N.A. Gross
T.L. Sharova
I.Y. Berkutova
G.V. Bukanova
All-Russian Research Institute of Physical Culture and Sport, Moscow

Keywords: vertical postural control, motor abilities, infantile cerebral palsy, rehabilitation, physical exercises, training simulator.

Background. The growing numbers of disabled people in our country reported by a variety of statistical accounts for the last few years and the necessary growth of the special rehabilitation centres to serve the disabled population are indicative of the public health problems getting more and more serious [3]. Special attention needs to be paid to the disabled children’s rehabilitation initiatives for the children are more susceptible to corrective and developmental impacts and the appropriate corrective methods.

Physical loads have long been ranked among the most important rehabilitation tools albeit their impacts on people diagnosed with different health limitations still need to be studied in more detail and, therefore, a high priority should be given to this issue. This holds true for disabled children too. Since no human life is possible without movement, the studies to explore reasons for the motor limitations and ways to recover motor abilities in children with health impairments are highly relevant at this juncture.

Vertical postural control is a natural and key ability providing a basis for every motor action including a variety of postures, spatial movement sequences etc. Vertical postural control function of the children diagnosed with serious impairments of the musculoskeletal system is normally poor. In the worst cases, the functional deficiency enables them to stand, sit and walk; and even when some vertical postural control is maintained, the postures and walking skills are never perfect enough, and the rehabilitation efforts may not always be successful in developing the relevant motor skills. It is commonly recognised today that the children’s motor functions may be notably improved when they are subject to age-specific individualized physical training. However, when the physical training process is suspended or decreased for some time (when the child, for example, stays in bed or otherwise has to be inactive for some reason), the acquired skills may be lost, particularly if they were underdeveloped [1, 2]. Studies of the vertical postural control in the disabled children’s physical training process will help improve the rehabilitation systems based on the better knowledge of the bodily functional reserves and better grounds for the physical training process design and management.

A variety of special methods and sets of exercises are applied nowadays to help build up the vertical postural control ability, the exercises being applicable in traditional ways or using different appliances and training simulators. Due care need to be taken in the motor skills formation process to select the most appropriate physical loads customized for the actual condition and potential resources of every child. When the set of exercises is well customized to the individual physiological abilities and resources, the training process may contribute to and develop specific motor skills. Inadequate training loads, however, may trigger a variety of negative bodily conditions and hamper the motor abilities improvement/ building process.

Objective of the study was to analyse the effects of special vertical postural control exercises based on stabilograms of children with impairments diagnosed with motor disorders including: infantile cerebral palsy, autism and combined health disorders.

Methods and structure of the study. The children’s vertical postural control was rated by stabilometric data obtained by Stabilan-01 computer force plate, with disabled children aged 3 to 14 years being subject to the tests [4]. The children were also tested by the eyes-open and eyes-closed Romberg's tests prior to the training session and immediately after each of the exercises, followed by the relevant physical rehabilitation practices. We applied general movement rates to measure the balancing ability on the whole.

 We selected the following 7 active test exercises for the study: Reck Motomed movement therapy - passive working exercises at the rate of 20 rotations per minute taking 10 min; 10 min treadmill practice at the rate of 1-2.0 km/ hour; Gross Training Simulator working with assisted rotation/ straight aerial movements for 3 minutes (with the instructor’s assistance); back-to-chest roll-overs for 1 minute on the mats; Gross Training Simulator working with push-ups from the floor and forward movement for 5 minutes; cycling around the gym and exercise bicycle working for 10 minutes; and the swinging practices stomach-down (1 min) and back-down (1 min) on the oval ball. Each group for the study was composed of limited and varying numbers of children with impairments due to the natural limitations for such kind of studies.

Study results and discussion. Given in Table 1 are the summarized study data for the diagnose-specific groups of children obtained by the eyes-open and eyes-closed Romberg's tests with the right and left turns of the head prior to and after the exercises. The lower test rates were interpreted as indicative of the better vertical postural control.

