AEROBİK, ESNEKLİK VE KUVVET EGZERSİZLERİNİN SEREBRAL PALSİLİ ÇOCUKLAR ÜZERİNDEKİ ETKİLERİNE YÖNELİK BİR DERLEME

Öz

Serebral palsili (SP) bireylerde aktivite, genellikle kas zayıflığı ya da spastisite ile sınırlanmıştır. Yapılan son çalışmalarda fiziksel aktivitenin spastisite ve hareket paternleri üzerinde olumlu etkilerinin olduğu, fiziksel aktivitenin arttırılmasının, bu popülasyondaki morbidite ve mortalite oranlarını iyileştirdiğini gösterilmektedir. Bu derlemenin amacı, farklı egzersiz türlerinin (aerobik, esneklik, kuvvet) serebral palsili çocuklar üzerindeki etkilerine ilişkin güncel çalışmaları incelemek ve etkilerini özetleyerek konu hakkında güncel ve derleyici bilgi sunmaktır. Doküman analizi kullanılarak gerçekleştirilen bu araştırmada Google Scholar, PubMed ve Web of Science veri tabanlarında sistematik bir tarama gerçekleştirilmiştir. Taramada, “cerebral palsy (serebral palsi)” ve “exercise (egzersiz)” ve “rehabilitation (rehabilitasyon)” ve “children (çocuklar)” ve “aerobic (aerobik)” ve “stretching (esnetme)” ve “strengthening (kuvvetlendirme)” ve “endurance (dayanıklılık)” anahtar sözcükleri ve kombinasyonları kullanılmış, 2002-2022 yılları arasında yayınlanan makaleler incelenmiştir. Araştırma sonucunda serebral palsili çocuklarda egzersizin, spastisite ve hareket paternleri üzerinde olumlu birçok etkisi olduğu görülmüş, çocukların fiziksel, bilişsel ve sosyal durumlarında yararlı sonuçlar doğurduğu bulunmuştur. Araştırmaya dâhil edilen çalışmalardan elde edilen bulgulara göre serebral palsili çocuklarda egzersiz yapılması mutlaka önerilmektedir. Aynı zamanda daha büyük popülasyonlar ile yapılacak ileri çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Serebral palsi
• egzersiz
• aerobik
• kuvvet
• esneklik.

A REVIEW ON THE EFFECTS OF AEROBIC, FLEXIBILITY AND STRENGTH EXERCISE ON CHILDREN WITH CEREBRAL PALSY

Öz

Activity in individuals with cerebral palsy (CP) is usually limited by muscle weakness or spasticity. Recent studies have shown that physical activity has positive effects on spasticity and movement patterns, and increasing physical activity improves morbidity and mortality rates in this population. The purpose of this review is to examine the current studies on the effects of different types of exercise (aerobics, flexibility, strength) on children with cerebral palsy and to summarize their effects and to provide up-to-date and compiling information on the subject. In this study, which was carried out using document analysis, a systematic review was carried out inGoogle Scholar, PubMed and Web of Science databases. The keywords and combinations of "cerebral palsy" and "exercise" and "rehabilitation" and "rehabilitation" and "children" and "aerobic" and "stretching" and "strengthening" and "endurance" were used in the search and articles published between 2002 and 2022 were analysed. As a result of the research, it was seen that exercise had many positive effects on spasticity and movement patterns in children with cerebral palsy, and it was found to have beneficial results in children's physical, cognitive and social conditions. According to the findings obtained from the studies included in the research, it is strongly recommended to exercise in children with cerebral palsy. Further studies with larger populations are also needed.

Kaynakça

1. Paneth N., Hong T., Korzeniewski S. (2006). The descriptive epidemiology of cerebral palsy. Clinics in Perinatology. 33(2), 251–267.
2. Bax M., Goldstein M., Rosenbaum, P., Leviton A., Paneth N., Dan B., Jacobsson B., Damiano D. (2005). Proposed definition and classification of cerebral palsy. Developmental Medicine and Child Neurology. 47(8), 571–576.
3. Styer-Acevedo, J. (1999) Physical therapy for the child with cerebral palsy, Içinde: Pediatric physical therapy. Tecklin JS. (Editör). Lippincott Williams & Wilkins,107-162.
4. Toldi J., Escobar J., Brown A. (2021). Cerebral palsy: sport and exercise considerations. Current Sports Medicine Reports. 20(1), 19–25.
5. American College of Sports Medicine (2000). ACSM’s guidelines for exercise testing and prescription. Lippincott Williams & Wilkins.
6. World Health Organization. (2003). Health and development through physical activity and sport. https://apps.who.int/iris/handle/10665/67796 [Erişim tarihi: 20.05.2022].
7. Ross SA., Engsberg, JR. (2002). Relation between spasticity and strength in individuals with spastic diplegic cerebral palsy. Developmental Medicine and Child Neurology. 44(3), 148–157.
8. Engsberg JR., Ross SA., Olree K. S., Park TS. (2000). Ankle spasticity and strength in children with spastic diplegic cerebral palsy. Developmental Medicine and Child Neurology. 42(1), 42–47.

