Serebral paralizili yetişkinlerde spastisite ile mobilite ve aktivite düzeyi arasındaki ilişki

Year 2020, Volume: 13 Issue: 3, 635 - 644, 18.09.2020

Mine Pekesen Kurtça , Salih Angın

https://doi.org/10.31362/patd.669956

Abstract

ÖZ
Amaç: Bu çalışmada, yetişkin serebral paralizili (SP) bireylerde spastisite ile mobilite ve aktivite düzeyi arasındaki ilişkinin incelenmesi amaçlanmıştır.
Yöntem: Çalışma on beş yaş ve üstü spastik serebral paralizi tanısı alan otuz dört olgu ile gerçekleştirilmiştir. Olguların klinik ve demografik bilgileri kaydedilmiş, spastisite dereceleri Modifiye Ashworth Skalası (MAS) ile değerlendirilmiştir. Mobilite düzeyleri için Rivermead Mobilite İndeksi (RMI), aktivite düzeyleri için Fonksiyonel Bağımsızlık Ölçümü’nün (FIM) mobilite, kendine bakım ve lokomosyon alt parametreleri kullanılmıştır. Tüm olgular Kaba Motor Fonksiyon Sınıflandırma Sistemine (KMFSS) göre gruplandırılmış, motor limitasyon düzeyini gösteren KMFSS’ye göre seviye 1, 2 ve 3’teki olgular grup 1; KMFSS’ye göre seviye 4 ve 5’teki olgular grup 2’ye dahil edilmiştir. Verilerin analizinde Pearson Korelasyon Analizi, Kruskal Wallis Varyans Analizi ve Mann-Whitney U Testi kullanılmış, p anlamlılık düzeyi 0,05 olarak kabul edilmiştir.
Bulgular: Toplam Modifiye Ashworth skoru ile lokomosyon, mobilite, RMI ve KMFSS puanı arasında negatif yönde, anlamlı ilişki bulunmuştur (p<0,05). Toplam Modifiye Ashworth skoru ile kendine bakım puanı arasında herhangi bir ilişki bulunmamıştır (p>0,05). Ekstremite tutulumuna göre ayrılan üç grup arasında RMI puanı açısından fark anlamlı bulunmuş, bu farkın hemiparetik gruptan kaynaklandığı belirlenmiştir (p<0,05). KMFSS’ye göre oluşturulan iki grup arasında Modifiye Ashworth, RMI, lokomosyon, mobilite, kendine bakım ve toplam FIM puanı açısından farkın anlamlı olduğu saptanmıştır (p<0,05).
Sonuç: SP’li bireylerin mobilite ve aktivite düzeyleri spastisiteden olumsuz yönde etkilenmektedir. Yetişkin serebral paraliziye yönelik rehabilitasyon programı içerisinde mobilitenin devamlılığı ve fonksiyonel düzeyin yükseltilmesi için spastisitenin azaltılmasına yönelik yaklaşımların geliştirilmesi gerekmektedir.
ABSTRACT
Objective: This study aimed to investigate the relationship between spasticity, mobility and activity level in adults with cerebral palsy (CP).
Methods: Thirty four spastic cerebral palsy patients who were fifteen years and over included in this study. The demographic and clinical features were recorded, and spasticity was assessed with the modified ashworth scale (MAS). Rivermead Mobility İndex (RMI) , mobility, self-care and locomotion parameters of Functional İndependence Measure (FIM) were conducted to analyse level of mobility and activity. Gross Motor Function Classification System (GMFCS) was applied for each subject. All subjects splitted to two groups: Group 1 consisted with level 1, 2 and 3; group 2 consisted with level 4 and 5 according to KMFSS score. Pearson Correlation Analysis, Kruskal Wallis Analysis of Variance and Mann- Whitney U Test were performed for data analysis. α level was set 0.05.
Results: Total modified ashworth scale ratings was found to be significantly and reversely correlated with KMFSS level, RMI, locomotion, mobility scores (p<0.05). Correlation between modified ashworth scale ratings and self-care scores was found to be non- significant (p>0.05). Within group comparison, MAS, RMI, locomotion, mobility, self care and total FIM score was found to be significantly different (p<0.05) . RMI scores in hemiparetic group were found to be significantly different when the patients allocated among the three groups as hemiparetic, diparetic and quadriparetic according to the extremity involvement (p<0.05).
Conclusion: Since the mobility and activity level negatively effected by spasticity in adult patients with cerebral palsy, the spasticity managment methods should not be underestimated for increasing functional level and mobility.

