Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Serebral Palsili Çocukların Kaba Motor ve Fonksiyonel Seviyeleri ile Solunum Fonksiyonları Arasındaki İlişkinin İncelenmesi
Investigation of the Relationship Between Gross Motor and Functional Levels and Respiratory Functions in Children with Cerebral Palsy
Ayşegül DEMİR SARIİPEKa
aBandırma Onyedi Eylül Üniversitesi Sağlık Hizmetleri Meslek Yüksekokulu, Fizyoterapi Programı, Balıkesir, TÜRKİYE
Turkiye Klinikleri J Health Sci. 2021;6(4):770-8
doi: 10.5336/healthsci.2020-79021
Article Language: TR
Full Text
ÖZET
 Amaç: Bu çalışmanın amacı, serebral palsili (SP) çocukların kaba motor seviyeleri ve fonksiyonel seviyeleri ile solunum fonksiyonları arasındaki ilişkinin incelenmesidir. Gereç ve Yöntemler: Çalışmaya İstanbul'da bulunan Yeşeren Düşler Özel Eğitim ve Rehabilitasyon Merkezi'ne devam eden 50 SP'li çocuk (26 erkek, 24 kız) ve bu çocukların 30 sağlıklı kardeşleri (16 kız, 14 erkek) dâhil edildi. Olgular Kaba Motor Fonksiyon Sınıflama Sistemine (KMFSS) ve SP tiplerine göre sınıflandırıldı. Fonksiyonel seviye Pediatrik Fonksiyonel Bağımsızlık Ölçeği (WeeFIM) ile değerlendirildi. Solunum fonksiyonları ölçümü için SpiroAnalyzer ST-75 spirometre kullanıldı. Değişkenler arasındaki ilişkinin incelenmesi için Pearson Korelasyon Analizi ve gruplar arasındaki farkın değerlendirilmesi için Independent Samples t-test kullanıldı. Bulgular: SP grubunda KMFSS ve WeeFIM ölçekleri arasında korelasyon bulundu (p≤0,01). İki grup arasında zirve ekspiratuar akımı (PEF) dışında tüm değişkenler açısından istatistiksel olarak anlamlı fark bulundu (p<0,05). KMFSS'ye göre seviye I-II ve III-V arasında olan SP'li çocukların zorlu vital kapasite (FVC), zorlu ekspiryumun 1. saniyesinde çıkarılan hava hacmi (FEV1), FEV1/FVC, PEF, zorlu vital kapasitenin %75'inin atıldığı noktadaki zorlu ekspiratuar akım hızı (MEF75) değerleri arasında istatistiksel olarak anlamlı fark bulundu (p<0,05). Sonuç: SP'li çocukların solunum değerlerinin, normal gelişim gösteren yaşıtlarından düşük ve fonksiyonellik ile ilişkili olduğu dolayısıyla SP'nin solunum fonksiyonlarını etkilediği sonucuna varıldı. SP'li çocuklara uygulanan rehabilitasyon programlarına, solunum rehabilitasyonun da dâhil edilmesi ile solunum fonksiyonlarının gelişimine yardımcı olunabilir.

Anahtar Kelimeler: Serebral palsi; kaba motor; fonksiyonel seviye; solunum fonksiyonları
ABSTRACT
 Objective: The aims of this study were to asses the impact of gross motor development level and functional level of children with Cerebral Palsy on respiratory functions. Material and Methods: 50 children with CP (26 males, 24 females) who treated at Yeşeren Düşler Special Education and Rehabilitation Center and 30 healthy siblings (16 females, 14 males) were included in this study. The cases were classified according to the Gross Motor Function Classification System (GMFCS) and CP types. The functional level was assessed with the Pediatric Functional Independence Measure (WeeFIM). SpiroAnalyzer ST-75 spirometer was used for respiratory functions measuring. Pearson Correlation Analysis was used to examine the relationship between variables and Independent Samples t-test was used to evaluate the difference between groups. Results: A correlation was found between KMFSS and WeeFIM scales of SP group. (p ≤0.01) A statistically significant difference was found between the two groups in terms of all variables except peak expiratory flow (PEF) (p<0.05) According to KMFSS, children with CP between levels I-II and III-V were compared and there were statistically significant difference was found between forced vital capacity (FVC), air volume ejected in the first second of forced expiration (FEV1), FEV1 / FVC, PEF, forced expiratory flow rate at the point where 75% of forced vital capacity is expelled (MEF75) values. (p<0.05) Conclusion: As a conclusion, respiratory values of children with CP were lower than their peers with normal development and correlated with functionality, so CP affected the respiratory functions. Incorporation of respiratory rehabilitation into rehabilitation programs for children with CP can help to improve pulmonary capacities.

