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Effect of Neuromuscular Electrical Stimulation on Functional Mobility in Children with Hemiplegic Cerebral Palsy

Yıl 2018, Cilt: 16 Sayı: 3, 16 - 27, 03.12.2018

Öz

INTRODUCTION: Ankle deformities are frequently seen in children with cerebral palsy (CP) and affect the functioning of children negatively. The purpose of this study was to investigate the effect of electrical stimulation on the range of motion and functional mobility of movements of tibialis anterior, peroneus longus and peroneus brevis muscles in children with hemiplegic spastic type CP. METHODS: A total of 40 hemiplegic spastic type CP children between 5 and 15 years of age were included in the study. Children are randomly divided into 2 groups. Neurodevelopmental therapy and neuromuscular electrical stimulation (NMES) was applied to the treatment group (n = 20), only neurodevelopmental therapy was applied to the control group (n = 20). A total 36 treatments were administered for 12 weeks, with 3 treatment sessions per week. After recording the age, body mass index, and gross motor function levels of the children, motor functional levels with the Gross Motor Function Scale (GMFM-88), ankle range of motion with goniometer, functional mobility skills with timed up and go test, timed stairs up and down test were evaluated. Statistical analysis was done by SPSS 22.0 program and significance was accepted as p <0.05.

RESULTS: The average age of the children participating in the study was 8.30 ± 2.49 years. Comparisons between groups before and after treatment showed statistically significant improvement in range of active dorsi flexion, timed up and go test, and timed stairs up and down test in the treatment group (p=0.033, 0.015, 0.036).

DISCUSSION and CONCLUSION: NMES therapy has been identified as a method that strengthens the weak muscles of children with hemiplegic CP, relaxes them by creating stretching effects on spastic muscles, and normalizes muscle imbalance, thereby increasing gross motor functions, walking ability, and functional ability.

Kaynakça

  • 1.Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109:8-14.
  • 2. Willerslev-Olsen M, Lorentzen J, Nielsen JB. Gait training reduces ankle joint stiffness and facilitates heel strike in children with Cerebral Palsy. NeuroRehabilitation 2014;35:643-55.
  • 3. Rasool AH, Birgani PM, Azizi S, Shahrokhi A, Mirbagheri MM. Therapeutic effects of an anti-gravity locomotor training (AlterG) on postural balance and cerebellum structure in children with Cerebral Palsy. IEEE Int Conf Rehabil Robot. 2017;2017:101-105.
  • 4. Novak I, McIntyre S, Morgan C, Campbell L, Dark L, Morton N, et al. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol. 2013;55:885–910.
  • 5. Detrembleur C, Lejeune TM, Renders A, Van Den Bergh PY. Botulinum toxin and short-term electrical stimulation in the treatment of equines in cerebral palsy. Mov Disord 2002;17:162-9.
  • 6. El Ö, Baydar M, Berk H, Peker Ö, Koşay C, Demiral Y. Inter observer reliability of the Turkish version of the expanded and revised gross motor function classification system. Disability and Rehabilitation 2012; 34: 1030-33.
  • 7. 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. Phys Ther. 2000;80:873–885.
  • 8.Williams E, Carroll SG, Reddihough DS, Philips BA, Galea MP. Investigation of the timed up&go test in children. Developmental Medicine&Child Neurology 2005;47: 518-524.
  • 9. Ziano CA, Marchese VG, Westcott SL. Timed Up and Down Stairs Test: Preliminary Reliability of a New Measure of Functional Mobility. Pediatric Physical Therapy 2004; 90-98.
  • 10. Dinçer Ü, Çakar E, Kıralp MZ, Dursun H. Diplejik serebral palsili hastalarda botulinum toksin uygulaması sonrasında fizyoterapi ve alt ekstremite ortezinin etkinliğinin karşılaştırılması. Türk Fiz Tıp Rehab Derg 2008; 54: 41-5.
  • 11. Tekin F, Kavlak E, Cavlak U, Altug F. Effectiveness of Neuro-Developmental Treatment (both concept) on postural control and balance in Cerebral Palsied Children. J Back Musculoskelet Rehabil. 2017;1-7.
  • 12. Park ES, Park CI, Lee HJ, Cho YS. The effect of electrical stimulation on the trunk control in young children with spastic diplegic cerebral palsy. J Korean Med Sci. 2001;16:347-350.
  • 13. Crenna P, Inverno M. Objective detection of pathophysiological factors contributing to gait disturbance in supraspinal lesions. In: Motor Development in Children. London: John Libbey Press; 1994. p.103-18.
  • 14. Kamper DG, Yaskawa AM, Barrett KM, Gaebler-Spira DJ. Effects of neuromuscular electrical stimulation treatment of cerebral palsy on potential impairment mechanisms: A pilot study. Pediatr Phys Ther 2006; 18:31-8.
  • 15. Daichman J, Johnston TE, Evans K, Tecklin JS. The effects of a neuromuscular electrical stimulation home program on impairments and functional skills of a child with spastic diplegic cerebral palsy: A case report. Pediatr Phys Ther 2003; 15:153-8.
  • 16. Stackhouse SK, Binder-Macleod SA, Stackhouse CA, McCarthy JJ, Prosser LA, Lee SC. Neuromuscular electrical stimulation versus volitional isometric strength training in children with spastic diplegic cerebral palsy: a preliminary study. Neurorehabil Neural Repair 2007; 21:475-85.
  • 17. Carmick J. Managing equines in children with cerebral palsy: Electrical stimulation to strengthen the triceps surae muscle. Dev Med Child Neurol 1995; 37:965-75.
  • 18. Hazlewood ME, Brown JK, Rowe PJ, Salter PM. The use of therapeutic electrical stimulation in the treatment of hemiplegic cerebral palsy. Dev Med Child Neurol. 1994; 36: 661-73.
  • 19. Karabay I, Doğan A, Ekiz T, Köseoğlu BF, Ersöz M. Training postural control and sitting in children with cerebral palsy: Kinesio taping vs. neuromuscular electrical stimulation. Complementary Therapies in Clinical Practice 2016; 24: 67-72.
  • 20. Kerr C, McDowell B, Cosgrove A, Walsh D, Bradbury I, McDonough S. Electrical stimulation in cerebral palsy: a randomized controlled trial. Dev Med Child Neurol. 2006; 48: 870-6.
  • 21. Van der Linden ML, Hazlewood ME, Aitchison AM, Hillman SJ, Robb JE. Electrical stimulation of gluteus maximus in children with cerebral palsy: effects on gait characteristics and muscle strength. Dev Med Child Neurol. 2003; 45: 385-90.
  • 22. Park EY, Kim WH. Effect of neurodevelopmental treatment-based physical therapy on the change of muscle strength, spasticity, and gross motor function in children with spastic cerebral palsy. J Phys Ther Sci. 2017; 29: 966-969.
  • 23. Steinbok P. Selection of treatment modalities in children with spastic cerebral palsy. Neurosurg Focus. 2006; 21: 4.
  • 24. Wright PA, Durham S, Ewins DJ, et al. Neuromuscular electrical stimulation for children with cerebral palsy: A review. Arch Dis Child 2012; 97: 364-71.

