Turkish Journal of Physical Medicine and Rehabilitation 2001 , Vol 47 , Num 3

Paraplejiklerde Pelvik Bantlı Makara Sistemiyle Progresif Rezistif Egzersizin PelvikStabilizasyona Etkisi

Ayşe Karamercan 1 ,Alper Aşcı 2 ,Şenay Özdolap 3 ,Canan Tıkız 4 ,Aytül Çakcı 5
1 Ankara Fizik Tedavi Rehabilitasyon Eğitim ve Araştırma Hastanesi, Ankara
2 Hacettepe Üniversitesi Spor Bilimleri ve Teknolojisi Yüksek Okulu, Ankara
3 Bülent Ecevit Üniversitesi Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Zonguldak, Türkiye
4 Celal Bayar Üniversitesi Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Manisa, Türkiye
5 Sağlık Bakanlığı Ankara Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, Fiziksel Tıp ve Rehabilitasyon Kliniği, Ankara, Türkiye

The Effect of Progressive Resistive Exercises with a Pelvic Belt Pulley System on Pelvic Stability in Paraplegics In paraplegics pelvic and truncal stability is essential both for transfer activities and ambulation. Patients mostly maintain their standing positions by increasing lumbar lordosis and locking their hips against anterior pelvifemoral ligaments. Strengthening the muscles lying below the lesion level but receiving their innervation from cervical region-namely latissimus dorsi, lower fibres of trapezius, pectoral and serratus anterior musclesis essantial in the maintenance of truncal and pelvic stability in these patients. In this study we aimed to strengthen these muscles by a progressive resistive exercise programme with a pelvic belted pulley system and to evaluate its additive effect to pelvic stability and functional improvement. Thoracal 10-12 lesion-leveled 14 complete paraplegic patients that were ambulated at parallel bar have received progressive resistive exercise programme by a system padded belt around the pelvis attached to a cable carrying weight over a pulley for 8 weeks duration. Before and after exercise programme, the improvement of flexor and extansor groups of upper and lower truncal muscles were evaluated by using a dynomometer. Exercise programmes were planned based on the first dynamometric measurement for each individual patient. Gait and transfer subscales of Functional Independency Measurement scale and pelvic and low back stabilization’s of patients were evaluated clinically both at the admission and at the dicharge. In addition, 8 paraplegic patients whose lesion levels were the same included as  the control group. Control group measurements were performed before and after the conventional rehabilitation programme. After exercise programme in both groups back and pelvic stability on parallel and transfer and walking activities that are evalueted by FIM scales are increased (in study group p<0.001 and control group p<0.05). Increments were established in muscle strength of lower truncal flexors and extansors, more significant in extansors, as a result of dynamometric measures in both groups. The difference between admission and disharge of lower trunk extansor muscles dynomometric measure of the study group was significantly higher than the control group (18.36 for the study group and 5.85 for the control group, p<0.05). We concluded that resistive exercises of upper myotomal muscles that lie lower the lession level can make supportive effect on pelvic stability and this would lead to increase patient’s daily living activities such as transfer success and the chance of ambulation. Also this could prevent possible pelvi-femoral deformities that might develop in time

Keywords : Paraplegia, pelvic stability, progressive resistive exercies.