Revista

de la

Universidad

del Zulia

Fundada en 1947

por el Dr. Jesús Enrique Lossada

ANIVERSARIO

DEPÓSITO LEGAL ZU2020000153

ISSN 0041-8811

E-ISSN 2665-0428

Ciencias

Exactas,

Naturales

y de la Salud

Año 15 N° 43

Mayo - Agosto 2024

Tercera Época

Maracaibo-Venezuela

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The Use of a Virtual Reality System in the Rehabilitation of Children with

Progressive Muscular Dystrophies

Tеtіana Khrystova



Vladyslav Pyurko



Olga Pyurko



Andriy Protsenko



Tetiana Osadchenko



Mykhailo Oliinyk



ABSTRACT

The research aim is to prove the effectiveness of individual programs of physical therapy

and occupational therapy for children with progressive muscular dystrophy (PMD), which

include game technologies of virtual reality. The following research methods were used in

the work: general scientific (analysis, synthesis, synthesis of literature); clinical (clinical

examination); pedagogical (observation, experiment); biomedical (development of motor

functions), mathematical statistics. It has been proven that after the implementation of a

synergistic rehabilitation program on the MFM scale positive changes were observed

among children with dystrophic pathologies; according to the Vignos scale, no

improvement in results was recorded; according to the Brooke scale - similar situation,

among children with PMD Landusy-Dejerin, Emery-Dreyfus and unspecified form, the final

results did not differ from the weekend, and among children with Duchenne muscular

dystrophy, born PMD and Erb-Roth PMD showed deterioration of parameters.

KEYWORDS: Physical therapy, progressive muscular dystrophy, children, virtual reality

technologies.



Bogdan Khmelnytsky Melitopol State Pedagogical University, Ukraine. ORCID ID: https://orcid.org/0000-

0003-1621-695X. E-mail: fizreabznu@gmail.com

  Bogdan Khmelnytsky Melitopol State Pedagogical University, City Council of Zaporizhia Region,

Ukraine. ORCID ID: https://orcid.org/0000-0001-9296-6619. E-mail: vlad.1994ak@gmail.com

***Bogdan Khmelnytsky Melitopol State Pedagogical University, Ukraine. ORCID ID:

https://orcid.org/0000-0002-3681-073X. E-mail: diser0303@gmail.com

****Bogdan Khmelnytsky Melitopol State Pedagogical University, Ukraine. ORCID ID:

https://orcid.org/0000-0002-9092-7015. E-mail: andrey-prozenko@ukr.net



Pavlo Tychyna Uman State Pedagogical University, Ukraine. ORCID ID: https://orcid.org/0000-0003-

2198-7206. E-mail: taniasudjba@gmail.com

******Zaporizhzhia State Medical and Pharmaceutical University, Ukraine. ORCID ID:

https://orcid.org/0000-0003-4131-7664. E-mail: oleynikmikel.1991@ukr.net

Recibido: 20/12/2023 Aceptado: 05/03/2024

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El uso de un sistema de realidad virtual en la rehabilitación de niños con

distrofias musculares progresivas

RESUMEN

El objetivo del estudio es demostrar la eficacia de los programas individuales de fisioterapia

y terapia ocupacional para niños con distrofia muscular progresiva (DMP), que incluyen

tecnologías de juego de realidad virtual. En el estudio se utilizaron los siguientes métodos

de investigación: científico general (análisis, síntesis, generalización de la literatura); clínico

(examen clínico); pedagógico (observación, experimento); médico y biológico (desarrollo de

las funciones motoras), estadística matemática. Se comprobó que, tras la aplicación del

programa de rehabilitación sinérgica, se observaron cambios positivos entre los niños con

patologías distróficas según la escala MFM; no se registró ninguna mejora según la escala de

Vignos; de acuerdo con la escala de Brook - una situación similar, entre los niños con

Landusi-Deguerin, Emery-Dreyfus y forma no especificada de PMD, los resultados finales

no difirieron de la línea de base, y entre los niños con distrofia muscular de Duchenne, forma

congénita de PMD y Erb-Roth PMD, se observó deterioro de los indicadores.

