The Experience of Using Dynamic Proprioceptive Correction in Children with ICP

V. I. Marushkov
L. V. Martyanova
N. M. Voronina
Chair of hospital pediatry, the Yaroslavl State Medical Academy, the Skobykino Children’s Psycho Neurological Sanatorium.

Skobykino Children’s Psycho Neurological Sanatorium, Yaroslavl, Russia

The method of dynamic proprioceptive correction by means of Adeli Therapeutical Suit (Adeli techniques) was begun to be used since July 1994 in the Children’s Psycho Neurological Sanatorium for rehabilitation of children suffering from infantile cerebral paralysis at the residual stage. Multiple changes in the system of antigravitation underlie the pathogenesis of motor disorders in ICP patients. They form in their turn the pathology of the reflectory sphere: retardation in extinction of tonic reflexes of the neonatal period for several years; a slow formation of the locomotor development and voluntary motorics.

One can distinguish the following principles of the CNS development and first of all motorics of the healthy fetus and infant:

  1. The development of the brain in the intrauterine life takes place under the influence of multifactorial afferentation, with afferentaton from the joint-muscle apparatus playing the major role in the processes of organization of this development.
  2. In the postnatal ontogenesis the further development of the brain is stimulated and determined by multifactorial afferentation from various analyzing systems, while doing so the impulsation from the joint-muscle apparatus continues to be of the tone-genic origin and to determine the possibilities of the further development of motorics.
  3. The development of the motor system takes place in the process of the motor act itself, on the basis of the back afferentation that determines and controls the performed motor act and its adaptive possibilities.

The infants who experienced in the perinatal period of life different harmful effects, the development of the brain proceeds in the pathologic manner, consequently, its motorics and a number of other functional systems of the brain will be formed in the pathologic manner.

This served as the basis for the hypothesis that under certain conditions the corrected proprioceptive impulsation can exert the normalizing action on the activity of the disordered structures which control motorics.

The Adeli Therapeutical Suit possessing the properties to realize the hypothesis is made by the Ayurveda JS Co. and approved by the Committee for new medical equipment of the RF Ministry of Health (the extract from the minutes No. 4 as of 08.09.1993, the Ref. No. 18/3-545-93). The design of the suit is developed on the basis of the Penguin Loading Suit used in cosmonautics for reducing adverse consequences of zero gravity on the human body.

The technique of using the therapeutical suit is based on the principle of simultaneous correcting effect of the vestibuloproprioceptive flow going into the central structures of the motor analyzer in the process of movement from the muscle-joint apparatus. The absorbers of the Adeli Suit act on the locomotor apparatus of the patient in the following way: during stretch of all absorbers it is possible to create not only the axial vertical load on the body of up to 40 kg magnitude but also to change the position including the creation of the necessary angles in the major joints as well as flexion and extension, turns of the trunk. Using the Adeli Therapeutical Suit allows to decrease significantly the degree of the pathologic position and tonic reflexes and to accelerate the development of a new, closer to the norm, motor stereotype.

Distribution of Patients

Distribution of Patients

In the sanatorium 110 patients aged from 1.5 to 35 years were treated by this method [Table 1]. The sessions in the Adeli Therapeutical Suit were begun from the minimum load which was gradually increased with sessions depending on the patient’s condition. The duration of the sessions was also gradually increased from 15-20 min at the beginning to 1.5 hours at the end of the course (including breaks for rest). The course consisted of 30 sessions. The initial step was the testing of the patient to assess the condition of the motor functions, the form and severity of the disease. Based on the testing’s results, the scheme of treatment was developed for each patient. Using the therapeutical suit requires certain preparatory work: conducting massage, neuromuscular stimulation, applying ozokerite, the complex of individual exercises aimed at an increase of the volume of movements in the involved joints. As a result of using the Adeli Therapeutical Suit, one can note a positive dynamics in the patient’s condition and the dynamics becomes distinct by the end of the first course.

