TOTAL KÖR, AZ GÖREN VE NORMAL GÖRME YETİSİ OLAN ÇOCUKLARDA STATİK POSTURAL KONTROL VE DİNAMİK TEPE KUVVET DEĞERLERİNİN KARŞILAŞTIRILMASI VE PARAMETRELER ARASI İLİŞKİLERİN İNCELENMESİ

Öz

Giriş: Görme yetisi, postural kontrolün sürdürülebilmesinde önemli bir rol oynar Amaç: Çalışmamızın amacı farklı seviyelerde doğuştan görme kaybı olan ve normal görme yetisine sahip çocuklarda, statik CoP (Center of Pressure) salınımı ile dinamik plantar temas alanlarındaki tepe kuvvet torklarının karşılaştırılması ve bu parametreler arasındaki ilişkilerin incelenmesidir. Yöntem: Çalışmaya 7-14 yaş aralığında olan 68 çocuk dahil edildi ve normal gören, az gören ve total kör olarak 3 gruba ayrıldı. Statik CoP değerlerinin ve dinamik tepe kuvvet torklarının elde edilmesi amacıyla taşınabilir AS Ayak Tarama (Analiz Sistem®, İstanbul, Türkiye) sistemi kullanıldı. Bulgular: Çocukların yaş, vücut ağırlığı, boy uzunluğu, beden kütle indeksi, cinsiyet ve dominant ekstremite dağılımlarının benzer olduğu görüldü (p>0,05). Statik ayakta duruşta gruplar arası karşılaştırmalarda CoP toplam yol uzunluğu (path length) değeri hariç (p=0,002) diğer sonuçlar açısından grupların benzer olduğu görüldü (p>0,05). Dinamik olarak ölçülen tepe kuvvet tork değerlerinin dominant ve non-dominant alt ekstremitelerde üç grup arasında benzer olduğu bulundu (p>0,05). Normal görenlerde ise CoP path length değerlerinin dominant ve non-dominat ayağın 1. metatarsal alanı, orta ayak ve topuk medialinden elde edilen tepe kuvvet torkları ile negatif yönde ve orta kuvvette ilişkisi olduğu bulundu (p<0,05). Sonuç: Görme engelli çocuklar, statik postural kontrol sırasında normal gören akranlarına kıyasla daha fazla salınım göstermelerine rağmen, dinamik plantar kuvvet dağılımında anlamlı bir fark bulunmamıştır. Statik ölçüm sonuçları ile dinamik tepe kuvvet tork değerleri arasındaki zayıf–orta ilişki, postural kontrolün sağlanması için geliştirilen bir strateji gibi görünmektedir. Bu durum, görsel girdi eksikliğinin denge mekanizmaları üzerinde etkili olduğunu göstermektedir.

Anahtar Kelimeler

• Görme engeli
• pedobarografik analiz
• postural kontrol

COMPARISON OF STATIC POSTURAL CONTROL AND DYNAMIC PEAK FORCE VALUES IN TOTALLY BLIND, LOW VISION AND NORMAL VISION CHILDREN AND EXAMINATION OF RELATIONSHIPS BETWEEN PARAMETERS

Öz

Background: Vision plays an important role in maintaining postural control. Aim: The aim of our study is to compare static CoP (Center of Pressure) sway with peak force torques in dynamic plantar contact areas in children with different levels of congenital vision impairment and children with normal vision, and to examine the relationships between these parameters. Method: Sixty-eight children aged 7–14 years were included in the study and divided into three groups: normal vision, low vision, and total blindness. A portable AS Foot Scanning System (Analiz Sistem®, Istanbul, Turkey) was used to obtain static CoP values and dynamic peak force torques. Results: The age, body weight, height, body mass index (BMI), gender, and dominant extremity distribution of the children included in the study were found to be similar (p>0.05). Examination of the CoP data during static standing revealed that, except for the CoP Path Length value (p=0.002), the intergroup comparisons showed similar results (p>0.05). The dynamically measured peak force torque values of the dominant and non-dominant lower extremities were also found to be similar among the three groups (p>0.05). Conclusion: Although visually impaired children show more postural sway than their sighted peers during static postural control, no significant difference was found in dynamic plantar force distribution. The weak to moderate relationship between static results and dynamic peak force torque values appears to be a strategy developed to maintain postural control. This demonstrates that the lack of visual input affects balance mechanisms. Keywords: Visual impairment, pedobarographic analysis, postural control