9. Lebiedowska MK., Fisk JR. (2003). Quantitative evaluation of reflex and voluntary activity in children with spasticity. Archives of Physical Medicine and Rehabilitation. 84(6), 828–837.
10. Bobath KA. (1980). Neurological basis for the treatment of cerebral palsy. William Heineman Books.
11. Balemans AC., Van Wely L., De Heer S. J., Van Den Brink J., De Koning JJ., Becher JG., Dallmeijer AJ. (2013). Maximal aerobic and anaerobic exercise responses in children with cerebral palsy. Medicine and Science in Sports and Exercise. 45(3), 561-568.
12. Nooijen C., Slaman J., Van Der Slot W., Stam H., Roebroeck M., Van Den Berg-Emons R. (2014). Health-related physical fitness of ambulatory adolescents and young adults with spastic cerebral palsy. Journal of Rehabilitation Medicine. 46(7), 642-647.
13. Verschuren O., Takken T. (2010). Aerobic capacity in children and adolescents with cerebral palsy. Research in Developmental Disabilities. 31(6), 1352–1357.
14. Hoofwijk M., Unnithan V., Bar-Or O. (1995). Maximal treadmill performance of children with cerebral palsy. Pediatric Exercise Science. 7(3), 305-313.
15. Lundberg Å. (1984). Longitudinal study of physical working capacity of young people with spastic cerebral palsy. Developmental Medicine & Child Neurology. 26(3), 328–334.
16. Nsenga AL., Shephard RJ., Ahmaidi S. (2013). Aerobic training in children with cerebral palsy. International Journal of Sports Medicine. 34(6), 533–537.
17. Verschuren O., Ketelaar M., Takken T., Helders PJ., Gorter JW. (2008). Exercise programs for children with cerebral palsy: A systematic review of the literature. American Journal of Physical Medicine & Rehabilitation. 87(5), 404–417.
18. Berg K. (1970). Effect of physical training of school children with cerebral palsy. Acta paediatrica Scandinavica. 204, 27.
19. Shinohara TA., Suzuki N., Oba M., Kawasumi M., Kimizuka M., Mita K. (2002). Effect of exercise at the AT point for children with cerebral palsy. Bulletin Hospital for Joint Diseases. 61(1-2), 63–67.
20. Schlough K., Nawoczenski D., Case LE., Nolan K., Wigglesworth JK. (2005). The effects of aerobic exercise on endurance, strength, function and self-perception in adolescents with spastic cerebral palsy: A report of three case studies. Pediatric Physical Therapy. 17(4), 234–250.
21. Lundberg Å, Ovenfors Co, Saltin B. (1967) Effect of physical training on school-children with cerebral palsy. Acta Paediatrica Scandinavica. 56(2), 182–188.
22. Van den Berg-Emons RJ., Van Baak MA., Speth L., Saris, WH. (1998). Physical training of school children with spastic cerebral palsy: Effects on daily activity, fat mass and fitness. International Journal of Rehabilitation Research. 21(2), 179–194.
23. Dormans JP., Rang M. (1990). The problem of Monteggia fracture-dislocations in children. Orthopedic Clinics of North America. 21(2), 251-256.
24. James M., Farmer SE. (2001). Contractures in orthopaedic and neurological conditions: a review of causes and treatment. Disability and Rehabilitation. 23(13), 549-558.
25. Kalkman BM., Holmes G., Bar-On L., Maganaris CN., Barton GJ., Bass A., Wright DM., Walton R., O'Brien TD. (2019). Resistance training combined with stretching ıncreases tendon stiffness and ıs more effective than stretching alone in children with cerebral palsy: a randomized controlled trial. Frontiers in Pediatrics. 7, 333.
26. Wiart L., Darrah J., Kembhavi G. (2008). Stretching with children with cerebral palsy: What do we know and where are we going?. Pediatric Physical Therapy. 20(2), 173–178.
27. Gormley ME. (2001). Treatment of neuromuscular and musculoskeletal problems in cerebral palsy. Pediatric Rehabilitation. 4(1), 5–16.
28. Unnithan VB., Dowling JJ., Frost G., Bar-Or O. (1996). Role of cocontraction in the O2 cost of walking in children with cerebral palsy. Medicine and Science in Sports and Exercise. 28(12), 1498–1504.
29. Eek MN., Beckung E. (2008). Walking ability is related to muscle strength in children with cerebral palsy. Gait & Posture. 28(3), 366–371.
30. Unnithan VB., Katsimanis G., Evangelinou C., Kosmas C., Kandrali I., Kellis E. (2007). Effect of strength and aerobic training in children with cerebral palsy. Medicine and Science in Sports and Exercise. 39(11), 1902–1909.
31. Mockford M., Caulton JM. (2008). Systematic review of progressive strength training in children and adolescents with cerebral palsy who are ambulatory. Pediatric Physical Therapy. 20(4), 318–333.
