In 20 – 25. 2 . 2023, Blended Intensive program in Neurological rehabilitation ran. More than 30 physiotherapy students and teachers from three universities (Savonia University of Applied Sciences, Finland, Third Faculty of Medicine, Charles University, Czech Republic and University of Thessaly, Greece) actively participated. Students worked together and wrote articles devoted to on the following themes: stroke and rehabilitation, multiple sclerosis and rehabilitation, Parkinson’s disease and rehabilitation, children with neurological disorders and rehabilitation, spinal cord injury and rehabilitation and virtual reality and exergames in rehabilitation of neurological patients. We are going to present their great work here.[1]

Neurological disorders are medically defined as disorders that affect the brain, nerves, and the spinal cord. The abnormalities can result in a range of symptoms such as paralysis, muscle weakness, poor coordination, loss of sensation, seizures, confusion, pain, and altered levels of consciousness and they are mainly divided into groups like physical, cognitive, emotional, and behavioral.[2]

The causes of children’s neurological disorders can be classified into four groups. For the first congenital abnormalities or disorders (genetic or chromosomal disorders, disorders caused by chemicals, or certain infections during pregnancy – spina bifida, Down syndrome, Duchenne’s and Becker’s muscular dystrophy. The second group is infections (meningitis), the third environmental influence, and the fourth is injury, hypoxia, or growing tumor.

Disorders can also be classified according to when they occur prenatal (like congenital neurological defects or metabolic disorders), perinatal (mainly hypoxia-caused cerebral palsy), and postnatal (as immune disorders or injuries). [3]

Complete paralysis is when someone can’t control their muscles at all and doesn’t have the ability to feel. Partial or incomplete paralysis or paresis is when you still have some feeling and control over the affected muscles. Localized paralysis affects one specific area. Generalized paralysis is all over the body. Monoplegia affects just one limb. Diplegia affects the same area on both sides. Hemiplegia affects just one side of your body either the left or the right. Quadriplegia (or tetraplegia) is when all four limbs are paralyzed. Paraplegia is paralysis from the waist down. It is described as spastic or stiff when the muscles are tight and jerky. It is described as floppy when the tone is very low. The type of paralysis depends on the area of the brain that is pathological or damaged. If the affected area is in the central nervous system the paralysis is usually spastic and if there is a problem in the peripheral nervous system the paralysis is usually flaccid.

The term cerebral palsy includes many symptoms caused by brain damage. These impairments are permanent and do not evolve over time. It is described as a sensorimotor dysfunction by Bobath in 1965. [4] Cerebral palsy has multiple etiologies. The movement disorders associated with cerebral palsy are categorized as spasticity (muscle stiffness), dyskinesia (uncontrollable movements), ataxia (poor coordination) or mixed. Spasticity is the most common movement disorder. Movement disorders of cerebral palsy can result in secondary problems, including hip pain or dislocation, balance problems, hand dysfunction, and equinus deformity. An instrument such as the Gross Motor Function Classification System can be used to evaluate severity and treatment response. It is also used to monitor and assess the efficacy of the treatment. Treatments for the movement disorders associated with cerebral palsy include intramuscular (botulinum toxin A), physical therapy, occupational therapy, etc. [5]

Rehabilitation for cerebral palsy

a) Vojta’s therapy was developed by Czech pediatric neurologist prof. Václav Vojta and it is based on a light tactile pressure stimulation on exact pre-defined zones on the body. This will start an involuntary motor response which will lead the body to specific certain movement patterns. All of that is happening due to reflex locomotion which will activate the central nervous system. Besides the main effects, it can also stimulate the vegetative and autonomic nervous system which will appear as eye coordination, jaw and towel movements, or bowel and bladder coordination. According to Vojta, it can be used almost for every movement disorder and for other disorders like stroke, respiratory distress syndrome, or even spina bifida but it is mostly used for child patients with cerebral palsy. [6]

b) Bobath Neurodevelopmental Approach is based on neurodevelopmental theories and normal motor patterns. The most important goal of the NDT approach (NDT-Bobath) for CP in pediatrics is to help the patients be as independent and as functional as possible. Additionally, NDT aims at preventing abnormal motor patterns and facilitating normal motor synergies during every day functional activities. The abnormal patterns must be stopped and basic patterns of movement and posture are used to provide the appropriate stimuli while the abnormal patterns are inhibited.