Anahtar Kelimeler

• Visual impairment
• pedobarographic analysis
• postural control

Kaynakça

1. 1. Ghasemi Fard F, Mirzaie H, Hosseini SA, Riazi A, Ebadi A. Vision-related tasks in children with visual impairment: A multimethod study. Frontiers in Psychology. 2023;14:1180669.
2. 2. Bakke HA, Cavalcante WA, de Oliveira IS, Sarinho SW, Cattuzzo MT. Assessment of motor skills in children with visual impairment: A systematic and integrative review. Clinical Medicine Insights: Pediatrics. 2019;13:1179556519838287.
3. 3. Gogate P, Gilbert C, Zin A. Severe visual impairment and blindness in infants: Causes and opportunities for control. Middle East African Journal of Ophthalmology. 2011;18(2):109-14.
4. 4. Yu B, Dai L, Chen J, Sun W, Chen J, Du L, et al. Prenatal and neonatal factors for the development of childhood visual impairment in primary and middle school students: A crosssectional survey in Guangzhou, China. BMJ Open. 2020;10(9):e032721.
5. 5. Gazzellini S, Lispi ML, Castelli E, Trombetti A, Carniel S, Vasco G, et al. The impact of vision on the dynamic characteristics of the gait: Strategies in children with blindness. Experimental brain research. 2016;234(9):2619-27.
6. 6. Mesci E. Pedobarographic evaluations in physical medicine and rehabilitation practice. Turkish Journal of Physical Medicine and Rehabilitation. 2023;69(4):400-9.
7. 7. Teo I, Thompson J, Neo YN, Lundie S, Munnoch DA. Lower limb dominance and volume in healthy individuals. Lymphology. 2017;50(4):197-202.
8. 8. Kokhan S, Romanova E, Nadeina L, Skaliy T, Kowalski W, Petrova-Gotova T, et al. Goalball as a factor of physical rehabilitation of students with visual impairments. Palaestra. 2021;35(3):28-36.

