Likra Giysinin Skolyozlu Spastik Diplejik Serebral Palsili Bireylerde Denge Ve Solunum Fonksiyonlarına Etkisi

Abstract

This double-blinded, randomized controlled study aimed to evaluate the effects of using a dynamic elastomeric fabric orthosis (Lycra garment) on postural stability, respiratory functions, and functional performance in spastic diplegic cerebral palsy (CP)individuals with scoliosis. Participants were divided into two groups as intervention (n=12) and control (n=12). Both groups received an individualized physiotherapy program including scoliosis-specific exercises twice a week for 16 weeks. In addition, the intervention group wore a specially designed Lycra garment, while the control group wore a placebo garment made of cotton fabric without compressive effect for 6 hours daily. Scoliosis severity was assessed radiologically using Cobb angle; balance and weight bearing capacity were evaluated using the Sensory Organization Test (SOT) and Weight Bearing Squat (WBS) tests via Computerized Dynamic Posturography. Respiratory functions were assessed using a spirometer, and respiratory muscle strength was measured with a Respiratory Pressure Manometer (RPM). Functional capacity was evaluated with the Gross Motor Function Measure (GMFM-66), independence with the Functional Independence Measure (FIM), participation level with the Activlim, quality of life with the SRS-22 questionnaire, and postural alignment with the Posterior Trunk Symmetry Index (POTSI). The Cobb angle was measured at baseline and at the 16th week, while all other assessments were conducted at three time points: baseline, 8th week, and 16th week. At baseline, demographic variables were similar between the groups (p>0.05). A significant decrease in Cobb angle was observed only in the intervention group (F=31.977, p<0.001, η²=0.592), while no significant change was noted in the control group (F=2.507, p=0.128). Although SOT scores improved significantly in both groups (intervention: p<0.001; control: p=0.029), the group-time interaction revealed a large effect size in favor of the intervention group (η²=0.489). POTSI scores decreased significantly in both groups (p<0.001), but no significant group-time interaction was detected (p=0.246). No significant within-group differences were found in WB scores (p>0.05); however, at 0° measurement, a moderate-to-large effect size was detected in favor of the intervention group for group-time interaction (F=3.897, p=0.028, η²=0.15). Regarding respiratory functions, all parameters significantly improved in the intervention group (p<0.05) but not in the control group (p>0.05). In terms of respiratory functions, except for PEF (p=0.076), all group-time interactions showed large effect sizes in favor of the intervention group (FVC: η²=0.168; FEV₁: η²=0.529; VC: η²=0.532; TV: η²=0.455; MVV: η²=0.439). For respiratory muscle strength, only the intervention group showed significant increases in MIP (F=6.795, p=0.005, η²=0.393) and MEP (F=6.321, p=0.007, η²=0.376), while changes in the control group were not significant (MIP: p=0.066; MEP: p=0.371). GMFM-66, Activlim, and SRS-22 scores improved over time in both groups (p<0.001), while FIM scores improved only in the intervention group (p<0.001), with no significant change in the control group (p=0.231). Group-time interactions for all GMFM-66, Activlim, SRS-22, and FIM outcomes demonstrated large effect sizes in favor of the intervention group (η² > 0.14). In conclusion, lycra garment provided statistically and clinically meaningful benefits with moderate to large effect sizes in reducing scoliosis severity and improving postural stability, posture, respiratory functions, motor function, participation, independencei and quality of life in individuals with CP. These findings support the use of lycra garments as a complementary strategy in rehabilitation programs for this population.