Structural Equation Modeling of Participation Restrictions, Trunk Control, Dynamic Balance and Environmental Factors in Children with Diplegic Cerebral Palsy

Yıl 2024, Cilt: 11 Sayı: 2, 601 - 614, 02.08.2024

Hasan Bingöl , Dilan Demirtaş Karaoba

https://doi.org/10.21020/husbfd.1397362

Öz

Objective: To test a structural model of trunk balance, dynamic balance and environmental factors as potential determinants of participation restrictions in children with diplegic cerebral palsy (CP)
Material and Method: A total of 35 children with diplegic CP aged between 5-14 years (mean age: 8,68 SD 3.1; 17 boys and 18 girls) were included in the study. Trunk control, dynamic balance, environmental factors, and participation outcomes of the included children were measured with the Trunk Control Measurement Scale (TCMS), Timed Up and Go (TUG) test, European Child Environment Questionnaire (ECEQ), and Assessment of Life Habits (Life-H), respectively. Complex or multiple relationships between defined variables were explored using path analysis-one of Structural Equation Modelling (SEM).
Results: The proposed path model revealed that trunk control had significant and direct effects on dynamic balance and environmental factors variables ((β1= -0,66; p<0,001) and β2= -0,79; p<0,001). A direct effect between trunk control variable and participation parameters could not be found (p>0,05), In contrast, the effects of trunk control on participation parameters was mediated by dynamic balance (β1=-0,10; p<0,05 and β2=-0,46; p<0,05) and environmental factors parameters (β1=-0,58; p<0,001 and β2=-0,21; p<0,05). Furthermore, trunk control, dynamic balance, and environmental factors variables explained 33,9% of variance in participation in daily activities scaled score, whereas the same parameters explained only 9 % of variance in the score of participation in social settings.
Conclusion: Impaired trunk control, poor dynamic balance, and environmental barriers were found to be responsible for poor participation outcomes in children with diplegic CP. This suggests that improving the participation outcomes of the target population necessitates trunk control training, dynamic balance exercises, and environmental modifications.

Anahtar Kelimeler

Child, diplegic cerebral palsy, participation, structural equation modelling

Diplejik Serebral Palsi’li Çocuklarda Katılım Kısıtlılıkları, Gövde Dengesi, Dinamik Denge ve Çevresel Faktörlerin Yapısal Eşitlik Modellemesi

Öz

Amaç: Diplejik Serebral Palsi (SP)’li çocuklarda katılım kısıtlılıklarının potansiyel belirleyicileri olan gövde dengesi, dinamik denge ve çevresel faktörlerin yapısal modelini test etmek
Gereç ve Yöntem: Çalışmaya yaşları 5-14 yıl (ortalama yaş:10,28±2,47; 17 erkek 18 kız) arasında değişen toplam 35 diplejik SP’li çocuk dâhil edildi. Çalışmaya dâhil edilen çocukların gövde kontrolü, dinamik denge ve fonksiyonel mobiliteleri, çevresel faktörler ve katılım özellikleri sırasıyla Gövde Kontrol Ölçüm Skalası (GKÖS), Zamanlı Kalk ve Yürü Testi (ZKYT), Avrupa Çocuk Çevre Anketi (AÇÇA) ve Yaşam Alışkanlıkları Değerlendirme Anketi (Life -H) kullanılarak değerlendirildi. Belirlenen değişkenler arasındaki kompleks veya çoklu ilişkiler yapısal bir eşitlik modeli (YEM) olan Yol Analizi kullanılarak belirlendi.
Bulgular: Önerilen yol modeli, diplejik SP’li çocuklarda gövde kontrolünün dinamik denge ve çevresel faktörler değişkenleri üzerinde anlamlı ve doğrudan etkileri olduğunu ortaya koydu (β1= -0,66; p<0,001 ve β2= -0,79; p<0,001). Gövde kontrolünün katılım parametreleriyle doğrudan ilişkisi bulunamadı (p>0,05). Buna karşılık, gövde kontrollünün katılım parametreleri üzerindeki etkilerine dinamik denge (β1=-0,10; p<0.05 ve β2=-0,46; p<0,05) ve çevresel faktörler (β1=-0,58; p<0,001 ve β2=-0,21; p<0,05) değişkenleri aracılık etmiştir. Son olarak, gövde kontrolü, dinamik denge ve çevresel faktörler parametreleri birlikte günlük aktivitelere katılım skorundaki varyansın %33,9’unu açıklarken, aynı parametreler sosyal ortamlara katılım parametresi skorundaki varyansın sadece %9’unu açıkladı.
Sonuç: Bozulmuş gövde kontrolü, zayıf dinamik denge ve çevresel engeller, diplejik SP'li çocuklarda kötü katılım sonuçlarından sorumlu bulundu. Bu durum, hedef kitlenin katılım sonuçlarının iyileştirilmesi için gövde kontrol eğitimi, dinamik denge egzersizleri ve çevresel değişikliklerin yapılması gerektiğini göstermektedir.

