Issue 24-2, 2025

The Effectiveness of the Biofeedback Complex in the Treatment of Children with Cerebral Palsy: a Randomized Controlled Study

^1,2,* Aleksandr V. Egorov, ¹ Svetlana K. Yakovleva, ^1,2 Roza V. Petrova, ¹ Elena V. Preobrazhenskaya

¹ Federal Center for Traumatology, Orthopedics and Arthroplasty (Cheboksary), Cheboksary, Russia
² Chuvash State University named after I.N. Ulyanov, Cheboksary, Russia

ABSTRACT

INTRODUCTION.  The consequences of perinatal lesions of the central nervous system (CNS) are one of the leading causes of childhood disability. Spasticity plays a leading role in the formation of motor disorders. An important aspect of the medical rehabilitation of children with perinatal CNS lesions, including premature infants, remains the minimal use of drug therapy, in this regard, the main task is to develop and scientifically substantiate new non-drug technologies for medical rehabilitation.

AIM.  To study the dynamics of motor activity of patients with cerebral palsy in the postoperative period using a robotic complex based on functional scales.

MATERIALS AND METHODS.  The main 1 group (n = 30) consisted of 20 boys and 10 girls, the control 2 group (n = 30) consisted of 17 boys and 13 girls. The patients received comprehensive rehabilitation treatment: robotic mechanotherapy procedures at the Lokomat complex, individual therapeutic gymnastics procedures, physiotherapy, massage, in addition, some patients received botulinum therapy for the lower extremities. In the main group, in addition to the standard rehabilitation program, classes were held at the DIEGO complex. The functional scales of muscle strength scale (MRC), Manual Ability Classification System (MACS), and the Ashworth scale were used to assess the effectiveness of treatment.

RESULTS AND DISCUSSION.  On the scale of muscle strength, the proportion of patients with an increase of 1 point was 40 % among the patients of the main group, 3.3 % among the control group; on the Ashworth scale, with a decrease of 2 points — 20 % and 10 %, respectively. The volume of movements in the affected limb after a course of treatment using DIEGO complex training in the main group increased statistically significantly in the shoulder joint during extension (p = 0.0197), retraction (p = 0.0216) and reduction (p = 0.0232).

CONCLUSION.  The inclusion of additional classes on the DIEGO robotic complex in the treatment program for patients with cerebral palsy (GMFCS II–III art.) due to the positive dynamics of motor skills on the muscle strength and Ashworth scales allows us to recommend this method as an auxiliary for use in an individual rehabilitation program for such patients.

KEYWORDS: cerebral palsy, biofeedback, DIEGO, muscle Strength scale, MRC, Manual Ability Classification System, MACS, Ashworth scale, GMFCS

FOR CITATION:

Egorov A.V., Yakovleva S.K., Petrova R.V., Preobrazhenskaya E.V. The Effectiveness of the Biofeedback Complex in the Treatment of Children with Cerebral Palsy: a Randomized Controlled Study. Bulletin of Rehabilitation Medicine. 2025; 24(2):8–19. https://doi.org/10.38025/2078-1962-2025-24-2-8-19 (In Russ.). 

Aleksandr V. Egorov, Е-mail: aegorov@orthoscheb.ru

References:

1. Бугун О.В., Машанская А.В., Аталян А.В. и др. Комплексная реабилитация пациентов с двигательными нарушениями при спастических формах ДЦП. Acta biomedica scientifica. 2021; 6(6–2): 82–91. https://doi.org/10.29413/ABS.2021-6.6-2.9 [Bugun O.V., Mashanskaya A.V., Atalyan A.V., et al. Comprehensive rehabilitation of patients with motor disorders and spastic forms of cerebral palsy. Acta biomedica scientifica. 2021; 6(6–2): 82–91. https://doi.org/10.29413/ABS.2021-6.6-2.9 (In Russ.).]

2. Союз педиатров России. Клинические рекомендации «Детский церебральный паралич (ДЦП)». Москва. 2017; 62 с. Доступно на: https://rehabrus.ru/Docs/2017/06/KR_DPC.pdf (Дата обращения 01.07.2024). [The Union of Pediatricians of Russia. Clinical recommendations «Cerebral palsy (cerebral palsy)». 2017; 62 p. Available at: https://rehabrus.ru/Docs/2017/06/KR_DPC.pdf (Accessed 01.07.2024) (In Russ.).]

3. Куренков А.Л., Клочкова О.А., Бурсагова Б.И. и др. Применение препарата ботулинического токсина типа А (Ботокс) в лечении детского церебрального паралича. Нервно-мышечные болезни. 2014; 3: 28–41. https://doi.org/10.17650/2222-8721-2014-0-3-28-41 [Kurenkov A.L.,Klochkova O.A., Bursagova B.I., et al. Use of botulinum toxin type A (Botox) in the treatment of infantile cerebral palsy. Neuromuscular Diseases. 2014; 3: 28–41. https://doi.org/10.17650/2222-8721-2014-0-3-28-41 (In Russ.).]

