بررسی تاثیر بازخورد بینایی در حفظ تعادل ایستای کودکان فلج مغزی دای پلژی اسپاستیک و مقایسه آن با کودکان سالم

نوع مقاله: مقاله پژوهشی

نویسندگان

1 دانشجوی کارشناسی ارشد، گروه کاردرمانی، دانشکده توانبخشی، دانشگاه علوم پزشکی تهران، تهران، ایران

2 مربی، گروه کاردرمانی، دانشکده توانبخشی، دانشگاه علوم پزشکی تهران، تهران، ایران

3 دانشیار، گروه ارتوپدی فنی، دانشکده توانبخشی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه و اهداف
چگونگی تاثیر درون­داد بینایی در تعادل ایستا و اثربخشی استفاده از بازخورد بینایی از آینه در حفظ تعادل ایستای کودکان فلج مغزی بحث برانگیز است. بنابراین هدف از مطالعه حاضر، بررسی تاثیر بازخورد بینایی در حفظ تعادل ایستای کودکان فلج مغزی دای پلژی اسپاستیک و مقایسه آن در کودکان با رشد طبیعی است.
مواد و روش­ها
شرکت­کننده­ها شامل 15 کودک فلج مغزی دای پلژیک اسپاستیک و 15 کودک با رشد طبیعی بودند که به­صورت در دسترس انتخاب شدند. از افراد خواسته شد تا با پای برهنه به مدت 60 ثانیه در حالت­های چشم بسته، چشم باز و بازخورد بینایی از آینه بر روی فورس پلیت بایستند. از آزمون­های t مستقل و t زوجی به منظور تحلیل داده­ها استفاده شد.
یافته­ها
در حالت­های چشم باز، چشم بسته و بازخورد بینایی از آینه، در گروه کودکان سالم در مقایسه با کودکان فلج مغزی تنها در پارامترهای نوسان مرکز فشار در صفحات داخلی-خارجی و قدامی-خلفی تفاوت معنادار بود (0.05P≤). در مقایسه دو حالت چشم بسته و چشم باز، در گروه کودکان فلج مغزی تنها در پارامترهای نوسان مرکز فشار در صفحه­ی داخلی-خارجی (03. =P) و طول مسیر مرکز فشار در صفحه­ی داخلی-خارجی (01. =P) تفاوت معنادار بود (0.05P≤). در مقایسه دو حالت چشم بسته و چشم باز، در گروه کودکان سالم تنها در پارامتر سرعت مرکز فشار در صفحه­ی داخلی-خارجی تفاوت معنادار بود (0.05P≤).
نتیجه ­گیری
کودکان فلج مغزی دای پلژی اسپاستیک و کودکان با رشد طبیعی جهت حفظ تعادل ایستا به میزان مشابه وابسته به اطلاعات درون­داد بینایی هستند. همچنین استفاده از آینه منجر به کاهش توانایی تعادل ایستای فرد شده و استفاده از آن به عنوان یک گزینه درمانی در بهبود تعادل ایستای کودکان فلج مغزی دای پلژی اسپاستیک گزینه مناسبی به نظر نمی­رسد.

کلیدواژه‌ها


عنوان مقاله [English]

Effect of Visual Feedback on Static Standing Balance in Children with Spastic Diplegic Cerebral Palsy Compared to Normal Children

نویسندگان [English]

  • Ali Tahmasebi 1
  • Parvin Raji 2
  • Mohammad Taghi Karimi 3
1 MSc Student, Tehran University of Medical Sciences, Rehabilitation Faculty, Occupational Therapy Department, Tehran, Iran
2 Lecturer, Tehran University of Medical Sciences, Rehabilitation Faculty, Occupational Therapy Department, Tehran, Iran
3 Associate Professor, Isfahan University of Medical Sciences, Rehabilitation Faculty, Orthotics and Prosthetics Department, Isfahan, Iran
چکیده [English]

Background and Aim: The results of literature review revealed a controversy with regard to the effect of visual input on static standing balance in children with spastic diplegic cerebral palsy. Moreover, it has been suggested that using combining tasks, such as mirror visual feedback, can improve static standing balance. Therefore, the aim of the present study was to investigate the effect of visual feedback on static standing balance in children with spastic diplegic cerebral palsy compared with that in normal children.
Materials and Methods: Participants included 15 children with spastic diplegic cerebral palsy and 15 normal children were selected conveniently. Children were instructed to stand with bare feet for 60 seconds on a Kistler force platform with their eyes open, eyes closed, and mirror visual feedback. Independent t-test and paired t-test were used for data analysis.
Results: A significant difference was reported in comparing children with spastic diplegic cerebral palsy and normal children during conditions of eyes open, eyes closed, and mirror visual feedback [P≤0.05]. A significant difference was reported in COP excursion [P=0.03] and COP path length in mediolateral plane [P=0.01] when comparing the two conditions of eyes open and eyes closes in children with spastic diplegic cerebral palsy [P≤0.05]. A significant difference was also reported in COP velocity in mediolateral plane when comparing the eyes open and eyes closed conditions in normal children [P≤0.05].
Conclusion: According to the results of the study, it can be suggested that children with spastic diplegic cerebral palsy and normal children are similarly dependent on visual input to maintain their static standing balance. Moreover, using mirror visual feedback can adversely affect static standing balance and it cannot benefit static standing balance in children with spastic diplegic cerebral palsy.