Anahtar Kelimeler

Çocuk, diplejik serebral palsi, katılım, yapısal eşitlik modellemesi

Etik Beyan

Çalışma deseni Muş Alparslan Üniversitesi Bilimsel Araştırma ve Yayın Etiği Kurulu tarafından 08.11.2023-116354 numaralı etik kurul raporuyla onaylanmıştır.

Teşekkür

Çalışma yazarları, bu çalışmanın başarılı bir şekilde tamamlanması için tereddütsüz bağlılıkları ve katılımları vazgeçilmez olan ailelere, hizmet sağlayıcılara ve ilgili kuruluşlara en içten şükranlarını sunarlar.

Kaynakça

• Akbas, A. N., Cankaya, O., Biyik, K. S., Sefa, U., Tuncdemir, M., Arslan, U. E.,& Gunel, M. K. (2021). Reliability and construct validity of the Turkish adaptation of the Assessment of Life Habits for children and adolescents with cerebral palsy. Marmara Medical Journal, 34(2), 101-111. https://doi.org/10.5472/marumj.943118
• Arakelyan, S., Maciver, D., Rush, R., O'Hare, A., &Forsyth, K. (2020). Community‐based participation of children with and without disabilities. Developmental Medicine &Child Neurology, 62(4), 445-453. 10.1111/dmcn.14402
• Bentler, P. M., ve Chou, C.P. (1987). Practical issues in structural modeling. Sociological methods & research, 16(1), 78-117. https://doi.org/10.1177/0049124187016001004
• Bingöl, H., ve Günel, M. K. (2022). Comparing the effects of modified constraint-induced movement therapy and bimanual training in children with hemiplegic cerebral palsy mainstreamed in regular school: A randomized controlled study. Archives de Pédiatrie, 29(2), 105-115. https://doi.org/10.1016/j.arcped.2021.11.017
• Boomsma, A. (1987). The robustness of maximum likelihood estimation in structural equation models. In P. Cuttance & R. Ecob (Eds.), Structural modeling by example: Applications in educational, sociological, and behavioral research (pp. 160–188). Cambridge University Press.
• Calley, A., Williams, S., Reid, S., Blair, E., Valentine, J., Girdler, S., &Elliott, C. (2012). A comparison of activity, participation and quality of life in children with and without spastic diplegia cerebral palsy. Disability and Rehabilitation, 34(15), 1306-1310. https://doi.org/10.3109/09638288.2011.641662
• Cans, C. (2000). Surveillance of cerebral palsy in Europe: A collaboration of cerebral palsy surveys and registers. Developmental Medicine & Child Neurology, 42(12), 816-824. https://doi.org/10.1017/s0012162200001511
• Carey, H., ve Long, T. (2012). The pediatric physical therapist's role in promoting and measuring participation in children with disabilities. Pediatric Physical Therapy, 24(2), 163-170. https://doi.org/10.1097/PEP.0b013e31824c8ea2
• Carey, H., Martin, K., Combs-Miller, S., &Heathcock, J. C. (2016). Reliability and responsiveness of the timed up and go test in children with cerebral palsy. Pediatric Physical Therapy, 28(4), 401-408. https://doi.org/10.1097/PEP.0000000000000301
• Chabrier, S., Pouyfaucon, M., Chatelin, A., Bleyenheuft, Y., Fluss, J., Gautheron, V., & Vuillerot, C. (2020). From congenial paralysis to post-early brain injury developmental condition: Where does cerebral palsy actually stand? Annals of Physical and Rehabilitation Medicine, 63(5), 431-438. https://doi.org/10.1016/j.rehab.2019.07.003
• Chiarello, L. A., Bartlett, D. J., Palisano, R. J., McCoy, S. W., Fiss, A. L., Jeffries, L., & Wilk, P. (2016). Determinants of participation in family and recreational activities of young children with cerebral palsy. Disability and rehabilitation, 38(25), 2455-2468. https://doi.org/10.3109/09638288.2016.1138548
• Çankaya, Ö., Kerem Günel, M., &Özdemir, P. (2022). Construct-concurrent validity and reliability of the European Child Environment Questionnaire (ECEQ) in a sample of Turkish children with cerebral palsy. Disability and Rehabilitation, 44(10), 2104-2112. https://doi.org/10.1080/09638288.2020.1822930