PALABRAS CLAVE: Fisioterapia, distrofia muscular progresiva, niños, tecnologías de

realidad virtual.

Introduction

In today's turbulent times, the future of the nation is determined, first of all, by the

expansion of the health zone of the child population, the prevailing determinants of which

are the system-environmental homeostasis of humans and ecosystems, the stability of the

bioecosystem, and stable resources (Pyurko et al., 2022). The transversal unity of its

physical, mental, and social sides in consolidation with the achievements of bioecomedicine

can be considered the main lines of implementation of predictors of children's health

(Khrystova, Kovalchuk, 2021). In the last decade in Ukraine, despite the implementation of

a system of complex measures in the aspect of preserving and strengthening the health of

the young generation, its deterioration has been noted (Kalynychenko et al., 2020;

Khrystova, 2012). This is associated with a large mental and physical load, with a decrease

in the prestige of the child's healthy behavior. The increase in the share of severe chronic

diseases, in particular hereditary and congenital, in the structure of morbidity among

children contributes to an increase in the frequency of such adverse consequences as

limitation of life activities and social insufficiency (Znak et al., 2018; Khrystova, 2013). This

is manifested in somatic weakness, the presence of organic pathology, the emergence of a

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tendency to increase the prevalence of deviations in the development of children, which

indicates the urgency of the problem of improving medical, social-psychological, and

pedagogical assistance to children who experience developmental difficulties from early

childhood (Ravi et al., 2017; McDonald, 2002).

Progressive muscular dystrophies (PMD) are a group of hereditary diseases, with a

debut in most cases in childhood, characterized by muscle weakness, muscle atrophy and a

progressive course due to the degeneration of muscle fibers (Brooke et al., 1989; Duan et al.,

2021; Wicklund, 2013; Freitas et al., 2019). Currently, there are no effective drugs for the

complete treatment of muscular dystrophies, only supportive therapy is prescribed (Bushby

et al., 2010; Fowler, 1982; Jameson et al., 2020; Grange, Call, 2007). A system of corrective

and rehabilitation methods of treatment, including exercises with movements of the whole

body and aimed at the development of fine motor skills, are important for the prevention of

complications and improvement of the quality and duration of life of children of this

nosology (Bothwell et al., 2003; Hinton et al., 2006; Jackson, 2008; Markert et al., 2011).

Many domestic and foreign scientists are engaged in researching the problems of

development of therapeutic practices, medical technologies of rehabilitation, (Kondratenko,

V., Okopnyk, O., Fomichov, K., Voronkova, V., Oleksenko, R., Kondratenko, V., Manzhula,

A., Sobol, Y., Myroniuk, R.) but the digital segment of such services remains outside the

area of attention. The introduction of a phased system of physical therapy for children with

PMD, which begins from the first year of life and continues in preschool and school age

with the use of modern technologies of digitalization of the rehabilitation process in the

form of a virtual reality game system, is an urgent problem (Bohil et al., 2011; Li et al., 2009;

Merians et al., 2006). Virtual reality technology provides an opportunity to individualize

treatment needs, while maintaining the availability and quality of rehabilitation effects

(Coons et al., 2011; Henderson et al., 2007; Parsons et al., 2009; Cho et al., 2002).

The research

aim is to prove the effectiveness of individual physical therapy programs for

children with progressive muscular dystrophies, which include modern gaming virtual reality

(VR) technologies.

1. Materials and methods

The theoretical and methodological basis of the work was the synergistic use of

scientific principles and a systematic approach, which determined a transparent approach

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to the choice of research methods, in particular: general scientific (analysis, synthesis,

systematization, generalization of literary sources); clinical (clinical examination data

according to the generally accepted examination scheme); pedagogical (observation,

scientific experiment); medical and biological (level of development of motor functions),

methods of mathematical statistics.

