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Publication date: 01.04.2022
DOI: 10.51871/2782-6570_2022_01_01_6
UDC 376.2
ASSESSMENT OF MOTOR FUNCTIONS OF PRIMARY SCHOOL CHILDREN WITH SPASTIC DIPLEGIA OF CEREBRAL PALSY
N.V. Lunina, A.S. Korneev
Russian State University of Physical Culture, Sports, Youth and Tourism, Moscow, Russia
Annotation. This article presents data on the assessment of motor functions of primary school children with spastic diplegia of cerebral palsy. The results of goniometry reflected a decrease in the amplitude of movement in all joints of the lower extremities. According to the Ashworth scale, moderate spasticity and hypertonicity of the lower extremities were revealed. According to the Gross Motor Function Measure scale, a violation of dynamic equilibrium was revealed, the quality of walking and the level of coordination abilities of the studied group were reduced. According to the Berg scale, a low level of stability, reduced support capacity, decreased coordination and general imbalance of children with spastic diplegia of cerebral palsy were noted. The data obtained are going to form the basis for the development of a physical rehabilitation program, taking into account age and existing disorders.
Keywords: motor functions, primary school children, spastic diplegia, cerebral palsy.
Introduction. According to the World Health Organization, 13 to 15 cases of cerebral palsy are registered per 1000 newborn, spastic forms take the leading role in occurrence [1-2].
Cerebral palsy is one of the most severe diseases of the central nervous system, which is shown in combined motor, speech and mental disorders of various severity [3]. Structures of the brain, which regulate voluntary movements, speech and other cortical functions, suffer the most.
The disease is characterized by a broad variation of clinical signs, accompanying symptoms, severity of motor disorders, degrees of compensation, causes that create complications when forming and developing skills needed for life-sustaining activity [1, 2, 4].
The purpose of this study was to evaluate motor functions of lower extremities in children of primary school age with spastic diplegia of cerebral palsy.
Methods and organization. When evaluating motor functions of lower extremities, we used following research methods:
- goniometry of joints in lower extremities;
- evaluation of global motor functions (Gross Motor Function Measure (GMFM-66) scale);
- muscle spasticity evaluation (modified Ashworth scale);
- equilibrium evaluation (Berg scale);
- mathematical statistics methods (mean value, standard derivation).
The study was carried out within the period from September 2020 till December 2021 in the Moscow City Center of Rehabilitation and the pool of the Secondary School of Olympic Reserve “Moskvich” specialized in rehabilitation of individuals with disorders of the musculoskeletal system.
The group of children of primary school age with cerebral palsy was formed in cooperation with pediatricians, attending traumatologists – orthopedists and neurologists. The examined group involved 12 children of the primary school age with spastic diplegia (average age – 8,5 years), with predominant damage of the lower extremities and the level of motor function development according to the Gross Motor Function Classification System (GMFCS) I and II (two children had the first level, others – the second level).
Main criteria of being included into the study: age, disorders of the central nervous system, damage of the musculoskeletal system.
In order to identify the initial level of motor capabilities, evaluation of muscles’ spasticity and presence of joint contractures in children of primary school age with cerebral palsy, we conducted testing of participants and goniometric measurement.
The statistical data processing was meant to define mean values and standard mean error (M±m).
Results and discussion. An adequate mobility in joints, characterized by flexibility, appropriate state of the capsular ligament and muscle apparatuses that make movements is needed for normal functioning. The goniometric study was carried out for all joints of the right and left leg: hip, knee and ankle joints. Results of joint goniometry indicators are presented in table 1.
Table 1
Goniometric measurements of the lower extremities' joints in primary school aged childrenwith cerebral palsy, M±m, °
|
№ |
Indicators |
Main group |
|
|
Right leg |
Left leg |
||
|
1 |
Hip joint abduction with the legs unbent |
51.4±9.1 |
51.6±9.4 |
|
2 |
Hip joint abduction with the legs bent |
74.4±12.8 |
74.4±12.6 |
|
3 |
Internal hip rotation |
65±18.4 |
65.4±18.6 |
|
4 |
External hip rotation |
51±9.1 |
50.8±9.5 |
|
5 |
Hip joint flexion |
113.8±6.3 |
114.4±7.02 |
|
6 |
Hip joint extension |
10.6±7.9 |
10.4±8.8 |
|
7 |
Knee joint flexion |
150±18.6 |
149.6±18.8 |
|
8 |
Knee joint extension |
159.8±16.8 |
160.6±16.04 |
|
9 |
Ankle joint dorsiflexion with the knee bent |
58.8±16.7 |
60±11.7 |
|
10 |
Ankle joint dorsiflexion with the knee unbent |
62.6±11.4 |
62.8±9.12 |
Data from the goniometric study have revealed rapid derivation from the physiological norm and decrease in amplitude of movement in all examined joints of the right and left leg.
