NÖROMUSKÜLER HASTALIKLARDA GÖRÜLEN POSTÜR BOZUKLUĞU İLE HASTALIK ŞİDDETİ, FONKSİYONEL KAPASİTE, GÜNLÜK YAŞAM AKTİVİTELERİ VE DENGE ARASINDAKİ İLİŞKİNİN ARAŞTIRILMASI

Öz

Amaç: Bu çalışmanın amacı, nöromusküler hastalığa sahip erişkin bireylerde postür bozukluklarını araştırmak ve postür bozukluklarının hastalık şiddeti, fonksiyonel kapasite, günlük yaşam aktiviteleri, denge ve düşme ile ilişkisini belirlemektir. Yöntem: Çalışmaya nöromusküler hastalık tanısı konan ve yaş ortalaması 36,34 ± 14,03 yıl olan 47 hasta dahil edilmiştir. New York Postür Derecelendirme Ölçeği (NYPD) ile genel vücut postürü, fleksible ruler ile torakal kifoz açısı (TKA)- lumbal lordoz açısı (LLA) değerlendirilmiştir. Skolyometre kullanılarak olası skolyoz varlığı ve pelvik asimetri değerlendirilmiştir. Üst Ekstremite (ÜEFS) ve Alt Ekstremite Fonksiyon İndeksi (AEFS) ile hastalık şiddeti, 2 Dakika Yürüme Testi (2DKYT) ile fonksiyonel kapasite, Zamanlı Kalk Yürü Testi (ZKYT) ile denge ve düşme riski, Fonksiyonel Bağımsızlık Ölçeği (FIM) ile günlük yaşam aktiviteleri kaydedilmiştir. Sonuçlar: Postüral deformitelerin değerlendirilmesi sonucunda hastaların NYPD’si ortalamasının 40,24±9,56 olduğu belirlenmiştir. Yapılan ölçümlerde hastaların %46,34’ünde TKA’nın, %24,39’unda ise LLA’nın açısının norm değerlerin dışına çıktığı ve skolyometre ölçümleri sonucunda 30 hastada (%73,2) olası skolyoz varlığı, 11 hastada (%26,8) spinal asimetri olduğu, 27 hastada (%65,9) ise pelvik asimetri olduğu bulunmuştur. NYPD ile ÜEFS, 2DKYT, FIM ve ZKYT arasında istatiksel olarak anlamlı ilişki olduğu belirlenmiştir (p <0,05). Tartışma: Rehabilitasyon programları planlanırken vücut biyomekaniğini etkileyen postüral bozuklukları detaylı değerlendirmenin ve bu değerlendirme sonuçlarına uygun müdahale planları oluşturmanın hastaların günlük yaşam aktivitesi performanslarını, fonksiyonel kapasitelerini, denge ve düşme risklerini olumlu yönde etkileyebileceği düşünülmektedir. Ancak sonuçların genelleştirilebilmesi için daha fazla sayıda hasta ile ve farklı NMH gruplarının dahil edildiği çalışmalara ihtiyaç duyulmaktadır.

Anahtar Kelimeler

• Nöromusküler hastalıklar
• Omurga deformiteleri
• Skolyoz
• Spinal asimetri

INVESTIGATION OF THE RELATIONSHIP BETWEEN POSTURE DISORDER AND DISEASE SEVERITY, FUNCTIONAL CAPACITY, ACTIVITIES OF DAILY LIFE AND BALANCE IN NEUROMUSCULAR DISEASES

Abstract

Purpose: This study was conducted to examine postural problems in adults with neuromuscular diseases, the incidence of these disorders and to determine the relationship of posture problems with disease severity, functional capacity, activities of daily living, balance and falling. Methods: 47 patients diagnosed with neuromuscular disease with a mean age of 36.34 ± 14.03 years were included in the study. General body posture was evaluated with New York Posture Rating Scale (NYPR) and thoracic kyphosis (TKA) - lumbar lordosis angles (LLA) was evaluated with flexible ruler. Possible scoliosis and pelvic asymmetry were evaluated using a scoliometer. Disease severity was measured with the Upper (UEFI) and Lower Extremity Function Index (LEFI), functional capacity with 2 Minute Walk Test (2MWT), and balance and fall risk with the Timed Up and Go Test (TUG), and daily living activities were recorded with Functional Independence Measure (FIM). Results: The evaluation of postural deformities indicated that the mean NYPR of the patients was 40.24±9.56. The angle of kyphosis was observed in 46.34 % of the patients and the angle of the LLA was out of the norm values in 24.39 %. Scoliometer measurements showed that possible scoliosis was found in 30 (73.2%), spinal asymmetry was found in 11 (26.8%), and pelvic asymmetry was found in 27 patients (65.9%). The correlation between NYPR and UEFI, 2MWT, FIM and TUG was statistically significant (p <0.05). Conclusion: When planning rehabilitation programs, it is thought that detailed evaluation of postural disorders affecting body biomechanics and creating intervention plans appropriate to the results of these evaluations may positively affect the patients’ performance of daily living activities, functional capacities, balance and fall risks. However, studies with larger numbers of patients and including different NMD groups are needed to generalize the results.

Keywords

• Neuromuscular diseases
• Spinal deformities
• Scoliosis
• Spinal asymmetry

Kaynakça

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