Currently, there is a problem of cerebral palsy; it is one of the most urgent problems in Pediatric Orthopedics and Neuropathology. In the social context, the problem is significance as well [1]. Due to the combination of underdevelopment and pathology of motor development, disorders of the regulation of muscle tone - such as spasticity, rigidity, dystonia, and hypotension-are particularly significant and complicated [2]. The aim of the treatment of cerebral palsy children with is a possible more complete adaptation, the degree of which largely depends on mental and motor functions, speech development, and intelligence. Adaptation is associated with the choice of an individual rehabilitation scheme for each patient.
In children, motor disorders are primarily determined by a pronounced increase in muscle tone (spasticity) in combination with muscle weakness (paretic). This leads to difficulty or impossibility of voluntary movements. Prolonged muscle spasm in cerebral palsy affects the capillaries and leads to a violation of microcirculation in the muscle.
As a non-medicinal means of restoring normal peripheral blood circulation, we consider effects aimed at relaxing the muscle-tours – massage. Differentiated technique of segmental reflex massage with physical therapy developed by us reduces muscle tone and most intensively contributes to an increase in peripheral blood circulation, the external manifestation of which is arterial hyperemia. Determining the degree of severity of muscle spasticity, we can talk about the qualitative (indirect) state of peripheral blood circulation. Identification the level of muscle tone and correction the strength and duration of massage effects are key elements in management of cerebral palsy patients.
In our study to assess and monitor the functional state of the muscles, we used such device as myotonometer, which is an analog of the myotonometer system of Dr. Sirmai (Hungary). We examined 14 children under the age of 3 years with cerebral palsy (spastic form).
Methods of measurement: 1. Checking the calibration of the device. Firstly,we put the myotonometer with its base on the glass and count the reading of the device on the scale. This reading should be equal to 250 myotons (1 myoton is equal to the deviation of the arrow of the device by 1 division). If the reading of the device is different from 250, then we move the stop flange to get this reading. 2. Place the device with its base on the measured muscle group. With a light force, press the device against the measured area of the body and touch the flange-limiter of this area. 3. Make a reading on the myotonometer scale.
Muscle tone was determined in the center of the abdomen of individual muscles. The rod of the myotonometer was installed strictly perpendicular to the examined muscle. All measurements were performed in the initial lying position (before the massage, after the massage). Experimental data were obtained (significance level $\alpha = 0.05$):
| Points for measuring muscle tone | Before the massage | After the massage | ||
|---|---|---|---|---|
| (readings in myotonic) | (readings in myotonic) | |||
| Experiment roup | Control group | Experiment group | Control group | |
| Mid-biceps | 86,77±1,26 | 83,07±1,42 | 64,85±1,01 | 73,14±1,42 |
| Mid-calf muscle | 91,23±1,44 | 94,14±1,69 | 73,64±1,29 | 86,14±0,74 |
| Middle of the adductor muscle of the thigh | 82,50±1,75 | 79,21±0,46 | 66,64±1,10 | 72,07±0,77 |
The level of muscle tone is significantly reduced in the experimental group, where an individual massage technique is used with the inclusion of elements of physical therapy. We use a modern method of prevention and treatment – massage, providing the correct, differentiated in time and strength massage effect. Taking into account the severity of cerebral palsy and using a myotonometer, we create a more effective therapeutic result in the conditions of the procedure, by increasing the work on the muscle group that is more prone to spastic reactions. This technique is being implemented in the practice of a massage therapist.
The activities can significantly facilitate the efforts of experts in various fields (doctors, remedial gymnastics trainers, speech therapists, speech pathologists, educators of special institutions, as well as parents) in order to ensure maximal social adaptation of patients and their proper inclusion into the society.