HEMİPARETİK SEREBRAL PALSİLİ ÇOCUKLARDA EV EGZERSİZİ OLARAK UYGULANAN AYNA TEDAVİSİNİN EL BECERİLERİ ÜZERİNE ETKİSİ
Yıl 2025,
Cilt: 3 Sayı: 1, 33 - 47, 25.04.2025
Hacı Osman Talaz
Erdoğan Kavlak
Öz
Amaç: Hemiparetik serebral palsili çocuklarda ev egzersizi olarak uygulanan ayna tedavisinin el becerileri üzerine etkisini incelemek amacıyla planlanmıştır.
Yöntem: Çalışmaya toplamda 4- 18 yaş arası 23 Hemiparetik SP (Serebral Palsi)’li çocuk dahil edildi. Çalışma gruplarındaki çocuklar randomizasyon yöntemi ile belirlendi. Tüm katılımcılar Özel Denizli Yağmur Çocukları Özel Eğitim ve Rehabilitasyon Merkezi ve Özel Esenyurt Özel Eğitim ve Rehabilitasyon Merkezi’nden belirlendi. Bu kapsamda Hemiparetik SP’li çocuklar Kaba Motor Fonksiyon Ölçütü (KMFÖ), Kaba Motor Fonksiyon Sınıflandırma Sistemi (KMFSS), El Becerileri Sınıflandırma Sistemi (EBSS), Dokuz Delikli Peg Testi, ölçekleri kullanılarak değerlendirildi. Toplamda her iki grup çocuklar 8 hafta boyunca Bobath Terapisi alırken çalışma grubundaki çocuklara ek ev egzersizi olarak ayna egzersizleri yaptırıldı, telekonferans ve video kayıt yöntemiyle izlendi.
Sonuçlar: Çalışmada sekiz hafta boyunca çalışma grubundaki çocuklara fizyoterapist ve aile gözetiminde Ev Egzersizi Olarak Uygulanan Ayna Tedavisinin el becerileri üzerine anlamlı bir etkisi olduğu bulundu (p<0,05). Kontrol grubundaki bazı çocuklarda minimal düzeyde ilerleme olduğu görüldü (p<0,05). Hemiparetik SP’li çocuklarda ev egzersizi olarak uygulanan Ayna Tedavisinin el becerilerinin artırılmasında daha etkili olduğu belirlendi (p<0,05).
Tartışma: Çalışmada ev egzersizi olarak yapılan ayna tedavisi sonucunda çocuklarda üst ekstremite fonksiyonel kapasitesinin anlamlı olarak arttığı görülmüştür. Bu gelişme sonucunda ayna egzersiz programında kullanılan egzersizlerin üst ektremite kas kuvvetini artırmasında etkili olduğunu düşünmekteyiz. Bununla beraber ayna tedavisinin Hemiparetik SP’li çocukların üst ekstremite kas kuvveti üzerine etkisini net olarak belirleyebilmek için ileri çalışmalar yapılmasına ihtiyaç olduğu kanısındayız.
Etik Beyan
Çalışma için Pamukkale Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulundan 16.01.2018 tarih ve 60116787-020/4316 sayılı etik kurul onayı alınmıştır. Yüksek Lisans Tez projesi Pamukkale Üniversitesi Bilimsel Araştırma Projesi (BAP)(2018SABE019 ) tarafından desteklenmiştir.
Destekleyen Kurum
Yüksek Lisans Tez projesi Pamukkale Üniversitesi Bilimsel Araştırma Projesi (BAP)(2018SABE019 ) tarafından desteklenmiştir.
Proje Numarası
2018SABE019
Teşekkür
Yüksek Lisans Tez projesini destekleyen Pamukkale Üniversitesi Bilimsel Araştırma Projelerine teşekkür ederiz.
Kaynakça
-
1. Bax M, Bower E, Boyd RN, Brown JK, Damiano D, Edwards S. Management of the motor disorders of children with cerebral palsy. In: Scrutton D, Damiano D, Mayston M, editors. 2nd ed. London: Mac Keith Press; 2004.
-
2. Cavlak U, Kavlak E. Analysing of ankle-foot deformities in cerebral palsied children: A retrospective study. Journal of Medical Science. 2005;5(1):55-60.
-
3. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M. A report: the definition and classification of cerebral palsy. Dev Med Child Neurol. 2007;49:8-14.
-
4. Bourelle S, Berge B, Gautheron V, Cottalorda J. Computerized static posturographic assessment after treatment of equinus deformity in children with cerebral palsy. J Pediatr Orthop. 2010;19:211-220.
-
5. Winter S, Autry A, Boyle C, Yeargin-Allsopp M. Trends in the prevalence of cerebral palsy in a population-based study. Pediatrics. 2002;110(6):1220-5.