• De Kegel, A., Dhooge, I., Peersman, W., Rijckaert, J., Baetens, T., Cambier, D., &Van Waelvelde, H. (2010). Construct validity of the assessment of balance in children who are developing typically and in children with hearing impairments. Physical Therapy, 90(12), 1783-1794. https://doi.org/10.2522/ptj.20100080
• Elbasan, B., Bozkurt, E., Oskay, D., & Öksüz, Ç. (2017). Upper extremity impairments and activities in children with bilateral cerebral palsy. Iranian Journal of Pediatrics, 27(6). https://doi.org/10.5812/ijp.7711
• Emara, H. A. M. A. H. (2015). Effect of a new physical therapy concept on dynamic balance in children with spastic diplegic cerebral palsy. Egyptian Journal of Medical Human Genetics, 16(1), 77-83. https://doi.org/10.1016/j.ejmhg.2014.09.001
• Heyrman, L., Molenaers, G., Desloovere, K., Verheyden, G., De Cat, J., Monbaliu, E., & Feys, H. (2011). A clinical tool to measure trunk control in children with cerebral palsy: the Trunk Control Measurement Scale. Research in Developmental Disabilities, 32(6), 2624-2635. https://doi.org/10.1016/j.ridd.2011.06.012
• Howard, J., Soo, B., Graham, H. K., Boyd, R. N., Reid, S., Lanigan, A., & Reddihough, D. S. (2005). Cerebral palsy in Victoria: Motor types, topography and gross motor function. Journal of Paediatrics and Child Health, 41(9‐10), 479-483. https://doi.org/10.1111/j.1440-1754.2005.00687.x
• Imms, C., Adair, B., Keen, D., Ullenhag, A., Rosenbaum, P., & Granlund, M. (2016). ‘Participation’: A systematic review of language, definitions, and constructs used in intervention research with children with disabilities. Developmental Medicine & Child Neurology, 58(1), 29-38. https://doi.org/10.1111/dmcn.12932
• Kallem Seyyar, G., Aras, B., & Aras, O. (2019). Trunk control and functionality in children with spastic cerebral palsy. Developmental Neurorehabilitation, 22(2), 120-125. https://doi.org/10.1080/17518423.2018.1460879
• Khumlee, N., Suriyaamarit, D., & Boonyong, S. (2022). Effects of sensory cues on dynamic trunk control in children with spastic diplegic cerebral palsy. Physiotherapy Theory and Practice, 38(13), 2621-2628. https://doi.org/10.1080/09593985.2021.1967541
• Kim, W. H., ve Park, E. Y. (2011). Causal relation between spasticity, strength, gross motor function, and functional outcome in children with cerebral palsy: A path analysis. Developmental Medicine & Child Neurology, 53(1), 68-73. https://doi.org/10.1111/j.1469-8749.2011.04006.x
• King, G., Lawm, M., King, S., Rosenbaum, P., Kertoy, M. K., & Young, N. L. (2003). A conceptual model of the factors affecting the recreation and leisure participation of children with disabilities. Physical and Occupational Therapy in Pediatrics, 23(1), 63-90. PMID: 12703385
• Lee, Y. C., Wu, C. Y., Liaw, M. Y., Lin, K. C., Tu, Y. W., Chen, C. L., ... & Liu, W. Y. (2010). Developmental profiles of preschool children with spastic diplegic and quadriplegic cerebral palsy. The Kaohsiung journal of medical sciences, 26(7), 341-349. https://doi.org/10.1016/S1607-551X(10)70057-7
• Longo, E., Badia, M., ve Orgaz, B. M. (2013). Patterns and predictors of participation in leisure activities outside of school in children and adolescents with cerebral palsy. Research in Developmental Disabilities, 34(1), 266-275. https://doi.org/10.1016/j.ridd.2012.08.017
• Marsico, P., Mitteregger, E., Balzer, J., & van Hedel, H. J. (2017). The Trunk Control Measurement Scale: reliability and discriminative validity in children and young people with neuromotor disorders. Developmental Medicine & Child Neurology, 59(7), 706-712. https://doi.org/10.1111/dmcn.13425
