Serebral palsili çocukların tedavisinde Pediatrik Bobath Konsepti: Türk Bobath terapistlerinin görüşü

Öz

Amaç: Pediatrik Bobath Konsepti (PBK), serebral palsi ve benzeri nörogelişimsel probleme sahip çocukların fonksiyonel becerilerini desteklemek amacıyla transdisipliner uygulanan aile-çocuk merkezli holistik bir konsepttir. Bu çalışmanın amacı, Türkiye'deki Bobath terapistlerinin bakış açısından PBK'nin çocuklara, ebeveynlere ve kendilerine etkilerini incelemekti. Yöntem: Bu gözlemsel çalışmaya yaş ortalaması 37.9+6.1 yıl olan 104 (%69.2 kadın) Bobath terapisti katıldı. Delphi yöntemi ile Pediatrik-Bobath Etki Anketi (P-BIQ) geliştirildi. İçerik geçerliliği (Lawshe's İçerik Geçerlik İndeksi-CVI) ve test-tekrar test güvenilirliği (Sınıfiçi Korelasyon Katsayısı-ICC) incelendi. Çocuklar, ebeveynler ve terapistlerdeki değişim oranları arasındaki ilişkiler Ki Kare (χ2) testi kullanılarak analiz edildi ve ilişkilerin etki büyüklükleri Cramer's V değerlerine göre incelendi. Bulgular: P-BIQ anketine (CVI=0.836, ICC>0.737) göre terapistlerin en az %74’ü PBK’nin çocukları (terapi ve ev programına uyum/motivasyon, vücut yapı ve fonksiyonları, aktivite ve katılımları, çevresel düzenlemeler), ebeveynleri (terapi ve ev programına uyum/motivasyon) ve kendilerini (mesleki yeterlilik hissi ve motivasyon) olumlu etkilediğini belirtti. Çocuk, ebeveyn ve terapistin uyumu/motivasyonu çocuğun aktivite, katılım düzeyleri ve çevresel düzenlemeler ile pozitif ilişkiliydi (p<0.001, Cramer’s V>0.20). Sonuç: Çocukların gelişimine olduğu kadar PBK, ebeveynlerin uyumuna ve terapistin eğitimine ve mesleki yeterlilik duygusuna da katkıda bulunur. Çocukların, ebeveynlerin ve terapistlerin artan uyumu, çocuğun işlevsel gelişimini, sosyal katılımını ve çevreye uyumunu destekler.

Anahtar Kelimeler

• Serebral palsi
• Çocuk
• Geçerlik çalışması

Pediatric Bobath Concept in management of children with cerebral palsy: view of Turkish Bobath therapists

Öz

Purpose: Pediatric Bobath Concept (PBC) is a family-child centered holistic concept applied interdisciplinary to support the functional skills of children with cerebral palsy. The aim of this study was to examine the effects of PBC on children, parents, and themselves from the perspective of Bobath therapists in Turkey. Methods: In this observational study, 104 (69.2% female) Bobath therapists with a mean age of 37.9+6.1 years participated. The Pediatric-Bobath Impact Questionnaire (P-BIQ) was developed by the Delphi method. Content validity (Lawshe's Content Validity Index-CVI) and test-retest reliability (Intraclass correlation coefficient -ICC) were examined. The relationships between the rates of change in children, parents, and therapists were analyzed using the Chi Square (χ2) test and the effect sizes of the relationships were analyzed according to Cramer's V values. Results: According to the P-BIQ (CVI=0.836, ICC >0.737), at least 74% of therapists reported that the PBC positively affected children (compliance with therapy and home program, body structure and function, activity and participation, environmental adaptations), parents (compliance with therapy and home program) and themselves (sense of professional competence and motivation). Compliance of the child, parent, and therapist was positively associated with the child's activity and participation levels and environmental adaptation (p<0.001, Cramer's V>0.20). Conclusion: PBC contributes to the development of children as well as to parental compliance, and to the therapist's training and sense of professional competence. Increased compliance of children, parents, and therapists supports the child's functional development, social participation, and adaptation to the environment.