32. Yıldırım A., Şimşek H. (2018). Sosyal bilimlerde nitel araştırma yöntemleri. Seçkin Yayıncılık. Ankara.
33. Miles MB., Huberman AM. (1994). Qualitative data analysis: An expanded sourcebook. Sage Publication.
34. Thorpe D., Reilly M. Case L. (2005). The effects of an aquatic resistive exercise program on ambulatory children with cerebral palsy. Journal of Aquatic Physical Therapy. 13. 21-34.
35. Verschuren O., Ketelaar M., Gorter JW., Helders PJ., Uiterwaal CS., Takken T. (2007). Exercise training program in children and adolescents with cerebral palsy: A randomized controlled trial. Archives of Pediatrics & Adolescent Medicine. 161(11), 1075–1081.
36. Retarekar R., Fragala-Pinkham MA., Townsend EL. (2009). Effects of aquatic aerobic exercise for a child with cerebral palsy: Single-subject design. Pediatric Physical Therapy. 21(4), 336–344.
37. Kelly ME., Darrah J., Sobsey R, Haykowsky M. Legg D. (2009). Effects of a community-based aquatic exercise program for children with cerebral palsy: A single subject design. Journal of Aquatic Physical Therapy. 17(2), 1-11.
38. Gorter H., Holty L., Rameckers EE., Elvers HJ., Oostendorp RA. (2009). Changes in endurance and walking ability through functional physical training in children with cerebral palsy. Pediatric Physical Therapy. 21(1), 31–37.
39. Fowler EG., Knutson LM., Demuth SK., Siebert KL., Simms VD., Sugi MH., Souza RB., Karim R., Azen SP. (2010). Pediatric endurance and limb strengthening (PEDALS) for children with cerebral palsy using stationary cycling: A randomized controlled trial. Physical Therapy. 90(3), 367–381.
40. Olama KA, (2011). Endurance exercises versus treadmill training in improving muscle strength and functional activities in hemiparetic cerebral palsy. The Egyptian Journal of Medical Human Genetics. 12, 193–199.
41. Ballaz L., Plamondon S., Lemay M. (2011). Group aquatic training improves gait efficiency in adolescents with cerebral palsy. Disability and Rehabilitation. 33(17-18), 1616-1624.
42. Fragala-Pinkham MA., Smith HJ., Lombard KA., Barlow C., O'Neil ME. (2014). Aquatic aerobic exercise for children with cerebral palsy: a pilot intervention study. Physiotherapy Theory and Practice. 30(2), 69–78.
43. Lauglo R., Vik T., Lamvik T., Stensvold D., Finbråten AK., Moholdt T. (2016). High-intensity interval training to improve fitness in children with cerebral palsy. BMJ Open Sport & Exercise Medicine, 2(1), e000111.
44. Mattern-Baxter K., Looper J., Zhou C., Bjornson K. (2020). Low-ıntensity vs high-İntensity home-based treadmill training and walking attainment in young children with spastic diplegic cerebral palsy. Archives of Physical Medicine and Rehabilitation. 101(2), 204–212.
45. Wu YN., Hwang M., Ren Y., Gaebler-Spira D., Zhang LQ. (2011). Combined passive stretching and active movement rehabilitation of lower-limb impairments in children with cerebral palsy using a portable robot. Neurorehabilitation and Neural Repair. 25(4), 378–385.
46. Theis N., Korff T., Kairon H., Mohagheghi AA. (2013). Does acute passive stretching increase muscle length in children with cerebral palsy?. Clinical Biomechanics. 28(9-10), 1061–1067.
47. Elshafey MA., Abd-Elaziem A., Gouda RE. (2014). Functional stretching exercise submitted for spastic diplegic children: A randomized control study. Rehabilitation Research and Practice. 2014, 814279.
48. Theis N., Korff T., Mohagheghi AA. (2015). Does long-term passive stretching alter muscle-tendon unit mechanics in children with spastic cerebral palsy?. Clinical Biomechanics. 30(10), 1071–1076.
49. Tupimai T., Peungsuwan P., Prasertnoo J., Yamauchi J. (2016). Effect of combining passive muscle stretching and whole body vibration on spasticity and physical performance of children and adolescents with cerebral palsy. Journal of Physical Therapy Science. 28(1), 7–13.
50. Awan WA., Masood T. (2016). Role of stretching exercises in the management of constipation ın spastic cerebral palsy. Journal of Applied Mathematics and Computing. 28(4), 798–801.
51. Elanchezhian C., Swarnakumari P. (2019). Efficacy of cold therapy and passive stretching to improve gait in spastic diplegic cerebral palsy children. International Journal of Pediatrics. 7(9), 10109-10118.
