Preterm ve Term Çocuklarda Serbest ve İkili Görevli Yürüme Parametrelerinin Karşılaştırılması ve Nörogelişimsel Sonuçlar ile İlişkinin İncelenmesi
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Topal, Y., Comparison of Self-Selected Speed and Dual-Task Gait Parameters in Preterm and Term Children and Examination of the Relationship with Neurodevelopmental Outcomes, Hacettepe University, Graduate School of Health Sciences, Physical Therapy and Rehabilitation, Doctor of Philosophy Thesis, Ankara, 2023. This study aimed to investigate self-selected speed and dual-task gait spatiotemporal characteristics, variations in plantar pressure distributions, and their relationship with neurodevelopmental assessment parameters at 3 years of age before kindergarten in children born preterm. The 81 preterm children included in the study were divided into two groups extremely-very preterm (<32) and moderately-late preterm (32≤ and <37) according to their gestational weeks. In addition, 31-term children aged 3 years were included in the study for normalization of gait parameters. A walking platform GAITRite was used for the spatiotemporal characteristics and dynamic plantar base pressure distributions of preterm and term children aged between 30-42 months at self-selected speed and dual-task while carrying a ball with a diameter of a 22 cm and weight of 180 gr in their hands, and the Bayley Scales of Infant and Toddler Development-III (Bayley-III) was used for neurodevelopmental evaluations of preterm children. Moderately-late preterm children were found to walk with increased stride width compared to term children (p=0.024) and with increased stride length variability compared to extremely-very preterm children (p=0.038), and term children (p=0.003) during self-selected speed walking. There was no difference between the groups in terms of spatiotemporal characteristics during dual-task walking (p>0,05). In extremely-very preterm children, medial foot dynamic plantar peak pressure increased (p=0.004) and lateral foot dynamic plantar peak pressure decreased (p=0.005) during dual-task walking compared to self-selected speed walking. No difference was found between the groups in terms of dynamic plantar peak pressure and time during self-selected speed and dual-task walking (p>0,05). The step factor of extremely-very preterm children during self-selected speed walking was found to be associated with cognitive composite, motor composite, fine and gross motor, and during dual-task walking with receptive language scale and language composite (p<0,05). Fine motor outcomes of extremely-very preterm children during self-selected speed walking were negatively related to forefoot dynamic plantar peak pressure and positively related to hindfoot dynamic plantar peak pressure (p<0,05). In conclusion, it is important to evaluate 3-year-old pre-kindergarten preterm children in terms of neurodevelopmental function as well as their performance during self-selected speed and dual-task walking. In particular,while the moderate-late preterm children had an impaired gait performance compared to their term peers during self-selected speed walking, this difference disappeared during dual-task walking. The gait performances and dynamic plantar pressure distributions of extremely-very preterm children, who were found to be more at risk for neurodevelopmental problems, may be impaired. In conclusion, the moderately-late preterm children, who were found to be at risk for neurodevelopmental problems, should be followed up with age-specific evaluations and follow-ups like extremely-very preterm children to refer to early intervention programs when necessary.