Spastik Serebral Palsili Çocuklarda Gövde Eğitiminin Gövde, Üst ve Alt Ekstremite Motor Fonksiyonları Üzerine Etkisi: Tabakalı Randomize Kontrollü Çalışma

Amaç: Bu çalışmanın amacı, bilateral spastik Serebral Palsili çocuklarda gövde eğitiminin gövde, üst ve alt ekstremite motor fonksiyonları üzerindeki etkilerini araştırmaktır.Gereç ve Yöntem: Bu çalışmaya 36 çocuk alındı; çocuklardan 19’u Gövde eğitimi grubuna, 17’si ise kontrol grubuna dâhil edildi. Çocukların motor fonksiyonları; Gövde Kontrol Ölçüm Ölçeği, Kaba Motor Fonksiyon Ölçümü, Üst Ekstremite Becerileri Kalitesi Testi, Pediatrik Denge Ölçeği, Gillette Fonksiyonel Değerlendirme Ölçeği, Çocuklar İçin Fonksiyonel Bağımsızlık Ölçümü, Aile Etkilenimi Ölçeği ile başlangıçta ve sekiz hafta süren müdahale sonrasında değerlendirildi. Farklılıkları değerlendirmek için Wilcoxon Sıralı İşaret Testi ve Mann-Whitney U Testi kullanıldı.Bulgular: Gövde eğitim grubunda; Gövde Kontrol Ölçüm Ölçeği (p = 0.008), Kaba Motor Fonksiyon Ölçümü (p = 0.047), Üst Ekstremite Becerileri Kalitesi Testi (p = 0.032), Pediatrik Denge Ölçeği (p = 0.006), Gillette Fonksiyonel Değerlendirme Ölçeği (p. = 0.011) ve Çocuklar için Fonksiyonel Bağımsızlık Ölçümü (p = 0.03) puanları gelişme gösterdi (p <0,05). Sonuç: Bireysel olarak yapılandırılmış gövde eğitimi, bilateral spastik Serebral Palsili çocukların gövde, üst ve alt ekstremite motor fonksiyonlarını ve aktivite düzeylerini geliştirmek için ümit vaat eden bir yöntemdir.

Anahtar Kelimeler:

Serebral Palsi, Fizyoterapi, Kuvvetlendirme, Gövde

Effects of Trunk Training on Trunk, Upper and Lower Limb Motor Functions in Children with Spastic Cerebral Palsy: A Stratified Randomized Controlled Trial

Objective: The aim of this study was to investigate the effects of trunk training on the trunk, upper and lower limb motor functions of children with bilateral spastic Cerebral Palsy. Methods: 36 children were recruited for this study; 19 children were included in the trunk training group and 17 children were included in the control group. Motor functions of the children were assessed by the Trunk Control Measurement Scale, Gross Motor Function Measurement, Quality of Upper Extremity Skills Test, Pediatric Balance Scale, Gillette Functional Assessment Scale, Functional Independence Measure for Children and Impact on Family Scale at baseline and after an 8 week of intervention period. Wilcoxon Signed-Rank Test and Mann–Whitney U Test were used to assess the differences. Results: The Trunk Control Measurement Scale (p=0.008), Gross Motor Function Measurement (p=0.047), Quality of Upper Extremity Skills Test (p=0.032), Pediatric Balance Scale (p=0.006), Gillette Functional Assessment Scale (p=0.011) and Functional Independence Measure for Children (p=0.03) scores improved in favor of the trunk training group (p<0.05). Conclusion: Individually structured trunk training is a promising method to improve trunk, upper and lower extremity motor functions and activity levels of children with bilateral spastic Cerebral Palsy.

Keywords:

