SEREBRAL PALSİLİ ÇOCUKLARDA DÜZENLİ FİZYOTERAPİ YAKLAŞIMINA BAŞLAMA YAŞININ ARAŞTIRILMASI

Yıl 2019, Cilt: 2 Sayı: 2, 31 - 37, 01.12.2019

Neslihan Altuntaş Yılmaz , Gökmen Yapalı

Öz

Amaç:
Bu çalışma serebral
palsili çocukların ilk tanı aldıkları yaş ile düzenli olarak fizyoterapiye
başlama yaşlarının belirlenmesini amaçlamıştır.

Gereç
ve Yöntemler:
Özel eğitim ve rehabilitasyon kurumunda, düzenli olarak rehabilitasyon desteği
alan 57 çocuk hasta çalışmaya dahil edildi. 
Hastaların demografik verileri, klinik tipleri, risk faktörleri
belirlendi ve fonksiyonel kapasiteleri Kaba Motor Fonksiyon Sınıflama Sistemi
(KMFSS) ile değerlendirildi.

Bulgular: Hastaların yaş ortalaması 11,70 ± 7,45
yıldır, 22’si (%40,74) kız, 35’i (%61,4) erkekti. 40
hasta (% 70,2) spastik tip, 3 hasta  (%
5,3) diskinetik tip, 3 hasta  (% 5,3)
ataksik tip, 11 hasta (% 19,3) miks tipti. 
KMFSS ve doğum ağırlıkları ilişkisi açısından anlamlı bir ilişki
bulunmadı (p>0,05). Çocukların ilk motor gelişim geriliğinin fark edildiği
yaş ay olarak 7,74 ± 7,09 iken düzenli olarak ilk fizyoterapi ve rehabilitasyon
yaklaşımlarına başlama yaşı ay olarak 29,95± 11,04 olarak tespit edildi.

Sonuç: Serebral palsili olan çocukların ilk
motor gelişim geriliklerinin fark edildiği andan, düzenli fizyoterapi
yaklaşımlarına başlama yaşlarına kadar geçen sürecin ciddi bir kayıptır. Erken
dönem fizyoterapi müdahalesi için riskli bebeklerin ilgili uzmanlara
yönlendirilmesi gerekir. Sağlık politikalarının bu doğrultuda planlanması
gerektiğini düşünüyoruz.

Anahtar Kelimeler

Serebral palsi, fizyoterapi, tedaviye başlama yaşı

CHILDREN with CEREBRAL PALSY INVESTIGATION of the AGE to START a REGULAR PHYSIOTHERAPY APPROACH

Öz

Aim:
The aim of this study was to determine the age at which children with
cerebral palsy were first diagnosed and the age at which they started regular
physiotherapy.

Material
and Methods:
Fifty-seven children who received regular rehabilitation support in a special
education and rehabilitation institution were included in the study.
Demographic data, clinical types, risk factors, and functional capacities of
the patients were evaluated using the Gross Motor Function Classification
System (GMFSS).

Results: The mean age of the patients was
11.70 ± 7.45 years, 22 (40.74%) were female and 35 (61.4%) were male. Forty
patients (70.2%) were spastic type, 3 patients (5.3%) were dyskinetic type, 3
patients (5.3%) were ataxic type, 11 patients (19.3%) were mixed type. There
was no significant relationship between GMFSS and birth weights (p> 0.05).
The age at which the first motor developmental retardation of the children was
noticed was 7.74 ± 7.09 months and 29.95 ± 11.04 months for the first
physiotherapy and rehabilitation approaches.

Conclusion: It is a serious loss of the period from the
first motor developmental retardation of children with cerebral palsy to the
age of starting regular physiotherapy approaches. Risky babies should be
referred to the relevant specialists for early physiotherapy intervention. We
think that health policies should be planned accordingly

