The study of the effectiveness of botulinum toxin therapy incombination with other methods of rehabilitation of cerebral palsy (CP)remains relevant, as it allows clinicians to significantly expand the scopeof rehabilitation opportunities.

Our aim was to study the effect of the combined application ofbotulinum therapy and robotic kinesiotherapy in the complexrehabilitation of children with spastic diplegia on improvement ofgeneral motor function.

The study involved 162 children with CP (spastic diplegia). The studygroup (n=82) in complex rehabilitation received robotickinesiotherapy (with the help of the Lokomat® complex) andintramuscular injection of botulinum toxin type A. In the control group(n=80), children underwent rehabilitative treatment with traditionalmethods. Motor rehabilitation was evaluated using the Ashworthspasticity scale and Gross Motor Function Measure-88 (GMFM).

The inclusion criteria were: CP diagnosis, spastic diplegia; thepatients` age should be 4 years and older, the motor developmentlevel according to Gross Motor Function Classification System(GMFCS) II and III.

The exclusion criteria were: severe concomitant somatic pathology;uncontrolled epileptic seizure; orthopedic surgery; hip jointinstability; concomitant diseases with clinical signs of motordamage. BTA injection exclusion criteria were: acute inflammatoryconditions, hyperthermia, pathological characteristics of the generalanalysis of blood and urine, persistent contracture.

Statistical analysis of this study results was carried by using IBM SPSSStatistics Professional 21.0.

The present study showed a significant improvement inthe parameters of general motor development with thecombined use of botulinum and robotic walking in thecomplex rehabilitation of children with spastic diplegia.Thus, the combined use of botulinum therapy androbotic kinesiotherapy in complex rehabilitation can beconsidered as one of the effective methods of motorrehabilitation with CP.

Distribution of patients by age, gender and motor development levelaccording to GMFCS is given in Table 1. In comparing the baselineindicators of the study parameters, no differences between groupswere observed (P>0.05).

Improvement of spasticity with a transition to an easier form wasobserved in 30 patients of the study group vs 7 patients in the controlgroup. Here, the number of children with the highest spasticity in thestudy group decreased from 12 (14.63%) to 1 (1.22%) (P=0.001), andin the control group from 9 (11.25%) to 4 (5.0%) (P=0.146) (Figure 1).

In the analysis of GMFM data, the highest results were obtained in thestudy group, where the average motor development index increasedwith a difference of 6.42 points (Table 2). In the control group , thisindicator increased with a difference of 2.40 points. The mostsignificant progress was noted in patients of the III development levelaccording to Gross Motor Function Classification System (study group,7.86; control group, 2.42).

Table 1. Characteristics of groups

Age, years, M±SD 4.84±0.56 4.78±0.61 0.570

Gender: males/

females, n (%)

48/34

(58.54/41.6)

45/35

(56.25/43.75)0.772

GMFCS II, n (%) 45 (54.88) 39 (48.75)

0.436GMFCS III, n (%) 37 (45.12) 41 (51.25)

MAS, M±SD 2.84 (0.72) 2.66 (0.50) 0.156

GMFCS: Gross Motor Function Classification System; MAS -

Modified Ashworth Scale for Grading Spasticity; M - mean;

SD - standard deviation.

2,44

3,66

21,95

2,50

3,75

35,37

51,22

35,00

42,5

46,34

23,17

51,25

48,75

14,63

1,22

11,25

5,00

0% 20% 40% 60% 80% 100%

pre

post

pre

post

stu

dy

gro

up

con

tro

l g

rou

p

0 1 2 3 4Modified Ashworth Score:

Levels

Before

p-

value

After

p-

value

Difference

p-

value

Study

group

Control

group

Study

group

Control

group

Study

group

Control

group

Mean±SD Mean±SD Mean±SD

GMFCS II 81.95±5.68 79.68±7.20 0.183 87.19±5.55 82.07±7.48 0.002 5.24±2.41 2.39±1.26 0.0001

GMFCS III 55.44±7.40 54.95±7.24 0.589 63.31±7.48 57.38±7.38 0.001 7.86±4.01 2.42±1.78 0.0001

GMFCS II

& III69.99±14.76 67.01±14.35 0.171 76.41±13.59 69.41±14.45 0.002 6.42±3.47 2.40±1.54 0.0001

GMFCS: Gross Motor Function Classification System; SD - standard deviation; probability (p) was calculated

using the Mann-Whitney U test

Table 2. The dynamics of general motor development indicators by GMFM-88

Figure 1. The distribution of spasticity on a Modified Ashworth scale

5,24

7,87

6,4281,95

55,44

69,99

87,19

63,31

76,41

GMFCS II GMFCS III GMFCS II-III

pre post

2,39

2,43

2,479,68

54,95

67,01

82,07

57,38

69,41

GMFCS II GMFCS III GMFCS II-III

pre post

Figure 2. The dynamics of general motor development indicators by GMFM-88

Study group Control group