The research was conducted on the basis of the Municipal non-profit enterprise

«Center for the provision of social services and medical rehabilitation» of the Melitopol City

Council of the Zaporizhia region in 2021-2022. The experiment involved 20 children with

PMD aged 6 to 9 years who have severe cognitive impairment, convulsions noted for 3 years

before the beginning of rehabilitation effects, widespread weakness in the upper limbs

(when performing the tests, the children could not raise their arms to mouth level). Of them,

the largest number was children with Duchenne muscular dystrophy (DMD) - 56.9%,

followed by Erb-Roth PMD (13.9%), congenital PMD (11.1%), PMD of unspecified form

(9.7%), Emery-Dreyfus PMD (5.6%), Landuzy-Dejerin PMD (2.8%). Informed consent to

participate in the research was obtained from the parents of the children who participated

in the experiment.

The peculiarity of the said contingent of children with PMD was that most of the

patients had not previously been involved in physical education and sports, that is, they had

not received regular physical exercise. The perception of physical therapy as a necessary

component of a complex of rehabilitation measures was very weak.

In this regard, when building the methodology of the introductory period of

rehabilitation, it was taken into account that for most children, physical exercises and the

system of regular training itself represent a new type of activity. This determined the need

for the formation of motivation and a positive attitude to classes, compliance with the main

general pedagogical, specific and psychological principles. Therefore, special importance

was attached to establishing personal contact with each child participating in the study;

built their relationships on a detailed acquaintance not only with complaints, but also on

studying the way of life, habits, character traits, degree of interest in classes, main

motivations. In the course of pedagogical observations, positive dynamics of not only

physical, but also emotional state were noted.

Taking into account the fact that PMD is characterized by muscle weakness, muscle

atrophy and a progressive course due to the degeneration of muscle fibers, all rehabilitation

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tactics were aimed at preventing the progression of the symptoms of the disease itself and

its complications.

In the process of work, individual physical therapy programs were implemented,

which included the following tools: therapeutic physical culture, light hand massage,

orthopedic stacking, magnetic therapy, and virtual reality game systems. A new

rehabilitation technology for children with PMD, the effectiveness of which was evaluated

during the rehabilitation period, was a VR gaming system (Microsoft Xbox 360 Kinect;

Microsoft Corporation; Redmond, Washington, USA), which is used to ensure the process

of forming basic movements in children with PMD.

To optimize children's motivation, a huge selection of games was offered.

Commercial games were used for children aged 6-7: «Sesame Street: Once upon a monster»

or «Kinectimals». For children 8-9 years old, games were offered: «Kinect Disneyland

Adventures», «Kinect Adventures» or «Kinect Rush: A Disney Pixar Adventure».

Classes with children with PMD were conducted in a separate office with an area of

15 m2. Air humidity and temperature were maintained within 70-80% and 20-24°C,

respectively. The number of sessions per rehabilitation course is 10, the frequency of

sessions is daily, with a break on Sundays, during daytime hours (from 3:00 p.m. to 6:00

p.m.), in between children's meals. The duration of the procedure was 20 to 30 minutes,

with the duration of the active phase being strictly 15 minutes and the inactive phase being

5 to 15 minutes, depending on the chosen game.

During the game/exercises on the VR game system, the children performed

movements with the whole body, while the movements and their repetition were voluntary

and performed physiologically, the intensity and pace of the exercises were determined by

individual capabilities, which corresponds to the approaches to the rehabilitation of

children with PMD. When performing exercises on the game console, the use of high-

intensity strength training and eccentric exercises, which can cause damage to children

with PMD, is excluded. VR games are aimed at developing not only large, but also fine

motor skills, which is important for children with PMD, since fine motor skills affect the

quality of life of patients (children can maintain motor independence longer). Also, when

using games in the rehabilitation process, it was possible to maintain the level of motivation

in children, which is essential for the successful rehabilitation of children with this

nosology.

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The effectiveness of the VR game system was evaluated using specially selected

scales that reflect the dynamics of gross and fine motor skills in the rehabilitation process of

children with PMD.

Vignos scale. This scale was used to assess the ability to move the lower limbs

(Vignos, Archibald, 1960). According to this scale, patients were divided into 10 functional

classes, according to their ability to move.

Brooke scale. This scale was used to assess the ability to move the upper limbs

(Brooke et al., 1989). According to this scale, patients were divided into 6 functional classes

according to their ability to move.

