IS POSTURAL SWAY MEASURED IN CHILDREN WITH OBSTETRIC BRACHIAL PLEXUS INJURY DIFFERENT FROM TYPICALLY DEVELOPING CHILDREN?

Abstract

Purpose: Asymmetric use of the upper extremity as a result of injury in children with Obstetric Brachial Plexus Injury (OBPI) affects the development of postural control and postural sway values. The objective of the present study was to investigate the changes in postural sway values in children with OBPI and to compare them with healthy controls. Methods: Fifty-five children with OBPI with a mean age of 6.35±1.40 years and 45 healthy subjects with typical development, with a mean age of 6.09±0.76 years were included in the study. Demographic information of both groups and the degree of injury of children with OBPI according to the Narakas Classification System were recorded. The postural sway values of the postural control parameters of the groups were obtained with the Balance Check Screener force platform (Model BP5050; Bertec, Columbus, OH, USA). Results: In the statistical analysis, demographic characteristics between the groups were found to be similar. The statistics related to anteroposterior oscillation values were found to be significantly increased in patients with OBPI compared to healthy patients with typical development (p<0.05). It was observed that the amount of oscillation in the medio-lateral direction was higher in OBPY cases with eyes closed and the difference was statistically significant (p<0.05). No difference was observed between the results of the groups in terms of medio-lateral oscillation values obtained with eyes open on hard and soft ground (p ˃0.05). Conclusion: The results of our study showed that the postural sway of children with OBPI increased when compared to their healthy peers. It is assumed that the asymmetric development of the upper extremities and the emergence of compensations as a result of injury in children with OBPI negatively affect the development of postural control. In this context, it is recommended to evaluate the effects of trunk asymmetry, postural control and balance losses from a holistic perspective, instead of treatment approaches involving only the affected extremity in individuals with OBPI, and to create treatment strategies for them in the earliest period and include them in treatment programs.

Keywords

• Obstetric Brachial Plexus Injury
• Postural Control
• Postural Sway

OBSTETRİK BRAKİYAL PLEKSUS YARALANMASI OLAN ÇOCUKLARDA ÖLÇÜLEN POSTURAL SALINIM TİPİK GELİŞİM GÖSTEREN ÇOCUKLARDAN FARKLI MIDIR?

Öz

Amaç: Obstetrik Brakial Pleksus Yaralanması (OBPY) olan çocuklarda yaralanma sonucu üst ekstremitede gelişen asimetrik kullanım postural kontrol gelişimini ve postural salınım değerlerini etkilemektedir. Bu çalışmada OBPY’li çocuklarda postural salınım değerlerindeki değişimi incelemek sağlıklı kontrol olgularıyla karşılaştırmak amaçlandı. Yöntem: Çalışmaya, yaşları ortalama 6,35±1,40 yıl olan OBPY tanılı 55 çocuk ve yaşları ortalama 6,09±0,76 yıl olan 45 tipik gelişim gösteren sağlıklı olgu dahil edildi. Her iki grubun demografik bilgileri ve OBPY'li çocukların ayrıca Narakas Sınıflandırma Sistemine göre yaralanma dereceleri kaydedildi. Çalışmada grupların postural kontrol parametrelerine ait postural salınım değerleri Balance Check Screener kuvvet platformu (Model BP5050; Bertec, Columbus, OH, ABD) ile elde edildi. Sonuçlar: Yapılan istatistiksel analizde gruplar arası demografik özellikler benzer bulundu (p˃0,05). OBPY olgularında, tipik gelişim gösteren sağlıklı olgulara göre, anterio-posterior salınım değerlerinin istatistiksel olarak anlamlı düzeyde artmış olduğu saptandı (p<0,05). OBPY olgularında gözler kapalı medio-lateral yönünde salınım miktarının daha yüksek olduğu ve farkın istatistiksel olarak anlamlı olduğu belirlendi (p<0,05). Sert ve yumuşak zeminde gözler açık olarak elde edilen medio-lateral salınım değerleri açısından gruplar arası karşılaştırma sonuçları arasında fark olmadığı görüldü (p˃0,05). Tartışma: Çalışmamızın sonuçları, OBPY'li çocukların sağlıklı yaşıtları ile karşılaştırıldığında, postural salınımlarının arttığını göstermiştir. OBPY'li çocuklarda yaralanma sonucu üst ekstremitelerin asimetrik gelişimi ve buna bağlı olarak kompansasyonların açığa çıkmasının, postural kontrol gelişimini de olumsuz etkilediği düşünülmektedir. Bu kapsamda, OBPY'li bireylerde sadece etkilenen ekstremiteyi içeren tedavi yaklaşımları yerine, bütüncül bir bakış açısıyla gövde asimetrisi, postural kontrol ve denge kayıplarının değerlendirilmesi ve bunlara yönelik tedavi stratejilerinin en erken dönemde oluşturularak tedavi programlarına dahil edilmesi önerilmektedir.

Anahtar Kelimeler

• Obstetrik Brakiyal Pleksus Yaralanması
• Postural Kontrol
• Postural Salınım

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