4. Микитченко Н.А., Дегтярева М.Г., Иванова И.И. и др. Войта-терапия в медицинской реабилитации детей с последствиями перинатальных поражений центральной нервной системы. Вестник восстановительной медицины. 2022; 21 (4): 51–59. https://doi.org/10.38025/2078-1962-2022-21-4-51-59 [Mikitchenko N.A., Degtyareva M.G., Ivanova I.I., et al. Vojta Therapy in Medical Rehabilitation of Children with Consequences of Perinatal Central Nervous System Affections. Bulletin of Rehabilitation Medicine. 2022; 21(4): 51–59. https://doi.org/10.38025/2078-1962-2022-21-4-51-59 (In Russ.).]

5. Вовченко А.В., Фисенко В.С., Грибов Д.Е. и др. Состояние и динамика инвалидности, комплексная реабилитация и абилитация инвалидов и детей-инвалидов в Российской Федерации: ежегодный доклад. Отчет о НИР. 2022. 436 с. [Vovchenko A.V., Fisenko V.S., Gribov D.E., et al. he state and dynamics of disability, comprehensive rehabilitation and habilitation of disabled people and children with disabilities in the Russian Federation: annual report. Research Report. 2022. 436 p. (In Russ.).]

6. Клочкова О.А., Куренков А.Л. Ботулинотерапия при детском церебральном параличе. Практические советы и ультразвуковой контроль. 2-е изд., перераб. и доп. Москва: МедПресс-Информ. 2023; 248 с. [Klochkova O.A., Kurenkov A.L. Botulinum therapy for cerebral palsy. Practical tips and ultrasound control. 2nd Ed., reprint. and additional. Moscow; MedPress-Inform. 2023; 248 p. (In Russ.).]

7. Яковлева С.К., Андреева В.Э., Преображенская Е.В. и др. Реабилитационный маршрут ребенка с детским церебральным параличом: опыт Чувашии. Физическая и реабилитационная медицина, медицинская реабилитация. 2021; 3(1): 149–158. https://doi.org/10.36425/rehab46598 [Yakovleva S.K., Andreeva V.E., Preobrazhenskaya E.V., et al. Rehabilitation Route for a Child with Cerebral Palsy: the Experience of Chuvashia. Physical and rehabilitation medicine, medical rehabilitation. 2021; 3(1): 149–158. https://doi.org/10.36425/rehab46598 (In Russ.).]

8. Huang C., Chen Y., Chen G., et al. Efficacy and safety of core stability training on gait of children with cerebral palsy: A protocol for a systematic review and meta-analysis. Medicine (Baltimore). 2020; 99(2): e18609. https://doi.org/10.1097/MD.0000000000018609

9. Kolpashchikov D., Gerget O., Meshcheryakov R. Robotics in healthcare. Intelligent systems reference library. 2022; 212: 281–306. https://doi.org/10.1007/978-3-030-83620-7_12

10. Алиева А.А., Алиева Х.М., Махмудова Т.А. и др. Характеристика реабилитационного потенциала и реабилитационного прогноза детей-инвалидов с детским церебральным параличом. Медико-социальная экспертиза и реабилитация. 2012; 15(4): 24–27. https://doi.org/10.17816/MSER35699 [Alieva A.A., Alieva H.M., Makhmudova T.A., et al. Characteristics of the rehabilitation potential and rehabilitation prognosis of disabled children with cerebral palsy. Medical and social expertise and rehabilitation. 2012; 15(4): 24–27. https://doi.org/10.17816/MSER35699 (In Russ.).]

11. Дунаева В.А., Ключкин А.В. Механотерапевтические аппараты и датчики. Актуальные вопросы современной науки и образования. Сборник статей XIX Международной научно-практической конференции 20.05.2022. Часть 1. Пенза: Наука и просвещение. 2022; с. 80–84. [Dunaeva V.A., Klyuchkin A.V. Mechanotherapeutic devices and sensors. Topical issues of modern science and education. Collection of articles of the XIX International Scientific and Practical Conference. Part 1. Penza: Science and Education. 2022; pp. 80–84. (In Russ.).]

12. Попадюха Ю.А., Лазарева Е.Б. Применение роботизированного комплекса «Amadeo» для восстановления и развития мелкой моторики кисти у больных ортопедо-травматологического и неврологического профиля. Современные здоровьесберегающие технологии. 2017; 1:149-161. [Popadyukha Yu.A., Lazareva E.B. The application of the robotic system “Amadeo” for recovering and improvement of the shallow motor skills in patients withorthopedic trauma and neurological disorders Modern health-saving technologies. 2017; 1: 149–161. (In Russ.).]

