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NÖROMUSKÜLER HASTALIKLARDA GÖRÜLEN POSTÜR BOZUKLUĞU İLE HASTALIK ŞİDDETİ, FONKSİYONEL KAPASİTE, GÜNLÜK YAŞAM AKTİVİTELERİ VE DENGE ARASINDAKİ İLİŞKİNİN ARAŞTIRILMASI

Amaç: Bu çalışmanın amacı, nöromusküler hastalığa sahip erişkin bireylerde postür bozukluklarını araştırmak ve postür bozukluklarının hastalık şiddeti, fonksiyonel kapasite, günlük yaşam aktiviteleri, denge ve düşme ile ilişkisini belirlemektir. Yöntem: Çalışmaya nöromusküler hastalık tanısı konan ve yaş ortalaması 36,34 ± 14,03 yıl olan 47 hasta dahil edilmiştir. New York Postür Derecelendirme Ölçeği (NYPD) ile genel vücut postürü, fleksible ruler ile torakal kifoz açısı (TKA)- lumbal lordoz açısı (LLA) değerlendirilmiştir. Skolyometre kullanılarak olası skolyoz varlığı ve pelvik asimetri değerlendirilmiştir. Üst Ekstremite (ÜEFS) ve Alt Ekstremite Fonksiyon İndeksi (AEFS) ile hastalık şiddeti, 2 Dakika Yürüme Testi (2DKYT) ile fonksiyonel kapasite, Zamanlı Kalk Yürü Testi (ZKYT) ile denge ve düşme riski, Fonksiyonel Bağımsızlık Ölçeği (FIM) ile günlük yaşam aktiviteleri kaydedilmiştir. Sonuçlar: Postüral deformitelerin değerlendirilmesi sonucunda hastaların NYPD’si ortalamasının 40,24±9,56 olduğu belirlenmiştir. Yapılan ölçümlerde hastaların %46,34’ünde TKA’nın, %24,39’unda ise LLA’nın açısının norm değerlerin dışına çıktığı ve skolyometre ölçümleri sonucunda 30 hastada (%73,2) olası skolyoz varlığı, 11 hastada (%26,8) spinal asimetri olduğu, 27 hastada (%65,9) ise pelvik asimetri olduğu bulunmuştur. NYPD ile ÜEFS, 2DKYT, FIM ve ZKYT arasında istatiksel olarak anlamlı ilişki olduğu belirlenmiştir (p <0,05). Tartışma: Rehabilitasyon programları planlanırken vücut biyomekaniğini etkileyen postüral bozuklukları detaylı değerlendirmenin ve bu değerlendirme sonuçlarına uygun müdahale planları oluşturmanın hastaların günlük yaşam aktivitesi performanslarını, fonksiyonel kapasitelerini, denge ve düşme risklerini olumlu yönde etkileyebileceği düşünülmektedir. Ancak sonuçların genelleştirilebilmesi için daha fazla sayıda hasta ile ve farklı NMH gruplarının dahil edildiği çalışmalara ihtiyaç duyulmaktadır.

Anahtar Kelimeler:

Nöromusküler hastalıklar, Omurga deformiteleri, Skolyoz, Spinal asimetri

INVESTIGATION OF THE RELATIONSHIP BETWEEN POSTURE DISORDER AND DISEASE SEVERITY, FUNCTIONAL CAPACITY, ACTIVITIES OF DAILY LIFE AND BALANCE IN NEUROMUSCULAR DISEASES

Purpose: This study was conducted to examine postural problems in adults with neuromuscular diseases, the incidence of these disorders and to determine the relationship of posture problems with disease severity, functional capacity, activities of daily living, balance and falling. Methods: 47 patients diagnosed with neuromuscular disease with a mean age of 36.34 ± 14.03 years were included in the study. General body posture was evaluated with New York Posture Rating Scale (NYPR) and thoracic kyphosis (TKA) - lumbar lordosis angles (LLA) was evaluated with flexible ruler. Possible scoliosis and pelvic asymmetry were evaluated using a scoliometer. Disease severity was measured with the Upper (UEFI) and Lower Extremity Function Index (LEFI), functional capacity with 2 Minute Walk Test (2MWT), and balance and fall risk with the Timed Up and Go Test (TUG), and daily living activities were recorded with Functional Independence Measure (FIM). Results: The evaluation of postural deformities indicated that the mean NYPR of the patients was 40.24±9.56. The angle of kyphosis was observed in 46.34 % of the patients and the angle of the LLA was out of the norm values in 24.39 %. Scoliometer measurements showed that possible scoliosis was found in 30 (73.2%), spinal asymmetry was found in 11 (26.8%), and pelvic asymmetry was found in 27 patients (65.9%). The correlation between NYPR and UEFI, 2MWT, FIM and TUG was statistically significant (p <0.05). Conclusion: When planning rehabilitation programs, it is thought that detailed evaluation of postural disorders affecting body biomechanics and creating intervention plans appropriate to the results of these evaluations may positively affect the patients’ performance of daily living activities, functional capacities, balance and fall risks. However, studies with larger numbers of patients and including different NMD groups are needed to generalize the results.

