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Spastik serebral palsili çocuklarda spastisiteyi değerlendiren iki farklı klinik ölçeğin kaba motor fonksiyonu ile ilişkisi

Year 2016, Volume: 3 Issue: 3, 77 - 83, 01.12.2016

Ayşe Numanoğlu Akbaş Mintaze Kerem Günel

Abstract

Amaç: Bu çalışma spastik serebral palsili (SP) çocuklarda spastisiteyi değerlendirmek için kullanılan iki farklı klinik yöntemin
birbirleri ve kaba motor fonksiyon ile ilişkilerini belirlemek amacıyla yapıldı. Kaba motor fonksiyon üzerinde hangi kasların
etkili olduğu araştırıldı.


Yöntem: Çalışmada, 37 spastik SP’li çocuğun dirsek fleksör, el bileği fleksör, kalça addüktör, hamstring, gasroknemius ve
soleus kasları spastisitenin şiddeti açısından Modifiye Ashworth Skalası (MAS) ve Modifiye Tardieu Skalası (MTS) ile
değerlendirildi. Çocukların kaba motor fonksiyon seviyeleri Kaba Motor Fonksiyon Sınıflandırma Sistemi (KMFSS) ile
belirlendi.


Bulgular: MAS ve MTS arasındaki ilişki analiz edildiğinde en çok uyum dirsek fleksörleri, el bileği fleksörleri, kalça
addüktörleri ve hamstring kasları için bulundu (p<0,05). MAS ve MTS’nin KMFSS ile olan ilişkisine bakıldığında ise iki testte
de hamstring kasları ile KMFSS seviyesi arasında anlamlı ilişki bulundu (p<0,05).

Sonuç: Bu çalışmanın sonuçlarına göre MAS ve MTS’nin genel olarak birbirleriyle uyumlu olduğu fakat bu uyumun
değerlendirilen kaslara göre değişiklik gösterebileceği, hamstring kaslarının spastisitesinin ve statik kontraktürlerinin kaba
motor fonksiyonu etkilediği görüldü.

Keywords

Hasta sonuç değerlendirmesi Serebral palsi Kas spastisitesi Motor beceriler

References

  • 1. Koman LA, Smith BP, Shilt JS. Cerebral palsy. Lancet. 2004;363(9421):1619-1631.
  • 2. Cooney KM, Sanders JO, Concha MC, et al. Novel biomechanics demonstrate gait dysfunction due to hamstring tightness. Clin Biomech. 2006;21(1):59-66.
  • 3. Krigger KW. Cerebral palsy: an overview. Am Fam Physician. 2006;73(1):91-100.
  • 4. Scherzer, Alfred L. Early diagnosis and interventional therapy in cerebral palsy: an interdisciplinary age-focused approach. Informa Health Care; 2000.
  • 5. Elovic EP, Simone LK, Zafonte R. Outcome assessment for spasticity management in the patient with traumatic brain injury: the state of the art. J Head Trauma Rehabil. 2004;19(2):155-177.
  • 6. Brown P. Pathophysiology of spasticity. J Neurol Neurosur Psychiatry. 1994;57(7):773-777.
  • 7. Sheean G. The pathophysiology of spasticity. Eur J Neurol. 2002;9(s1):3-9.
  • 8. Albright AL. Spasticity and movement disorders in cerebral palsy. J Child Neurol. 1996;11(1 suppl):1-4.
  • 9. Mehrholz J, Wagner K, Meissner D, et al. Reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in adult patients with severe brain injury: a comparison study. Clin Rehabil. 2005;19(7):751-759.
  • 10. Priori A, Cogiamanian F, Mrakic-Sposta S. Pathophysiology of spasticity. Neurol Sci. 2006:27(4):s307-s309.
  • 11. Gage JR. (ed.). The Treatment of Gait Problems in Cerebral Palsy. London: Mac Keith Press, 2004.
  • 12. Livanelioğlu A, Kerem Günel M. Serebral Palside Fizyoterapi. Ankara, Yeni Özbek Matbaası, 2009.
  • 13. Flett PJ. Rehabilitation of spasticity and related problems in childhood cerebral palsy. J Paediatr Child Health. 2003;39(1):6-14.
  • 14. Esquenazi A. Upper motor neurone syndrome and spasticity. The Lancet Neurology. 2009;8(6):517.
  • 15. Yam WKL, Leung MSM. Interrater reliability of Modified Ashworth Scale and Modified Tardieu Scale in children with spastic cerebral palsy. J Child Neurol. 2006;21(12):1031-1035.
  • 16. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth Scale of muscle spasticity. Phys Ther. 1987;67(2):206-207.
  • 17. Ansari NN, Naghdi S, Younesian P, et al. Interand intrarater reliability of the Modified Modified Ashworth Scale in patients with knee extensor poststroke spasticity. Physiother Theory Pract. 2008;24(3):205-213.
  • 18. Boyd RN, Graham HK. Objective measurement of clinical findings in the use of botulinum toxin type A for the management of children with cerebral palsy. Eur J Neurol. 1999;6(S4): 23-35.
  • 19. Haugh AB, Pandyan AD, Johnson GR. A systematic review of the Tardieu Scale for the measurement of spasticity. Disabil Rehabil. 2006;28(15):899-907.
  • 20. Alhusaini AA, Dean CM, Crosbie J, et al. Evaluation of spasticity in children with cerebral palsy using Ashworth and Tardieu Scales compared with laboratory measures. J Child Neurol. 2010;25(10):1242-1247.
  • 21. Numanoglu, A. Spastik Serebral Palsili Çocuklarda Spastisiteyi Değerlendirmede İki Farklı Klinik Yöntemin Gözlemci İçi Güvenirliğinin İncelenmesi. Sağlık Bilimleri Enstitüsü, Fizyoterapi ve Rehabilitasyon Programı. Ankara, Hacettepe Üniversitesi, Yüksek Lisans tezi: 99; 2010.
  • 22. Gracies JM, Burke K, Clegg NJ, et al. Reliability of the Tardieu Scale for assessing spasticity in children with cerebral palsy. Arc Phys Med Rehabil. 2010;91(3): 421-428.
  • 23. Numanoglu A, Günel MK. Intraobserver reliability of modified Ashworth scale and modified Tardieu scale in the assessment of spasticity in children with cerebral palsy. Acta Orthop Traumatol Turc. 2012;46(3):196-200.
  • 24. Ohata K, Tsuboyama T, Haruta T, et al. Relation between muscle thickness, spasticity, and activity limitations in children and adolescents with cerebral palsy. Dev Med Child Neurol. 2008;50(2):152-156.
  • 25. Ostensjø S, Carlberg EB, Vøllestad NK. Motor impairments in young children with cerebral palsy: relationship to gross motor function and everyday activities. Dev Med Child Neurol. 2004;46(09):580-589.
  • 26. Gorter JW, Verschuren O, van Riel L, et al. The relationship between spasticity in young children (18 months of age) with cerebral palsy and their gross motor function development. BMC Musculoskelet Disord. 2009;10:108.

