Postgraduate student A.S. Volokitin¹
Associate professor, Ph.D. A.A. Bruykov¹
Professor, Dr.Med. A.V. Gulin¹
Associate professor, Ph.D. V.V. Apokin^2
1Lipetsk State Pedagogical University, Lipetsk
²Surgut State University Khanty-Mansi Autonomous Region - Yugra, Surgut

Keywords: hippotherapy, cerebral palsy.

Introduction. Cerebral Palsy (CP) is a polietiologic disease, which comprises a group of different clinical implications of the syndromes resulting from the underdevelopment of the brain or its damage at various phases of the ontogenesis and is characterized by the inability to maintain normal posture and perform voluntary movements [1, 2]. Those who suffer most in case of cerebral palsy are the centers responsible for voluntary movements, that is the disruption of the locomotor system occurs. Many children with cerebral palsy have expressed limited mobility in the joints, in most cases caused by the joint muscle contraction.

In the general set of medicobiological means of recovery of disturbed functions in children with various forms of cerebral palsy special place with regard to effectiveness belongs to a variety of massages and therapeutic exercises as natural, accessible and effective methods of stimulation of the human body.

Over the last years, new, non-traditional, methods accelerating normalization of disturbed functions have been implemented in the practice of rehabilitation, and along with the familiar recovery and preventing means, fixation massage with developmental gymnastics are of particular value, primarily owing to their efficiency in the development of joint mobility in children with CP [4].

Implementation of new methods of recovery of the body of children with CP is a relevant issue of today. Currently, the method of hippotherapy is used in this view, as it has a positive impact on the functional state of particular body systems of children with CP [3].

The fundamental difference of hippotherapy from other types of therapeutic exercises (TE) is that here, like nowhere else, almost all grounds of muscles of a rider are activated simultaneously. Moreover, this happens reflexly, since, sitting astride a horse, moving with it and astride it, a child tries to keep balance by instinct during the whole training session, thus inciting to active work both healthy and affected muscles of his/her body. Besides, it cannot arouse in children that strongest, multidirectional motivation which is typical for hippotherapy sessions.

 Consequently, the presented general scientific data testify to the necessity to conduct the follow-up study on the effects of the new means of health promotion and preventive care influencing the development of joint mobility in the body of children with CP, particularly the effects of hippotherapy. All this was used as a reason for selection of the research guidelines.

The purpose of the research was to study the effects of hippotherapy on the development of joint mobility in 8-10-year-old children with CP in the form of spastic diplegia.

Materials and methods. We examined 28 boys and girls who had CP in the form of spastic diplegia. The subjects were divided into 2 equal groups: control (Group 1), mean age – 9.2±0.9 years and experimental (Group 2), mean age – 9.5±0.7 years. The observation lasted 6 months. With that, the rehabilitation measures for the children of Group 1 included standard massage and therapeutic exercises. The children of Group 2 trained according to the special program of hippotherapy. The children of both groups were examined twice: first - before the treatment course (base-line examination) and for the second time - upon the treatment course (final examination). A total of 2 courses of massage and therapeutic exercises were carried out, they consisted of 15 procedures each. The hippotherapy classes (40 procedures) were given 3 times a week on a going basis. Massage and succeeding therapeutic exercises lasted 90 min, hippotherapy procedures - 45 min.

Joint mobility was estimated by the maximum joint extension angle. Joint extension or flexion angle was measured using a goniometer consisting of two jaws and a circular curve with divisions (0 to 360 degrees). The goniometer was placed so that its axis went through the joint flexion axis, and the jaws were positioned parallel to the axes of the corresponding extended segments of the extremities. Joint mobility was assessed by the goniometer scale at its maximum active extension. Movements in the elbow joint were carried out towards flexion and extension. The amplitude of these movements was measured when a forearm was in the mid-position between pronation and supination (thumb directed forwards). The goniometer was placed on the external surface of the arm, in the plane of joint movements of the forearm so that its knuckle was situated near the joint gap (slightly lower the palpable external epicondyle of the shoulder). One jaw of the goniometer was placed along the shoulder axis, the other - along the forearm axis.

The elbow joint mobility was estimated by the angle of joint extension, and the ankle joint mobility - by the total volume of joint flexion and extension, which normally amounts to 60-70 degrees. The normal elbow extension angle is about 170 degrees.

To estimate the physiological reserve of the corresponding movement we calculated the ankle extension amplitude deficit (AEAD). We used a goniometer to determine the amplitudes of active and passive ankle extension (AAE and PAE) in the ankle joint lying flat on back with stretched lower extremities and calculated AEAD by the following formula:

AEAD = AAE – PAE – 5 (in degrees).