Cerebral Palsy, Physiotherapy, Strength Training, Trunk,

PDF

___

Cans C. Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Dev Med Child Neurol. 2000;42(12):816-24.
Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109(suppl 109):8-14.
Holt KG, Ratcliffe R, Jeng S-F. Head stability in walking in children with cerebral palsy and in children and adults without neurological impairment. Phys Ther. 1999;79(12):1153-62.
Koop SE. Scoliosis in cerebral palsy. Dev Med Child Neurol. 2009;51(s4):92-8.
Prosser LA, Lee SC, Barbe MF, VanSant AF, Lauer RT. Trunk and hip muscle activity in early walkers with and without cerebral palsy–A frequency analysis. J Electromyogr Kinesiol. 2010;20(5):851-9.
Karthikbabu S, Chakrapani M, Ganeshan S, Rakshith KC, Nafeez S, Prem V. A review on assessment and treatment of the trunk in stroke: A need or luxury. Neural Regen Res. 2012;7(25):1974.
Curtis DJ, Woollacott M, Bencke J, Lauridsen HB, Saavedra S, Bandholm T, et al. The functional effect of segmental trunk and head control training in moderate-to-severe cerebral palsy: A randomized controlled trial. Dev Neurorehabil. 2016:1-10.
Barton GJ, Hawken MB, Foster RJ, Holmes G, Butler PB. The effects of virtual reality game training on trunk to pelvis coupling in a child with cerebral palsy. J Neuroeng Rehabil. 2013;10(1):15.
Bonnechère B, Omelina L, Jansen B, Van Sint Jan S. Balance improvement after physical therapy training using specially developed serious games for cerebral palsy children: preliminary results. Disabil Rehabil. 2015:1-4.
Krigger KW. Cerebral palsy: an overview. Am Fam Physician. 2006;73(1):91-100.
Mayston MJ. People with cerebral palsy: effects of and perspectives for therapy. Neural Plast. 2001;8(1-2):51-69.
Heyrman L, Molenaers G, Desloovere K, Verheyden G, De Cat J, Monbaliu E, et al. A clinical tool to measure trunk control in children with cerebral palsy: the Trunk Control Measurement Scale. Res Dev Disabil. 2011;32(6):2624-35.
Russell DJ, Rosenbaum PL, Avery LM, Lane M. Gross motor function measure (GMFM-66 and GMFM-88) user's manual: Cambridge University Press; 2002.
DeMatteo C, Law M, Russell D, Pollock N, Rosenbaum P, Walter S. The reliability and validity of the Quality of Upper Extremity Skills Test. Phys Occup Ther Pediatr. 1993;13(2):1-18.
Franjoine MR, Gunther JS, Taylor MJ. Pediatric Balance Scale: a modified version of the Berg Balance Scale for the school-age child with mild to moderate motor impairment. Pediatr Phys Ther. 2003;15(2):114-28.
Gunel MK, Tarsuslu T, Mutlu A, Livanelioglu A. Investigation of interobserver reliability of the Gillette Functional Assessment Questionnaire in children with spastic diparetic cerebral palsy. Acta Orthop Traumatol Turc. 2004;44(1):63-9.
Hamilton B, Granger C. Functional Independence Measure for Children (WeeFIM). Buffalo, NY: Research Foundation of the State University of New York. 1991.
Nilgün B, YAKUT Y, ŞİMŞEK İE, Suat E, UYGUR F. Turkish Version of Impact on Family Scale: A Study of Reliability and Validity. Turkiye Klinikleri J Pediatr. 2010;19(1):98.
Lee Y-s, Kim W-b, Park J-w. The Effect of Exercise Using a Sliding Rehabilitation Machine on the Gait Function of Children with Cerebral Palsy. J Phys Ther Sci. 2014;26(11):1667.
Şimşek TT, Türkücüoğlu B, Çokal N, Üstünbaş G, Şimşek İE. The effects of Kinesio® taping on sitting posture, functional independence and gross motor function in children with cerebral palsy. Disabil Rehabil. 2011;33(21-22):2058-63.
Lee M, Ko Y, Shin MMS, Lee W. The effects of progressive functional training on lower limb muscle architecture and motor function in children with spastic cerebral palsy. J Phys Ther Sci. 2015;27(5):1581-4.
Kibler WB, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD, et al. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the ‘scapular summit’. Br J Sports Med. 2013:bjsports-2013-092425.
Jaume-i-Capo A, Martinez-Bueso P, Moya-Alcover B, Varona J. Interactive rehabilitation system for improvement of balance therapies in people with cerebral palsy. IEEE Trans Neural Syst Rehabil Eng. 2014;22(2):419-27.
Tarakci D, Ozdincler AR, Tarakci E, Tutuncuoglu F, Ozmen M. Wii-based balance therapy to improve balance function of children with cerebral palsy: a pilot study. J Phys Ther Sci. 2013;25(9):1123.

ISSN: 1309-3878
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2009
Yayıncı: Düzce Üniversitesi Tıp Fakültesi Aile Hekimliği AD adına Yrd.Doç.Dr.Cemil Işık Sönmez