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

Year 2019, Volume: 30 Issue: 1, 11 - 22, 16.04.2019

Ayşe Numanoğlu Akbaş Mintaze Kerem Günel

https://doi.org/10.21653/tfrd.382366

Cited By: 1

Abstract

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.

Keywords

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

References

• 1. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109(suppl 109):8-14.
• 2. Park ES, Park CI, Lee HJ, Cho YS. The effect of electrical stimulation on the trunk control in young children with spastic diplegic cerebral palsy. Journal of Korean medical science. 2001;16(3):347-50.
• 3. Mayston MJ. People with cerebral palsy: effects of and perspectives for therapy. Neural plasticity. 2001;8(1-2):51-69.
• 4. Prosser LA, Lee SC, Barbe MF, VanSant AF, Lauer RT. Trunk and hip muscle activity in early walkers with and without cerebral palsy–A frequency analysis. Journal of Electromyography and Kinesiology. 2010;20(5):851-9.
• 5. Şimşek TT, Türkücüoğlu B, Çokal N, Üstünbaş G, Şimşek İE. The effects of Kinesio® taping on sitting posture, functional independence and gross motor function in children with cerebral palsy. Disability and rehabilitation. 2011;33(21-22):2058-63.
• 6. Footer CB. The effects of therapeutic taping on gross motor function in children with cerebral palsy. Pediatric Physical Therapy. 2006;18(4):245-52.
• 7. Tseng S-H, Chen H-C, Tam K-W. Systematic review and meta-analysis of the effect of equine assisted activities and therapies on gross motor outcome in children with cerebral palsy. Disability and rehabilitation. 2013;35(2):89-99.
• 8. Gonca A, GÜNEL MK. Serebral palsili çocuklarda nörogelişimsel tedaviye dayalı gövde eğitiminin gövde kontrolüne etkisi. Journal of Exercise Therapy and Rehabilitation. 2015;2(3):79-85.
• 9. Arı G, Günel MK. A Randomised Controlled Study to Investigate Effects of Bobath Based Trunk Control Training on Motor Function of Children with Spastic Bilateral Cerebral Palsy. International Journal of Clinical Medicine. 2017;8(04):205.
• 10. [Available from: http://www.seniam.org/.
• 11. Kasman GS, Wolf SL. Surface EMG made easy: a beginner's guide for rehabilitation clinicians: Noraxon USA; 2002.
• 12. Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G. Development of recommendations for SEMG sensors and sensor placement procedures. Journal of electromyography and Kinesiology. 2000;10(5):361-74.
• 13. Beith I, Synnott R, Newman S. Abdominal muscle activity during the abdominal hollowing manoeuvre in the four point kneeling and prone positions. Manual therapy. 2001;6(2):82-7.
• 14. Chanthapetch P, Kanlayanaphotporn R, Gaogasigam C, Chiradejnant A. Abdominal muscle activity during abdominal hollowing in four starting positions. Manual therapy. 2009;14(6):642-6.
• 15. Haugh A, Pandyan A, Johnson G. A systematic review of the Tardieu Scale for the measurement of spasticity. Disability and rehabilitation. 2006;28(15):899-907.
• 16. Numanoglu A, Gunel MK. Intraobserver reliability of modified Ashworth scale and modified Tardieu scale in the assessment of spasticity in children with cerebral palsy. Acta orthopaedica et traumatologica turcica. 2012;46(3):196-200.
• 17. 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. European Journal of Neurology. 1999;6(S4):s23-s35.
• 18. Damiano DL, Dodd K, Taylor NF. Should we be testing and training muscle strength in cerebral palsy? Developmental Medicine & Child Neurology. 2002;44(01):68-72.
• 19. Ayalon M, Ben‐Sira D, Hutzler Y, Gilad T. Reliability of isokinetic strength measurements of the knee in children with cerebral palsy. Developmental Medicine & Child Neurology. 2000;42(6):398-402.
• 20. Berry ET, Giuliani CA, Damiano DL. Intrasession and intersession reliability of handheld dynamometry in children with cerebral palsy. Pediatric Physical Therapy. 2004;16(4):191-8.
• 21. dos Santos CG, Pagnussat AS, Simon A, Py R, do Pinho AS, Wagner MB. Humeral external rotation handling by using the Bobath concept approach affects trunk extensor muscles electromyography in children with cerebral palsy. Research in developmental disabilities. 2015;36:134-41.
• 22. Heyrman L, Desloovere K, Molenaers G, Verheyden G, Klingels K, Monbaliu E, et al. Clinical characteristics of impaired trunk control in children with spastic cerebral palsy. Research in developmental disabilities. 2013;34(1):327-34.
• 23. Fowler EG, Ho TW, Nwigwe AI, Dorey FJ. The effect of quadriceps femoris muscle strengthening exercises on spasticity in children with cerebral palsy. Physical Therapy. 2001;81(6):1215-23.
• 24. Lee Y-s, Kim W-b, Park J-w. The Effect of Exercise Using a Sliding Rehabilitation Machine on the Gait Function of Children with Cerebral Palsy. Journal of physical therapy science. 2014;26(11):1667.