Keywords:

Neuromuscular diseases, Spinal deformities, Scoliosis, Spinal asymmetry,

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Stefanetti RJ, Blain A, Jimenez-Moreno C, Errington L, Ng YS, McFarland R, et al. Measuring the effects of exercise in neuromuscular disorders: a systematic review and meta-analyses. Wellcome Open Res. 2020;5:84.
Voet NB. Exercise in neuromuscular disorders: a promising intervention. Acta Myol. 2019;38(4):207-14.
Kilinc M, Yildirim SA, Tan E. The effects of electrical stimulation and exercise therapy in patients with limb girdle muscular dystrophy A controlled clinical trial. Neurosciences. 2015;20(3):259-66.
Siciliano G, Schirinzi E, Simoncini C, Ricci G. Exercise therapy in muscle diseases: open issues and future perspectives. Acta Myol. 2019;38(4):233-8.
Mary P, Servais L, Vialle R. Neuromuscular diseases: Diagnosis and management. Orthop Traumatol Surg Res. 2018;104(1S):S89-S95.
Turturro F, Montanaro A, Calderaro C, Labianca L, Di Sanzo V, Ferretti A. Rate of complications due to neuromuscular scoliosis spine surgery in a 30-years consecutive series. Eur Spine J. 2017;26(Suppl 4):539-45.
Borges PA, Zelada FGB, dos Santos Barros TF, Letaif OB, da Rocha ID, Marcon RM, et al. A comparative study of sagittal balance in patients with neuromuscular scoliosis. Clinics. 2017;72(8):481-4.
Kinali M, Main M, Mercuri E, Muntoni F. Evolution of abnormal postures in Duchenne muscular dystrophy. Ann Indian Acad Neurol. 2007;10(5):44.
Tanguay F, Mac-Thiong J-M, de Guise JA, Labelle H. Relation between the sagittal pelvic and lumbar spine geometries following surgical correction of adolescent idiopathic scoliosis. Eur Spine J. 2007;16(4):531-6.
La Maida GA, Zottarelli L, Mineo GV, Misaggi B. Sagittal balance in adolescent idiopathic scoliosis: radiographic study of spino-pelvic compensation after surgery. Eur Spine J. 2013;22 Suppl 6(Suppl 6):S859-S867.
Ringel F, Villard J, Ryang Y-M, Meyer B. Navigation, robotics, and intraoperative imaging in spinal surgery. Adv Tech Stand Neurosurg. 2014;41:3-22.
Yang H, Yim D, Park MH. Converting from the Montreal cognitive assessment to the Mini-mental state Examination-2. PLoS One. 2021;16(7):e0254055.
Öztürk SA, Kıyak G, Arslan E, Acar HT, Ercan S, Çetin C. Cerrahlardaki egzersiz alışkanlığının kas-iskelet sistemi ağrısına ve postüre etkisi. Pam Tıp Derg. 2021;15(1), 117-23.
McRoberts LB, Cloud RM, Black CM. Evaluation of the New York Posture Rating Chart for assessing changes in postural alignment in a garment study. Cloth Text Res J. 2013;31(2):81-96.
Seidi F, Rajabi R, Ebrahimi T, Tavanai A, Moussavi S. The Iranian flexible ruler reliability and validity in lumbar lordosis measurements. World J Sport Sci. 2009;2(2):95-9.
Harimaya K, Lenke LG, Mishiro T, Bridwell KH, Koester LA, Sides BA. Increasing lumbar lordosis of adult spinal deformity patients via intraoperative prone positioning. Spine. 2009;34(22):2406-12.
Macagno AE, O’Brien MF. Thoracic and thoracolumbar kyphosis in adults. Spine. 2006;31(19S):S161-S70.
Ahmadi F, Safari Variani A, Saadatian A, Varmazyar S. The impact of 10 weeks of Pilates exercises on the thoracic and lumbar curvatures of female college students. Sport Sci Health. 2021;17(4):989-97.
Ma H-H, Tai C-L, Chen L-H, Niu C-C, Chen W-J, Lai P-L. Application of two-parameter scoliometer values for predicting scoliotic Cobb angle. Biomed Eng Online. 2017;16(1):1-13.
Prowse A, Pope R, Gerdhem P, Abbott A. Reliability and validity of inexpensive and easily administered anthropometric clinical evaluation methods of postural asymmetry measurement in adolescent idiopathic scoliosis: a systematic review. Eur Spine J. 2016;25(2):450-66.
Korovessis PG, Stamatakis MV. Prediction of scoliotic Cobb angle with the use of the scoliometer. Spine. 1996;21(14):1661-6.
Coelho DM, Bonagamba GH, Oliveira AS. Scoliometer measurements of patients with idiopathic scoliosis. Braz J Phys Ther. 2013;17(2):179-84.
