Ayse Livanelioglu

Effects of Johnstone pressure splints combined with neurodevelopmental therapy on spasticity and cutaneous sensory inputs in spastic cerebral palsy

The purpose of this study was to investigate the effectiveness of Johnstone pressure splints (JPSs) on spasticity and cutaneous sensory inputs in children with spastic cerebral palsy (CP). Thirty-four children with spastic diplegic CP participated in this study. Children whose motor development levels were similar were divided into a treatment and a control group. Each group consisted of 17 participants (six females and 11 males). Mean age of the treatment group was 48.82 months (SEM 4.42), and the control group, 47.52 months (SEM 5.27). The treatment group underwent Bobaths neurodevelopmental therapy (NDT) combined with JPSs. The control group underwent NDT alone five days a week for three months. Before and after treatments, lower-extremity passive range of motion (ROM) by goniometric measurements, spasticity by Modified Ashworth Scale (MAS), and somatosensory evoked potentials (SEPs) were measured. Passive ROM showed significant improvements in both groups (p<0.01). In the treatment group, all MAS scores increased. In the control group, the difference was significant except for values of internal rotator muscles. Improvements in passive ROM in the treatment group were significantly higher than the control group except in hip abduction and external rotation (p<0.05). MAS scores of the treatment group were significantly higher than the control group (p<0.05). SEP values increased in both groups but values of the treatment group were significantly higher than the control group (p<0.05).

Intra-Individual Consistency in the Quality of Neonatal General Movements

Background:The qualitative assessment of general movements (GMs) proved to be a highly sensitive and specific diagnostic tool for the assessment of the integrity of the young nervous system. It is essential that the quality of GMs remains consistent in an individual during a given recording at a certain date. Objectives:The aim of the study was to investigate the intra-individual consistency of the quality of GMs during one recording. Methods: 39 preterm infants were recorded at least twice; some were recorded three times. In all, 88 recordings were available but three recordings were excluded due to frequent crying, seizures or hypokinesia. Three scorers assessed 2–3 sequences of these 85 GM recordings.Results:The inter-scorer agreement was high (ĸ 0.85–0.94). Intra-individual consistency revealed a ĸ of 0.90 with a 95% CI (0.51, 1.00) for preterm GMs, 0.96 with a 95% CI (0.57, 1.00) for writhing GMs, and 0.92 with a 95% CI (0.53, 1.00) for fidgety GMs. Conclusions:The individual quality of GMs remains consistent for a neonate or young infant at a certain date.

Relationship between quality of life and functional status of young adults and adults with cerebral palsy

Purpose. The aim of this study was investigate the relation between health related quality of life (HRQoL) and functional status in young adult or adult cerebral palsied individuals. Methods. The study included 45 cerebral palsied subjects who were divided into two groups as young adults (n = 21, group 1) and adults (n = 24, group 2), over the age 15 years. Gross Motor Function Classification System (GMFCS), Functional Independence Measurement (FIM), Physical Mobility Scale (PMS), Nottingham Health Profile (NHP), Visual Analogue Scale (VAS) were used as outcome measures. Results. In group 1, GMFCS and PMS scores were significantly correlated with total the total score of FIM (p < 0.05). Although total FIM, PMS, LS and GMFCS scores were not correlated with the total NHP score (p > 0.05), pain subscale of NHP was significantly correlated with self care and mobility subscales of FIM (p < 0.05). Also, self care, mobility, locomotion subscales and total score of FIM were highly correlated with the physical activity subscale of NHP (p < 0.05). In group 2, our findings were also similar to those of young adults when the relations between total NHP score and total FIM, PMS, LS and GMFCS were investigated (p > 0.05) and also some subscales of FIM and NHP presented high correlations in between. In addition, there were significant differences between the groups in GMFCS, LS and locomotion and self care subscales of FIM (p < 0.05). Conclusion. Although HRQoL in young cerebral palsied individuals seems to be more effected by parameters related to physical condition, in cerebral palsied adults psychological and emotional aspects may be more important indicators related to HRQoL. For that reasons, more population specific measures have to be developed for in-depth analysis of these factors.

Agreement between parents and clinicians for the motor functional classification systems of children with cerebral palsy

Purpose. This study aimed to evaluate whether parental ratings of expanded and revised Gross Motor Function Classification System (GMFCS E&R) and Manual Ability Classification System (MACS) had agreement with clinicians’ ratings when classifying children with CP to these two well-known classifications of motor functioning and hereby to evaluate intertester reliability of the classification systems between clinicians and parents. Method. The process of study was designed to collect data from parents using the GMFCS E&R and MACS. The total participants consisted of 100 children with CP and their parents. The overall agreement between the parents and physiotherapist GMFCS and MACS scores was analysed using intraclass correlation coefficient (ICC). Results. The ICC value between parents and physiotherapist was 0.96 (95%% confidence interval [CI] 0.95–0.97) for GMFCS and 0.96 (95%% CI 0.94–0.97) for MACS and indicated excellent agreement. Conclusions. The excellent agreement between parents and clinicians indicated that parents and clinicians can talk in the same language for the motor functional classification systems of children with CP if careful administrations are provided.

