Effect of fixing massage with ontogenetic gymnastics and therapeutic swimming practices on cardio-respiratory system functionality in children diagnosed with spastic cerebral palsy

Фотографии: 

ˑ: 

PhD, Associate Professor A.A. Bruykov1
PhD, Associate Professor V.V. Apokin2
PhD, Associate Professor А.I. Petkevich3
Dr.Med., Professor A.V. Gulin1
1
Tambov State University named after G.R. Derzhavin
2Surgut State University, Surgut
3Lipetsk State Pedagogical University, Lipetsk

 

Keywords: fixing massage, ontogenetic gymnastics, therapeutic swimming, infantile cerebral palsy.

Background. Infantile cerebral palsy (ICP) may be considered a clinical diagnosis rather than etiological, i.e. the descriptive term that refers to a group of health conditions evoked by a selective defect of cerebral motor function [1].

Motor function disorders imply changes in visceral systems, and condition of the latter depends on how physically active the health-impaired children are [2]. This is the reason for the special interest in the studies of the functional systems of children with ICP and their correlations with the physical capacities that have long been subject for developmental physiology and medicine; with the cardiorespiratory disorders prevention being ranked among the priority practical goals.

Generally, a special priority in the sets of biomedical rehabilitation tools applied for the cardio-respiratory function correction or rehabilitation of children with ICP has been given to different massage and gymnastic techniques [2]. Presently the newly developed and tested special fixing massage and ontogenetic gymnastic practices are available for these purposes as they have been proved beneficial and recommended for implementation in the national health system as the new correction and rehabilitation practices [3]. Traditional massage techniques are applied without fixation of the patients’ body parts and, hence, they may evoke some pathological synkineses and stimulated hyperkineses in the unfixed bodily parts. With time the pathological synkineses and stimulated hyperkineses tend to consolidate and evolve to insurmountable obstacle (particularly for children with ICP) in the motor stereotype correction and building process; and even may make impossible some specific motor functions for the patients [3, 4].

The above problem may be solved by the newly developed and tested special fixing massage and ontogenetic gymnastic practices [5]. In the fixing massage procedure, every body part is fixed excluding the part(s) intended for the massage or post-massage gymnastics. The ontogenetic gymnastic practices were designed to include the gymnastic exercises proved effective for the natural ontogenetic sequence of the child’s motor functionality development pattern that has been formed historically in the human evolution process.

Furthermore, special aquatic exercises and swimming practices have been proved beneficial for the cardiorespiratory function development, correction or rehabilitation of children with ICP. The new therapeutic swimming practices showed their benefits versus the classical massage and therapeutic gymnastic practices, particularly for the cardiorespiratory system potential mobilisation and building purposes [6, 7]. Subject to a special interest in this context are the effects of the special fixing massage and ontogenetic gymnastic practices combined with the therapeutic swimming practices.

Objective of the study was to assess benefits of the newly developed special fixing massage and ontogenetic gymnastic practices combined with the therapeutic swimming practices for the cardiorespiratory function in children with ICP.

Methods and structure of the study. Subject to the study were 10-12 year-old children (n=48) diagnosed with infantile cerebral palsy. The subjects were split up into 4 equal groups. Reference Group 1 and Study Group 2 were composed of children diagnosed with spastic diplegia and aged 10.5±1.5 and 10.9±0.8 years on average, respectively. Reference Group 3 and Study Group 4 were composed of the children diagnosed with spastic bilateral hemiplegia. RG1 and RG3 were subject to a traditional rehabilitation program including classical massage and traditional therapeutic gymnastic and swimming practices. SG2 and SG4 were subject to the new special fixing massage and ontogenetic gymnastic practices combined with the therapeutic swimming practices. Every group was subject to two rehabilitation courses including 3 rehabilitation classes (15 procedures in total), with a break of 3 months between the courses. Each group was tested prior to and after the rehabilitation course.