9. 9. Seyhan S, Açar G, Yaşasın Y, Üzümcü B, Sinen H. Investigation of foot biomechanics in 5–15 years old children performing gymnastics. Research in Sport Education and Sciences. 2024;26(3):119-25.
10. 10. Soylu C, Karataş CŞ, Açar G. Reliability and validity of Analiz Sistem in plantar pressure assessment for unilateral chronic ankle instability. Istanbul Gelisim University Journal of Health Sciences. 2025;26:464-76.
11. 11. Quijoux F, Nicolaï A, Chairi I, Bargiotas I, Ricard D, Yelnik A, et al. A review of center of pressure (COP) variables to quantify standing balance in elderly people: Algorithms and openaccess code. Physiological Reports. 2021;9(22):e15067.
12. 12. Prion S, Haerling KA. Making sense of methods and measurement: Spearman-rho ranked-order correlation coefficient. Clinical Simulation in Nursing. 2014;10(10):535-6.
13. 13. Tomomitsu MS, Alonso AC, Morimoto E, Bobbio TG, Greve J. Static and dynamic postural control in low-vision and normal-vision adults. Clinics. 2013;68(4):517-21.
14. 14. Zarei H, Norasteh AA, Lieberman LJ, Ertel MW, Brian A. Balance control in individuals with visual impairment: A systematic review and meta-analysis. Motor Control. 2023;27(4):677-704.
15. 15. Alghadir AH, Alotaibi AZ, Iqbal ZA. Postural stability in people with visual impairment. Brain and Behavior. 2019;9(11):e01436.
16. 16. Daneshmandi H, Norasteh AA, Zarei H. Balance in the blind: A systematic review. Physical Treatments-Specific Physical Therapy Journal. 2021;11(1):1-12.
17. 17. Nakata H, Yabe K. Automatic postural response systems in individuals with congenital total blindness. Gait Posture. 2001;14(1):36-43.
18. 18. Schmid M, Nardone A, De Nunzio AM, Schmid M, Schieppati M. Equilibrium during static and dynamic tasks in blind subjects: No evidence of cross-modal plasticity. Brain. 2007;130(Pt8):2097-107.
19. 19. Salari A, Sahebozamani M, Daneshjoo A, Karimi Afshar F. Assessment of balance recovery strategies during manipulation of somatosensory, vision, and vestibular system in healthy and blind women. Journal of Rehabilitation Sciences & Research. 2019;6(3):123-9.
20. 20. Zipori AB, Colpa L, Wong AMF, Cushing SL, Gordon KA. Postural stability and visual impairment: Assessing balance in children with strabismus and amblyopia. PLoS One. 2018;13(10):e0205857.
21. 21. Mohammadi F, Bayati M, Abbasi H, Allafan N. Better functioning of the somatosensory system in postural control of blind athletes compared to non-athletes. The Scientific Journal of Rehabilitation Medicine. 2019;8(3):179-87.
22. 22. Häkkinen A, Holopainen E, Kautiainen H, Sillanpää E, Häkkinen K. Neuromuscular function and balance of prepubertal and pubertal blind and sighted boys. Acta Paediatrica. 2006;95(10):1277-83.
23. 23. Rutkowska I, Skowroński W. A comparison of body balance of blind children aged 7–16 years in sex and age categories. Studies in Physical Culture & Tourism. 2007;14(Suppl):287-92.
24. 24. Rutkowska I, Bednarczuk G, Molik B, Morgulec-Adamowicz N, Marszałek J, Kaźmierska-Kowalewska K, et al. Balance functional assessment in people with visual impairment. Journal of Human Kinetics. 2015;48:99-109.
25. 25. Kırmızı M, Şengül YS, Angın S. The effects of gait speed on plantar pressure variables in individuals with normal foot posture and flatfoot. Acta of Bioengineering and Biomechanics. 2020;22(3):161–168.
26. 26. Fragua-Blanca R, Tovaruela-Carrión N, TenaLeón MJ, Escamilla-Martínez E. Variations in centre of pressure and balance performance induced by footwear drop in healthy adults. International Orthopaedics. 2025;1-9.
27. 27. Abu-Faraj ZO, Faraj YT, Mohtar KH, Rammal MM. Characterization of plantar pressures in visually impaired individuals: A pilot study. 6th International IEEE/EMBS Conference on Neural Engineering. 2013;2013:1549-53.
28. 28. Castro KJS, Salomão RC, Feitosa NQ Jr, Henriques LD, Kleiner AFR, Belgamo A, et al. Changes in plantar load distribution in legally blind subjects. PLoS One. 2021;16(4):e0249467.
29. 29. Hallemans A, Ortibus E, Truijen S, Meire F. Development of independent locomotion in children with a severe visual impairment. Research in Developmental Disabilities. 2011;32:2069-74.
30. 30. Majlesi M, Farahpour N, Robertson GE. Comparisons of spatiotemporal and ground reaction force components of gait between individuals with congenital vision loss and sighted individuals. Journal of Visual Impairment & Blindness. 2020;114:277-88.
31. 31. Hallemans A, Ortibus E, Meire F, Aerts P. Low vision affects dynamic stability of gait. Gait Posture. 2010;32(4):547-55.