Relation of two different clinical scales evaluating spasticity with gross motor function in children with spastic cerebral palsy

Year 2016, Volume: 3 Issue: 3, 77 - 83, 01.12.2016

Ayşe Numanoğlu Akbaş Mintaze Kerem Günel

Abstract

Purpose: The aim of this study was to analyze relation within two different clinical methods which assess spasticity, gross
motor function in children with cerebral palsy (CP). It was investigated which muscles have more effects on gross motor
function.

Methods: Elbow flexor muscles, wrist flexor muscles, hip adductors, hamstrings, gastrocnemius and soleus muscles of 37
children with spastic CP were evaluated using the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) in terms
of the severity of spasticity. Gross motor function levels of children were determined by the Gross Motor Function
Classification System.


Results: For MAS and MTS, most related values were for the elbow flexors, wrist flexors, hip adductors and hamstrings
(p<0.05). The relationship between GMFCS level and MAS and MTS scores were significant correlated between for the
hamstring muscles and GMFCS (p<0.05).


Conclusion: According to results of this study, it was observed that MAS and MTS were in general compatible with each other,
but the spasticity of the hamstring muscles and static contractures affect gross motor function, which may vary according to
the evaluated muscles. 

Keywords

Patient outcome assessment Cerebral palsy Muscle spasticity Motor skills.

