Serebral Palsili Çocuklarda Botulinum Toksin Enjeksiyonu Sonrası Fizyoterapi ve Rehabilitasyon Programının Vücut Fonksiyonları, Aktivite ve Katılım Üzerine Etkilerinin İncelenmesi

Abstract

The aim of this study was to investigate the effects of particularly structured for child and parent, goal directed, activity based physiotherapy and rehabilitation program following Botulinum Toxin (BoNT-A) injection on body functions, activity and participation in children with Cerebral Palsy (CP). 24 children with spastic diplegic CP aged between 3-10 years, in level II or III according to Gross Motor Function Classification System, received “the Traditional Physical Therapy and Rehabilitation Program” (T-PTR) twice a week at in a Special Education and Rehabilitation Center were included in this study. Children were divided into two groups as the study (n = 12) and control group (n = 12). The study group had “the Structured for Child and Parent, Goal Directed, Activity-Based Physical Therapy and Rehabilitation Program” (S-PTR) for an hour a day, twice a week for 8 weeks and the control group had T-PTR for the same duration. In the study group, goals related activity and participation were determined by child, parent and physiotherapist for each child and assessed according to Goal Attaintment Scale (GAS). Daily activities and participation (Pediatric Evaluation of Disability Inventory-PEDI), motor functions (Gross Motor Function Measurement standing and, walking, running and jumping sub division - GMFM D and E), walking performance (Gilette Functional Gait Assessment Questionnaire), balance (Pediatric Balance Scale), the muscle tone (Modified Ashworth Scale, Modified Tardieu Scale), muscle strength (manual muscle tester), selective motor control ability (Selective Control of Lower Extremity-SCALE), extremity positions during gait (Observational Gait Analysis), temporo-spatial characteristics of gait (Gait trainer Biodex II) of children were assessed before and after treatment. The parent’s concern, satisfaction, and the child's compliance to the program were evaluated. As a result; in the study group, statistically significant improvements were observed in GAS scores aiming at improving activity and participation in life (p <0.05). In the walking performance, the standing section of the GMFM and the mobility section of the PEDI of the study group, there was a statistically significant increase compared to the control group (p<0.05). The SCALE scores of the ankles and toes and walking speed of the study group were significantly higher than the control group (p <0.05). The decrease in the tone of the adductor, hamstring and gastrocnemius muscles in the study group were statistically significant compared to control group, although the tones of lower extremity muscles were decreased in both groups (p<0.05). The muscle strength of the trunk and lower extremities of the study group increased and the increase in hip extensor and flexor muscle strength was significantly higher than the control group (p <0.05). The parents were more satisfied and complied with the program in the study group (p <0.05). In conclusion, after multi-level BoNT-A injections, S-PTR program provided more positive contributions to children's motor functions, walking quality, daily life activities and participation in life by affecting muscle tonus, muscle strength and selectivity of lower extremity more when compared to T-PTR program.