SPASTİK DİPARETİK SEREBRAL PARALİZİLİ ÇOCUKLARDA OTURMA POSTÜRÜNÜN İNCELENMESİ

Yıl 2007, Sayı: 1, 17 - 24, 01.05.2007

Mintaze Kerem Günel Ayşe Livanelioğlu

Öz

Çalışmanın amacı spastik diparetik serebral paralizi (SP)’ li çocuklarda oturma postürünü ve oturma postürüne etki eden faktörleri incelemektir. Çalışmada SP tanısı konmuş yaşları 2–10 yıl arasında değişen (ort: 5, 5 ± 3, 1 yıl) 50 spastik diparetik çocuk değerlendirildi. Oturma pozisyonu, Oturma Postürü Değerlendirme Skalası (OPDS) kullanılarak belirlendi. Alt ekstremitelerde kalça fleksörleri, adduktörleri, internal rotatörleri, hamistringler ve plantar fleksörlerin kas tonusu değerlendirmesi Modifiye Ashwort Skalası (MAS)’na göre yapıldı. Her iki alt ekstremite için toplam MAS skoru hesaplandı. Olguların motor fonksiyonu Kaba Motor Fonksiyon Sınıflaması- Gross Motor Functional Classification System (GMFCS)’ye göre yapıldı. OPDS ile oturma postürü değerlendirilen diparetik spastik SP’li olgularda, oturmada gövde ve ayak kontrolü motor fonksiyon seviyeleri ve alt ekstremitelerdeki spastisite şiddetinden etkilenirken (P<0. 01), buna karşın baş kontrolü üzerinde etkili olmadığı (P>0. 05) bulundu. Bu sonuç spastik diparatik çocuklarda OPDS’nin gövde ve ayak kontrolünü belirlemede etkin olabileceği ancak baş kontrolü için hassas olmadığını düşündürmüştür. Daha fazla sayıda spastik diparetik olgularda oturma değerlendirmesi için başka değerlendirme skalaları ile çalışmalara ihtiyaç vardır

Anahtar Kelimeler

Serebral paralizi, Diparetik, Oturma postürü

POSTURAL CONTROL IN SITTING CHILDREN WITH SPASTIC DIPARETIC CEREBRAL PALSY

Öz

The aim of this study was to evaluate the sitting posture and to investigate the factors affecting sitting posture. 50 spastic diparetic children between ages of 2-10 years (5. 5±3. 1) who are diagnosed as cerebral palsy (CP) were included in the study. Sitting posture was assessed utilizing Sitting Posture Assessment Scale (SPAS). Hip flexor, adductor, internal rotator, hamstring and plantar flexor muscles tonus in lower extremity were evaluated according to Modified Ashworth Scale (MAS). A total MAS score was obtained for both lower extremities. Motor functions of the subjects were classified using Gross Motor Functional Classification System (GMFCS). Whilst the control of the feet and trunk in sitting was affected by the level of motor function and the severity of the spasticity (p<0. 05); it does not have an effect on head control (p>0. 05). This result indicates that in children with spastic diparetic. OPDS may be effective in determining the trunk and feet control however, it is not sensitive for head control. Further studies involving greater numbers of subjects are needed which use different scales evaluating sitting

Anahtar Kelimeler

Cerebral palsy, Diparetic, Sitting posture, Rehabilitation

Kaynakça

• Koman LA. Smith, BP. Shilt, JS. Cerebral palsy. Lancet. 2004; 363: 1619-1631
• Costa MF. Salomao SR. Berezovsky A. et. al. Relationship between vision and motor impairment in children with cerebral palsy: new evidence from electrophysiology. Behav Brain Res. 2004; 149: 145-150
• Pirila S. Meere. J. Pentikainen T. et. al. Language and motor speech skills in children with cerebral palsy. J Commun Disord. 2006. Jul 21
• Gramsbergen A. Posture and locomotion in the rat: independent or interdependent development?. Neurosci Biobehav Rev. 1998; 22(4): 547-553
• Brogren E. Hadder- Algra M. Forssberg H. Postural Control in children with spastic diplegia: muscle activity during perturbations in sitting. Dev Med Child Neurol. 1996; 38: 379-388
• Assaiante C. Development of locomotor balance control in helathy children. Neurosci Biobehav Rev. 1998; 22(4): 527-532
• Forssberg H. Hirschfeld H. Postural adjustments in sitting humans following external perturbations: muscle activity and kinematics. Exp Brain Res. 1994; 97: 515-527
• Brogren E. Hadder- Algra M. Forssberg H. Postural control in sitting children with cerebral palsy. Neurosci Biobehav Rev. 1998; 22(4): 591-596
• Woollacott M. Burtner P. Jensen J. et. al. Development of postural responses during standing in healthy children and children with spastic diplegia. Neurosci Biobehav Rev. 1998; 22(4): 583-589
• Myhr U. Wendt L. Improvement of functional sitting position for children with cerebral palsy. Dev Med Child Neurol. 1991; 33: 246-256
• Pope PM. Bowes CE. Booth E. Postural control in sitting the sam system: evaluation of use over three years. Dev Med Child Neurol. 1994; 36: 241-252
• Bohannon RW. Smith MB. Interrater reliability of a modified ashworh scale of muscle spasticity. Phys Ther. 1987; 67(2): 206-207
• Palisano R. Rosenbaum P. Walter S. et. al. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997; 39: 214-223
• Eliasson AC. Rosblad B. Krumlinde- Sundholm L. et. al. Manuel ability classification system (MACS) for children with cerebral palsy- Afield Version. European Academy of Childhood Disability Annual Meeting. Oslo. Norway. October 2003
• Mutch L. Alberman E. Hagberg B. et. al. Cerebral palsy epidemiology: where are we now and where are we going?. Dev Med Child Neurol. 1992; 34(6): 547-555
• Liao SF. Yang TF. Hsu TC. Et. al. Differences in seated postural control in children with spastic cerebral palsy and children who are typically developing. Am J Phys Med Rehabil. 2003; 82: 622-626
• McClenaghan BA. Thombs L. Morris M. Effects of seat-surface ınclination on postural stability and function of the upper extremities of children with cerebral palsy. Dev Med Child Neurol. 1992; 34: 40-48
• Myhr U. Von Wndt L. Norrlin S. et. al. Five-year follow-up of functional sitting position in children with cerebral palsy. Dev Med Child Neurol. 1995; 37(7): 587-96
• Van Der Heide J. Fock JM. Otten B. et. al. Kinematic characteristics of postural control during reaching in preterm children with cerebral palsy. Pediatric Research. 2005; 58(3): 586-593
• Eliasson A. Krumlinde-Sundholm L. Rösblad B. et. al. The manuel ability classification system (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol. 2006; 48(7): 549-554
• Kreulen M. Smeulders MJC. Veeger HEJ. et. al. Movement patterns of the upper extremity and trunk before and after corrective surgery of impaired forearm rotation in patients with cerebral palsy. Dev Med Child Neurol. 2006; 48(6): 436-441
• Redstone F. West JF. The importance of postural control for feeding. Pediatr Nurs. 2004; 30(2): 97-100
• Butler P. A preliminary report on the effectiveness of trunk targeting in achieving independent sitting balance in children with cerebral palsy. Clin Rehabil. 1998; 12: 281-293.