Serebral Palsili Çocuklarda Yürüme Bandında Eğitiminin Postüral Kontrol, Denge ve Yürüme Zaman-Mesafe Özellikleri Üzerine Etkilerinin Araştırılması

Abstract

The aim of this study was to investigate the effects of treadmill training additional to physiotherapy and rehabilitation program (PTR) on postüral control parameters, balance and temporo-spatial charecteristics in children with spastic diplegic cerebral palsy. A total of 12 children aged 6 to 15 years with spastic diplegic CP level I and II according to the Gross Motor Function Classification System (GMFCS) were included in the study. The children were divided into two groups with the randomized sampling method. The study was a cross-over design, at the first phase, children in the first group (n=6) were undergone PTR program for 45 minutes a day, 3 days a week for 12 weeks; children in the second group were undergone 20 minutes treadmill training beside of PTR program 45 minutes a day, 3 days a week for 12 weeks. After twelveth week a wash period was given for 4 weeks and at the end of fourth week children in both groups crossed over; the second phase of therapy was started; children in the first group were started additional treadmill training for 20 minutes beside of PTR program for 45 minutes a day, 3 days a week for 8 weeks and children in the second group were started PTR program for 45 minutes a day, 3 days a week for 12 weeks. All tests were applied at the beginning and at the end of the first and second phases of the study. Postüral control and gait were evaluated by posturography and modified clinical test of sensory balance interaction, test of limits of stability, test of ryhtmic weight shifting, sit to stand, walk across, tandem walk, stairs up and down and forwerd lunge tests. Balance was evaluated by pediatric balance scale and timed up and go test. Gross motor function was assessed by Gross Motor Function Measure (GMFM), D and E subtests. Trunk control was evaluated by Trunk Control Measurement Scale and functional muscle force evaluated. There were not any significant difference was present between the measurements of the two groups before the treatment (p>0,05). After treatment program with treadmill training, there were significant differences on postüral control parameters, gait and balance in patients (p<0,01) especially on alignment of gravity line and weight shifting to the backwards. In conclusion, tradmill training addition to PTR program can benefit therapy programs targeted to develop postural control, balance and gait in children with spastic CP.