Serebral palsi'li çocuklarda denge ve solunum kas eğitiminin fonksiyonel kapasite, denge, solunum fonksiyonları ve solunum kas kuvvetine etkileri / The effects of balance and respiratory muscle training on functional capacity, balance, respiratory function and respiratory muscle strength in children with cerebral palsy

Abstract

Cerebral palsy (CP) is a disorder of the development of movement and posture, causing activity limitations, musculo-skeletal and sensory systems that occurred in the immature brain. The aim of the study was to investigate the effects of balance training and respiratory muscle training on functional capacity, balance, respiratory function and respiratory muscle strength in children with CP. The study included 30 cases with hemiplegic cerebral palsy who are in levels I and II according to Gross Motor Function Classification System, and were randomly assigned to a control (n=15) or a study (n=15) group. All the cases included in the study underwent a physiotherapy program 3 times a week for 8 weeks; 1 exercise session was performed under the supervision of a physiotherapist, other 2 sessions a week were performed at home. While the control group's physiotherapy program included balance exercises based on neurodevelopmental therapy (NGT), the study group's program included inspiratory muscle training (IMT) in addition to balance exercises based on NGT. The IMT which performed on the study group was performed at least 5 days a week. The Six Minute Walking Test (6MWT), pulmonary function test, respiratory muscle strength measurement and postural stability and balance (with Biodex Balance System®) were evaluated in all cases, and after 8 weeks of treatment all the evaluations were repeated. As a result of the study, PEF value, maximum inspiratory and expiratory pressure values, 6MWT distance, and equilibrium functions (except for eyes closed evaluations) (p<0.05) improved in both groups, whereas FVC, FEV1 and FEV1/FVC was not changed before and after treatment (p>0.05). There was no significant differences in the change scores of respiratory function, 6MWT distances, and balance scores between the groups (p> 0.05), whereas the maximum inspiratory and expiratory pressure values further increased in study group compared to control group (p<0.05). In conclusion, respiratory muscle training in children with CP did not have any effect on respiratory function, functional capacity and balance, but significantly increased respiratory muscle strength. There are a limited number of studies regarding respiratory muscle strength and respiratory muscle training in children with CP. Considering the association between respiratory problems and CP, we think that respiratory muscle strength assessment in children with CP and the identification of children who need it, and adding IMT to physiotherapy programs will contribute greatly to the rehabilitative approach of children with CP. Key words: Cerebral palsy, respiratory muscle strength, respiratory muscle training, respiratory function, balance.