Investigation of interobserver reliability of the Gillette Functional Assessment Questionnaire in children with spastic diparetic cerebral palsy

OBJECTIVES Information obtained from families is of particular importance in the evaluation of functional mobility skills of children with cerebral palsy (CP) after orthopedic interventions and long-term rehabilitation applications. This study was designed to evaluate the interobserver reliability of the Gillette Functional Assessment Questionnaire (FAQ) which was administered to the mothers and the physiotherapist for children with CP. METHODS The study included 52 spastic diparetic children with CP (22 girls, 30 boys; mean age 7.8+/-4.4 years; range 4 to 12 years) and their mothers. According to the Gross Motor Function Classification System (GMFCS), all the children were in level 1 to 3. The Gillette FAQ was administered to the mother and physiotherapist to determine the functional walking level of the child and the interobserver reliability of the FAQ was calculated. In addition, gross motor performance was evaluated by the standing and walking-running-jumping dimensions of the Gross Motor Performance Measure (GMPM), and functional independence level was evaluated by the transfer and locomotion dimensions of the Functional Independence Measure for Children (WeeFIM). Correlations were sought between the FAQ results of the physiotherapist and mothers and the GMFCS, GMPM, and WeeFIM. RESULTS The intraclass correlation coefficient for interobserver reliability of the Gillette FAQ was 0.94 (95% CI 0.898-0.966). A highly significant correlation was found between the responses of the mother and physiotherapist to the Gillette FAQ (r=0.882, p<0.01). The responses of the mother and physiotherapist to the Gillette FAQ showed a negative correlation with the GMFCS level, and positive correlations with the dimensions of the GMPM and WeeFIM studied (p<0.01). CONCLUSION The Gillette FAQ can be used by the physiotherapists to determine the functional changes in spastic diparetic children with CP and can help clinicians derive important information from the families about functional walking of their children.

Impact of the clinical Pilates exercises and verbal education on exercise beliefs and psychosocial factors in healthy women.

[Purpose] Exercise is one of the most important components of a healthy life. The purpose of this study was to analyze exercise beliefs and psychosocial factors in sedentary and active healthy women and observe the changes in these parameters resulting from clinical Pilates exercises and verbal education in healthy women. [Subjects and Methods] Sixty-six healthy women were included in the study. Participants were divided into clinical Pilates (n=21), verbal education (n=25), and control groups (n=20). Prior to and at the end of the study, demographic information, body mass index, waist-hip circumference, exercise beliefs, physical activity index, and psychosocial factors (Rosenberg self-esteem scale, Body Cathexis Index, SF-36 quality of life, Beck Depression Scale, visual analog scale for tiredness) of the subjects were recorded. [Results] Meaningful changes for all the parameters took place in the clinical Pilates and verbal education groups. Our analyses indicated that the changes in the clinical Pilates group were more meaningful than those in the verbal education group. When the data of the study groups were compared with those of the control group, the clinical Pilates group showed meaningful differences. [Conclusion] The result of this study indicate that both clinical Pilates and verbal education are effective in changing exercise beliefs and physical and psychosocial parameters.

Beyin felci olan çocuklarda kaba motor işlevleri kazanma yaşının işlevsel motor bozukluk üzerine etkisi

Amac: Bu calismanin amaci beyin felci olan cocuklarda kaba motor islevleri kazanma yasinin islevsel motor bozukluk uzerine etkisinin arastirilmasidir Gerec ve Yontem: Calismamiza cocuk norologu tarafindan tanisi konulmus ve Hacettepe Univeristesi Saglik Bilimleri Fakultesi Fizyoterapi ve Rehabilitasyon Bolumu Serebral Paralizi Birimi rsquo;ne fizyoterapi rehabilitasyon programi almak icin gonderilmis 671 beyin felci olan cocuk alindi ve ailelerine cocuklarin kaba motor islevleri kazanma yaslari soruldu Islevsel motor bozukluk Kaba Motor Fonksiyon Siniflandirma Sistemine gore belirlendi Bulgular: Beyin felci olan olgularin klinik tipleri 625 rsquo;i spastik 93 1 32 rsquo;si diskinetik 4 8 10 rsquo;u ataksik 1 5 dordu karisik tip 0 6 olarak belirlendi Kaba Motor Fonksiyon Siniflandirma Sistemine gore seviye I rsquo;de 152 22 7 seviye II rsquo;de 102 15 2 seviye III rsquo;de 111 16 5 seviye IV rsquo;de 60 8 9 seviye V rsquo;de 246 36 7 olgu yer almaktaydi Bagimsiz oturma becerisi kazanma yasi ortanca degeri seviye I rsquo;de dokuz ay seviye II rsquo;de 12 ay seviye III rsquo;de 24 aydi Emekleme yetenegi kazanma yasi ortanca degeri seviye I rsquo;de 12 ay seviye II rsquo;de 18 ay seviye III rsquo;de 48 aydi Bagimsiz yurume yasi ortanca degeri seviye I rsquo;de 18 ay seviye II rsquo;de 33 aydi Calisma icin Hacettepe Universitesi Tip Fakultesi Etik Komitesinden onay alindi No: HEK 09 60 Cikarimlar: Bizim de bekledigimiz gibi motor bozuklugun siddeti arttikca kaba motor islevi kazanma yaslari giderek artmistir Bu calismanin sonuclarinin beyin felci olan cocugun kaba motor bozuklugunun seyri ile ilgili bilgi verebilecegini dusunmekteyiz Turk Ped Ars 2012; 47: 193 8