Spastik Diplejik Serebral Palsili Çocuklarda, Gövde Kontrolünün Yürüme Özellikleri ve Kapasitesine Etkisi

Year 2023, Issue: 19, 58 - 67, 29.04.2023

Cemil ÖZAL Songül AKSOY Mintaze KEREM GÜNEL

https://doi.org/10.38079/igusabder.1123778

Abstract

Amaç: Bu çalışma, spastik diplejik serebral palsili (SP) çocuklarda, gövde kontrolüyle yürümenin zaman mesafe özellikleri ve yürüme kapasitesiyle ilişkisinin belirlenmesi amacıyla yürütüldü.
Yöntem: Çalışmaya yaşları 7-13 arasında değişen, Kaba Motor Fonksiyon Sınıflandırma Sistemi’ne göre Seviye I-II olan 14 spastik diplejik serebral palsili çocuk dahil edilmiştir. Gövde kontrolü, Gövde Kontrolü Ölçüm Skalasıyla (TCMS; statik, dinamik, uzanma ve toplam puan) değerlendirildi. Yürüme zaman-mesafe özellikleri NeuroCom Inc. postürografi cihazı ile force-plate aracılığı ile değerlendirildi ve adım uzunluğu (cm), adım genişliği (cm), yürüme hızı (cm/s) ve yürümede sağ – sol simetrisi (%) değerlendirildi. Yürüme kapasitesi, modifiye zamanlı kalk ve yürü testi (mTUG) ile değerlendirildi. Değişkenler arasındaki ilişkiler Spearman Korelasyon ve doğrusal regresyon analizleri ile değerlendirildi.
Bulgular: Korelasyon analizlerine göre, TCMS'nin statik alt ölçeği ile mTUG arasında anlamlı derecede negatif iyi düzey bir ilişki (r: -0,754; p<0,01), dinamik ve uzanma alt ölçekleri ile toplam TCMS puanları arasında ise anlamlı derecede negatif mükemmel (sırasıyla r=-0,837; -0,861; -0,872 p<0,01) bir ilişki vardı. Ek olarak, TCMS'nin statik alt ölçeği ile adım uzunluğu, adım genişliği ve simetri arasında anlamlı derecede iyi pozitif korelasyonlar vardı (sırasıyla 0,624; 0,690; 0,720 p<0,01); TCMS'nin dinamik alt ölçeği ile adım uzunluğu arasında iyi pozitif korelasyon (r: 0,636 p<0,01), TCMS'nin uzanma alt boyutu ile adım uzunluğu arasında iyi pozitif korelasyon (r: 0,724; p<0,01); TCMS toplam puanı ile adım uzunluğu, adım genişliği ve yürüyüş simetrisi arasında orta ila iyi pozitif korelasyon vardı (sırasıyla r:-0,872; 0,677; 0,585; 0,626 p<0,01). Regresyon analizine göre, toplam TCMS puanı, yürüme hızı dışındaki tüm yürüyüş özelliklerinin ve mTUG’un prediktörüdür (sırasıyla R2 = 0,796; 0,394; 0,303; 0,027; 0,320).
Sonuç: Bu çalışmanın sonuçları, spastik diplejik SP'li çocuklarda gövde kontrolünün yürüme özellikleri ve kapasitesi üzerindeki önemini göstermektedir.

Keywords

Serebral palsi, postüral kontrol, yürüme

Influence of Trunk Control on Gait Characteristics and Capacity in Children with Spastic Diplegic Cerebral Palsy

Abstract

Aim: This study was conducted with the aim of to determine the relationship between trunk control and walking with time-distance characteristics and walking capacity in children with spastic diplegic cerebral palsy.
Method: The study included 14 children with spastic diplegic cerebral palsy, aged between 7-13 years, who were Level I-II according to Gross Motor Function Classification System. Trunk control was assessed with the Trunk Control Measurement Scale (TCMS; static, dynamic, reach, and total score). Temporo-spatial characteristics of gait were evaluated with a posturography device NeuroCom Inc. by means of a force-plate, and step length (cm), step width (cm), walking speed (cm/s) and right-left symmetry in walking (%) were evaluated. Walking capacity was evaluated with the modified timed get up and go test (mTUG). Relationships between variables were evaluated with Spearman’s Correlation and linear regression analysis.
Results: According to the correlation analysis, there was a significantly negative good relationship between the static subscale of TCMS and mTUG (r: -0.754; p<0.01), and a significantly negative excellent relationship between dynamic and reaching subscales and total TCMS scores (respectively r=-0.837; -0.861; -0.872 p<0.01). Additionally, there were significantly good positive correlations between the static subscale of TCMS and step length, step wide and symmetry (respectively 0.624; 0.690; 0.720 p<0.01); a good positive correlation between the dynamic subscale of TCMS and step length, good positive correlation between reaching subscale of TCMS and step length; moderate to good positive correlations between total score of TCMS and step length, step wide and gait symmetry (respectively r:-0.872; 0.677; 0.585; 0.626 p<0.01). According to the regression analysis, the total TCMS score was a predictor of all gait characteristics except gait velocity; and mTUG (R2 = 0.796; 0.394; 0.303; 0.027; 0.320).
Conclusion: The results of this study show the importance of trunk control on gait characteristics and capacity in children with spastic diplegic CP.

Keywords

Cerebral palsy, postural control, gait

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