Serebral Palsili Çocuklarda Üst Ekstremite Fonksiyonelliğinin İncelenmesi

Yıl 2016, Cilt: 2 Sayı: 2, 37 - 50, 10.10.2016

Hasan Atacan Tonak Mustafa Can Kılıç Özge Karadeniz Yenilmez Ali Kitiş

Öz

Çalşmann amac 7-18 yaşlar arasndaki hemiplejik ve quadriplejik

serebral palsili (SP) çocuklarda üst ekstremite fonksiyonelliğinin ve derin

duyularnn değerlendirilmesidir. Çocuklarn yaş ve cinsiyet gibi temel

demografik özelliklerinin yannda aldklar tedaviler sorguland. Üst

ekstremitede stereognozi ve pasif hareket duyusu ile birlikte, kavrama

fonksiyonelliğini değerlendirmek için Modifiye Green ve Banks

Snflamas kullanld. Fonksiyonel değerlendirme için Jebson-Taylor El

Fonksiyon Testi (JEFT) uyguland. Çalşmaya yaş ortalamalar 13,6±3,95

yl olan 25 çocuk alnd. Çocuklarn 13’ü (%52) erkek, 12’si (%48) kzd.

16’snn (%64) dominant eli sağ, 9’unun (%36) soldu. 13 (%52) çocuk

hemiplejik SP, 12 (%48) çocuk ise quadriplejik SP tansna sahipti.

Çocuklarn 12 (%48)’sinin sol, 13(%52)’ünün sağ elinde Modifiye Green

ve Banks Snflamas’na göre el fonksiyonellikleri 2. düzeyde (zayf)

bulundu. Stereognozi ve pasif hareket duyular iyi düzeyde bulunurken,

JEFT alt testlerinin ikisinde iki SP tipi arasnda anlaml farkllğa (p<0,05)

rastlan

Anahtar Kelimeler

Serebral Palsi, Üst Ekstremite, Fonksiyonel Değerlendirme

Kaynakça

• [1] Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy. Dev Med Child Neurol Suppl 2007; 109:8-14. [2] Mark T. Jobe. Campbell's Operative Orthopaedics. 12. Edition. Mosby; 2013, 3535-3554. [3] Sakzewski L, Ziviani J, Boyd R. Systematic review and metaanalysis of therapeutic management of upper-limb dysfunction in children with congenital hemiplegia. Pediatrics, 2009; 123 6: e1111-e1122. doi:10.1542/peds.2008-3335. [4] Kinnucan E, Van Heest A & Tomhave W. Correlation of motor function and stereognosis impairment in upper limb cerebral palsy. Journal of Hand Surgery 2010; 35(8), 1317–1322. [5] Himmelmann K, Beckung E, Hagberg G & Uvebrant P. Gross and fine motor function and accompanying impairments in cerebral palsy. Developmental Medicine & Child Neurology 2006; 48, 417–423. [6] DeLuca PA. The Musculoskeletal management of children with cerebral palsy. Pediatric Clinics of North America 1996; 43: 1135- 1150. [7] Flett PJ. Rehabilitation of spasticity and related problems in childhood cerebral palsy. J Paediatr Child Health 2003; 39:6-14. [8] Schneider JW, Gurucharri LM, Gutierrez AL, Gaebler-Spira DJ. Health-related quality of life and functional outcome measures for children with cerebral palsy. Dev Med Child Neurol. 2001; 43(9):601- 608. [9] Williams LA. A suggested method for evaluating proprioception, stereognosis, and body scheme in adult patients with cerebral vascular accident for occupational therapists. (Master’s project). San Jose state College, 1964. [10] Muen WJ, Bannister CM. Hand function in subject with spina bifida. Eur. J. Pediatr.Surg 1997; 7(1):18-22. [11] Hwang R, Kentish M, Burns Y. Hand positioning sense in children with spina bifida myelomeningocele. Australian Journal of Physiotherapy 2002; 48: 17-22. [12] Green WT, Banks HH. Flexor carpi ulnaris transplant and its use in cerebral palsy. J Bone Joint Surg Am 1962; 44:1343-52. Aydın Sağlık Dergisi - Yıl 2 Sayı 2 - 2016 (37-50) 49 [13] Samilson RL, Morris JM. Surgical improvement of the cerebralpalsied upper limb: Electromyographic studies and results of 128 operations. J Bone Joint Surg Am. 1964; 46:1203–16. [14] Jansen J, Taudorf K, Pedersen H, et al. Upper extremity function in spina bifida. Child's Nervous System 2005; 7(2): 67-71. [15] Muen WJ, Bannister CM. Hand function in subject with spina bifida. Eur. J. Pediatr.Surg 1997; 7(1):18-22. [16] Wai E, Young N, Feldman B. The relationship between function and self-perception and spinal deformity. J Pediatr Orthop 2005; 25:64–69. [17] Chin TYP, Duncan JA, Johnstone BR, Graham HK. Management of the upper limb in cerebral palsy. J Pediatr Orthop 2005;14:389. [18] Van Heest AE, Ramachandran V, Stout J, et al. Quantitative and qualitative functional evaluation of upper extremity tendon transfers in spastic hemiplegia caused by cerebral palsy. J Pediatr Orthop 2008; 28:679. [19] Langan J, Kern K, Hurvitz E, Brown S. Upper-limb position sense deficits in adults with cerebral palsy. Am. J. Phys. Med. Rehabil. 2014; Vol. 93, No. 9 774 - 781. [20] Green D, Schertz M, Gordon A, Moore A, et al. A multi-site study of functional outcomes following a themed approach to hand-arm bimanual intensive therapy for children with hemiplegia. Department of Occupational Therapy, Faculty of Medicine, Tel Aviv University, Israil 2013. [21] Crajé C, Aarts P, Nijhuis-van der Sanden M & Steenbergen B. Action planning in typically and atypically developing children (unilateral cerebral palsy). Research in Developmental Disabilities 2010; 31(5), 1039-1046. [22] Bolanos AA, Bleck EE, Firestone P, et al. Comparison of stereognosis and two-point discrimination testing of the hands of children with cerebral palsy. Developmental Medicine & Child Neurology. 1989; 31: 371–376. [23] Gordon AM, Duff SV. Relation between clinical measures and fine manipulative control in children with hemiplegic cerebral palsy. Developmental Medicine & Child Neurology 1999; 41: 586–91. [24] Wilson BC, Wilson JJ. Sensory and perceptual functions in the cerebral palsied. II. Stereognosis. Journal of Nervous and Mental Disease. 1967; 145:61–68. [25] Van Heest AE, House J, Putnam M. Sensibility deficiencies in the hands of children with spastic hemiplegia. Journal of Hand Surgery – American Volume. 1993; 18:278–81. [26] Krumlinde-Sundolm L, Elliasson A. Comparing tests of tactile sensibility: aspects relevant to testing children with spastic hemiplegia. Developmental Medicine & Child Neurology. 2002; 44: 604–612.