Publication: Spastik serebral palsili hastalarda uygulanan eşik altı elektrik stimülasyonunun spastisite ve fonksiyonellik üzerine etkisi
Abstract
Amaç: Serebral palsili (SP) çocuklarda Nörogelişimsel Tedavi Yöntemleri ile birlikte uygulanan eşik altı elektrik stimülasyonunun ayak bileği eklem hareket açıklığı, spastisite, kas tonusu ve biyomekanik özellikleri ve fonksiyonellik üzerine etkilerini araştırmaktır. Gereç ve Yöntem: Cross over olarak tasarlanan çalışmaya 11 SP tanılı hasta dahil edildi. Hastalara 12x2x60 hafta/ gün/ dk boyunca Nörogelişimsel Tedaviden Yapılandırılmış Fizyoterapi NGTYFP) uygulandı. 6 haftalık NGTYFP tedavisinin ardından, tedavi programına 6x3x30 hafta/ gün/ dakika süre ile eşik altı elektrik stimülasyonu (NGTYFP+EAES) eklendi. Değerlendirmeler çalışmanın başlangıcında, 6. ve 12. haftaların sonunda olmak üzere 3 defa tekrarlandı. Değerlendirme ölçütleri olarak Pasif Eklem Hareket Açıklığı (PEHA), Modifiye Ashworth Skalası (MAS), Modifiye Tardieu Skalası (MTS), Myoton®PRO, Zamanlı Kalk Yürü Testi (ZKYT), 10 Metre Yürüme Testi (OMYT), 5 Defa Otur Kalk Testi (BDOKT), Pediatrik Fonksiyonel Bağımsızlık Ölçeği (PFBÖ) ve Alt Ekstremite Selektif Kontrol Değerlendirme Skalası (AESKDS) kullanıldı. Bulgular: NGTYFP+EAES yöntemi sonrasında başlangıca göre fonksiyonellik parametrelerinde (ZKYT, BDOKT OMYT ve PFBÖ) anlamlı artış olduğu (p>0,05), MTS, AESKDS ve MAS sonuçlarının ise değişmediği saptandı (p>0,05). Ayrıca ayak bileği dorsifleksiyon ve inversiyon eklem hareket açılarında ve gastrosoleus kas grubu ve aşil tendonu Myoton®PRO sonuçlarında anlamlı iyileşme saptandı (p>0,05). Sonuç: Nörogelişimsel Tedavi yaklaşımıyla birlikte uygulanan eşik altı elektrik stimülasyonunun SP’li çocukların spastisitesinin azaltılmasında, eklem hareket açıklığı ve fonksiyonelliğin arttırılmasında ise tek başına uygulanan NGTYFP yaklaşımına göre daha etkili olduğu belirlendi.
Objective: To investigate the effects of subthreshold electrical stimulation applied with Neurodevelopmental Therapy Based Structured Physiotherapy Program (NDTBSPP) on ankle joint range of motion, spasticity, muscle biomechanical and viscoelastic properties, and functionality in children with cerebral palsy. Material and Methods: Eleven patients with CP were included in the study, which was designed as a crossover. Neurodevelopmental Therapy Based Structured Physiotherapy Program (NDTBSPP) was applied to the patients for 12x2x60 weeks/ day/ min. After 6 weeks of NDTBSPP, subthreshold electrical stimulation (NDTBSPP+EAES) for 6x3x30 weeks/ day/ minute was added to the treatment program. Evaluations were repeated 3 times at the beginning of the study and at the end of the 6th and 12th weeks. As evaluation criteria, Passive Joint Range of Motion (PROM), Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS), Myoton®PRO, Timed Up and Go Test (TUG), 10 Meter Walk Test (10MWT), 5 Times Sit and Stand Test (5XSST), Pediatric Functional Independence Scale (WeeFIM), and Lower Extremity Selective Control Evaluation Scale (LESCES) were used. Results: After the NDTBSPP+SES method, it was determined that there was a significant increase in the functionality parameters (TUGT, BDOCT OMYT and PFPS) compared to the baseline (p>0.05), while the results of MTS, AESKDS and MAS did not change (p>0.05). In addition, significant improvement was found in ankle dorsiflexion and inversion joint range of motion, and in the gastrosoleus muscle group and Achilles tendon Myoton®PRO results (p>0.05). Conclusion: It was determined that subthreshold electrical stimulation applied together with the NDTBSPP was more effective in reducing spasticity and increasing joint range of motion and functionality in children with CP compared to the NDTBSPP approach applied alone.
Objective: To investigate the effects of subthreshold electrical stimulation applied with Neurodevelopmental Therapy Based Structured Physiotherapy Program (NDTBSPP) on ankle joint range of motion, spasticity, muscle biomechanical and viscoelastic properties, and functionality in children with cerebral palsy. Material and Methods: Eleven patients with CP were included in the study, which was designed as a crossover. Neurodevelopmental Therapy Based Structured Physiotherapy Program (NDTBSPP) was applied to the patients for 12x2x60 weeks/ day/ min. After 6 weeks of NDTBSPP, subthreshold electrical stimulation (NDTBSPP+EAES) for 6x3x30 weeks/ day/ minute was added to the treatment program. Evaluations were repeated 3 times at the beginning of the study and at the end of the 6th and 12th weeks. As evaluation criteria, Passive Joint Range of Motion (PROM), Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS), Myoton®PRO, Timed Up and Go Test (TUG), 10 Meter Walk Test (10MWT), 5 Times Sit and Stand Test (5XSST), Pediatric Functional Independence Scale (WeeFIM), and Lower Extremity Selective Control Evaluation Scale (LESCES) were used. Results: After the NDTBSPP+SES method, it was determined that there was a significant increase in the functionality parameters (TUGT, BDOCT OMYT and PFPS) compared to the baseline (p>0.05), while the results of MTS, AESKDS and MAS did not change (p>0.05). In addition, significant improvement was found in ankle dorsiflexion and inversion joint range of motion, and in the gastrosoleus muscle group and Achilles tendon Myoton®PRO results (p>0.05). Conclusion: It was determined that subthreshold electrical stimulation applied together with the NDTBSPP was more effective in reducing spasticity and increasing joint range of motion and functionality in children with CP compared to the NDTBSPP approach applied alone.