Intensive Neurophysiological Rehabilitation System for Treatment of Patients with Cerebral Palsy
Proceedings of the 5th International Congress on
Cerebral Palsy in Bled, Slovenia, 2001
The new treatment method for patients with Cerebral Palsy - Intensive Neurophysiological Rehabilitation System (INRS) is presented in the article. The main components of the rehabilitation system are: biomechanical correction of the spine, extremity joint mobilization, reflexotherapy, mobilizing physical exercises, special massage system, rhythmical group exercises, mechanotherapy and apitherapy (usage of bee's products).
There is currently a large number of rehabilitation methods for patients with Cerebral Palsy. Some of the most widely used are Neurodevelopmental treatment by Bobath, Vatslaw Vojta - therapy, conductive education by Andrash Peto, Doman Delacato method as well as many others. The majority of these rehabilitation programs underestimate the significance of the pathological influence of the changed musculoskeletal system on the dysfunction of the central nervous system .
Our research, which began in the mid 1980's, showed that afferent flow from the pathologically changed muscles, tendons and joints increases the dysfunction of the central nervous system and still more retards and distorts the motor development of the patients with Cerebral Palsy. For the elimination of this pathological influence and releasing of the functional blockages the method of biomechanical correction of the spine was created [1,3]. This method became the basis of a new treatment - Intensive Neurophysiological Rehabilitation System. Application of the INRS activates compensatory possibilities and plasticity of the brain and creates a new functional state in the child's organism. Along with muscle tone normalization, improvement of blood circulation and improved range of motion, this new functional state opens the possibility for faster motor and mental development of the child [2,3,4,7].
INRS, created more than 15 years ago, is officially approved in Ukraine and has attracted wide international interest. During the last 10 years over 10 thousand patients including about 6 thousand from Germany, Austria, Switzerland, France, USA, as well as many other countries of the world have been treated in our center with good long-lasting results.
INRS is a multimode rehabilitation system in which the influence of one component are complemented and intensified by the others [4,7]. Main treatment program includes biomechanical correction of the spine, extremity joint mobilization, reflexotherapy, mobilizing physical exercises, special massage system, rhythmical group exercises, mechanotherapy and apitherapy which are described below (Fig.1).
Biomechanical correction of the spine
The basis of rehabilitation system is the polysegmental biomechanical correction of the spine created by Prof. V. Kozyavkin MD. It is aimed at releasing the functional blockages (so-called vertebral subluxation) of the spinal movement segments and resumption of normal mobility of joints . Biomechanical correction of the spine is carried out consecutively in lumbar, thoracic and cervical regions. Lumbar spine correction includes simultaneous influence on all blocked movement segments using our method of the "backward rotation". Correction of the thoracic blockages is performed starting from upper regions to lower using special impulse techniques. Corrections of the cervical spine are performed using movement with complex trajectory with simultaneous influence on all blocked segments [2,3].
Extremity Joint Mobilization
Extremity Joint Mobilization is used for the resumption of the mobility of the joints, stretching and improving muscle elasticity, stimulating blood circulation and for prevention of joint contractures. Mobilization starts with the influence on the large joints (hip, knee, shoulder) with gradual involvement of the small joints. In our work we use classical principles and also newly created techniques. The joints in our rehabilitation system are brought out of the passive range of motion using a certain limited force. The traction methods are used in combination with vibrating movements as well as impulse techniques of tapping along the joint cleft. During the treatment course the intensity of the mobilization increases gradually. Mobilization of the mandibullar joints with the facial massage is used for improvement of articulation and chewing movements.
Our method of reflexotherapy serves the purpose of intensifying the achieved spasticity reduction, elimination of trigger points in the muscles and correction of autonomic disturbances. The biologically active points are influenced by means of a portable electric low voltage stimulator. Our technique of reflexotherapy applies the points of classical meridians as well as specific points. Influence on the trigger points is performed simultaneously with the post-isometric and post-isotonic muscle relaxation. Reflexotherapy is done with intact skin integrity and avoiding any pain.
Mobilizing Physical Exercises
Physical therapy is an essential part of our rehabilitation system. In our program we use mobilizing physical exercises, that are aimed at the improvement of mobility of the spinal and extremity joints, creation of new motor patterns, and at acquiring the necessary mobility for every day life skills. The exercises are performed following the rule "from center to periphery" which means the main influence is on the trunk movement and proximal joints with gradual involvement of movement in distal small joints. Teaching of new motor acts is done following the principle "from passive movement through passive- active to active movement" and "from simple movement to complex movement". Everyday sessions include breathing exercises, exercises for joint mobilization as well as strengthening exercises.
