OBSTETRİK BRAKİAL PLEKSUS PARALİZİSİNDE FARKLI YARALANMA TİPLERİNE SAHİP OLAN OKUL ÖNCESİ YAŞTAKİ ÇOCUKLARDA AKTİVİTE VE KATILIM

Öz

Amaç: Obstetrik brakiyal pleksus palsi (OBPP), kas-iskelet sisteminde çeşitli bozukluklara yol açmaktadır. Önceki çalışmaların birçoğu vücut yapı ve fonksiyon alanı incelenmiştir; ancak OBPP'nin farklı fonksiyonel seviyelerindeki aktivite ve katılım alanları hakkında çok az çalışma bulunmaktadır. Bu çalışma, farklı fonksiyonel düzeydeki OBPP'li çocukların aktivite ve katılım düzeylerinin belirlemeyi amaçlamaktadır. Yöntem: Çalışmaya 44-77 aylık (56.55 ± 8.69) yüz on iki çocuk dahil oldu. Çocuklar Narakas Sınıflamasına göre gruplandırıldı: Grup 1: Narakas Tip 1; Grup 2: Narakas Tip 2; Grup 3: Hem Narakas Tip 3 hem de 4’ü içermektedir. Çocukların aktivite ve katılım alanları Pediatrik Sonuç Veri Toplama Aracı (PODCI) kullanılarak değerlendirildi. Sonuçlar: PODCI Global'de grup 1 ve grup 2 en yüksek skora sahipti ve iki grup arasında fark yoktu, grup 3 ise en düşük skora sahipti (p <0.001). PODCI'nin Üst Ekstremite Fonksiyonu ve Mutluluk alt ölçeğinde, üç grubun puanları birbirinden farklıydı (p <0.001), ayrıca grup 1 en yüksek puanı ve grup 3 en düşük puanı aldı. PODCI'nin Spor ve Ağrı/Konfor alt ölçekleri sadece 3. grubun diğer gruplardan farklı olduğunu gösterdi (p <0.001) ve bu grubun skorları en düşüktü. Tartışma: OBPP’nin üst pleksus yaralanması olan tipleri benzer şekilde yüksek skorlara sahipti; PODCI’nin tüm skalalarında, total pleksus yaralanması olan çocuklar en düşük skorları aldı ve diğer gruplardan kolayca ayırt edildi. PODCI'nin Ağrı/Konfor ve Mutluluk alt ölçeğinde, Grup 1 tavan etkisini gösterdi. PODCI, total pleksus yaralanması olan çocukları diğerlerinde ayırabilse de üst pleksus yaralanmalarına sahip çocuklar genellikle çok yüksek puanlara sahipti, bu nedenle aktivite / katılım alanlarını daha detaylı şekilde değerlendirmek için hastalığa özgü bir değerlendirmeye ihtiyaç vardır.

Anahtar Kelimeler

• Brakiyal Pleksus
• Doğum Yaralanması
• Katılım
• Günlük Yaşam Aktiviteleri
• Sağlık Durumu

ACTIVITY AND PARTICIPATION IN PRESCHOOL CHILDREN WITH DIFFERENT INJURY TYPES OF OBSTETRIC BRACHIAL PLEXUS PARALYSIS

Abstract

Purpose: Obstetric brachial plexus palsy (OBPP) causes various disorders in the musculoskeletal system. Studies investigating activity and participation in different types of injury are limited. This study aimed to determine the activity and participation levels of preschool children with different injury types of OBPP.
Methods: The 112 children with OBPP, aged between 44 and 77 months, were included. The children were grouped according to the Narakas Classification System: Type 1 (n=7), Type 2 (n=91), Type 3 (n=2), and Type 4 (n=12). Both Type 3 and Type 4 represented a total brachial plexus injury. The Pediatric Outcome Data Collection Instrument (PODCI) was used to evaluate activity and participation.
Results: Narakas Type 1 and Type 2 had similarly high scores in PODCI Global (p<0.001), and PODCI Upper Extremity (p<0.001), Pain/Comfort (p<0.001), and Sport (p<0.001) subscales as compared with Narakas Type 3/4. In the PODCI Happiness subscale, Narakas Type 1 had the highest score, followed by lower scores of Narakas Type 2 and Type 3/4 (p<0.001).
Conclusion: Preschool children with total OBPP had lower levels of activity and participation, less use of their arm in daily living activities, and express a lower level of sport participation compared to those with upper plexus injuries (Narakas Type 1 and Type 2). As activity and participation problems persist or even got worse as the children grow, it is essential to evaluate both activity and participation, particularly in those with total plexus injuries, in preschool age and preferably earlier.

Keywords

• Activities of Daily Living
• Birth Injury
• Brachial Plexus
• Heath Status
• Participation

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