-
6. Serdaroğlu A, Cansu A, Özkan S, Tezcan S. Prevalence of cerebral palsy in Turkish children between the ages of 2 and 16 years. Dev Med Child Neurol. 2006;48(6):413-6.
-
7. Erkin G, Delialioğlu SU, Ozel S, Culha C, Sirzai H. Risk factors and clinical profiles in Turkish children with cerebral palsy: analysis of 625 cases. Int J Rehabil Res. 2008;31(1):89-91.
-
8. Livanelioğlu A, Günel M. Serebral Palsi'de fizyoterapi. Ankara: Yeni Özbek Matbaası; 2009. p. 5-12.
-
9. Sgandurra G, Ferrari A, Cossu G, et al. Upper limb children action-observation training (UP-CAT): a randomised controlled trial in hemiplegic cerebral palsy. BMC Neurol. 2011;11:80.
-
10. Duque J, Thonnard JL, Vandermeeren Y, et al. Correlation between impaired dexterity and corticospinal tract dysgenesis in congenital hemiplegia. Brain. 2003;126:732-47.
-
11. Lim AJ, Han SH, Kim SR, et al. The effect of eye movement program on postural control and visual perceptual ability of children with spastic cerebral palsy. KSOT. 2011;19:85-96.
-
12. Hong EK. Systematic review on occupational therapy for children with cerebral palsy. J Korean Conten Assoc. 2013;13:315-30.
-
13. Bhasin A, Padma Srivastava MV, Kumaran SS, et al. Neural interface of mirror therapy in chronic stroke patients: a functional magnetic resonance imaging study. Neurol India. 2012;60:570-6.
-
14. Rizzolatti G, Craighero L. The mirror-neuron system. Annu Rev Neurosci. 2004;27:169-92.
-
15. Fleishman EA, Rich S. Role of kinesthetic and spatial–visual ability in perceptual-motor learning. J Exp Psychol. 1963;66(1):6-11.
-
16. Verrel J, Bekkering H, Steenbergen B. Eye–hand coordination during manual object transport with the affected and less affected hand in adolescents with hemiparetic cerebral palsy. Exp Brain Res. 2008;187(1):107-16.
-
17. Stevens JA, Stoykov ME. Using motor imagery in the rehabilitation of hemiparesis. Arch Phys Med Rehabil. 2003;84:1090-2.
-
18. Park SH, Lee SM, Kim SB. The influence of motor cortical excitability on visual illusion using mirror, motor imagery and action observation. KJSP. 2009;20:211-22.
-
19. Cho S, Ku J, Cho YK, et al. Development of virtual reality proprioceptive rehabilitation system for stroke patients. Comput Methods Programs Biomed. 2014;113(1):258-65.
-
20. Smorenburg ARP, Ledebt A, Deconinck FJA, Savelsbergh GJP. Matching accuracy in hemiparetic cerebral palsy during unimanual and bimanual movement with (mirror) visual feedback. Res Dev Disabil. 2012;33(6):2088-98.
-
21. Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH. Content validity of the expanded and revised Gross Motor Function Classification System. Dev Med Child Neurol. 2008;50(10):744-50.
-
22. Russell DJ, Avery LM, Rosenbaum PL, Raina PS, Walter SD, Palisano RJ. Improved scaling of the gross motor function measure for children with cerebral palsy: evidence of reliability and validity. Phys Ther. 2000;80(9):873-85.
-
23. Eliasson AC, Krumlinde Sundholm L, Rösblad B, Beckung E, Arner M, Öhrvall AM, Rosenbaum P. The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol. 2006;48:549-54.
-
24. Kellor M, Frost J. Am J Occup Ther. 1971 Mar;25(2):77-83.
-
25. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67(2):206-7.
-
26. Wulf G, Chiviacowsky S, Lewthwaite R. Normative feedback effects on learning a timing task. Res Q Exerc Sport. 2010;81(4):425-31.
-
27. Iacoboni M, Mazziotta JC. Mirror neuron system: basic findings and clinical applications. Ann Neurol. 2007;62(3):213-8.
-
28. Broetz D, Birbaumer N. Behavioral physiotherapy in post stroke rehabilitation. NeuroRehabilitation. 2013;33(3):377-84.
-
29. Cho S, Ku J, Cho YK, et al. Development of virtual reality proprioceptive rehabilitation system for stroke patients. Comput Methods Programs Biomed. 2014;113(1):258-65.
-
30. Eng K, Siekierka E, Pyk P, et al. Interactive visuo-motor therapy system for stroke rehabilitation. Med Biol Eng Comput. 2007;45(9):901-7.
-
31. McCabe CS, Haigh RC, Ring EF, et al. A controlled pilot study of the utility of mirror visual feedback in the treatment of complex regional pain syndrome (type 1). Rheumatology (Oxford). 2003;42:97-101.
