Original study
Health ministry of the Republic Uzbekistan
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Neurologic Association of the Republic Uzbekistan
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»Neurology«
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1 (53), 2012
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NEVROLOGIYA –
НЕВРОЛОГИЯ
NEUROLOGY
Original study
Originalarbeit
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»NEVROLOGIYA« – 1 (53), 2012
НЕВРОЛОГИЯ
Effectiveness of motor-assisted MOTOmed
®
movement therapy in the
rehabilitation of children diagnosed with infantile cerebral palsy
S. Nurmatova
1
, F. Khamraev
1
, A. Mirsaev
1
, W. Diehl
2
1
Republican pediatric psycho-neurologic institution Prof. Kurbanov, Uzbekistan
2
German sports university, Cologne, Germany
Abstract: From 2009 to 2011, 120 patients in the Republican pediatric psycho-neurologic institution received active and passive treatment with the movement
therapy device MOTOmed gracile12. In the treatment results, improved gait was measured as one of the biomechanical parameters. Step length was increased
from 39.8 cm (15.7 in) to 43.3 cm (17 in). Moreover, active (+ 6.2°) and passive (+ 8.5°) mobility of knee and ankle joint were improved as well. On average,
muscle tone could be reduced by one point on the Ashworth scale.
Study design: From 2009 until 2011, 120 patients with
spastic types of cerebral palsy participated in the clinical study
on the effectiveness of motor-assisted movement therapy in
neurologic rehabilitation. 66 boys (55 %) and 54 girls (45 %)
ages between 5 and 14 years (Ø age: 6.7 years) took part in
the study.
75 of the test persons (62.5 %) suffered from spastic
diplegia, 45 patients (37.5 %) from hemiplegia. Therapy
success on motor level was measured in common test
procedures (stabilography, dynamometry, and goniometry),
pre- and post-test results of each procedure were compared.
The Ashworthscale was used in order to evaluate muscle tone
or respectively the resistance against passive movement.
In addition to conventional therapy measures, the test
persons received cyclic movement training by means of the
MOTOmed gracile12 movement therapy device for upper
and lower extremities. Moderate intensity (slightly exhausting)
was chosen. Medical staff could adapt the preset training
parameters (speed, duration, resistance level, movement
direction) to the daily condition of each child at any time.
During the complete training, safety was ensured by the
protective program of the device (MOTOmed Movement-
Protector with SpasmControl) which was developed especially
for children with spastic movement disorders. This protective
program works in the background automatically and is active
during training of the upper as well as the lower extremities.
By regular use of motor-assisted movement therapy with
the aid of a MOTOmed gracile12 movement therapy device,
the following therapy goals were pursued:
1) improvement or maintenance of gait
2) reduce spasticity, ease the musculature
3) remove or alleviate outcomes of lack of movement
4) improvement of the movement coordination
5) improvement of proprioception
6) improvement of the general capability
Introduction:
Movement is an essential characteristic
of all living organisms. It configures the body, activates and
strengthens it – from the inside and outside [1]. The term
infantile cerebral palsy (ICP) defines movement disorders
deriving from infantile brain damage. The disability caused by
it is characterized by disorders of the nervous and muscular
system in the area of random movement coordination [5].
The Republican psycho-neurologic pediatric institution
Prof. Kurbanov is known as an institution specialized on
pediatric rehabilitation and offers holistic therapy for
children suffering from ICP in many regions of the Republic
Uzbekistan. The holistic therapy of children suffering from
disorders in the area of random movement coordination is
one of the main working aspects in the institution. The most
important basic principles of holistic rehabilitation should
be mentioned here as well: Each therapy should take place
immediately, individually, and multidisciplinary. Moreover, it
is very important in the rehabilitation of children with
disorders of the central nervous system (CNS) to introduce
therapy measures as soon as possible and to integrate the
parents into the rehabilitation process [2].
Due to the variety of movement disorders, introducing
modern technical aids into the rehabilitation of neurologic
patients opens up new perspectives and mostly leads to
positive effects. Therefore, active-passive movement therapy
with the aid of a movement therapy device represents an
effective component of holistic rehabilitation in children
suffering from cerebral palsy. The model gracile12 of the
company RECK Medizintechnik GmbH (www.motomed.com)
belongs to the motor-assisted movement therapy devices
mentioned above.
This prospective study aims at verifying the non-
objection of motor-assisted movement therapy with the
MOTOmed gracile12 movement therapy device in the therapy
of children suffering from ICP as well as examining the
effectiveness regarding the improvement of gait ability. The
present study was carried out with scientific support of a
graduate of the German sports university Cologne (Germany).
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»
НЕВРОЛОГИЯ« – 1 (53), 2012
НЕВРОЛОГИЯ
Exclusion criteria for this study were:
1) evident cognitive restrictions of the test person
2) negative attitude of the test person towards such therapy
MOTOmed training took place in sitting position and under
guidance of an experienced movement therapist (image 1).
During their inpatient stay of 15 to 20 days the children
received an additional daily training from 10 to 25 minutes
(depending on age, physical endurance, and the present
limitations) on the movement therapy device.
Image 1 Child is training with the MOTOmed gracile12
Each therapy unit consisted of three phases:
1) warm-up: passive training in accordance to the
preset parameters (speed, movement direction,
duration of training)
2) main part: active or assistive (servo) training with
individual intensity
3) finish: active training with lower intensity or
passive training
During and after the training, the user received clearly
legible feedback on the large screen: training duration,
covered distance, performance, muscle tension (spasticity),
energy consumption, etc. were displayed on the screen.
