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Background. Acute hematogenous osteomyelitis in the lesion of the proximal femur causes hypofunction or destruction of the metaepiphyseal growth zone of the femur. Theoretically, this leads to the formation of orthopedic consequences, including shortening of the lower limb. Aim. The study aimed to examine the plantographic characteristics of the feet in children with a lesion of the proximal femur and analyze the influence of the regularities of plantar pressure distribution in the asymmetry of the load on the lower limbs. Material and methods. Total 15 pediatric patients aged 6–16 years with consequences of acute hematogenous osteomyelitis of the proximal femur and shortening of the affected lower limb by 1.0–6.0 cm were examined. In addition, 15 healthy children belonging to the same age were examined for comparison. Stabilometry and plantography methods were used, and the statistical study included correlation and regression analysis. Results. When we conducted tests with a double-support load on the feet, in comparison to healthy children, pediatric patients exhibited a significant decrease in the value of the anterior index of the support t in both the affected and unaffected sides. The parameters of other support indices (namely, m, s, and l) of the contralateral feet in patients were within the normal range, indicating the functional consistency of the corresponding arches of the feet, providing static and dynamic limb support ability. However, the correlation and regression analysis showed that, in comparison with the norm, the foot support ability in pediatric patients is implemented due to the strengthening of the functional relationship between the inner and the medial longitudinal arches of the foot on the intact side and the inversion of the interaction of the longitudinal arches with the transverse arch on the side of the lesion. Conclusion. In children with consequences of acute hematogenous osteomyelitis of the proximal femur, the parameters of the plantographic characteristics indicate a change in the activity and consistency of the muscles that form all the feet arches on both the affected and intact lower limbs.

Введение. Восстановительное лечение пациентов с детским церебральным параличом до сих пор является крайне сложной задачей . Устойчивые и нарастающие двигательные ограничения у таких больных обусловли-вают пожизненную необходимость в лечебных и реабилитационных мероприятиях . Нейрореабилитация детей с церебральным параличом на современном этапе не только включает в себя традиционные средства физиче-ской реабилитации, но и активно использует методики роботизированной механотерапии и новые технологии в области нейрофизиологии . Одной из таких технологий является неинвазивная чрескожная электростимуля-ция спинного мозга . Цель исследования. Изучить влияние чрескожной электрической стимуляции спинного мозга на двига-тельные функции детей со спастической диплегией во время роботизированной механотерапии в системе «Локомат» . Материалы и методы. В статье представлено клиническое исследование 26 пациентов в возрасте от 6 до 12 лет с детским церебральным параличом . 11 пациентов (основная группа) получили курс роботизированной механотерапии на системе «Локомат» в сочетании с чрескожной электрической стимуляцией спинного мозга и 15 пациентов (контрольная группа) получили курс только роботизированной механотерапии . Результаты. Сравнительный анализ в двух группах проводился на основании результатов клинического об-следования с помощью специальных шкал (GMFCS, GMFM-88, Modified Ashworth Scale of Muscle Spasticity), локомоторных тестов (L-FORCE, L-ROM) и оценки активности мышц с помощью электромиографии . Было установлено, что в обеих группах после курса реабилитации отмечалось улучшение двигательных функций, но в основной группе, где использовалась чрескожная электростимуляция спинного мозга, положительная динамика была более значимой . Заключение. На основании клинических данных, изменений показателей локомоторных тестов L-FORCE и L-ROM, а также по оценке изменений активности мышц можно заключить, что двигательная реабилитация детей со спастической диплегией с использованием роботизированной механотерапии в системе «Локомат» в сочетании с чрескожной электрической стимуляцией спинного мозга была более эффективной по сравнению с результатами изолированного применения роботизированной механотерапии .Ключевые слова: детский церебральный паралич (ДЦП), двигательная реабилитация, роботизирован-ная механотерапия, чрескожная электрическая стимуляция спинного мозга (ЧЭССМ), электромиография (ЭМГ) . Aim of the study: To assess the effect of transcutaneous electrical stimulation of the spinal cord to improve the motor function of children with spastic diplegia using the "Lokomat" robotic mechanotherapy system . Materials and methods.A clinical rehabilitation study of 26 patients aged 6-12 years with CP was conducted . The treatment group included 11 patients who received one course of robotic mechanotherapy using the "Lokomat" system combined with transcutaneous electrical stimulation of the spinal cord . The control group included 15 patients who received one course of robotic mechanotherapy only . Results. A comparative analysis of...

