Influence of Robotic Mechanotherapy in Various Combinations with Non-Invasive Electrostimulation of Muscles and Spinal Cord on the Postural Balance in Children with Severe Forms of Cerebral Palsy

Abstract

Introduction. Postural disorders are significant in severe forms of cerebral palsy (CP). The aim of the work was to study the effect of locomotor training in combination with transcutaneous electrical stimulation of the spinal cord and functional electrical stimulation (FES) of the muscles of the lower extremities on the restoration of the function of maintaining a vertical posture in children with III level of limitation of motor activity according to the GMFCS classification. Materials and methods. 20 patients with CP at the age from 8 to 12 years old were examined. Patients of the main group (10 children) received 15 sessions of 45 minutes rehabilitation in the ≪Lokomat≫ robotic simulator in the sequence: 1) ≪Lokomat≫ in combination with FES, 2) ≪Lokomat≫ in combination with transcutaneous electrical stimulation of the spinal cord, 3) ≪Lokomat≫ in combination with FES and transcutaneous electrical stimulation of the spinal cord. The intervals between courses were 6 months. Patients from the control group (10 children) underwent only locomotor training. Results. The dynamics of regaining control of the upright posture in children was evaluated by the method of stabilometry, which revealed the active response of the musculoskeletal system in patients of the main group only in the case of combined robotic mechanotherapy and FES. This was manifested in a significant increase in the amplitude of oscillations A of the pressure center, a clear increase in the variance of the parameters of the LFS parameter, and a decrease in the strength of the correlation between the parameters LFS and A towards normalization. However, with a combination of locomotor training with FES and transcutaneous electrical stimulation of the spinal cord, there were no convincing signs of improving the regulation of the vertical posture. Conclusion. It is suggested that multilevel neurostimulation of patients with CP is necessary, which may be more effective, since it will affect the central components of motor activity.