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

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

Cemil Özal Songül Aksoy Mintaze Kerem Günel

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

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

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

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

References

• Baxter P, Morris C, Rosenbaum P, et al. The definition and classification of cerebral palsy. Dev Med Child Neurol. 2007;49(s109):1-44.
• Koman LA, Smith BP, Shilt JS. Cerebral palsy. The Lancet. 2004;63:1619–1631.
• Gage JR. The treatment of gait problems in children with cerebral palsy. London:Mac Keith Press;2004.
• Kiernan D. The relationship of trunk kinematics and kinetics with lower limb pathology during gait in children with spastic cerebral palsy. Gait & Posture. 2021;86:33-37.
• Ozal C, Ari G, Kerem Gunel MK. Inter–intra observer reliability and validity of the Turkish version of trunk control measurement scale in children with cerebral palsy. Acta Orthopaedica et Traumatologica Turcica. 2019;53(5):381-384.
• Parameyong A, Boripuntakul S, Thawinchai N, Chawawisuttikool J, Kamnardsiri T. Reliability and validity of the swaymeter for measuring the trunk control in children with spastic cerebral palsy. Developmental Neurorehabilitation. 2022;25(7):462-468.
• Heyrman L, Desloovere K, Molenaers G, et al. Clinical characteristics of impaired trunk control in children with spastic cerebral palsy. Research in Developmental disabilities. 2013;34(1):327-334.
• Tarfa HB, Hassan AB, Badaru UM, Abdullahi A. Predictors of gross motor function and activities of daily living in children with cerebral palsy. International Journal of Rehabilitation Research. 2021;44(4):330-335.
• Sæther R, Helbostad JL, Adde L, et al. The relationship between trunk control in sitting and during gait in children and adolescents with cerebral palsy. Developmental Medicine & Child Neurology. 2015;57(4):344-350.
• Kim DH, An DH, Yoo WG. The relationship between trunk control and upper limb function in children with cerebral palsy. Technology and Health Care. 2018;26(3):421-427.
• Kallem Seyyar G, Aras B, Aras O. Trunk control and functionality in children with spastic cerebral palsy. Developmental Neurorehabilitation. 2019;22(2):120-125.
• Kavanagh J, Barrett R, Morrison S. The role of the neck and trunk in facilitating head stability during walking. Experimental Brain Research. 2006;172(4):454-463.
• Balzer J, Marsico P, Mitteregger E, et al. Influence of trunk control and lower extremity impairments on gait capacity in children with cerebral palsy. Disability and Rehabilitation. 2018;40(26):3164-3170.
• Palisano R, Rosenbaum P, Walter S, et al. Gross motor function classification system for cerebral palsy. Dev Med Child Neurol. 1997;39(4):214-23.
• El Ö, Baydar M, Berk H, et al. Interobserver reliability of the Turkish version of the expanded and revised gross motor function classification system. Disability and Rehabilitation. 2012;34(12):1030-1033.
• Heyrman L, Molenaers G, Desloovere K, et al. A clinical tool to measure trunk control in children with cerebral palsy: The trunk control measurement scale. Research in Developmental Disabilities. 2011;32(6):2624-2635.
• Williams EN, Carroll SG, Reddihough DS, et al. Investigation of the timed ‘up & go’ test in children. Dev Med Child Neurol. 2005;47:518–524.
• Portney L, Watkins M. Foundations of Clinical Research: Applications To Practice (3rd edn). Upper Saddle River, New Jersey: Pearson Prentice Hall; 2009.
• Van de Walle P, Hallemans A, Truijen S, et al. Increased mechanical cost of walking in children with diplegia: The role of the passenger unit cannot be neglected. Research in Developmental Disabilities. 2012;33:1996–2003.
• Stebbins J, Harrington M, Thompson N, Zavatsky A, Theologis T. Gait compensations caused by foot deformity in cerebral palsy. Gait and Posture. 2010;32:226–230.
• Numanoglu Akbas A, Kerem Gunel M. Effects of trunk training on trunk, upper and lower limb motor functions in children with spastic cerebral palsy: A stratified randomized controlled trial. Konuralp Medical Journal. 2019;11(2):253-259.