52. Ahmadizadeh Z., Khalili MA., Ghalam MS., Mokhlesin M. (2019). Effect of whole body vibration with stretching exercise on active and passive range of motion in lower extremities in children with cerebral palsy: A randomized clinical trial. Iranian Journal of Pediatrics. 29(5), e84436.
53. Kruse A., Habersack A., Jaspers RT., Schrapf N., Weide G., Svehlik M., Tilp, M. (2022). Acute effects of static and proprioceptive neuromuscular facilitation stretching of the plantar flexors on ankle range of motion and muscle-tendon behavior in children with spastic cerebral palsy-A randomized clinical trial. International Journal of Environmental Research and Public Health. 19(18), 11599.
54. Blundell SW., Shepherd RB., Dean CM., Adams RD., Cahill BM. (2003). Functional strength training in cerebral palsy: A pilot study of a group circuit training class for children aged 4-8 years. Clinical Rehabilitation. 17(1), 48–57.
55. Dodd K., Taylor N., Graham H. (2003). A randomized clinical trial of strength training in young people with cerebral palsy. Developmental Medicine & Child Neurology. 45(10), 652-657.
56. Morton JF., Brownlee M., McFadyen AK. (2005). The effects of progressive resistance training for children with cerebral palsy. Clinical Rehabilitation. 19(3), 283–289.
57. Engsberg JR., Ross SA., Collins DR. (2006). Increasing ankle strength to improve gait and function in children with cerebral palsy: A pilot study. Pediatric Physical Therapy. 18(4), 266–275.
58. Unger M., Faure M., Frieg A. (2006). Strength training in adolescent learners with cerebral palsy: A randomized controlled trial. Clinical Rehabilitation. 20(6), 469–477.
59. Lee JH., Sung IY., Yoo JY. (2008). Therapeutic effects of strengthening exercise on gait function of cerebral palsy. Disability and Rehabilitation. 30(19), 1439–1444.
60. McNee AE., Gough M., Morrissey MC., Shortland AP. (2009). Increases in muscle volume after plantarflexor strength training in children with spastic cerebral palsy. Developmental Medicine and Child Neurology. 51(6), 429–435.
61. Reid S., Hamer P., Alderson J., Lloyd D. (2010). Neuromuscular adaptations to eccentric strength training in children and adolescents with cerebral palsy. Developmental Medicine and Child Neurology. 52(4), 358–363.
62. Scholtes VA., Becher JG., Comuth A., Dekkers H., Van Dijk L., Dallmeijer AJ. (2010). Effectiveness of functional progressive resistance exercise strength training on muscle strength and mobility in children with cerebral palsy: a randomized controlled trial. Developmental Medicine and Child Neurology. 52(6), e107–e113.
63. Jung JW., Her JG., Ko J. (2013). Effect of strength training of ankle plantarflexors on selective voluntary motor control, gait parameters, and gross motor function of children with cerebral palsy. Journal of Physical Therapy Science. 25(10), 1259–1263.
64. Dos Santos AN., da Costa CS., Golineleo MT., Rocha NA. (2013). Functional strength training in child with cerebral palsy KMFSS IV: Case report. Developmental Neurorehabilitation. 16(5), 308–314.
65. van Vulpen LF., de Groot S., Rameckers E., Becher JG., Dallmeijer AJ. (2017). Improved walking capacity and muscle strength after functional power-training in young children with cerebral palsy. Neurorehabilitation and Neural Repair. 31(9), 827–841.
66. Peungsuwan P., Parasin P., Siritaratiwat W., Prasertnu J., Yamauchi J. (2017). Effects of combined exercise training on functional performance in children with cerebral palsy: a randomized-controlled study. Pediatric Physical Therapy. 29(1), 39–46.
67. Fosdahl MA., Jahnsen R., Kvalheim K., Holm I. (2019). Effect of a combined stretching and strength training program on gait function in children with cerebral palsy, kmfss level I & II: a randomized controlled trial. Medicina, 55(6), 250.
68. Kruse A., Schranz C., Svehlik M., Tilp M. (2019). The effect of functional home-based strength training programs on the mechano-morphological properties of the plantar flexor muscle-tendon unit in children with spastic cerebral palsy. Pediatric Exercise Science. 31(1), 67–76.
69. Ryan JM., Lavelle G., Theis N., Noorkoiv M., Kilbride C., Korff T., Baltzopoulos V., Shortland A., Levin W., Star Trial Team. (2020). Progressive resistance training for adolescents with cerebral palsy: The STAR randomized controlled trial. Developmental Medicine and Child Neurology. 62(11), 1283–1293.