TREATMENT OF SPASTICITY AND DEGENERATIVE-DYSTROPHIC CHANGES IN MUSCLES IN CHILDREN WITH CEREBRAL PALSY

One of the most urgent problems of rehabilitation of children with cerebral palsy (CP) is overcoming spasticity and pathological structural changes in muscles, which leads to impaired statics and locomotion of gait, and reduced social adaptation. A central focus of multidisciplinary rehabilitation of patients with CP is the reduction muscle spasticity. One of the most effective methods for achieving this is the administration of botulinum toxin type A. However, existing data on combination therapy involving neurotoxin and agents that stimulate tissue regeneration remain fragmented, predominantly advisory in nature, and require further investigation. Objective: To evaluate the efficacy of combined treatment for muscle tone disorders in children with cerebral palsy through the use of neurotoxin therapy alongside agents that stimulate muscle tissue regeneration. Materials and methods. The study analyzed data from 40 pediatric patients with CP presenting with muscle tone disorders such as reflex tonic hypertonia, spasticity, and rigidity. Clinical and instrumental diagnostic methods were employed to assess the condition of the patients. Quantitative data were statistically processed using the mean ± standard error (M±m), and statistical significance was determined using Student’s t-test. The significance was set at the level of p < 0.5-0.05. The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committee of the All-Ukrainian Centre for Motherhood and Childhood of the National Academy of Medical Sciences of Ukraine. Informed consent was obtained from all participants. Results. The comparative analysis demonstrated a more pronounced positive clinical response in patients receiving botulinum toxin as part of a comprehensive rehabilitation program. The combined therapy, targeting the entire myofascial chain of the lower limb and paraspinal muscles, resulted in statistically significant improvements (p<0.05) in subgroups A and B of the main cohort, compared to the control group. Patients in subgroup C received therapy aimed at preventing the progression of joint contractures and delaying the need for surgical intervention. Conclusions. The proposed multimodal treatment for children with cerebral palsy and muscle tone abnormalities—specifically reflex tonic hypertonia and spasticity—effectively reduces pain and spasticity, restores tropocollagen levels in soft tissues and ligamentous structures, which significantly improves gait biomechanics. Timely conservative treatment aimed at reducing spasticity and stimulating muscle tissue regeneration contributes to marked clinical improvement and facilitates the development of a physiological motor pattern. In patients with muscle rigidity, the implemented treatment approach helps delay surgical intervention and reduces the risk of recurrent contractures requiring reoperation.