Investigation of the relationship between trunk control, functional mobility, and balance in children with spastic cerebral palsy

Abstract

Purpose: The aim of this study was to investigate the relation between trunk control, functional mobility and balance in children with cerebral palsy (CP). Methods: Nine hemiparetic and 10 diparetic children with spastic CP, between the ages of 5-17 years were included in the study. The Trunk Impairment Scale (TIS) was used to evaluate functional strength, postural control and quality of trunk movements. The Pediatric Berg Balance Scale (PBBS) was used to evaluate functional balance in daily living activities. The timed up and go test (TUG) and Timed Up and Down Stairs Test were used to evaluate functional mobility and balance. Ankle dorsiflexion selective motor control (SMC) test was used in evaluating selective movements. Results: There were significant relationships between dynamic, coordination and total sub-items of TIS and SMC; between static sub-item and PBBS, TUG, TUDS (p<0.05). Conclusion: The limitations in postural control and balance cause limitations in voluntary skills performance including mobility abilities. The importance of this study is manifesting the relationship between trunk control and functional mobility skills and balance

Keywords

• Cerebral palsy
• Postural balance
• Motor skills

Spastik serebral palsili çocuklarda gövde kontrolü ile fonksiyonel mobilite ve denge arasındaki ilişkinin incelenmesi

Abstract

Amaç: Bu çalışmada spastik tip serebral palsili (SP) çocuklarda gövde kontrolü ile fonksiyonel mobilite ve denge arasındaki ilişkinin incelenmesi amaçlandı. Yöntem: Yaşları 5-17 yıl arasında değişen, 9’u hemiparetik, 10’u ise diparetik olan 19 spastik tip SP’li çocuk alındı. Gövdenin fonksiyonel kuvvetini, postüral kontrolünü ve gövde hareketlerinin niteliğini değerlendirmek için Gövde Etkilenim Ölçeği (GEÖ); günlük yaşam aktivitelerindeki fonksiyonel dengeyi değerlendirmek amacıyla Pediatrik Berg Denge Ölçeği (PBDÖ) kullanıldı. Fonksiyonel mobilite ve dengeyi değerlendirmek için fonksiyonel hareket becerileri testlerinden zamanlı ayağa kalk ve yürü testi (ZKY) ile zamanlı merdiven çıkıp inme testi (ZMÇİ) kullanıldı. Selektif hareketlerin değerlendirilmesinde ayak bileği dorsifleksiyonu selektif motor kontrol testi (SMK) kullanıldı. Bulgular: GEÖ’nin dinamik, koordinasyon alt başlıkları ve toplam puanlarının PBDÖ, ZKY, ZMÇİ ve SMK ile; statik alt başlığın ise PBDÖ, ZKY ve ZMÇİ ile anlamlı düzeyde bir ilişki olduğu görüldü (p

Keywords

• Serebral palsi
• Postüral denge
• Motor beceriler

References

1. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M. A report: the definition and classification of cerebral palsy. Dev Med Child Neurol. 2007;49:8-14.
2. Livanelioğlu A, Kerem Günel M. Serebral Palside Fizyoterapi. Ankara: Yeni Özbek Matbaası; 2009.
3. Bourelle S, Berge B, Gautheron V, et al. Computerized static posturographic assessment after treatment of equinus deformity in children with cerebral palsy. J Pediatr Orthop B. 2010;19:211-220.
4. Shumway-Cook, Woollacott, MH. Motor Control: Translating Research Into Clinical Practise. Pennsylvania: Lippincott Williams & Wilkins; 2007.
5. Gjelsvik BEB. The Bobath Concept in Adult Neurology. 1 ed. Stuttgart: Georg Thieme Vorlag; 2008.
6. Sæther R. Trunk control in children with cerebral palsy :A reliability study of the Trunk Impairment Scale (thesis). Tromsø: Universiteteti Tromsø; 2010.
7. Bertenthal B, VonHofsten C. Eye, head and trunk control: the foundation for manual development. Neurosci Biobehav Rev. 1998;22:515–520.
8. Graaf-Peters VB, Blauw-Hospers CH, Dirks T, et al. Development of postural control in typically developing children and children with cerebral palsy: Possibilities for intervention? Neurosci Biobehav Rev. 2007;31:1191-1200.

