THE EFFECT OF DOMAN-DELACATO AND PERFETTI METHODS IN CHILDREN WITH SPASTIC HEMIPLEGIC CEREBRAL PALSY
Authors: Valerieva Avramova Margarita 
Published: August 2019

Child Cerebral Palsy (CP) is the most common cause of disability in children. Quality treatment requires active therapy from an early age. In 2004, at the International Workshop on Definition and Classification of CP in Bethesda, Maryland, the following definition was adopted: "A group of diseases of the development of movement and posture causing limitations in activities which belong to the non-progressive disabilities observed in the developing brain of the fetus and the baby. Increasingly, in addition to routine kinesitherapy, innovative neurodevelopmental methods such as Doman-Delacato and Perfetti are included in the work with such children. These methods are based on the neuroplastic properties of the brain. The research on the topic suggests the need to apply more innovative methods and assess their effectiveness. This motivates us to do the following research. Aim. The aim of the present study is to investigate the effect of the application of new specialized kinesitherapeutic methods in order to optimize the treatment of children and improve their motor activity. Methods. 30 children aged 3-7 years old with a spastic hemiplegic CP were randomized and split equally in two groups - a control group (CG) recieving routine kinesitherapeutic method and an experimental group (EG) including, besides the routine methodology and specialized neurodevelopmental methods of Doman-Delacato and Perfetti. For children in both groups, kinesitherapy was applied three times a week with a duration of each procedure of 50 minutes. All participants were evaluated with Ashworth Modified Scale, the Holt and Hoskins - Squires Test, modified for children by Chavdarov (1985), and Global Motor Measurement, through the Gross Motor Function Measurement Test - GMFM - 66. The study period ran from February 2017 to February 2018. The evaluation were done before kinesitherapy, 6 months after kinesitherapy and 1 year after kinesitherapy. Friedmann ANOVA Test and post Bonferroni multiple comparison test were used to evaluate within and between-group differences respectively. The level of significance was accepted as p<0.05. Results and analysis. The dynamics of the results in the two research groups was followed. Muscle spasticity in EG children decreases as early as the sixth month of the kinesitherapy with a statistically significant difference p <0.01, and after one year it decreases even further with a difference p <0.001. In KG children, spasticity decreases much later with a statistically less significant difference p <0.05, 1 year after kinesitherapy. The results of Holt and Hoskins - Squires test we obtained were with statistically significant differences in EG p <0.05, 1 year after treatment, while in KG there were no statistically significant differences between the period before kinesitherapy and 1 year after. In terms of global motor function measured by GMFM-66, both groups reached the results 1 year after the treatment, but the difference was statistically more significant in EG p <0.01. Conclusion. In conclusion, we can argue that innovative neurodevelopmental kinesitherapeutic methodologies, such as Doman-Delacato and Perfetti in combination with routine kinesitherapy, lead to statistically significant differences in the group of children with CP they were applied. This demonstrates the effectiveness of the applied complex of exercises in which neurodevelopmental methods have been intentionally added in parallel with standard approaches. Therefore, we can assert that our methodology optimizes the treatment of children with CP and improves their motor activity.