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Serebral Palsili Çocukların Yürüme Karakteristiğinin BiyomekanikDeğerlendirmesi

Serebral palsi (SP), kas iskelet sisteminde pek çok deformiteye neden olan ve çeşitli yürüme patolojileri ile kendini gösteren birhastalıktır. Bükük diz yürüyüşü en çok karşılaşılan yürüme problemlerinden biridir. SP’li hastaların kinetik ve kinematikparametrelerinin sağlıklı kişilere göre farklılık gösterdiği bilinmektedir. Bu çalışmada, bükük diz yürüyüşüne sahip çocukların eklemkinematiği ve kinetiği ile alt ekstremite kas kuvvetleri açısından sağlıklı bireylere göre olan farklılıklarının belirlenmesiamaçlanmıştır. Bunun için OpenSim yazılımı kullanarak SP’li hastaların ve sağlıklı bireylerin yürüme hareketinin analizi yapılmıştır.Ters kinematik analiz ile kalça, diz ve ayak bileği fleksiyon / ekstansiyon açıları elde edilmiştir. Eklem momentlerinin hesaplanmasıiçin ters dinamik yöntemi kullanılmıştır. Statik optimizasyon yöntemi ile medial hamstring, biseps femoris, rektus femoris,gastroknemius ve tibialis anterior kasları için kas kuvvetleri hesaplanmıştır. SP’li hastalardan kaydedilen elektromiyografi (EMG)verisi ile de kestirilen kas aktivasyonlarının zamanlamalarının deneysel veriyle örtüşüp örtüşmediği kontrol edilmiştir. SP’liçocuklarda kalça eklemi fleksiyon / ekstansiyon açısında sağlıklı bireylere göre farklılık gözlenmemektedir. Ancak SP’li çocuklardadiz ve ayak bileği fleksiyon/ektansiyon açılarının sağlıklı bireylerden anlamlı şekilde farklı olduğu belirlenmiştir. Kalça, diz ve ayakbileğindeki fleksiyon/ekstansiyon momentleri incelendiğinde maksimum kalça ekstansör momenti ve ikinci diz ekstansör momentidışındaki diğer bütün parametreler için SP’li hastalar ve sağlıklı bireyler arasında anlamlı farklılıklar tespit edilmiştir. SP’li çocuklardabiseps femoris ve semimembranosus kas kuvvetleri sağlıklı kişilere göre daha yüksek bulunurken, gastroknemius, rektus femoris vetibialis anterior kas kuvvetleri daha düşük bulunmuştur. Kestirilen kas kuvvetleri EMG verisi ile karşılaştırıldığında kaslarınaktivasyon zamanlarının deneysel olarak elde edilen aktivasyon zamanları ile uyumlu olduğu görülmüştür.

Biomechanical Evaluation of Gait Characteristics of the Children with Cerebral Palsy

Cerebral palsy (CP) is a disease that causes several deformities in the musculoskeletal system and it is manifested by various gaitpathologies. Crouch gait is one of the most common gait problems. It is known that the kinetic and kinematic parameters of thepatients with CP differ from healthy individuals. In this study, it was aimed to determine the differences in joint kinematics, jointkinetics, and muscle forces between healthy children and children with crouch gait. To do so, OpenSim was employed for the analysisof the patients with CP and healthy individuals during walking. Flexion/extension angles of the hip, knee, and ankle joints wereobtained using the inverse kinematics approach. The inverse dynamics approach was applied for the calculation of the joint moments.Muscle forces of the medial hamstring, biceps femoris, rectus femoris, gastrocnemius, and tibialis anterior were calculated using thestatic optimization method. It was investigated whether the timings of the theoretically predicted muscle activations match with theexperimental data by using electromyography (EMG) data recorded from patients with CP. There was no significant difference in theflexion/extension angle of the hip joint between children with CP and healthy individuals. However, flexion/extension angles of theknee and ankle joints of the children with CP were found to be significantly different from healthy individuals. Significant differenceswere also found between the patients with CP and healthy individuals for the hip, knee, and ankle joint moments in the sagittal plane, except for the hip extensor moment and second knee extensor moment. While biceps femoris and semimembranosus muscle forces ofthe children with CP were higher than those of healthy individuals, gastrocnemius, rectus femoris, and tibialis anterior muscle forceswere lower. The activation patterns of the calculated muscle forces were found to be compatible with the experimentally obtainedactivation times.

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