ORIJINAL ARAŞTIRMA
Tek Taraflı Serebral Palsili Çocuklarda Kas Mimarisi ile Fonksiyonel Motor Becerileri Arasındaki İlişki
Relationship in Children with Unilateral Cerebral Palsy Between Muscle Architecture and Functional Motor Skills
Received Date : 24 Jan 2024
Accepted Date : 07 Jun 2024
Available Online : 13 Jun 2024
Orhan GÜVENERa, Figen DAĞb, Özlem TEZOLc, Asena Ayça ÖZDEMİRd, Melek SEZGİNa
aMersin University Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Mersin, Türkiye
bMersin University Vocational School of Health Services, Department of Medical Services and Techniques, Mersin, Türkiye
cMersin University Faculty of Medicine, Department of Child Health and Diseases, Mersin, Türkiye
dMersin University Faculty of Medicine, Department of Medical Education, Mersin, Türkiye
Doi: 10.31609/jpmrs.2024-101632 - Makale Dili: EN
Turkiye Klinikleri Journal of Physical Medicine and Rehabilitation Sciences. 2024;27(3):175-84.
ÖZET
Amaç: Bu çalışmanın amacı, unilateral serebral palsili [unilateral
cerebral palsy (UCP)] çocuklarda kas mimari özelliklerindeki farklılıkları
ve bunların fonksiyonel motor becerilerle ilişkisini
araştırmaktır. Gereç ve Yöntemler: Bu çalışmaya 36 UCP’li ve 36 sağlıklı
çocuk dâhil edildi. Bacak kas mimarileri ultrasonografi ile değerlendirildi.
Fonksiyonel motor beceriler; Zamanlı Kalk ve Yürü Testi, 5
Tekrarlı Otur Kalk Testi [5 Times Sit and Stand Test (5xSST)], 10
Metre Yürüme Testi, Kaba Motor Fonksiyon Ölçütü’nün [Gross Motor
Function Measure-88 (GMFM-88)] D ve E alt grupları ve Pediatrik
Berg Denge Ölçeği [Pediatric Berg Balance Scale (PBS)] ile değerlendirildi.
Bulgular: UCP’li bireylerde etkilenen ekstremitenin mediyal
gastroknemius [medial gastrocnemius (Gm)], lateral gastroknemius [lateral
gastrocnemius (Gl)], tibialis anterior (Ta) ve tibialis posterior kaslarının
kalınlıkları etkilenmeyen ekstremiteye göre daha inceydi
(p=0.004, p=0.02, p<0.001, p<0.001; sırasıyla). Etkilenmiş ekstremitenin
soleus kası hariç diğer kaslarının fasikül uzunlukları etkilenmemiş
ekstremiteye göre daha kısaydı (p<0.05). 5xSST ile Gm ve Gl kas kalınlığı
arasında (sırasıyla; r=-0.38, p=0.04; r=-0.33, p=0.02); PBS ile
Gm kası pennasyon açısı ve sol kas fasikül uzunluğu arasında; (sırasıyla;
r=-0.37, p=0.03; r=-0.37, p=0.03) ve GMFM-88-E ile Ta kası
pennasyon açısı arasında zayıf-orta korelasyon vardı (r=0.34, p=0.04).
Sonuç: UCP’li çocukların etkilenen tarafının kas mimari özellikleri etkilenmeyen
taraftan ve sağlıklı taraftan farklıydı. Bu farklılıklar UCP’li
çocukların fonksiyonel beceri düzeylerini etkilemiştir.
Anahtar Kelimeler: Serebral palsi; kas geometrisi; pennat açı; ultrasonografi; fasikül uzunluğu
ABSTRACT
Objective: This study aim was to investigate differences
in muscle architectural characteristics in children with unilateral cerebral
palsy (UCP) and their relationship with functional motor skills.
Material and Methods: This study enrolled thirty-six children with
UCP and thirty-six healthy controls. Leg muscle architecture was evaluated
with ultrasound. Functional motor skills were assessed via the
Timed Up and Go Test, the 5 Times Sit and Stand Test (5xSST), the
10m Walk Test, the Dimensions D and E of Gross Motor Function
Measure-88 (GMFM-88), and the Pediatric Berg Balance Scale (PBS).
Results: The thickness of the medial gastrocnemius (Gm), lateral gastrocnemius
(Gl), tibialis anterior (Ta), and tibialis posterior muscles
were smaller in the affected extremity than the unaffected extremity in
UCP (p=0.004, p=0.02, p<0.001, p<0.001; respectively). Except for the
soleus (Sol) muscle, the fascicle lengths of the other muscles of the affected
extremity were shorter than those of the unaffected extremity
(p<0.05). There were significant weak-moderate correlations between
5xSST and Gm and Gl muscles thickness (respectively; r=-0.38,
p=0.04; r=-0.33, p=0.02), between PBS and Gm muscle pennation
angle and Sol muscle fascicle length (respectively; r=-0.37, p=0.03; r=-
0.37, p=0.03). Additionally, a correlation was observed between
GMFM-88-E and Ta muscle pennation angle (r=0.34, p=0.04). Conclusion:
The muscle architectural characteristics of the affected side of
children with UCP was different from those of the unaffected side and
from those of healthy controls. These differences affected the functional
skill levels of children with UCP.
Keywords: Cerebral palsy; muscle geometry; pennation angle; ultrasound; fascicle length
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