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SPASTİK DİPLEJİK SEREBRAL PALSİLİ ÇOCUKLARDA PELVİK KONTROL EGZERSİZLERİNİN AYAKTA DURMA ÜZERİNE ETKİSİ: PİLOT RANDOMİZE KONTROLLÜ ÇALIŞMA

Yıl 2025, Cilt: 36 Sayı: 1, 20 - 40, 25.04.2025

Aartı Gupta , Dr. Siddhartha Sen

https://doi.org/10.21653/tjpr.1413181

Öz

Amaç: Pelvik instabilite, spastik diplejik serebral palsili (SP) çocuklarda sık görülen bir bulgudur. Hareketlilik ve günlük işlevsellik, uygunsuz kas aktivasyonu ve pelvis çevresindeki hareketin yetersiz düzenlenmesi nedeniyle engellenir. Çalışmanın amacı spastik diplejik SP'li çocuklarda pelvik kontrol egzersizlerinin postür üzerine etkilerini araştırmaktı.
Yöntem: Bu tek-kör çalışmaya katılan SP'li 24 spastik diplejik çocuk, basit rastgele örnekleme yoluyla rastgele iki gruba ayrıldı. Grup A'ya (n=12) geleneksel müdahale ve pelvik kontrol egzersizleri yapılırken, Grup B'ye (n=12) yalnızca geleneksel müdahale uygulandı. Sekiz hafta boyunca müdahale haftada üç gün gerçekleştirildi. Torasik eğim (TI), gövde açısı (TA), pelvik eğim (PT), lomber açı (LA), lomber eğri (LC), anterior superior iliak omurganın yatay hizalaması (HAASIS), posterior superior iliak yatay hizalaması gibi postüral açılar omurga (HAP), müdahalenin bitiminden önce ve sonra sonuç ölçüsü olarak değerlendirildi. İki grup arasındaki farklılıkları incelemek için bağımsız t testi, grup içi farklılıkları incelemek için eşleştirilmiş t testi kullanıldı.
Sonuçlar: Her iki grubun sonuç ölçümleri tedavi öncesinde karşılaştırıldığında anlamlı bir fark gözlenmedi. A çalışma grubundaki postüral açı değerleri, konvansiyonel fizyoterapi ve pelvik kontrol egzersizleri ile yapılan tedavi sonrasında, tek başına konvansiyonel tedaviye kıyasla anlamlı bir iyileşme gösterdi. TA (p=0,030) ve LC (p=0,007) açıları artarken, TI (p=0,027), PT (p<0,001), LA (p=0,005), HAASIS (p=0,054) ve HAP (p=0,017) grup A'da düşüş gösterdi ve bu da daha iyi gövde ve pelvik hizalanma sağladı.
Tartışma: Sonuçlar, spastik diplejik SP'li çocuklarda pelvik kontrol eğitiminin postürün iyileştirilmesinde faydalı olabileceğini gösterdi.

