Access of Children with Cerebral Palsy to Rehabilitation and Special Education Services During the COVID-19 Pandemic

Abstract

Objectives: Prohibitions and precautions implemented due to the coronavirus disease-2019 (COVID-19) pandemic have disrupted children with cerebral palsy (CP) from accessing special education, rehabilitation and medical care. This study aimed to determine the changes and problems of children with CP regarding health and special education due to the COVID-19 pandemic. Materials and Methods: Hundred children were included with CP who were followed up with a diagnosis of CP in the Ankara University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Pediatric Rehabilitation Unit. Hundred patients aged 0-18 years, who accepted to participate, were included between January 1, 2021 and January 31, 2022. Afterwards, questions were asked to the parents within the scope of the questionnaire consisting of 25 open- and close-ended questions. Results: Hundred children with CP [47 female, 53 male; mean age 7.4 (2-16 years)] were included. It was determined that 19% of children had COVID-19 infection and only 2 children had impaired functional status. It was determined that 38% of children could not continue special education, but 81% could go to regular outpatient clinic control. It was observed that 31 (31%) children needed botulinum toxin injection and only 17 children were injected. It was noted that 92% of the participants had internet access at home, but only 2 (2%) had knowledge about telemedicine or telerehabilitation. In this process, it was seen that 44% of the participants continued their home exercises every day and 30% of them performed more than 3 days a week. Conclusion: It was determined that, pediatric patients with CP who needed special education and rehabilitation were affected due to the COVID-19 pandemic. Difficulty in accessing interventional procedures such as botulinum toxin injection, special education services and the use of telerehabilitation were identified as the most affected areas. This pandemic has taught us that we should include alternative approaches such as telemedicine and telerehabilitation in the rehabilitation program to minimize these effects. Key Words: Cerebral Palsy, COVID-19, Rehabilitation, Telerehabilitation, Telemedicine

Keywords

• Cerebral Palsy
• COVID-19
• Rehabilitation
• Telerehabilitation
• Telemedicine

COVID-19 Pandemi Sürecinde Serebral Palsili Çocukların Rehabilitasyon ve Tedavi Hizmetlerine Ulaşımlarının Değerlendirilmesi

Abstract

Amaç: Koronavirüs hastalığı-2019 (COVID-19) pandemisi nedeniyle uygulanan önlemler serebral palsili (SP) çocukların özel eğitim, rehabilitasyon ve tıbbi tedavilere erişimlerinde kesintilere neden olmuştur. Bu çalışmada, COVID-19 pandemisi nedeniyle SP’li çocukların ve ailelerinin, sağlık ve eğitim ile ilgili yaşadıkları değişimleri ve sorunları belirlemek amaçlanmıştır. Gereç ve Yöntem: Ankara Üniversitesi Tıp Fakültesi Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı Pediyatrik Rehabilitasyon Ünitesi’nde SP tanısı ile izlenen 100 SP’li çocuk dahil edilmiştir. Açık ve kapalı 25 sorudan oluşan anket formu ile 1 Ocak 2021-31 Ocak 2022 arasında değerlendirme yapılmıştır. Bulgular: Çocukların 47’si kız, 53’ü erkek olup ortalama yaş 7,4’tür (2-16 yaş). SP tiplerine göre dağılımları ise; %30’u hemiplejik, %49’u diplejik ve %21’i tüm vücut tutulumlu şeklindeydi. SP’li çocukların %19’unun COVID-19 enfeksiyonu geçirdiği ve sadece 2 tanesinin fonksiyonel durumunda bozulma olduğu görüldü. SP’li çocukların %38’i pandemi sürecinde özel eğitime devam edememiştir, buna karşılık %81’inin düzenli fiziksel tıp ve rehabilitasyon polikliniği kontrolüne gidebildiği saptanmıştır. Otuz bir hastanın pandemi sürecinde botulinum toksin enjeksiyonu ihtiyacınınolduğu ve yalnızca 17 hastaya botulinum toksin enjeksiyonu yapıldığı görülmüştür. Katılımcıların %92’si evinde internet erişimi olduğunu, ancak katılımcılardan sadece 2 tanesinin (%2) teletıp veya telerehabilitasyon konusunda bilgi sahibi olduğu dikkat çekmiştir. Bu süreçte %68 hastanın evde egzersizlerinin yaptırıldığı ve bu hastaların %44’ünün her gün, %30’unun ise haftada 3 günden fazla ev egzersizlerine devamlılık sağladığı görülmüştür. Sonuç: COVID-19 pandemisi nedeniyle tüm hasta grupları gibi özel eğitim ve rehabilitasyon ihtiyacı duyan SP’li çocuk yaş grubu hastaların da etkilendiği saptanmıştır. En sık etkilenen alanlar olarak; özel eğitim hizmetleri, botulinum toksin enjeksiyonu gibi girişimsel işlemlere ulaşımda güçlük ve telerehabilitasyon uygulamalarının yaygın olarak kullanılmadığı saptanmıştır. Günümüzde teknolojideki gelişimler, birçok medikal alanda kullanılmaktadır, bu pandemi nedeniyle görüyoruz ki teknolojideki bu gelişimleri teletıp ve telerehabilitasyon alanlarına uyarlayarak rehabilitasyon programlarına daha sık dahil etmeliyiz. Anahtar Kelimeler: Serebral Palsi, COVID-19, Rehabilitasyon, Telerehabilitasyon, Teletıp