Keywords

Günlük yaşam aktiviteleri, mobilite limitasyonu, serebral paralizi, spastisite

The relationship between spasticity, mobility and activity level in adults with cerebral palsy

Abstract

Abstract
Purpose: This study aimed to investigate the relationship between spasticity, mobility and activity level in adults
with cerebral palsy (CP).
Materials and methods: Thirty-four spastic cerebral palsy patients who were fifteen years and over included in
this study. The demographic and clinical features were recorded, and spasticity grades was assessed with the
modified ashworth scale (MAS). Rivermead Mobility İndex (RMI), mobility, self-care and locomotion parameters
of Functional İndependence Measure (FIM) were conducted to analyse level of mobility and activity. Gross Motor
Function Classification System (GMFCS) was applied for each subject. All subjects were split into splitted to two
groups: Group 1 consisted with level 1, 2 and 3; group 2 consisted with level 4 and 5 according to KMFSS score.
Pearson Correlation Analysis, Kruskal Wallis Analysis of Variance and Mann-Whitney U Test were performed for
data analysis. Α level was set 0.05.
Results: Total modified ashworth scale ratings was found to be significantly and reversely correlated with
KMFSS level, RMI, locomotion, mobility scores (p<0.05). Correlation between modified ashworth scale ratings
and self-care scores was found to be non- significant (p>0.05). Within group comparison, MAS, RMI, locomotion,
mobility, self-care and total FIM score was found to be significantly different (p<0.05). RMI scores in hemiparetic
group were found to be significantly different when the patients allocated among the three groups as hemiparetic,
diparetic and quadriparetic according to the extremity involvement (p<0.05).
Conclusion: Since the mobility and activity level negatively affected by spasticity in adult patients with cerebral
palsy, the spasticity management methods should not be underestimated for increasing functional level and
mobility. 

