SPASTİK DİPLEJİK SEREBRAL PALSİLİ ÇOCUKLARDA PELVİK KONTROL EGZERSİZLERİNİN AYAKTA DURMA ÜZERİNE ETKİSİ: PİLOT RANDOMİZE KONTROLLÜ ÇALIŞMA

Abstract

Amaç: Pelvik instabilite, spastik diplejik serebral palsili (SP) çocuklarda sık görülen bir bulgudur. Hareketlilik ve günlük işlevsellik, uygunsuz kas aktivasyonu ve pelvis çevresindeki hareketin yetersiz düzenlenmesi nedeniyle engellenir. Çalışmanın amacı spastik diplejik SP'li çocuklarda pelvik kontrol egzersizlerinin postür üzerine etkilerini araştırmaktı. Yöntem: Bu tek-kör çalışmaya katılan SP'li 24 spastik diplejik çocuk, basit rastgele örnekleme yoluyla rastgele iki gruba ayrıldı. Grup A'ya (n=12) geleneksel müdahale ve pelvik kontrol egzersizleri yapılırken, Grup B'ye (n=12) yalnızca geleneksel müdahale uygulandı. Sekiz hafta boyunca müdahale haftada üç gün gerçekleştirildi. Torasik eğim (TI), gövde açısı (TA), pelvik eğim (PT), lomber açı (LA), lomber eğri (LC), anterior superior iliak omurganın yatay hizalaması (HAASIS), posterior superior iliak yatay hizalaması gibi postüral açılar omurga (HAP), müdahalenin bitiminden önce ve sonra sonuç ölçüsü olarak değerlendirildi. İki grup arasındaki farklılıkları incelemek için bağımsız t testi, grup içi farklılıkları incelemek için eşleştirilmiş t testi kullanıldı. Sonuçlar: Her iki grubun sonuç ölçümleri tedavi öncesinde karşılaştırıldığında anlamlı bir fark gözlenmedi. A çalışma grubundaki postüral açı değerleri, konvansiyonel fizyoterapi ve pelvik kontrol egzersizleri ile yapılan tedavi sonrasında, tek başına konvansiyonel tedaviye kıyasla anlamlı bir iyileşme gösterdi. TA (p=0,030) ve LC (p=0,007) açıları artarken, TI (p=0,027), PT (p<0,001), LA (p=0,005), HAASIS (p=0,054) ve HAP (p=0,017) grup A'da düşüş gösterdi ve bu da daha iyi gövde ve pelvik hizalanma sağladı. Tartışma: Sonuçlar, spastik diplejik SP'li çocuklarda pelvik kontrol eğitiminin postürün iyileştirilmesinde faydalı olabileceğini gösterdi.

Keywords

• Serebral Palsi
• Dipleji
• Postür
• Spastisite
• pelvis

THE EFFECT OF PELVIC CONTROL EXERCISES ON STANDING POSTURE IN CHILDREN WITH SPASTIC DIPLEGIC CEREBRAL PALSY: A PILOT RANDOMIZED CONTROLLED TRIAL

Abstract

Purpose: Pelvic instability is a common finding in children with spastic diplegic cerebral palsy (CP). Mobility and day-to-day functioning are impeded by improper muscle activation and inadequate regulation of movement around the pelvis. The study's objective was to investigate the effects of pelvic control exercises on posture of children with spastic diplegic CP. Methods: 24 spastic diplegic children with CP who participated in this single-blind trial were divided into two groups at random by simple random sampling. Group A (n = 12) received conventional intervention and pelvic control exercises, while Group B (n = 12) received only conventional intervention. For a period of eight weeks, the intervention was carried out three days a week. Postural angles like thoracic inclination (TI), trunk angle (TA), pelvic tilt (PT), lumbar angle (LA), lumbar curve (LC), horizontal alignment of anterior superior iliac spine (HAASIS), horizontal alignment of posterior superior iliac spine (HAP) were evaluated as outcome measure before and after the intervention is finished. While the independent t test was used to examine differences between the two groups, the paired-t test was employed to examine differences within the group. Results: When outcome measures from both groups were compared prior to treatment, no significant differences were observed. The values of postural angles in study group A showed a significant improvement after the treatment with conventional physiotherapy and pelvic control exercises in comparison with conventional treatment alone. Angles of TA (p=0.030) and LC (p=0.007) increased while those of TI (p=0.027), PT (p<0.001), LA (p=0.005), HAASIS (p=0.054), and HAP (p=0.017) decreased in group A resulting in better trunk and pelvic alignment. Conclusion: The results indicated that pelvic control training could be beneficial in improving posture of children with spastic diplegic CP.

Keywords

• Cerebral Palsy
• Diplegia
• Posture
• Spasticity
• pelvis

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