Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
The Effects of Supervised Intensive Exercises Programme on Activity Performance Following Tendon Transfers in Brachial Plexus Birth Injury: Randomized Controlled Trial
Doğumsal Brakiyal Pleksus Yaralanmalarında Tendon Transferi Sonrası Supervize Yoğun Egzersiz Programının Aktivite Performansı Üzerine Etkisi: Randomize Kontrollü Çalışma
Zeynep HOŞBAYa, Ela TARAKCIb, Atakan AYDINc, Arzu RAZAK ÖZDİNÇLERa
aDepartment of Physiotherapy and Rehabilitation, Biruni University Faculty of Health Sciences, İstanbul, TURKEY
bDepartment of Physiotherapy and Rehabilitation, İstanbul University-Cerrahpaşa Faculty of Health Sciences, İstanbul, TURKEY
cDepartment of Plastic and Reconstructive Surgery, İstanbul University Faculty of Medicine, İstanbul, TURKEY
Turkiye Klinikleri J Health Sci. 2021;6(4):760-9
doi: 10.5336/healthsci.2020-79025
Article Language: EN
Full Text
ABSTRACT
 Objective: The purpose of this study was to determine the effect of intensive exercise therapy program on the activity performance in children ages 4 to 8 with brachial plexus birth injury (BPBI) who were applied modified Hoffer technique for improving abduction and external rotation of the shoulder. Material and Methods: The inclusion criteria consisted of age: between 4-8 years, postoperative status: at least one year. Exclusion criteria covered patients with the previous microsurgery in the early stages of brachial plexus renovation. Forty-three children with BPBI were included in the study. The mean age of Group 1 was 5.98±1.25 years, and the mean age of Group 2 was 6.36±1.39 years, Group 1 consisted of 22 children who received one hour supervised intensive exercise therapy (SIET) program daily for five days a week, while Group 2 consisted of 21 children who received an individualized home exercise program. Range of motion and functionality were evaluated. Functional assessments were performed by using the Mallet Scale, Quality of Upper Extremity Skill Test (QUEST), Pediatric Evaluation of Disability Inventory (PEDI) and Canadian Occupational Performance Measure (COMP). Results: A significant difference was found in pre-treatment and post-treatment of Mallet, QUEST independent movements, PEDI functional activities, COMP scores in both groups (p<0.05). Although the changes were observed in both groups, pre-treatment and post-treatment differences were more in Group 1 than in Group 2 (p<0.05). Conclusion: Supervised intensive exercises and individual home exercise programs are effective in children with BPBI. SIET group was more efficient, and adding supervised exercises to these children's physiotherapy protocol was important because there was an increase in the functionality of the upper extremity.

Keywords: Brachial plexus; birth injury; exercise; functional activity; shoulder tendon transfer
ÖZET
 Amaç: Çalışmanın amacı, 4-8 yaş arasında omuz abdüksiyon ve eksternal rotasyonunu artırmak için modifiye Hoffer tekniği uygulanan doğumsal brakiyal pleksus yaralanmalı (DBPY) çocuklarda denetimli yoğun egzersiz tedavisinin aktivite performansı üzerine etkisini belirlemekti. Gereç ve Yöntemler: Tendon transferi sonrası en az 1 yıl geçmiş olgular çalışmaya dâhil edilirken erken dönemde sinir cerrahisi geçiren olgular çalışmaya dâhil edilmedi. DBPY'li 43 çocuk çalışmaya dâhil edildi. Yirmi iki olgudan oluşan Grup 1'e haftada 5 gün 1 saatlik denetimli yoğun egzersiz programı verilirken 21 olgudan oluşan Grup 2'ye bireyselleştirilmiş ev egzersiz programı verildi. Grup 1'in yaş ortalaması 5,98±1,25 yıl, Grup 2'nin yaş ortalaması 6,36±1,39 yıl idi. Olguların, eklem hareket açıklığı ve fonksiyonel değerlendirmeleri yapıldı. Fonksiyonel değerlendirmeler için Mallet Skalası, Üst Ekstremite Beceri Kalitesi Testi bağımsız hareketler alt skoru, Pediatrik Özürlülük Envanterinin fonksiyonel aktiviteler skorları ve Kanada Rol Performans ölçümü kullanıldı. Bulgular: Her iki grupta da tedavi öncesi ve sonrası Mallet Skalası, Üst Ekstremite Beceri Kalitesi testi bağımsız hareketler alt skoru, Pediatrik Özürlülük Envanteri Fonksiyonel aktiviteler alt skoru ve Kanada Rol Performans Ölçümü skorları arasında anlamlı farklılık bulunurken tedavi öncesi ve sonrası farklar Grup 1'de daha fazla idi (p<0,05). Sonuç: Denetimli yoğun egzersiz ve ev egzersiz programı gruplarının her ikisinin de tedavi öncesi ve sonrası skorlarda anlamlı farklılık bulunsa da denetimli yoğun egzersizler üst ekstremite fonksiyonelliği üzerinde daha etkili idi. DBPY'li çocuklarda fizyoterapi programlarına denetimli yoğun egzersiz programlarının eklenmesinin üst ekstremite fonksiyonlarının artırılması için önemli olduğu görüşündeyiz.

Anahtar Kelimeler: Brakiyal pleksus; doğum yaralanması; egzersiz; fonksiyonel aktivite; omuz tendon transferi
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