Keywords

• Serebral Palsi
• COVID-19
• Rehabilitasyon
• Telerehabilitasyon
• Teletıp

References

1. 1. Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109:8-14.
2. 2. Serdaroğlu A, Cansu A, Ozkan S, et al. Prevalence of cerebral palsy in Turkish children between the ages of 2 and 16 years. Dev Med Child Neurol. 2006;48:413-416.
3. 3. Dong Y, Mo X, Hu Y, et al. Epidemiology of COVID-19 Among Children in China. Pediatrics. 2020;145:e20200702.
4. 4. Tezer H, Bedir Demirdağ T. Novel coronavirus disease (COVID-19) in children. Turk J Med Sci. 2020;50:592-603.
5. 5. Pathak EB, Salemi JL, Sobers N, et al. COVID-19 in Children in the United States: Intensive Care Admissions, Estimated Total Infected, and Projected Numbers of Severe Pediatric Cases in 2020. J Public Health Manag Pract. 2020;26:325-333.
6. 6. Wilder-Smith A, Freedman DO. Isolation, quarantine, social distancing and community containment: pivotal role for old-style public health measures in the novel coronavirus (2019-nCoV) outbreak. J Travel Med. 2020;27:taaa020.
7. 7. Longo E, de Campos AC, Palisano RJ. Let’s make pediatric physical therapy a true evidence-based field! Can we count on you? Braz J Phys Ther. 2019;23:187-188.
8. 8. Neves E. Trends in Neuropediatric Physical Therapy. Frontiers in Public Health. 2013;1:5.

9. 9. Russell TG. Physical rehabilitation using telemedicine. J Telemed Telecare. 2007;13:217-220.
10. 10. Akpinar P, Aktas I, Unlu Ozkan F, et al. Rehabilitation status of children with cerebral palsy and anxiety of their caregivers during the COVID-19 pandemic. North Clin Istanb. 2021;8:545-553.
11. 11. Ben-Pazi H, Beni-Adani L, Lamdan R. Accelerating Telemedicine for Cerebral Palsy During the COVID-19 Pandemic and Beyond. Front Neurol. 2020;11:746.
12. 12. Bertamino M, Cornaglia S, Zanetti A, et al. Impact on rehabilitation programs during COVID-19 containment for children with pediatric and perinatal stroke. Eur J Phys Rehabil Med. 2020;56:692-694.
13. 13. Cacioppo M, Bouvier S, Bailly R, et al. Emerging health challenges for children with physical disabilities and their parents during the COVID-19 pandemic: The ECHO French survey. Ann Phys Rehabil Med. 2021;64:101429.
14. 14. Cankurtaran D, Tezel N, Yildiz SY, et al. Evaluation of the effects of the COVID-19 pandemic on children with cerebral palsy, caregivers’ quality of life, and caregivers’ fear of COVID-19 with telemedicine. Ir J Med Sci. 2021;190:1473-1480.
15. 15. Meireles ALF, de Meireles LCF. Impact of Social Isolation due to the COVID-19 Pandemic in Patients With Pediatric Disorders: Rehabilitation Perspectives From a Developing Country. Phys Ther. 2020;100:1910-1912.
16. 16. Karbuz A, Akkoc G, Bedir Demirdag T, et al. Epidemiological, Clinical, and Laboratory Features of Children With COVID-19 in Turkey. Front Pediatr. 2021;9:631547.
17. 17. Capan N, Özyemişçi Taşkıran Ö, Karadağ Saygı E, et al. The impact of the COVID-19 pandemic on children with disabilities and their parents or caregivers. Turk J Phys Med Rehabil. 2023;69:75-82.
18. 18. Cristinziano M, Assenza C, Antenore C, et al. Telerehabilitation during COVID-19 lockdown and gross motor function in cerebral palsy: an observational study. Eur J Phys Rehabil Med. 2022;58:592-597.
19. 19. Celikel R, Ramazanoglu E, Talu B. The effect of motor learning-based telerehabilitation on quality of life of children with cerebral palsy during the COVID-19 pandemic. Arch Pediatr. 2023;30:383-388.