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18ACTIVE REHABILITATION MEASURES TO TRAIN MOBILITY IN DISABLED CHILDREN
UDC 796.034.2
PhD N.A. Gross1 PhD T.L. Sharova1 A.V. Molokanov1 A.V. Malinin2
1Federal Scientific Center for Physical Culture and Sports, Moscow 2St. Petersburg Scientific Research Institute of Physical Culture, St. Petersburg
Corresponding author:niinagross@yandex.ru
Abstract
Objective of the study was to design and test by experiment the effectiveness of the rehabilitation course with the use of active physical exercises to develop motor abilities in disabled children.
Methods and structure of the study. The study involved 50 children with disabilities aged 3-16 years. Depending on the level of development of their gross motor functions within the international Gross Motor Function Classification System (GMFCS), out of 50 disabled children, 6 were categorized into the 1st level of GMFCS, 15 -to the 2nd, 6 - to the 3rd, 10 - to the 4th, 13 - to the 5th. The program consisted of 16 individual one-hour training sessions conducted 2-3 times a week. The active physical exercises were performed using the training simulators adapted to the disabled children's physical abilities.
Results and conclusions. Children with disabilities of all degrees of difficulty have great potential, which should be realized in a timely manner through active physical exercises.
The study found that out of 142 exercises mastered, 26.1% were directed towards the development and correction of walking skills, 15.5% - towards the development of balancing skills and ability for balance maintenance in the sitting and standing positions, 8.5% - towards the adaptation to physical loads, 5.6% - towards the formation of step movements and the ability to stand up from the sitting position, increasing the subjects' overall endurance to physical loads.
The children in the most difficult Levels 4 and 5 on the Gross Motor Function Classification System scale were able to master 29 and 35 exercises, respectively, no less than in other groups.
Individual training sessions with the use of active physical exercises and pedagogical tests increase the effectiveness of rehabilitation measures.
Keywords: children with disabilities, motor disabilities, physical exercises, level of development of motor functions on Gross Motor Function Classification System scale.
Background. Among the numerous types of diseases in children, locomotor disorders take a significant place, thus leading to a decreased motor activity, changes in the cardiovascular and respiratory systems functionality, disruption of metabolic processes, reduced working capacity, changes in the psyche, and negative effects on the quality of life. As a result, long-term akinesia aggravates children's social adaptation [3-5, 8]. Therefore, it is promotion of motor activity of children with disabilities through the use of physical education means in an environment that takes into account their individual characteristics and
in exercise rooms conformed to their activities, that has the potential for rehabilitation measures efficiency enhancement. The modern scientific literaturecontains a great deal of evidence in that physical loads have a positive effect on the development of motor abilities of disabled children [1, 2, 5, 7, 8]. However, the lack of consistency, guidance on the organization of training sessions for children with disabilities, as well as the lack of opportunities for early rehabilitation determine the delayed formation of motor skills. Proper formation and consolidation of the disabled children's motor skills can be achieved through the selection of physical
loads that are adequate to their functional state and motor abilities, as well as through the prolongation of the uninterrupted training process. If the proposed exercises are consistent with the physiological capabilities of the children's body, they start to play a formative role and contribute to the development of their motor skills. Inadequate loads cause various pathological changes and exacerbate motor problems [3, 5, 8]. It is therefore particularly important to select physical exercises that would target the development of motor abilities of children with disabilities, taking into account their individual capabilities and the level of development of gross motor functions.
Objective of the study was to design and test by experiment the effectiveness of the rehabilitation course with the use of active physical exercises to develop motor abilities in disabled children.
Methods and structure of the study. The study involved 50 children with disabilities aged 3-16 years. Depending on the level of development of their gross motor functions within the international Gross Motor Function Classification System (GMFCS), out of 50 disabled children, 6 were attributed to the 1st level of GMFCS, 15 - to the 2nd, 6 - to the 3rd, 10 - to the 4th, 13 - to the 5th. The program consisted of 16 individual one-hour training sessions conducted 2-3 times a week. The training sessions with the use of active physical exercises were carried out with the extensive use of training simulators adapted to the disabled children's physical abilities and "Gross's
simulator", in which the child was in a vertical position, protected from falling, could move, rotate, jump, learn to exercise. The functional state of the children's body was assessed based on their HR and blood pressure, as well as was visually assessed by the instructor. The changes in the subjects' motor abilities were determined in the pedagogical tests conducted at the beginning and at the end of the course. The test exercises were selected according to the children's motor abilities. The total number of exercises that caused positive changes was 142. They were grouped into 14 variations. Each child could be tested in two or three different exercises. The expert evaluation given by the adaptive physical education instructors was carried out according to a points system: 0 points -cannot perform at all; 1 point - tries to perform with the help of the instructor or with the use of "Gross's simulator"; 2 points - performs with the help of the instructor or with the use of "Gross's simulator"; 3 points - tries to perform independently; 4 points -performs on his own.
Results and conclusions. The table presents the study results indicating the number of mastered exercises grouped into different variations by the level of development of gross motor functions according to GMFCS scale for the course of 16 training sessions with the use of active physical exercises.
