PhD, Associate Professor A.A. Bruykov¹
PhD, Associate Professor V.V. Apokin²
Dr.Med., Professor A.V. Gulin^1
1Tambov State University n.a. G.R. Derzhavin, Tambov
²Surgut State University, Surgut

Keywords: cerebral palsy, fixation massage, developmental exercises, therapeutic swimming.

Introduction. In recent years, cerebral palsy (CP) has become one of the world’s most common neurological disorders that appear in early childhood [5]. CP damages the brain at the stage of its active development. This disease affects those brain areas that are responsible for voluntary movements, that is, there occur locomotor disorders [3]. The disease leads to a serious incapacitation of a child, affecting not only his motor system, but other systems as well, including the respiratory one [4]. Locomotor disorders involve definite changes in the visceral system, which functional state depends on the level of physical activity of children with impairments. In this connection, it is of particular interest to study the specific characteristics of the functional systems of the body of children diagnosed with CP, that determine the level of their overall physical working capacity, which is one of the relevant objectives of developmental physiology and medicine. At the same time, prevention of respiratory dysfunctions is the applied problem number one.

All the methods and techniques of rehabilitation of patients diagnosed with CP are chosen individually for each child, depending on the specifics of those abnormal muscle synergies that define the basic characteristics of pathological movement patterns, with due regard to the stage and form of CP, the presence of contractures, level of intellectual development and other individual characteristics [1-3]. Water exercises are crucial for the development and normalization of movements in children with CP [6]. Various kinds of massage also take a special place in the general complex of medical and biological means of rehabilitation of children diagnosed with CP. Classical massage improves the respiratory function.

Nowadays, there exists an approved system of fixation massage combined with ontogenetic gymnastics, which effectiveness made it possible to implement it in healthcare practice as the new corrective and rehabilitation means. It is proved that fixation massage used along with ontogenetic gymnastics has an effective impact on the functional state of the respiratory system of children with spastic forms of CP [2]. However, the effects of fixation massage and ontogenetic gymnastics combined with other rehabilitation means on the respiratory function in children with CP are still poorly studied.

The research objective was to study the effects of fixation massage and ontogenetic gymnastics combined with therapeutic swimming on the respiratory function of children with cerebral palsy.

Research methods and organization. 48 children of both sexes aged 10-11, diagnosed with CP in the form of spastic diplegia and double spastic hemiplegia, were involved in the study.  The examined children were divided into 4 equal groups. Reference group #1 was made of children with spastic diplegia, whose mean age was 10.6±1.6 years old, Reference group #2 – of children with double spastic hemiplegia, mean age – 10.8±1.3 years old. Rehabilitation activities of children from Groups 1 and 2 included classical massage, remedial gymnastics and therapeutic swimming. Group 3 was made of children diagnosed with spastic diplegia, whose mean age was 11.2±0.7 years old, Group 4 – of children diagnosed with double spastic hemiplegia, mean age – 10.2±1.4 years old. Rehabilitation activities of children from Groups 3 and 4 included fixation massage along with ontogenetic gymnastics and therapeutic swimming. Each group underwent 2 courses of massage and gymnastics, each of them consisted of 15 treatments. There was a 2-month gap in the treatment courses. Therapeutic swimming consisted of 36 treatments and was conducted continuously. Each group of children with CP was examined twice: before the course of treatment (initial examination) and after the course of treatment (final examination).

The results were statistically processed using the SPSS 16.0 software for Windows.

Respiratory function was examined at rest before and after the treatments. Vital capacity - VC (ml) and voluntary cessation of inspiratory (s) and expiratory (s) flow were determined. VC characterizes the level of development of the respiratory muscles and functional capacity of the respiratory system. VC was measured 3 times using a spirometer, and the highest value was considered.

Fixation massage session lasted 45 minutes, ontogenetic gymnastics - 30 minutes. The same amount of time was allotted for classical massage and remedial gymnastics. Fixation massage was carried out in accordance with the specially developed technique, classical massage - in the blood flow and lymph flow direction using the traditional techniques: stroking, kneading, vibrations (tapping technique). In case of fixation massage all parts of a patient’s body are fixed, except for those (or that part), which are massaged or are subject to massage exercises at the given moment. We gave reflexology massage of the chest.

Those movements a child was not able to form independently and master naturally were duplicated compulsorily by means of special gymnastic exercises, which conformed to the laws of ontogenetic development of movements. An essential feature of the proposed ontogenetic gymnastics consists in the fact that an instructor holds the child’s body parts fixed or uses the necessary fixation tools.

During the swimming classes, it was required to hold the child's head in the appropriate position (as due to the neck muscle weakness the head dropped toward the chest). The trainer was to submerge the child’s spastically bent fingers in the water and unbend them actively, moving with the child along the swimming pool and holding his hand in the necessary position. We used various positions of the child toward the coach, various directions of motion: face front, back first, sideways. There was developed a new set of exercises based on the child's supine position with his head in the water as he moves with the help of the trainer.

