KINESITHERAPY AND ULTRASOUND IN CHILDREN WITH BRONCHIAL ASTHMA

and ultrasound. Spirometric and anthropometric parameters were recorded at the beginning and end of the therapeutic course. The ratios between actual and expected spirometric parameters, adjusted for all anthropometric parameters, were included in the statistical analysis. Results:- In both groups, the ratios between the actual and the expected spirometric parameters improved significantly after 10 days of treatment compared to before (P<0.05). The improvement after treatment was significantly greater in the "physiotherapeutic" compared to the "control" group (P<0.05). Conclusion:- In the 10-day treatment of children with bronchial asthma, the combination of kinesitherapy and ultrasound has a significant therapeutic effect, building on that of pharmacotherapy.

There are no studies in the literature on asthma in children regarding the combination of ultrasound and exercise. Ultrasound therapy has local and general anti-allergic (desensitizing), anti-inflammatory, resorbable, vasodilating, relaxing (antispastic), and analgesic effects (16). In addition, general immunological reactivity of the body, blood and lymph circulation is activated (16). The functions of the endocrine organs and the sympathetic function of the nervous system are stimulated (16). The tone of the respiratory muscles and the bronchial drainage function is improved (16).
The aim of the study was to compare the effect of the combination of kinesitherapy and ultrasound in children with bronchial asthma compared to a control group without rehabilitation.

Material And Methods:-
24 children with bronchial asthma (age 9.63 ± 3.56 years) were followed for 10 days (5 days as inpatients and 5 days as outpatients) at the Children's Clinic of a University Hospital. They were randomized into two identical groups -"physiotherapeutic" and "control". Both groups were treated with identical standard pharmacotherapy (7). The "physiotherapy" group was additionally treated with ultrasound and kinesitherapy.
Ultrasound was performed over two zones with direct contact, constant mode, labile method (with longitudinal movements) (17). The dose by intensity was 0.2 W/cm2 (17). The first zone was paravertebral two centimeters from processi spinosi of T1 to T12 (17). It affects the sympathetic ganglia of the chest corresponding to the innervations of the bronchi (17). The second zone was over VI-th and VII-th intercostals spaces bilaterally (from paravertebral to axial line). It relaxes the spastic respiratory muscles (17). On the first day, the first zone was treated for 2 minutes bilaterally with a total duration of 4 minutes (17). On the second day, both zones were treated with a total duration of 8 minutes (17). The course of treatment consisted of 10 procedures (17).
Spirometric (15) and anthropometric (2,(6)(7)(8)10,13) parameters were recorded at the beginning and end of the therapeutic course. Spirometry was performed in each test three times with a computer spirometer (15). The best of three consecutive trials was recorded (15). Anthropometric parameters were:-age (d), height (cm), weight (kg), chest circumference at pause, at maximum inspiration and expiration, Brugsh index (mean chest circumference divided by height in cm), Erisman index (chest pause circumference -1/2 of the height in cm.), Tomayer test (toefloor distance in cm.), Ott test (mobility of the spine in cm.), sagittal and frontal diameter of the chest and their ratio (2,8,10,12).
Correlation analyzes with post-hoc multiple linear regression tests were used to calculate the significance of the interaction between spirometric and anthropometric parameters, obtaining significant real multiple regression formulas. Based on them, we calculated the expected spirometric parameters, adjusted for all anthropometric parameters. They had higher statistical flexibility than the expected spirometric parameters, calculated automatically by the computer spirometer based on only 3 anthropometric parameters (age, height, and weight), which did not change for 10 days. In the statistical analysis, we additionally included the ratios in percentages between the real spirometric results and the expected spirometric parameters according to the obtained real regression formulas. For statistical analysis, a balanced design of MANOVA with 2x2 levels of interaction was used -"before" versus "after" treatment and "physiotherapeutic" versus "control" group. Post-hoc multiple Bonferroni comparative tests were used to isolate which statistical clusters differed significantly from the others.

Results:-
There were no statistically significant MANOVA interactions (P>0.05) with respect to the individual real spirometric parameters and with respect to the ratios between the actual and the parameters predicted by the computer spirometer, adjusted for age, height, and weight. Statistically significant multiple correlations (P<0.05) between the actual forced expiratory volume for 1 second ("FEV1 Act1") and all anthropometric parameters, allowed us to calculate based on these real results, the following statistically significant multiple regression formula: This real formula was applied to calculate the expected "FEV1 Pred1 formula", adjusted for all anthropometric parameters. The ratio between the actual and the expected forced expiratory volume for 1 second, according to this formula ("FEV1% Act1/Pred formula"), was subjected to statistical MANOVA analysis with post-hoc multiple comparative tests of Bonferroni.
After the 10-day course, there was a significant increase in "FEV1% Act1/Pred formula" in the "physiotherapy" group (P<0.05) and the "control" group (P<0.05), but the "physiotherapy" group showed a statistically significantly higher value of this parameter compared to the "control" group after the two-week follow-up (P<0.05) (Figure 1).
334 Figure 1:-The ratio between the actual and the expected forced expiratory volume for 1 second, according to the formula ("FEV1% Act1/Pred formula"), in the "physiotherapy" group and the "control" group at the beginning and after the two-week follow-up.
The results from the other ratios between actual and expected spirometric parameters, adjusted for all anthropometric parameters, were similar to "FEV1% Act1/Pred formula". They are not presented due to a limitation in the scope of this article.

Discussion:-
At a 10-day follow-up, the actual spirometric parameters and the ratios between the actual and the predicted parameters by the computer spirometer were not sensitive enough to reach statistically significant differences. The expected spirometric parameters calculated by the computer spirometer cannot verify improvement after a 10-day period, as they are based only on inert anthropometric measurements (age, height, and weight). The remaining anthropometric parameters showed sufficient flexibility and sensitivity within a two-week follow-up. That is why the ratios between actual and expected spirometric parameters, adjusted for all anthropometric parameters, showed statistically significant dynamics within a two-week follow-up.
In both groups, an improvement was found after the 10-day therapeutic course in terms of the percentage ratios between the actual and the expected spirometric parameters, adjusted for all anthropometric parameters. This confirms the therapeutic effect of pharmacotherapy and rehabilitation with a combination of kinesitherapy and ultrasound in children with asthma.
A constructive effect of the combination of kinesitherapy and ultrasound on that of pharmacotherapy in children with asthma was found, as the improvement after treatment was significantly greater in the "physiotherapeutic" group compared to the "control" group.

Conclusion:-
The combination of kinesitherapy and ultrasound has a significant therapeutic effect in 10-day inpatient and outpatient treatment of children with bronchial asthma, building on that of pharmacotherapy. Literature:-