Adar Sevda, Dündar Ümit, Demirdal Ümit Seçil, Ulaşlı Alper Murat, Toktaş Hasan, Solak Özlem
Department of Physical Medicine and Rehabilitation, Medical Faculty of Afyon Kocatepe University, Afyonkarahisar, Turkey.
Department of Physical Medicine and Rehabilitation, Medical Faculty of Katip Çelebi University, İzmir, Turkey.
Turk J Phys Med Rehabil. 2017 Aug 14;63(3):239-248. doi: 10.5606/tftrd.2017.280. eCollection 2017 Jun.
The primary aim of this study was to compare the effects of aquatic exercises and land-based exercises on spasticity, quality of life, and motor function in children with cerebral palsy (CP). The secondary aim was to assess the morphology of spastic muscle using ultrasonography.
Thirty-two children (17 boys, 15 girls; mean age 9.7±2.7 years; range 4 to 17 years) with CP were enrolled in this study. The patients were randomly assigned to two groups to receive 30 sessions of an aquatic or a land-based exercise program. The patients were assessed for the impairment level, functional measures, and quality of life before and after therapy. Ultrasonographic assessment of spastic gastrocnemius muscle was also performed.
Both group showed significant improvements in most functional outcome measures. There were no significant differences in the percentage changes of the scores for functional outcome measures between the two groups. However, aquatic exercise produced a higher improvement in quality of life scores than the land-based exercises. Post-treatment ultrasonographic assessment of spastic gastrocnemius muscle showed a significant improvement in the compressibility ratio in the aquatic exercise group. The modified Ashworth Scale score of spastic gastrocnemius muscle in patients with CP showed a negative and weak-to-moderate correlation with the compressibility ratio based on the ultrasonographic evaluation.
Our study results suggest that the aquatic exercises are as effective as land-based exercises for spasticity management and motor function improvement in children with CP. Aquatic exercise can result in a higher level of improvement in quality of life scores than the land- based exercises. Ultrasonographic muscle compressibility ratio may be used to evaluate muscle elasticity in children with CP.
本研究的主要目的是比较水上运动和陆上运动对脑瘫（CP）患儿痉挛、生活质量和运动功能的影响。次要目的是使用超声评估痉挛肌肉的形态。
32例CP患儿（17例男孩，15例女孩；平均年龄9.7±2.7岁；范围4至17岁）纳入本研究。患者被随机分为两组，接受30节水上或陆上运动训练课程。在治疗前后对患者进行损伤程度、功能指标和生活质量评估。还对痉挛的腓肠肌进行了超声评估。
两组在大多数功能结局指标上均有显著改善。两组之间功能结局指标得分的百分比变化无显著差异。然而，水上运动比陆上运动在生活质量得分方面有更高的改善。治疗后对痉挛腓肠肌的超声评估显示，水上运动组的可压缩率有显著改善。CP患者痉挛腓肠肌的改良Ashworth量表评分与基于超声评估的可压缩率呈负相关且弱至中度相关。
我们的研究结果表明，水上运动在CP患儿的痉挛管理和运动功能改善方面与陆上运动同样有效。水上运动比陆上运动能使生活质量得分有更高水平的改善。超声肌肉可压缩率可用于评估CP患儿的肌肉弹性。