Anahtar Kelimeler

Cerebral palsy, physiotherapy, treatment age

Kaynakça

• Akman İ, & Hafızoğlu N. (2018). TOTBİD Dergisi Türk Ortopedi ve Travmatoloji Birliği Derneği. TOTBİD Dergisi, 17, 405–413.
• Als, H., & B. McAnulty, G. (2011). The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) with Kangaroo Mother Care (KMC): Comprehensive Care for Preterm Infants. Current Women’s Health Reviews, 7(3), 288–301. https://doi.org/10.2174/157340411796355216
• Boyle, C. A., Yeargin-Allsopp, M., Doernberg, N. S., Holmgreen, P., Murphy, C. C., & Schendel, D. E. (1996). Prevalence of selected developmental disabilities in children 3-10 years of age: the Metropolitan Atlanta Developmental Disabilities Surveillance Program, 1991. MMWR. CDC Surveillance Summaries : Morbidity and Mortality Weekly Report. CDC Surveillance Summaries, 45(2), 1–14. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8602136
• Canbak Yekta. (2009). Çok Düşük Doğum Ağırlıklı Yenidoğanlarda Mortalite ve Morbidite Oranları. Okmeydanı Eğitim ve Araştırma Hastanesi.
• Cans, C. (2007). Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Developmental Medicine & Child Neurology, 42(12), 816–824. https://doi.org/10.1111/j.1469-8749.2000.tb00695.x
• Cejas, G., Gómez, Y., Roca, M. del C., & Domínguez, F. (2015). Neurodevelopment of very low birth weight infants in the first two years of life in a Havana tertiary care hospital. MEDICC Review, 17(1), 14–17. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25725763
• Copper, R. L., Goldenberg, R. L., Creasy, R. K., DuBard, M. B., Davis, R. O., Entman, S. S., Iams, J. D., & Cliver, S. P. (1993). A multicenter study of preterm birth weight and gestational age-specific neonatal mortality. American Journal of Obstetrics and Gynecology, 168(1 Pt 1), 78–84. https://doi.org/10.1016/s0002-9378(12)90889-3
• Ergenç, H. (2001). Görme Engelli Çocukların Bilişsel Gelişimleri ve 0-6 Yaşın Önemi. Türk Psikiyatri Dizini, 22, 47–79.
• Erol, E., Bülent, E., Erol, B. özge, Gökhan, Y., Umut, A., Koçyiğit, murat fatih, & Gücüyener, K. (2016). Pediatrik Fizyoterapi Rehabilitasyon Ünitesine Başvuran Hastaların Demografik Özellikleri. Gazi Üniversitesi Sağlık Bilimleri Dergisi (Vol. 1).
• Glascoe, F. P. (2005). Screening for developmental and behavioral problems. Mental Retardation and Developmental Disabilities Research Reviews, 11(3), 173–179. https://doi.org/10.1002/mrdd.20068
• Himpens, E., Van den Broeck, C., Oostra, A., Calders, P., & Vanhaesebrouck, P. (2008). Prevalence, type, distribution, and severity of cerebral palsy in relation to gestational age: a meta-analytic review. Developmental Medicine and Child Neurology, 50(5), 334–340. https://doi.org/10.1111/j.1469-8749.2008.02047.x
• Hubermann, L., Boychuck, Z., Shevell, M., & Majnemer, A. (2016). Age at Referral of Children for Initial Diagnosis of Cerebral Palsy and Rehabilitation. Journal of Child Neurology, 31(3), 364–369. https://doi.org/10.1177/0883073815596610
• Hüner, B., Özgüzel, H., Aydoğan, A. R., Telli, H., Tedavi, F., & Kliniği, R. (2011). Serebral Palsi: Risk Faktörleri ve Fonksiyonel Kapasite İlişkisi. Okmeydanı Tıp Dergisi 27(2):79-83, 27(2), 79–83. https://doi.org/10.5222/otd.2011.079
• Knoches, A. M., & Doyle, L. W. (1993). Long-term outcome of infants born preterm. Bailliere’s Clinical Obstetrics and Gynaecology, 7(3), 633–651. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7504604
• Larroque, B., Ancel, P.-Y., Marret, S., Marchand, L., André, M., Arnaud, C., Pierrat, V., Rozé, J.-C., Messer, J., Thiriez, G., Burguet, A., Picaud, J.-C., Bréart, G., Kaminski, M., & EPIPAGE Study group. (2008). Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE study): a longitudinal cohort study. Lancet (London, England), 371(9615), 813–820. https://doi.org/10.1016/S0140-6736(08)60380-3
• Luu, T. M., Ment, L. R., Schneider, K. C., Katz, K. H., Allan, W. C., & Vohr, B. R. (2009). Lasting effects of preterm birth and neonatal brain hemorrhage at 12 years of age. Pediatrics, 123(3), 1037–1044. https://doi.org/10.1542/peds.2008-1162
