Serebral Palsili Ambulatuar Çocuklarda Yaşam Kalitesi, Fiziksel Aktivite ve Fonksiyonel Bağımsızlığın Araştırılması

Öz

Amaç: Çalışmanın amacı, farklı fonksiyonel seviyelerdeki Serebral Palsi (SP)’li ambulatuar çocuklarda yaşam kalitesi, fiziksel aktivite ve fonksiyonel bağımsızlığın araştırılmasıdır. Yöntem: Çalışmaya Özel Eğitim Merkezi'nde eğitim gören, Kaba Motor Fonksiyon Sınıflandırma Sistemi (KMFSS)”ne göre seviyesi I, II ve III olan 8-12 yaş arasındaki çocuklar dahil edildi. Olgularda yaşam kalitesi “Serebral Palsi’de Yaşam Kalitesi Anketi (CP QOL) ile, fonksiyonel bağımsızlık seviyesi WeeFIM ile, fiziksel aktivite düzeyleri “Çocuklar için Fiziksel Aktivite Anketi” (PAQ-C) ile değerlendirildi. Bulgular: KMFSS seviyelerine göre WeeFIM'in sfinkter kontrolü, sosyal ve kognitif alt parametreleri hariç tüm alt parametrelerinde, WeeFIM total skoru ve PAQ-C skorunda istatistiksel olarak anlamlı fark bulundu (p<0,017). CPQOL'ın “hizmete erişebilirlik” ve “ebeveyn sağlığı” dışındaki tüm alt parametrelerinde üç grup arasında istatistiksel olarak anlamlı farklılık olduğu görüldü (p<0,017). Çalışma, KMFSS seviyelerine göre karşılaştırıldığında; seviye III’ün, WeeFIM’in tüm alt alanları ve fiziksel aktivite (FA) skorlarının, CP-QOL- Çocuk Ölçeği’nin ise “ebeveyn sağlığı”, “emosyonel iyi olma ve özgüven” ile “hizmete erişebilirlik” alanları hariç tüm alan skorlarının düşük olduğu, seviye I’in en yüksek bağımsızlık seviyesine sahip olduğu görülmüştür. Sonuç: Çalışma, ambulatuar SP tanılı çocukların fonksiyonel bağımsızlık seviyelerinin, FA’lerinin ve yaşam kalitelerinin KMFSS seviyelerine göre değişiklik gösterdiğini ve seviye III olan çocukların daha fazla etkilendiğini ortaya koymaktadır. İleride değerlendirme yöntemleri objektif olan ve daha büyük örnekleme sahip çalışmalar planlanmalıdır.

Anahtar Kelimeler

• Serebral palsi
• fiziksel aktivite
• yaşam kalitesi
• fonksiyonel bağımsızlık

Investigation of Quality of Life, Physical Activity and Functional Independence in Ambulatory Children with Cerebral Palsy

Öz

Aim: The aim of this study is to investigate quality of life, physical activity, and functional independence in ambulatory children with CP at different functional levels. Method: Children between the ages of 8 and 12 who were educated at the Special Education Center and whose levels were I, II and III according to the Gross Motor Function Classification System (GMFCS) were included in the study. Quality of life was evaluated with the "Quality of Life in Cerebral Palsy Questionnaire (CP QOL), functional independence level with WeeFIM, and physical activity levels with the "Physical Activity Questionnaire for Children" (PAQ-C). Results: A statistically significant difference was found in WeeFIM total score and PAQ-C score in all sub-parameters of WeeFIM except sphincter control, social and cognitive sub-parameters according to KMFSS levels (p<0.017). There was a statistically significant difference between the three groups in all sub-parameters of CPQOL except “accessibility to service” and “parental health” (p<0.017). Compared to KMFSS levels; All sub-domains of WeeFIM and physical activity (PA) scores of level III are low, and CP-QOL- Child Scale has low scores in all domains except “parental health”, “emotional well-being and self-confidence” and “accessibility to service” and level 1 It was found that ' had the highest level of independence. Conclusion: This study reveals that the functional independence levels, FA and quality of life of children with ambulatory CP differ according to their CMFSS levels, and that children with level III are more affected. Future studies with objective evaluation methods and larger samples should be planned.

