Razi Journal of Medical Sciences

fa ارتباط افتادن با عملکرد حرکتی و سطح توانایی عملکرد حرکتی درشت در بزرگسالان مقیم در جامعه مبتلا به فلج‌مغزی Association between Falling with Functional Mobility and Gross Motor Function in Community-dweller Adults with Cerebral Palsy فیزیوتراپی Physiotherapy پژوهشي Research <div style="text-align: justify;">زمینه و هدف: هدف از این مطالعه حاضر، بررسی ارتباط بین افتادن با عملکرد حرکتی (توانایی و زمان اجرا راه‌رفتن) و سطح توانایی عملکرد حرکتی درشت در بزرگسالان مقیم در جامعه مبتلا به فلج‌مغزی (با/ بدون سابقه افتادن) بوده است. روش کار: در این مطالعه از نوع تحلیلی-مقطعی بر روی 90 شرکت‌کننده بزرگسال (45 زن و 45 مرد) مقیم در جامعه مبتلا به فلج‌مغزی با میانگین سنی 23/4±02/25 سال انجام شد. شرکت‌کنندگان با روش نمونه‌گیری ساده به دو گروه با/ بدون سابقه افتادن تقسیم شدند. این افراد در صورتی وارد مطالعه می‌شدند که با تشخیص فلج‌مغزی و مقیم در جامعه بوده و از نظر شناختی کسب امتیاز 21 و بالاتر در آزمون معاینه مختصر وضعیت شناختی (Mini Mental Status Examination)، داشته باشند. سابقه و تعداد افتادن در شش ماه گذشته با پرسش ثبت گردید. عملکرد حرکتی افراد با آزمون مقیاس عملکرد حرکتی (Functional Mobility Scale) و آزمون زمان خیزش و رفت (Timed Up and Go) و سطح توانایی عملکرد حرکتی درشت با آزمون سطح توانایی عملکرد حرکتی درشت (Gross Motor Function Classification Systems) ارزیابی شد. سپس برای مقایسه دو گروه با و بدون سابقه افتادن از آزمون‌های مجذور-کای و تی-تست مستقل استفاده شد. یافته‌ها: 56 نفر از بزرگسالان فلج‌مغزی، سابقه افتادن در طول شش ماه گذشته داشتند. 34 نفر (71/60%) با سطح متوسط توانایی در عملکرد حرکتی درشت، بیشترین تعداد افتادن را داشتند. افرادی که از نظر عملکرد حرکتی روی سطوح هموار به صورت مستقل راه می‌رفتند و همچنین آن هایی که از صندلی‌چرخدار استفاده می‌کردند، بیشترین تعداد افتادن را در مسافت 500 متر گزارش کردند، در حالی‌که افرادی که روی تمام سطوح بصورت مستقل راه می‌رفتند، بیشترین تعداد افتادن را در مسافت 5 متر داشتند. نتیجه‌گیری: نتایج مطالعه نشان داد که احتمالاً بیشترین تعداد افتادن در افرادی است که از نظر سطح توانایی عملکرد حرکتی درشت در سطح متوسط هستند و از نظر عملکرد حرکتی توانایی راه‌رفتن مستقل بر روی سطوح هموار را دارند. </div> <div style="text-align: justify;">Background & Aims: Cerebral Palsy (CP) is increasingly recognized as a lifespan condition with escalating exploration into functional changes associated with ageing (1) and difficulty moving limbs and maintaining posture, which leads to permanent impairments in posture control, movement and physical capability in patients (2). Despite being a non-progressive disease, due to secondary musculoskeletal disorders that are caused over time in this population, changes in activity and functional mobility, including problems in the ability to walk occurred (3). As a result, the individual’s participation in social activities decreases. (2,4) Among the consequences of a reduction in the ability to walk falling incidents (3) is one of the important health issues. The sixty eight percent of people with CP during the past 6 months have had a history of falling at once (11-13). The side-effects that arise from falling in these people include: the fear of falling and so reduced mobility, osteoporosis, fractures, withdrawing from routine daily activities and social settings, increases in healthcare costs due to hospitalization and nurse-care and rehabilitation thereafter (14,16). During the process of development and over time, the ability to walk independently in individuals with CP is reduced with adulthood (5,17). Morgan and McGinley (2013), conducted a pilot study on 25 adults with CP (aged 30-65 years). They found that people with intermediate grade (II) in GMFCS had the greatest history of falling compared to those with severely impaired gross motor I and III (6). In this pilot study, researchers examined the association between having a history falling incidents with dynamic balance. Additionally, their