wright M., Avery L.M. Gross motor function measure (GMFM­66 & GMFM­88) user’s manual. Vol. 159. Lon-don: Mac Keith Press, 2002.

Kachmar O.O., Kozyavkin V.I., Hordiievych M.S. Reliability of the Ukrainian version of the Gross motor function classification system. Interna-tional Neurological Journal. 2010. 5. 357.

Norkin C.C., White D.J. Measurement of joint motion: a guide to goniometry. 5th ed. Philadelphia: Davis Company, 2016.

Bohannon R.W., Smith M.B. Interrater reliability of a modified Ashworth scale of muscle spasticity. Physical Therapy. 1987. 67(2). 206­207.

Kozijavkin V., Kachmar O. Correction of movement utilizing the “Spiral” suit — an important part of the Kozijavkin method. Cerebral Palsy Magazine. 2004. 14­18.

Evans­Rogers D.L., Sweeney J.K., Holden­Huchton P., Mullens P.A. Short­term, intensive neurodevelopmental treatment program experiences of parents and their children with disabilities. Pediatric Physical Therapy. 2015. 27(1). 61­71.

Roelofsma R., Rameckers E. The effect of a functional intensive intervention program on self­care in children with cerebral palsy: a case study. Int. J. Brain Disord. Treat. 2017. 3.

Oeffinger D. et al. Outcome tools used for ambulatory children with cerebral palsy: responsiveness and minimum clinically important differences. Dev. Med. Child Neurol. 2008. 50(12). 918­925.­8749.2008.03150.x.

Ko J. Sensitivity to functional improvements of GMFM­88, GMFM­66, and PEDI mobility scores in young children with cerebral palsy. Percept. Mot. Skills. 2014 Aug. 119(1). 305­19.

Novak I. Evidence­based diagnosis, health care, and rehabilitation for children with cerebral palsy. J. Child Neurol. 2014 Aug. 29(8). 1141­56.

Katusic A., Alimovic S. The relationship between spasticity and gross motor capability in nonambulatory children with spastic cerebral palsy. Int. J. Rehabil. Res. 2013 Sep. 36(3). 205­10.

Stuberg W.A., Fuchs R.H., Miedaner J.A. Reliability of goniometric measurements of children with cerebral palsy. Dev. Med. Child Neurol. 1988. 30. 657­66.

MсDowell B.C., Hewitt V., Nurse A., Weston T., Baker R. The variability of goniometric measurements in ambulatory children with spastic cere-bral palsy. Gait & Posture. 2000. 12. 114­21.

Nordmark E., Hägglund G., Lauge­Pedersen H., Wagner P., Westbom L. Development of lower limb range of motion from early childhood to adolescence in cerebral palsy: a population­based study. BMC Medicine. 2009. 7(1).


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© Publishing House Zaslavsky, 1997-2019


   Seo анализ сайта