Anahtar Kelimeler

• Cerebral palsy
• Child
• Validation study

Kaynakça

1. 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.
2. Mayston M. Systems science: An answer to dealing with the complexity of cerebral palsy? Dev Med Child Neurol. 2023;65:996-997.
3. Veličković TD, Perat MV. Basic principles of the neurodevelopmental treatment. Medicina 2005;42(41):112-120.
4. Farjoun N, Mayston M, Florencio LL, et al. Essence of the Bobath concept in the treatment of children with cerebral palsy. A qualitative study of the experience of Spanish therapists. Physiother Theory Pract. 2022;38:151-163.
5. Novak I, Morgan C, Fahey M, et al. State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. Curr Neurol Neurosci Rep. 2020;20:3.
6. Te Velde A, Morgan C, Finch-Edmondson M, et al. Neurodevelopmental Therapy for Cerebral Palsy: A Meta-analysis. Pediatrics. 2022;149(6).
7. Alcântara de Torre CRM. Bobath in Brazil: what is the best study design for intervention for children with cerebral palsy? Dev Med Child Neurol. 2022;64:531.
8. Furtado SR, Sampaio RF, Kirkwood RN, et al. Moderating effect of the environment in the relationship between mobility and school participation in children and adolescents with cerebral palsy. Braz J Phys Ther. 2015 ;19:311-319.

9. Serdaroğlu A, Cansu A, Ozkan S, et al. Prevalence of cerebral palsy in Turkish children between the ages of 2 and 16 years. Dev Med Child Neurol. 2006;48:413-416.
10. Bobath E, (EBTA) TA. Bobath Courses and Events 2023. Available from: https://www.bobathtutors.com/events.php#courses
11. de Meyrick J. The Delphi method and health research. Health Educ. 2003;103:7-16.
12. Ayre C, Scally AJ. Critical values for Lawshe’s content validity ratio: revisiting the original methods of calculation. Meas Eval Cauns Dev. 2014;47:79-86.
13. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15:155-163.
14. Kim H-Y. Statistical notes for clinical researchers: Chi-squared test and Fisher's exact test. Restor Dent Endod. 2017;42:152-155.
15. Zanon MA, Pacheco RL, Latorraca COC, et al. Neurodevelopmental Treatment (Bobath) for Children With Cerebral Palsy: A Systematic Review. J Child Neurol. 2019;34:679-686.
16. Goldsmith S, McIntyre S, Blair E, et al. Cerebral Palsy: Epidemiology. Neurodevelopmental Pediatrics: Genetic and Environmental Influences: Springer; 2023;479-495.
17. Terwee CB, Prinsen CA, Chiarotto A, et al. COSMIN methodology for evaluating the content validity of patient-reported outcome measures: a Delphi study. Qual Life Res. 2018;27:1159-1170.
18. Niederberger M, Spranger J. Delphi Technique in Health Sciences: A Map. Front Public Health. 2020;8:457.
19. Mokkink LB, Terwee CB, Patrick DL, et al. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010;19:539-549.
20. Ivanenko Y, Gurfinkel VS. Human postural control. Front Neurosci. 2018;12:171.
21. Akbaş AN, Günel MK. Effects of individually structured trunk training on body function and structures in children with spastic cerebral palsy: a stratified randomized controlled trial. Fiz Rehabil. 2019;30:11-22.
22. Arı G, Kerem Günel M. A randomised controlled study to investigate effects of Bobath based trunk control training on motor function of children with spastic bilateral cerebral palsy. Int J Cli Med. 2017;8:205-215.
23. Türker D, Korkem D, Özal C, et al. The effects of neurodevelopmental (Bobath) therapy based goal directed therapy on gross motor function and functional status of children with cerebral palsy. Int J Ther Rehab Res. 2015;4:9-20.
24. Acar G, Ejraei N, Turkdoğan D, et al. The effects of neurodevelopmental therapy on feeding and swallowing activities in children with cerebral palsy. Dysphagia. 2022;37:800-811.
25. Duff SV, Kimbel JD, Grant-Beuttler M, et al. Lifelong Fitness in Ambulatory Children and Adolescents with Cerebral Palsy II: Influencing the Trajectory. Behav Sci. 2023;13:504.
26. Agarwal S, Scher MS, Tilton A. Cerebral palsy and rehabilitative care: The role of home-based care and family-centered approach. Indian Pediatr. 2021;58:813.
27. Evans-Rogers DL, Sweeney JK, Holden-Huchton P, et al. Short-term, intensive neurodevelopmental treatment program experiences of parents and their children with disabilities. Pediatr Phys Ther. 2015;27:61-71.