MFM scale. This scale is a general assessment of motor abilities of patients with

neuromuscular diseases (Motor Function Measure, 2003/2005) (Bérard et al., 2005). The

MFM scale allows for a comprehensive assessment of proximal, distal and axial motor

disorders. It contains 32 items, which include static and dynamic assessments, divided into

three dimensions (Dimensions): dimension 1 (D1) – «standing and moving» (13 items),

dimension 2 (D2) – «axial and proximal motor weakness» (12 points), dimension 3 (D3) –

«distal motor weakness» (7 points, 6 of them - upper limbs). D is the sum of points

according to dimensions D1, D2, D3.

The digital material obtained in the research process was processed using Statistica

version 10.0 general purpose data processing software package. The reliability of differences

between groups (comparison of the average values of the indicator for each group) was

determined using the Student's test (t).

Results and discussion

Based on the generalization and systematization of scientific and methodological

literature (Znak et al., 2018; Duan et al., 2021; Wicklund, 2013; Jackson, 2008), it can be

stated that the number of children with PMD is increasing every year, both in Ukraine and

throughout the world. The main causes of various forms of PMD are related to the human

genetic apparatus, namely autosomal deletions, or the sex X chromosome. These genetic

changes are manifested in the phenotypic sphere by progressive muscular dystrophies. In

order for a child with such a pathology to have the opportunity to develop, both socially

and intellectually, it is advisable to use non-drug methods of restorative treatment along

with drug ones (McDonald, 2002; Brooke et al., 1989; Bushby et al., 2010; Jameson et al.,

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2020; Grange, Call, 2007; Jackson, 2008). Methods of physical therapy and occupational

therapy are constantly updated and improved. Thus, along with therapeutic gymnastics,

various mechanical and automatic devices that allow training the musculoskeletal system,

recently virtual game systems have been used (Coons et al., 2011; Henderson et al., 2007;

Parsons et al., 2009; Cho et al., 2002). They can be used in hospital inpatient settings and at

home, which makes it possible to eliminate the barrier of territorial inaccessibility to

rehabilitation services (Bohil et al., 2011; Li et al., 2009; Merians et al., 2006). VR improves

the function of the musculoskeletal system, fine motor skills, coordination abilities, muscle

strength and quality of life of children with PMD.

The structural and logical analysis of the obtained results (Figs. 1-6) showed that the

overall average assessment of motor abilities of children of primary school age with PMD

before restorative treatment was 77.11±7.25% (D – general motor development)

=0.001),

according to the first measurement (D1) – 58.61±3.71% (

<0.001), according to the second

measurement (D2) – 90.06±7.11% (р=0.018), according to the third measurement (D3) –

88.31±6.58% (

=0.017). The average score according to the Vignos scale of all examined

children at the beginning of the study was 2.92±0.58 points (

=0.001), according to the

Brooke scale – 1.53±0.11 points (р=0.007).

It should be noted that the average results of indicators of various scales are largely

determined by the clinical picture of various types of PMD. We characterize the vectors of

changes in motor functions of children with PMD depending on the PMD type.

As a result of initial testing of the motor function of children of primary school age

with DMD, the following parameters were recorded (Fig. 1): according to the MFM scale, D

– 74.68±6.12% (р<0.01), D1 – 52.38± 4.37% (р=0.006), D2 – 90.99±8.22% (р<0.02), D3 –

87.16±7.08% (р<0.001); on the Vignos scale – 3.2±0.41 points (p<0.001), on the Brooke scale –

1.44±0.09 points (p=0.005).

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Fig. 1. Dynamics of indicators of motor development of children with DMD according to the

MFM, Vignos and Brooke scales.

In children 6-9 years old with PMD Landuzi-Dezherin at the beginning of the

experimental study, the following results of the state of motor abilities were obtained (Fig.

2): according to the MFM scale, D – 95.32±8.36 (

=0.002), D1 – 96 ,17±9.07% (

<0.003), D2 –

91.67±7.86% (

<0.001), D3 – 100.0±9.27% (

=0.02); on the Vignos scale – 1.0±0.08 points

(p<0.001), on the Brooke scale – 1.0±0.07 points (p=0.002).

