Serebral palsi'li çocuklarda su içi egzersizlerin spastisite ve motor fonksiyonlar üzerine etkisi

Objective: Our study aimed to investigate the effect of aquatic exercises on motor function and spasticity in the children with cerebral palsy (CP). Material-Method: The aquatic exercise group and land-based exercise group included 17 and 15 children, respectively. Aquatic exercise program involving joint range of motion (ROM), stretching and strengthening exercises and aerobic exercises (such as walking in shallow water, swimming) were applied in the aquatic exercises grup in a therapeutic pool. The temperature of water was 33°C. Aquatic exercises were applied with a physiotherapist and hydrotherapist, by the accompaniment of parents. The land-based exercise group was given a pediatric neurological rehabilitation program involving joint range of motion, stretching and strengthening exercises, an education for sitting, standing and walking according to the functional level of the child and aerobic exercises. Land based execises were applied with a physiotherapist in a pediatric rehabilitation unit. Both groups were treated for 60 minutes per day, 5 days a week along 6 weeks. The children were evaluated before and after treatment. Evaluation parameters were; ankle ROM, MAS, Timed-up-go Test, GMFM-88, GMFCS, WeeFIM, PedsQL-CP Module and USG of gastrocnemius muscle. SPSS version 18.0 for Windows was used for statistical analyses. Distribution of data was evaluated by Kolmogorov-Smirnov Test. Numerical datas which had normal distribution were analysed with İndependent T-Test, numerical datas without normal distribution and non-numerical datas were analysed with Mann Whitney U-Test (For comparision of pretreatment data and percentage of difference between two groups). Numerical datas with normal distribution before and after treatment were compaired with Paired T-Test. Numerical datas without normal distribution and non numerical datas before and after treatment were compaired with Wilcoxon Test. The relationship between parameters was assessed with Spearman Correlation Test. The level of statistical significance was set at p<0.05. Results: No difference was found between groups in age, age at diagnosis, gender, CP-type, prenatal, natal and postnatal risk factors, GMFCS score and gastrocnemius MAS levels before therapy. Post-treatment evaluations revealed increased ankle joint ROM, decreased spasticity, increased walking speed, an improvement in gross motor functions and increased functional independence by the similar rates in the both groups. The functional level evaluated by GMFCS demonstrated an improvement in the aquatic exercise group. A beter improvement was observed in some subparameters of quality of life of children in aquatic exercise group compared with land based exercise group. The USG evaluation of the aquatic exercise group revealed significantly increased compressibility. Conclusion: The aquatic exercises are effective on spasticity and motor functions at least as much as land-based exercises in the children with CP and were found more effective on quality of life and ambulation levels. We conclude that USG is a low-cost and easy method in morphological evaluation of the gastrocnemius muscle in the children with CP.