Adölesan idiopatik skolyoz'lu hastalarda inspiratuar kas eğitiminin solunum kas gücü, solunum fonksiyonları ve fonksiyonel kapasiteye etkisi / The effect of the inspiratory muscle training on respiratory muscle strength, respiratory function and functional capasity in adolescents with idiopatic scoliosis

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Başbuğ, Gözde
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Bezmialem Vakıf University
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Scoliosis is defined as a lateral flexion of the spine greater than 100 in the anteroposterior radiograph. However, in reality, a 3-dimensional structural deformity involving a curvature in the coronal plane, a change in the curves in the sagittal plane, and a rotation in the transverse plane. Scoliosis deformity is usually progressive and can cause chronic pain, cosmetic problems, decreased quality of life, and activity participation in patients. This three dimensional deformity also causes various respiratory dysfunctions. In this context, scoliosis brings about findings such as decreased respiratory function, inadequate functional capacity and low respiratory muscle strength. The adverse consequences of scoliosis when the angle of the curve exceeds 40 -50 degree usually last for life. Adolescent idiopathic scoliosis (AIS) is defined as "a structural curvature of the spinal cord with lateral flexion and rotation components that occur around the puberty period in healthy children". AIS is the most common type of scoliosis with a 2% incidence in the general population. AIS accounts for 80% of scoliosis cases. Risk of progress of AIS; natural history, skeletal maturity, sex, and curve size. In girls, the curvature is more likely to progress and more likely to need treatment. The size of the curveture increases with the skeletal growth; therefore, a patient who is not yet skeletally immature is at greater risk for progression of the disease. The relationship between scoliosis and altered pulmonary functions has long been known and studied in the literature. Impairment of pulmonary function and functional capacity seen on the AIS are tought depends on spinal curvature, rotation, thoracic kyphosis and lordosis, and chest deformation. Possible disabilities for untreated AIS, such as back pain and pulmonary limitations affect the functional capacity and self-esteem of the person. There are very few studies in this area. From a literary perspective; a significant proportion of the conservative treatment parameter of scoliosis is exercises training for increasing respiratory functions and functional capacity. Assessing respiratory function, determining the risk of restrictive lung disease, identifying respiratory problems of patients with scoliosis, and adding respiratory exercises to their treatment program have great importance for the rehabilitation of patients with scoliosis. In this context, studies are needed to develop the scoliosis specific parameters of respiratory rehabilitation. In our study, we aimed to increase respiratory muscle strength, respiratory functions and functional capacities by providing respiratory training to children with mild to moderate scoliosis. The study included patients who applied to the Faculty of Medicine, Department of Orthopedics and Traumatology of the Bezmialem Vakif University. Patients were directed by the orthopedic surgeon to the Department of Physiotherapy and Rehabilitation of the Faculty of Health Sciences at Bezmialem Vakif University with the diagnosis of AİS. Thirty-four patients were included in the study and randomized into control and training groups. During the first visit of all patients, an evaluation form was filled in which included demographic and clinical features. A 6-min walk distance (6MWD) was calculated for all cases in the training and control groups by applying the 6-min walk test (6MWT). Beside this, pulmonary function test (PFT), respiratory muscle strength (MIP: maximal inspiratory pressure, MEP: maximal expiratory pressure) was assessed and the results is recorded. Angle of trunk rotation (ATR) has evaluated by the same physiotherapist with a scoliometer and were recorded in the patient evaluation form, as well as the demographic information of the patients, as Risser classification, Cobb angle evaluation determined by the orthopedic surgeon. After the initial evaluation, all patients (training and control group) were given a home-based exercise program by the physiotherapist, consisting of deep diaphragmatic respiratory exercises, resistive respiratory exercises to weak zones on the concave sides of the scoliosis, spinal stabilization exercises, strengthening of interscapular muscles and stretching exercises. In the training group, the same home based exercise program as well as inspiratory muscle training (IMT) were given. Inspiratory muscle training was performed with Threshold IMT for 8 weeks, 30% of MIP value, 7 days a week, 15 minutes per set and twice a day. Patients in the training group were taken into control once a week to reevaluate the MIP values and 30% of the measured MIP was identified as the new training workload. In both control and training groups, during weekly controls, home based exercise program has repeated with physiotherapist accompanied by intraoral pressure measurements. At the end of the 8-week training period, the patients were reevaluated. The evaluations at the end of treatment showed statistically significant improvements in respiratory function test parameters including FEV1 (% predictive) and PEF (% predictive) and MIP, MEP values of respiratory muscle strength parameters in both control and training groups (p<0.05). The training group also showed a significant improvement in the value of forced vital capacity (FVC) (% predicted) (p <0.05). We think that home based exercise training, given in both groups with AIS in our study are very useful in terms of development of respiratory muscle power, respiratory functions and functional capacities. In addition to these gains, there was a statistically significant decrease in the ATR of the both patient group after 8 weeks of exercise training (p <0,05). We think that the exercise program we have applied was based on spinal stabilization and 3D breathing exercises, has been very beneficial on trunk rotation. When we look at the results obtained at the end of the 8-week training period, the increases in FVC (% predictive), MIP, MEP and 6MWD were found to be statistically higher than the increases in the control group (p <0,05). In this case, as we have already mentioned in our hypothesis, we can say that IMT has a positive effect especially on FVC, which is a sign of lung volumes, in pulmonary function test parameters. In addition, we think that IMT has a developmental effect on respiratory muscle strength and functional capacity, which is lower in children with AİS than healthy age groups. As a result of our study, the exercise program, consisted of spinal stabilization exercises, interscapular strengthening exercises, stretching exercises and respiratory exercises including diaphragmatic deep breathing exercises and resistive local expansion exercises to the concave regions of the scoliosis were performed throughout the patient group with AIS, is effective by the development of respiratory muscle power, the improvement of respiratory functions, the development of functional capacity and the reduction of trunk rotation caused by scoliosis. In addition to this, according to data of our study, IMT is quite effective at removing the deficits and achieving significant cardiorespiratory gains in mild to moderate AIS cases with inadequate respiratory muscle strength and functional capacities, apart from respiratory dysfunction arising from the likely natural course of the disease. In the light of findings obtained from our study, we would like to inform that a comprehensive exercise program in addition with IMT is a very effective method for cardiopulmonary physiotherapy and rehabilitation of AİS and it is useful for this patient group to disseminate its usage.
Thesis (Doktoral)--Bezmialem Vakıf University, Department of Cardiopulmonary Physiotherapy and Rehabilitation, Istanbul, 2018
Fizyoterapi ve Rehabilitasyon = Physiotherapy and Rehabilitation, Egzersiz tedavisi = Exercise therapy, Ergenler = Adolescents, Fizik tedavi yöntemleri = Physical therapy modalities, Hasta eğitimi = Patient education, Skolyoz = Scoliosis, Solunum = Respiration, Solunum fonksiyon testleri = Respiratory function tests, Solunum kasları = Respiratory muscles
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