Hemiparetik ve diparetik serebral palsili çocuklarda somatosensoriyel algı ve propriyosepsiyonun üst ekstremite fonksiyonel becerilerine etkisi

Year 2024, Volume: 29 Issue: 3, 285 - 296, 23.09.2024

Büşra Doğan , Hatice Adıgüzel , Arzu Demirgüç

https://doi.org/10.21673/anadoluklin.1395613

Abstract

Amaç: Bu çalışmanın amacı hemiparetik ve diparetik Serebral Palsi (SP)’li çocuklarda somatoduyusal algı ve propriosepsiyonun üst ekstremite fonksiyonel becerilerine etkilerini belirlemektir.

Yöntemler: Çalışmaya yaş ortalamaları 10,71± 4,09 olan, Kaba Motor Fonksiyon Sınıflama Sistemi (GMFCS) 1-2 ve 3 ile El Beceri Sınıflama Sistemi (MACS) 1-2-3 düzeyindeki 15 hemiparetik SP’li çocuk, 15 diparetik SP’li çocuk ve 15 sağlıklı çocuk (24 erkek/21 kız) dahil edildi. Somatoduyusal algı Ayres Güney Kaliforniya Duyu Bütünleme ve Praxis Testi (SIPT)’nin alt parametreleri olan kinestezi, dokunma uyarısının lokalizasyonu, çift dokunma uyarısı lokalizasyonu, parmak tanıma ve sağ-sol ayırımı testleriyle değerlendirildi. Propriosepsiyon değerlendirmesi için omuz, dirsek, el-el bileğine gonyometrik ölçümü yapıldı. Üst ekstremite fonksiyonel becelerileri Jebsen Taylor El Fonksiyon Testi (JTEFT) değerlendirildi.

Bulgular: SP’li çocuklar ile kontrol grubu arasında somatoduyusal algı ile propriosepsiyonun farklı olduğu ve bu parametrelerin de el becerileriyle anlamlı olarak ilişkili olduğu bulundu (p<0.05). Kontrol grubunun somatoduyusal algı ve propriosepsiyonlarının SP’li gruplara göre anlamlı düzeyde daha iyi olduğu bulundu (p<0.05). SP’li çocukların somatoduyusal algı, propriosepsiyon ve JTEFT testlerinde; hemiparetik grubun diparetik gruba göre anlamlı düzeyde daha iyi olduğu bulundu (p<0.05).

Sonuç: SP’li çocukların sağlıklı yaşıtlarına göre üst ekstremitelerinde daha düşük somatosensoriyel algı düzeylerine sahip olduğu ve üst ekstremitelerinde propriyoseptif kayıpların olduğu belirlendi. Sağlıklı akranlarına göre somatosensoriyel algı ve propriyosepsiyon testlerinde diparetik çocukların hemiparetiklerden daha düşük skorlarının olduğu gösterildi. SP’li çocukların sağlıklı akranlarına göre daha düşük el becerilerine sahip oldukları, hemiparetik çocukların ise diparetik gruba göre daha iyi düzeyde olduğu belirlendi.

Keywords

Algı, üst ekstremite, propriyosepsiyon, serebral palsi

The effect of somatosensory perception and proprioception on upper extremity functional skills in children with hemiparetic and diparetic cerebral palsy

Abstract

Aim: The aim of the current research is to determine the impacts of somatosensory perception and proprioception on upper extremity functional skills in children with hemiparetic and diparetic cerebral palsy (CP).

Methods: Children with hemiparetic (n=15) and diparetic (n=15) CP at Gross Motor Function Classification System (GMFCS) I-III and Manual Ability Classification System (MACS) I-III levels and healthy children (n=15) with a mean age of 10.71± 4.09 were enrolled in the research. Somatosensory perception was evaluated with the Ayres’ Southern California Sensory Integration and Praxis Test (SIPT) sub-parameters, kinesthesia (KIN), touch stimulus localization (TSL), double-touch stimulus localization (DTL), finger recognition (FR), and right-left discrimination (RLD) tests. Proprioception measurements were performed with a goniometer on the shoulder, elbow, and hand-wrist. Upper extremity functional skills were evaluated by the Jebsen-Taylor Hand Function Test (JTHFT).

