Premature ve zamanında doğan bebeklerde erken fizyoterapi sonuçlarının karşılaştırılması

Yıl 2015, Cilt: 2 Sayı: 1 - Cilt: 2 Sayı: 1, 27 - 34, 23.07.2016

Nilay Çömük Balcı Zafer Erden Mintaze Kerem Günel

Öz

Amaç: Riskli bebeklerde erken fizyoterapi nöromotor problemleri azaltmaktadır. Bu çalışma, erken dönem hedefe yönelik nöromotor fizyoterapinin etkinliğini, premature ve zamanında doğan bebekler arasında karşılaştırmak amacıyla planlandı. Yöntem: Yaşları 0-12 ay arasında olan 18 riskli bebek, yaşları ve gestasyonel yaşlarına göre premature doğan ve zamanında doğan gruplarına ayrıldı. Her grup 12 hafta boyunca haftada 3 gün, günde 45 dk erken dönem hedefe yönelik nöromotor fizyoterapi yaklaşımı içeren tedavi aldı. Terapilerin etkinliği Alberta Infant Motor Scale (AIMS), Hammersmith Infant Neurological Examination (HINE), ve Goal Attainment Scale (GAS) kullanılarak değerlendirildi. Bulgular: Her bir grupta tedavi öncesine göre tedavi sonrasında tüm değerlendirmelerde postüral kontrol ve nöromotor yönden anlamlı gelişme kaydedildi (p0.05). Tartışma: Erken dönem hedefe yönelik nöromotor fizyoterapi yaklaşımı, premature doğan ve zamanında doğan riskli bebeklerde nöromotor gelişimi desteklemektedir ve erken rehabilitasyonun nörogelişimsel sonuçları üzerinde gestasyonel yaşın etkisi bulunmamaktadır

Anahtar Kelimeler

İnfant, Risk, Rehabilitasyon

Comparing early physiotherapy results between term and preterm at-risk infants

Öz

Purpose: Early physiotherapy reduces neuromotor problems in at-risk infants. This study was planned to compare the effects of an early goal-directed neuromotor physiotherapy (GDNT) application between preterm and term at-risk infants. Methods: Eighteen at-risk infants between the ages of 0 and 12 months were assigned to the preterm and term groups according to their gestational and corrected age. Each group received GDNT for 45 min, three days per week for 12 weeks. The effectiveness of the therapy was measured using the Alberta Infant Motor Scale (AIMS), the Hammersmith Infant Neurological Examination (HINE), and Goal Attainment Scale (GAS). Results: Both groups improved significantly in postural control and neuromotor aspects after treatment (p<0.05). No differences were found in AIMS, HINE, and GAS findings between the groups (p>0.05). Conclusion: The GDNT can enhance neuromotor development in at-risk term and preterm infants, and gestational age does not have any effect on the neurodevelopmental outcomes of the early rehabilitation

