Kronik Obstrüktif Akciğer Hastalığında Servikal Bölge Biyomekaniği, Kas Performansı ve Solunum Kas Kuvvetinin İncelenmesi

Abstract

Although information is available regarding musculoskeletal system changes due to systemic involvement in chronic obstructive pulmonary disease (COPD), knowledge about the posture and biomechanics of the cervical region remains limited. This study aimed to compare the respiratory functions, respiratory muscle strength, cough strength, craniocervical region (CCR) muscle strength and endurance, functional capacity, posture, and posture-related conditions, as well as the static and dynamic biomechanics of the CCR between individuals with COPD and healthy individuals. Additionally, it aimed to examine how these parameters vary according to disease severity and stages. The study included 35 individuals with COPD and 35 age- and sex-matched healthy individuals. For individuals with COPD, the COPD Assessment Test, modified Medical Research Council Dyspnea Scale, Combined COPD Assessment, and pulmonary function test were administered to determine symptoms and disease severity. Respiratory muscle strength, CCR muscle strength and endurance, and cough strength were assessed using an inspiratory and expiratory pressure device, the CCR flexion test, a hand dynamometer, and a peak flow meter, respectively. Functional exercise capacity was evaluated using the 6-minute walk test, and upper extremity functional capacity was assessed with the 6-minute pegboard and ring test. Posture and posture-related conditions were analyzed through photographic methods, focusing on scapular position and orientation. Static and dynamic biomechanical analysis of the CCR was conducted using photographic analysis and cervical joint range of motion assessment, respectively. Neck disability, depression-anxiety levels, and neck pain severity were evaluated using the Neck Disability Index, Beck Depression and Beck Anxiety Inventory, and a Visual Analog Scale. As a result, individuals with COPD had less scapular anterior tilt and internal rotation, cervical rotation, flexion, extension, and lateral flexion angles than healthy individuals (p<0.05). While the superficial cervical flexor and extensor muscle strength of individuals with COPD was greater than that of healthy individuals, the endurance of deep neck flexor muscles was lower (p<0.05). The cervical right rotation and right scapular internal rotation angles were greater in individuals with severe COPD than those with mild and moderate COPD (p<0.05). Regarding disease stages, differences in the right tragus-C7-shoulder angle and cervical lateral flexion were due to Group A. Right scapular upward rotation differed in Group B, while left scapular upward rotation was affected by Group E. Left scapular elevation and cervical muscle strength decline resulted from A-B group differences (p<0.05). Biomechanical changes in CCR and scapular orientation observed in individuals with COPD compared to healthy controls are thought to be associated with accessory respiratory muscle activation. For this reason, the role of inspiratory muscle activation and functional adaptation strategies in pulmonary rehabilitation for COPD should be explored with CCR involvement, respiratory functions, muscle strength, and functional limitations.