Results: Somatosensory perception and proprioception of the control group were determined to be significantly better than those of both groups with CP (p<0.05). The somatosensory perception, proprioception, and JTHFT test results of children with CP were significantly better in the hemiparetics in comparison with the diparetics (p<0.05).

Conclusion: The study showed that children with CP had lower somatosensory perception levels in their upper extremities and had proprioceptive losses in their upper extremities in comparison with their healthy peers. It was shown that diparetic children had lower scores than hemiparetic children in somatosensory perception and proprioception tests compared to their healthy peers.
It was determined that children with CP had lower hand skills compared to their healthy peers and hemiparetic children were better than diparetic group in hand skills. It was revealed that children with CP had lower manual dexterity than their healthy peers, and hemiparetic children had better skills than the diparetic group.

Keywords

Cerebral palsy, hand, perception, proprioception

Ethical Statement

Approval for the research was received from the XXXXX Clinical Research Ethics Committee on 07.07.2020 with the decision numbered 2020/09-11, and the study was performed in accordance with the Declaration of Helsinki.

Supporting Institution

None.

Thanks

We express our gratitude to the children and their families participating in this study.

References

• Morris C. Definition and classification of cerebral palsy: a historical perspective. Dev Med Child Neurol. 2007;49:3-7.
• Beckung E, Hagberg G. Neuroimpairments, activity limitations, and participation restrictions in children with cerebral palsy. Dev Med Child Neurol. 2002;44(5):309-16.
• Yardımcı-Lokmanoğlu BN, Bingöl H, Mutlu A. The forgotten sixth sense in cerebral palsy: do we have enough evidence for proprioceptive treatment?. Disabil Rehabil. 2020;42(25):3581-90.
• Marco EJ, Khatibi K, Hill SS, et al. Children with autism show reduced somatosensory response: an MEG study. Autism Res. 2012;5(5):340-51.
• Clayton K, Fleming JM. Behavioral responses to tactile stimuli in children with cerebral palsy. Phys Occup Ther Pediatr. 2003;23(1):43-62.
• Wingert JR, Burton H, Sinclair RJ, et al. Tactile sensory abilities in cerebral palsy: deficits in roughness and object discrimination. Dev Med Child Neurol. 2008;50(11):832-8.
• Auld ML, Boyd R. Tactile function in children with unilateral cerebral palsy compared to typically developing children. Disabil Rehabil. 2012;34(17):1488-94.
• Büyükturan B. Spastik diparetik ve hemiparetik serebral palsili çocuklarda alt ekstremite duyu bozukluklarının motor performans üzerine etkilerinin incelenmesi [master’s thesis]. Sağlık Bilimleri Enstitüsü; 2012.
• Sanger TD, Kukke SN. Abnormalities of tactile sensory function in children with dystonic and diplegic cerebral palsy. J Child Neurol. 2007;22(3):289-93.
• Gandevia SC, Refshauge KM, Collins DF. Proprioception: peripheral inputs and perceptual interactions. Adv Exp Med Biol. 2002;508:61-68.
• 11. Smania N, Montagnana B, Faccioli S, et al. Rehabilitation of somatic sensation and related deficit of motor control in patients with pure sensory stroke. J Phys Med Rehabil. 2003;84(11):1692-702.
• Flett PJ. Rehabilitation of spasticity and related problems in childhood cerebral palsy. J Paediatr Child Health. 2003;39(1):6-14.
• Arner M, Eliasson AC, Nicklasson S, Sommerstein K, Hägglund G. Hand function in cerebral palsy. Report of 367 children in a population-based longitudinal health care program. J Hand Surg Am. 2008;33(8):1337-47.
