Introduction
The Glazov Rehabilitation Centre treats children aged 3–18 from all towns and districts of the Udmurt Republic. Specialised admissions cover eye and ear diseases, musculoskeletal disorders including cerebral palsy, bronchopulmonary disease, gastrointestinal and central nervous system disorders, and others. Rehabilitation lasts one month. Comprehensive medical rehabilitation includes therapeutic exercise, massage, the Gross training system, the Adeli system, a sensory room and physical modalities [2,6]. Hypoxic therapy is one of our principal apparatus-based physiotherapy methods and is provided to all children without contraindications. It is intended to prevent and treat a broad range of diseases and increase nonspecific resistance [3,4].
This article focuses on the effects of hypoxic therapy in children with different forms of cerebral palsy and aggravating comorbidities: anaemia, skin disease, enuresis, dysbiosis, ENT disease and frequent acute viral respiratory infections, four to five episodes annually. Such conditions markedly reduce nonspecific resistance.
Early and long-term effects of hypoxic therapy on the child’s body were followed. Our objective was to assess objectively its influence on the course of disease in children with different forms of cerebral palsy and aggravating comorbidities.
Patients and rehabilitation methods
Accordingly, 47 children aged 4–15 years with different forms of cerebral palsy were selected.
Clinical forms were distributed as follows: severe hyperkinetic form, eight children; hemiparetic form with moderate hemiparesis, twelve; moderate spastic diplegia with flexion-adduction ankle contractures, seven; pronounced tetraparesis, four; hyperkinetic form, eleven; and cerebral palsy with secondary contracture of the masticatory and facial muscles and dysarthria, five. Five children walked with assistance, four used wheelchairs, seven did not walk at all, and the remainder walked independently.
All 47 children had comorbidities: seven had anaemia, with blood haemoglobin 9.2–10.1 per mille; three of these also had intestinal dysbiosis. Eight had enuresis, six compensated congenital heart defects, three marked hospitalism with prolonged rocking of the trunk and head while falling asleep and restless sleep, and nineteen frequent respiratory disease, four to five times yearly. Nine of the 47 children had profound intellectual disability.
The control group received conventional comprehensive rehabilitation: therapeutic exercise, massage and training devices. The main group received hypoxic therapy together with conventional rehabilitation.
Sessions used the BIO-NOVA-204 hypoxic therapy system, Mountain Air [1]. Treatment comprised 13–15 sessions lasting 30–60 minutes, breathing a hypoxic mixture containing 12% O2, which our observations found optimal. During each session, patients breathed the hypoxic mixture for two to five minutes, then atmospheric air for five minutes, constituting one cycle. The number of cycles ranged from three to six.
Effectiveness was assessed using clinical data before rehabilitation and after treatment completion, with particular attention to comorbidities. Children with anaemia underwent blood counts. Thirty percent of children received repeat hypoxic therapy.
Results and observations
Comparison of clinical results in the control and main groups showed a significantly greater clinical effect in children receiving hypoxic therapy, substantially exceeding that in controls.
Stable positive results, particularly in motor function, were observed in 92% of hypoxic therapy recipients, compared with 79% of controls. There was a clear trend towards improved coordination and less chaotic movement in 90%, increased active movement in major joints in 89% and passive movement in 87%. Limb muscle tone decreased, voluntary foot extension improved with more pronounced weight-bearing support through the foot, and lower-limb clonus diminished.
A severe complication of cerebral palsy is contracture of the masticatory, facial and neck muscles arising from paresis and spasm. Consequences included difficulty opening the mouth, impaired chewing, swallowing and breathing, unclear speech and neurotic disturbances. Five children with this diagnosis received intermittent normobaric hypoxia. Two received hypoxic therapy for the first time; three were undergoing their third course.
During careful observation, children displayed positive emotions and looked forward to subsequent sessions. Continued treatment reduced facial and neck muscle tone, improved mental state, normalised difficult breathing and improved sleep. In three of five children, combined with acupressure, sound articulation improved noticeably. One child with severe speech delay showed only a small improvement.
Our practical experience supports repeat hypoxic therapy courses for these children.
Enuresis is a frequent comorbidity in cerebral palsy. We observed eight children with this condition. Hypoxic therapy combined with exercises strengthening the pelvic floor produced a marked clinical effect: five became completely free of enuresis, two had only occasional episodes, and one remained affected.
In six children with cerebral palsy complicated by congenital ventricular septal defects and grade 0–I heart failure, hypoxic therapy with 12% O2 was evaluated clinically. Clearly positive changes included improved overall vitality, less fatigue, better sleep and well-being and reduced tachycardia. Red blood cell counts and haemoglobin increased significantly. No adverse effects were observed during sessions.
Two children with hospitalism improved after the fifth session: involuntary movements while falling asleep disappeared, sleep began much sooner and became longer and calmer.
After two or three courses, nine children with profound intellectual disability showed reduced anxiety and irritability, improved behaviour, calmer sleep and fewer manifestations of aggression.
Hypoxic therapy was particularly effective in children with cerebral palsy accompanied by atopic dermatitis or anaemia, with an early clinical response.
In children with atopic dermatitis, improvement appeared after four sessions: dryness, itching and weeping lesions disappeared, and remission was achieved by the end of the hypoxic therapy course.
Haemoglobin rose to normal levels in all children with anaemia. These findings demonstrate the sustained positive effect of hypoxic therapy.
Of nineteen children with cerebral palsy and frequent acute viral respiratory infections, three had none in the year following hypoxic therapy, seven had one episode and nine two episodes, all mild. This indicates increased immunity in debilitated children.
Conclusion
Medical rehabilitation aims at secondary prevention: preventing disease progression, complications and relapses, as well as severe functional impairments that ultimately cause disability or increase its severity [5].
Hypoxic therapy therefore has considerable potential in preventive and rehabilitation medicine. Used alone or alongside other measures, it provides highly effective health improvement for children with various forms of cerebral palsy and comorbidities.
References
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2. Блинов Ю.А., Горшунова Н.К., Игнатьева С.А. Трудовая и медицинская реабилитация детей и подростков с ограниченными возможностями. // Мин. труда и социального развития Российской Федерации. М.: Просвещение, 2001.
3. Р.Б.Стрелков, А.Я.Чижов. Прерывистая нормобарическая гипоксия в профилактике, лечении и реабилитации. Екатеринбург: Уральский рабочий. – 2001. – 400 c.
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5. Р.Б.Стрелков, Ю.М.Караш, А.Я.Чижов и др. Метод повышения неспецифической резистентности организма с помощью нормобарической гипоксиической стимуляции. Методические рекомендации. Москва, 1985.
6. Э.И.Танюхина, В.П.Шестаков, К.А.Семенова. Комплексная реабилитация детей с детским церебральным параличом (методические указания). Москва – Санкт-Петербург, 1998.
Full main-text translation of: Дьякова Э.В. Нормобарическая гипокситерапия в реабилитации различных форм детского церебрального паралича у детей. Глазовский реабилитационный центр. С. 211–215.
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