Anahtar Kelimeler

Serebral Palsi Dipleji Postür Spastisite pelvis

Kaynakça

  • Braendvik SM, Elvrum , Vereijken B, Roeleveld K. Relationship between neuromuscular body functions and upper extremity activity in children with cerebral palsy. Developmental Medicine & Child Neurology. 2010 Feb;52(2):e29-34.
  • Yokochi K. Gait patterns in children with spastic diplegia and periventricular leukomalacia. Brain and Development. 2001 Feb 1;23(1):34-7.
  • Tang-Wai R, Webster RI, Shevell MI. A clinical and etiologic profile of spastic diplegia. Pediatric neurology. 2006 Mar 1;34(3):212-8.
  • Domagalska-Szopa M, Szopa A. Postural orientation and standing postural alignment in ambulant children with bilateral cerebral palsy. Clinical Biomechanics. 2017 Nov 1; 49:22-
  • Szopa A, Domagalska-Szopa M, Siwiec A, Kwiecień-Czerwieniec I. Canonical correlation between body-posture deviations and gait disorders in children with cerebral palsy. PLoS One. 2020 Jun 16;15(6):e0234654.
  • CJ S. Transfer of lumbosacral load to iliac bones and legs. Pt 1: Biomechanics of self-bracing and its significance for treatment & exercise. Clin Biomech. 1993; 8:285-94.
  • El-Nabie A, Abd El-Hakiem W, Saleh MS. Trunk and pelvic alignment in relation to postural control in children with cerebral palsy. Journal of Back and Musculoskeletal Rehabilitation. 2019 Jan 1;32(1):125-30.
  • Miller F. Hip and Pelvic Kinematic Pathology in Cerebral Palsy Gait. Cerebral Palsy. 2020:1471-87.
  • Quint C, Toomey M. Powered saddle and pelvic mobility: an investigation into the effects on pelvic mobility of children with cerebral palsy of a powered saddle which imitates the movements of a walking horse. Physiotherapy. 1998 Aug 1; 84(8):376-84.
  • Park EY, Kim WH. Meta-analysis of the effect of strengthening interventions in individuals with cerebral palsy. Research in developmental disabilities. 2014 Feb 1; 35(2):239-249.
  • Gupta N, Kumar S, Gupta A, Rishi P. Effect of Vibratory Inhibition and Pelvic Stabilization Exercise on Tone, Balance and Gross Motor Function in Spastic Cerebral Palsy-A Comparative Study.
  • Dubey L, Karthikbabu S, Mohan D. Effects of pelvic stability training on movement control, hip muscles strength, walking speed and daily activities after stroke: a randomized controlled trial. Annals of neurosciences. 2018 Jan 25;25(2):80-9.
  • Karthikbabu S, Solomon JM, Manikandan N, Rao BK, Chakrapani M, Nayak A. Role of trunk rehabilitation on trunk control, balance and gait in patients with chronic stroke: a pre-post design. Neuroscience and medicine. 2011 Jun 29;2(02):61-7.
  • Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Bmj. 2010 Mar 24;340.
  • Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharmaceut. Statist. 2005 Oct; 4(4):287-91.
  • Paušić J, Pedišić Ž, Dizdar D. Reliability of a photographic method for assessing standing posture of elementary school students. J Manipulative Physiol Ther. 2010 Jul 1;33(6):425-31.
  • Gupta A, Sen S, Bajpai R. Postural assessment of children with spastic cerebral palsy: a cross-sectional study. Int J Res Med Sci 2023; 11:3763-71.
  • Claeys K, Brumagne S, Deklerck J, Vanderhaeghen J, Dankaerts W. Sagittal evaluation of usual standing and sitting spinal posture. J. Bodyw. Mov. Ther. 2016 Apr 1;20(2):326-33.
  • Ferreira EA, Duarte M, Maldonado EP, Bersanetti AA, Marques AP. Quantitative assessment of postural alignment in young adults based on photographs of anterior, posterior, and lateral views. J Manipulative Physiol Ther. 2011 Jul 1;34(6):371-80.
  • Fernández-González P, Koutsou A, Cuesta-Gómez A, Carratalá-Tejada M, Miangolarra Page JC, Molina-Rueda F. Reliability of kinovea® software and agreement with a three-dimensional motion system for gait analysis in healthy subjects. Sensors. 2020 Jun2;20(11):3154.
  • Van den Broeck C, De Cat J, Molenaers G, Franki I, Himpens E, Severijns D, Desloovere K. The effect of individually defined physiotherapy in children with cerebral palsy (CP). european journal of paediatric neurology. 2010 Nov 1;14(6):519-25.
  • Davies PM. Steps to follow: the comprehensive treatment of patients with hemiplegia. Springer Science & Business Media; 2000 May 8.
  • Carlberg EB, Hadders-Algra M. Postural dysfunction in children with cerebral palsy: some implications for therapeutic guidance. Neural plasticity. 2005;12(2-3):221-8.
  • Cook A, Wollacott M. Motor control: theory & practical application. 2nd ed. Baltimore: Lippincott Williams and Wilkins; 2001
  • Suh SW, Suh DH, Kim JW, Park JH, Hong JY. Analysis of sagittal spinopelvic parameters in cerebral palsy. The Spine Journal. 2013 Aug 1;13(8):882-8.
  • Said DM, Hussein A, Ali S, Ali A. Effect of pelvic stability on balance in children with spastic cerebral palsy. International Journal of Recent Advances in Multidisciplinary Research. 2020 Jan;7(01), 5449-5452.
  • Sharma V, Kaur J. Effect of core strengthening with pelvic proprioceptive neuromuscular facilitation on trunk, balance, gait, and function in chronic stroke. J Exerc rehabil. 2017 Apr;13(2):200.
  • Campbell, S.K., 1999. Decision Making in Pediatric Neurologic Physical Therapy. 1st ed. Churchill Livingstone
  • Dubey L, Karthikbabu S, Mohan D. Effects of pelvic stability training on movement control, hip muscles strength, walking speed and daily activities after stroke: a randomized controlled trial. Annals of neurosciences. 2018 Jan 25;25(2):80-9.
  • Kim JH, Seo HJ. Effects of trunk-hip strengthening on standing in children with spastic diplegia: a comparative pilot study. J Phys Ther Sci. 2015;27(5):1337-40.
  • Martín-Valero R, Vega-Ballón J, Perez-Cabezas V. Benefits of hippotherapy in children with cerebral palsy: A narrative review. Eur. J. Paediatr. Neurol. 2018 Nov 1;22(6):1150-60.