• McIntyre, S., Goldsmith, S., Webb, A., Ehlinger, V., Hollung, S. J., McConnell, K., & Khandaker, G. (2022). Global prevalence of cerebral palsy: A systematic analysis. Developmental Medicine & Child Neurology, 64(12), 1494-1506. https://doi.org/10.1111/dmcn.15346
• Novak, I. (2014). Evidence-based diagnosis, health care, and rehabilitation for children with cerebral palsy. Journal of Child Neurology, 29(8), 1141-1156.
• Palisano, R. J., Chiarello, L. A., Orlin, M., Oeffinger, D., Polansky, M., Maggs, J., & Children's Activity and Participation Group (2011). Determinants of intensity of participation in leisure and recreational activities by children with cerebral palsy. Developmental Medicine & Child Neurology, 53(2), 142-149. https://doi.org/10.1111/j.1469-8749.2010.03819.x
• Panibatla, S., Kumar, V., ve Narayan, A. (2017). Relationship between trunk control and balance in children with spastic cerebral palsy: A cross-sectional study. Journal of Clinical and Diagnostic research: JCDR, 11(9), YC05-YC08. https://doi.org/10.7860/JCDR/2017/28388.10649
• Serdaroǧlu, A., Cansu, A., Özkan, S., & Tezcan, S. (2006). Prevalence of cerebral palsy in Turkish children between the ages of 2 and 16 years. Developmental Medicine & Child Neurology, 48(6), 413-416. 10.1017/S0012162206000910
• Shevell, M. I., Dagenais, L., Hall, N., & Consortium, R. (2009). The relationship of cerebral palsy subtype and functional motor impairment: A population‐based study. Developmental Medicine & Child Neurology, 51(11), 872-877. https://doi.org/10.1111/j.1469-8749.2010.03652.x
• Söke, F., Ataoğlu, N. E. E., Öztekin, M. F., Koçer, B., Karakoç, S., Gülşen, Ç., & Bora, H. A. (2023). Impaired trunk control and its relationship with balance, functional mobility, and disease severity in patients with cervical dystonia. Turkish Journal of Medical Sciences, 53(1), 405- https://doi.org/412. 10.55730/1300-0144.5597
• Tang-Wai, R., Webster, R. I., & Shevell, M. I. (2006). A clinical and etiologic profile of spastic diplegia. Pediatric Neurology, 34(3), 212-218. 10.1016/j.pediatrneurol.2005.08.027
• The Australian Cerebral Palsy Register (ACPR) Group [İnternet]. Australian Cerebral Palsy Register Report 2018 [Erişim Tarihi: 15 Mayıs 2023]. Erişim Linki: https://cpregister.com/wp-content/uploads/2019/02/Report-of-the-Australian-Cerebral-Palsy-Register-Birth-Years-1995-2012.pdf
• Yun, G., Huang, M., Cao, J., & Hu, X. (2023). Selective motor control correlates with gross motor ability, functional balance and gait performance in ambulant children with bilateral spastic cerebral palsy. Gait ve Posture, 99, 9-13. https://doi.org/10.1016/j.gaitpost.2022.10.009
• Wiklund, L. M., ve Uvebrant, P. (1991). Hemiplegic cerebral palsy: Correlation between CT morphology and clinical findings. Developmental Medicine & Child Neurology, 33(6), 512-523. https://doi.org/10.1111/j.1469-8749.1991.tb14916.x
• Wright, F. V., Rosenbaum, P. L., Goldsmith, C. H., Law, M., & Fehlings, D. L. (2008). How do changes in body functions and structures, activity, and participation relate in children with cerebral palsy? Developmental Medicine & Child Neurology, 50(4), 283-289. 10.1111/j.1469-8749.2008.02037.x
• World Health Organization [Internet]. International Classification of Functioning, Disability, and Health: Children ve Youth Version: ICF-CY: World Health Organization; 2007 [Erişim Tarihi: 20 Haziran 2023]. Erişim Linki: https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-healthOzal, C., Ari, G., ve Gunel, M. K. (2019). Inter–intra observer reliability and validity of the Turkish version of Trunk Control Measurement Scale in children with cerebral palsy. Acta Orthopaedica et Traumatologica Turcica, 53(5), 381-384.