-
32. You SJ. An effect of mirror therapy on upper extremity function and activities of daily living in patients with post-stroke hemiplegia. Daegu University; 2010.
-
33. Nojima I, Mima T, Koganemaru S, et al. Human motor plasticity induced by mirror visual feedback. J Neurosci. 2012;32:1293-300.
-
34. Ramachandran VS, Rogers-Ramachandran D. Synaesthesia in phantom limbs induced with mirrors. Proc Biol Sci. 1996;263(1369):377-86.
-
35. Ramachandran VS. Phantom limbs, neglect syndromes, repressed memories, and Freudian psychology. Int Rev Neurobiol. 1994;37:291-333; discussion 369-72.
THE EFFECT OF MIRROR THERAPY APPLIED AS HOME EXERCISE ON HAND SKILLS IN CHILDREN WITH HEMIPARETIC CEREBRAL PALSY
Yıl 2025,
Cilt: 3 Sayı: 1, 33 - 47, 25.04.2025
Hacı Osman Talaz
Erdoğan Kavlak
Öz
Purpose: The aim of this study was to investigate the effect of mirror therapy applied as a home exercise on manual dexterity in children with hemiparetic cerebral palsy.
Methods: A total of 23 children with hemiparetic CP (Cerebral Palsy) aged 4-18 years were included in the study. Children in the study groups were determined by randomization method. All participants were recruited from Denizli Yağmur Çocukları Private Education and Rehabilitation Center and Esenyurt Private Education and Rehabilitation Center. In this context, children with hemiparetic CP were evaluated using the Gross Motor Function Measure (GMFM), Gross Motor Function Classification System (GMFCS), Manual Skills Classification System (MDSS), Nine Hole Peg Test, scales. In total, both groups of children received Bobath Therapy for 8 weeks, while the children in the study group were given mirror exercises as an additional home exercise and monitored by teleconference and video recording.
Results: In the study, it was found that Mirror Therapy Applied as Home Exercise to the children in the study group under the supervision of a physiotherapist and family for eight weeks had a significant effect on manual dexterity (p<0.05). Some children in the control group showed minimal improvement (p<0.05). Mirror therapy applied as a home exercise was found to be more effective in increasing manual dexterity in children with hemiparetic CP (p<0.05).
Conclusion: In the study, it was observed that the functional capacity of the upper extremity increased significantly in children as a result of mirror therapy as home exercise. As a result of this development, we think that the exercises used in the mirror exercise program are effective in increasing upper extremity muscle strength. However, we believe that further studies are needed to determine the effect of mirror therapy on upper extremity muscle strength of children with hemiparetic CP.
Etik Beyan
The study was approved by Pamukkale University Non-Interventional Clinical Research Ethics Committee dated 16.01.2018 and numbered 60116787-020/4316. The Master's Thesis project was supported by Pamukkale University Scientific Research Project (BAP) (2018SABE019).
Proje Numarası
2018SABE019
Kaynakça
-
1. Bax M, Bower E, Boyd RN, Brown JK, Damiano D, Edwards S. Management of the motor disorders of children with cerebral palsy. In: Scrutton D, Damiano D, Mayston M, editors. 2nd ed. London: Mac Keith Press; 2004.
-
2. Cavlak U, Kavlak E. Analysing of ankle-foot deformities in cerebral palsied children: A retrospective study. Journal of Medical Science. 2005;5(1):55-60.
-
3. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M. A report: the definition and classification of cerebral palsy. Dev Med Child Neurol. 2007;49:8-14.
-
4. Bourelle S, Berge B, Gautheron V, Cottalorda J. Computerized static posturographic assessment after treatment of equinus deformity in children with cerebral palsy. J Pediatr Orthop. 2010;19:211-220.
-
5. Winter S, Autry A, Boyle C, Yeargin-Allsopp M. Trends in the prevalence of cerebral palsy in a population-based study. Pediatrics. 2002;110(6):1220-5.
-
6. Serdaroğlu A, Cansu A, Özkan S, Tezcan S. Prevalence of cerebral palsy in Turkish children between the ages of 2 and 16 years. Dev Med Child Neurol. 2006;48(6):413-6.
-
7. Erkin G, Delialioğlu SU, Ozel S, Culha C, Sirzai H. Risk factors and clinical profiles in Turkish children with cerebral palsy: analysis of 625 cases. Int J Rehabil Res. 2008;31(1):89-91.
-
8. Livanelioğlu A, Günel M. Serebral Palsi'de fizyoterapi. Ankara: Yeni Özbek Matbaası; 2009. p. 5-12.
-
9. Sgandurra G, Ferrari A, Cossu G, et al. Upper limb children action-observation training (UP-CAT): a randomised controlled trial in hemiplegic cerebral palsy. BMC Neurol. 2011;11:80.