Aytar A, Yuruk ZO, Tuzun EH, Baltaci G, Karatas M, Eker L. The Upper Extremity Functional Index (UEFI): Cross-cultural adaptation, reliability, and validity of the Turkish version. J Back Musculoskelet Rehabil. 2015;28(3):489-495.
Citaker S, Kafa N, Hazar Kanik Z, Ugurlu M, Kafa B, Tuna Z. Translation, cross-cultural adaptation and validation of the Turkish version of the Lower Extremity Functional Scale on patients with knee injuries. Arch Orthop Trauma Surg. 2016;136(3):389-95.
Çankaya M, Karakaya İÇ, Karakaya MG. Reliability and validity of the Turkish version of the Lower Extremity Functional Scale in patients with different lower limb musculoskeletal dysfunctions. Int J Ther Rehabil. 2019;26(9), 1-14.
Aytar A, Yuruk ZO, Tuzun EH, Baltaci G, Karatas M, Eker L. The Upper Extremity Functional Index (UEFI): cross-cultural adaptation, reliability, and validity of the Turkish version. J Back Musculoskelet Rehabil. 2015;28(3):489-95.
Knak KL, Andersen LK, Witting N, Vissing J. Reliability of the 2-and 6-minute walk tests in neuromuscular diseases. J Rehabil Med. 2017;49(4):362-6.
Andersen LK, Knak KL, Witting N, Vissing J. Two-and 6-minute walk tests assess walking capability equally in neuromuscular diseases. Neurology. 2016;86(5):442-5.
Eagles D, Perry JJ, Sirois M-J, Lang E, Daoust R, Lee J, et al. Timed Up and Go predicts functional decline in older patients presenting to the emergency department following minor trauma. Age Ageing. 2017;46(2):214-28.
Yavuzer G, Suldur N, Kucukdeveci A, Elhan A. Türkiye'de nörorehabilitasyon hastalarının değerlendirilmesinde fonksiyonel bağımsızlık ölçeği ve Modifiye Barthel İndeksi'nin yeri. Romatol Tıb Rehabil Derg. 2000;11(1):26-31.
Hayran M, Hayran M. Saglik arastirmalari icin temel istatistik. 1th ed. Ankara, Turkey: Art Ofset Matbaacılık Yayıncılık Organizasyon Ltd;2011.
Hammarén E, Kjellby-Wendt G, Lindberg C. Muscle force, balance and falls in muscular impaired individuals with myotonic dystrophy type 1: a five-year prospective cohort study. Neuromuscul Disord. 2015;25(2):141-8.
Choudhury MZB, Tsirikos AI, Millner PA. Neuromuscular scoliosis: clinical presentation, types of deformity, assessment and principles of treatment. Orthop Trauma. 2017;31(6):350-6.
Bozgeyik S, Karaduman A, Yılmaz O, Topaloğlu H, Alemdaroğlu I. The relationship between postural alignment and physical performance in boys with Duchenne muscular dystrophy. Neuromuscul Disord. 2016;26:S123.
Filiz MB, Toraman NF, Kutluk MG, et al. Effects of lumbar lordosis increment on gait deteriorations in ambulant boys with Duchenne Muscular Dystrophy: A cross-sectional study. Braz J Phys Ther. 2021;25(6):749-55.
Pokharel RK, Brisco L, Mandal M, Agrawal J, Dillon D, Vitale M, et al. Effect of sitting posture on development of scoliosis in duchenne muscular dystrophy cases. J Nepal Health Res Counc. 2014;12(27), 94-9.
Murphy RF, Mooney JF. Current concepts in neuromuscular scoliosis. Curr Rev Musculoskelet Med. 2019;12(2):220-7.
Li Z, Shen J, Liang J. Scoliosis in mitochondrial myopathy: case report and review of the literature. Medicine. 2015;94(6).
Baptista CR, Costa AA, Pizzato TM, Souza FB, Mattiello-Sverzut AC. Postural alignment in children with Duchenne muscular dystrophy and its relationship with balance. Braz J Phys Ther. 2014;18(2):119-26.
Stępień A, Mazurkiewicz Ł, Maślanko K, Rekowski W, Jędrzejowska M. Cervical rotation, chest deformity and pelvic obliquity in patients with spinal muscular atrophy. BMC Musculoskelet Disord. 2020;21(1):726.
Jung J-Y, Cha E-J, Kim K-A, Won Y, Bok S-K, Kim B-O, et al. Influence of pelvic asymmetry and idiopathic scoliosis in adolescents on postural balance during sitting. Biomed Mater Eng. 2015;26 Suppl 1:S601-S610.
McCarthy RE. Management of neuromuscular scoliosis. Orthop Clin North Am. 1999;30(3):435-49.
Missaoui B, Rakotovao E, Bendaya S, Mane M, Pichon B, Faucher M, et al. Posture and gait abilities in patients with myotonic dystrophy (Steinert disease). Evaluation on the short-term of a rehabilitation program. Ann Phys Rehabil Med. 2010 Aug-Sep;53(6-7):387-98.
Allam AM, Schwabe AL. Neuromuscular scoliosis. PM R. 2013;5(11):957-63.