Yürüyebilen Spastik Serebral Palsili Çocuklarda Yürüme Özellikleri, Vücut Fonksiyonları, Aktivite ve Katılım Arasındaki İlişki

Abstract

Amaç: Bu kesitsel çalışma, bağımsız olarak yürüyebilen spastik serebral palsili (CP) çocuklarda gözlemsel yürüme analizi kullanılarak değerlendirilen yürüme özellikleri ile vücut fonksiyonları, aktivite ve katılım arasındaki ilişkileri araştırmayı amaçlamıştır. Yöntem: Çalışmaya 4–15 yaş aralığında (ortalama 7,77; dağılım 4–13) olan, Kaba Motor Fonksiyon Sınıflandırma Sistemi’ne (GMFCS) göre seviye I–II düzeyinde sınıflandırılmış, yirmi iki hemiparetik ve yirmi iki diparetik olmak üzere toplam kırk dört spastik SP’li çocuk dahil edilmiştir. Yürüme; Yürüyüşün Zaman-Mesafe Parametreleri (YZMP), Hekim Değerlendirme Skalası (PRS) ve Gillette Fonksiyonel Değerlendirme Anketi (GFAQ) ile değerlendirilmiştir. Beden işlevleri; alt ekstremite kas tonusunu değerlendiren Modifiye Tardieu Skalası (MTS), gövde kontrolünü değerlendiren Gövde Bozukluk Ölçeği (TIS) ve Pediatrik Uzanma Testi (PRT) ile ölçülmüştür. Aktivite ve katılım düzeyleri ise Kaba Motor Fonksiyon Ölçeği (GMFM) ve Pediatrik Engellilik Değerlendirme Envanteri kullanılarak değerlendirilmiştir. Bulgular: Çalışmanın bulguları, spastik SP’li çocukların yürüme özellikleri ile aktivite ve katılım düzeyleri arasında; ayrıca beden yapısı ve işlevleri alanındaki gövde kontrolü değişkeni ile anlamlı ilişkiler bulunduğunu göstermiştir (p < .01). Sonuç: Özellikle gövde kontrolünü değerlendiren TIS ve PRT ile yürüme değerlendirmeleri arasındaki ilişkinin, rehabilitasyon yönetiminde dikkate alınması gerektiği vurgulanmalıdır.

Keywords

• Serebral palsi
• yürüme
• fonksiyon
• katılım
• ICF
• gözlemsel yürüme analizi

Relationships Between Gait Characteristics, Body Functions, Activity, and Participation in Children with Ambulant Spastic Cerebral Palsy

Abstract

Purpose: This cross-sectional study aimed to investigate the relationships between gait characteristics, assessed using observational gait analysis, and body functions, activity, and participation in independently ambulant children with spastic cerebral palsy (CP). Method: A total of 44 children with spastic CP, comprising 22 children with spastic hemiplegia (mean age: 7.18±2.58 years, range: 4–13) and 22 children with spastic diplegia (mean age: 6.95±2.77 years, range: 4–12), classified as levels I and II according to the Gross Motor Function Classification System (GMFCS), were included in the study. Gait was evaluated using Spatiotemporal Gait Parameters (STGP), the Modified Physician Rating Scale (MPRS), and the Gillette Functional Assessment Questionnaire (GFAQ). Body functions were assessed using the Modified Tardieu Scale (MTS) for lower limb muscle tone, and the Trunk Impairment Scale (TIS) and Pediatric Reach Test (PRT) for trunk control. Activity and participation levels were assessed with the Gross Motor Function Measure (GMFM) and the Pediatric Evaluation of Disability Inventory (PEDI). Results: Significant moderate-to-strong correlations were found between gait parameters and ICF components. Trunk control (TIS) showed significant positive correlations with observational gait (MPRS: r=0.576, p<0.001) and functional mobility (GFAQ: r=0.568, p<0.001), but a negative correlation with cadence (r=-0.356, p=0.018). Gross motor activity (GMFM-Total) was strongly correlated with MPRS (r=0.737, p<0.001) and GFAQ (r=0.850, p<0.001). Discussion: In ambulant children with spastic CP, gait quality and walking performance are closely related to trunk control, standing balance, and gross motor skills rather than muscle spasticity alone. Greater trunk stability, dynamic balance, and stride length are positively associated with higher functional mobility and lower caregiver assistance in daily life. Practical observational tools such as the GFAQ and MPRS can effectively guide gait-focused rehabilitation goals in clinical settings.

