Introduction. Spasticity – the basic and the most common clinical syndrome of cerebral palsy. Most of the time child’s functional and movement disorders depend on this. Botulinum toxin is a drug that relaxes muscles by blocking the release of acetylcholine (ACH) in neuro muscular connection and reduces level of spasticity. The short-term effect of BTX has been proven in scientific literature and it is well known. The effect of treatment with BTX –A in a long-term remains insufficiently studied. Purpose. To evaluate the effect on changes in child’s with cerebral palsy conditions of ankle and child’s mobility over the long time (over 1 year) in the treatment with BTX-A. Method. 98 children with cerebral palsy were treated. The main indication for the treatment of BTX- A was a dynamic ankle joint contracture, resulting in functional status or movement disorders. Condition of all children were evaluated 1 month before starting the treatment with BTX; prior to each injection; within 1 – 2 months after the beginning of treatment with Dysport and after 4 months while planning further treatment with botulinum toxin. The passive ROM of child’s ankle joint was assessed with goniometer measuring the ankle of dorsiflexion while stretching the child’s knee. The functional movement of the child was assessed using the GMFM -88 scale. Results. The average age of children after first BTX-A injection was 33.29 ± 16.235 months. The majority of children (n = 45) were mobile belonging to I - II level at the GMFCS and partly mobile belonging to level III (n = 35). The number of injections of BTX –A ranged from 2 to 8 times per child. The data suggest that despite long-term treatment with BTX –A and physical therapy with the increase of child’s age the contracture of the ankle joint forms. In all cases the only criteria which are statistically significant is time. It means that passive changes in ankle joint dorsiflexion depend on its treatment time. Assessment of child’s functional movement with GMFM -88 scale showed that with each injection of BTX –A the functional movement of a child is enhanced. The highest improvement in motion has been established after the sixth injection of botulinum toxin. Conclusion. Treatment with BTX-A doesn’t have an impact on increase of passive amplitude of ankle and it doesn‘t affect the formation of contractures. Functional movements of a child improvement depend on treatment time: the best result was reached after sixth injection of BTX.

Tikslas. Nustatyti, kada ir kokius pirmuosius kalbos ir bendravimo raidos sutrikimus pastebi tėvai, augi­nantys kalbos raidos sutrikimų turinčius vaikus, ir kaip tai susiję su raidos vertinimu ir ankstyvu raidos sutrikimo diagnozavimu. Tyrimo medžiaga ir metodai. Atliktas vienmomentis skerspjūvio tyrimas anoniminės anketinės apklausos metodu. Apklausti 103 tėvai, atvykę į Vaikų ligoninės, Vilniaus universiteto ligoninės Santaros klinikų fili­alo, Vaiko raidos centro Ankstyvosios reabilitacijos skyrių ir auginantys kalbos raidos sutrikimų turinčius vaikus (1-7 metų). Tyrimas vyko 2018 – 2019 metais. Rezultatai. Dauguma tėvų (78,2 %) nurodė, jog pir­mieji atkreipė dėmesį į vaiko kalbos raidą. Daugiau kaip pusė tėvų (65 %) pastebėjo vaiko iki 2 metų kalbos raiškos sutrikimą. Sudėtingiau tėvams buvo pastebėti vaiko kalbos supratimo problemas, atpažinti autizmo požymius, todėl neretai (30-35 % atvejų) dėmesys vaiko raidai buvo pavėluotas. Tik pusės tiriamųjų raida buvo tikrinta šeimos gydytojų pa­gal psichomotorinės raidos tikrinimo lenteles. Jiems nustatytas įvairiapusis raidos sutrikimas (37,3 %), mišrus raidos sutrikimas (22,0 %), kalbos sutrikimas (14,7 %), nenurodyta diagnozė (26,0 %). Daugiau kaip pusei tiriamųjų (56 %) raidos sutrikimas dia­gnozuotas esant 2-3 metų. Nustatyta koreliacija tarp diagnozės nustatymo laiko ir vaiko raidos sutrikimo pastebėjimo laiko (r=0,498) vaiko psichomotorinės raidos tikrinimo metu (r=0,158). Išvados. Kuo anksčiau pastebimi vaiko raidos atsi­likimo požymiai, tuo greičiau nustatoma diagnozė. Vaiko kalbos raidos sutrikimai anksčiau diagno­zuojami, jei jie buvo vertinti šeimos gydytojų pa­gal psichomotorinės raidos tikrinimo lenteles. Tė­vai pavėluotai pastebi vaiko raidos sutrikimus, laiku neatkreipia dėmesio į tai, jog vaikas mažai kalba, nevykdo prašymų, nereaguoja į vardą.

Research background. One of the newest children’s cerebral palsy abilitation techniques are special neuro – orthopedic suits, which are used in physiotherapy procedures. “Atlant” suit rehabilitation has been introduced relatively recently, and it has not yet been extensively studied, especially in comparison with other methods. In Lithuania, this treatment method was introduced only a year ago. There is still lack of information about these suits effect on the motor skills of children with cerebral palsy. The aim of the research was to evaluate the effectiveness of physiotherapy using Atlanto suit for children with cerebral palsy. Methods. The research included 20 subjects, 14 boys and 6 girls. Participants were divided into two groups: experimental and control (10 children each). Participants were evaluated twice; at the beginning and at the end of rehabilitation. Points of evaluation included: • lower limb muscle tone (according to the modified Asworth scale); • range of joint motion (goniometry); • balance and gait (according Tinetti scale); • gross motor function (according to the gross motor measure scale – GMFM-88). Results. The study showed that the experimental group, where “Atlant” suit was used figures were statistically significantly higher (p < 0.05) assessing: evaluating the changes of muscle tone; changes of balance and gait and changes of gross motor functions, in comparison with the control group, which did not apply to neuro – orthopedic suit. Evaluated figures changes of joint range of motion for the experimental and control groups it was established that they did not differ statistically significant (p > 0.05). Conclusion. Physiotherapy combined with “Atlant” suit is more effective than conventional methods of physiotherapy treatment, improving children’s, suffering from cerebral palsy, general motor function, balance and gait and also muscle tone reduction.Keywords: children, cerebral palsy, “Atlant” suit.