Anahtar Kelimeler

• Cerebral palsy
• physical activity
• quality of life
• functional independence

Kaynakça

1. 1. Kerr C, McDowell BC, Parkes J, Stevenson M, Cosgrove AP. Age‐related changes in energy efficiency of gait, activity, and participation in children with cerebral palsy. Developmental Medicine & Child Neurology. 2011;53(1):61-67. doi: 10.1111/j.1469-8749.2010.03795.x.
2. 2. 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. Erratum in: Dev Med Child Neurol. 2007;49(6):480.
3. 3. Sritipsukho P, Mahasup N. Correlations between gross motor functions and health-related quality of life in Thai children with spastic diplegia. J Med Assoc Thai. 2014;97Suppl 8:S199-204.
4. 4. Bjornson KF, Belza B, Kartin D, Logsdon R, McLaughlin J, Thompson EA. The relationship of physical activity to health status and quality of life in cerebral palsy. Pediatr Phys Ther. 2008;20(3):247-253.
5. 5. World Health Organization. Geneva: The World Health report 2002 – Reducing risks promoting healthy life. https://www.who.int/publications/i/item/9241562072. Yayınlanma tarihi 2002. Erişim Tarihi 22 Kasım 2021.
6. 6. Bloemen M, Van Wely L, Mollema J, Dallmeijer A, de Groot J. Evidence for increasing physical activity in children with physical disabilities: a systematic review. Dev Med Child Neurol. 2017;59(10):1004-1010.
7. 7. Kallings L. Physical activity on prescription: studies on physical activity level, adherence and cardiovascular risk factors [PhD Thesis]. Solna, Sweden: Karolinska Institutet Department of Neurobiology, Care Sciences and Society;2008.
8. 8. Fowler EG, Kolobe TH, Damiano DL, et al. Promotion of physical fitness and prevention of secondary conditions for children with cerebral palsy: section on pediatrics research summit proceedings. Phys Ther. 2007;87(11):1495-1510.

9. 9. Jahnsen R, Villien L, Egeland T, Stanghelle JK, Holm I. Locomotion skills in adults with cerebral palsy. Clin Rehabil. 2004;18(3):309-316.
10. 10. Opheim A, Jahnsen R, Olsson E, Stanghelle JK. Walking function, pain, and fatigue in adults with cerebral palsy: a 7‐year follow‐up study. Dev Med Child Neurol. 2009;51(5):381-388.
11. 11. Andersson, C, Mattsson E. Adults with cerebral palsy: a survey describing problems, needs, and resources, with special emphasis on locomotion. Dev Med Child Neurol. 2001;43(2):76-82.
12. 12. Schenker R, Coster W, Parush S. Participation and activity performance of students with cerebral palsy within the school environment. Disabil Rehabil. 2005;27(10):539–552.
13. 13. Kwon KB, Choi Y, Sung KH, et al. Correlation between accelerometer and questionnaire-based assessment of physical activity in patients with cerebral palsy. Clin Orthop Surg. 2020;12(1):107-112.
14. 14. Ryan JM, Forde C, Hussey JM, Gormley J. Comparison of patterns of physical activity and sedentary behavior between children with cerebral palsy and children with typical development. Phys Ther. 2015;95(12):1609-1616.
15. 15. Keawutan P, Bell KL, Oftedal S, Davies PS, Ware RS, Boyd RN. Quality of life and habitual physical activity in children with cerebral palsy aged 5 years: A cross-sectional study. Res Dev Disabil. 2018; 74:139-145.
16. 16. Palisano RJ, Hanna SE, Rosenbaum PL, et al. Validation of a model of gross motor function for children with cerebral palsy. Phys Ther. 2000;80(10):974-985.
17. 17. Atasavun Uysal S, Düger T, Elbasan B, Karabulut E, Toylan İ. Reliability and validity of the cerebral palsy quality of life questionnaire in the Turkish population. Percept Mot Skills. 2016;122(1):150-164.
18. 18. Davis E, Shelly A, Waters E, Davern M. Measuring the quality of life of children with cerebral palsy: comparing the conceptual differences and psychometric properties of three instruments. Dev Med Child Neurol. 2010;52(2):174-180.
19. 19. Erkin G, Aybay C. Pediatrik Rehabilitasyonda kullanılan fonksiyonel değerlendirme metodları. Turk J Phys Med Rehab. 2001;47(3):16-20.
20. 20. Elbasan B, Düzgün İ. Fiziksel aktivite skalaları-kanıta dayalı fiziksel aktivite. Turkiye Klinikleri J Physiother Rehabil-Special Topics. 2016;2(1):36-39.
21. 21. Lee BH. Relationship between gross motor function and the function, activity and participation components of the International Classification of Functioning in children with spastic cerebral palsy. J Phys Ther Sci. 2017;29(10):1732-1736.
22. 22. Gorton GE. Social and ecological determinants of physical activity for youth with cerebral palsy [PhD Thesis]. Minnesota, United States: Walden University;2020.
23. 23. Van den Berg-Emons HJ, Saris WH, De Barbanson DC, Westerterp KR, Huson A, Van Baak MA. Daily physical activity of school children with spastic diplegia and of healthy control subjects. J Pediatr. 1995;127(4):578-584.
24. 24. Makris T, Dorstyn D, Crettenden A. Quality of life in children and adolescents with cerebral palsy: a systematic review with meta-analysis. Disabil Rehabil. 2021;43(3):299-308.
25. 25. Badia M, Orgaz MB, Gomez-Vela M, Verdugo MA, Ullan AM, Longo E. Do environmental barriers affect the parent-reported quality of life of children and adolescents with cerebral palsy? Res Dev Disabil. 2016;49-50:312-321.
26. 26. Böling S, Varho T, Kiviranta T, Haataja L. Quality of life of Finnish children with cerebral palsy. Disabil Rehabil. 2016;38(7):683-688.