Fig. 2. Dynamics of indicators of motor development of children with PMD Landuzi-

Dezherin according to the MFM, Vignos and Brooke scales.

Low initial results on all scales of assessment of children's gross and fine motor skills

at the beginning of the implementation of the synergistic program of physical therapy and

occupational therapy were obtained among patients with congenital PMD (Fig. 3):

according to the MFM scale, D – 56.15±4.81 (р< 0.01), D1 – 28.69±1.97% (р=0.001), D2 –

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74.66±6.91% (

=0.003), D3 – 74.56±6.85% (

< 0.002); on the Vignos scale – 5.88±4.93 points

(p<0.01), on the Brooke scale – 2.88±2.03 points (p<0.001).

Fig. 3. Dynamics of indicators of motor development of children with congenital PMD

according to the MFM, Vignos and Brooke scales.

Monitoring of motor function at the beginning of the experimental study among

children with Erb-Roth PMD showed the initial parameters at the following level (Fig. 4):

according to the MFM scale, D – 89.94±8.21 (р=0.003), D1 – 79.36 ±6.58% (p<0.005), D2 –

97.11±9.17% (p<0.001), D3 – 96.90±8.94% (p=0.01); according to the Vignos scale – 1.4±0.08

points (р=0.005), according to the Brooke scale – 1.1±0.05 points (р<0.002).

Fig. 4. Dynamics of indicators of motor development of children with Erb-Roth PMD

according to the MFM, Vignos and Brooke scales.

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A comprehensive check of the initial motor skills of children aged 6-9 years who

suffer from Emery-Dreyfus PMD on all scales made it possible to obtain satisfactory results

(Fig. 5): on the MFM scale, D – 92.19±7.76 (р<0.001), D1 – 86.54±7.17% (p=0.003), D2 –

95.97±8.92% (p<0.001), D3 – 94.05±8.14% (p=0.004); according to the Vignos scale –

1.25±0.07 points (р<0.01), according to the Brooke scale – 1.0±0.06 points (р=0.003).

Fig. 5. Dynamics of motor development indicators of children with Emery-Dreyfus PMD

according to the MFM, Vignos and Brooke scales.

In children of primary school age with an unspecified form of PMD, the state of the

motor sphere before carrying out synergistic rehabilitation measures was at the following

level (Fig. 6): according to the MFM scale, D – 83.19±6.81 (р=0.002), D1 – 72, 89±6.54%

(р<0.001), D2 – 88.29±7.73% (р=0.003), D3 – 91.84±8.23% (р<0.005); according to the Vignos

scale – 1.57±0.08 points (р=0.001), according to the Brooke scale – 1.57±0.07 points (р<0.002).

So, in the process of comparative analysis of the initial level of development of motor

function of children with PMD, it was established that patients with PMD Landuzi-Dejerin

have the highest (best) indicators of motor development on all scales (exception - D2), in

second place - children with PMD Emery-Dreyfus (exception – D2, D3), then – children

with Erb-Roth syndrome (exception – D2, D3), children with DMD and children with

PMD of unspecified form. Patients with congenital pathology had the lowest motor ability

scores on all scales among children with PMD.

To determine the vector of changes in the motor function of children with PMD, the

values of indicators in dynamics were calculated: the difference between initial and final

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values during the period of rehabilitation effects.

Fig. 6. Dynamics of indicators of motor development of children with PMD of an

unspecified form according to the MFM, Vignos and Brooke scales.

A comparative analysis of the state of motor functions after the application of

individual programs of physical therapy using the VR system (Fig. 1-6) showed that

according to the data of the MFM scale, the average score for measuring D in children with

PMD at the end of the study was 78.89±7.02% (p=0.001), D1 – 60.68±5.17% (p<0.001), D2 –

91.51±8.39% (p=0.020), D3 – 90.57±7.10% (p =0.014). The average score on the Vignos scale

among elementary school children with neuromuscular pathologies after rehabilitation was

2.88±0.59 points (p=0.001); according to the Brooke scale - 1.50±0.10 points (р=0.012).