THE EFFECT OF PELVIC CONTROL EXERCISES ON STANDING POSTURE IN CHILDREN WITH SPASTIC DIPLEGIC CEREBRAL PALSY: A PILOT RANDOMIZED CONTROLLED TRIAL

Yıl 2025, Cilt: 36 Sayı: 1, 20 - 40, 25.04.2025

Aartı Gupta , Dr. Siddhartha Sen

https://doi.org/10.21653/tjpr.1413181

Öz

Purpose: Pelvic instability is a common finding in children with spastic diplegic cerebral palsy (CP). Mobility and day-to-day functioning are impeded by improper muscle activation and inadequate regulation of movement around the pelvis. The study's objective was to investigate the effects of pelvic control exercises on posture of children with spastic diplegic CP.
Methods: 24 spastic diplegic children with CP who participated in this single-blind trial were divided into two groups at random by simple random sampling. Group A (n = 12) received conventional intervention and pelvic control exercises, while Group B (n = 12) received only conventional intervention. For a period of eight weeks, the intervention was carried out three days a week. Postural angles like thoracic inclination (TI), trunk angle (TA), pelvic tilt (PT), lumbar angle (LA), lumbar curve (LC), horizontal alignment of anterior superior iliac spine (HAASIS), horizontal alignment of posterior superior iliac spine (HAP) were evaluated as outcome measure before and after the intervention is finished. While the independent t test was used to examine differences between the two groups, the paired-t test was employed to examine differences within the group.
Results: When outcome measures from both groups were compared prior to treatment, no significant differences were observed. The values of postural angles in study group A showed a significant improvement after the treatment with conventional physiotherapy and pelvic control exercises in comparison with conventional treatment alone. Angles of TA (p=0.030) and LC (p=0.007) increased while those of TI (p=0.027), PT (p<0.001), LA (p=0.005), HAASIS (p=0.054), and HAP (p=0.017) decreased in group A resulting in better trunk and pelvic alignment.
Conclusion: The results indicated that pelvic control training could be beneficial in improving posture of children with spastic diplegic CP.

