Relation between balance, functional mobility, walking endurance and participation in ambulatory children with spastic bilateral cerebral palsy - Balance and participation in cerebral palsy

Öz

Purpose: This study aimed to investigate the relationship between balance, functional mobility, walking performance and level of participation in ambulatory children with cerebral palsy. Methods: the study included 43 children with spastic bilateral cerebral palsy and 26 children with typical development. Mobility of children with cerebral palsy was evaluated with Gross Motor Function Classification System, in which 18 of them were in level I and 25 children in level II. Balance skills and functional mobility were evaluated with Pediatric Balance Scale, Timed Up and Go Test, and 1 Minute Walk Test in children with cerebral palsy and typical development. Pediatric Outcome Data Collection Instrument was used to assess the participation level of children of two groups. The differences between groups were determined by Kruskall Wallis test and the Spearman Correlation test was used to analyze the relationship between functional balance, activity, and participation. Results: Compared to children with typical development, balance skills were found to be lower in children with cerebral palsy (p:0.001). Balance status were correlated positively with walking performance (r:0.631) and activity of participation (r:0.796), but negatively (r:-0.774) with functional mobility in children with cerebral palsy. Conclusion: The impairment of balance skills in children with CP reduces the levels of mobility, transfer, functionality and participation in daily life activities. As dynamic balance skills increase, functional balance, mobility level and social functions also improve.

Anahtar Kelimeler

• Cerebral palsy
• Participation
• Postural balance

Yürüyebilen spastik bilateral serebral palsili çocuklarda denge, fonksiyonel mobilite, yürüme enduransı ve katılım arasındaki ilişki - Serebral palside denge ve katılım

Öz

Amaç: Bu çalışma yürüyebilen serebral palsili çocuklarda denge, fonksiyonel mobilite, yürüme performansı ve katılım düzeyi arasındaki ilişkisinin araştırılması amacıyla yapılmıştır. Yöntem: Çalışmaya bilateral spastik serebral palsili 43 çocuk ve tipik gelişim gösteren 26 çocuk dahil edildi. Serebral palsili çocuklarda mobilite Kaba Motor Fonksiyon Sınıflandırma Sistemi ile değerlendirildi; bunların 18'i seviye I, 25'i ise seviye II idi. Serebral palsili ve tipik gelişim gösteren çocuklarda, denge becerileri ve fonksiyonel hareketlilik, Pediatrik Denge Skalası, Süreli Kalk ve Yürü Testi ve 1 Dakika Yürüme Testi ile değerlendirildi. İki gruptaki çocukların katılım düzeyini değerlendirmek için Pediatrik Sonuç Veri Toplama Aracı kullanıldı. Gruplar arasındaki farklar Kruskall Wallis testi ile belirlendi ve fonksiyonel denge, aktivite ve katılım arasındaki ilişkinin analizinde Spearman Korelasyon testi kullanıldı. Bulgular: Serebral palsili çocuklarda denge becerileri normal gelişim gösteren çocuklara göre daha düşük olduğu belirlendi (p:0,001). Serebral palsili çocuklarda denge durumu, yürüme performansı (r:0,631) ve katılım aktivitesi (r:0,796) ile pozitif, fonksiyonel hareketlilik ile ise negatif (r:-0,774) ilişkili olarak bulundu. Sonuç: SP'li çocuklarda denge becerilerinin etkilenimi, hareketlilik, transfer, işlevsellik ve günlük yaşam aktivitelerine katılım düzeylerini azaltmaktadır. Dinamik denge becerileri arttıkça fonksiyonel denge, mobilite düzeyi ve sosyal işlevler de gelişmektedir.

Anahtar Kelimeler

• Serebral palsi
• Katılım
• Postural denge

Kaynakça

1. Gunel MK, editor. Cerebral palsy: Current steps. Definition, Epidemiology, and Etiological Factors of Cerebral Palsy. Kurt E. BoD–Books on Demand; 2016;4-5.
2. Saether R, Helbostad JL, Riphagen II, Vik T. Clinical tools to assess balance in children and adults with cerebral palsy: a systematic review. Dev Med Child Neurol. 2013;55:988.
3. Beckung E, Hagberg G, Uldall P, Cans C, Surveillance of Cerebral Palsy in Europe. Probability of walking in children with cerebral palsy in Europe. Pediatrics. 2008;121:e187-92.
4. Freeborn D, Knafl K. Growing up with cerebral palsy: perceptions of the influence of family. Child Care Health Dev. 2014;40:671-9.
5. Alriksson‐Schmidt A, Nordmark E, Czuba T, Westbom L. Stability of the Gross Motor Function Classification System in children and adolescents with cerebral palsy: a retrospective cohort registry study. Developmental Medicine & Child Neurology. 2017;59:641-6.
6. Sahoo R, Rege S, Rao S. Social Participation in Children with Cerebral Palsy. Online J Health Allied Scs. 2017;16:5.
7. Schiariti V, Mahdi S, Bölte S. International Classification of Functioning, Disability and Health Core Sets for cerebral palsy, autism spectrum disorder, and attention‐deficit–hyperactivity disorder. Dev Med Child Neurol. 2018;60:933-41.
8. Kwon JY, Chang HJ, Yi SH, Lee JY, Shin HY, Kim YH. Effect of hippotherapy on gross motor function in children with cerebral palsy: a randomized controlled trial. J Altern Complement Med. 2015;21:15-21.

9. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Gross motor function classification system for cerebral palsy. Dev Med Child Neurol.1997;39:214-23.
10. El Ö, Baydar M, Berk H, Peker Ö, Koşay C, Demiral Y. Interobserver reliability of the Turkish version of the expanded and revised gross motor function classification system. Disabil Rehabil. 2021;34:1030-33.
11. Chen CL, Shen IH, Chen CY, Wu CY, Liu WY, Chung CY. Validity, responsiveness, minimal detectable change, and minimal clinically important change of Pediatric Balance Scale in children with cerebral palsy. Res Dev Disabil. 2013;34:916-22.
12. Erden A, Acar Arslan E, Dündar B, Topbaş M, Cavlak U. Reliability and validity of Turkish version of pediatric balance scale. Acta Neurologica Belgica. 2021;121:669-75.
13. Dhote SN, Khatri PA, Ganvir SS. Reliability of "Modified timed up and go" test in children with cerebral palsy. J Pediatr Neurosci. 2012;7:96-100.
14. McDowell BC, Kerr C, Parkes J, Cosgrove A. Validity of a 1 minute walk test for children with cerebral palsy. Dev Med Child Neurol. 2005;47:744-8.
15. Hassani S, Krzak JJ, Johnson B, Flanagan A, Gorton III G, Bagley A, et al. One‐Minute Walk and modified Timed Up and Go tests in children with cerebral palsy: performance and minimum clinically important differences. Dev Med Child Neurol. 2014;56:482-9.
16. Keskin Dilbay N, Kerem Günel M, Aktan T. Pediatrik Veri Toplama Aracının (PVTA) Türkçe versiyonunun serebral palsili bireylerde geçerlik ve güvenirliği. Fizyoter Rehabil. 2013;24:118-126.
17. Faul F, Erdfelder E, Lang AG, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:75-191.
18. Kembhavi G, Darrah J, Magill-Evans J, Loomis J. Using the berg balance scale to distinguish balance abilities in children with cerebral palsy. Pediatr Phys Ther. 2002;14:92-9.
19. Gan SM, Tung LC, Tang YH, Wang CH. Psychometric properties of functional balance assessment in children with cerebral palsy. Neurorehabil Neural Repair. 2008;22:745-53.
20. Barnes D, Linton JL, Sullivan E, Bagley A, Oeffinger D, Abel M, et al. Pediatric outcomes data collection instrument scores in ambulatory children with cerebral palsy: an analysis by age groups and severity level. J Pediatr Orthop. 2008;28:97-102.
21. Mehraban AH, Hasani M, Amini M. The comparison of participation in school-aged Cerebral Palsy children and normal peers: A preliminary study. Iran J Pediatr. 2016;26:e5303.
22. Oeffinger D, Gorton G, Bagley A, Nicholson D, Barnes D, Calmes J, et al. Outcome assessments in children with cerebral palsy, part I: descriptive characteristics of GMFCS Levels I to III. Dev Med Child Neurol. 2007;49:172-80.
23. Park ES, Rha D-W, Shin JS, Kim S, Jung S. Effects of hippotherapy on gross motor function and functional performance of children with cerebral palsy. Yonsei Med J. 2014;55:1736-42.
24. Sadowska M, Sarecka-Hujar B, Kopyta I. Cerebral Palsy: Current Opinions on Definition, Epidemiology, Risk Factors, Classification and Treatment Options. Neuropsychiatr Dis Treat. 2020;16:1505-18.
25. Moraes AG, Copetti F, Angelo VR, Chiavoloni LL, David AC. The effects of hippotherapy on postural balance and functional ability in children with cerebral palsy. J Phys Ther Sci. 2016;28:2220-6.
26. Alghamdi MS, Chiarello LA, Palisano RJ, McCoy SW. Understanding participation of children with cerebral palsy in family and recreational activities. Res Dev Disabil. 2017;69:96-104.
27. El-Shamy SM, Abd El Kafy EM. Effect of balance training on postural balance control and risk of fall in children with diplegic cerebral palsy. Disabil Rehabil. 2014;36:1176-83.
28. Gainsborough M, Surman G, Maestri G, Colver A, Cans C, Surveillance of Cerebral Palsy in Europe collaborative group.Validity and reliability of the guidelines of the surveillance of cerebral palsy in Europe for the classification of cerebral palsy. Developmental Med Child Neurol. 2008;50:828-31.