Keywords: Cerebral palsy; gross motor; functional status; respiratory functions
REFERENCES:
  1. Arslan C, Yıldız A, Tarakcı D, Algun C. Serebral palsi tanılı skolyozlu hastada solunum fizyoterapisinin fonksiyonel kapasiteye etkisi: Olgu sunumu [A case report: The effect of respiratory physiotherapy on functional capacity in a patient with cerebral palsy and scoliosis]. Hacettepe University Faculty of Health Sciences Journal. 2015;1(4). [Link] 
  2. Köseoğlu E, Karaoğlan B, Zinnuroğlu M. Serebral Palsili 132 olgunun demografik verileri ve klinik özellikleri [Demografic data and clinical characteristics of 132 cerebral palsy cases]. JPMR Sci. 2014;17:161-5. [Link] 
  3. Eriman E, İçağasıoğlu A, Demirhan E, Kolukısa Ş. Demographic data and clinical characteristics of 202 cerebral palsy cases. Turk J Phys Med Rehab. 2009;55(3):94-7. [Link] 
  4. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109:8-14. Erratum in: Dev Med Child Neurol. 2007;49(6):480. [PubMed] 
  5. Erdoğanoğlu Y, Günel M. Serebral paralizili çocukların ailelerinin sağlıkla ilgili yaşam kalitelerinin araştırılması [Investigation of the relationship between motor and functional levels with health-related quality of life in children with cerebral palsy]. Bulletin of Community Medicine. 2007;26(2). [Link] 
  6. Hays RM, Massagli TL. Rehabilitation Concepts in Myelomeningocele. In: Braddom RL, editor. Physical Medicine and Rehabilitation. 1st. Philadelphia: W.B.Saunders; 1996. 1133- 48.
  7. Cate IM, Kennedy C, Stevenson J. Disability and quality of life in spina bifida and hydrocephalus. Dev Med Child Neurol. 2002;44(5):317-22. [Crossref] [PubMed] 
  8. Pellegrino L, Dormans JP. Definitions, Etiology, and Epidemiology of Cerebral Palsy. In: Dormans JP, Pellegrino L, editors. Caring for Children with Cerebral Palsy. 1st ed. Baltimore: Brookes Publishing Co; 1998. p. 1- 30.
  9. Bartlett DJ, Palisano RJ. Physical therapists' perceptions of factors influencing the acquisition of motor abilities of children with cerebral palsy: implications for clinical reasoning. Phys Ther. 2002;82(3):237-48. [Crossref] [PubMed] 
  10. Kwon YH, Lee HY. Differences of respiratory function according to level of the gross motor function classification system in children with cerebral palsy. J Phys Ther Sci. 2014;26(3):389-91. [Crossref] [PubMed] [PMC] 
  11. Muammer R, Baktır S, Muammer K. Comparison of respiratory parameters in physically disabled and healthy children. Bezmialem Science. 2015;3(1):8-11. [Crossref] 
  12. Choi JY, Rha DW, Park ES. Change in Pulmonary Function after Incentive Spirometer Exercise in Children with Spastic Cerebral Palsy: A Randomized Controlled Study. Yonsei Med J. 2016;57(3):769-75. [Crossref] [PubMed] [PMC] 
  13. Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH. Content validity of the expanded and revised Gross Motor Function Classification System. Dev Med Child Neurol. 2008;50(10):744-50. [Crossref] [PubMed] 
  14. Özer S. Serebral Palsi. Beyazova M, Kutsal YG, editörler. Fiziksel Tıp ve Rehabilitasyon. Cilt 2. Ankara: Güneş Kitabevi; 2000. p.2359-439.