Anahtar Kelimeler

Infant, Risk, Rehabilitation

Kaynakça

• Comuk Balci N, Kerem Gunel M. Riskli bebeklerde nöromotor değerlendirme yöntemleri. In: Akman I, editor. Riskli Bebek İzlemi. İstanbul: Boyut Matbaacılık; 2014:89.
• Mutlu A, Livanelioğlu A. Erken Dönem Fizyoterapi Yaklaşımları. J Med Sci, Pediatric Rehabilitation Special Issue. 2010;3:8-13.
• Shonkoff JP, Meisels SJ. Handbook of Early Childhood Intervention. Cambridge: Cambridge University Press; 2000.
• Kolb B, Brown R, Witt-Lajeunesse A, et al. Neural compensations after lesion of the cerebral cortex. Neural Plast. 2001;8:1-16.
• Yolande N, Roslyn B. Neonatal assessments for the preterm infant up to 4 months corrected age: a systematic review. Dev Med Child Neurol. 2012;54:129-139.
• Javier FRF, Antonia GC, Julio PL. Efficiacy of early physiotherapy intervention in preterm infant motor development a systematic review. J Phys Ther Sci. 2012;24:933-940.
• Löwing K, Bexelius AM, Brogren Carlberg E. Activity-focused and goal-directed therapy for children with cerebral palsy-do goals make a differance? Disabil Rehabil. 2009;31:1808-1816.
• Ahl EL, Johansson E, Granat T, et al. Functional therapy for children with cerebral palsy: an ecological approach. Dev Med Child Neurol. 2005;47:613-619.
• Sorsdahl AB, Moe-Nilssen R, Kaale HK, et al. Change in basic motor abilities, quality of movement and everyday activities following intensive, goal-directed, activity focused physiotherapy in a group setting for children with cerebral palsy. BMC Pediatrics. 2010;10:26.
• Storvold GV, Jahnsen R. Intensive motor skills training program combining group and individual sessions for children with cerebral palsy. Ped Phys Ther. 2010;22:150-159.
• Als H, Duffy FH, McAnulty GB, et al. Early experience alters brain function and structure. Pediatrics. 2004;113:846-857.
• Cabral TI, Pereira da Silva LG, Tudella E, et al. Motor development and sensory processing: a comparative study between preterm and term infants. Res Dev Disabil. 2015;36:102-107.
• Bremmer P, Byers JF, Kiehl E. Noise and the premature infant: physiological effects and practice implications. J Obstet Gynecol Neonatal Nurs. 2003;32:447-454.
• Kayenne Martins Roberto Formiga C, Linhares MB. Motor development curve from 0 to 12 months in infants born preterm. Acta Paediatr. 2011;100:379-384.
• Hielkema T, Blauw-Hospers CH, Dirks T, et al. Does physiotherapeutic intervention affect motor outcome in high-risk infants? An approach combining a randomized controlled trial and process evaluation. Dev Med Child Neurol. 2011;53:e8-e15.
• Blauw-Hospers CH, de Graaf-Peters VB, Dirks T, et al. Does early intervention in infants at high risk for a developmental motor disorder Çömük Balcı et al / Journal of Exercise Therapy and Rehabilitation 2015;2(1) www.jetr.org.tr 34 improve motor and cognitive development? Neurosci Biobehavior R. 2007;31:1202-1212.
• Park GH, Choi SY, Kim MS, et al. Effect of NDT on motor development and growth in premature infants. J Korean Soc Neonatol. 2010;17:207-216.
• Ohgi S, Fukuda M, Akiyama T, et al. Effect of an early intervention programme on low birthweight infants with cerebral injuries. J Paediatr Child Health. 2004;40:689-695.
• Badr LK, Garg M, Kamath M. Intervention for infants with brain injury: results of a randomized controlled study. Infant Behav Dev. 2006;29:80-90.
• Heathcock JC, Lobo M, Galloway JC. Movement training advances the emergence of reaching in infants born at less than 33 weeks of gestational age: a randomized clinical trial. Phys Ther. 2008;88:310-322.
• Acunaş B, Baş AY, Uslu S. Yüksek Riskli Bebek İzlemi 2014. Turkish Neonatology Association: Ankara, 2014.
• Haataja L, Mercuri E, Regev R, et al. Optimality score for the neurologic examination of the infant at 12 and 18 months of age. J Pediatr. 1999;135:153-161.
• Haataja L, Cowan F, Mercuri E, et al. Application of a scorable neurologic examination in healthy term infants aged 3 to 8 months. J Pediatr. 2003;143:546.
• Piper MC, Darrah JM. Motor Assessment of the Developing Infant. Alberta: WB Saunders; 1994.
• Darrah J, Piper M, Watt MJ. Assessment of gross motor skills of at-risk infants: predictive validity of the Alberta Infant Motor Scale. Dev Med Child Neurol. 1998;40:485-491.
• Kiresuk TJ, Sherman RE. Goal attainment scaling: a general method for evaluating comprehensive community mental health programs. Community Ment Health J. 1968;4:443-453.
• Hurn J, Kneebone I, Cropley M. Goal setting as an outcome measure: a systematic review. Clin Rehabil. 2006;20:756-772.
• Nelson MN, White-Traut RC, Vasan U, et al. One-year outcome of auditory-tactile-visualvestibular intervention in the neonatal intensive care unit: effects of severe prematurity and central nervous system injury. J Child Neurol. 2001;16:493-498.
• Badr LK, Garg M, Kamath M. Intervention for infants with brain injury: results of a randomized controlled study. Infant Behav Dev. 2006;29:80-90.
• Carlberg EB, Löwing K. Goal directed training in children with cerebral palsy. Türkiye Klinikleri J PM&R-Special Topics 2010;3(3):5357.
• Ketelaar M, Vermeer A, Hart H, et al. Effects of a functional therapy program on motor abilities of children with cerebral palsy. Phys Ther. 2001;81:1534-1545.
• Pin TW, Darrer T, Eldridge B, et al. Motor development from 4 to 8 months corrected age in infants born at or less than 2 weeks’ gestation. Dev Med Child Neurol. 2009;51:739745.
• de Kieviet JF, Piek JP, Aarnoudse-Moens CS, et al. Motor development in very preterm and very low-birth-weight children from birth to adolescence: a meta-analysis. JAMA 2009;302:2235-2242.
• Lorefice LE, Galea MP, Clark RA, et al. Postural control at 4 years in very preterm children compared with term-born peers. Dev Med Child Neurol. 2015;157:175-180.