-
10. Duque J, Thonnard JL, Vandermeeren Y, et al. Correlation between impaired dexterity and corticospinal tract dysgenesis in congenital hemiplegia. Brain. 2003;126:732-47.
-
11. Lim AJ, Han SH, Kim SR, et al. The effect of eye movement program on postural control and visual perceptual ability of children with spastic cerebral palsy. KSOT. 2011;19:85-96.
-
12. Hong EK. Systematic review on occupational therapy for children with cerebral palsy. J Korean Conten Assoc. 2013;13:315-30.
-
13. Bhasin A, Padma Srivastava MV, Kumaran SS, et al. Neural interface of mirror therapy in chronic stroke patients: a functional magnetic resonance imaging study. Neurol India. 2012;60:570-6.
-
14. Rizzolatti G, Craighero L. The mirror-neuron system. Annu Rev Neurosci. 2004;27:169-92.
-
15. Fleishman EA, Rich S. Role of kinesthetic and spatial–visual ability in perceptual-motor learning. J Exp Psychol. 1963;66(1):6-11.
-
16. Verrel J, Bekkering H, Steenbergen B. Eye–hand coordination during manual object transport with the affected and less affected hand in adolescents with hemiparetic cerebral palsy. Exp Brain Res. 2008;187(1):107-16.
-
17. Stevens JA, Stoykov ME. Using motor imagery in the rehabilitation of hemiparesis. Arch Phys Med Rehabil. 2003;84:1090-2.
-
18. Park SH, Lee SM, Kim SB. The influence of motor cortical excitability on visual illusion using mirror, motor imagery and action observation. KJSP. 2009;20:211-22.
-
19. Cho S, Ku J, Cho YK, et al. Development of virtual reality proprioceptive rehabilitation system for stroke patients. Comput Methods Programs Biomed. 2014;113(1):258-65.
-
20. Smorenburg ARP, Ledebt A, Deconinck FJA, Savelsbergh GJP. Matching accuracy in hemiparetic cerebral palsy during unimanual and bimanual movement with (mirror) visual feedback. Res Dev Disabil. 2012;33(6):2088-98.
-
21. Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH. Content validity of the expanded and revised Gross Motor Function Classification System. Dev Med Child Neurol. 2008;50(10):744-50.
-
22. Russell DJ, Avery LM, Rosenbaum PL, Raina PS, Walter SD, Palisano RJ. Improved scaling of the gross motor function measure for children with cerebral palsy: evidence of reliability and validity. Phys Ther. 2000;80(9):873-85.
-
23. Eliasson AC, Krumlinde Sundholm L, Rösblad B, Beckung E, Arner M, Öhrvall AM, Rosenbaum P. The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol. 2006;48:549-54.
-
24. Kellor M, Frost J. Am J Occup Ther. 1971 Mar;25(2):77-83.
-
25. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67(2):206-7.
-
26. Wulf G, Chiviacowsky S, Lewthwaite R. Normative feedback effects on learning a timing task. Res Q Exerc Sport. 2010;81(4):425-31.
-
27. Iacoboni M, Mazziotta JC. Mirror neuron system: basic findings and clinical applications. Ann Neurol. 2007;62(3):213-8.
-
28. Broetz D, Birbaumer N. Behavioral physiotherapy in post stroke rehabilitation. NeuroRehabilitation. 2013;33(3):377-84.
-
29. Cho S, Ku J, Cho YK, et al. Development of virtual reality proprioceptive rehabilitation system for stroke patients. Comput Methods Programs Biomed. 2014;113(1):258-65.
-
30. Eng K, Siekierka E, Pyk P, et al. Interactive visuo-motor therapy system for stroke rehabilitation. Med Biol Eng Comput. 2007;45(9):901-7.
-
31. McCabe CS, Haigh RC, Ring EF, et al. A controlled pilot study of the utility of mirror visual feedback in the treatment of complex regional pain syndrome (type 1). Rheumatology (Oxford). 2003;42:97-101.
-
32. You SJ. An effect of mirror therapy on upper extremity function and activities of daily living in patients with post-stroke hemiplegia. Daegu University; 2010.
-
33. Nojima I, Mima T, Koganemaru S, et al. Human motor plasticity induced by mirror visual feedback. J Neurosci. 2012;32:1293-300.
-
34. Ramachandran VS, Rogers-Ramachandran D. Synaesthesia in phantom limbs induced with mirrors. Proc Biol Sci. 1996;263(1369):377-86.
-
35. Ramachandran VS. Phantom limbs, neglect syndromes, repressed memories, and Freudian psychology. Int Rev Neurobiol. 1994;37:291-333; discussion 369-72.