13. Солопова И.А., Мошонкина Т.Р., Умнов В.В. и др. Нейрореабилитация пациентов с детским церебральным параличом. Физиология человека. 2015; 41(4): 123. https://doi.org/10.7868/S0131164615040153 [Solopova I.A., Moshonkina T.R., Umnov V.V., et al. Neurorehabilitation of patients with cerebral palsy. Human physiology. 2015; 41(4): 123. https://doi.org/10.7868/S0131164615040153 (In Russ.).]

14. Корсунская Л.Л., Ротанов А.Г., Савельев П.В. и др. Перспективы использования виртуальной реальности для повышения эффективности реабилитации пациентов с ДЦП с применением роботизированных устройств и биологической обратной связи. Детская и подростковая реабилитация. 2021; 2(45): 13–17. [Korsunskaya L.L., Rotanov A.G., Saveliev P.V., et al. The prospects of using virtual reality to improve the effectiveness of rehabilitation of patients with cerebral palsy using robotic devices and biofeedback. Child and adolescent rehabilitation. 2021; 2(45): 13–17 (In Russ.).]

15. Бердина О.Н., Михнович В.И., Белогорова Т.А. и др. Эффективные возможности применения роботизированной биомеханотерапии в реабилитации пациентов с детским церебральным параличом. Фарматека. 2018; S4: 54–57. https://dx.doi.org/10.18565/pharmateca.2018.s4.54-57 [Berdina O.N., Mikhnovich V.I., Belogorova T.A., et al. Effective possibilities of using robotic biomechanotherapy in the rehabilitation of patients with cerebral palsy. Pharmateca. 2018; S4: 54–57. https://dx.doi.org/10.18565/pharmateca.2018.s4.54–57 (In Russ.).]

16. Яковлева С.К., Петрова Р.В., Грачева Т.М. и др. Опыт применения роботизированной механотерапии комплекса «LOCOMAT PRO» у детей с двигательными нарушениями в условиях ФГБУ «ФЦТОЭ» Минздрава России (г. Чебоксары). Вопросы медицинской реабилитации: сборник научных трудов по итогам Межрегиональной научно-практической конференции. Чебоксары: Издательство Чувашского университета. 2018; 188 с. [Yakovleva S.K., Petrova R.V., Gracheva T.M., et al. The experience of using robotic mechanotherapy of the «LOCOMAT PRO» complex in children with motor disorders in the conditions of the FSBI «FCTOA» of the Ministry of Health of the Russian Federation (Cheboksary). Issues of medical rehabilitation: collection of scientific papers on the results of the Interregional scientific-practical conference. Cheboksary: Chuvash University Publishing House. 2018; 188 p. (In Russ.).]

17. Duke R.E., Torty C., Okorie U., et al. Bowman R. Pattern of comorbidities in school-aged children with cerebral palsy in Cross River State, Nigeria. BMC Pediatr. 2021; 21(1): 165. https://doi.org/10.1186/s12887-021-02637-9

18. Bohannon R.W., Smith M.B. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987; 7(2): 206–207.https://doi.org/10.1093/ptj/67.2.206 19. Outsika C., Vangelis K., Ioanna P., et al. Bradykinesia assessment in children with cerebral palsy and periventricular leukomalacia. Eur J Paediatr Neurol. 2023; 42: 71–74. https://doi.org/10.1016/j.ejpn.2022.11.008

20. Yazıcı M., Livanelioğlu A. Gucuyener K., et al. Effects of robotic rehabilitation on walking and balance in pediatric patients with hemiparetic cerebral palsy. Gait Posture. 2019; 70: 397–402. https://doi.org/10.1016/j.gaitpost.2019.03.017

21. Burrough M., Garrod R., Moys R., Kelly G.A knowledge translation approach to implementation of upper limb robotics in the rehabilitation of children with acquired brain injury, Archives of Disease in Childhood (ADC) 2023; 108(Suppl. 2): A41.2–A42. https://doi.org/10.1136/archdischild-2023-rcpch.68

22. Андреев В.Н., Добрынина Л.А. Физическая реабилитация мужчин после ишемического инсульта на основе применения роботизированного комплекса «diego» с биологической обратной связью. Физическая реабилитация и спортивная медицина: наука и практика. Материалы XI Всероссийской научно-практической конференции с международным участием. Москва: РУС «ГЦОЛИФК». 2023; с. 9–13. [Andreev V.N., Dobrynina L.A. Physical rehabilitation of men after ischemic stroke based on the use of a robotic complex «diego» with biofeedback. Physical rehabilitation and sports medicine: science and practice. Materials of XI All-Russian Scientific and Practical Conference with International Participation. Moscow: RUS «GTSOLIFK», 2023; pp. 9–13 (In Russ.).]

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