Serebral paralizili yetişkinlerde spastisite ile mobilite ve aktivite düzeyi arasındaki ilişki

Yıl 2020, Cilt: 13 Sayı: 3, 635 - 644, 18.09.2020

Mine Pekesen Kurtça , Salih Angın

https://doi.org/10.31362/patd.669956

Öz

ÖZ
Amaç: Bu çalışmada, yetişkin serebral paralizili (SP) bireylerde spastisite ile mobilite ve aktivite düzeyi arasındaki ilişkinin incelenmesi amaçlanmıştır.
Yöntem: Çalışma on beş yaş ve üstü spastik serebral paralizi tanısı alan otuz dört olgu ile gerçekleştirilmiştir. Olguların klinik ve demografik bilgileri kaydedilmiş, spastisite dereceleri Modifiye Ashworth Skalası (MAS) ile değerlendirilmiştir. Mobilite düzeyleri için Rivermead Mobilite İndeksi (RMI), aktivite düzeyleri için Fonksiyonel Bağımsızlık Ölçümü’nün (FIM) mobilite, kendine bakım ve lokomosyon alt parametreleri kullanılmıştır. Tüm olgular Kaba Motor Fonksiyon Sınıflandırma Sistemine (KMFSS) göre gruplandırılmış, motor limitasyon düzeyini gösteren KMFSS’ye göre seviye 1, 2 ve 3’teki olgular grup 1; KMFSS’ye göre seviye 4 ve 5’teki olgular grup 2’ye dahil edilmiştir. Verilerin analizinde Pearson Korelasyon Analizi, Kruskal Wallis Varyans Analizi ve Mann-Whitney U Testi kullanılmış, p anlamlılık düzeyi 0,05 olarak kabul edilmiştir.
Bulgular: Toplam Modifiye Ashworth skoru ile lokomosyon, mobilite, RMI ve KMFSS puanı arasında negatif yönde, anlamlı ilişki bulunmuştur (p<0,05). Toplam Modifiye Ashworth skoru ile kendine bakım puanı arasında herhangi bir ilişki bulunmamıştır (p>0,05). Ekstremite tutulumuna göre ayrılan üç grup arasında RMI puanı açısından fark anlamlı bulunmuş, bu farkın hemiparetik gruptan kaynaklandığı belirlenmiştir (p<0,05). KMFSS’ye göre oluşturulan iki grup arasında Modifiye Ashworth, RMI, lokomosyon, mobilite, kendine bakım ve toplam FIM puanı açısından farkın anlamlı olduğu saptanmıştır (p<0,05).
Sonuç: SP’li bireylerin mobilite ve aktivite düzeyleri spastisiteden olumsuz yönde etkilenmektedir. Yetişkin serebral paraliziye yönelik rehabilitasyon programı içerisinde mobilitenin devamlılığı ve fonksiyonel düzeyin yükseltilmesi için spastisitenin azaltılmasına yönelik yaklaşımların geliştirilmesi gerekmektedir.
ABSTRACT
Objective: This study aimed to investigate the relationship between spasticity, mobility and activity level in adults with cerebral palsy (CP).
Methods: Thirty four spastic cerebral palsy patients who were fifteen years and over included in this study. The demographic and clinical features were recorded, and spasticity was assessed with the modified ashworth scale (MAS). Rivermead Mobility İndex (RMI) , mobility, self-care and locomotion parameters of Functional İndependence Measure (FIM) were conducted to analyse level of mobility and activity. Gross Motor Function Classification System (GMFCS) was applied for each subject. All subjects splitted to two groups: Group 1 consisted with level 1, 2 and 3; group 2 consisted with level 4 and 5 according to KMFSS score. Pearson Correlation Analysis, Kruskal Wallis Analysis of Variance and Mann- Whitney U Test were performed for data analysis. α level was set 0.05.
Results: Total modified ashworth scale ratings was found to be significantly and reversely correlated with KMFSS level, RMI, locomotion, mobility scores (p<0.05). Correlation between modified ashworth scale ratings and self-care scores was found to be non- significant (p>0.05). Within group comparison, MAS, RMI, locomotion, mobility, self care and total FIM score was found to be significantly different (p<0.05) . RMI scores in hemiparetic group were found to be significantly different when the patients allocated among the three groups as hemiparetic, diparetic and quadriparetic according to the extremity involvement (p<0.05).
Conclusion: Since the mobility and activity level negatively effected by spasticity in adult patients with cerebral palsy, the spasticity managment methods should not be underestimated for increasing functional level and mobility.

Anahtar Kelimeler

Günlük yaşam aktiviteleri, mobilite limitasyonu, serebral paralizi, spastisite

The relationship between spasticity, mobility and activity level in adults with cerebral palsy

Öz

Abstract
Purpose: This study aimed to investigate the relationship between spasticity, mobility and activity level in adults
with cerebral palsy (CP).
Materials and methods: Thirty-four spastic cerebral palsy patients who were fifteen years and over included in
this study. The demographic and clinical features were recorded, and spasticity grades was assessed with the
modified ashworth scale (MAS). Rivermead Mobility İndex (RMI), mobility, self-care and locomotion parameters
of Functional İndependence Measure (FIM) were conducted to analyse level of mobility and activity. Gross Motor
Function Classification System (GMFCS) was applied for each subject. All subjects were split into splitted to two
groups: Group 1 consisted with level 1, 2 and 3; group 2 consisted with level 4 and 5 according to KMFSS score.
Pearson Correlation Analysis, Kruskal Wallis Analysis of Variance and Mann-Whitney U Test were performed for
data analysis. Α level was set 0.05.
Results: Total modified ashworth scale ratings was found to be significantly and reversely correlated with
KMFSS level, RMI, locomotion, mobility scores (p<0.05). Correlation between modified ashworth scale ratings
and self-care scores was found to be non- significant (p>0.05). Within group comparison, MAS, RMI, locomotion,
mobility, self-care and total FIM score was found to be significantly different (p<0.05). RMI scores in hemiparetic
group were found to be significantly different when the patients allocated among the three groups as hemiparetic,
diparetic and quadriparetic according to the extremity involvement (p<0.05).
Conclusion: Since the mobility and activity level negatively affected by spasticity in adult patients with cerebral
palsy, the spasticity management methods should not be underestimated for increasing functional level and
mobility. 

Anahtar Kelimeler

Activities of daily living, mobility limitation, cerebral palsy, spasticity

Kaynakça

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