As a result of the experiment, 50 disabled children were subjected to 14 different exercise variations and were able to perform or partially perform 142 exercises
Levels on GMFCS
№ Exercise variations and their number 1 2 3 4 5 Total %
1 Walking in various variations 8 13 9 3 4 37 26.1
2 Ability to stand up from the sitting position - 5 1 2 8 5.6
3 Jumping training 1 1 2 1 5 3.5
4 Arm work - 4 1 1 - 6 4.2
5 Roller skate and cycle training 2 1 1 - - 4 2.9
6 Ability for balance maintenance in the sitting and standing positions - 7 3 5 7 22 15.5
7 Improvement of overall endurance - 7 1 - - 8 5.6
8 Improvement of movement coordination - 2 2 5 1 10 7.0
9 Ability to execute the instructor's commands 1 3 1 1 - 6 4.2
10 Crawling - - - 3 2 5 3.5
11 Adaptation to physical loads 3 - - 3 6 12 8.5
12 Formation of support on both arms 1 - - - 6 7 4.9
13 Ability to hold the head straight - - - - 4 4 2.9
14 Formation of step movements - - - 6 2 8 5.6
Total exercises 16 43 19 29 35 142 100
Table 1. Number of exercises mastered by disabled children in each variation and according to GMFCS scale
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in total. The children (13 individuals attributed to the 5th level of GMFCS scale), who had previously been unable to change their body position, mastered 10 different exercise variations, a total of 35 exercises, 7 of which aimed to develop the disabled children's balancing skills while holding the standing or sitting position.
The children in Level 4 on GMFCS scale (10 individuals), who could sit on their own but could not walk, mastered 9 different exercise variations, 29 in total, of which 6 exercises aimed to form step movements.
The children in Level 3 on GMFCS scale (6 individuals), who were able to walk using a handheld mobility device, mastered 8 different exercise variations, 19 in total, 9 of which aimed to develop the walking skills and 3 - to develop their ability for balance maintenance in the sitting and standing positions.
The children in Level 2 on GMFCS scale (15 individuals), who were able to walk with limitations, mastered 9 different exercise variations, 43 in total, 13 of which aimed to develop their walking skills.
The children in Level 1 on GMFCS scale (6 individuals), who were able to walk without limitations, mastered 6 different exercise variations, 16 in total, 8 of which aimed to improve their walking skills.
Thus, out of 142 exercises mastered, the largest number - 37 (26.1%) - aimed to develop and correct the children's walking skills. 22 exercises (15.5%) aimed to develop the balancing skills and form the ability for balance maintenance in the sitting and standing positions. In 12 cases (or 8.5%), we noted the subjects' adaptation to physical loads. 8 exercises (or 5.6%) aimed to form the children's step movements and their ability to stand up from the sitting position. In 5.6% of cases, there was an increase in overall endurance.
It should be noted that the children in the most difficult Levels 4 and 5 on GMFCS scale (10 and 13 subjects, respectfully) were able to master 29 and 35 exercises, no less than in other groups. This indicated the children's potential to improve their motor activity through regular physical activities [5, 6, 8,].
The findings brought out clearly that the rehabilitation of disabled children is becoming more effective through regular individual trainings with the use of active physical exercises. They get involved in motor activity and, as a result, succeed to master the exercises, which they were previously unable to perform; their functional state improves, which in turn contributes to the improvement of their health. Given that active physical exercises involve many mental processes, children also enhance behavioral control, emotional responses, and socialization, as well as increase their interest in sports.
Conclusions. Children with disabilities of all degrees of difficulty have great potential, which should be realized in a timely manner through active physical exercises.
The study found that out of 142 exercises mastered, 26.1% were directed towards the development and correction of walking skills, 15.5% - towards the development of balancing skills and ability for balance maintenance in the sitting and standing positions, 8.5% - towards the adaptation to physical loads, 5.6% - towards the formation of step movements and the ability to stand up from the sitting position, increasing the subjects' overall endurance to physical loads.
The children in the most difficult Levels 4 and 5 on the Gross Motor Function Classification System scale were able to master 29 and 35 exercises, respectively, no less than in other groups.
Individual training sessions with the use of active physical exercises and pedagogical tests increase the effectiveness of rehabilitation measures.
References
1. Babushkina O.F., Arkhipenko I.V., Dubksiy A.V., Kolenchenko V.V. Physical exercises to correct motor disorders in children with a spastic form of cerebral palsy. Nauchny vestnik Kryma. No. 7 (18). 2018.
2. Goryuchev D.V. Adaptive physical education for children with disabilities. Molodoy ucheny. 2019. No. 11. pp. 266-268.
3. Evseev S.P. Theory and organization of adaptive physical education. M.: Sport publ., 2016.
4. Karelina I.B., Turkina M.V. Psychological and pedagogical abilitation and rehabilitation of children with disabilities. Universum: Meditsina i farmakologiya: electronic scientific journal. 2016. No. 11 (33). Available at: http://7universum. com/ru/med/archive/item/3848.
5. Klochkova E.V. Introduction to physical therapy, physical rehabilitation of children with cerebral palsy and other motor disorders of neurological nature. M.: Terenif publ., 2014. 122 p.
6. Nasibulina T.V. Organization of adaptive physical education classes with children with disabilities. Syktyvkar, 2016.
7. Popova I.E., Varenikova N.A., Babushkina O.F Effect of physical therapy on neuromuscular system of children with cerebral palsy. Biomedical and pedagogical foundations of adaptation, sports activities and healthy lifestyle. Proc. VII national correspondence research-practical conference with international participation. Voronezh: Nauchnaya kniga publ., 2018. pp. 417-421.
8. Semenova K.A. Reconstructive treatment of children with perinatal damage to nervous system and with cerebral palsy. M.: Zakon i poryadok, ser. «Velikaya Rossiya. Nasledie publ., 2007. 616 p.