Keywords

• Cerebral Palsy
• Gait
• Postural Balance
• Social Participation
• International Classification of Functioning
• Disability and Health

References

1. Kavčič A, Vodušek DB. A historical perspective on cerebral palsy as a concept and a diagnosis. Eur J Neurol. 2005;12(8):582-7.
2. Yalçın S, Berker N, Dormans J, Sussman M, editors. Serebral palsi tedavi ve rehabilitasyon. İstanbul: Mas Matbaacılık; 2000.
3. Berker N, Yalçın S. The HELP guide to cerebral palsy. 2nd ed. Istanbul: Global-HELP Organization; 2010.
4. Minear WL. A classification of cerebral palsy. Pediatrics. 1956;18(5):841-52.
5. Quinby JM, Abraham A. Musculoskeletal problems in cerebral palsy. Curr Paediatr. 2005;15(1):9-14.
6. Livanelioğlu A, Kerem Günel M. Serebral palside fizyoterapi. Ankara: Yeni Özbek Matbaası; 2009.
7. Papavasiliou AS. Management of motor problems in cerebral palsy: a critical update for the clinician. Eur J Paediatr Neurol. 2009;13(5):387-96.
8. Sawyer JR. Cerebral palsy. In: Canale ST, Beaty JH, editors. Campbell's operative orthopaedics. 12th ed. Philadelphia: Elsevier; 2013: p. 1254-1311.

