پژوهش در طب ورزشی و فناوری

تاثیر شش هفته تمرینات جسمانی منتخب بر تعادل، کنترل قامت و عملکرد اندام تحتانی کودکان مبتلا به میلومننگوسل

نویسندگان

الهه پیمانی
غلامعلی قاسمی
مهدی قادریان
چکیده
میلومننگوسل پس از فلج مغزی شایع‌ترین نقص مادر­زادی سیستم عصبی است که موجب اختلال در عملکرد بسیاری از ساختارهای بدن می‌­شود. هدف پژوهش حاضر بررسی تاثیر شش­ هفته تمرینات جسمانی منتخب بر تعادل، کنترل قامت و عملکرد اندام تحتانی کودکان میلومننگوسلی بود. در این مطالعه شبه آزمایشگاهی 10 پسر 10 تا 11 ساله مبتلا به میلومننگوسل با ضایعه در سطوح L4 -L5 که مستقلاً قادر به ایستادن و برداشتن حداقل پنج گام بودند، انتخاب و پس از اخذ رضایت­‌نامه کتبی از والدین در یک گروه تجربی قرار گرفتند. پیش و پس از شش ­هفته (چهار جلسه 60 دقیقه­‌ای در هفته) انجام پروتکل تمرینی محق­ساخته، متغیرهای تعادل ایستا و پویا (مقیاس تعادلیPBS)، نوسانات پاسچر (دستگاه فوت اسکن)، زاویه کرانیوورتبرال گردن و دامنه حرکتی زانو و ران (گونیامتر)، زاویه قوس پشتی (خط­‌کش منعطف)، قدرت اکستنسورهای تنه و زانو (دینامومتر) آزمودنی­‌ها اندازه­‌گیری شد. اطلاعات با آزمون تی وابسته در نرم‌­افزار SPSS 22 تحلیل گردید (0/05≥p). نتایج نشان­‌دهندۀ تفاوت معنادار میان پیش‌­آزمون و پس‌­آزمون در همه متغیرها به جز شاخص کلی نوسانات قامتی و قدرت اکستنسورهای تنه (0/05≤p) بود. باتوجه به اثربخشی پروتکل تمرینی استفاده شده، می­‌توان از این پروتکل، برای بهبود وضعیت قامت، تعادل و عملکرد اندام تحتانی در توانبخشی مبتلایان میلومننگوسل و افراد مشابه با این افراد استفاده کرد.

کلیدواژه‌ها

میلومننگوسل
کنترل قامت
تعادل
عملکرد
تمرینات جسمانی

عنوان مقاله English

The effect of six weeks selected physical training on balance, postural control and lower limb function in children with Meningomyelocele

نویسندگان English

Elaheh Peymani
Gholam Ali Ghasemi
Mehdi Ghaderiyan
چکیده English

Meningomyelocele after cerebral palsy is the most common congenital defects of the nervous system that impairs the functioning of many body’s structures. This study aimed to assess the effect of six weeks selected physical training on balance, postural control and lower limb function in children with Meningomyelocele. In this quasi-experimental study, 10 boys aged 10-11 years with Meningomyelocele in L4-L5 levels that independently able to stand and take at least 5 steps were selected and after obtaining written consent from the parents, placed in an experimental group. Before and after 6 weeks (four 60-minute sessions per week) participation in a researcher-designed exercise protocol, Static and dynamic balance (Balance Scale PBS), postural sway (foot pressure device), neck craniovertebral angle and knee and hip range of motion (goniometer), thoracic arch angle (flexible ruler) and trunk and knee extensors strength (dynamometer) were measured. Data by t-test in SPSS 22 software was analyzed (p≤0/05). The results were showed significant difference between pre-test and post-test in all variables except the total index of postural control and trunk extensors strength (P≥0/05). Due to the effectiveness of the used exercise protocol, this protocol can be used to improve the postural control, balance and lower extremity function in rehabilitation of patients with Meningomyelocele and similar to those.


