Non-Ambulatuar Duchenne Musküler Distrofili Hastalarda El Fonksiyonlarını Etkileyen Faktörlerin Araştırılması

Abstract

This study was planned to determine the factors affecting hand function of children with Duchenne Muscular Dystrophy who have lost walking ability and to investigate the effects of these factors on general upper extremity performance and quality of life. Twenty-three patients from Level 1-5 according to Brooke Upper Extremity Functional Classification (BUEFC) were included in our study. Performance of upper limb, hand functions, passive range of motion limitations, thumb opposition, tripod, lateral, two-point pinch strengths, gross grip strength, all upper extremity muscle strength including shoulder, elbow, hand and wrist, activity limitationsand the quality of life of children and their parents were assessed. It was determined that BUEFC (r=-0.69), duration of wheelchair use (r=-0.50), pinch, lateral, tripod and gross grip strenght (respectively r=0.61, r=0.56, r=0.63, r=0.54) and total upper extremity muscle strength (r=0.54) were the factors that affect hand functions (p<0.05). In addition, all the factors affecting hand functions were related to general upper extremity performance (p<0.05). From these factors, BUEFC were found to be correlated with PedsQL-child (r=-0,48), and with PedsQL-parent report (r=-0,50), (p<0.05). Additionally, ABILHAND-Kids score could be explained by 60-70% and the PUL (total) score by 83-87% with the evaluated parameters. According to the results obtained, it is considered that the hand dexterity of children with DMD can be more affected by loss of muscle strength and grip strength. Rehabilitation approaches for the protection / development of distal upper extremity functions of children with DMD are important because factors affecting hand function of children with DMD are related to general upper extremity function and upper extremity functional levels are related to the quality of life of both children and their parents.