Diplejik Serebral Palsi’li Çocuklarda Katılım Kısıtlılıkları, Gövde Dengesi, Dinamik Denge ve Çevresel Faktörlerin Yapısal Eşitlik Modellemesi

Abstract

Amaç: Diplejik Serebral Palsi (SP)’li çocuklarda katılım kısıtlılıklarının potansiyel belirleyicileri olan gövde dengesi, dinamik denge ve çevresel faktörlerin yapısal modelini test etmek Gereç ve Yöntem: Çalışmaya yaşları 5-14 yıl (ortalama yaş:10,28±2,47; 17 erkek 18 kız) arasında değişen toplam 35 diplejik SP’li çocuk dâhil edildi. Çalışmaya dâhil edilen çocukların gövde kontrolü, dinamik denge ve fonksiyonel mobiliteleri, çevresel faktörler ve katılım özellikleri sırasıyla Gövde Kontrol Ölçüm Skalası (GKÖS), Zamanlı Kalk ve Yürü Testi (ZKYT), Avrupa Çocuk Çevre Anketi (AÇÇA) ve Yaşam Alışkanlıkları Değerlendirme Anketi (Life -H) kullanılarak değerlendirildi. Belirlenen değişkenler arasındaki kompleks veya çoklu ilişkiler yapısal bir eşitlik modeli (YEM) olan Yol Analizi kullanılarak belirlendi. Bulgular: Önerilen yol modeli, diplejik SP’li çocuklarda gövde kontrolünün dinamik denge ve çevresel faktörler değişkenleri üzerinde anlamlı ve doğrudan etkileri olduğunu ortaya koydu (β1= -0,66; p<0,001 ve β2= -0,79; p<0,001). Gövde kontrolünün katılım parametreleriyle doğrudan ilişkisi bulunamadı (p>0,05). Buna karşılık, gövde kontrollünün katılım parametreleri üzerindeki etkilerine dinamik denge (β1=-0,10; p<0.05 ve β2=-0,46; p<0,05) ve çevresel faktörler (β1=-0,58; p<0,001 ve β2=-0,21; p<0,05) değişkenleri aracılık etmiştir. Son olarak, gövde kontrolü, dinamik denge ve çevresel faktörler parametreleri birlikte günlük aktivitelere katılım skorundaki varyansın %33,9’unu açıklarken, aynı parametreler sosyal ortamlara katılım parametresi skorundaki varyansın sadece %9’unu açıkladı. Sonuç: Bozulmuş gövde kontrolü, zayıf dinamik denge ve çevresel engeller, diplejik SP'li çocuklarda kötü katılım sonuçlarından sorumlu bulundu. Bu durum, hedef kitlenin katılım sonuçlarının iyileştirilmesi için gövde kontrol eğitimi, dinamik denge egzersizleri ve çevresel değişikliklerin yapılması gerektiğini göstermektedir.

Keywords

• Çocuk
• diplejik serebral palsi
• katılım
• yapısal eşitlik modellemesi

Structural Equation Modeling of Participation Restrictions, Trunk Control, Dynamic Balance and Environmental Factors in Children with Diplegic Cerebral Palsy

Abstract

Objective: To test a structural model of trunk balance, dynamic balance and environmental factors as potential determinants of participation restrictions in children with diplegic cerebral palsy (CP) Material and Method: A total of 35 children with diplegic CP aged between 5-14 years (mean age: 8,68 SD 3.1; 17 boys and 18 girls) were included in the study. Trunk control, dynamic balance, environmental factors, and participation outcomes of the included children were measured with the Trunk Control Measurement Scale (TCMS), Timed Up and Go (TUG) test, European Child Environment Questionnaire (ECEQ), and Assessment of Life Habits (Life-H), respectively. Complex or multiple relationships between defined variables were explored using path analysis-one of Structural Equation Modelling (SEM). Results: The proposed path model revealed that trunk control had significant and direct effects on dynamic balance and environmental factors variables ((β1= -0,66; p<0,001) and β2= -0,79; p<0,001). A direct effect between trunk control variable and participation parameters could not be found (p>0,05), In contrast, the effects of trunk control on participation parameters was mediated by dynamic balance (β1=-0,10; p<0,05 and β2=-0,46; p<0,05) and environmental factors parameters (β1=-0,58; p<0,001 and β2=-0,21; p<0,05). Furthermore, trunk control, dynamic balance, and environmental factors variables explained 33,9% of variance in participation in daily activities scaled score, whereas the same parameters explained only 9 % of variance in the score of participation in social settings. Conclusion: Impaired trunk control, poor dynamic balance, and environmental barriers were found to be responsible for poor participation outcomes in children with diplegic CP. This suggests that improving the participation outcomes of the target population necessitates trunk control training, dynamic balance exercises, and environmental modifications.

Keywords

• Child
• diplegic cerebral palsy
• participation
• structural equation modelling

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