کلیدواژه‌ها English

Meningomyelocele
Postural Control
Balance
Function
Physical Training
1. Dagenais, L.M., Lahay, E.R., Stueck, K.A., White, E., Williams, L., Harris, S.R. (2009). Effects of electrical stimulation, exercise training and motor skills training on strength of children with meningomyelocele: a systematic review. Physical & Occupational Therapy in Pediatrics. 29(4):445-63.
2. Nejat, F., Kazemi, S., Tajik, P. (2006). An evaluation of intelligence quotient in children with myelomeningocele aged 5-12 years. Iranian Journal of Pediatrics. 16(3):259-64. [In Persian]
3. Teulier, C., Smith, B.A., Kubo, M., Chang, C.L, Moerchen, V., Murazko, K., Ulrich, B.D. (2009). Stepping responses of infants with myelomeningocele when supported on a motorized treadmill. Physical Therapy. 89(1):60-72.
4. Song, R.B., Glass, E.N., Kent, M. (2016). Spina bifida, meningomyelocele, and meningocele. Veterinary Clinics of North America: Small Animal Practice. 46(2):327-45.
5. Halevy, A., Konen, O., Mimouni-Bloch, A. (2016). Congenital anomalies of the central nervous system. Health care for people with intellectual and developmental disabilities across the lifespan: Springer. p: 951-61.
6. Cohen, A., Robinson, S. (2004). Myelomeningocele and myelocystocele. Youmans Neurological Surgery. 2:3215-28.
7. Mahmood, D., Dicianno, B., Bellin, M. (2011). Self‐management, preventable conditions and assessment of care among young adults with myelomeningocele. Child: Care, Health and Development. 37(6):861-5. [In Persian]
8. Buffart, L.M., van den Berg-Emons, R.J., van Wijlen-Hempel, M.S., Stam, H.J., Roebroeck, M.E. (2008). Health-related physical fitness of adolescents and young adults with myelomeningocele. European Journal of Applied Physiology. 103(2):181-8.
9. Chang, C.L., Ulrich, B.D. (2008). Lateral stabilization improves walking in people with myelomeningocele. Journal of Biomechanics. 41(6):1317-23.
10. Bartonek, A., Saraste, H. (2001). Factors influencing ambulation in myelomeningocele: a cross‐sectional study. Developmental Medicine & Child Neurology. 43(4):253-60.
11. Gutierrez, E.M., Bartonek, A., Haglund-kerlind, Y., Saraste, H. (2003). Characteristic gait kinematics in persons with lumbosacral myelomeningocele. Gait & Posture. 18(3):170-7.
12. Mazur, J.M., Kyle, S. (2004). Efficacy of bracing the lower limbs and ambulation training in children with myelomeningocele. Developmental Medicine and Child Neurology. 46(5):352-6.
13. Ulus, Y., Tander, B., Akyol, Y., Ulus, A., Tander, B., Kuru, O. (2014). Function of Lower Extremities in Children with Lumbar Spina Bifida: Impact on Functional Status. Turkish Journal of Physical Medicine and Rehabilitation. 60(1):57-62.
14. Verhoef, M., Barf, H., Post, M., Van Asbeck, F., Gooskens, R., Prevo, A. (2004). Secondary impairments in young adults with spina bifida. Developmental Medicine and Child Neurology. 46(6):420-7.
15. Nora, M., Paina, G., Ferrari, A., Bertani, L. (1993). Untethering the cord. The Restored Infant Florence: Edition Fisioray p: 68-73.
16. Ferreira, P.L., Baltazar, C.F., Cavalheiro, L., Cabri, J., Gonçalves, R.S. (2014). Reliability and validity of PedsQL for Portuguese children aged 5-7 and 8-12 years. Health and Quality of Life Outcomes. 12(1):122.
17. Harvey, A.R., Morris, M.E., Graham, H.K., Wolfe, R., Baker, R. (2010). Reliability of the functional mobility scale for children with cerebral palsy. Physical & Occupational Therapy in Pediatrics. 30(2):139-49.
18. Chen, C.l., Shen, I.h., Chen, C.y., Wu, C.y., Liu, W.Y., Chung, C.y. (2013). Validity, responsiveness, minimal detectable change, and minimal clinically important change of pediatric balance scale in children with cerebral palsy. Research in Developmental Disabilities. 34(3):916-22.
19. Yi, S.H., Hwang, J.H., Kim, S.J., Kwon, J.Y. (2012). Validity of pediatric balance scales in children with spastic cerebral palsy. Neuropediatrics. 43(6):307-13.
20. Ghaderiyan, M., Ghasemi, G.A., Zolaktaf, V. (2016). The effect of rope jumping exercise on postural control, static and dynamic balance in male students with cavus foot. Qom University of Medical Sciences Journal. 10(4):58-68. [In Persian]
