Vol 24, No 3 (2021)

BACKGROUND: In children with spastic forms of cerebral palsy often prescribed difference type of trunk-hip-knee-ankle foot orthosis (THKAFO). At the same time, we have not found any significant reports in the world literature dedicated to the study of the influence of these orthosis on the gait biomechanical parameters.

AIM: To demonstrate the results of a comparative analysis of the effect of trunk-hip-knee-ankle-foot orthosis and ankle-foot orthosis on the gait biomechanical parameters in children with cerebral palsy.

MATERIALS AND METHODS: The study involved two 13-and 15-year-old children with a diagnosis of “cerebral palsy, spastic diplegia, GMFCS 3, MACS 2–3, Ashworth Scale 2–3”. Six studies were conducted ― three tests for each child (barefoot, in AFO and THKAFO) using the 3D video analysis system “Qualisys” (Sweden). The spatio-temporal and kinematic indicators of gait, as well as the gait index, were evaluated.

RESULTS: Analysis of the results in patient D. demonstrated that using the THKAFO in comparison with AFO led to a slight improvement in spatio-temporal gait indicators (from 4.0–12.5%), but to a deterioration in hip kinematics and a deterioration in the gait index (2.5–28.1%). Whereas in patient A., it was noted that the use of the THKAFO in comparison with AFO had a negative effect on the spatio-temporal parameters of gait (4.0–97.6%), on the kinematics of the knee and ankle joints, and on the improvement of the hip kinematics in the sagittal plane, but the effect on the gait index was not unambiguous. According to the totality of the analyzed data, patient D. was recommended to wear AFO instead of the THKAFO. Patient A. was also recommended to wear an AFO instead of a THKAFO, even despite the ambiguous results of the biomechanical research, since the final decision on the choice of the orthosis design took into account not only “accurate” changes in biomechanical parameters, but also a number of other factors, in particular social and household ones.

CONCLUSION: In patients with level GMFCS 3, for improve the biomechanical parameters of gait, it is advisable to give preference to shorter and functional orthoses before prescribing orthoses that capture two or more body segments.

One of the urgent problems of neurorehabilitation is spasticity ― a motor disorder that depends on the rate of muscle stretching due to the enhancement of tonic stretch reflexes due to a violation of supraspinal inhibitory signals, which is manifested by intermittent or prolonged involuntary muscle activation. In addition to spasticity, the clinical forms of lesions of the upper motor neurons in the form of muscle hypertonicity include rigidity and dystonia.

Although spasticity is one of the most common occurrences, its precise definition and pathophysiology remain unclear.

Spasticity reduces the effectiveness of rehabilitation of patients with severe disabling diseases. With organic lesions of the brain, movement disorders are often caused by increased muscle tone, which makes it difficult to perform simple movements. For the correct setting of treatment goals for a patient with spasticity syndrome, including for the development of an individual rehabilitation program with a further assessment of its effectiveness, it is necessary to correctly determine the spasticity and its severity, differentiate from other forms of pathological changes in muscle tone (rigidity, plasticity, contractures), as well as to assess the impact on the active and passive function of the limb, daily life and quality of life of the patient.

An important issue in the rehabilitation process is the method of quantitative assessment of the pathological increase in muscle tone, for which the collection of complaints and anamnesis, physical neurological examination, scales and various options for instrumental examination are used.

The review article presents modern and traditional methods for quantifying muscle tone, as well as methods of therapy.

The first case of COVID-19 infection in Russia was recorded on March 1, 2020. The Government of the Russian Federation and the executive authorities of the constituent entities of the Federation, as well as health authorities, have taken unprecedented measures to prevent the spread of a new coronavirus infection in the country, but it has not been possible to fully avoid mass infection of the population.

The epidemic of coronavirus infection required large-scale decisions from the authorities of all countries to ensure the safety of the population. In conditions of limited time and material resources, flexible organizational models were needed that combined the efforts of healthcare and social protection of the population. All health care resources were involved. New permanent and temporary “covid” hospitals were put into operation as soon as possible. A significant number of health care facilities were repurposed to provide medical care to patients with a new coronavirus infection. Stationary institutions of social protection of the population have become an important reserve for the deployment of observators to monitor convalescents and contact persons in the city of Moscow. Observators were deployed at their base to isolate contact persons. The specifics of the contingent planned for placement in observatories and the organizational features of social protection institutions have led to a number of significant differences from similar departments in healthcare institutions.

Within 19 days, an observatory for 241 beds was organized and equipped on the basis of a large institution of social protection of the population of the city of Moscow of the State Budgetary Institution “Scientific and Practical Rehabilitation Center”. In the first wave of the rise in morbidity, 759 patients were observed in the observatory.

We present a detailed plan for the deployment of the observatory developed by the headquarters of the State Budgetary Institution “Scientific and Practical Rehabilitation Center”, which ensured its implementation and further functioning.

Saul–Wilson syndrome, like Rubinstein–Taybi syndrome, is classified as a rare genetic disease according to modern classification. So, to date, there are descriptions of 16 patients from different countries in literary sources.

The Saul–Wilson syndrome is characterized by a combination of nanism, pathology of long tubular bones, the spine and the organ of vision, typical dysmorphic facial features and radiological data; Rubinstein–Taybi syndrome has various skeletal defects (low height, dilation of the phalanges of the fingers, polydactyly on the legs, deformities of the face and skull, high arched palate, changes in the shape and position of the auricles, dilated phalanges of the fingers, lordosis, kyphosis, scoliosis), strabismus, anomalies refraction, disorders of internal organs, disorders of intellectual and physical development.

The article presents a complex clinical and expert case with a combination of two genetic diseases ― Saul–Wilson and Rubinstein–Taybi syndromes, typical manifestations of which were visible craniofacial dysmorphia, changes in the musculoskeletal system in the form of progressive bilateral coxarthrosis, instability of the thoracic spine, deformities of the feet, accompanied by pronounced disorders of neuromuscular, skeletal and statodynamic functions. The multi-system lesion of the body caused difficulties for specialists during the medical and social examination. These nosological forms are absent in the current classifications and criteria for establishing disability, and therefore the quantitative assessment of persistent functional disorders was carried out individually ― according to the degree of severity of impaired functions, their combination and influence on each other.

The use of modern diagnostic methods, including genetic studies, in hereditary diseases allows to establish a diagnosis at an early stage, to determine the tactics of managing children in order to ensure timely pathogenetic treatment, including surgical, prevention of the development of severe complications, functional disorders. The successes of medicine can not only significantly improve the quality of life of this category of children, but also increase their life expectancy. Since in most cases hereditary diseases involving the musculoskeletal system are accompanied by persistent disorders of the body’s functions and lead to disability, classifications and criteria for establishing disability should include a quantitative assessment of the degree of impaired functions in congenital anomalies and hereditary diseases.