Spastik serebral palsili bireylerde farklı üst ekstremite patternleri ve bağımsızlık seviyesi arasındaki ilişkinin ICF perspektifine göre incelenmesi

Öz

Amaç: Serebral palsili (SP) bireylerde şu ana kadar çeşitli el ve kol tutulum patternleri tanımlanmış olsa da, günlük yaşamdaki işlevsellikleri hakkındaki bilgilerimiz hala yetersizdir. Bu çalışmanın amacı, spastik SP'li bireylerde üst ekstremite tutulum patternlerini işlevsellik düzeyine göre araştırmaktı. Yöntemler: Çalışmaya yaşları 7-21 yıl arasından değişen toplam 101 spastik SP’li tanılı birey (%30 unilateral SP, % 70 bilateral SP; toplam 172 el ve kol patterni) dahil edildi. Anormal el ve kol patternlerini tanımlamak için El ve Kol Pattenleri Sınıflandırma Sistemleri ayrı ayrı kullanıldı. Sonrasında, çalışmaya dahil edilen hastaların el işlevsellikleri ve günlük yaşam aktivitelerindeki bağımsızlık düzeyleri El Becerileri Sınıflandırma Sistemi (EBSS) ve Fonksiyonel Bağımsızlık Ölçütü (FBÖ) kullanılarak belirlendi Bulgular: EBSS I ve Simple Flex el patterni arasında yüksek düzeyde bir ilişki bulunurken r=0,72) ve EBSS II ve Simple Flex el patterni arasında orta düzeyde bir ilişki tanımlanmıştır (r=0,57). Ayrıca, Tip Ia ve Tip Ic kol patternleri ile günlük yaşam aktivitelerindeki bağımsızlık seviyesi arasında orta derecede bir ilişki saptandı (r1=0,56 ve r2=0,44) Sonuç: Elde edilen verilerin ışığında; bir yandan Tip Ia ve Tip Ic kol patternlerinin diğer yandan Simple Flex el patterninin fonksiyonellik açısından verimli olduğu sonucuna varıldı. Ek olarak, Simple Flex Plus ve Intrinsic Punching Hand el patternlerinin el işlevselliği açısından verimli olmadıkları bulundu. Sonuç olarak SP’li çocuklarda yaygın olarak görülen farklı kol ve el patternlerinin işlevsellik açısından birbirlerinden farklıdırlar. Bundan Ötürü spastisite yönetiminde sıklıkla başvurulan yöntemlerden biri olan BoNT-A tedavisine karar vermeden önce hasta hem rijit hem de fonksiyonel açıdan kapsamlı bir şekilde değerlendirilmelidir.

Anahtar Kelimeler

• Serebral palsi
• Üst esktremite
• Pattern
• ICF
• GYA
• Bağımsızlık

The relationship between different upper extremity patterns and independence level in individuals with spastic cerebral palsy from the ICF perspective

Abstract

Aim: Although various upper limb and hand involvement patterns in individuals with cerebral palsy (CP) have been defined, our knowledge about their functionality in daily life is still insufficient. The purpose of this study was to investigate upper extremity involvement patterns concerning the level of functionality in individuals with spastic CP. Methods: A total of 101 individuals, aged 7 to 21 years, with spastic cerebral palsy (30% unilateral CP, 70% bilateral CP), and a total of 172 hand and upper limb patterns were evaluated in this study. To identify different spastic upper extremity patterns, two classification systems, one for the upper limb and one for the hand (Classification of Upper Limbs and Hand Patterns), were used separately. Then, the Manual Ability Classification System [MACS] and Functional Independency Measure [Wee-FIM] were utilized to quantify hand functions and functional independency level, respectively, in the activities of daily living. Results: A strong correlation was found between MACSI and Simple Flex of Hand Pattern (r=0.72) while a moderate correlation was detected between MACSII and Simple Flex of Hand Pattern (r2=0.57). Besides, the level of independence in daily living activities was consistent with Type Ia and Type Ic patterns of the upper limb (r1=0.56 and r2=0.44) Conclusion: It was concluded in the light of the obtained data that Type Ia and Type Ic patterns of the upper limb, as well as Simple Flex of the hand pattern, are very efficient for functionality. Additionally, the pattern of Simple Flex Plus and Intrinsic Punching Hand were significantly related to bad capacity in hand functioning. The various upper limb and hand patterns affect the functionality or functional independence in daily living. Consequently, abnormal upper limb and hand patterns, which commonly occur in the upper extremities of children with CP, are quite different from each other in terms of functionality. Hence, it is recommended that before the application of BoNT-A or orthopedic surgery in managing spasticity, the client should be comprehensively evaluated in both terms of rigidity and functionality.

Keywords

• Cerebral Palsy
• upper limb
• pattern
• ICF
• ADL
• Independency

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