Anahtar Kelimeler

Cerebral Palsy Diplegia Posture Spasticity pelvis

Kaynakça

  • Braendvik SM, Elvrum , Vereijken B, Roeleveld K. Relationship between neuromuscular body functions and upper extremity activity in children with cerebral palsy. Developmental Medicine & Child Neurology. 2010 Feb;52(2):e29-34.
  • Yokochi K. Gait patterns in children with spastic diplegia and periventricular leukomalacia. Brain and Development. 2001 Feb 1;23(1):34-7.
  • Tang-Wai R, Webster RI, Shevell MI. A clinical and etiologic profile of spastic diplegia. Pediatric neurology. 2006 Mar 1;34(3):212-8.
  • Domagalska-Szopa M, Szopa A. Postural orientation and standing postural alignment in ambulant children with bilateral cerebral palsy. Clinical Biomechanics. 2017 Nov 1; 49:22-
  • Szopa A, Domagalska-Szopa M, Siwiec A, Kwiecień-Czerwieniec I. Canonical correlation between body-posture deviations and gait disorders in children with cerebral palsy. PLoS One. 2020 Jun 16;15(6):e0234654.
  • CJ S. Transfer of lumbosacral load to iliac bones and legs. Pt 1: Biomechanics of self-bracing and its significance for treatment & exercise. Clin Biomech. 1993; 8:285-94.
  • El-Nabie A, Abd El-Hakiem W, Saleh MS. Trunk and pelvic alignment in relation to postural control in children with cerebral palsy. Journal of Back and Musculoskeletal Rehabilitation. 2019 Jan 1;32(1):125-30.
  • Miller F. Hip and Pelvic Kinematic Pathology in Cerebral Palsy Gait. Cerebral Palsy. 2020:1471-87.
  • Quint C, Toomey M. Powered saddle and pelvic mobility: an investigation into the effects on pelvic mobility of children with cerebral palsy of a powered saddle which imitates the movements of a walking horse. Physiotherapy. 1998 Aug 1; 84(8):376-84.
  • Park EY, Kim WH. Meta-analysis of the effect of strengthening interventions in individuals with cerebral palsy. Research in developmental disabilities. 2014 Feb 1; 35(2):239-249.
  • Gupta N, Kumar S, Gupta A, Rishi P. Effect of Vibratory Inhibition and Pelvic Stabilization Exercise on Tone, Balance and Gross Motor Function in Spastic Cerebral Palsy-A Comparative Study.
  • Dubey L, Karthikbabu S, Mohan D. Effects of pelvic stability training on movement control, hip muscles strength, walking speed and daily activities after stroke: a randomized controlled trial. Annals of neurosciences. 2018 Jan 25;25(2):80-9.
  • Karthikbabu S, Solomon JM, Manikandan N, Rao BK, Chakrapani M, Nayak A. Role of trunk rehabilitation on trunk control, balance and gait in patients with chronic stroke: a pre-post design. Neuroscience and medicine. 2011 Jun 29;2(02):61-7.
  • Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Bmj. 2010 Mar 24;340.
  • Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharmaceut. Statist. 2005 Oct; 4(4):287-91.
  • Paušić J, Pedišić Ž, Dizdar D. Reliability of a photographic method for assessing standing posture of elementary school students. J Manipulative Physiol Ther. 2010 Jul 1;33(6):425-31.
  • Gupta A, Sen S, Bajpai R. Postural assessment of children with spastic cerebral palsy: a cross-sectional study. Int J Res Med Sci 2023; 11:3763-71.
  • Claeys K, Brumagne S, Deklerck J, Vanderhaeghen J, Dankaerts W. Sagittal evaluation of usual standing and sitting spinal posture. J. Bodyw. Mov. Ther. 2016 Apr 1;20(2):326-33.
  • Ferreira EA, Duarte M, Maldonado EP, Bersanetti AA, Marques AP. Quantitative assessment of postural alignment in young adults based on photographs of anterior, posterior, and lateral views. J Manipulative Physiol Ther. 2011 Jul 1;34(6):371-80.
  • Fernández-González P, Koutsou A, Cuesta-Gómez A, Carratalá-Tejada M, Miangolarra Page JC, Molina-Rueda F. Reliability of kinovea® software and agreement with a three-dimensional motion system for gait analysis in healthy subjects. Sensors. 2020 Jun2;20(11):3154.
  • Van den Broeck C, De Cat J, Molenaers G, Franki I, Himpens E, Severijns D, Desloovere K. The effect of individually defined physiotherapy in children with cerebral palsy (CP). european journal of paediatric neurology. 2010 Nov 1;14(6):519-25.
  • Davies PM. Steps to follow: the comprehensive treatment of patients with hemiplegia. Springer Science & Business Media; 2000 May 8.
  • Carlberg EB, Hadders-Algra M. Postural dysfunction in children with cerebral palsy: some implications for therapeutic guidance. Neural plasticity. 2005;12(2-3):221-8.
  • Cook A, Wollacott M. Motor control: theory & practical application. 2nd ed. Baltimore: Lippincott Williams and Wilkins; 2001
  • Suh SW, Suh DH, Kim JW, Park JH, Hong JY. Analysis of sagittal spinopelvic parameters in cerebral palsy. The Spine Journal. 2013 Aug 1;13(8):882-8.
  • Said DM, Hussein A, Ali S, Ali A. Effect of pelvic stability on balance in children with spastic cerebral palsy. International Journal of Recent Advances in Multidisciplinary Research. 2020 Jan;7(01), 5449-5452.
  • Sharma V, Kaur J. Effect of core strengthening with pelvic proprioceptive neuromuscular facilitation on trunk, balance, gait, and function in chronic stroke. J Exerc rehabil. 2017 Apr;13(2):200.
  • Campbell, S.K., 1999. Decision Making in Pediatric Neurologic Physical Therapy. 1st ed. Churchill Livingstone
  • Dubey L, Karthikbabu S, Mohan D. Effects of pelvic stability training on movement control, hip muscles strength, walking speed and daily activities after stroke: a randomized controlled trial. Annals of neurosciences. 2018 Jan 25;25(2):80-9.
  • Kim JH, Seo HJ. Effects of trunk-hip strengthening on standing in children with spastic diplegia: a comparative pilot study. J Phys Ther Sci. 2015;27(5):1337-40.
  • Martín-Valero R, Vega-Ballón J, Perez-Cabezas V. Benefits of hippotherapy in children with cerebral palsy: A narrative review. Eur. J. Paediatr. Neurol. 2018 Nov 1;22(6):1150-60.
Toplam 31 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Fizyoterapi
Bölüm Araştırma Makaleleri
Yazarlar

