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3Functional and motor abilities of children diagnosed with cerebral palsy
UDC 796.077-056.266
PhD N.A. Gross1 PhD T.L. Sharova1 A.V. Molokanov1
1Federal Scientific Center for Physical Culture and Sports (VNIIFK), Moscow
Corresponding author: niinagross@yandex.ru
Abstract
Objective of the study was to integrate the baseline characteristics of the functional and motor abilities of disabled children and their deviations from the norm for use in planning physical loads during a rehabilitation process.
Methods and structure of the study. To systematize the characteristics determining the functional and motor fitness of disabled children and assess the degree of its compliance with the indices in healthy children, we consolidated the data obtained in the studies of 2017-2020. The studies were carried out before the start of the rehabilitation course and involved 3-16 year-old disabled children, both males and females, (n=95) of all five levels of development of the gross motor functions on the GMFCS scale. The following methods were applied: anthropometry, pulsometry, heart rate variability, stabilometry, podometry, pedagogical testing of motor abilities. The subjects' movements were assessed over 54 parameters from the following initial positions: lying on the back and stomach, sitting on the floor and chair, standing and in motion (crawling and walking).
Results and conclusion. Children diagnosed with cerebral palsy, who lead a sedentary lifestyle, lag behind healthy children in terms of all the studied parameters, which necessitates increasing the effectiveness of the rehabilitation process by increasing the overall motor activity.
The heart rate variability rates in the initial state indicated that the body of children with cerebral palsy is characterized by the state of detraining and impaired functional abilities.
The baseline characteristics of the functional and motor abilities can be used as guidelines in assessing the dynamics of changes during the rehabilitation process.
Keywords: disabled children diagnosed with cerebral palsy, functional indicators, motor disturbances, physical exercises, level of development of motor functions on GMFCS scale.
Background. One of the most common central nervous system diseases in children is cerebral palsy, a characteristic clinical symptom of which is a locomotor disturbance due to the loss of muscle tone. This leads to a decrease in the children's motor activity, which entails a change in the cardiovascular and respiratory systems, a violation of the metabolic processes, speech abilities, and a change in the psyche. Disabled children have difficulties with special body awareness and can hardly perform age-appropriate movements, due to which they lead a sedentary lifestyle. Long-term akinesia complicates children's social adaptation, which negatively affects their quality of life [2, 3, 5].
If a disabled child does not perform age-appropriate physical loads, the process of physical development will be disrupted. The mechanisms of formation of children's motor skills are improved from earliest infancy, are associated with overcoming the forces of gravity, and are aimed at adapting the body to maintaining an upright position when performing voluntary movements. The lack of the capacity to maintain the upright posture limits disabled children in the development of natural movements at the earliest stages of development [6].
The skill to maintain the upright position is not congenital but is acquired from the moment of birth as a result of a child's motor activity. With a decrease or
absence of physical loads (for example, a long stay in a horizontal position) antigravity mechanisms may either not develop or be lost with a corresponding loss of motor skills, first of all, the skills to maintain the upright position and walk. A complex of negative manifestations acquired by such children makes them lag in their physical and functional development behind healthy children [4].
When designing a rehabilitation process for children with cerebral palsy, it is properly organized training sessions that are important, in which the decisive role belongs to the active, not passive physical exercises [1]. In this case, knowledge of the characteristics of the state of the body of disabled children and their difference from healthy ones helps to choose the right direction in increasing the effectiveness of the rehabilitation process.
Objective of the study was to integrate the baseline characteristics of the functional and motor abilities of disabled children and their deviations from the norm for use in planning physical loads during a rehabilitation process.
Methods and structure of the study. To systematize the characteristics determining the functional and motor fitness of disabled children and assess the degree of its compliance with the indices in healthy children, we consolidated the data obtained in the studies of 2017-2020. The studies were carried out before the start of the rehabilitation course and involved 3-16 year-old disabled children, both males and females, (n=95) of all five levels of development of the gross motor functions on the GMFCS scale. The following methods were applied: anthropometry, pulsometry, heart rate variability, stabilometry, podometry, pedagogical testing of motor abilities. The subjects' movements were assessed over 54 parameters from the following initial positions: lying on the back and stomach, sitting on the floor and chair, standing and in motion (crawling and walking).
