Spastik Serebral Palsili Çocuklarda Selektif Motor Kontrolün Değerlendirilmesi ve Aktivite, Katılım ve Sağlıkla İlgili Yaşam Kalitesi Üzerine Etkisinin İncelenmesi

The aim of this study was to assess the selective motor control and investigate the effect of selective motor control on activity, participation and health related quality of life in children with spastic cerebral palsy (CP). In addition, the Turkish version, validity and reliability studies of the Selective Control Assessment of the Lower Extremity (SCALE) and Selective Control of the Upper Extremity Scale (SCUES) were also planned. 52 children with spastic CP with aged between 4-18 years were included into the study. Selective motor control, functional levels, muscle tone, upper extremity functions, gross motor function, activity-participation and quality of life were evaluated. First evaluations were recorded on video. After 2 weeks, SCALE and SCUES tools were scored again via same video. SCALE tool was found to have high intrarater reliability (ICC=0.996). SCALE tool was highly correlated with Gross Motor Function Classification System (GMFCS), Modified Ashworth Scale (MAS), Physician Rating Scale (PRS) and Gross Motor Function Measurement (GMFM) (r= -0.786/- 0.743/0.761/0.863, p<0.001). SCUES tool was found to have high intrarater reliability (ICC=0.982). SCUES tool was highly correlated with Manual Ability Classification System (MACS), Upper Limb Physician’s Rating Scale (ULPRS), MAS and Quality of Upper Extremity Skills Test (QUEST) (r= -0.672/0.879/- 0.937/0.813, p<0.001). Selective motor control ability was found effective on activity-participation and health-related quality of life (p<0.001-0.05). Assessment of selective motor control skills is very important in children with spastic CP. Improvement in selective motor control skills will also improve activity-participation and health-related quality of life.Bu çalışmanın amacı, spastik Serebral Palsili (SP) çocuklarda selektif motor kontrolün değerlendirilmesi ve selektif motor kontrolün aktivite, katılım ve sağlıkla ilgili yaşam kalitesi üzerine etkisini araştırmaktı. Ayrıca çalışma kapsamında Alt Ekstremite Selektif Kontrol Değerlendirme Skalası’nın (SCALE) ve Üst Ekstremite Selektif Kontrol Skalası’nın (SCUES) Türkçe versiyon, geçerlik ve güvenirlik çalışmalarının yapılması da planlandı. Çalışmaya yaşları 4-18 yıl arasında değişen 52 spastik SP’li çocuk dahil edildi. Çalışmaya dahil edilen çocukların selektif motor kontrol becerileri, fonksiyonel seviyeleri, kas tonusları, üst ekstremite fonksiyonları, kaba motor fonksiyon seviyeleri, aktivite-katılım düzeyleri ve yaşam kaliteleri değerlendirildi. İlk değerlendirmeler sırasında video çekildi. Aradan 2 hafta geçtikten sonra SCALE ve SCUES video üzerinden tekrar skorlandı. SCALE ölçüm aracının gözlemci içi güvenirliği yüksek bulundu (ICC=0,996). SCALE’in Kaba Motor Fonksiyon Sınıflandırma Sistemi (GMFCS), Modifiye Ashworth Skalası (MAS), Modifiye Hekim Değerlendirme Skalası (PRS) ve Kaba Motor Fonksiyon Ölçütü (GMFM) ile yüksek derecede ilişkili olduğu bulundu (r= - 0,786/- 0,743/0,761/0,863, p<0,001). SCUES ölçüm aracının gözlemci içi güvenirliği yüksek bulundu (ICC=0,982). SCUES’in El Becerileri Sınıflandırma Sistemi (MACS), Üst Ekstremite Hekim Değerlendirme Skalası (ULPRS), MAS ve Üst Ekstremite Becerileri Kalite Testi (QUEST) ile yüksek derece korelasyona sahip olduğu bulundu (r= - 0,672/0,879/- 0,937/0,813, p<0,001). Selektif motor kontrol becerisinin aktivite-katılım ve sağlıkla ilgili yaşam kalitesi üzerine etkili olduğu bulundu (p<0,001-0,05). Spastik SP’li çocuklarda selektif motor kontrol becerisinin değerlendirilmesi çok önemlidir. Selektif motor kontrol becerisinde sağlanacak gelişme aktivite-katılım ve sağlıkla ilgili yaşam kalitesinde de gelişme sağlayacaktır

Effects of Telerehabilitation-Based Structured Home Program on Activity, Participation and Goal Achievement in Preschool Children with Cerebral Palsy: A Triple-Blinded Randomized Controlled Trial

A home program is implemented as an evidence-based mode of delivering services for physiotherapy and rehabilitation. Telerehabilitation is a method applied in physiotherapy modalities for children. This study aims to determine the effectiveness of usual care plus a Telerehabilitation-Based Structured Home Program on preschool children with cerebral palsy (CP) compared to usual care. Forty-three children aged 3-6 years (mean age 4.66 +/- 1.08 years) with CP were randomly assigned to the Telerehabilitation-Based Structured Home Program and usual care groups. Their motor function was assessed with the Gross Motor Function Measure (GMFM); performance and satisfaction were evaluated with the Canadian Occupational Performance Measure (COPM); goal achievement was assessed with the Goal Attainment Scale (GAS); and activity and participation were evaluated with Pediatric Evaluation of Disability Inventory (PEDI). Participants were evaluated at baseline, immediately post-intervention (12 weeks) and at follow-up (24 weeks). There was a statistically significant difference between pre- and post-test GMFM, COPM, GAS and PEDI scores in the intervention and control groups (p < 0.001). The Telerehabilitation-Based Structured Home Program showed statistically significant changes in activity, participation and goal achievement after 12 weeks of intervention (p < 0.001). However, significant results were not obtained in the usual care group. The Telerehabilitation-Based Structured Home Program may be an effective method for preschool children with CP. (Registration number: NCT04807790; no = KA-20124/26.01.2021)