The cardiorespiratory function in with children with ICP was tested at rest and after the above procedures, with the following test rates obtained in the study: vital capacity (VC), ml; inspiratory and expiratory breath holds, s; heart rate (HR); systolic blood pressure (SBP); and diastolic blood pressure (DBP). As dictated by the neuro-orthopaedic status of children with ICP, we applied the controlled physical loads in the Martine Probe procedure considered the most adequate to the actual physical abilities of the subjects [1]. HR (beats per min) was registered at rest and after the 1-2-3min loads. Blood pressure rates (mm of mercury column) were rated using the Korotkov method at rest and after the 1-2-3min loads. The test data were processed and the key statistical parameters were computed (М ± m), with the meaning of the data differences being estimated by the non-parametric Wilcoxon criterion using the standard MS Excel toolkit; with the confidence rate of the outcome data estimated as high.

The fixing massage session took 45 minutes, and the ontogenetic gymnastic session lasted for 30 minutes. The classical massage and therapeutic gymnastic procedures took the same time. The swimming practices in the two groups lasted for 45 minutes and were standard.

The proposed ontogenetic gymnastics practices were new in the sense that the instructor applied special fixing grips to immobilise some body parts in the process. The therapeutic swimming practices were versatile in terms of the child’s body positions including a variety of face-down, back-down and side positions. In some back-down practices, the child’s head was kept in water and swimming was assisted by the instructor. Special respiratory practices in water, handrail holding exercises, swimming board assisted exercises, instructor-supported and passive limb flexion-extension practices were applied.

Study results and discussion. After the classical massage, therapeutic gymnastics and swimming procedures, the VC was tested to grow by 14.9%; and the inspiratory and expiratory breath holds were tested to grow by 10.4% and 12.9%, respectively. Furthermore, after the special fixing massage and ontogenetic gymnastic practices combined with the therapeutic swimming practices, the subjects diagnosed with spastic diplegia showed notable progress in the respiratory function rates, with the VC tested to grow by 21%; and the inspiratory and expiratory breath holds tested to grow by 15.4% and 12.9%, respectively.

The special fixing massage and ontogenetic gymnastic practices combined with the therapeutic swimming practices were found beneficial in application to the subjects diagnosed with bilateral hemiplegia. The above new practices were found more efficient than the classical massage and therapeutic gymnastics and swimming practices as verified by the inspiratory and expiratory breath holds tested to grow by 20.3% and 23.1%, respectively; and the VC rates increased by 19.1%; In the groups (diagnosed with bilateral hemiplegia) subject to the classical massage and therapeutic gymnastics and swimming practices, progress in the inspiratory and expiratory breath holds was lower (9.7% and 10.3%, respectively) than in SG4, and the VC rates were also much lower (plus 12.3% only) than in SG4.

Having analysed the benefits of the newly developed special fixing massage and ontogenetic gymnastic practices combined with the therapeutic swimming practices versus the classical massage with therapeutic gymnastics and swimming practices as verified by the post-exercise blood pressure (BP) rates, and haemodynamic rate recovery periods.

Given in Table 1 hereunder are the BP recovery rates which are particularly high in SG2 in case of the special fixing massage and ontogenetic gymnastic practices combined with the therapeutic swimming practices. Thus the SBP and DBP were tested to drop by 9.8% and 10.9% by the 3rd minute, respectively; and the HR was tested to recover by 8.7% by the 3rd minute. In case of the classical massage with therapeutic gymnastics and swimming practices, the BP recovery rates were found lower, with the SBP and DBP tested to drop by 7.7% and 5.2% by the 3rd minute, respectively; and the HR tested to recover by only 5.7% by the 3rd minute.