Keywords

Activities of daily living, mobility limitation, cerebral palsy, spasticity

References

• 1. Kerem Günel M. Rehabilitation of children with cerebral palsy from a physiotherapist’s perspective. Acta Orthop Traumatol Turc 2009. doi:10.3944/AOTT.2009.173.
• 2. Tarsuslu T, Livanelioğlu A. Serebral paralizili bireylerde motor limitasyonun mobilite ve bağımsızlık düzeyi üzerine etkisi. Fizyoter Rehabil 2008;19:117- 122.
• 3. Akın B, Emiroğlu ON. Rivermead mobilite indeksi (RMI) Türkçe formunun yaşlılarda geçerlilik ve güvenilirliği. Turkish Journal of Geriatrics 2007;10:124- 130.
• 4. Tieman BL, Palisano RJ, Gracely EJ et al. Gross motor capability and performance of mobility in children with cerebral palsy: a comparison across home, school, and outdoors/ community settings. Phys Ther 2004. doi:10.1093/ptj/84.5.419.
• 5. Life Expectancy for Adults with Cerebral Palsy. http://www.cerebralpalsysource.com/About_CP/life_cp/index.html. Erişim tarihi 9 Kasım 2019. (Accessed November 9, 2019.).
• 6. Tarsuslu T. Genç yetişkin ve yetişkin serebral paralizili bireylerde sağlıkla ilgili yaşam kalitesinin değerlendirilmesi Yayınlanmış Doktora Tezi. Hacettepe Üniversitesi Sağlık Bilimleri Enstitüsü, Fizik Tedavi ve Rehabilitasyon Anabilim Dalı, Ankara, 2007.
• 7. Rapp CE, Torres MM. The adult with cerebral palsy. Arch Fam Med 2000. doi:10.1001/archfami.9.5.466.
• 8. Rosenbaum P. Cerebral palsy: what parents and doctors want to know. BMJ 2003. doi:10.1136/bmj.326.7396.970.
• 9. Bohannon RW, Smith MB. İnterrater reliability of a modified ashworth scale of muscle spasticity. Phys Ther 1987. doi: 10.1093/ptj/67.2.206.
• 10. Ostensjo S, Carlberg EB, Vollestad NK. Motor impairments in young children with cerebral palsy: relationship to gross motor function and everyday activities. Dev Med Child Neurol 2004;46:580- 589.
• 11. The Rivermead mobility index: a further development of the rivermead motor assessment. Int Disabil Stud 1991. doi:10.3109/03790799109166684.
• 12. Kıdd D, Stewart G, Baldry J. et al. The Functional Independence Measure: a comparative validity and reliability study. Disabil Rehabil 1995. doi: 10.3109/09638289509166622.
• 13. Küçükdeveci AA, Yavuzer G, Elhan AH. et al. Adaptation of the functional independence measure for use in Turkey. Clin Rehabil 2001. doi: 10.1191/026921501676877265.
• 14. Hall KM, Hamilton BB, Gordon WA. et al. Characteristics and comparisons of functional assessment indices: disability rating scale, functional ındependence measure, and functional assessment measure. J Head Trauma Rehabil 1993;8:60-74.
• 15. GMFCS Türkçe. Available at: https://canchild.ca/system/tenon/assets/attachments/000/000/083/original/GMFCS-ER_Translation-Turksih.pdf. Erişim tarihi 2 Şubat 2011. (Accessed February 02,2011.).
• 16. Shortland A. Muscle deficits in cerebral palsy and early loss of mobility: can we learn something from our elders? Dev Med Child Neurol 2009. doi:10.1111/j.1469-8749.2009.03434.x.
• 17. Hilberink SR, Roebroeck ME, Nieuwstraten W. et al. Health issues in young adults with cerebral palsy: towards a life-span perspective. J Rehabil Med 2007. doi:10.2340/16501977-0103.
• 18. Gür G. Yürüyebilen ve yürüyemeyen serebral palsili çocuklarda ayak deformitelerinin incelenmesi. Yayınlanmış Yüksek Lisans Tezi. Hacettepe Üniversitesi Sağlık Bilimleri Enstitüsü, Fizik Tedavi ve Rehabilitasyon Anabilim Dalı, Ankara, 2010.
• 19. Krigger KW. Cerebral palsy: an overview. Am Fam Physician 2006;73:91-100.
• 20. Andersson C, Mattsson E. Adults with cerebral palsy: a survey describing problems, needs, and resources, with special emphasis on locomotion. Dev Med Child Neurol 2001. doi:10.1017/s0012162201.
• 21. Benner JL, Noten S, Limsakul C. et al. Outcomes in adults with cerebral palsy: systematic review using the international classification of functioning, disability and health. Dev Med Child Neurol 2019;61:1153-1161.
• 22. van der Dussen L, Nieuwstraten W, Roebroeck M. et al. Functional level of young adults with cerebral palsy. Clin Rehab 2001. doi:10.1191/026921501670159475.
• 23. Bottos M, Feliciangeli A, Sciuto L. et al. Functional status of adults with cerebral palsy and implications for treatment of children. Dev Med Child Neurol 2001;43:516- 528.
• 24. Strauss, D, Ojdana, K, Shavelle, R. et al. Decline in function and life expectancy of older persons with cerebral palsy. Neuro Rehabilitation 2004;19:69-78.
• 25. Day SM, Wu YW, Strauss DJ. et al. Change in ambulatory ability of adolescents and young adults with cerebral palsy. Dev Med Child Neurol 2007;49:647–653.
• 26. Hägglund G. Development of spasticity with age in a total population of children with cerebral palsy. BMC Musculoskelet Disord 2008. doi: 10.1186/1471-2474-9-150.
• 27. Maruishi M. Cerebral palsy in adults: independent effects of muscle strength and muscle tone. Arch Phys Med Rehabil 2001. doi: 10.1053/apmr.2001.22336.
• 28. Ohata K, Tsuboyama T, Haruta T. et al. Relation between muscle thickness, spasticity and activity limitation in childeren and adolescents with cerebral palsy. Dev Med Child Neurol 2008;50:152-156.
• 29. Azaula M, Msall ME, Buck G. et al. Measuring functional status and family support in older school aged children with cerebral palsy: comparison of three instruments. Arch Phys Med Rehabil 2000;81:307-311.
• 30. Molnar GE, Gordon SU. Cerebral palsy: predictive value of selective clinical signs for early prognostication of motor function. Arch Phys Med Rehabil 1976;57:153–158.
• 31. Sandström K, Alinder J, Öberg B. Descriptions of functioning and health and relations to a gross motor classification in adults with cerebral palsy. Disabil Rehabil 2004. doi:10.1080/09638280410001703503.