References

  • 1. Koman LA, Smith BP, Shilt JS. Cerebral palsy. Lancet. 2004;363(9421):1619-1631.
  • 2. Cooney KM, Sanders JO, Concha MC, et al. Novel biomechanics demonstrate gait dysfunction due to hamstring tightness. Clin Biomech. 2006;21(1):59-66.
  • 3. Krigger KW. Cerebral palsy: an overview. Am Fam Physician. 2006;73(1):91-100.
  • 4. Scherzer, Alfred L. Early diagnosis and interventional therapy in cerebral palsy: an interdisciplinary age-focused approach. Informa Health Care; 2000.
  • 5. Elovic EP, Simone LK, Zafonte R. Outcome assessment for spasticity management in the patient with traumatic brain injury: the state of the art. J Head Trauma Rehabil. 2004;19(2):155-177.
  • 6. Brown P. Pathophysiology of spasticity. J Neurol Neurosur Psychiatry. 1994;57(7):773-777.
  • 7. Sheean G. The pathophysiology of spasticity. Eur J Neurol. 2002;9(s1):3-9.
  • 8. Albright AL. Spasticity and movement disorders in cerebral palsy. J Child Neurol. 1996;11(1 suppl):1-4.
  • 9. Mehrholz J, Wagner K, Meissner D, et al. Reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in adult patients with severe brain injury: a comparison study. Clin Rehabil. 2005;19(7):751-759.
  • 10. Priori A, Cogiamanian F, Mrakic-Sposta S. Pathophysiology of spasticity. Neurol Sci. 2006:27(4):s307-s309.
  • 11. Gage JR. (ed.). The Treatment of Gait Problems in Cerebral Palsy. London: Mac Keith Press, 2004.
  • 12. Livanelioğlu A, Kerem Günel M. Serebral Palside Fizyoterapi. Ankara, Yeni Özbek Matbaası, 2009.
  • 13. Flett PJ. Rehabilitation of spasticity and related problems in childhood cerebral palsy. J Paediatr Child Health. 2003;39(1):6-14.
  • 14. Esquenazi A. Upper motor neurone syndrome and spasticity. The Lancet Neurology. 2009;8(6):517.
  • 15. Yam WKL, Leung MSM. Interrater reliability of Modified Ashworth Scale and Modified Tardieu Scale in children with spastic cerebral palsy. J Child Neurol. 2006;21(12):1031-1035.
  • 16. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth Scale of muscle spasticity. Phys Ther. 1987;67(2):206-207.
  • 17. Ansari NN, Naghdi S, Younesian P, et al. Interand intrarater reliability of the Modified Modified Ashworth Scale in patients with knee extensor poststroke spasticity. Physiother Theory Pract. 2008;24(3):205-213.
  • 18. Boyd RN, Graham HK. Objective measurement of clinical findings in the use of botulinum toxin type A for the management of children with cerebral palsy. Eur J Neurol. 1999;6(S4): 23-35.
  • 19. Haugh AB, Pandyan AD, Johnson GR. A systematic review of the Tardieu Scale for the measurement of spasticity. Disabil Rehabil. 2006;28(15):899-907.
  • 20. Alhusaini AA, Dean CM, Crosbie J, et al. Evaluation of spasticity in children with cerebral palsy using Ashworth and Tardieu Scales compared with laboratory measures. J Child Neurol. 2010;25(10):1242-1247.
  • 21. Numanoglu, A. Spastik Serebral Palsili Çocuklarda Spastisiteyi Değerlendirmede İki Farklı Klinik Yöntemin Gözlemci İçi Güvenirliğinin İncelenmesi. Sağlık Bilimleri Enstitüsü, Fizyoterapi ve Rehabilitasyon Programı. Ankara, Hacettepe Üniversitesi, Yüksek Lisans tezi: 99; 2010.
  • 22. Gracies JM, Burke K, Clegg NJ, et al. Reliability of the Tardieu Scale for assessing spasticity in children with cerebral palsy. Arc Phys Med Rehabil. 2010;91(3): 421-428.
  • 23. Numanoglu A, Günel MK. Intraobserver reliability of modified Ashworth scale and modified Tardieu scale in the assessment of spasticity in children with cerebral palsy. Acta Orthop Traumatol Turc. 2012;46(3):196-200.
  • 24. Ohata K, Tsuboyama T, Haruta T, et al. Relation between muscle thickness, spasticity, and activity limitations in children and adolescents with cerebral palsy. Dev Med Child Neurol. 2008;50(2):152-156.
  • 25. Ostensjø S, Carlberg EB, Vøllestad NK. Motor impairments in young children with cerebral palsy: relationship to gross motor function and everyday activities. Dev Med Child Neurol. 2004;46(09):580-589.
  • 26. Gorter JW, Verschuren O, van Riel L, et al. The relationship between spasticity in young children (18 months of age) with cerebral palsy and their gross motor function development. BMC Musculoskelet Disord. 2009;10:108.
There are 26 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Ayşe Numanoğlu Akbaş

Mintaze Kerem Günel This is me

Publication Date December 1, 2016
Submission Date June 8, 2016
Published in Issue Year 2016 Volume: 3 Issue: 3

Cite

Vancouver Numanoğlu Akbaş A, Kerem Günel M. Spastik serebral palsili çocuklarda spastisiteyi değerlendiren iki farklı klinik ölçeğin kaba motor fonksiyonu ile ilişkisi. JETR. 2016;3(3):77-83.
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