1 ФГБУ «Научно-исследовательский детский ортопедический институт им. Г.И. Турнера» Минздрава России, Пушкин, Санкт-Петербург, Россия; 2 ФГБУН «Институт физиологии им. И.П. Павлова» РАН, Санкт-Петербург Россия; 3 ООО «Косима», Москва, Россия Одним из симптомов детского церебрального паралича (ДЦП) является значительное нарушение способности удерживать вертикальную позу. Цель -изучить влияние локомоторных тренировок в сочетании с чрескожной электростимуляцией спинного мозга (ЧЭССМ) и функциональной электростимуляцией мышц (ФЭСМ) на восстановление функции поддержа-ния вертикальной позы у детей с ДЦП. Пациенты и методы. В исследование были включены 19 пациентов в возрасте 6-12 лет с тяжелой формой ДЦП, с уровнем тяжести клинических проявлений по классификации основных моторных функций (Gross Motor Function Classification System) около 3. Все пациенты были разделены на 2 группы: основную и кон-трольную. Пациентам обеих групп в течение 3 нед было проведено по 15 процедур роботизированной механотерапии на локомоторном тренажере. Больным основной группы во время каждой локомоторной тренировки проводили ЧЭССМ и ФЭСМ. Пациентам контрольной группы проводили только локомоторную тренировку. Динамику восстановления верти-кальной позы у детей оценивали с помощью стабилометрии. Результаты. Стабилометрия выявила значимое возрастание постуральной устойчивости у пациентов основной группы по сравнению с больными контроля. Это проявлялось статисти-чески достоверным (p<0,05) уменьшением длины и площади статокинезиограммы при открытых глазах (в среднем соот-ветственно на 167 мм и 112 мм 2 ) и тенденцией к нормализации положения проекции центра масс в сагиттальной плоско-сти. Вывод. В исследовании установлено, что проведение ЧЭССМ и ФЭСМ в сочетании с локомоторными тренировками способствует нормализации нарушения системы управления балансом у детей с тяжелыми формами ДЦП. One of the cerebral palsy (CP) symptoms is the impairment of the ability to maintain upright standing. The objective of the present study was to investigate the effect of the locomotor training combined with electrical transcutaneous spinal cord stimulation (TSCS) and functional electrical stimulation (FES) of the muscles to facilitate the restoration of the vertical posture function in the children presenting with cerebral palsy. The patients and methods. This article is designed to present the results of the study that included 19 patients at the age from 6 to 12 years. The severity of the CP clinical manifestations was estimated to be around 3 in accordance with The Gross Motor Function Classification System (GMFCS). All the patients underwent 15 half-hour daily sessions of robotic mechanotherapy with the use of a locomotor training device. In 8 patients from the main group, each locomotor training session was accompanied by the TSCS and FES procedures. The patients of the control group underwent the locomotor training alone. Results. The dynamics of regaining the standing posture regulation was evaluated by stabilometry that has revealed a significant increase of ...

Introduction. All forms of infantile cerebral paralysis involve motor function defects. In clinical practice, the stabilometrics method is widely used due to its ability to perform detailed analyses of the mechanisms of disturbance and restoration of postural control in patients with various cerebral lesions. Aim. The study aimed to analyze the parameters of orthostatic balance in practically healthy children and in children with motor disorders caused by infantile cerebral paralysis of various severities. Material and methods. We examined 6- to 12-year-old children with mild and severe cerebral paralysis and impaired vertical postural control with a preserved ability to self-balance in the principal posture. Each group examined for comparison comprised 10 patients (children with infantile cerebral paralysis, and impaired vertical postural control) and 10 healthy children in the same age range. The stabilometrics method was used, and the statistical evaluation included correlation and regression analyses. Results. The results revealed that in comparison with the healthy children, the patient group exhibited a decrease in the vertical postural stability, which manifested as pronounced deviations from the nominal values of the stabilometric parameters. However, a strong correlation between the parameters of S, LFS, and the amplitude A of the pressure center was revealed, which significantly exceeded that of the healthy children, being most pronounced in cases of severe infantile cerebral paralysis. This indicates a more ordered center of pressure trajectory and, consequently, a higher synchronization of the vertical balance management system in children with infantile cerebral paralysis compared with that in healthy children. Conclusion. The use of correlation and regression analysis to study the vertical balance of patients provides a deeper understanding of the mechanisms used by the postural control system in patients with infantile cerebral paralysis to maintain a complex multilevel structure of the musculoskeletal system in equilibrium in the process of standing still. Increased ordering of the center of pressure trajectory of statokinesiograms of children with infantile cerebral paralysis can be considered as a dynamic indicator of postural control deficiency.

