Bejan Alexandra Ioana (Unione Genitori Italiani contro il tumore dei bambini UGI ODV, Turin, Italy)
Naretto Gabriella Elena (Ospedale Infantile Regina Margherita, Turin, Italy)
Imazio Paola (Ospedale Infantile Regina Margherita, Turin, Italy)
Cerebral palsy (CP) is one of the most frequent causes of motor disability in children. According to the current definition, developed by an international team of experts, cerebral palsy is a group of permanent, but not unchanging, disorders of movement and/or posture and of motor function, which are due to a non-progressive interference, lesion, or abnormality of the developing/immature brain (1-2). According to European data, the average frequency of CP is 2.08 per 1000 live births (3-4). Spasticity, in combination with muscle tightness, weakness, decreased selectivity and reduced motor control, contributes to limitations in ambulation, functional ability, balance, physical fitness and participation (5). Therapeutic management focuses on minimizing disabilities and maximizing goal-related functional performance and participation. Administering Botulinum toxin to spastic muscles is promising to improve gait pattern and functional walking ability in ambulant children with cerebral palsy. This intervention creates a therapeutic window aimed at enhancing not only the gait pattern but also both static and dynamic balance.
We enrolled 15 patients (10 males and 5 females) with cerebral palsy (7 hemiplegic and 8 diplegic), with an average age of 9 years (ranging from 4 to 18 years) and classified as Gross Motor Function Classification System (GMFCS) II (10 patients) and GMFCS III (5 patients). We assessed their motor skills using the Berg Balance Scale, the Timed Up and Go (TUG) test, and the VRRS Khymeia technological tool.
We collected the data at two time points: T0 at the time of toxin inoculation and T1 at the check-up one month after inoculation.
The Berg Balance Scale is a test used to assess functional balance and it evaluates both dynamic and static balance through 14 tasks regarding mobility. The scale has been useful in predicting the risk of falls (6).
The Timed Up and Go (TUG) test is a reliable, cost-effective, safe, and time-efficient way to evaluate overall functional mobility (7).
The Virtual Reality Rehabilitation System (VRRS) Khymeia is a medical device that allows clinicians to assess postural control and acquire quantitative data. Its operation is based on the principles of Biofeedback and virtual reality and is equipped with the motor, postural and immersive VR modules. During the evaluation the device records and reports the patient’s COP (Center of Pressure) displacement, enabling the saving of numerical charts through which the results of the patient performance can be objectively and measurably evaluated (8).
During this timeframe, all patients underwent physical therapy treatments combined with the use of AFO (Ankle-Foot Orthoses). We observed a statistically significant improvement in the scores obtained on the TUG and Berg evaluation scales (95% confidence interval). However, regarding the evaluation with the VRRS Khymeia, there was an increase in the score one month after inoculation, which was not statistically significant.
In conclusion, we can affirm that it is necessary to enrol a larger sample of patients and administer the evaluations (TUG, BERG, and Khymeia) also at 3 and 6 months in order to verify a statistically significant relevance of the evaluation with VRRS Khymeia. We also consider it is important to highlight the increase in the score obtained by patients one month after the inoculation, and we are hopeful to further explore this research.