• Section On Complementary And Integrative Medicine; Council on Children with Disabilities; American Academy of Pediatrics, Zimmer M, Desch L. Sensory integration therapies for children with developmental and behavioral disorders. Pediatrics. 2012;129(6):1186-9.
• Jebsen RH, Taylor N, Trieschmann RB, Trotter MJ, Howard LA. An objective and standardized test of hand function. Arch Phys Med Rehabil. 1969;50(6):311-319.
• Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67(2):206-7.
• alisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214-23.
• Akpinar P, Tezel CG, Eliasson AC, Icagasioglu A. Reliability and cross-cultural validation of the Turkish version of Manual Ability Classification System (MACS) for children with cerebral palsy. Disabil Rehabil. 2010;32(23):1910-6.
• Sade A, AS O. Serebral paralizi’de değerlendirme ve tedavi yöntemleri, 2. baskı. Ankara: Hacettepe Üniversitesi Fizik Tedavi ve Rehabilitasyon Yüksekokulu Yayınları; 1997:1-18.
• Ayres AJ. Southern California sensory integration tests manual. Western Psychological Services. 1980:35-43.
• Ayres AJ, Tickle LS. Hyper-responsivity to touch and vestibular stimuli as a predictor of positive response to sensory integration procedures by autistic children. Am J Occup Ther. 1980;34(6):375-81.
• Cooper J, Majnemer A, Rosenblatt B, Birnbaum R. The determination of sensory deficits in children with hemiplegic cerebral palsy. J Child Neurol. 1995;10(4):300-9.
• Bhojne USHA, Rege PV. A preliminary study of somatosensory abilities of normal school going children and cerebral palsy children in the age group 6–8 years. Indian J Occup Ther. 2001;33(1).
• Riquelme I, Montoya P. Developmental changes in somatosensory processing in cerebral palsy and healthy individuals. Clin Neurophysiol. 2010;121(8):1314-20.
• Wingert JR, Burton H, Sinclair RJ, Brunstrom JE, Damiano DL. Joint-position sense and kinesthesia in cerebral palsy. Arch Phys Med Rehabil. 2009;90(3):447-53.
• Doğan FZ, Akel BS. Disleksili Çocuklarda Dans Hareket Terapisinin Praksis Üzerindeki Etkisi; Vaka Serisi Çalışması. Ergoterapi ve Rehabilitasyon Dergisi. 2021;9(1):41-8.
• Lewis CA, Goble DJ, Hurvitz EA, et al. Sensorimotor Coordination in Children With Hemiplegic Cerebral Palsy. Arch Phys Med Rehabil. 2005;86(9):e37.
• Duque J, Thonnard JL, Vandermeeren Y, Sébire G, Cosnard G, Olivier E. Correlation between impaired dexterity and corticospinal tract dysgenesis in congenital hemiplegia. Brain. 2003;126(Pt 3):732-47.
• Goble DJ, Hurvitz EA, Brown SH. Deficits in the ability to use proprioceptive feedback in children with hemiplegic cerebral palsy. Int J Rehabil Res. 2009;32(3):267-9.
• Hoon AH Jr, Stashinko EE, Nagae LM, et al. Sensory and motor deficits in children with cerebral palsy born preterm correlate with diffusion tensor imaging abnormalities in thalamocortical pathways. Dev Med Child Neurol. 2009;51(9):697-704.
• Sköld A, Josephsson S, Eliasson AC. Performing bimanual activities: the experiences of young persons with hemiplegic cerebral palsy. Am J Occup Ther. 2004;58(4):416-25.
• Tomhave WA, Van Heest AE, Bagley A, James MA. Affected and contralateral hand strength and dexterity measures in children with hemiplegic cerebral palsy. J Hand Surg Am. 2015;40(5):900-7.
• Law K, Lee EY, Fung BK, et al. Evaluation of deformity and hand function in cerebral palsy patients. J Orthop Surg Res. 2008;3:52.
• Elbasan B, Bozkurt E, Oskay D, Oksuz C. Upper Extremity Impairments and Activities in Children with Bilateral Cerebral Palsy. Iran J Pediatr. 2017;27(6):e7711.
• Tonak HA, Kilic MC. Serebral Palsili Çocuklarda Üst Ekstremite Fonksiyonelliğinin İncelenmesi. Aydın Sağlık Dergisi. 2016;2(2):37-50.