Results and discussion. The studies showed that the heart rate and blood pressure rate in the majority of the disabled children at rest were above the norm, and within the age norm - only in 25% of children. The overwhelming majority of the subjects (70%) had hypertension, which may have been due to the high muscle tone typical of cerebral palsy. The analysis of the functionality of the cardiovascular system in terms of heart rate variability on the "Varicard" diagnostic device revealed that disabled children are characterized by vegetative dysfunction and detraining of the bodily
systems in different age periods from 3 to 16 years. It was found that 56% of the children had a low level of physical working capacity. Conversely, they had a rather high level of development of adaptive potential, which probably indicated the internal readiness of the body to develop motor abilities.
It is noteworthy that in terms of the body length rates, 58% to 65% of the children reached the normal level, in terms of the body weight rates - from 51% to 67% of the children. Only one-third of the children (31%) had no deviations in the age norm in terms of head circumference, which may indicate complex neurological disorders. In terms of chest circumference, 48-53% of the children met the average standards. A strong asymmetry in the children was also observed in terms of thigh and shin circumferences.
There were significant differences from healthy children in the indicators of vertical stability and support ability in the stabilometric tests. The average pressure center movement speed rate in the disabled children was three times lower than in healthy ones, the ellipse area rate was ten times worse. The ability to stand steadily on two legs was observed in 0.6% of the children only.
The results of the motor skills tests, including exercises that a healthy child should be able to perform from the initial positions "lying", "sitting", "standing" (54 parameters in total), showed that only one-third of the children could move independently and maintain the upright position. A fairly high percentage obtained in different groups during the exercises performed from the initial positions "lying" and "sitting" indicated that they spent most of their lives in these positions, and limited motor activity or ineffective exercises did not allow them to completely master the necessary motor skills that a healthy child possesses.
The motor test results of the children, distributed according to the levels of development of their gross motor functions on the GMFCS scale, showed that the children attributed to the 1st level, who were able to move independently without limitations, were able to fulfill only 87.7% of the maximum possible 106 points. The children in Level 2, who moved independently with limitations, could gain only 85.1% of the maximum. The children in Level 3 who walked using a hand-held mobility device (walking sticks, walkers) - 61.6% of points. The children in Level 4, who could sit on their own, but could not walk, were able to score only 44.0% of points. The children in Level 5, who were unable to
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change their body position without assistance, were able to score 26.8% of points.
Therefore, in the initial state, the disabled children's ability to perform movements ranged from 26.8 to 87.8%. Even the children in Level 1 on the GMFCS scale, who were able to move independently, could not correctly perform all the proposed exercises that a healthy child can. The minimum lag behind healthy children was 12.2%.
Consequently, insufficient physical activity, especially during the first year of life, leads to various disturbances in the development of the physiological processes of the body, the formation of a limited range of movements. The variety of inconsistencies with the physiological norms of the body development of a disabled child complicates the improvement of life activity, reduces the level of motivation, and contributes to the preservation of the disabled status [4].
The data obtained are quite informative for the formation of an idea of the general characteristics of the state of the body of disabled children and can be used as benchmarks in assessing the dynamics of changes during the rehabilitation process.
Conclusion. Children diagnosed with cerebral palsy, who lead a sedentary lifestyle, lag behind healthy children in terms of all the studied parameters, which necessitates increasing the effectiveness of the rehabilitation process by increasing the overall motor activity.
The heart rate variability rates in the initial state indicated that the body of children with cerebral palsy is characterized by the state of detraining and impaired functional abilities.
The baseline characteristics of the functional and motor abilities can be used as guidelines in assessing the dynamics of changes during the rehabilitation process.
References
1. Gross N.A., Sharova T.L. System approach to physical rehabilitation of disabled children with cerebral palsy. Actual problems of adaptive physical education. Proc. I research- practical conference. Institute of Natural Science and Sports Technologies. M., 2020. pp. 96-100.
2. 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.
3. Gross N.A., Berkutova I.Yu., Sharova T.L. et al. Assessment of motor abilities of children with cerebral palsy during exercises from different starting positions. Uchenye zapiski universiteta im. P.F. Lesgafta. 2016. No. 4 (134). pp. 64-70.
4. Gross N.A., Sharova T.L., Berkutova I.Y et al. Solutions to problems of rehabilitation of children with motor impairments by means of physical education. Vestnik sportivnoy nauki. 2018. No. 5. pp. 58-64.
5. Semenova K.A. Reconstructive treatment of children with perinatal damage to nervous system and with cerebral palsy. M.: Zakon i pory-adok, ser. Velikaya Rossiya. Nasledie publ., 2007. 616 p.
6. Gross N.A. [ed.] Modern methods of physical rehabilitation of children with musculoskeletal system disorders. M.: Sovetskiy sport publ.. 2005. 235 p.