The functional capabilities of the locomotor system are determined by the volumes of joint movements and compensatory adaptation of the adjacent parts. The amplitude values of AAE and PAE were estimated using a common goniometer.

A child's preparatory position is lying flat on back with stretched lower extremities and feet outside the couch. When measuring the amplitude of movements or locked position of the foot, the goniometer was placed in a sagittal plane, on the internal surface of the foot. The goniometer knuckle was placed on the internal side of the ankle. And one jaw was positioned along the lower leg axis, the other - along the line connecting the front-and-back support points of the foot. Moreover, an increase in the amplitude of movements was characterized by a decrease in the corresponding absolute values. The error of measurement was 5 degrees. Upon rehabilitation course the amplitude of active and passive ankle extension was reexamined. We deemed significant an increase in the amplitude value by 10 and more degrees. According to the literature sources, the algebraic difference between the values of the amplitude of AAE and PAE was in the norm equal to 5 degrees or so [4].

Results and discussion. We studied the effects of hippotherapy on joint mobility in children with cerebral palsy. The focus was mostly on the elbow and ankle joints, since at spastic forms of cerebral palsy the most serious mobility disorders are detected in these joints. Herewith, restricted range of ankle flexion is generally caused by hipertonicity and contraction of the gastrocnemius muscle, as well as by the peroneus relative atonia. Restricted range of elbow extension is mainly caused by hypertonicity and contraction of the biceps and brachioradial muscles, as well as by relative atonia of the triceps muscle of arm [2].

The analysis of the obtained data has revealed that hippotherapy had a more effective impact on the development of the elbow joint mobility compared with classical massage and therapeutic exercises. Thus, the volume of movements in response to hippotherapy in Group 2 has increased by 7.2% and 6.8% in the left and right elbow joints respectively. In Group 1, the changes were less pronounced and amounted to 4.2% in the right joint and 4.5% in the left one (Table 1).

Table 1. Changes in elbow joint mobility in response to classical massage and remedial gymnastics compared with hippotherapy

Note. Group 1 – standard massage and therapeutic exercises were used, group 2 – hippotherapy was used, p – coefficient of significance of differences.

In Group 2, where hippotherapy was applied, we observed a decrease in AEAD in the right hand by 7.5%, and by 6.9% in the left hand, while in Group 1, upon rehabilitation, which included classical massage and therapeutic exercises, AEAD equaled 4.2% and 3.8% for the right and left hand respectively.

Conclusions. Therefore, the findings of the study conform with the general theories of physiology and neurophysiology stating that the success of formation of child's motor skills during ontogenesis depends on the principle of heterochrony in cortical maturation. Hippotherapy classes applied, which by their content pertain to the laws of consequent maturation of the cortical apparatus of the motor-kinesthetic analyzers, on the one hand, form the basis of efficiency of these structures, and on the other hand, can be considered as the new scientific facts obtained during the study on the high efficiency of hippotherapy for improvement of development of joint mobility in children with spastic forms of CP.

References

1. Bortfeld, S.A. LFK i massazh pri detskom tserebral'nom paraliche (Physical therapy and massage in case of cerebral palsy) / S.A. Bortfeld, E.I. Rogacheva. - Leningrad: Meditsina. 1986. – 175 P.
2. Bruykov, A.A. Razvitie podvizhnosti sustavov u detey s detskim tserebral'nym paralichom pod vliyaniem fiksatsionnogo massazha i ontogeneticheskoy gimnastiki (Development of joint mobility in children with cerebral palsy under the influence of fixation massage and developmental gymnastics) / A.A. Bruykov, A.V. Gulin // Health for All // Proceedings of the 3^rd internat. theor.-pract. conf., Polessk state university, Pinsk, 2011. – P. 32–34.
3. Bruykov, A.A. Issledovanie motornoy aktivnosti u detey so spasticheskimi formami DTsP (Study of motor activity of children with spastic cerebral palsy) / A.A. Bruykov, A.V. Gulin. Vestnik Tambovskogo Universiteta. Ser. Estestvennye i tekhnicheskie nauki. – Tambov, 2011. – V. 16. – Iss. 6. – P. 1516–1519.
4. Bruykov, A.A. Fiziologicheskaya kharakteristika vliyaniya fiksatsionnogo massazha i ontogeneticheskoy gimnastiki na funktsional'noe sostoyanie TsNS u detey s DTsP (Physiological characteristic of the effect of fixation massage and developmental gymnastics on functional state of central nervous system in children with cerebral palsy) / A.A. Bruykov, A.V. Gulin, V.V. Apokin. Teoriya i Praktika Fizicheskoy Kul'tury. – Moscow, 2010. – № 11. – p. 99–101.

Corresponding author: apokin_vv@mail.ru