Hemiplejik serebral palsili çocuklarda nöromuskuler elektrik stimülasyonunun fonksiyonel hareketlilik üzerine etkisi
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Date
2018
Authors
Duymaz, Tomris
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
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.
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.
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.
Description
Keywords
Serebral palsi, Nöromuskuler elektrik stimulasyonu, Fonksiyonel mobilite, Cerebral palsy, Neuromuscular electrical stimulation, Functional mobility
Citation
Duymaz, T. (2018). "Hemiplejik serebral palsili çocuklarda nöromuskuler elektrik stimülasyonunun fonksiyonel hareketlilik üzerine etkisi". Güncel Pediatri, 16(3), 17-27.