21. Rajabi, R., Samadi, H. (2013). Corrective exercise laboratory. University of Tehran press 2nd edition, Tehran. 237-8. [In Persian]
22. Youdas, J.W., Hollman, J.H., Krause, D.A. (2006). The effects of gender, age, and body mass index on standing lumbar curvature in persons without current low back pain. Physiotherapy Theory and Practice. 22(5):229-37.
23. Rajabi, R., Latifi, S. (2010). The norm of the thoracic (kyphosis) and lumbar (lordosis) spinal vertebral flexible curvature in Iranian men and women. Sport Medicine Studies. 2(7):13-30. [In Persian]
24. Gogia, P.P., Braatz, J.H., Rose, S.J., Norton, B.J. (1987). Reliability and validity of goniometric measurements at the knee. Physical Therapy. 67(2):192-5.
25. Nussbaumer, S., Leunig, M., Glatthorn, J.F., Stauffacher, S., Gerber, H., Maffiuletti, N.A. (2010). Validity and test-retest reliability of manual goniometers for measuring passive hip range of motion in femoroacetabular impingement patients. BMC Musculoskeletal Disorders. 11:194
26. Flanagan, A., Gorzkowski, M., Altiok, H., Hassani, S., Ahn, K.W. (2011). Activity level, functional health, and quality of life of children with myelomeningocele as perceived by parents. Clinical Orthopaedics and Related Research. 469(5):1230-5.
27. Mohammadi, V., Alizadeh, M.H., Gaieni, A. (2013). The effects of strength, balance and combined (strength and balance) exercise programs on the dynamic balance of young male athletes. Journal of Research in Rehabilitation Sciences. 9(1):113-23. [In Persian]
28. Shahheidari, S., Norasteh, A., Mohebi, H., Saki, F. (2011). The relationship between leg muscle strength, trunk muscle endurance, rang of motion of lower extremity and anthropometric factors with balance in female athletes. Journal of Sport Medicine. 1(3):5-23. [In Persian]
29. Douris, P., Southard, V., Varga, C., Schauss, W., Gennaro, C., Reiss, A. (2003). The effect of land and aquatic exercise on balance scores in older adults. Journal of Geriatric Physical Therapy. 26(1):3-6.
30. Christensen, C., Lowes, L.P. (2014). Treadmill training for a child with spina bifida without functional ambulation. Pediatric Physical Therapy. 26(2):265-73.
31. Fragala‐Pinkham, M., Haley, S.M., O’Neil, M.E. (2008). Group aquatic aerobic exercise for children with disabilities. Developmental Medicine & Child Neurology. 50(11):822-7.
32. Buffart, L.M., van den Berg-Emons, R.J., Burdorf, A., Janssen, W.G., Stam, H.J., Roebroeck, M.E. (2008). Cardiovascular disease risk factors and the relationships with physical activity, aerobic fitness, and body fat in adolescents and young adults with myelomeningocele. Archives of Physical Medicine and Rehabilitation. 89(11):2167-73.
33. Ebrahimi, A.A., Sarvari, F., Saeidi, M., Khorshid, S.m. (2013). Relationship between lower extremity muscle strength and dynamic balance in women with multiple sclerosis (MS). Journal of Research in Rehabilitation Sciences. 9:20-7. [In Persian]
34. Fakoor Rashid, H., Daneshmandi, H. (2013). The effects of a 6 weeks corrective exercise program on improving flat foot and static balance in boys. Journal of Practical Studies of Biosciences in Sport (JPSBS). 1(2):52-66.
35. Yaggie, J.A., Campbell, B.M. (2006). Effects of balance training on selected skills. Journal of Strength and Conditioning Research. 20(2):422-8.
36. Julie, A., Wickham, P, MHS A. (2009). Fitness program for a 4-year old child with spina bifida myelomeningocele that 2 utilizes an amTryke Therapeutic Tricycle Combination Hand/Foot Drive. 12.04.2018. https://ambucs.org/content/uploads/2015/06/Julie-Wickham-Cohort-4-Capstone-Project-Final.pdf
37. Young, W.K., Metzl, J.D. (2010). Strength training for the young athlete. Pediatric Annals. 39(5): 293-9.
38. Anderson, K.G., Behm, D.G. (2004). Maintenance of EMG activity and loss of force output with instability. The Journal of Strength & Conditioning Research. 18(3): 637-40.
39. Heitkamp, H.C., Horstmann, T., Mayer, F., Weller, J., Dickhuth, H.H. (2001). Gain in strength and muscular balance after balance training. International Journal of Sports Medicine. 22(04): 285-90.