Serebral Palside Eşlik Eden Bozuklukların Serebral Palsi Şiddetine Etkisi: Tek Merkez Bulguları

Öz

Amaç: Çalışmanın amacı, Serebral Palsi (SP) alt tipleri ve Kaba Motor Fonksiyon Sınıflandırma Sistemi (GMFCS) seviyeleri arasında Bozukluk İndeksi (Bİ) dağılımını tanımlamak ve Bİ, SP alt tipleri, doğum ağırlığı ve doğum haftası arasındaki ilişkiyi incelemektir. Yöntem: Bu retrospektif çalışma 0-18 yaş aralığında 423 SP'li çocukla yürütüldü. Veriler çocukların tıbbi kayıtlarından toplandı. Doğum ağırlığı ve haftası, fonksiyonel sınıflandırma seviyeleri, bilişsel bozukluk, görme, işitme sorunları, epilepsi varlığı kaydedildi. Tüm çocuklar GMFCS, El Becerileri Sınıflandırma Sistemi (MACS), Yeme ve İçme Becerileri Sınıflandırma Sistemi (EDACS), İletişim Fonksiyonu Sınıflandırma Sistemi (CFCS) ve SP alt tiplerine göre sınıflandırıldı. Katılımcılar, kaba motor, bilişsel, görme ve işitme bozuklukları ile epilepsiden oluşan Bİ'ye göre kategorize edildi. Bİ ile fonksiyonel sınıflandırma sistemleri, doğum ağırlığı ve doğum haftası arasındaki ilişkileri açıklamak multivariat doğrusal regresyon modeli kullanıldı. Bulgular: Analiz edilen 423 çocuktan (ortalama yaş 6,38±4,57 yıl) Bİ’ye göre 130'unda (%30,7) düşük düzeyde bozukluk, 159'unda (%31,7) orta düzeyde bozukluk ve 134'ünde (%31,7) yüksek düzeyde bozukluk saptandı. Unilateral spastik SP'li çocukların %61,5'inde düşük düzeyde Bİ (p<0,05), bilateral spastik SP'li çocukların %44,2'sinde orta düzeyde Bİ (p<0,05), diskinetik SP'li çocukların %67,9'unda yüksek düzeyde Bİ p<0,05) saptandı. Ataksik tipte ise Bİ düzeyleri arasında anlamlı bir fark yoktu (p=0,06). Regresyon analizi sonucunda kaba motor fonksiyon düzeyi (Beta=0,85; p<0,01) ve doğum ağırlığının (Beta=-0,05; p=0,04) Bİ’nin yordayıcıları olduğu ve varyansın %73'ünü açıkladığı görüldü. Sonuç: Çocukların yaklaşık üçte biri yüksek Bİ’ye sahipti; doğum ağırlığı ve kaba motor fonksiyonel seviyesi Bİ’nin prediktörleridir. Bu sonuçlar, SP’de rehabilitasyona yönelik yaklaşımların geliştirilmesine ve sosyal hizmetlerin iyileştirilmesine yardımcı olabilir.

Anahtar Kelimeler

• Serebral palsi
• fizyoterapi
• bozukluk
• ICF

The Effects of Associated Impairments on Severity of Cerebral Palsy: Insights from a Single-Center

Abstract

Aim: The aim of the study was to describe the distribution of the impairment index across Cerebral Palsy (CP) subtypes and Gross Motor Function Classification System (GMFCS) levels and investigate the relationship between CP subtypes, birth weight, gestational age, and the impairment index. Method: This retrospective study was conducted with 423 children with CP aged between 0-18 years. Data were gathered from the medical records of children. Birth weight and week, functional classification levels, intellectual impairment, presence of vision, hearing problems, epilepsy recorded. All children were classified according to the GMFCS, Manual Abilities Classification System (MACS), Communication Function Classification System (CFCS), Eating and Drinking Abilities Classification System (EDACS), and CP subtypes. Participants were categorized according to Impairment Index (II) that consist of gross motor, intellectual, vision and hearing impairments and epilepsy. Multivariate backward modelling linear regression model was used to explain relations between impairment index and functional classification systems, birth weight and birth week. Results: Amongst the 423 children (mean age 6.38±4.57 years) analyzed, 130 (30.7) of the children had low impairment, 159 (31.7%) of them had moderate impairment, and 134 (31.7%) of them had high impairment according to the II. In unilateral spastic type CP, 61.5% had a low impairment index (p<0.05), in bilateral spastic CP, 44.2% of children had a moderate impairment index (p<0.05), in dyskinetic CP 67.9% of children had a high impairment index (p<0.05). In ataxic type there were not any difference significantly between impairment index levels (p=0.06). As a result of regression analysis gross motor function level (Beta=0.85, p<0.01) and birth weight (Beta=-0.05, p=0.04) were predictors of the Impairment Index, and explained 73% of the variance. Conclusion: Nearly one third of the children had high II; birth weight and gross motor functional level are the predictors of II. These results can help improve rehabilitation and social services.

Keywords

• Cerebral palsy
• physiotherapy
• impairment
• ICF

Kaynakça

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