Hemiplejik Serebral Palsili Çocuklarda Nöromuskuler Elektrik Stimülasyonunun Fonksiyonel Hareketlilik Üzerine Etkisi

Yıl 2018, Cilt: 16 Sayı: 3, 16 - 27, 03.12.2018

Öz

GİRİŞ ve AMAÇ: Serebral palsili (SP) çocuklarda ayak bileği deformiteleri sıklıkla görülmekte ve çocukların fonksiyonelliğini olumsuz yönde etkilemektedir. Bu çalışmanın amacı, hemiplejik spastik tip SP’li çocukların tibialis anterior, peroneus longus ve peroneus brevis kaslarına uygulanan elektrik stimulasyonunun eklem hareket açıklığı ve fonksiyonel hareket becerileri üzerine olan etkinliğini araştırmaktır. YÖNTEM ve GEREÇLER: Çalışmaya 5-15 yaş arası toplam 40 hemiplejik spastik tip SP tanılı çocuk alınmıştır. Çocuklar randomize olarak 2 gruba ayrılmıştır. Tedavi grubuna (n=20) nörogelişimsel tedavi ile birlikte nöromuskuler elektrik stimulasyonu (NMES), kontrol grubuna (n=20) ise sadece nörogelişimsel tedavi uygulanmıştır. Tüm tedavi yöntemleri haftada 3 gün olmak üzere 12 hafta boyunca toplam 36 seans uygulanmıştır. Tüm çocukların yaş, vücut kütle indeksi, kaba motor fonksiyon sınıflandırma sistemine (KMFSS) göre seviyeleri kaydedildikten sonra kaba motor fonksiyon ölçeği-88(KMFÖ-88) ile motor fonksiyonları, gonyometre ile ayak bileği eklem hareket açıklıkları, zamanlı ayağa kalk yürü ve zamanlı merdiven çıkıp inme testleri ile fonksiyonel hareket becerileri değerlendirilmiştir. İstatistiksel analizinde SPSS 22.0 programı kullanılarak p<0,05 düzeyi anlamlı kabul edilmiştir.
BULGULAR: Çalışmaya katılan çocukların yaş ortalaması 8.30±2.49’dur. Tedavi öncesi ve sonrası gruplar arası ve gruplar içerisinde yapılan karşılaştırmalarda tedavi grubunun aktif dorsi fleksiyon açıklığı, zamanlı kalk yürü testi ve zamanlı merdiven çıkıp inme testlerinde istatistiksel olarak anlamlı iyileşme gözlenmiştir(p=0,033; 0,015; 0,036).
TARTIŞMA ve SONUÇ: NMES tedavisinin,hemiplejik SP’li çocukların zayıf olan kaslarını kuvvetlendiren, spastik kaslarda germe etkisi oluşturarak gevşemelerini sağlayan ve kas imbalansını normalize ederek kaba motor fonksiyonlar, yürüme kabiliyeti ve fonksiyonel yeteneğin artmasını sağlayan bir yöntem olduğu belirlenmiştir.