• Marret, S., Ancel, P.-Y., Marpeau, L., Marchand, L., Pierrat, V., Larroque, B., Foix-L’Hélias, L., Thiriez, G., Fresson, J., Alberge, C., Rozé, J.-C., Matis, J., Bréart, G., Kaminski, M., & Epipage Study Group. (2007). Neonatal and 5-year outcomes after birth at 30-34 weeks of gestation. Obstetrics and Gynecology, 110(1), 72–80. https://doi.org/10.1097/01.AOG.0000267498.95402.bd
• Murphy, D. J., Sellers, S., MacKenzie, I. Z., Yudkin, P. L., & Johnson, A. M. (1995). Case-control study of antenatal and intrapartum risk factors for cerebral palsy in very preterm singleton babies. Lancet (London, England), 346(8988), 1449–1454. https://doi.org/10.1016/s0140-6736(95)92471-x
• Ostensjo, S., Carlberg, E.B., & Vollestad, N.K. (2003). Everyday Functioning in Young Children With Cerebral Palsy: Functional Skills, Caregiver Assistance, and Modifications of The Environment. Dev Med Child Neurol, 45(9):603-12. https://doi.org/10.1017/s0012162203001105
• Özel, S., Çulha, C., Delialioğlu, S. Ü., Sarı, İ. F., & Köklü, K. (2016). Serebral palsili çocuklarda Kaba Motor Fonksiyon Sınıflama Sistemi düzeyleri ve tedavi yöntemleri arasındaki ilişki. Turk J Phys Med Rehab, 62(2), 116–122. https://doi.org/10.5606/tftrd.2016.09069
• Palisano, R. J., Rosenbaum, P., Bartlett, D., & Livingston, M. H. (2008). Palisano RJ, Rosenbaum P, Bartlett D, et al. Content validity of the expanded and revised Gross Motor Function Classification System. Developmental Medicine and Child Neurology, 50(10), 744–750. https://doi.org/10.1111/j.1469-8749.2008.03089.x
• Pharoah, P. O., Cooke, T., Rosenbloom, I., & Cooke, R. W. (1987). Trends in birth prevalence of cerebral palsy. Archives of Disease in Childhood, 62(4), 379–384. https://doi.org/10.1136/adc.62.4.379
• Robertson, P. A., Sniderman, S. H., Laros, R. K., Cowan, R., Heilbron, D., Goldenberg, R. L., Lams, J. D., & Creasy, R. K. (1992). Neonatal morbidity according to gestational age and birth weight from five tertiary care centers in the United States, 1983 through 1986. American Journal of Obstetrics and Gynecology, 166(6 PART 1), 1629–1645. https://doi.org/10.1016/0002-9378(92)91551-K
• Shikako-Thomas, K., Dahan-Oliel, N., Shevell, M., Law, M., Birnbaum, R., Rosenbaum, P., Poulin, C., & Majnemer, A. (2012). Play and be happy? Leisure participation and quality of life in school-aged children with cerebral palsy. International Journal of Pediatrics, 2012, 387280. https://doi.org/10.1155/2012/387280
• Stephens, B. E., & Vohr, B. R. (2009). Neurodevelopmental outcome of the premature infant. Pediatric Clinics of North America, 56(3), 631–646, Table of Contents. https://doi.org/10.1016/j.pcl.2009.03.005
• Tutar Güven, Ş., & Dalgiç, A. İ. (2017). An Indıvıdualızed Supportıve Developmental Care Program Developed For Premature Newborns. JACSD, 9, 41–61. https://doi.org/10.17367/JACSD.2017.1.004
• Tyson, J. E., Parikh, N. A., Langer, J., Green, C., Higgins, R. D., & National Institute of Child Health and Human Development Neonatal Research Network. (2008). Intensive care for extreme prematurity--moving beyond gestational age. The New England Journal of Medicine, 358(16), 1672–1681. https://doi.org/10.1056/NEJMoa073059
• Yalçinkaya, E. Y., Hüner, B., Dinçer, Ü., Diraçoğlu, D., Aydin, R., Cerebral, İ., Study, P., Members, G. O., İçağasioğlu, A., Demirhan, E., Yalçin, L., Öneş, K., Çağlar, N., Yüksel, A., Karamehmetoğlu, Ş. S., Türkdoğan, D., Zorer, G., Yapici, Z., Erhan, B., Akyürek, B., Kuran, B., Akbaş, H., Paker, N., Uçar, D., Öztürk, K., & Özaras, N. (2014). Demographic and Clinical Findings of Cerebral Palsy Patients in Istanbul: A Multicenter Study İstanbul’daki Serebral Palsi Olgularının Klinik ve Demografik Özellikleri: Çok Merkezli Çalışma. Türk Fiz T›p Rehab Derg, 60, 134–142. https://doi.org/10.5152/tftrd.2014.42402
• Yılmaz Yalçınkaya, E., Karaağaç, F., Bora Ayna, A., Öneş, K., adresi, Y., Ebru Yılmaz Yalçınkaya, U., & Kahveci Bulvarı Eski Londraasfaltı İstanbul Fizik Tedavi Eğitim ve Araştırma Hastanesi, A. (2008). Serebral Palsili Çocuklarda Vücut Ağırlığı Persentili. https://doi.org/10.5222/otd.2015.1006
• Zafeiriou, D. I. (2004, July). Primitive reflexes and postural reactions in the neurodevelopmental examination. Pediatric Neurology. https://doi.org/10.1016/j.pediatrneurol.2004.01.012