Table 1. Blood pressure (BP, mm Hg) rates after the physical exercises in children with ICP (М ± m)

Recovery time, min

Test rates

 Reference Group 1

Study Group 2

SBP

DBP

SBP

DBP

Prior to exercise

118,2±3,1

81,3 ± 2,9

117,5 ± 4,1

79,5 ± 2,6

Minute 1

133,1±2,7

91,7 ± 2,9

134,9 ± 2,9

93,1 ± 3,7

Minute 2

129,9± 3,3

89,1 ± 2,3

128,7 ± 3,7

89,7 ± 2,9

Minute 3

122,9 ± 2,9*

86,9 ± 2,7*

121,7 ± 3,1*

82,9 ± 2,8*

Recovery rate by min 3, %

7,7

5,2

9,8

10,9

 

Reference Group 3

Study Group 4

Post-exercise

117,4 ± 4,3

82,6 ± 2,5

118,9± 4,8

83,7 ± 3,1

Minute 1

138,1 ± 3,5

93,7 ± 2,8

    141,1±3,2

92,9± 4,9

Minute 2

134,7 ± 3,1

90,1 ± 2,3

138,7± 3,7

89,8± 3,5

Minute 3

128,9 ± 3,4*

86,8  ± 2,6*

  127,1 ± 4,1*

83,5± 3,1*

Recovery rate by min 3, %

6,7

7,3

9,9

10,1

* versus Minute 1

In the group with infantile bilateral hemiplegia, the post-exercise BP recovery time was faster in case of special fixing massage and ontogenetic gymnastic practices combined with therapeutic swimming practices versus classical massage with therapeutic gymnastics and swimming practices. Thus the SBP and DBP in SG4 were tested to recover by 9.9% and 10.1% on average, respectively; versus the case of classical massage with therapeutic gymnastics and swimming practices: with the SBP and DBP in SG3 tested to recover by 6.7% and 7.3% on average, respectively.

Similar test data were obtained by the Martine Probe tests rating the exercise effects on the HR. The HR recovery rates were faster in case of special fixing massage and ontogenetic gymnastic practices combined with therapeutic swimming practices (9.7%) versus classical massage with therapeutic gymnastics and swimming practices (6.4%).

The newly obtained data have supported our previous finding that special fixing massage and ontogenetic gymnastic practices combined with therapeutic swimming practices are more efficient than classical massage with therapeutic gymnastics and swimming practices in the external breathing development domain [2-4]. The consolidated positive effects of special fixing massage and ontogenetic gymnastic practices combined with therapeutic swimming practices, as found by the study, were notably higher than the other reported data on the effects of fixing massage and ontogenetic gymnastic practices on the cardiorespiratory function in the children with ICP. The study data showed that the fixing stroking chest massage helped slow down the respiratory movements of the chest. This finding may be indicative of the stroking action being of an inhibitory effect on the higher departments of the CNS associated with the mitigating effect on the respiratory centre excitability. The massage facilitated the transition from the hurried surface breathing to the deep regular (i.e. more efficient) breathing rhythm. The ontogenetic gymnastic practices combined with therapeutic swimming practices were found to increase the cardiorespiratory reserve capacities of children with ICP as verified by growth of every test rate.

Conclusion. The study data and analyses showed benefits of the special fixing massage and ontogenetic gymnastics combined with therapeutic swimming practices on the cardiorespiratory function and reserve capacity building in the 10-12 year-olds diagnosed with infantile cerebral palsy.

The above experimental data showed benefits of the special fixing massage and ontogenetic gymnastics combined with therapeutic swimming practices for the cardiorespiratory function in children with ICP. Therefore, the new special fixing massage and ontogenetic gymnastics combined with therapeutic swimming practices may be recommended as highly efficient for improvement of the condition of children with ICP.