Background. In modern orthopedics, the problem of unilateral shortening of the lower limbs in children is extremely important. In the process of child growth, there occurs progression of the shortened segment, which leads to anatomical asymmetry of the lower limbs and an increase in the imbalance of the limb load. Secondary deformities of the pelvis and spine aggravate the patients disability. The features of abnormal postural balance of the body depending on the etiology of the disease, such as congenital or acquired, as well as the degree of preservation of motor stereotypes in children with unilateral shortening of the lower limbs, are still understudied. Aim. The aims of this work are to study postural stability in children with unilateral shortening of the lower limbs and to assess the disorders of body balance depending on the etiology of the lesion. Materials and methods. The standard stabilometric values of 11 healthy children (average age, 11.9 0.73 years) were determined (group 1), as well as the statokinesiogram parameters in 22 patients with unilateral shortening of the lower limb. The second group included 11 children (average age, 11.9 1.05 years) with congenital shortening of the lower limb (average shortening, 4.8 0.8 cm). The third group also consisted of 11 children (average age, 12.2 0.78 years), but with acquired shortening of the lower limb (average shortening, 4.5 0.38 cm). Statistical research included correlation analysis. Results. A significant decrease in the stability of the vertical balance was observed in both groups of patients, which was demonstrated by pronounced deviations from the nominal values of stabilometric parameters, compared with healthy children: an increased center of pressure displacement, large values of the statokinesiogram area, and the length of the pressure displacement path. It was possible to determine the state of adaptive postural mechanisms for assessing the formation of the degree of adequacy of the motor strategy in patients with unilateral shortening of the lower limb, depending on the etiology of the lesion, owing to the method of stabilometry. Conclusion. An appropriate adaptive motor stereotype has been formed in patients with acquired shortening of the lower limb; in the new conditions, the system for ensuring postural balance is stabilized. There is a different strategy for maintaining posture stability characterized by a nonoptimal motor stereotype in patients with congenital shortening of the lower limb. The stabilometric assessment of the asymmetry of the lower limb load is a promising method for studying the formation of compensatory mechanisms for controlling the locomotion system, which is important when planning rehabilitation measures.

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Objective. To study the functional state of the musculoskeletal system in patients with Legg Calve Perthes disease after surgical treatment. Material and methods. The study of 31 patients at the age of 8 to 13 years with unilateral Legg Calve Perthes disease (LCPD) was performed in the period from 2 to 5 years after surgical treatment. In the control group (15 children), correcting (varus) osteotomy (VO) was fulfilled, in the main group (16 children) triple pelvic osteotomy (TPO), and the group of healthy children (18 persons) was examined as well. Walking biomechanics was studied using of the STEDIS complex (Neurosoft LLC, Ivanovo, Russia). The vertical balance of the body was evaluated on a stabilometric platform MBN "Biomechanics" (LLC NMF MBN, Moscow). Results. After surgical treatment, the indicators of vertical balance and biometry of the step phases in both groups of children with LCPD did not reach the same level as in healthy individuals at the indicated follow-up dates. The least significant indicators of step phase asymmetry were found in patients after TPO compared with patients after VO. In patients after VO, the destabilization of the center of pressure significantly exceeded that in patients after TPO. Conclusions. Biomechanical studies allow us to compare the functional results of various techniques of surgical treatment of children with unilateral LCPD. After TPO operation, patients have a more complete restoration of the supportability of the affected lower limb compared to VO operation.