CLINICAL AND NEUROPHYSIOLOGICAL MONITORING OF CHILDREN WITH DISEASES OF THE PERIPHERAL NERVOUS SYSTEM

Abstract

Untimely detection of spasticity reduces the effectiveness of rehabilitation measures in general, adversely affecting the functional outcome.
The purpose of the study . To study the possibilities of a multimodal approach in the diagnosis and treatment of lower limb spasticity in the early recovery period of polyneuropathies in children.
Materials and research methods . A total of 70 children with various lesions of peripheral nerves took part in the study. The duration of participation in the study for the full sample of patients (n = 70) was 3 months. Four examinations were carried out (on days 1, 14, 30 and 90 of the study), including clinical and neurological assessment and clinical and functional testing (according to the modified Ashworth, Tardieu, FIM, Rankine, Barthel scales, determination of the Rivermead mobility index, measurement by visual -analogue scale, assessment of the degree of movement disorders according to the scale of the Scientific Center of Neurology of the Russian Academy of Medical Sciences).
Research results. All patients were assessed using the Modified Ashworth Scale (MSE), which is the gold standard for assessing muscle tone. The groups were homogeneous in terms of the distribution of baseline ISE scores (p = 0.2316; Fisher's exact test). At the first examination in both groups, only values of 2 or more points according to the ISE were recorded: 2 points in 21 (60.0%) patients in group 1 and in 15 (42.9%) patients in the comparison group; 3 points in 14 (40.0%) patients in group 1 and 20 (57.1%) in the comparison group.
The regression of pathological muscle tone in the comparison group was more intense, and already from the second examination, patients in this group had statistically significantly lower scores compared to the comparison group (p < 0.0001 at each of examinations 2, 3 and 4; exact test Fisher).
A decrease to 1 point according to the ISE in the comparison group after three months of the study (examination 4) was achieved by 20 (57.1%) patients, to 1+ point — 9 (25.7%) patients; in 6 (17.1%) patients, by the time of the last examination, 2 points remained, however, an improvement of at least 1 point was noted in all patients of group 1. At the same time, in the group of muscle relaxants 1 and 1+ points after three months were observed only in one (2.9%) and five (14.3%) patients, respectively; 21 (60.0%) patients in the comparison group retained their original ISE score (10 - 2 points, 11 - 3 points).
Conclusions: As a result of a comprehensive clinical assessment of patients in the early recovery period after lesions of peripheral nerves, it was revealed that spasticity is a factor that reduces the volume of active movements in the ankle joint, reduces the rate of recovery, the ability to move independently, social and household activity, preventing the achievement of individual rehabilitation goals .