  15. Erkin G, Aybay C. Pediatrik rehabilitasyonda kullanılan fonksiyonel değerlendirme metodları [Functional assessment methods used in pediatric rehabilitation]. Türkiye Fiziksel Tıp ve Rehabilitasyon Dergisi. 2001;47(3);16-26. [Link] 
  16. Uysal A. Solunum fonksiyon testleri: Spirometri, PEF ölçümü, DLCO endikasyonları ve uygulama teknik bilgileri [Respiratory function tests: Spirometry, PEF measurement, DLCO indications and application technical information]. Türk Toraks Dergisi. 2011;12(1):1-2. [Link] 
  17. Yavuz B, Çimen S. Serebral palsili çocukların öz bakım becerilerini gerçekleştirme düzeyleri ve etkileyen etmenlerin incelenmesi [Investigation of the fulfilment levels of the self-care skills of the children with cerebral palsy and affectional factors]. Journal of Cumhuriyet University School of Nursing. 2007;11(1). [Link] 
  18. Yalçın S, Özaras N, Dormans J. Cerebral Palsy Treatment and Rehabilitation; Mas Publication; 2000; 13-31, 51-56.
  19. Matthews DJ, Wilson P. Cerebral Palsy. In: Molnar GE, Alexander MA, eds. Pediatric Rehabilitation. 3rd ed. Philadelphia: Hanley and Belfus Inc; 1999;193-213.
  20. Özel S, Çulha C, Ünsal S, Sarı İ, Köklü K. The relationship between the gross motor function classification system and treatment modalities in children with cerebral palsy [serebral palsili çocuklarda kaba motor fonksiyon sınıflama sistemi düzeyleri ve tedavi yöntemleri arasındaki ilişki]. Turk J Phys Med Rehab. 2016;62(2):116-122. [Crossref] 
  21. Erkin G, Delialioglu SU, Ozel S, Culha C, Sirzai H. Risk factors and clinical profiles in Turkish children with cerebral palsy: analysis of 625 cases. Int J Rehabil Res. 2008;31(1):89-91. [Crossref] [PubMed] 
  22. Raina P, O'Donnell M, Schwellnus H, Rosenbaum P, King G, Brehaut J, et al. Caregiving process and caregiver burden: conceptual models to guide research and practice. BMC Pediatr. 2004;4:1. [Crossref] [PubMed] [PMC] 
  23. Beckung E, Hagberg G. Neuroimpairments, activity limitations, and participation restrictions in children with cerebral palsy. Dev Med Child Neurol. 2002;44(5):309-16. [Crossref] [PubMed] 
  24. Majnemer A, Shevell M, Rosenbaum P, Law M, Poulin C. Determinants of life quality in school-age children with cerebral palsy. J Pediatr. 2007;151(5):470-5, 475.e1-3. [Crossref] [PubMed] 
  25. Damiano DL, Abel MF. Relation of gait analysis to gross motor function in cerebral palsy. Dev Med Child Neurol. 1996;38(5):389-96. [Crossref] [PubMed] 
  26. Kwon HY. Comparison of differences in respiratory function and pressure as a predominant abnormal movement of children with cerebral palsy. J Phys Ther Sci. 2017;29(2):261-5. [Crossref] [PubMed] [PMC] 
  27. Kwon YH, Lee HY. Differences of respiratory function in children with spastic diplegic and hemiplegic cerebral palsy, compared with normally developed children. J Pediatr Rehabil Med. 2013;6(2):113-7. [Crossref] [PubMed] 
  28. Kwon YH, Lee HY. Differences in respiratory pressure and pulmonary function among children with spastic diplegic and hemiplegic cerebral palsy in comparison with normal controls. J Phys Ther Sci. 2015;27(2):401-3. [Crossref] [PubMed] [PMC] 
  29. Kwon YH, Lee HY. Differences of respiratory function according to level of the gross motor function classification system in children with cerebral palsy. J Phys Ther Sci. 2014;26(3):389-91. [Crossref] [PubMed] [PMC] 
  30. Lee HY, Kim K. Can walking ability enhance the effectiveness of breathing exercise in children with spastic cerebral palsy? J Phys Ther Sci. 2014;26(4):539-42. [Crossref] [PubMed] [PMC] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com