9. Heyrman L, Desloovere K, Molenaers G, et al. Clinical characteristics of impaired trunk control in children with spastic cerebral palsy. Res Dev Disabil. 2013;34:327-34.
10. Kavanagh J, Barrett R, Morrison S. The role of the neck and trunk infacilitating head stability during walking. Exp Brain Res. 2006;172:454463.
11. Ledebt A, Bril B. Acquisition of upper body stability during walking in toddlers. Dev Psychobiol. 2000;36:311-324.
12. Patla AE, Adkin A, Ballard T. Online steering: Coordination and control of body center of mass, head and body reorientation. Exp Brain Res. 1999;129:629-634.
13. Saavedra S, Joshi A, Woollacott M, et al. Eye hand coordination in children with cerebral palsy. Exp Brain Res. 2009;192:155-165.
14. Schmid M, DeNunzio AM, Schieppati M. Trunk muscle proprioceptive input assists steering of locomotion. Neurosci Lett. 2005;384:127-132.
15. Van deWalle, 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. Res Dev Disabil. 2012;33:1996-2003.
16. Hsue BJ, Miller F, Su FC. The dynamic balance of the children with cerebral palsy and typical developing during gait. Part I: Spatial relationship between COM and COP trajectories. Gait Posture. 2009;29:465-470.
17. Sæther R, Jørgensen L. Intra-and inter observer reliability of the Trunk Impairment Scale for children with cerebral palsy. Res Dev Disabil. 2011;32:727-739.
18. Franjoine MR, Gunther JS, Taylor MS. Pediatric Balance Scale: a modified version of the Berg Balance Scale for the school-age child with mild to moderate motor impairment. Pediatr Phys Ther. 2003;15:114-120.
19. Williams EN, Carroll SG, Reddihough DS, et al. Investigation of the timed ‘up & go’ test in children. Dev Med Child Neurol. 2005;47:518524.
20. Ziano CA, Marchese VG, Westcott SL. Timed up and down stairs test: preliminary reliability of a new measure of functional mobility. Pediatr Phys Ther. 2004;16:90-98.
21. Boyd RN, Graham HK. Objective measurement of clinical findings in the use of botulinum toxin type A for the management of children with cerebral palsy. Eur J Neurol. 1999;6:23-35.
22. Donker SF, Ledebt A, Roerdink M, et al. Children with cerebral palsy exhibit greater and more regular postural sway than typically developing children. Exp Brain Res. 2008;184:363-370.
23. Liao SF, Yang TF, Hsu TC, et al. Differences in seated postural kontrol in children who are typically developing. Am J Phys Med Rehabil. 2003;82:622-626.
24. Brognen E, Hadders-Algra M, Forssberg H. Postural control in children with spastic diplegia: muscle activity during perturbations in sitting. Dev Med Child Neurol. 1996;38:379-388.
25. Woollacott MH, Shumway-Cook A. Postural dysfunction during standing and walking in children with cerebral palsy: what are the underlying problems and what new therapies might improve balance. Neural Plasticity. 2005;12:211-219.
26. Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy. Dev Med Child Neurol. 2007;49:8-14.
27. Rosenbaum P, Stewart D. The World Health Organisation International Classification of Functioning Disability and Health: a Model to Guide Clinical Thinking, Practice and Research in the Field of Cerebral Palsy. Semin Pediatr Neurol. 2004;1:5-10.
28. World Health Organisation. International Classification of Functioning, Disability and Health- Child and Youth Version (ICF-CY), Geneva, Switzerland: World Health Organisation; 2007.
29. Wright FV, Rosenbaum PL, Goldsmith CH, et al. How do changes in body functions and structures, activity and participation relate in children with cerebral palsy? Dev Med Child Neurol. 2008;50:283-289.
30. Cans C, Dalk H, Platt MJ, et al. Recommendations from the SCPE Collaborative Group for defining and classifying cerebral palsy. Dev Med Child Neurol. 2007;49:35-38.
31. Verheyden G, Williams AM, Ooms L, et al. Validity of the Trunk Impairment Scale as a measure of trunk performance in people with Parkinson’s Disease. Arch Phys Med Rehab. 2007;88:1304-1308.
32. Assaiante C, Mallau S, Viel S, et al. Development of postural control in healthy children: A functional approach. Neural Plasticity. 2005;12:109-117.
33. Moe-Nilssen R, Helbestad JL. Interstride trunk acceleration variability but not step width variability can differentiate between fit and frail older adults. Gait Posture. 2005;21:164-170.
34. Katz-Laurer M, Rotem H, Keren O, et al. Balance abilities and gait characteristics in post traumatic brain injury, cerebral palsy and typically developing children. Dev Neurorehabil. 2009;12:100-105
35. Habib Z, Westcott SL. assessment of dynamic balance abilities in Pakistani children age 5-13 years. Pediatr Phys Ther. 1999;6:73-82