Kaynakça

  • 1.Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109:8-14.
  • 2. Willerslev-Olsen M, Lorentzen J, Nielsen JB. Gait training reduces ankle joint stiffness and facilitates heel strike in children with Cerebral Palsy. NeuroRehabilitation 2014;35:643-55.
  • 3. Rasool AH, Birgani PM, Azizi S, Shahrokhi A, Mirbagheri MM. Therapeutic effects of an anti-gravity locomotor training (AlterG) on postural balance and cerebellum structure in children with Cerebral Palsy. IEEE Int Conf Rehabil Robot. 2017;2017:101-105.
  • 4. Novak I, McIntyre S, Morgan C, Campbell L, Dark L, Morton N, et al. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol. 2013;55:885–910.
  • 5. Detrembleur C, Lejeune TM, Renders A, Van Den Bergh PY. Botulinum toxin and short-term electrical stimulation in the treatment of equines in cerebral palsy. Mov Disord 2002;17:162-9.
  • 6. El Ö, Baydar M, Berk H, Peker Ö, Koşay C, Demiral Y. Inter observer reliability of the Turkish version of the expanded and revised gross motor function classification system. Disability and Rehabilitation 2012; 34: 1030-33.
  • 7. 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. Phys Ther. 2000;80:873–885.
  • 8.Williams E, Carroll SG, Reddihough DS, Philips BA, Galea MP. Investigation of the timed up&go test in children. Developmental Medicine&Child Neurology 2005;47: 518-524.
  • 9. Ziano CA, Marchese VG, Westcott SL. Timed Up and Down Stairs Test: Preliminary Reliability of a New Measure of Functional Mobility. Pediatric Physical Therapy 2004; 90-98.
  • 10. Dinçer Ü, Çakar E, Kıralp MZ, Dursun H. Diplejik serebral palsili hastalarda botulinum toksin uygulaması sonrasında fizyoterapi ve alt ekstremite ortezinin etkinliğinin karşılaştırılması. Türk Fiz Tıp Rehab Derg 2008; 54: 41-5.
  • 11. Tekin F, Kavlak E, Cavlak U, Altug F. Effectiveness of Neuro-Developmental Treatment (both concept) on postural control and balance in Cerebral Palsied Children. J Back Musculoskelet Rehabil. 2017;1-7.
  • 12. Park ES, Park CI, Lee HJ, Cho YS. The effect of electrical stimulation on the trunk control in young children with spastic diplegic cerebral palsy. J Korean Med Sci. 2001;16:347-350.
  • 13. Crenna P, Inverno M. Objective detection of pathophysiological factors contributing to gait disturbance in supraspinal lesions. In: Motor Development in Children. London: John Libbey Press; 1994. p.103-18.
  • 14. Kamper DG, Yaskawa AM, Barrett KM, Gaebler-Spira DJ. Effects of neuromuscular electrical stimulation treatment of cerebral palsy on potential impairment mechanisms: A pilot study. Pediatr Phys Ther 2006; 18:31-8.
  • 15. Daichman J, Johnston TE, Evans K, Tecklin JS. The effects of a neuromuscular electrical stimulation home program on impairments and functional skills of a child with spastic diplegic cerebral palsy: A case report. Pediatr Phys Ther 2003; 15:153-8.
  • 16. Stackhouse SK, Binder-Macleod SA, Stackhouse CA, McCarthy JJ, Prosser LA, Lee SC. Neuromuscular electrical stimulation versus volitional isometric strength training in children with spastic diplegic cerebral palsy: a preliminary study. Neurorehabil Neural Repair 2007; 21:475-85.
  • 17. Carmick J. Managing equines in children with cerebral palsy: Electrical stimulation to strengthen the triceps surae muscle. Dev Med Child Neurol 1995; 37:965-75.
  • 18. Hazlewood ME, Brown JK, Rowe PJ, Salter PM. The use of therapeutic electrical stimulation in the treatment of hemiplegic cerebral palsy. Dev Med Child Neurol. 1994; 36: 661-73.
  • 19. Karabay I, Doğan A, Ekiz T, Köseoğlu BF, Ersöz M. Training postural control and sitting in children with cerebral palsy: Kinesio taping vs. neuromuscular electrical stimulation. Complementary Therapies in Clinical Practice 2016; 24: 67-72.
  • 20. Kerr C, McDowell B, Cosgrove A, Walsh D, Bradbury I, McDonough S. Electrical stimulation in cerebral palsy: a randomized controlled trial. Dev Med Child Neurol. 2006; 48: 870-6.
  • 21. Van der Linden ML, Hazlewood ME, Aitchison AM, Hillman SJ, Robb JE. Electrical stimulation of gluteus maximus in children with cerebral palsy: effects on gait characteristics and muscle strength. Dev Med Child Neurol. 2003; 45: 385-90.
  • 22. Park EY, Kim WH. Effect of neurodevelopmental treatment-based physical therapy on the change of muscle strength, spasticity, and gross motor function in children with spastic cerebral palsy. J Phys Ther Sci. 2017; 29: 966-969.
  • 23. Steinbok P. Selection of treatment modalities in children with spastic cerebral palsy. Neurosurg Focus. 2006; 21: 4.
  • 24. Wright PA, Durham S, Ewins DJ, et al. Neuromuscular electrical stimulation for children with cerebral palsy: A review. Arch Dis Child 2012; 97: 364-71.
Toplam 24 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Araştırma
Yazarlar