Table 01: Distribution of Patients by Different Types of Cerebral Palsy and Severity of Disease

Degree of Severity Types of CP
1. Spastic diplegia 2. Double hemiplegia 3. Hemiparetic type 4. Hyperkinetic type 5. Atonic-astatic type
Severe 21 16 0 7 7
Medium Severe 41 0 7 5 0
Mild 0 0 6 0 0
Total (110) 62 16 13 12 7

Many patients suffering from infantile cerebral paralysis received many times the traditional and non-traditional methods of treatment before the use of the Adeli technique and had a stable neurological state without a positive dynamics for many years.

According to the results of the testing of the motor functions’ condition performed before the beginning of the therapeutical course, for each parameter of the clinical scale there were calculated the mean coefficient in per cents of the norm (the condition of the given function in the healthy infant of the corresponding age was taken for 100%) and the magnitude of its maximum possible improvement (the functional reserve). During the testing on completion of the treatment there were assessed a real improvement of each parameter of the clinical scale and the degree of using the functional reserve (the ratio of the magnitude of a real improvement to the maximum possible one expressed in per cent). [Figure 1], [Figure 2], [Figure 3], [Figure 4].

Table 02: Parameters of the Clinical Scale

1 2 3 4
Volume of Movements 54.2% 45.8% 21.3% 46.5%
Bearing Ability 60.7% 39.3% 11.3% 28.7%
Sitting 73.8% 26.2% 9.1% 34.7%
Taking the Position of All Fours 72.4% 27.6% 7.6% 27.5%
Going on All Fours 70.2% 29.8% 9.6% 32.2%
Kneeing 63.3% 36.7% 8.7% 23.7%
Ability of Standing 62.8% 37.2% 4.6% 12.4%
Walking 59.5% 40.5% 5.3% 13.1%
Hyperkinetic Syndrome and Serebellar Syndrome 85.4% 14.6% 8.2% 56.2%
Social Skills and Everyday Living Skills 70.6% 29.4% 10.1% 34.4%
1 – condition before treatment in % of norm; 2 – maximum possible improvement in % of norm; 3 – real improvement in % of norm; 4 – use of functional reserve in %

Figure 1: Volume of Movements

Figure 1: Volume of Movements

Figure 2: Bearing Ability

Figure 2: Bearing Ability

Figure 3: Hyperkinetik Syndrome and Cerebellar Syndrome

Figure 3: Hyperkinetik Syndrome and Cerebellar Syndrome

Figure 4: Social Skills and Everyday Lining Skills

Figure 4: Social Skills and Everyday Lining Skills

The clinical examination carried out on completion of the therapeutical course revealed in all patients the presence of improvement with respect to the motor sphere. An increase in the volume of movements was noted in 75%, an improvement of bearing ability – in 73%, an improvement of social skills and skills of everyday living – in 70%, a decrease in the degree of the hyperkinetic syndrome and cerebellar syndrome – in 60% of the patients. A decrease in the degree of the pathologic position and tonic reflexes resulted in an improvement of the motor skills (sitting, maintaining the vertical position, walking).

In the system of rehabilitation of ICP patients at the residual stage a good effect is produced by using the method of dynamic proprioceptive correction by means of the Adeli Therapeutical Suit which permits:

  • to improve the muscular tone,
  • to correct the position and the location of the body parts with respect to each other,
  • to increase the volume of active movements in the involved joints,
  • to improve balance and orientation with respect to space,
  • to reduce hyperkineses,
  • to improve speech and mentality of the patient.

The contraindications for the use of the Adeli Therapeutical Suit are:

  • destructive changes in the spinal column,
  • dislocations and subluxations, dysplasia of the hip joints,
  • rough deformations of the spinal column,
  • epilepsy in the attack period,
  • a marked impairment of intellect or rough disturbances of the mental and emotional sphere,
  • somatic diseases at the stage of decompensation,
  • fever conditions.