Publication: Serebral palsi tanısı konmuş olgularda Vojta Terapisi’nin konvansiyonel ve nörodevelopmental egzersizlerden oluşan ev programına üstünlüğünün araştırılması
Abstract
Bu çalışma Ağustos 2002-Mayıs 2004 tarihleri arasında Marmara Üniversitesi Fiziksel Tıp ve Rehabilitasyon nda yapıldı. Çalışmada spastik tip serebral palsili (SP) çocuklarda Vojta Tekniği ile nörodevelopmental teknik (NDT) ve konvansiyonel egzersizlerden oluşan ev programını karşılaştırmak amaçlandı. Spastik tip SP teşhisi konmuş 1-3 yaş arası 20 olgu çalışmaya dahil edildi. Vojta Tekniği ile tedavi gören 1. grubu 7'si erkek 3'ü kız olmak üzere 10 olgu oluşturdu. Olguların 5'i tüm vücut tutulumlu spastik SP, 3'ü spastik hemipleji, 2'si spastik dipleji olup yaş ortalamaları 17,9±6,62 ay idi. Ev verilen 2. grubu ise 4'ü erkek 6'sı kız olmak üzere 10 olgu oluşturdu. Bu olguların da 5'i tüm vücut tutulumlu spastik SP, 4'ü spastik hemipleji, 1'i spastik dipleji olup yaş ortalaması 22,35±6,24 ay idi. Olgular 6 ay süreyle aylık kontrollerle takip edildiler. Her 2 grup da tedavi öncesi ve sonrasında Kaba Motor Değerlendirme Ölçütü (GMFM), uyarılabilen durum refleksleri (UDRR), patokinetik motor seviye ölçümü ve Ashworth skalası ile değerlendirildi. Gruplara göre cinsiyet dağılımına ve yaş ortalamalarına bakıldığında istatistiksel olarak anlamlı bir fark bulunmadı (p>0,05). Tedavi öncesinde ve sonrasında gruplar arasında kaba motor fonksiyon ölçümü (GMFM) skorları ve patokinetik motor seviyeleri arasındaki fark istatistiksel olarak anlamlı değilken (p>0,05), her iki grupta da tedavi sonrasında başlangıç değerlerine göre istatistiksel olarak ileri düzeyde anlamlı bir fark gözlendi (p<0,01). Uyarılabilen durum reaksiyonlarında patolojik reaksiyon sayısına bakıldığında gruplar arasında tedavi öncesi ve sonrasında istatistiksel olarak anlamlı bir fark bulunmazken (p>0,05), tedavi sonrasında her iki grupta da patolojik reaksiyon sayısı öncesine göre istatistiksel olarak anlamlılık yaratacak düzeyde düşük bulundu (p<0,05). Ashworth skalasına göre gruplar arası alt ve üst ekstremite spastisite değerlerinde tedavi öncesi ve sonrasında anlamlı bir fark gözlenmezken (p>0,05) tedavi sonrasında önceki değerlerle karşılaştırıldığında fark genel olarak her iki grupta da istatistiksel olarak anlamlıydı (p<0,05). Sonuç olarak spastik tip SP'li çocukların tedavisinde Vojta Tekniği ile NDT ve konvansiyonel egzersizlerden oluşan ev karşılaştırılmış, her iki yöntemin de motor gelişim ve spastisite üzerinde olumlu yönde etkilerinin olduğu saptanmış olmakla birlikte birbirine üstünlüğü görülmemiştir. INVESTIGATION OF EFFECTIVENESS OF VOJTA TECHNIQUE AND HOME EXERCISE PROGRAM INCLUDING NEURODEVELOPMENTEL EXERCISES IN PATIENTS WITH CEREBRAL PALSY
This study was done between August 2002 and May 2004 in Marmara University Physical Medicine and Rehabilitation Department. The aim of this study was to compare Vojta Technique with home exercise program, including neurodevelopmental technique (NDT) and conventional exercises in children who had spastic type cerebral palsy (CP). 20 children with spastic CP who are 1-3 years old were included in the study. In Vojta treatment group there were 10 children; 3 of them female, the other 7 was male. This group consisted of 5 spastic quadriplegia, 3 spastic hemiplegia, and 2 spastic diplegia. The average age of children was 17.9±6.62 months. The second group who were given home exercise program included 10 children; 4 male, 6 female patient. This group had 5 spastic quadriplegia, 4 spastic hemiplegia, and 1 spastic diplegia. The avarage of children was 22.35±6.24 months. The cases were followed with monthly controls during the 6-month period. Both of the groups were evaluated before and after the treatments with Gross Motor Function Measure (GMFM), Stimulating Position Reflexes, Pathokinetic Motor Level Measure and Ashworth Scale. The two groups were identical for age and sex distribution of patients (p>0.05). Before and after treatment the differences of Gross Motor Function Measure (GMFM) and Pathokinetic Motor Level Measure were not statistically significant between the groups (p>0.05). However, each group showed significant differences with treatment within itself (p<0.01). Before and after treatment statistical differences were not significant in Stimulating Position Reflexes for the number of pathological reactions (p<0.05). After the treatment statistical results of each gruop were founded to be significantly different for pathological reaction numbers (p<0.05). According to the Ashworth Scale before and after treatment each group showed significant differences in themselves (p<0.05), but the difference between the two groups were not significant (p>0.05). We conclude that both Vojta Technique and home program including NDT and conventional exercises are effective in motor development and spasticity in children with spastic CP.
This study was done between August 2002 and May 2004 in Marmara University Physical Medicine and Rehabilitation Department. The aim of this study was to compare Vojta Technique with home exercise program, including neurodevelopmental technique (NDT) and conventional exercises in children who had spastic type cerebral palsy (CP). 20 children with spastic CP who are 1-3 years old were included in the study. In Vojta treatment group there were 10 children; 3 of them female, the other 7 was male. This group consisted of 5 spastic quadriplegia, 3 spastic hemiplegia, and 2 spastic diplegia. The average age of children was 17.9±6.62 months. The second group who were given home exercise program included 10 children; 4 male, 6 female patient. This group had 5 spastic quadriplegia, 4 spastic hemiplegia, and 1 spastic diplegia. The avarage of children was 22.35±6.24 months. The cases were followed with monthly controls during the 6-month period. Both of the groups were evaluated before and after the treatments with Gross Motor Function Measure (GMFM), Stimulating Position Reflexes, Pathokinetic Motor Level Measure and Ashworth Scale. The two groups were identical for age and sex distribution of patients (p>0.05). Before and after treatment the differences of Gross Motor Function Measure (GMFM) and Pathokinetic Motor Level Measure were not statistically significant between the groups (p>0.05). However, each group showed significant differences with treatment within itself (p<0.01). Before and after treatment statistical differences were not significant in Stimulating Position Reflexes for the number of pathological reactions (p<0.05). After the treatment statistical results of each gruop were founded to be significantly different for pathological reaction numbers (p<0.05). According to the Ashworth Scale before and after treatment each group showed significant differences in themselves (p<0.05), but the difference between the two groups were not significant (p>0.05). We conclude that both Vojta Technique and home program including NDT and conventional exercises are effective in motor development and spasticity in children with spastic CP.