Special Massage System
In our rehabilitation program the special massage system is used to prepare for the biomechanical correction of the spine, muscle relaxation and the influencing of the trigger points. It includes techniques of classical, segmental and periostal massage in combination with post- isometric and post- isotonic relaxation. For effective carrying out of the biomechanical correction of the spine the appropriate preparation of the musculoskeletal system is essential. Such preparation is provided by means of relaxation massage techniques. Elements of joint mobilization and acupressure are also included in the massage system. Techniques of stimulating massage are used for activation of hypotonic, weak muscles.
Rhythmical Group Exercises
Rhythmical group exercises are used with the aim to encourage emotional development and social integration of the child. Group exercises are performed with the elements of play therapy using music and dance. The groups of patients are formed depending on the age and the level of motor abilities. Parents are also involved in these sessions. Positive emotional background assists in the stimulation of the patient's motivation for recovery and strengthening belief in their own power and possibilities.
The method of apitherapy (treatment with bee's products) in our rehabilitation system includes beeswax wraps and application of bee venom. Apitherapy is used for the improvement of local blood circulation, metabolism and tissue trophicity. Allergic tests are done before this treatment. In technique of beeswax wraps the warm packages of beeswax mixed with paraffin, honey and propolis are applied to selected joint or muscle groups. Along with the thermal influence the diffusion of biologically active substances through the skin is important. In cases with expressed joint contractures bee venom therapy is used. Bee venom is applied using isolated bee sting. It is applied to the skin in the area of the involved joint cleft.
Means of mechanotherapy are used for strengthening muscles, improvement of coordination and correction of movement patterns. Lower extremities' training is done using lever devices. Adjusting levers, weights and number of repetitions the optimal training regime is set. Treadmill and cycling devices are used for the correction of lower extremity movement patterns. For the upper extremities we use primarily bloc devices. Devices like "Vibroextensor" which combines action of heat, vibration and mechanical massage of the para-vertebral regions are also used.
Biomechanical correction suite "Spiral"
are used for applying additional exertion to certain joints. Forces, applied by the elastic straps correct the posture of the patient and assist in acquiring new movement patterns.
in verbal, emotional, and psychological areas. In this group, speech improvement was noted in 79% of cases and attention improved in 73% of patients [4,6].
Intensive Neurophysiological Rehabilitation System combines different treatment modalities that complement and reinforce each other. Use of INRS creates a new functional state in a child's organism opening the possibility for faster motor and mental development. This treatment system is recommended for use in wide range of rehabilitation facilities. Further research and evaluation of INRS should be done.
- Kozyavkin V. Manual Therapy in Treatment of Spastic Forms of Cerebral Palsy. Proceedings of All-Union scientific conference for child neurology and psychiatry. Vilnius, 1989: 47-48 (in Russian).
- Kozijavkin V. Zur Rehabilitation der Cerebralparese durch manuelle Wirbelsauletherapie. Sozialpadiatrie in der Padiatrie fur Praxis und Klinik, 1993; 7: 377-381.
- Kozyavkin V. Structural and Functional Disturbances of the Cerebral and Spinal Formations in Cerebral Palsy and the System of Rehabilitation of these Patients. Kharkov, Kharkov State Institute for Advanced Medical Training, 1995 (in Russian).
- Kozijavkin V. Das System fur intensive neurophysiologische Rehabilitation. Die Kozijavkin-Methode. Frechen, Druckerei Peiffer GmbH, 1999.
- Kozyavkin V., Babadagly M., Tkachenko S., Kachmar.O. Infantile Cerebral Palsy. Basics of Clinical Diagnostics. Lviv, Medyzyna Svitu, 1999 (in Russian).
- Kozyavkin V., Shestopalova L., Podkorytov V. Infantile Cerebral Palsy. Medical Psychological Problems. Lviv, Ukrainski Technologii, 1999 (in Russian).
- Del Bello F., Kozijavkin V. Therapie bei Patienten mit infantiler Zerebralparese nach dem System der Intensiven Neurophysiologischen Rehabilitation (SINR). Krankengymnastik, 2000; 6: 1005-1013.