Comparative Efficacy of Medical Rehabilitation Methods in Children with Spastic Diplegia: Multichannel Myostimulation and Hydro-Kinesiotherapy in a Resort Setting

BACKGROUND: Cerebral palsy (CP), particularly spastic diplegia, remains a leading cause of motor impairment in children, with a prevalence of 2–3 cases per 1000 population. Although resort-based treatment (RBT) is widely used, its combinations with modern rehabilitation methods are insufficiently studied, and comparative and long-term data are limited.

AIM: The work aimed to compare the short- and long-term (6 months) efficacy of combining RBT with hydro-kinesiotherapy, multichannel myostimulation, vibrotherapy, and resistance physical therapy (PT) in children aged 8–13 years with spastic diplegia (GMFCS levels I–III).

METHODS: A prospective, non-randomized controlled study was conducted in a state-funded rehabilitation resort. Participants (n=185) were divided into five groups: the treatment group (RBT+hydro-kinesiotherapy, n=45), three comparison groups (RBT+myostimulation, vibrotherapy, or resistance physical therapy; n=30 each), and the control group (RBT, n=50). Interventions included hydro-kinesiotherapy (30 min/session, 34–36 °C), multichannel myostimulation (20–30 min, 10–150 Hz), vibrotherapy (50 Hz, 3–5 min/zone), and resistance PT (weights of 1–5% of body weight). Primary outcomes were reduced spasticity (Ashworth scale) and improved motor function (GMFM). Assessments were performed on Days 1 and 21, and after 6 months using clinical scales, stabilometry, and electromyography.

RESULTS: All participants completed treatment. Groups were comparable in age (10.2±1.5 years), sex (51% male), and GMFCS distribution (I: 38–43%, II: 33–40%, III: 23–26%; p >0.05). The greatest reduction in spasticity was observed in the myostimulation group (ΔAshworth=–25%, p <0.001, d=0.68) compared to the control (Δ=–5%, p=0.280). GMFM improved the most in group 2 (Δ=+22%, p=0.002, d=0.89), followed by hydrotherapy (Δ=+18%, p=0.001) and PT (Δ=+13%, p=0.018). Vibrotherapy was associated with balance deterioration (ΔPBS=–0.49, p=0.062). Among GMFCS II participants (n=72), a significant correlation was found between reduced spasticity and improved stabilometry findings (r=0.62, p=0.011). No adverse events were reported.

CONCLUSIONS: Multichannel myostimulation and hydro-kinesiotherapy in combination with RBT proved more effective in reducing spasticity and improving motor function in children with spastic diplegia. In contrast, the current vibrotherapy parameters should be revised. The findings support the inclusion of these modalities in guidelines; however, further research is needed to assess long-term outcomes and applicability to more severe CP forms (GMFCS IV–V).