References

  1. Batysheva T.T., Trepilets V.M., Klimov Y.A Sovremenny vzglyad na problemu detskogo tserebralnogo paralicha [Modern approach to the problem of infantile cerebral palsy]. Detskaya i podrostkovaya reabilitatsiya, Moscow, 2016, no. 2 (27), pp. 5-9.
  2. Bruykov A.A., Apokin V.V., Gulin A.V. Izmenenie pokazateley funktsionalnogo sostoyaniya dykhatelnoy sistemy organizma detey s razlichnymi formami tserebralnogo paralicha v protsesse reabilitatsii [Changes in respiratory function indices in children with various forms of cerebral palsy during rehabilitation]. Teoriya i praktika fiz. kultury, Moscow, 2016 (7), pp. 83 - 85.
  3. Bruykov A.A., Gulin A.V. Funktsionalnoe sostoyanie serdechno-sosudistoy sistemy u detey s tserebralnym paralichom v protsesse reabilitatsii [Functional state of cardiovascular system in children with cerebral palsy during rehabilitation]. Vestnik Tambovskogo universiteta, 2011, vol. 16. no. 1, pp. 23-25.
  4. Bruykov A.A., Gulin A.V. Fiziologicheskaya kharakteristika vliyaniya fiksatsionnogo massazha s ontogeneticheskoy gimnastikoy na funktsionalnoe sostoyanie kardiorespiratornoy sistemy u detey s DTsP [Physiological characteristics of the effect of fixing massage combined with ontogenetic gymnastics on cardiorespiratory system functionality in children with cerebral palsy]. Vestnik Tambovskogo universiteta. Ser. Estestvennye i tekhnicheskie nauki. Tambov, 2012, vol. 17, no. 1, pp. 298-300.
  5. Bruykov A.A., Gulin A.V., Apokin V.V. Fiziologicheskaya kharakteristika vliyaniya fiksatsionnogo massazha i ontogeneticheskoy gimnastiki na funktsionalnoe sostoyanie TsNS u detey s DTsP [Physiological characteristics of influence of bone-holding massage and ontogenetic gymnastics on functional condition of central nervous system in children with cerebral infantile paralysis]. Teoriya i praktika fiz. kultury. Moscow, 2010, no. 11, pp. 99-101.
  6. Kravtsevich P.V., Bruykov A.A., Gulin A.V. Sravnitelnaya kharakteristika vliyaniya lechebnogo plavaniya i ippoterapii na dykhatelnuyu sistemu organizma detey s detskim tserebralnym paralichom [Therapeutic swimming versus hippotherapy for respiratory system in children with cerebral palsy]. Vestnik Tambovskogo universiteta. Ser. Estestvennye i tekhnicheskie nauki. Tambov, 2014, vol. 19, no. 3, pp. 993-994.
  7. Kravtsevich P.V., Bruykov A.A., Gulin A.V., Petkevich A.I. Sravnitelnaya kharakteristika vliyaniya razlichnykh sredstv vosstanovleniya na funktsionalnoe sostoyanie kardiorespiratornoy sistemy u detey s detskim tserebralnym paralichom [Comparative characteristics of effect of various rehabilitation techniques on cardiorespiratory function in children with cerebral palsy]. Nauchnye vedomosti Belgorodskogo gosudarstvennogo universiteta Meditsina. Farmatsiya, Belgorod, 2013, no. 25(168), no. 24, pp. 100-104.

Corresponding author: apokin_vv@mail.ru

Abstract

The study analyses effects of special fixing massage, ontogenetic gymnastics and therapeutic swimming practices on the cardiorespiratory function in the 10-12 year-olds diagnosed with infantile cerebral palsy. The proposed ontogenetic gymnastics practices are innovative in the sense that the instructor applies special fixing grips to immobilise some body parts in the process. The therapeutic swimming practices are versatile in terms of the child’s body positions including a variety of face-down, back-down and side positions. In some back-down practices, the child’s head is kept in water and swimming is assisted by the instructor. Special respiratory practices in water, handrail holding exercises, swimming board assisted exercises, instructor-supported and passive limb flexion-extension aquatic practices were applied.

The study data and analyses showed benefits of the special fixing massage with ontogenetic gymnastics and therapeutic swimming practices on the cardiorespiratory function and reserve capacity building in the 10-12 year-olds with infantile cerebral palsy. The study findings make it possible to recommend the practices in combination with other common rehabilitative and corrective tools to improve the health of children with ICP.