SPASTİK SEREBRAL PALSİLİ ÇOCUKLARDA BİREYSEL YAPILANDIRILMIŞ GÖVDE EĞİTİMİNİN VÜCUT YAPI VE FONKSİYONU ÜZERİNE ETKİSİ: TABAKALANDIRILMIŞ RANDOMİZE KONTROLLÜ ÇALIŞMA

Öz

Amaç: Bu çalışmanın amacı, spastik serebral palsili (SP) çocuklarda gövde eğitiminin; vücut yapıları
ve fonksiyonları üzerindeki etkilerini araştırmaktı.
Yöntem: Bu çalışmaya dahil edilen çocuklar Kaba Motor Fonksiyon Sınıflandırma Sistemi’ne
(KMFSS) göre sınıflandırıldı; yaşlarına ve KMFSS seviyelerine göre tabakalı randomizasyon ile iki
gruba ayrıldı. Gövde eğitimi grubuna 19 çocuk (4 kız, 15 erkek, yaş=8,81±3,92 yıl), kontrol grubuna
17 çocuk (6 kız, 11 erkek, yaş=10,44±4,63 yıl) olmak üzere toplam 36 bilateral spastik SP tanılı
çocuk dahil edildi. Üst ve alt ekstremite kaslarının kas tonusu Modifiye Tardieu Ölçeği (MTÖ) ile,
gövde kaslarının kas aktivasyonu yüzey elektromiyografi ile dinlenme (sEMG minimum) ve ileri
doğru uzanma aktivitesi (sEMG maksimum) sırasında değerlendirildi. Değerlendirmeler başlangıçta
ve sekiz hafta süren müdahaleden sonra yapıldı.
Sonuçlar: Tedavinin etkisi ile meydana gelen değişimler incelendiğinde, her iki grupta da kas
tonusunda herhangi bir değişim olmadığı görüldü (p>0,05). Erektör spina kasları sEMG maksimum
skorları gövde eğitimi grubunda iyileşme gösterdi (sağ için p=0,025 ve sol için p=0,006). Lumbal
multifidus, M. rectus abdominis, internal oblik-transversus abdominis, eksternal oblik ve M. gluteus
maximus kaslarının sEMG değerlerinde herhangi bir değişim yoktu (p>0.05).
Tartışma: Bireysel yapılandırılmış gövde eğitimi gövde ekstansör kaslarının aktivasyonunu
artırmak için umut verici bir yöntemdir. Bu müdahale, SP'li çocuklarda üst ve alt ekstremitelerde
kas tonusunda artış riski olmaksızın güvenle kullanılabilir.

Anahtar Kelimeler

• Serebral Palsi,Çocuk,Egzersiz,Kaslar,Rehabilitasyon

EFFECTS OF INDIVIDUALLY STRUCTURED TRUNK TRAINING ON BODY FUNCTION AND STRUCTURES IN CHILDREN WITH SPASTIC CEREBRAL PALSY: A STRATIFIED RANDOMIZED CONTROLLED TRIAL

Abstract

Purpose: This study aimed to investigate the effects of trunk training on body function and
structures of children with spastic cerebral palsy (CP).
Methods: Children included in this study were classified according to the Gross Motor Function
Classification System (GMFCS) and divided into two groups by stratified randomization based
on their GMFCS levels and ages. A total of 36 children with bilateral spastic CP were recruited
for this study, and 19 children (4 females, 15 males, age=8.81±3.92 years) were included in the
trunk training group, and 17 children (6 females, 11 males, age=10.44±4.63 years) were included
in the control group. Muscle tone of upper and lower extremity muscles was assessed using the
Modified Tardieu Scale (MTS), and muscle activation of the trunk muscles was assessed using
Surface Electromyography during rest (sEMG minimum) and forward reaching (sEMG maximum) at
baseline and after an eight-week intervention.
Results: When the therapy-induced changes were considered, it was seen that there was no
difference in muscle tone in both groups (p>0.05). The sEMG maximum scores for erector spinae
muscles (p=0.025 for right and p=0.006 for left) improved in the trunk training group. There was no
change in the sEMG scores of lumbar multifidus, M. rectus abdominis, internal oblique-transversus
abdominis, external oblique, and M. gluteus maximus muscles (p>0.05).
Conclusion: Individually-structured trunk training is a promising method to increase activation of
trunk extensors. This intervention can be used safely without the risk of increasing muscle tone of
upper and lower extremities in children with CP. 

Keywords

• Cerebral Palsy,Child,Exercise,Muscles,Rehabilitation

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