Limitation of the movement amplitude in joints of the lower extremities matches with moderate spasticity and hypertonicity of the lower extremities, which are examined according to the Ashworth scale (1.8±0.83 points) (table 2). The existing joint contractures, moderate spasticity and hypertonicity of the lower extremities sharply limit volume and quality of performing motor actions.
The GMFM-66 scale study allowed us to assess the dynamic equilibrium level, to examine nature and quality of walking, level of coordination abilities of the examined group of children with spastic diplegia of cerebral palsy (table 2).
Table 2
Indicators of muscle spasticity and global motor functions of the lower extremities, statokinetic equilibrium level of the examined group, points
|
№ |
Indicators |
M±m |
|
1 |
Muscle spasticity level according to the Ashworth scale |
1.8±0.83 |
|
2 |
Evaluation of global motor function according to the GMFM-66 scale |
29.8±13.08 |
|
3 |
Equilibrium level according to the Berg scale |
37.4±8.20 |
Global motor functions were evaluated according to the GMFM-66 scale and amounted to 29.8±13.08 points in total, which indicates changes in the capsular ligament apparatus of children with cerebral palsy, possible secondary complications, lowered walking skills and disturbed coordination abilities of the lower extremities.
The equilibrium level in children with cerebral palsy was examined according to the Berg scale, the total rating amounted to 37.4±8.2 points, which indicates lower stability, reduced support capacity, lower coordination and general imbalance in patients with cerebral palsy, which, in whole, demonstrates a high risk of falling and additional injury of children.
Conclusion. The study of the lower extremities’ motor functions in primary school aged children with spastic diplegia of cerebral palsy has revealed a decrease in goniometry indicators in all joints of the lower extremities, moderate level of spasticity and hypertonicity of muscles, presence of changes in the capsular ligament apparatus of children, lowered skills of walking, equilibrium function and disturbed coordination abilities of the lower extremities. The data obtained are going to serve as a foundation for developing the physical rehabilitation program, considering age and present disorders.
REFERENCES
- Badalyan L.O., Zhurba L.T. Infantile cerebral palsy. Kiev: Slovo, 2009. 156 p. (in Russ.)
- Badalyan L.O., Zhurba L.T., Timonina O.V. Infantile cerebral palsy. Moscow, 2013. 325 p. (in Russ.)
- Babina G.V., Golovchits L.A., Krotkova A.V., Preschool education of children with special educational needs: a textbook. Moscow: Moscow Pedagogical State University, 2019. 288 p. (in Russ.)
- Yakubovskaya E.A. Topic 1. Clinical and functional characteristics of children with disorders of the musculoskeletal system. Fundamentals of the methodology of correctional and developmental work: textbook. method. manual. Minsk: Belarus State Pedagogical University, 2013. pp. 71-91. (in Russ.)
INFORMATION ABOUT THE AUTHORS:
Natal'ya Vladimirovna Lunina – Candidate of Biological Sciences, Associate Professor, Associate Professor of the Department of Physical Rehabilitation, Massage and Health-Improving Physical Culture named after Sarkizov-Serazini, Russian State University of Physical Culture, Sports, Youth and Tourism, Moscow, e-mail:
Aleksandr Sergeevich Korneev – Physical Rehabilitation Expert, Russian State University of Physical Culture, Sports, Youth and Tourism, Moscow, e-mail:
For citation: Lunina N.V., Korneev A.S. Assessment of motor functions of primary school children with spastic diplegia of cerebral palsy. Russian Journal of Sports Science: Medicine, Physiology, Training, 2022, vol. 1, no. 1.DOI: 10.51871/2782-6570_2022_01_01_6