research carried out on active individuals of society within the age group of 18 to 30 years (young adults). Those who had severely impaired gross motor IV and V and those who were depended on wheelchairs, were not included in their study. The aim of the present cross-sectional study was to determine association between falling history and functional mobility in community-dweller young adults with CP. Methods: This is an analytical study on 90 community-dweller young adults with CP (45 women and 45 men). After the approval of the Vice-Chancellor of Iran University of Medical Sciences and the approval of the Ethics Committee (IR.IUMS.REC.1394.9211340204), and obtaining the necessary permits for valuable sampling from daily rehabilitation centers in Tehran, it was carried out within six months. Then being familiar with the design and approving the consent form, volunteers entered this research project as participants. The inclusion criteria consisted of: a definitive confirmation of CP diagnosis by relevant physician, being between the ages of 18-30 years, present and active within the community, having a score of 21 or higher in the cognitive Mini-Mental State Examination (MMSE≥21), not having any other co-existing neurological disorders such as Parkinson’s or Multiple Sclerosis, abnormalities within their central nervous system and major orthopedic problems (such as fractures). An expert physiotherapist evaluated and completed the forms containing the participants’ information in the morning. Then, participants were divided into two groups (with and without history of falling) by using a simple sampling method. Firstly, the demographic and clinical information of each participant, including their age, gender, marital status, educational level, employment statues, type of CP (spastic [hemiplegia, diplegia, quadriplegia], flaccid, ataxic, athetoid), and type of assistive device used were completed. Afterwards, the participants answered two questions (whether they’ve had a history of falling incidents during the past six months) and if their answer was yes, next question was asked that was how many times had they fallen within the last six months? Therefore, no history of falling, having a falling incidence twice or more was recorded. Then, the Gross Motor Function Classification (GMFCS), the Functional Mobility Scale (FMS) and the Timed Up and Go test (TUG) assessments were taken randomly from the individuals. Results: In this study, 90 community-dweller young adults with CP between the ages of 18-30 years (mean average age of 25.02±4.23 years) were recruited. 62.2% of the participants had a history of falling incidents within the last six months out of which 36.7% had experienced falling incidents more than twice. Comparison of functional mobility (FMS) data show participants’ ability to walk with assistive devices over distances of 5, 50 and 500 meters, based on whether or not they had fallen in the past six months. The highest number of falls in the past six months was reported in people who were able to walk independently on flat surfaces (n=19), people who were able to move in a wheelchair for a distance of 500 meters (n=16, p=0.017), and people who were completely independent on all surfaces for a distance of 5 meters (n=17, p=0.018), respectively. The lowest history of falls in the past six months was reported in people using canes for distances of 50 and 500 meters (n=2, p<0.01), walkers for distances of 500 meters (n=5, p=0.017) and crutches for distances of 5 meters (n=6, p=0.018). Participants with moderate GMFCS levels (II and III) had a higher history of falls (Chi-Square Test X2=13.643, p=0.001), while those with mild GMFCS levels (I) had a Lower history of falls. In this Study, for functional mobility, which was measured by the Time Up Go Test (TUG), the