Tomris Duymaz 0000-0003-0917-2098

Yayımlanma Tarihi 3 Aralık 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 16 Sayı: 3

Kaynak Göster

APA Duymaz, T. (2018). Hemiplejik Serebral Palsili Çocuklarda Nöromuskuler Elektrik Stimülasyonunun Fonksiyonel Hareketlilik Üzerine Etkisi. Güncel Pediatri, 16(3), 16-27. https://doi.org/10.32941/pediatri.485217
AMA Duymaz T. Hemiplejik Serebral Palsili Çocuklarda Nöromuskuler Elektrik Stimülasyonunun Fonksiyonel Hareketlilik Üzerine Etkisi. Güncel Pediatri. Aralık 2018;16(3):16-27. doi:10.32941/pediatri.485217
Chicago Duymaz, Tomris. “Hemiplejik Serebral Palsili Çocuklarda Nöromuskuler Elektrik Stimülasyonunun Fonksiyonel Hareketlilik Üzerine Etkisi”. Güncel Pediatri 16, sy. 3 (Aralık 2018): 16-27. https://doi.org/10.32941/pediatri.485217.
EndNote Duymaz T (01 Aralık 2018) Hemiplejik Serebral Palsili Çocuklarda Nöromuskuler Elektrik Stimülasyonunun Fonksiyonel Hareketlilik Üzerine Etkisi. Güncel Pediatri 16 3 16–27.
IEEE T. Duymaz, “Hemiplejik Serebral Palsili Çocuklarda Nöromuskuler Elektrik Stimülasyonunun Fonksiyonel Hareketlilik Üzerine Etkisi”, Güncel Pediatri, c. 16, sy. 3, ss. 16–27, 2018, doi: 10.32941/pediatri.485217.
ISNAD Duymaz, Tomris. “Hemiplejik Serebral Palsili Çocuklarda Nöromuskuler Elektrik Stimülasyonunun Fonksiyonel Hareketlilik Üzerine Etkisi”. Güncel Pediatri 16/3 (Aralık 2018), 16-27. https://doi.org/10.32941/pediatri.485217.
JAMA Duymaz T. Hemiplejik Serebral Palsili Çocuklarda Nöromuskuler Elektrik Stimülasyonunun Fonksiyonel Hareketlilik Üzerine Etkisi. Güncel Pediatri. 2018;16:16–27.
MLA Duymaz, Tomris. “Hemiplejik Serebral Palsili Çocuklarda Nöromuskuler Elektrik Stimülasyonunun Fonksiyonel Hareketlilik Üzerine Etkisi”. Güncel Pediatri, c. 16, sy. 3, 2018, ss. 16-27, doi:10.32941/pediatri.485217.
Vancouver Duymaz T. Hemiplejik Serebral Palsili Çocuklarda Nöromuskuler Elektrik Stimülasyonunun Fonksiyonel Hareketlilik Üzerine Etkisi. Güncel Pediatri. 2018;16(3):16-27.