AN INVESTIGATION OF RELATIONSHIP BETWEEN TRUNK AND LOWER EXTREMITY MUSCLE STRENGTH AND FUNCTIONAL ACTIVITY IN CHILDREN WITH SPASTIC CEREBRAL PALSY

Yıl 2020, , 225 - 232, 17.12.2020

Ünal Değer , Akmer Mutlu

https://doi.org/10.21653/tjpr.542699

Cited By: 1

Öz

Purpose: Muscle weakness is an motor important impairment among children with cerebral palsy (CP). This study investigated the correlation between trunk and lower extremity isometric muscle strength and functional activity in children with ambulatory spastic CP. Methods: Fifty-four ambulatory children with spastic CP, aged 7-18 years (age=12.53±3.27 years) were included in this study. Hand dynamometer was used to determine trunk flexor and extansor and lower extremity muscles (hip flexos, extansor, abductor, and adductor, knee flexor and extansor, ankle dorsiflexor and plantar flexor muscles) isometric muscle strength. Gross motor function measured using Gross Motor Function Measure (GMFM) dimensions D and E, and Gross Motor Function Classification System (GMFCS) was used to classified gross motor function level. timed up and go test (TUG) and sit to stand test (SST) were used for the evaluation of functional activity. Results: The GMFM D and E scores were significantly related to hip flexor, extansor, abductor and adductor, knee extansor and flexor, ankle dorsiflexor, and plantar flexor muscle strength (p<0.05). The TUG test was significantly associated with hip extansor and abductor, knee extansor and ankle plantar flexor muscle strength (p<0.05). The SST was significantly correlated with hip extansor and abductor, knee extansor and ankle plantar flexor muscle strength (p<0.05). Conclusion: This study showed that there is a relationship between muscle strength of the trunk and lower extremity muscle strength in children with CP and functional activity at different levels, severity, and direction. Muscle strength might play critical role in functional activities in children with CP.

Anahtar Kelimeler

Cerebral Palsy, Child, Dynamometer, Strengh

SEREBRAL PALSİLİ ÇOCUKLARDA GÖVDE VE ALT EKSTREMİTE KAS KUVVETİ İLE FONKSİYONEL AKTİVİTE ARASINDAKİ İLİŞKİNİN İNCELENMESİ

Öz

Amaç: Serebral palsili (SP) olgularda kas zayıflığı önemli motor problemler arasında yer almaktadır. Bu çalışmanın amacı, ambule spastik tip SP’li olgularda gövde ve alt ekstremite kaslarının izometrik kuvveti ile fonksiyonel aktivite arasındaki ilişkiyi incelemekti. Yöntem: Çalışmaya yaşları 7-18 yıl arasında değişen ve yaş ortalamaları 12,53±3,27 yıl olan 54 spastik tip SP’li olgu dâhil edildi. Olguların gövde fleksor ve ekstansor kasları ve alt ekstremite kaslarının (kalça fleksor, ekstansor, abduktor ve adduktor, diz fleksor ve ekstansor, ayak bileği dorsifleksor ve plantar fleksor) izometrik kuvvet değerlendirmeleri el dinamometresi ile yapıldı. Olguların kaba motor fonksiyonları Kaba Motor Fonksiyon Ölçütü (KMFÖ)’nün D ve E bölümleri ile değerlendirildi ve Kaba Motor Fonksiyon Sınıflama Sistemi (KMFSS) ile seviyeleri belirlendi. Fonksiyonel aktivitenin değerlendirilebilmesi için süreli kalk yürü testi (TUG) ve otur kalk testi (OKT) kullanıldı. Sonuçlar: KMFÖ D ve E puanları ile kalça fleksor, ekstansor, abduktor ve adduktor, diz ekstansor ve fleksor, ayak bileği dorsifleksor ve plantar fleksor kas kuvveti arasında anlamlı ilişki olduğu gözlemlendi (p<0,05). TUG testi ile kalça ekstansor ve abduktor, diz ekstansor ve ayak bileği plantar fleksor kas kuvveti arasında anlamlı ilişki olduğu belirlendi (p<0,05). OKT ile kalça fleksor, ekstansor, abduktor adduktor, diz ekstansor ve fleksor, dorsifleksor ve plantar fleksor kasları arasında anlamlı ilişki olduğu gözlemlendi (p<0,05). Tartışma: Bu çalışma, SP’li çocuklarda gövde ve alt ekstremite kas kuvveti ile fonksiyonel aktivite arasında farklı seviyelerde, değişik şiddette ve yönde ilişki olduğunu göstermektedir. SP’li çocuklarda kas kuvveti fonksiyonel aktivite için kritik rol oynamaktadır.