Table 1. Average movement rates (radian per second) for the diagnose-specific groups of children obtained prior to and after the exercises

The tests showed the exercises being of different effects on the vertical postural control of the children with impairments. The post-exercise postural control rates were found to fall or grow depending on the difficulty level and intensity of the exercises. It was the treadmill practice that showed the highest growth of the vertical postural control rates in three groups out of 4 in the following tests: eyes-open and eyes-closed and head-to-the-right and head-to-the-left exercises. The exercise bicycle tests showed the same ratio of the postural control improvement/ loss cases. To assess the potential correlation of the diagnoses with the vertical postural control rates we summarised the movement rate improvement cases by the health groups: see Table 2.

Table 2. Movement rate improvement cases after the 7 gender- and diagnosis-specific tests, rad/s

It may be pertinent to mention that the girls with ICP group showed the highest proportion of the movement rate improvement cases (17 out of 28, or 60.7%) versus that in the other test groups. In the group of boys with ICP the tests found 7 improvement cases out of 28, or 25% of the total. This intergroup difference of the boys and girls’ groups may be explained by the prior gap in the initial functional ability rates that were higher in the girls’ group. The boys diagnosed with autism showed improvements in 4 test exercises, and the boys with combined conditions also showed improvements in 4 test exercises out of 7.

Conclusion. The vertical postural control rating after the special exercises may be recommended as an efficient method to profile the child’s functionality variations following the corrective practices and to adjust the individual training programs. The post-exercise postural control rates were found to fall or grow depending on the difficulty levels and intensities of the exercises which need to be duly designed and managed in the training process. There are reasons to assume that some sagging of the vertical postural control ability after some high-intensity exercises may be due to the growing fatigue that is manifested, among other things, in the temporal loss of the movement coordination ability; therefore, due consideration should be given to this fact in the rehabilitation program designs. The vertical postural control ability improvements after the low-intensity albeit relatively long treadmill practices may be due to the rhythmic exercises being beneficial for the vertical postural control ability building process.

References

1. Baranov A.A., Kuchma V.R., Sukhareva L.M. Podrostki: tendentsii zdorovya, puti ego sokhraneniya i ukrepleniya [Teens: Health trends, ways of its preservation and strengthening]. Sotsialnye i organizatsionnye problemy pediatrii [Social and procedural problems of pediatrics]. Moscow: Dinastiya publ., 2003, pp.153-173.
2. Emelyanov V.D. Tekhnologiya diagnostiki faktorov, opredelyayushchikh razvitie koordinatsionnoy struktury dvigatelnoy deyatelnosti u detey s ogranichennymi vozmozhnostyami zdorovja. Diss. kand. ped. nauk [Technology of diagnostics of factors that determine development of coordination structure of motor activity in children with disabilities. PhD diss.]. St. Petersburg, 2009, 100 p.
3. Reabilitatsiya invalidov v Rossiyskoy Federatsii [Rehabilitation of the disabled in the Russian Federation]. Sotsialny byulleten, no. 4, 2015. Analytical Center under the Government of the Russian Federation. Available at: http://ac.gov.ru/files/publication/a/7480.pdf
4. Skvortsov D.V. Klinicheskiy analiz dvizheniy. Stabilometriya [Clinical analysis of movements. Stabilometry]. Moscow: Antidor publ., 2000, 192 p.

Corresponding author: vniifk@yandex.ru

Abstract

The study was designed to analyse the effects of special vertical postural control exercises based on stabilograms of children with impairments diagnosed with motor disorders including: infantile cerebral palsy, autism and combined health disorders. The proposed sets of exercises resulted in the virtually equal cases of vertical postural control improvement and impairment, and this finding may be indicative of the need for the exercises being customized to the individual health requirements by types and intensity levels. The vertical postural control sagging after some high-intensity exercises may be attributed to the growing fatigue albeit the resultant movement coordination disorders were temporal. The notable improvements of the vertical postural control following the low-intensity and fairly long treadmill practices may be interpreted as indicative of the rhythmic cyclic movements being beneficial for the vertical postural control function.