Key principles of personalized approach to therapeutic exercise in children with hemiparetic cerebral palsy based on BESTest and pedobarography data

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Abstract

BACKGROUND: The hemiparetic form of cerebral palsy (CP) is associated with pronounced gait asymmetry and impaired balance. Conventional rehabilitation approaches often fail to account for objective biomechanical parameters and individual functional capacity, whereas standard physical examination has limited accuracy in identifying gait dysfunction. The study included a retrospective phase (November 2021–December 2023) and a prospective phase (January 2024–December 2024).

AIM: The work aimed to develop principles of a personalized physical rehabilitation approach for children with hemiparetic CP based on integrated BESTest and pedobarography data and to evaluate its effectiveness.

METHODS: This was a single-center observational study with retrospective and prospective components. At the Department of Pediatric Medical Rehabilitation of the Russian Children’s Clinical Hospital—a branch of Pirogov Russian National Research Medical University, 86 pedobarography and BESTest protocols of patients aged 7–17 years with a confirmed diagnosis of hemiparetic cerebral palsy were analyzed for the period from November 2021 to December 2023. The effectiveness of the proposed approach was assessed in 82 children from January 2024 to December 2024. Group allocation was performed using stratified randomization with consideration of age and GMFCS level.

RESULTS: Key markers of gait impairment and balance control were identified, including displacement of the foot support axis (lateral, medial, or absent), pressure distribution across different foot regions, and postural control parameters. Compensatory changes in the non-paretic limb were detected, manifested as a shift of the support axis in the direction opposite to that of the paretic limb. Core principles of a personalized approach to therapeutic exercise for children with hemiparetic CP were developed based on pedobarography and BESTest data (p <  0.001).

CONCLUSION: Integration of BESTest and pedobarography data enables the development of a personalized physical rehabilitation program that accounts for individual gait and balance impairments, remarkably improving rehabilitation effectiveness in children with hemiparetic CP.

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About the authors

Timofey S. Kovalchuk

Russian Children's Clinical Hospital — branch of the Pirogov Russian National Research Medical University

Author for correspondence.
Email: doctor@tim-kovalchuk.ru
ORCID iD: 0000-0002-9870-4596
SPIN-code: 2067-7912
Russian Federation, Moscow

Olga A. Laysheva

Russian Children's Clinical Hospital — branch of the Pirogov Russian National Research Medical University; Pirogov Russian National Research Medical University

Email: olgalaisheva@mail.ru
ORCID iD: 0000-0002-8084-1277
SPIN-code: 8188-2819

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow; Moscow

Igor O. Vedernikov

Russian Children's Clinical Hospital — branch of the Pirogov Russian National Research Medical University

Email: pulmar@bk.ru
ORCID iD: 0009-0006-1327-2525
SPIN-code: 5047-2594
Russian Federation, Moscow

Alexandr D. Andreev

Russian Children's Clinical Hospital — branch of the Pirogov Russian National Research Medical University

Email: alex10_97@mail.ru
ORCID iD: 0000-0002-2655-1615
Russian Federation, Moscow

Alexander V. Noskov

Pirogov Russian National Research Medical University

Email: parter1997@mail.ru
ORCID iD: 0009-0004-4878-1026
Russian Federation, Moscow

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2. Fig. 2. Comparison of BESTest scores before and after the rehabilitation course in the comparison group throughout the entire study period: BС, biomechanical constraints, LOS, limits of stability, APA, anticipatory postural adjustments, APR, automatic postural responses, SO, sensory orientation, GS, gait stability.

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3. Fig. 1. Comparison of BESTest scores before and after the rehabilitation course in the main group throughout the entire study period: BС, biomechanical constraints, LOS, limits of stability, APA, anticipatory postural adjustments, APR, automatic postural responses, SO, sensory orientation, GS, gait stability.

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4. Fig. 3. Comparative trends of BESTest scores. TE, therapeutic exercise.

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