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Lunina N.V., Skoryukova K.S. Postural balance training in the support and walk correction in children with motor disorders

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Publication date: 01.03.2023
DOI: 10.51871/2782-6570_2023_02_01_4
UDC 376.2; 616.831-009.11

POSTURAL BALANCE TRAINING IN THE SUPPORT AND WALK CORRECTION IN CHILDREN WITH MOTOR DISORDERS

N.V. Lunina1,2, K.S. Skoryukova1

1Russian State University of Physical Culture, Sports, Youth and Tourism, Moscow, Russia

2FSBI “North-Caucasian Federal Research and Clinical Center of the Federal Medical and Biological Agency”, Essentuki, Russia

Annotation. The article presents the results of applying postural balance training for children with motor disorders associated with cerebral palsy. The training consisted of the comprehensive use of physical rehabilitation measures: morning hygienic gymnastics, therapeutic massage, therapeutic exercises, sessions in the ADELI antigravity suit, stability training with biofeedback, sessions with the Corvit load simulator. The authors assessed the training results with the Global Motor Functions Assessment Scale (GMFM-88), the total score in which significantly (p≤0.01) increased from 84.5±5.23 to 93.7±3.16 points. The data obtained demonstrate the effectiveness of the use of the postural balance training in the correction of support and walk in children with motor disorders.

Keywords: postural balance, support and walk correction, children, physical rehabilitation, motor disorders, motor functions, cerebral palsy.

Introduction. Motor disorders associated with cerebral palsy (CP) are of diverse nature. The main signs are the dysfunction of coordination [1], postural balance while holding vertical position, static and dynamic balance while standing and walking. The motor disorders are often connected to mental, developmental disorders, as well as sensory analyzer defects [2], which makes it difficult to identify and correct them. The recovery efficiency of motor disorders in cerebral palsy largely depends on the severity of the clinical signs of the underlying and concomitant pathologies, objectively assessed by the quality and quantity of motor actions performed in various body positions [3-4]. The quality of maintaining vertical position in terms of static and dynamic balance while standing and walking is conditioned by postural balance preservation, the training of which is important for patients with motor disorders.

The purpose of the study – to evaluate the effect of the postural balance training on the support and walk correction of children with motor disorders.

Methods and organization. The support and walk functions were evaluated with the Global Motor Functions Assessment Scale (GMFM-88) [4]. The statistical processing of the results was made with the Statistica 13 software. The authors calculated arithmetic mean values and the standard deviation of the indicators obtained. The Wilcoxon’s t-test was used for assessing the significance of differences (p<0,05).

The study was carried out in the Oblast Children's Clinical Hospital (Yaroslavl), it included 6–8-year-old children (n=11) with motor disorders associated with cerebral palsy. The postural balance training was conducted during the rehabilitation course with passive-active recovery measures: morning hygienic gymnastics, therapeutic massage, therapeutic exercises, sessions in the ADELI antigravity suit, stability training with biofeedback using the Stabilan device (Russia) and sessions with the Corvit load simulator (Russia).

Results and discussion. The morning gymnastics sessions took place daily for 15 minutes at the beginning of the course, 5 minutes of which were given to breathing exercises aimed at reducing hypertonia, the positions of test subjects – sitting and lying. Near the end of the course, these sessions were conducted 7-8 minutes daily, the reason for it was learning the skill and the increased physical activity during the day due to application of other rehabilitation means. The exercises were performed at a slow pace at first with a gradual increase to a medium pace. Then these exercises were performed separately with 5–10-second pauses.  Exercises with sports equipment (gymnastic poles, balls, expanders) were also added. The number of exercises – 7-8, the number of repeats – 4-5. In order to form a stable vertical position during the exercises, this position was gradually added as the existing muscle imbalance was corrected and the muscles were strengthened.

Therapeutic massage was also done daily for 30 minutes before the morning gymnastics sessions to correct the asymmetrical muscle tone.  It was combined with the position treatment. At the end of the massage session, orthoses or splints were put on the legs to fix the physiological position of the lower limbs.

The therapeutic exercises were done daily, included calisthenics, breathing and special exercises. Special exercises contained the following: passive exercises aimed at increasing the amplitude of joints, the physiological position of which was shifted by spasmic muscles, with a consequent special positioning (position treatment); exercises on a balance board with a gradual increase in difficulty of applied initial positions (such as lying, sitting and standing) and verticalization with a specialized stand. Later the researchers added exercises for the development of the foot’s support function: feet rolling from heel to toe, squats, stepping over objects, strength exercises for improving lower limb muscles. Pauses between the exercises were gradually shortened down to 5 seconds. The pace was gradually increased from slow to medium. The set included 12-15 exercises, each of them was repeated 6-8 times. In order to preserve the correction effects, application of individual orthoses was recommended.

Application of the ADELI suit was carried out according to the principles of customization when choosing the fixating position, present disorders in preserving vertical position of the body and in walking, with a gradual load increase. On the first and second day, the duration of the session was 20 minutes. During the following days, if the tolerance to loads was strong, the duration was increased daily by 5 minutes, with total duration of no more than 30 minutes in 10 sessions. Then it was gradually increased to 60 minutes. If tolerance to loads was strong, the exercises also included stair walking.