کلیدواژه‌ها [English]

  • Visual Feedback
  • Static Standing Balance
  • Spastic Diplegic Cerebral Palsy
  1.  Oskoui M, Coutinho F, Dykeman J, Jetté N, Pringsheim T. An update on the prevalence of cerebral palsy: a systematic review and meta‐analysis. Developmental Medicine & Child Neurology. 2013;55[6]:509-19.##
  2. Dalvand H, Dehghan L, Hadian MR, Feizy A, Hosseini SA. Relationship between gross motor and intellectual function in children with cerebral palsy: a cross-sectional study. Archives of physical medicine and rehabilitation. 2012;93[3]:480-4.##
  3. Laisram N, Srivastava V, Srivastava R. Cerebral palsy: an etiological study. The Indian Journal of Pediatrics. 1992;59[6]:723-8.##
  4. Erkin G, Delialioglu SU, Ozel S, Culha C, Sirzai H. Risk factors and clinical profiles in Turkish children with cerebral palsy: analysis of 625 cases. International journal of rehabilitation Research. 2008;31[1]:89-91.##
  5. Umphred DA, Lazaro RT, Roller M, Burton G. Neurological rehabilitation: Elsevier Health Sciences; 2013.##
  6. Westcott SL, Lowes LP, Richardson PK. Evaluation of postural stability in children: current theories and assessment tools. Physical therapy. 1997;77[6]:629-45.##
  7. Ramachandran V, Altschuler EL. The use of visual feedback, in particular mirror visual feedback, in restoring brain function. Brain. 2009:awp135.##
  8. Liao H-F, Hwang A-W. Relations of balance function and gross motor ability for children with cerebral palsy. Perceptual and motor skills. 2003;96[3c]:1173-84.##
  9. Campbell SK, Palisano RJ, Vander Linden DW. Physical therapy for children: Saunders; 2006.##
  10. Lepage C, Noreau L, Bernard P, Fougeyrollas P. Profile of handicap situations in children with cerebral palsy. Scandinavian Journal of Rehabilitation Medicine. 1998;30[4]:263-72.##
  11. Rha D-w, Kim DJ, Park ES. Effect of hinged ankle-foot orthoses on standing balance control in children with bilateral spastic cerebral palsy. Yonsei medical journal. 2010;51[5]:746-52.##
  12. Winter DA. Biomechanics and motor control of human movement: John Wiley & Sons; 2009.##
  13. Winter DA, Patla AE, Frank JS. Assessment of balance control in humans. Medical Progress through Technology. 1990;16[1-2]:31-51.##
  14. Collins JJ, De Luca CJ. Open-loop and closed-loop control of posture: a random-walk analysis of center-of-pressure trajectories. Experimental brain research. 1993;95[2]:308-18.##
  15. Doyle RJ, Hsiao-Wecksler ET, Ragan BG, Rosengren KS. Generalizability of center of pressure measures of quiet standing. Gait & posture. 2007;25[2]:166-71.##
  16. De Kegel A, Dhooge I, Cambier D, Baetens T, Palmans T, Van Waelvelde H. Test–retest reliability of the assessment of postural stability in typically developing children and in hearing impaired children. Gait & posture. 2011;33[4]:679-85.##
  17. Lin D, Seol H, Nussbaum MA, Madigan ML. Reliability of COP-based postural sway measures and age-related differences. Gait & posture. 2008;28[2]:337-42.##
  18. Duarte M, Freitas SM. Revision of posturography based on force plate for balance evaluation. Brazilian Journal of physical therapy. 2010;14[3]:183-92.##
  19. Turbanski S, Schmidtbleicher D. Postural control depends on testing situation. Sportverletzung Sportschaden: Organ der Gesellschaft fur Orthopadisch-Traumatologische Sportmedizin. 2010;24[3]:123-8.##
  20. Nichols DS. Balance retraining after stroke using force platform biofeedback. Physical therapy. 1997;77[5]:553-8.##
  21. Sackley CM, Lincoln NB. Single blind randomized controlled trial of visual feedback after stroke: effects on stance symmetry and function. Disability and rehabilitation. 1997;19[12]:536-46.##
  22. Van Peppen R, Kortsmit M, Lindeman E, Kwakkel G. Effects of visual feedback therapy on postural control in bilateral standing after stroke: a systematic review. 2006.##
  23. Wu G. Real-time feedback of body center of gravity for postural training of elderly patients with peripheral neuropathy. Rehabilitation Engineering, IEEE Transactions on. 1997;5[4]:399-402.##
  24. Vaillant J, Vuillerme N, Janvy A, Louis F, Juvin R, Nougier V. Mirror versus stationary cross feedback in controlling the center of foot pressure displacement in quiet standing in elderly subjects. Archives of physical medicine and rehabilitation. 2004;85[12]:1962-5.##
