SEREBRAL PALSİLİ ÇOCUKLARDA KAS İÇİ GERME İLE PASİF GERME YÖNTEMLERİNİN SPASTİSİTE ÜZERİNE AKUT ETKİLERİ

Amaç: Serebral palsi (SP) rehabilitasyonunda spastisiteyi azaltma amacıyla birçok yöntem kullanılır. Bu yöntemlerden birisi de germe uygulamalarıdır. Bu çalışmanın amacı bilateral spastik tip SP’li çocuklarda kas içi germe ve pasif germenin spastisite üzerine akut etkilerini karşılaştırmaktı. Yöntem: Çalışmamıza 5-13 yaş arasında (12 erkek ve 10 kız çocuk, ortalama yaş=6,45±1,96 yıl), plantar fleksör kaslarında spastisitesi olan, bilateral spastik tip SP’li çocuklar dâhil edildi. Tüm çocuklara kişiye özel fizyoterapi programı uygulanmaktaydı. Çocukların fizyoterapi programına ek olarak bir taraf plantar fleksör kas grubuna kas içi germe uygulanırken, diğer taraf plantar fleksör kas grubuna pasif germe uygulandı. Spastisite değerlendirmeleri Modifiye Ashworth Skalası (MAS), Modifiye Tardieu Skalası (MTS) ve Silfverskiold testi ile yapıldı. Değerlendirmeler uygulamalardan önce ve sonra yapıldı ve iki taraf değerleri birbiri ile karşılaştırıldı. Sonuçlar: Tedavi öncesi ve sonrası değerleri karşılaştırıldığında kas içi germe yapılan tarafta (MAS p=0,024, MTS R2-R1 p<0,001, Silfverskiold test p=0,002) ve pasif germe yapılan tarafta (MAS p=0,014, MTS R2-R1 p=0,001, Silfverskiold test p=0,003) anlamlı fark görüldü. Ancak iki taraf arasında anlamlı fark yoktu (p>0,05). Tartışma: Bilateral spastik tip SP’li çocuklarda kas içi germe ve pasif germe yöntemleri spastisiteyi azaltmakta etkili yöntemlerdir ve akut etkileri benzerdir.

Anahtar Kelimeler:

Serebral Palsi, Masaj, Kas Spastisitesi, Kas Germe Egzersizleri, Kas Tonusu

ACUTE EFFECTS OF INTRAMUSCULAR STRETCHING AND PASSIVE STRETCHING ON SPASTICITY IN CHILDREN WITH CEREBRAL PALSY

Purpose: Several methods are used to reduce spasticity in cerebral palsy (CP) rehabilitation. One of these methods is stretching. This study aimed to compare the acute effects of intramuscular stretching and passive stretching on spasticity in children with bilateral spastic CP.Methods: The study included a total of 22 children (12 boys and 10 girls) with bilateral CP, between the ages of 5 and 13 years (mean age=6.45±1.96 years), who had spasticity in the plantar flexor muscle groups. All children were under an individualized physiotherapy program. In addition to the physiotherapy program, intramuscular stretching was applied to the plantar flexor muscles on one side, whereas passive manual stretching was applied to the other side. The Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS), and Silfverskiold test were used to assess the spasticity. Evaluations were performed before and after the applications.Results: There was a significant difference between pre and post-treatment comparisons in the intramuscular stretching side (MAS p=0.024, MTS R2-R1 p<0.001, Silfverskiold test p=0.002) and the passive stretching side (MAS p=0.014, MTS R2-R1 p=0.001, and the Silfverskiold test p=0.003). On the other hand, there was no difference between the intramuscular and passive stretching sides (p>0.05).Conclusion: Both intramuscular and passive stretching are effective methods for reducing spasticity in children with bilateral spastic CP, and their acute effects are similar.

Keywords:

Cerabral Palsy, Massage, Muscle Spasticity, Muscle Stretching Exercises, Muscle Tone,

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