Depending on the type of PMD in children with impaired motor function,

statistically significant changes in the average value were found as a result of the

implementation of a complex program of physical therapy and occupational therapy using

the BP system.

During the study period, the average changes in parameters of motor functions

among children aged 6-9 with DMD were equal (Fig. 1): according to the MFM scale, D

improved by 1.36% (reached values of 76.04±6.23, p=0.001), D1 – improved by 1.55%

(53.94±4.91%, p<0.001), D2 – increased by 1.01% (90.0±8.14% (p<0.002), D3 – increased by

2.88% (90.04±8.08%, (p=0.005); according to the Vignos and Brooke scales, the results

remained at the initial level, no probable changes were observed.

A slightly different picture was observed during the systematization of the dynamics

of the average indicators of motor abilities among the studied children with PMD Landuzi-

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Dezherin (Fig. 2); after the implementation of a synergistic program of physical therapy and

occupational therapy, they were at the following level: according to the MFM scale, D

improved by only 0.52% (equal to 95.84±8.46, p<0.002), D1 and D3 did not change

compared to according to the initial data, the highest positive dynamics was noted

according to the D2 measurement - the results increased by 1.4% (93.07±8.93% (

<0.005);

according to the Vignos and Brooke scales, no probable changes in motor parameters were

recorded.

In children of primary school age with congenital PMD against the background of

using the VR system, the average motor indicators underwent the following changes (Fig.

3): according to the MFM scale, D improved by 2.74% (reached values of 58.89±5.31,

p<0.003 ), D1 – improved by 2.53% (31.22±2.63%, p=0.001), D2 – increased by 2.95%

(77.61±6.83% (p<0.002), D3 – increased by 1.63% (76.19±6.67%, p<0.005); according to the

Vignos scale, the dynamics of motor abilities were not noted; according to the Brooke scale,

a slight deterioration of the results by 0.13 points was noted (the final data were equal to

2.75± 0.09 points, p<0.001).

After carrying out a complex of physical therapy and occupational therapy measures,

monitoring of the average motor function indicators of children with Erb-Roth PMD

according to the studied scales showed the following results (Fig. 4): according to the

MFM scale, D improved by 2.32% (reached values of 92.26±8 .77, p<0.005), D1 – improved

by 3.18% (82.54±7.41%, p<0.004), D2 – increased by 1.5% (98.61±8.90% (p =0.003), D3 -

increased by 2.27% (99.17±9.43%, p=0.001); according to the Vignos and Brooke scales, a

slight deterioration of the actual data by 0.1 points was noted in both cases (p<0.001) .

During the experiment, the dynamics of the average indicators of motor development

of children with Emery-Dreyfus PMD according to the MFM, Vignos and Brooke scales are

characterized by the following vectors (Fig. 5): according to the MFM scale, D results

improved by 2.08% (reached values of 94.27±8 .71, p<0.004), D1 – improved by 3.86%

(90.4±8.56%, p=0.005), D2 – increased by 2.64% (98.61±8.85% (p <0.002), D3 – no probable

changes were recorded, the indicators remained at the initial level; according to the Vignos

and Brooke scales, there were also no probable changes in the manifestation of children's

motor abilities, the actual results remained at the initial level.

Summarizing the effect of physical therapy and occupational therapy using the VR

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system on the motor content of children with PMD of an unspecified form allows us to

state that during the study period the average indicators changed as follows (Fig. 6): on the

MFM scale, D improved by 2.52% (reached level 85.71±7.83, p<0.002), D1 – improved by

2.57% (75.46±7.12%, p<0.003), D2 – increased by 1.6% (89.89± 8.66% (p=0.004), D3 -

increased by 1.35% (93.19±8.58%, p<0.001); according to the Vignos and Brooke scales, there

were no probable changes in the manifestation of children's motor abilities, the actual

results remained at the initial level and scored 1.57±0.08 points in both cases (

<0.01).