  25. Hlavackova P, Fristios J, Cuisinier R, Pinsault N, Janura M, Vuillerme N. Effects of mirror feedback on upright stance control in elderly transfemoral amputees. Archives of physical medicine and rehabilitation. 2009 Nov 30;90(11):1960-3.##
  26. Shumway-Cook A, Woollacott MH. Motor control: theory and practical applications: Williams & Wilkins Baltimore; 1995.##
  27. Cherng R-J, Su F-C, Chen J-JJ, Kuan T-S. Performance of static standing balance in children with spastic diplegic cerebral palsy under altered sensory environments. American journal of physical medicine & rehabilitation. 1999;78[4]:336-43.##
  28. Forssberg H, Nashner LM. Ontogenetic development of postural control in man: adaptation to altered support and visual conditions during stance. The journal of Neuroscience. 1982;2[5]:545-52.##
  29. Shumway-Cook A, Woollacott MH. The growth of stability: postural control from a developmental perspective. Journal of Motor Behavior. 1985;17[2]:131-47.##
  30. Liao HF, Jeny SF, Lai JS, Cheng CK, Hu MH. The relation between standing balance and walking function in children with spastic diplegic cerebral palsy. Developmental Medicine & Child Neurology. 1997;39[2]:106-12.##
  31. Donker SF, Ledebt A, Roerdink M, Savelsbergh GJ, Beek PJ. Children with cerebral palsy exhibit greater and more regular postural sway than typically developing children. Experimental Brain Research. 2008;184[3]:363-70.##
  32. Nobre A, Monteiro F, Golin M, Biasotto-Gonzalez D, Corrêa J, Oliveira C. Analysis of postural oscillation in children with cerebral palsy. Electromyography and clinical neurophysiology. 2009;50[5]:239-44.##
  33. Rose J, Wolff DR, Jones VK, Bloch DA, Oehlert JW, Gamble JG. Postural balance in children with cerebral palsy. Developmental Medicine & Child Neurology. 2002;44[01]:58-63.##
  34. Saxena S, Rao BK, Kumaran S. Analysis of postural stability in children with cerebral palsy and children with typical development: An observational study. Pediatric Physical Therapy. 2014;26[3]:325-30.##
  35. Saavedra S, Bellows D, Da Costa CS. Commentary on “Analysis of Postural Stability in Children With Cerebral Palsy and Children With Typical Development: An Observational Study”. Pediatric Physical Therapy. 2014;26[3]:331.##
  36. Nejati V, Bazrafkan F, Asari Jami S. Social cognition and motor control: Evidence from postural control of balance observer. Journal of Research in Rehabilitation Sciences. 2013;9[1]:59-64.##
  37. Case-Smith J, O'Brien JC. Occupational therapy for children and adolescents: Elsevier Health Sciences; 2014.##
  38. Santos BR, Delisle A, Lariviere C, Plamondon A, Imbeau D. Reliability of centre of pressure summary measures of postural steadiness in healthy young adults. Gait & Posture. 2008;27[3]:408-15.##
  39. Lafond D, Corriveau H, Hebert R, Prince F. Intrasession reliability of center of pressure measures of postural steadiness in healthy elderly people. Archives of physical medicine and rehabilitation. 2004;85[6]:896-901.##
  40. Doyle TL, Newton RU, Burnett AF. Reliability of traditional and fractal dimension measures of quiet stance center of pressure in young, healthy people. Arch Phys Med Rehabil. 2005;86[10]:2034-40.##
  41. Swanenburg J, de Bruin ED, Favero K, Uebelhart D, Mulder T. The reliability of postural balance measures in single and dual tasking in elderly fallers and non-fallers. BMC Musculoskelet Disord. 2008;9:162.##
  42. Lafond D, Corriveau H, Hebert R, Prince F. Intrasession reliability of center of pressure measures of postural steadiness in healthy elderly people. Arch Phys Med Rehabil. 2004;85[6]:896-901.##
  43. Shumway-Cook A, Woollacott MH. Motor control: translating research into clinical practice: Lippincott Williams & Wilkins; 2007.##
  44. Bar-Haim S, Al-Jarrah M, Nammourah I, Harries N. Mechanical efficiency and balance in adolescents and young adults with cerebral palsy. Gait & posture. 2013;38[4]:668-73.##
  45. Reilly DS, Woollacott MH, van Donkelaar P, Saavedra S. The interaction between executive attention and postural control in dual-task conditions: children with cerebral palsy. Archives of physical medicine and rehabilitation. 2008;89[5]:834-42.##