The stability training with biofeedback was started according to the state of vertical position correction and muscle strengthening, not earlier than a week after the beginning of the physical rehabilitation course. During the course, following tasks were being solved: learning to distribute weight symmetrically on both legs, eliminating asymmetry of vertical position learning to distribute weight symmetrically between heel and toe of the affected leg; increasing amplitude of the possible shift in the center of pressure; training the speed of posture correction by voluntarily moving the center of pressure as a response to a change in body position [5]. The training session was in the form of computer stabilographic games, during which the training and reinforcement of the skill of voluntary control of the pressure center takes place, as well as training of the balance function, neuromuscular coordination and postural balance.

It is recommended to carry out these sessions in stages in order to teach children with cerebral palsy the aforementioned skill.

At the first stage (3-5 sessions), the semantic and coordination basis of the skill is formed with a detailed explanation of the training’s purpose and objectives for the studied group. In order to reinforce the skill, it is recommended to play the stabilographic games 2-3 times in a row with rest intervals of 1-2 minutes. During the session, the instructor watches over and controls tasks on the computer, explains the details to the child and corrects their movements.

At the second stage (6-10 sessions) further correction and reinforcement of the skill are carried out, ensuring its stability and variability. At the same time, it is necessary to avoid and correct excessive stiffness of the child’s movements, the occurrence of associated movements (synkinesis), a reduced success of performing motor actions when changing the game, the formation of pathological strategies in the voluntary movement of the pressure center. If the increased spasticity is present, the time of force applied on the affected leg should not exceed 1-5 seconds (i.e., the time of the force phase of a healthy person’s step cycle). In order to prevent the tone build-up in the pauses between games, we applied exercises with relaxing swinging movements of the affected leg. In addition, in such cases, the selection of the game should be carried out taking into account the principle of small amplitudes and a gradual increase in the radius of the pressure displacement center in such patients.

Sessions with the Corvit simulator were carried out not less than 10 times in the vertical position. First two sessions were done in the sitting position, speed – 3 km/h, percentage of force applied by the foot – 30%, duration of the session – 14 minutes. Difficulty of the following sessions was gradually increased till the following combination: initial position – standing, speed – 3 km/h, percentage of force – 30%, duration – 7 minutes; in the following 7 minutes the speed was increased to 4 km/h, percentage of force – 40%.

The efficiency of the conducted postural balance training was assessed with the Global Motor Functions Assessment Scale(GMFM-88), in which, on a 4-point scale, movements were evaluated in five categories:

  1. lying and rolling;
  2. sitting;
  3. crawling and kneeling;
  4. standing;
  5. moving – walking, running and skipping (table).

Table

Results of changes in the indicators of the Global Motor Functions Assessment Scale (GMFM 88) in children with motor disorders

Indicator

Before training

After training

р<

Number of points
according to GMFM-88

84.5±5.23

93.7±3.16

0.01

The total score before the training amounted to 84.5±5.2 points, which shows present changes in the muscular and ligamentous system, disorders of coordination capabilities and shift in the center of pressure, mainly in vertical positions. The postural balance training contributed to a significant increase of the result to 93.7±3.16 points and an improvement of global motor functions in children with motor disorders associated with cerebral palsy.

Conclusion. The received results of improving motor functions in the examined children were achieved due to the postural balance training aimed at optimization of muscle tone, elimination of pathological motor stereotypes, improvement of the muscle corset, preservation of physiological vertical positions while maintaining static and dynamic balance.

REFERENCES

  1. Borzikov V.V., Rukina N.N., Kuznetsov A.N., Belova A.N. Objectification of motor disorders in children with cerebral palsy: what we know so far. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery, 2018, vol. 6, issue 1, pp. 67-77. DOI: 10.17816/PTORS6167-7. (in Russ.)
  2. Aksenova L.I., Arkhipov B.A., Belyakova L.I. et al. Special Pedagogy: a textbook for university N.M. Nazarova. Moscow, 2005. 396 p. (in Russ.)
  3. 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. Available at https://intsport.ru/arkhiv-nomerov/2022-1/lunina2022e (accessed 31.01.2022)
  4. Litus A.Yu, Feskov G.P. Usage of the GMFM-88 Scale for the Evaluation of the Effectiveness of Short-term Intensive Rehabilitation of Children with Motor Disorders. Bulletin of Rehabilitation Medicine, 2021, no. 20(4), pp. 90-98. DOI: 10.38025/2078-1962-2021-20-4-90-98. (in Russ.)
  5. Skvortsov I.A., Ermolenko N.A. Development of the nervous system in children in health and disease. Moscow: MEDpress-inform, 2003. 368 p. (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 I.M. Sarkizov-Serazini, Russian State University of Physical Culture, Sports, Youth and Tourism, Moscow; Senior Researcher of the Center of Biomedical Technologies, FSBI “North-Caucasian Federal Research-Clinical Center of Federal Medical and Biological Agency”, Essentuki, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it..
Ksenia Sergeevna Skoryukova – Master’s Student of the Department of Physical Rehabilitation, Massage and Health-Improving Physical Culture named after I.M. Sarkizov-Serazini, Russian State University of Physical Culture, Sports, Youth and Tourism, Moscow.

For citation: Lunina N.V., Skoryukova K.S. Postural balance training in the support and walk correction in children with motor disorders. Russian Journal of Sports Science: Medicine, Physiology, Training, 2023, vol. 2, no. 1. DOI: 10.51871/2782-6570_2023_02_01_4

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