Original article in German: www.kindernetzwerk.de/konzijavkin-methode-therapieverfahren-bei-cerebralparesen
Neurointensive Rehabilitation for Cerebral Palsy: The Kozyavkin Method.
Designed for children, adolescents and adults with cerebral palsy (CP)
Principles of the Multimodal Therapy
In the mid-1980s, Dr. Volodymyr Kozyavkin, a Ukraine-based neurologist and orthopaedist, developed his own concept for treating cerebral palsy. In more than 25 years, more than 70,000 patients have visited the medical centres in Truskavets and Lviv (Western Ukraine). Despite only partial financial support from official health insurance companies, children from Germany also underwent this treatment, organized in blocks lasting two to three weeks. However, in most cases, they were refused refunds to cover treatment costs.
This is a multimodal therapeutic method that is applied individually and focused mainly on using biomechanical manual therapy. The goals of this integrated treatment are as follows: improvement of gross and fine motor skills, intensification of proprioception, reduction or elimination of segmental blockages in large and small joints – primarily, in facet joints of the spine – trophic stimulation, relaxation of contractions, stretching of tendons, walking exercises to improve coordination and balance, gait training with body-support aids to optimize walking, rhythmic-musical therapy, and use of corrective suits, all of which contribute to enhancing personal and daily life skills (“quality of life”).
When children reach school age, particular attention should be paid to mobilizing hand functions. As non-functional hands are often subject to severe spastic deformities, hand mobilization eliminates spasticity caused by excessive muscular tone, and, combined with placement of the hand in an adducted position, it enables patients to acquire a number of cultural skills (writing and drawing), which, in turn, develops fine motor skills and coordination. The next step is to influence vegetative functions, namely, better blood supply to the limbs, reduction in false perceptions of movement in the peripheral visual fields (legs, feet, hands), and improvement of respiratory and digestive functions. It is also of utmost importance to address the issues of a healthy diet and nutrition guidelines. As a rule, the treatment lasts two weeks at the clinic, and daily therapeutic procedures last from three to four hours.
Hans-Henning Matthiaß, former director of the Orthopaedic University Clinic in Münster, is one of the few German doctors who publicly endorsed the Kozyavkin Method after his visit to the centre in Truskavets in 1996: “... I could see for myself that many children showed an obvious improvement on spasticity, which could later be used to continue basic therapeutic and physical education therapy (neuro-developmental treatment).”
The following data is based on documented results of treatment for patients in 2014 – 2016. These data refer to a group of 4,309 patients who completed 12,785 therapeutic courses. 75% of the patients suffered from different types of cerebral palsy.
Patients were divided into groups according to the Gross Motor Function Classification System (GMFCS): Level II – 22%; Level III – 22%; Level IV – 33%; Level V – 11%. The following group included 8,371 patients with CP, with 93% showing a clinically significant reduction in spasticity, while 7% showed no changes. 92% of the patients demonstrated an improvement in motor patterns, and gait patterns and active movements improved in 84%. Head control improved in 27% of GMFCS Level IV and V patients. Crawling was mastered best by small children in GMFCS Level III – 16%, and 49% of CP-affected children in GMFCS Level II and III learned how to sit and stand up without support.
Typically, many children with CP suffer from a range of serious problems associated with hand functions, or functions related to fine motor skills. The following results were achieved in this respect: Level II – up to 28%; Level III – up to 26%, Level IV – up to 21%, and Level V – up to 12%. Improvement in fine motor skills was generally observed in 32% of the patients.
Intensive Neurophysiological Rehabilitation using the Kozyavkin Method has not yet been recognized by official health insurance companies. Other therapeutic methods also remain without recognition, for example, Pető’s Conductive Education. However, over the years, we have established that, in some cases, health insurance companies partially reimburse such costs. It is not clear why compensation is denied, as many patients with CP show a clear reduction in spasticity symptoms. In addition, official health insurance companies have not yet taken into account the 2002 ruling of the Federal Social Court dated regarding the new definition of the “medical therapeutic method and its targets” (Case Identification: 1 B1 KR 34_01/20011115.rtf and 2 B1KR19_02/R20020424.rtf).
Critical Expert Assessment
Intensive Neurophysiological Rehabilitation using the Kozyavkin Method is based on therapeutic experience acquired in the course of treatment of about 70,000 patients with CP. The method itself is primarily based on a multimodal therapeutic offer and the concept of relaxing large and small joints.
In the case of CP, this primarily involves treating increased muscle tone associated with spasticity and the development of additional problems, which are mostly related to movement, correct posture, control of gross and fine motor skills, and coordination (“posture and gait”). In addition, a global therapeutic goal is necessary to offer patients with CP an opportunity to live a dignified life (“quality of life”). Each treatment and rehabilitation programme has to take into account individual differences, which are duly noted in further therapeutic prescriptions. Despite repeatedly described improvements in clinical symptoms of cerebral palsy, the Kozyavkin Method remains almost unknown and is not recognized in the Anglo-American medical community. The same applies to other therapeutic methods (Bobath Concept, Vojta Therapy, ergotherapy, etc.), since each of them has failed to present “scientifically based” evidence obtained as a result of scientific research of a particular therapeutic method.
In 2005, Dr. Mijna Hadders’ statement that the Kozyavkin Method is “magical” was a far cry from a flippant and opinionated remark. She does not endorse her statement with any scientifically convincing evidence. Responding to her comment, Ben Aris refuses such a patronizing evaluation, also pointing out that the Kozyavkin Clinic has generated international interest in the treatment of cerebral palsy.
Hubertus von Voss, University Professor Emeritus, Dr. med., Dr. h.c.
Honorary Head of the Registered Association Kindernetzwerk e.V.
Professor-Emeritus of Social Paediatrics and Adolescent Medicine at the Ludwig Maximilian University of Munich
Currently engaged in private practice in social paediatrics and adolescent medicine
Member of the Board of the Insopa Foundation
Original article in German: