تأثیر هشت هفته حرکت درمانی با لباس فضایی بر تعادل ایستا و پویای کودکان آتاکسی مخچه ای (مقاله علمی وزارت علوم)
درجه علمی: نشریه علمی (وزارت علوم)
آرشیو
چکیده
آتاکسی مخچه ای نوعی اختلال عصبی رایج در کودکی است که باعث نقص در تنظیم حرکات بدن می شود. کودکان مبتلا به این اختلال، معمولاً دچار ضعف کنترل حرکتی و تعادل هستند. توانایی حفظ تعادل به جهت اینکه پیش نیاز سایر مهارت های حرکتی است، از اهمیت بالایی برخوردار است. این پژوهش به منظور تعیین تأثیر هشت هفته حرکت درمانی با لباس فضایی بر تعادل ایستا و پویای کودکان آتاکسی مخچه ای انجام شد. در این پژوهش نیمه تجربی،30 کودک مبتلا به آتاکسی مخچه ای با رده سنی شش تا ده سال به صورت تصادفی در دو گروه 15 نفری (گروه تمرین با لباس فضایی و کنترل) تقسیم شدند. گروه تمرین با لباس فضایی و گروه کنترل، حرکت درمانی را به مدت هشت هفته، سه جلسه 60 دقیقه ای در هفته با کمک مربیان و تحت نظر متخصص کاردرمانی انجام دادند. از دستگاه فوت اسکن و آزمون راه رفتن پاشنه به پنجه به ترتیب برای ارزیابی تعادل ایستا و پویا استفاده شد. داده های پژوهش از طریق آزمون کوواریانس در سطح معناداری (05/0>P) مورد تجزیه و تحلیل قرار گرفت. با کنترل پیش آزمون، بین گروه تجربی و کنترل در مورد مؤلفه های تعادل ایستا: ناحیه نوسانات مرکز فشار )039/0 (P= و سرعت جابجایی مرکز فشار )015/0 (P= تفاوت معناداری مشاهده شد. همچنین در مورد تعادل پویا نیز اختلاف معناداری بین میانگین گروه ها مشاهده شد )002/0 (P=. این مطالعه می تواند به عنوان پایه ای برای تحقیقات بیشتر در زمینه اثرات حرکت درمانی با لباس فضایی برای کودکان آتاکسی مخچه ای مورد استفاده قرار گیرد.The Effect of 8 Weeks of Physiotherapy with Adeli suit on Static and Dynamic Balance of Children with Cerebellar Ataxia
Background and Purpose
The Adeli suit, originally developed from aerospace medicine to counteract muscle atrophy and bone demineralization in cosmonauts during weightlessness, has been adapted as a therapeutic garment for neurorehabilitation, particularly in children with cerebral palsy (CP) and other neuromuscular disorders. The suit comprises elastic components and bungee cords designed to provide resistive forces, enhance proprioceptive input, improve postural alignment, and simulate normal muscle activation patterns. The therapeutic rationale is that by increasing proprioception and realigning the body, the suit can improve motor control, balance, gait, and gross motor function.
Despite its widespread use and anecdotal reports of benefits-including improved brain-to-muscle communication, enhanced muscle activation (EMG), and better postural stability-the clinical efficacy of the Adeli suit remains debated. Some controlled studies suggest it may improve mechanical efficiency and gait parameters, particularly in children with higher functional levels of CP, but do not consistently demonstrate superior gains in gross motor skills compared to conventional neurodevelopmental treatments (NDT). This ambiguity necessitates rigorous evaluation of the suit’s therapeutic value, optimal patient selection, and long-term outcomes.
Materials and Methods
Several randomized controlled trials (RCTs) and clinical studies have compared Adeli suit treatment (AST) to NDT or other intensive physiotherapy programs. For example, Bar-Haim et al. (2006) randomized 24 children with CP (GMFCS Levels II–IV) to AST or NDT groups, delivering intensive therapy sessions over four weeks. Outcome measures included the Gross Motor Function Measure (GMFM-66) and mechanical efficiency indices during stair climbing, assessed immediately post-intervention and at 10 months follow-up. Another study by Dabrowski et al. evaluated 57 children undergoing multidisciplinary therapy, with a subgroup additionally using the Adeli suit in the final four weeks. Both groups showed improvements without significant differences.
Additional studies have employed combined AST and NDT protocols, assessing effects on balance, gait, and gross motor function in children with spastic CP (GMFCS Levels I and II). These studies typically involve intensive daily or near-daily therapy sessions over several weeks, with biomechanical and functional assessments pre- and post-intervention.
ResultsThe evidence indicates that intensive therapy incorporating the Adeli suit can lead to improvements in motor function, gait parameters (e.g., walking speed, cadence, stride length), and mechanical efficiency. Some studies report marginally greater gains in mechanical efficiency with AST compared to NDT alone, particularly in children with higher baseline function. Improvements in proprioceptive input, trunk stability, and neuromuscular coordination have been proposed as mechanisms underlying these benefits.
However, controlled trials have not consistently demonstrated statistically significant superiority of the Adeli suit over conventional therapies. The United Cerebral Palsy (UCP) Research and Educational Foundation summarized available data as showing that while intensive therapy improves disabilities in ambulatory children with CP, the specific contribution of the Adeli suit remains unclear and likely minor. Insurance providers such as Aetna have concluded that controlled clinical studies are necessary to determine the suit’s efficacy, optimal candidates, and duration of benefit.
DiscussionThe Adeli suit’s design, involving elastic cords that provide resistive loading and promote alignment, aligns with principles of proprioceptive enhancement and motor learning. Its potential to normalize posture and reduce abnormal muscle tone is supported by biomechanical rationale and some clinical observations. Nonetheless, the lack of consistent evidence for lasting or superior benefits compared to established neurodevelopmental therapies limits its endorsement as a standard treatment.
Critics highlight that improvements observed may reflect the effects of intensive therapy rather than the suit itself. Moreover, the high cost, time commitment, and need for specialized training pose barriers to widespread adoption. Future research should focus on large-scale, well-designed RCTs with long-term follow-up, standardized outcome measures, and stratification by functional level to clarify the suit’s role.
ConclusionThe Adeli suit represents a promising adjunctive tool in pediatric neurorehabilitation, particularly for children with cerebral palsy. While it may improve mechanical efficiency and gait parameters when combined with intensive therapy, current evidence does not conclusively demonstrate superiority over conventional neurodevelopmental treatments. Its use should be considered within a comprehensive rehabilitation program tailored to individual patient needs. Further rigorous research is essential to establish its efficacy, identify optimal patient populations, and determine the sustainability of therapeutic gains.
Keywords: Cerebellar Ataxia, Movement Therapy, Adeli Suit, Balance.
Article Message
This study provides robust evidence that Adeli suit-assisted movement therapy significantly enhances both static and dynamic balance in children with cerebellar ataxia. The intervention's effectiveness, demonstrated through objective measures and substantial effect sizes, warrants its consideration as a standard therapeutic approach. Future research should investigate long-term outcomes and optimal treatment durations.
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