c) Hydrotherapy is any method that uses water to treat various symptoms throughout the body and can be as simple as taking a warm bath at home or swimming in a pool. It is one of the most popular methods of complementary therapies for people with CP. Its advantages are found in reduction of gravity which allows easier and more active exercises. It can also improve endurance to multiple sensory stimuli and reduce muscle spasms. The effects of hydrotherapy can significantly contribute to the improvement of gross mobility, exercise endurance and quality of life of people with CP.[7]

d) Hippotherapy provides effective, and sensory stimulation for its rider through variable, rhythmic, and repetitive movements of the horse. The movement of the horse mimics the normal movements of the human pelvis during walking which improves balance and postural control while providing sensory stimulation. [8]

e) Therapy also comes in a form of music and can be presented in many ways such as singing, dancing, playing an instrument or simply listening to music. It has physical, social, emotional and cognitive effects. In patients with CP, it has been proven that music therapy is effective in improving motor function, allowing them to perform voluntary movements more easily. [9]

Conclusion

There is not a single perfect method addressing the treatment of children with CP. Each approach is based on different theories and has different elements. The optimal solution is to combine methods to tailor the therapy to each individual patient and their needs. Vojta therapy is more suitable for babies and toddlers up to 3 years old and the Bobath-NDT method is more suitable for babies and children. Additions to mentioned methods could be hydrotherapy, hippotherapy and music therapy.

Authors:

Natálie Kučírková, Physiotherapy students, Third Faculty of Medicine, Charles University, Czech Republic
Smaragda Pentsi, Physiotherapy students, Department School of Health Sciences, University of Thessaly, Greece
Markéta Kavenová Physiotherapy students, Third Faculty of Medicine, Charles University, Czech Republic
Aleš Novotný Physiotherapy students, Third Faculty of Medicine, Charles University, Czech Republic
Dr. Marja Äijö, PhD, Principal lecturer of gerontology and rehabilitation, Savonia University of Applied Sciences, Kuopio, Finland
Dr. Kamila Řasová, Ph.D., Associative professor of Physiotherapy, Third Faculty of Medicine, Charles University, Czech Republic
Dr. Thomas Besios, Assistant Professor, Department School of Health Sciences, University of Thessaly, Greece

References:

Äijö M, Řasová K & Besios T. 2022. Neurological rehabilitation, Blended Intensive program has started. Savonia Article, Savonia-ammattikorkeakoulu. In available: https://www.savonia.fi/en/articles/savonia-article-neurological-rehabilitation-blended-intensive-program-has-started/  

Neurological disorders. Available at: https://dphhs.mt.gov/schoolhealth/chronichealth/neurologicaldisorders (Accessed: February 23, 2023).

Neonatal neurological disorders: Children’s Hospital Pittsburgh. Children’s Hospital of Pittsburgh. Available at: https://www.chp.edu/our-services/brain/neurology/neonatal (Accessed: February 23, 2023).

Besios, T. et al. (2018) “Effects of the neurodevelopmental treatment (NDT) on the mobility of children with cerebral palsy,” Open Journal of Therapy and Rehabilitation, 06(04), pp. 95–103. Available at: https://doi.org/10.4236/ojtr.2018.64009.

D;, V.K.D.H.B. (no date) Cerebral palsy: An overview, American family physician. U.S. National Library of Medicine. Available at: https://pubmed.ncbi.nlm.nih.gov/32053326/ (Accessed: February 23, 2023).

Vojta therapy (no date) Physiopedia. Available at:

https://www.physio-pedia.com/Vojta_Therapy (Accessed: February 23, 2023).

The effect of hydrotherapy on the functioning and quality of life of…… Available at: https://www.researchgate.net/profile/Paris-Iakovidis-2/publication/353165338_The_effect_of _hydrotherapy_on_the_functioning_and_quality_of_life_of_children_and_young_adults_wit h_cerebral_palsy/links/60eacf39b8c0d5588cebb3f4/The-effect-of-hydrotherapy-on-the-functi oning-and-quality-of-life-of-children-and-young-adults-with-cerebral-palsy.pdf (Accessed: February 23, 2023).

Koca, T.T. and Ataseven, H. (2016) What is Hippotherapy? the indications and effectiveness of Hippotherapy, Northern clinics of Istanbul. U.S. National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5175116/ (Accessed: February 23, 2023).

Music therapy, Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital, Taipei. Available at: https://www1.cgmh.org.tw/intr/intr2/c3390/en/music-therapy.htm (Accessed: February 23, 2023).