Thus, in the process of a structural-logical generalized analysis of the state of the

motor sphere of children of primary school age with PMD after the implementation of a

synergistic program of physical therapy and occupational therapy using the BP system, it

was proved that according to the MFM scale (D, D1, D2 and D3) in the dynamics, positive

changes among children with different types of dystrophic pathologies (the exception is the

measurement of D3 in children with Emery-Dreyfus PMD), according to the Vignos scale,

the results did not improve, in most cases the indicators remained at the initial level, and in

children with Erb-Roth PMD they slightly decreased; according to the Brooke scale,

positive dynamics were also not noted in any case, among children with PMD Landuzy-

Dejerin, PMD Emery-Dreyfus and PMD of an unspecified form, the average final results did

not differ numerically from the initial values, and among children with DMD, congenital

PMD and Erba-Roth PMD, deterioration of average parameters was observed.

It should be noted that to assess the effectiveness of new technologies in the

rehabilitation treatment of children with PMD, it is more appropriate to use the indicators

of the MFM scale, which characterize fine motor skills. The Vignos and Brooke scales

mainly characterize the state of gross motor skills, which cannot be significantly changed

under the influence of BP means. Therefore, it is better to use these scales only to assess the

state of gross motor skills in children with PMD.

Conclusions

The following conclusions can be drawn on the basis of the conducted experimental

research.

1. The analysis of scientific and methodological and special literature on the topic

of the work showed that the number of children with PMD is increasing every year, both in

Ukraine and throughout the world. In order for the child to develop both socially and

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intellectually, the synergistic use of non-drug and drug rehabilitation methods, which are

constantly updated and improved, is necessary. In the conditions of the modern

information society, along with therapeutic gymnastics, various mechanical and automatic

devices that allow you to train the locomotor system, recently virtual game systems have

been used. They can be used in hospital inpatient settings and at home, which makes it

possible to remove the barrier of territorial inaccessibility to rehabilitation services. Digital

content improves the function of the musculoskeletal system, fine motor skills,

coordination abilities, and muscle strength of children with PMD.

2. In the course of the research, individual programs of physical therapy and

occupational therapy for children with various types of PMD were developed and

implemented, which included the following tools: therapeutic physical culture, light

manual massage, orthopedic stacking, magnetic therapy, virtual reality game systems. An

effective rehabilitation technology for children with progressive muscular dystrophies of

primary school age is a virtual reality gaming system (Xbox 360 Kinect).

3. In the process of comparative analysis of the initial level of motor function

development of children with PMD, it was established that patients with Landusi-Dejerin

PMD have the best indicators of motor development on all scales (exception - D2), in

second place - children with Emery-Dreyfus PMD (exception - D2, D3), then - children

with Erb-Roth syndrome (exception - D2, D3), children with DMD and children with PMD

of an unspecified form. Patients with congenital pathology had the lowest motor ability

scores on all scales among children with PMD.

4. In the process of a structural-logical generalized analysis of the state of the

motor sphere of children of primary school age with PMD after the implementation of a

synergistic program of physical therapy and occupational therapy using the BP system, it

was proven that positive changes were recorded in the dynamics according to the MFM

scale (D, D1, D2 and D3) among children with different types of dystrophic pathologies (the

exception is the measurement of D3 in children with Emery-Dreyfus PMD), according to

the Vignos scale, no improvement in results was recorded, in most cases the indicators

remained at the initial level, and in children with Erb-Roth PMD they slightly decreased;

according to the Brooke scale, positive dynamics were also not noted in any case, among

children with PMD Landuzy-Dejerin, PMD Emery-Dreyfus and PMD of an unspecified

form, the average final results did not differ numerically from the weekend values, and

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among children with DMD, congenital PMD and ErbPMD - the deterioration of the average

parameters was observed in the mouth.

5. To assess the effectiveness of new technologies in the rehabilitation treatment of

children with PMD, it is more appropriate to use the indicators of the MFM scale, which

characterize fine motor skills. The Vignos and Brooke scales mainly characterize the state

of gross motor skills, which cannot be significantly changed under the influence of BP

means. Therefore, it is better to use these scales only to assess the state of gross motor skills

in children with PMD.

The developed synergistic programs of physical therapy and occupational therapy for

children with PMD can be used in neurological and traumatology-orthopedic departments

of treatment and prevention facilities, in rehabilitation centers, as well as in sanatorium-

resort conditions.

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