Anahtar Kelimeler

Çocuk, Dinamometre, Kas Kuvveti, Serebral Palsi

Kaynakça

• 1. Bax M, Goldstein M, Rosenbaum P, Leviton A, Propoesed Defination And Classification Of Cerebral Palsy, Dev Med Child Neurol 2005, 47: 571-576
• 2. Serdaroglu A, Cansu A, Ozkan S, Tezcan S. Prevelance of cerebral palsy in Turkısh Children between 2 and 16 years. Dev Med Child Neurol. 2006: 48(6):413-6
• 3. Elder GC, Kirk J, Stewart G, Cook K, Weir D, Marshall A, Leahey L Contributing factors to muscle weakness in children with cerebral palsy. Developmental Medicine and Child Neurology, 2003 45: 542–550
• 4. Stackhouse SK, Binder-Macleod SA, Lee SC Voluntary muscle activation, contractile properties, and fatigability in children with and without cerebral palsy. Muscle and Nerve, 2005: 31: 594–601
• 5. Damiano DL, Quinlivan J, Owen BF, Shaffrey M, Abel MF Spasticity versus strength in cerebral palsy: relationships among involuntary resistance, voluntary torque, and motor function. European Journal of Neurology,2001: 8 Suppl 5: 40–49
• 6. Abel MF, Damiano DL, Strategies For Changing Walking Speed in Cerebral Palsy. J Pediatr Orthop, 1996:16:753-8
• 7. Ross SA, Engsberg JR, Relationships between spasticity, strength, gait, and the GMFM–66 in persons with spastic diplegia cerebral palsy. Archives of Physical Medicine and Rehabilitation, 2007: 88: 1114–1120
• 8. Goh HT, Thompson M, Huang WB, Schafer S. Relationships among measures of knee musculoskeletal impairements, gross motor function, and walking effiency in children with cerebral palsy. Pediatr Phys Ther. 2006:18:253-261
• 9. Kabakçı E, Göğuş A. T.C. BÖİB. İşlevsellik, Yetiyitimi ve Salığın Uluslararası Sınıflandırması. Bilge Matbaacılık. Ankara. 2001
• 10. SCPE Collaborative Group. Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Developmental Medicine and Child Neurology. 2000;42:816-24
• 11. Palisano R, Rosenbaum P, Walter S, Russel D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol, 1997; 39: 214-223
• 12. Erkin G, Aybay C; Pediatrik Rehabilitasyonda Kullanılan Fonksiyonel Değerlendirme Metodları; Türkiye Fiziksel Tıp Ve Rehabilitasyon Dergisi; 2001; 47; 16- 26
• 13. Bohannon RW. Test-Retest Reliability of Hand Held Dynamometry During A Single Session of Strength Assesment. Phys Ther 1986; 66: 206-209
• 14. Williams E, Carroll S, Reddihough D, Phillips B, Galea M, Investigation Of the Timed ‘’Up & Go’’ Test In Children. Developmental Medicineand Child Neurology, 2005, 47 (8), 518-524
• 15. Gan SM, Liao HF. The reliability study and comparision of sit-to-stand repetitive maximum capacity in children with cerebral palsy and children without disability. Formos J Phys Ther. 2002: 27, 292-302
• 16. Bjornson, KF, Belza B, Kartin D. Ambulatory physical activity performance in youth with cerebral palsy and youth whoe are developing typically. Phys Ther. 2007: 87: 248-257
• 17. Damiano DL, Activity, activity, activity re-thinking our physical therapy approach to cerebral palsy. Phys Ther. 2006:86:1534-40
• 18. Liao HF, Liu YC, Lıu WY, Lin YT, Effectiveness of Loaded Sit-to-Stand Resistance Exercise for Children with Mild Spastic Diplegia: A Randomized Clinical trial, Arch Phys Med Rehabil,2007:88:25-31
• 19. Mizner RL, Snyder-Mackler L. Altered loading during walking and sit to stand is affected by quadriceps weakness after total knee arthroplasty. J Orthop Res.2005:23:1083-1090
• 20. Mark FA, Damiano D, Strategies for increasing walking speed in diplegic cerebral palsy, Journal of Pediatric Orthopaedics, 1996: 16 (6), 753-758
• 21. Ostensjo S, Carlberg EB, Vollestad NK. Motor impairments in young children with cerebral palsy: relationship to gross motor function and everyday activities. Dev Med Child Neurol 2004;46(9):580–9
• 22. Kramer JD, MacPhail H. Relationships among measures of walking efficiency, gross motor ability and ısokinetic strength in adolescents with cerebral palsy. Pediatr Phys Ther 1994;6:3-30
• 23. Lamontagne A, Malouin F, Richards CL, Dumas F. Mechanisms of disturbed motor control in ankle weakness during gait after stroke. Gait Posture 2002; 15: 244–255
• 24. Wang TH, Liao HF, Peng YC, Reliability and validity of the five-repetition sit-to-stand test for children with cerebral palsy, Clinical Rehabilitation 26(7) 664– 67
• 25. Shum GL, Crosbie J, Lee RY. Three-dimensional kinetics of the lumbar spine and hips in low back pain patients during sit-to-stand and stand-to-sit. Spine (Phila Pa 1976) 2007; 32: 211–19
• 26. Damiano DL, Abel MF. Functional outcomes of strength training in spastic cerebral palsy. Arch Phys Med Rehabil 1998;79:119-25
• 27. Shin HI, Sung KH, Chung CY, Lee KM, Lee SY, Lee IH, Park MS, Relationships between Isometric Muscle Strength, Gait Parameters, and Gross Motor Function Measure in Patients with Cerebral Palsy, Yonsei Med J 2016;57(1):217-224
• 28. MacPhail HE, Kramer JF. Effect of isokinetic strength-training on functional ability and walking efficiency in adolescents with cere¬bral palsy. Dev Med Child Neurol 1995;37:763-75
• 29. Fasano VA, Broggi G, Barolat-Romana G, Sguazzi A. Surgical treatment of spasticity in cerebral palsy. Childs Brain 1978;4:289-305
• 30. Bobath K. Neurophysiological basis for the treatment of cerebral palsy. 2nd ed. London: William Heimenamm Medical Books Ltd; 1980