COMPARATIVE EFFECTIVENESS OF MEDICAL REHABILITATION METHODS IN CHILDREN WITH SPASTIC DIPLEGIA: MULTICHANNEL MYOSTIMULATION AND HYDROKINESIOTHERAPY IN THE CONDITIONS OF SANATORIUM-RESORT TREATMENT

BACKGROUND: Cerebral palsy (CP), especially spastic diplegia, remains the leading cause of motor disorders in children, with a prevalence of 2-3 cases per 1,000. Despite the widespread use of sanatorium-resort treatment (SCL), combinations with modern rehabilitation methods have not been sufficiently studied, and data on their comparative effectiveness and long-term effects are limited..

AIMS: To compare the short–term and long-term (6 months) efficacy of combinations of SCL with hydrokinesiotherapy, multichannel myostimulation, vibration therapy and physical therapy with weight loss in children aged 8-13 years with spastic diplegia (GMFCS I-III).

MATERIALS AND METHODS: A prospective non-randomized controlled trial was conducted in a state sanatorium. The participants (n=185) were divided into 5 groups: the main group (SCL+ hydrokinesiotherapy, n=45), three comparison groups (SCL+ myostimulation, vibration therapy, physical therapy; n=30 each) and the control group (SCL, n=50). The interventions included: Hydrokinesiotherapy (30 min/session, 34-36°C); Multi-channel myostimulation (20-30 min, 10-150 Hz); Vibration therapy (50 Hz, 3-5 min/zone); Physical therapy with weights (1-5% of body weight). Primary outcomes: decreased spasticity (Ashworth scale) and improved motor function (GMFM). The assessment was performed on days 1, 21, and 6 months later using clinical scales, stabilometry, and electromyography.

RESULTS: All participants completed the course of treatment. The greatest decrease in spasticity was recorded in the myostimulation group (ΔAshworth= -25%, p<0.001, d=0.68) versus the control (Δ= -5%, p=0.280).The improvement in GMFM in group 2 (Δ=+22%, p=0.002, d=0.89) surpassed the results of hydrotherapy (Δ= +18%, p=0.001) and physical therapy (Δ= +13%, p=0.018).Vibration therapy was associated with a deterioration in balance (ΔPBS= -0.49, p=0.062).In the GMFCS II subgroups (n=72), a correlation was found between a decrease in spasticity and an improvement in stabilometry (r=0.62, p=0.011). There were no adverse events.

CONCLUSIONS: Multichannel myostimulation and hydrokinesotherapy in combination with SCL have demonstrated superiority in reducing spasticity and improving motor functions in children with spastic diplegia, whereas vibrotherapy requires a revision of parameters. The results confirm the feasibility of including these methods in clinical guidelines, but the long–term efficacy and adaptation for severe forms of cerebral palsy (GMFCS IV-V) remain the subject of further research.