The achieved results could also be saved permanently and
analyzed on a chip card which can be ordered additionally.
Results: Observing patients of different age groups who
received an additional training with the MOTOmed gracile12
movement therapy device in the course of holistic therapy lets
us come to the conclusion that MOTOmed movement training as
therapeutic sports application represents an additional therapy
method which in many aspects is effective and efficient for
children suffering from cerebral palsy due to its functional and
psycho-social effects.
By means of the performance tests, clear improvements
in mobility and reduced stiffness of the joints were found in
most of the patients. When the study began, the average active
training phase of especially “weak” children was less than
15 % whereas the test persons could cycle actively for approx.
50 % of the preset training time in the last training week.
In the more “able-bodied” children, an evident increase in
covered distance on the MOTOmed gracile12 was documented
which on one hand is based on an increased active training
duration and on the other hand on the increased performance
or respectively an increased exercise tolerance.
After the seventh or eighth day of holistic rehabilitation, an
evidently decreased muscle tone, increased muscular strength,
and improved general mobility could already be observed in
most children who had trained using the MOTOmed gracile12.
All children exercised with the MOTOmed by choice and
enjoyed it so that their motivation to continue the MOTOmed
therapy increased continuously.
The authors of a similar study by Polonskaya et al. in 2010
(Russia) used a MOTOmed gracile12 movement therapy device
in combination with functional electric stimulation (FES) and
not only observed an improvement in movement kinematics
(increased mobility in knee and ankle joint), but also positive
dynamic concerning the reduction of muscle tone and the
increase of random muscle activity in the extensors [4].
The results of biomechanical tests carried out after the
15th or 20th day of treatment presented the following
changes (table 1):
1) extension of step length from Ø 39.8 cm (15.7 in)
to Ø 43.3 cm (17 in) (+ 8.8 %) which indicates less
movement restriction when walking
2) on average, the range of motion of the ankle joint
supination was improved by 2.2° and therefore almost
complied with the physiologic range of motion
Original study
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»NEVROLOGIYA« – 1 (53), 2012
НЕВРОЛОГИЯ
3) the active (Ø + 6.2°) and passive (Ø + 8.5°) range of
motion of knee and ankle joint were enlarged (image 2)
4) muscle strength was increased by Ø 17.4 %
Image 2 Diagram of active and passive range of motion in knee and
ankle joint, measured in degrees (°).
Moreover an evidently decreased spastic muscle tone
could be observed in the extremitites (Ø ~ -1 level on the
Ashworthscale).
Shen et al. achieved similar results in 2009 [7] in their
study about children suffering from cerebral palsy who
received a daily MOTOmed training for 20 minutes in the
context of their holistic therapy (Bobath, Voita, etc.). In
comparison to the control group (n = 24), significantly
decreased muscle tone (p < 0.05) and improved muscle
strength in the upper and lower extremities (p < 0.05)
could be found in the intervention group (n = 24).
The results of interviews with the parents of the children
who participated in the MOTOmed study confirmed that
approx. 75 % of the children actively tried to randomly move
their extremities after the intervention had taken place.
More or less complicated motion sequences like crawling or
walking could be carried out more easily in those children
who received more than 10 – 15 therapy units. Most of the
children were able to maintain their achieved biomechanical
improvements even after the study period was over if
individual holistic therapy measures continued according to
the basic principles of rehabilitation.
Summary: Without meaning to belittle the advantages
of conventional therapies, the analysis of the results
leads to the following conclusions concerning MOTOmed
movement therapy:
1) supports the decrease of spastic muscle tone, which leads
to an increased range of motion in the corresponding
joints
2) supports children in learning complex motion sequences
3) improves balance and gait symmetry
4) increases self-dependence in everyday life
5) preserves resources
6) increases the child’s motivation to continue with therapy
independently
7) shortens duration of therapy
Effects of regular motor-assisted movement therapy
Functional factors
Pre-test
Post-test
Difference
Step length
39.8 ± 1.62
43.3 ± 1.47
+ 8.8 %
Foot mobility
-1.40 ± 0.94
0.82 ± 0.50*
+ 2.2°
Muscle strength
2.3 ± 0.09
2.7 ± 0.11*
+ 17.4 %
Muscle tone
3.0 ± 0.12
2.1 ± 0.07**
~ -1 level (Ashworth)
Table 1
Results marked by asterisk indicate significant differences in the pre-post-comparison: * p < 0.05; ** p < 0.001.
Original study
Originalarbeit
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НЕВРОЛОГИЯ« – 1 (53), 2012
НЕВРОЛОГИЯ
Particular advantages of motor-assisted movement
therapy with the aid of the MOTOmed gracile12 compared to
conservative treatment methods in children suffering from ICP:
1) non-invasive therapy method
2) safety and easy operation
3) simultaneous monitoring of several children
4) increases motivation to continue therapy
5) moderate gear control for children with different
stages of the illness
GB 7
13.6/W80 06.12 ebnS
The data analysis contributes to the conclusion that motor-
assisted MOTOmed movement therapy should be an inherent
part in holistic rehabilitation of children suffering from
cerebral palsy. Regular use of the MOTOmed gracile12
movement therapy device can contribute to an improvement
in mobility and range of motion and therefore offers new
perspectives for social adaption of the children into modern
society.
The staff members of the psycho-neurologic institution
Prof. Kurbanov want to thank the “AB FORM SISTEM” company
(Taschkent) for technically and logistically supporting this
study.
Literature
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