Aartı Gupta 0000-0003-0637-8656

Dr. Siddhartha Sen 0000-0002-5269-5639

Erken Görünüm Tarihi 15 Mayıs 2025
Yayımlanma Tarihi 25 Nisan 2025
Gönderilme Tarihi 11 Ocak 2024
Kabul Tarihi 10 Şubat 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 36 Sayı: 1

Kaynak Göster

APA Gupta, A., & Sen, D. S. (2025). THE EFFECT OF PELVIC CONTROL EXERCISES ON STANDING POSTURE IN CHILDREN WITH SPASTIC DIPLEGIC CEREBRAL PALSY: A PILOT RANDOMIZED CONTROLLED TRIAL. Türk Fizyoterapi Ve Rehabilitasyon Dergisi, 36(1), 20-40. https://doi.org/10.21653/tjpr.1413181
AMA Gupta A, Sen DS. THE EFFECT OF PELVIC CONTROL EXERCISES ON STANDING POSTURE IN CHILDREN WITH SPASTIC DIPLEGIC CEREBRAL PALSY: A PILOT RANDOMIZED CONTROLLED TRIAL. Turk J Physiother Rehabil. Nisan 2025;36(1):20-40. doi:10.21653/tjpr.1413181
Chicago Gupta, Aartı, ve Dr. Siddhartha Sen. “THE EFFECT OF PELVIC CONTROL EXERCISES ON STANDING POSTURE IN CHILDREN WITH SPASTIC DIPLEGIC CEREBRAL PALSY: A PILOT RANDOMIZED CONTROLLED TRIAL”. Türk Fizyoterapi Ve Rehabilitasyon Dergisi 36, sy. 1 (Nisan 2025): 20-40. https://doi.org/10.21653/tjpr.1413181.
EndNote Gupta A, Sen DS (01 Nisan 2025) THE EFFECT OF PELVIC CONTROL EXERCISES ON STANDING POSTURE IN CHILDREN WITH SPASTIC DIPLEGIC CEREBRAL PALSY: A PILOT RANDOMIZED CONTROLLED TRIAL. Türk Fizyoterapi ve Rehabilitasyon Dergisi 36 1 20–40.
IEEE A. Gupta ve D. S. Sen, “THE EFFECT OF PELVIC CONTROL EXERCISES ON STANDING POSTURE IN CHILDREN WITH SPASTIC DIPLEGIC CEREBRAL PALSY: A PILOT RANDOMIZED CONTROLLED TRIAL”, Turk J Physiother Rehabil, c. 36, sy. 1, ss. 20–40, 2025, doi: 10.21653/tjpr.1413181.
ISNAD Gupta, Aartı - Sen, Dr. Siddhartha. “THE EFFECT OF PELVIC CONTROL EXERCISES ON STANDING POSTURE IN CHILDREN WITH SPASTIC DIPLEGIC CEREBRAL PALSY: A PILOT RANDOMIZED CONTROLLED TRIAL”. Türk Fizyoterapi ve Rehabilitasyon Dergisi 36/1 (Nisan 2025), 20-40. https://doi.org/10.21653/tjpr.1413181.
JAMA Gupta A, Sen DS. THE EFFECT OF PELVIC CONTROL EXERCISES ON STANDING POSTURE IN CHILDREN WITH SPASTIC DIPLEGIC CEREBRAL PALSY: A PILOT RANDOMIZED CONTROLLED TRIAL. Turk J Physiother Rehabil. 2025;36:20–40.
MLA Gupta, Aartı ve Dr. Siddhartha Sen. “THE EFFECT OF PELVIC CONTROL EXERCISES ON STANDING POSTURE IN CHILDREN WITH SPASTIC DIPLEGIC CEREBRAL PALSY: A PILOT RANDOMIZED CONTROLLED TRIAL”. Türk Fizyoterapi Ve Rehabilitasyon Dergisi, c. 36, sy. 1, 2025, ss. 20-40, doi:10.21653/tjpr.1413181.
Vancouver Gupta A, Sen DS. THE EFFECT OF PELVIC CONTROL EXERCISES ON STANDING POSTURE IN CHILDREN WITH SPASTIC DIPLEGIC CEREBRAL PALSY: A PILOT RANDOMIZED CONTROLLED TRIAL. Turk J Physiother Rehabil. 2025;36(1):20-4.
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