Some exercises were aimed at the unaided grabbing by a child of a stair handrail, a kick board; the trainer as a movable support; others – at the passive flexion-extension of the limbs with the trainer’s aid and hydrodynamic resistance to motion with cessation of breathing.

Results and discussion. As seen from Table 1, after classical massage, remedial gymnastics and therapeutic swimming, children diagnosed with spastic diplegia were observed to have an increase in the VC indices by 14.9%. The indicators of voluntary cessation of inspiratory flow increased by 10.4%, expiratory flow – by 12.9%. After the treatments using the techniques of fixation massage with ontogenetic gymnastics and therapeutic swimming with gymnastics, the children diagnosed with spastic diplegia were observed to have a significant improvement in their respiratory function. Thus, the VC index increased by 21%, timed inspiratory and expiratory capacity - by 15.4% and 12.9% respectively.

High efficiency of fixation massage combined with ontogenetic gymnastics and therapeutic swimming was noted in children diagnosed with CP in the form of double spastic hemiplegia. The techniques of fixation massage with ontogenetic gymnastics and therapeutic swimming turned out to be more effective than classical massage, remedial gymnastics and therapeutic swimming: in terms of the timed inspiratory-expiratory capacity in children diagnosed with double spastic hemiplegia, this index increased by 20.3% and 23.1% respectively. After the treatments, the VC indices in children from this group increased by 19.1%. The changes in the values of timed inspiratory and expiratory capacity after classical massage, remedial gymnastics and therapeutic swimming in children diagnosed with double spastic hemiplegia were less pronounced than in those from Group 4, and amounted to 9.7% and 10.3% respectively. The VC indices ​​were significantly lower than in Group 4 and increased only by 12.3%.

Table 1.  Changes in the respiratory function indices in 10-11- year-old children with various forms of cerebral palsy under the influence of different treatments, M ± m

Note. Group 1 – children diagnosed with spastic diplegia (classical massage, remedial gymnastics and therapeutic swimming were used); Group 2 – children diagnosed with double spastic hemiplegia (classical massage, remedial gymnastics and therapeutic swimming were used); Group 3 – children diagnosed with spastic diplegia (the treatment sessions included fixation massage with ontogenetic gymnastics and therapeutic swimming); Group 4 – children diagnosed with double spastic hemiplegia (the treatment sessions included fixation massage with ontogenetic gymnastics and therapeutic swimming)

As a result, we found that it was fixation massage that improved the respiratory function more effectively rather than classical one. Massaging the chest, back, respiratory muscles, as well as compressing the chest, contributed to the enhancement of ventilation of the corresponding segments of the lungs and blood circulation in them. Chest massage in the form of stroking, kneading and foulage lead to an increase in the depth of breathing, normalization of its rhythm and frequency.

This effect is due to the motor-visceral and skin-pulmonary reflexes leading to a decrease in the excitability of the respiratory center, which demonstrated by the results of this study. However, in case of CP, massage and remedial gymnastics caused pathologic synkineses, lead to an increase in the tonus of the respiratory muscles, which had a negative effect on the respiratory system of children. The solution to this problem was achieved by means of using fixation massage with ontogenetic gymnastics. Under their influence there was a suppression of pathologic synkineses and reduction of the respiratory muscle tone, as evidenced by the results of our work. Therapeutic swimming significantly increased the respiratory function indices in children diagnosed with CP.

Conclusion. The above mentioned indicates high-efficiency impact of fixation massage with ontogenetic gymnastics combined with therapeutic swimming on the functional indicators of the respiratory system in children diagnosed with cerebral palsy. The analysis of the findings revealed a more effective activating influence of fixation massage with ontogenetic gymnastics and therapeutic swimming on the respiratory system of children diagnosed with cerebral palsy, aimed to increase the reserve capacities of the body. Therefore, we recommend using fixation massage with ontogenetic gymnastics and therapeutic swimming as the basic means of rehabilitation to render an integrated effect on the body of children diagnosed with spastic cerebral palsy, as they significantly improve their respiratory function indices.

References

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Corresponding author: apokin_vv@mail.ru

Abstract
We have conducted a comparative analysis of the effects of fixation massage and remedial gymnastics combined with therapeutic swimming and classical means of rehabilitation on the respiratory function in 10-11-year-old children with cerebral palsy during rehabilitation. It has been established that these types of impacts increase the reserve capacities of the respiratory system of children diagnosed with various forms of cerebral palsy. Based on the research findings, we can recommend using fixation massage along with ontogenetic gymnastics and therapeutic swimming as the basic means of rehabilitation to render an integrated effect on the body of children with spastic cerebral palsy.