9. Kerem Günel M. Rehabilitation of children with cerebral palsy from a physiotherapist's perspective. Acta Orthop Traumatol Turc. 2009;43(2):173-80.
10. Günel MK, Tarsuslu T, Mutlu A, Livanelioğlu A. Investigation of interobserver reliability of the Gillette Functional Assessment Questionnaire in children with spastic diparetic cerebral palsy. Acta Orthop Traumatol Turc. 2010;44(1):63-9.
11. Mäenpää H, Autti-Rämö I, Varho T, Forsten W, Haataja L. Multiprofessional evaluation in clinical practice: establishing a core set of outcome measures for children with cerebral palsy. Dev Med Child Neurol. 2017;59(3):322-8.
12. Bos I, Kuks JBM, Wynia K. Development and testing psychometric properties of an ICF-based health measure: the neuromuscular disease impact profile. J Rehabil Med. 2015;47(5):445-53.
13. Schiariti V, Klassen AF, Cieza A, Sauve K, O'Donnell M, Armstrong R, et al. Comparing contents of outcome measures in cerebral palsy using the International Classification of Functioning (ICF-CY): a systematic review. Eur J Paediatr Neurol. 2014;18(1):1-12.
14. Mackey AH, Lobb GL, Walt SE, Stott NS. Reliability and validity of the Observational Gait Scale in children with spastic diplegia. Dev Med Child Neurol. 2003;45(1):4-11.
15. Novacheck TF, Stout JL, Tervo R. Reliability and validity of the Gillette Functional Assessment Questionnaire as an outcome measure in children with walking disabilities. J Pediatr Orthop. 2000;20(1):75-81.
16. World Health Organization. International classification of functioning, disability and health: ICF. Geneva: World Health Organization; 2001.
17. Gracies JM, Burke K, Clegg NJ, Browne R, Rushing C, Fehlings D, et al. Reliability of the Tardieu Scale for assessing spasticity in children with cerebral palsy. Arch Phys Med Rehabil. 2010;91(3):421-8.
18. Numanoğlu A, Günel MK. Intraobserver reliability of modified Ashworth scale and modified Tardieu scale in the assessment of spasticity in children with cerebral palsy. Acta Orthop Traumatol Turc. 2012;46(3):196-200.
19. Yam WK, Leung MS. Interrater reliability of Modified Ashworth Scale and Modified Tardieu Scale in children with spastic cerebral palsy. J Child Neurol. 2006;21(12):1031-5.
20. Saether R, Helbostad JL, Adde L, Jørgensen L, Vik T. Reliability and validity of the Trunk Impairment Scale in children and adolescents with cerebral palsy. Res Dev Disabil. 2013;34(7):2075-84.
21. Saether R, Jørgensen L. Intra- and inter-observer reliability of the Trunk Impairment Scale for children with cerebral palsy. Res Dev Disabil. 2011;32(2):727-39.
22. Verheyden G, Nieuwboer A, Mertin J, Preger R, Kiekens C, De Weerdt W. The Trunk Impairment Scale: a new tool to measure motor impairment of the trunk after stroke. Clin Rehabil. 2004;18(3):326-34.
23. Bartlett D, Birmingham T. Validity and reliability of a pediatric reach test. Pediatr Phys Ther. 2003;15(2):84-92.
24. Yuksel E, Ozcan Kahraman B, Nalbant A, Kocak UZ, Unver B. Functional Reach and Lateral Reach Tests in Turkish children. Phys Occup Ther Pediatr. 2017;37(4):389-98.
25. Brunton LK, Bartlett DJ. Validity and reliability of two abbreviated versions of the Gross Motor Function Measure. Phys Ther. 2011;91(4):577-88.
26. Feldman AB, Haley SM, Coryell J. Concurrent and construct validity of the Pediatric Evaluation of Disability Inventory. Phys Ther. 1990;70(10):602-10.
27. Nichols DS, Case-Smith J. Reliability and validity of the Pediatric Evaluation of Disability Inventory. Pediatr Phys Ther. 1996;8(1):15-24.
28. Elad D, Barak S, Eisenstein E, Bar O, Herzberg O, Brezner A. Reliability and validity of Hebrew Pediatric Evaluation of Disability Inventory (PEDI) in children with cerebral palsy: health care professionals vs. mothers. J Pediatr Rehabil Med. 2012;5(2):107-15.
29. Erkin G, Elhan AH, Aybay C, Sirzai H, Ozel S. Validity and reliability of the Turkish translation of the Pediatric Evaluation of Disability Inventory (PEDI). Disabil Rehabil. 2007;29(16):1271-9.
30. Stahlhut M, Gard G, Aadahl M, Christensen J. Discriminative validity of the Danish version of the Pediatric Evaluation of Disability Inventory (PEDI). Phys Occup Ther Pediatr. 2011;31(1):78-89.
31. Can A. SPSS ile bilimsel araştırma sürecinde nicel veri analizi. 4th ed. Ankara: Pegem Akademi; 2016.
32. Ross SA, Engsberg JR. Relationships between spasticity, strength, gait, and the GMFM-66 in persons with spastic diplegia cerebral palsy. Arch Phys Med Rehabil. 2007;88(9):1114-20.
33. Balzer J, Marsico P, Mitteregger E, van der Linden ML, Mercer TH, van Hedel HJA. Influence of trunk control and lower extremity impairments on gait capacity in children with cerebral palsy. Disabil Rehabil. 2018;40(26):3164-70.
34. Oeffinger D, Gorton G, Hassani S, Sison-Williamson M, Johnson B, Whitmer M, et al. Variability explained by strength, body composition and gait impairment in activity and participation measures for children with cerebral palsy: a multicentre study. Clin Rehabil. 2014;28(10):1053-63.
35. Huenaerts C, Van Campenhout A, Hanssen B, Papageorgiou E, Molenaers G. To what extent are body structure and gait parameters related with gross motor function in children with cerebral palsy? Gait Posture. 2019;73(Suppl 1):596-7.
36. Kamp FA, Lennon N, Holmes L, Dallmeijer AJ, Henley J, Miller F. Energy cost of walking in children with spastic cerebral palsy: relationship with age, body composition and mobility capacity. Gait Posture. 2014;40(1):209-14.
37. Sullivan E, Barnes D, Linton JL, Calmes J, Damiano D, Oeffinger D, et al. Relationships among functional outcome measures used for assessing children with ambulatory CP. Dev Med Child Neurol. 2007;49(5):338-44.
38. Bjornson KF, Zhou C, Stevenson RD, Christakis D. Relation of stride activity and participation in mobility-based life habits among children with cerebral palsy. Arch Phys Med Rehabil. 2014;95(2):360-8.
39. Fauconnier J, Dickinson HO, Beckung E, Marcelli M, McManus V, Michelsen SI, et al. Participation in life situations of 8-12 year old children with cerebral palsy: cross sectional European study. BMJ. 2009;338:b1458.