number of people who were wheelchair-bound was excluded (n=19) and then a comparison was made between the remaining 71 people with the ability to walk. The result showed that there was a significant difference between people with and without a history of falls in functional mobility, TUG (t-test=3.11, p=0.003). In other words, the TUG was higher among people with a history of falls compared to people without a history of falls. Conclusion: In the present study, it was found that people with CP with moderate (II and III) Gross Motor Function disorder severity (GMFCS) had the highest number of falling during the past six months (n=34, p=0.001), but a mild (I) GMFCS reported no history of falling in the past six months. Also, the result showed that the highest number of falls in community-dwelling adults with CP was in the group who had the ability to walk independently on flat surfaces in terms of functional mobility. And the ability to perform functional mobility using the FMS test, it was determined that people use assistive device less in short distance of 5 meters and try to be independent by walking without assistive devices. As the walking distance increases (distance of 50 and 500 meters), the tendency to use assistive devices increases, so that at a distance of 500 meters, most participants used manual and motorized wheelchairs for their mobility.  Also, the result showed that using these assistive devices for mobility increases their risk of falling, and the greater the severity of their GMFCS (moderate and sever levels), the more falls they reported despite using assistive devices. The results of the study also showed that people with a history of falling showed a longer time performing functional mobility by using TUG test. </div> تعادل, فلج‌مغزی, افتادن, عملکرد حرکتی, سطح توانایی عملکرد حرکتی درشت, بزرگسال جوان Balance, Cerebral Palsy, Falling, Functional Mobility, GMFCS, Young Adults 1 13 http://rjms.iums.ac.ir/browse.php?a_code=A-10-8553-1&slc_lang=fa&sid=1 Nahid Nassiri-Razi ناهید نصیری راضی 3900319475328460087406 009-0007-4355-3042 No MSc in Physical Therapy, Rehabilitation Research Center, Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran کارشناس ارشد فیزیوتراپی، مرکز تحقیقات توانبخشی، گروه آموزشی فیزیوتراپی، دانشکده علوم توانبخشی، دانشگاه علوم پزشکی ایران، تهران، ایران Shohreh Noorizadeh-Dehkordi شهره نوری زاده دهکردی noorizadeh.sh@iums.ac.ir 3900319475328460087407 3900319475328460087407 Yes PhD in Physical Therapy, Professor, Rehabilitation Research Center, Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran دکتری تخصصی فیزیوتراپی، استاد گروه فیزیوتراپی، مرکز تحقیقات توانبخشی، گروه آموزشی فیزیوتراپی، دانشکده علوم توانبخشی، دانشگاه علوم پزشکی ایران، تهران، ایران Mehdi Dadgoo مهدی دادگو 3900319475328460087408 3900319475328460087408 No PhD in Physical Therapy, Associate Professor, Rehabilitation Research Center, Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran دکتری تخصصی فیزیوتراپی، دانشیار گروه فیزیوتراپی، مرکز تحقیقات توانبخشی، گروه آموزشی فیزیوتراپی، دانشکده علوم توانبخشی، دانشگاه علوم پزشکی ایران، تهران، ایران Akram Azad اکرم آزاد 3900319475328460087409 3900319475328460087409 No PhD in Occupational Therapy, Professor, Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran دکتری تخصصی کاردرمانی، استاد گروه کاردرمانی، مرکز تحقیقات توانبخشی، گروه آموزشی کاردرمانی، دانشکده علوم توانبخشی، دانشگاه علوم پزشکی ایران، تهران، ایران Mahtab Roohi-Azizi مهتاب روحی عزیزی 3900319475328460087410 3900319475328460087410 No PhD in Neurosciences, Assistant Professor, Rehabilitation Research Center, Department of Rehabilitation Basic Sciences, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran دکتری تخصصی نروساینس، استادیار گروه علوم‌پایه، مرکز تحقیقات توانبخشی، گروه آموزشی علوم‌پایه، دانشکده علوم توانبخشی، دانشگاه علوم پزشکی ایران، تهران، ایران