SEREBRAL PALSİ’DE GÜNCEL FİZYOTERAPİ VE REHABİLİTASYON YAKLAŞIMLARI1

Öz

Serebral Palsi (SP), gelişimsel bir bozukluk olup; doğum öncesi, doğum sırası ya da doğum sonrasında immatür beyindeki lezyon nedeniyle oluşan hareket, denge ve postüral bozuklukları tanımlayan, çocukluk çağında yaygın olarak görülen ve bozukluk yaratan bir tablodur. Motor gelişim bozukluğunun yanı sıra; kognitif, görsel, işitsel ve davranışsal problemler de görülebilir. SP’ li çocuklarda, fonksiyonel bozukluklar ile birlikte gelişen fiziksel, kognitif, duyusal, emosyonel ve sosyal bozukluklarda çocukların hareket performanslarını olumsuz etkiler. Tıbbi tedavi, cerrahi uygulamalar ve rehabilitasyon modaliteleri çoklu ve multidisipliner konsepte uygun ele alınmalıdır. Fizyoterapi ve rehabilitasyon uygulamalarında, nörogelişimsel tedavi modalitesi ilkeleriyle edinilen fonksiyonel hareketler, hedefe yönelik olup, günlük yaşam aktivitelerine hareketlerine odaklanılarak yapılan zorunlu pasif hareketler, çocuğun aktif katılımını engeller ve istemsiz hareketler yaratabilir. Bu kapsamda, aile eğitimi, çocuğun ev ve okuldaki ihtiyaçları ve uygun ortez ile adaptif cihazlarının değerlendirilmesi büyük önem taşır. Fizyoterapi uygulamalarında; motivasyon, çeşitlilik ve tekrara odaklanılmalı ve çocuğun kişiliğine uygun seçilen fonksiyonel aktivitelerden hoşlanması için fırsat yaratılmalıdır. Erken fizyoterapi mevcut becerilerin geliştirilmesi ve ikincil komplikasyonların en aza edilmesine olanak sağlarken, çocuk ve ailesinin duruma erken adapte olmasını sağlar

Anahtar Kelimeler

• Serebral palsi, Fizyoterapi, Rehabilitasyon, Nörogelişimsel Tedavi

Current Physiotherapy and Rehabilitation Approach on Cerebral Palsy

Öz

It is a table that can cause defect, and that is seen commonly in childhood period. CP, which is a developmental disorder, is described as a neuromotor disorder in which movement, balance and postural disorders that occur as a result of a lesion in the immature brain before the birth, during the birth or after the birth. Besides the motor development disability, mental, visual, hearing, speaking and behavioural problems can be also seen. In children with CP, functional disorders that develop in parallel with physical, cognitive, sensory, emotional and social disorders, affect the movement performance of these children negatively and make difficult to fulfil their duties. Medical treatment, surgical applications and rehabilitation modalities should be handled with a multiple and multidisciplinary conception. Functional movements, which are gained by neurodevelopmental treatment modality principles in physiotherapy applications, should be goal-directed and adaptive to daily life activities. Focusing on the extremity movements with conservative exercise concept and the application of obligatory passive exercises prevent the active participation of the child and can increase the involuntary movements. Again, within this scope, it is important to determine family education, the needs of the child in environments like home and school, appropriate orthosis, adaptive equipments. During the physiotherapy applications it should be focused on motivation, variety and repetition; it should be created opportunities for the child to learn and to like the activities in functionality which are selected according to the child’s personal characteristics. Starting physiotherapy early enables for improving the existing skills and for minimizing the secondary complications, and also provides the early adaptation of the family and child to the illness

Anahtar Kelimeler

• Cerebral palsy, physiotherapy, rehabilitation, neurodevelopmental therapy

Kaynakça

1. Acavedo, S. J. (1999) . Physical Therapy for the Child with Cerebral Palsy. In: Tecklin, J. S. (Ed) . Pediatric Physical Therapy. 3. ed. Philadelphia: Saunders WB: 107- 162.
2. Amblard, B., Assaiante, C., Fabre, J. C., Martin, N. Massion, J., Mouchnino, L., Vernazza, S. (1995) . Voluntary head stabilization in space during trunk movements in weightlessness. Acta Astronaut. 36(8-12): 415-22.
3. Anttila, H., Autti-Rämö, I., Suoranta, J., Mäkelä, M., Malmivaara, A. (2008) . Effectiveness of physical therapy interventions for children with cerebral palsy: a systematic review. BMC Pediatr. 24(8): 1471-2431. doi:10.1186/1471-2431- 8-14
4. Bar-Haim, S., Harries, N., Belokopytov, M., Frank, A., Copeliovitch, L., Kaplanski, J., Lahat,E. (2006) . Comparsion of efficacy of Adeli suit and neurodevelopmental treatmants in children with cerebral palsy. Dev Med Child Neurol. 48: 325-3309. doi: 10.1017/S0012162206000727
5. Bobath, K., Bobath, B. (1984) . The neuro-developmental treatment. In: Scrutton D, editor. Management of the motor disorders of children with cerebral palsy. Philadelphia: J. B. Lippincott: p. 6-18.
6. Booth, C. M., Cortina-Borja, M. J., Theologis. T. N. (2001) . Collagen accumulation in muscles of children with cerebral palsy and correlation with severity of spasticity. 8749.2001.tb00211.x Med Child Neuro. 43:314-20.
7. Bower, E., McLellan, D. L. (1992) . Effect of increased exposure to physiotherapy on skill acquisition of children with cerebral palsy. Dev Med Child Neurol. 34(1):25–39. doi:10.1111/j.1469-8749.1992.tb08560.x
8. Butler, C., Darrah, J. (2001) . AACPDM Evidence report: Effects of neurodevelopmental treatment (NDT) for cerebral palsy. Dev Med Child Neurol. 43(11): 778–790. doi: 10.1111/j.1469-8749.2001.tb00160.x

9. Carlberg, E., Löwing, K. (2010) . Goal directed training in children with cerebral palsy. Turkiye klinikleri J PM&R-special topics. 3(3):53-57.
10. Carlsson, M., Hagberg, G., Olsson, I. (2003) . Clinical and aetiological aspects of epilepsy in children with cerebral palsy. Dev Med Child Neurol. 45(6): 371-376. Doi: 10.1111/j.1469-8749.2003.tb00415.x
11. Collet, J. P., Vanasse, M., Marois, P. (2001) . Hyperbaric oxygen for children with cerebral palsy: a randomised multicentre trial. HBO-CP Research Group. Lancet 2001; 357: 582–6.
12. Cowan, F., Rutherford, M., Groenendaal, F., Eken, P., Mercuri, E., Bydder, G. M., Meiners, L. C., Dubowitz, L. M. S., Vries, L. S. (2003) . Origin and timing of brain lesions interm infants with neonatal encephalopathy. Lancet. 361: 736– 42. doi:10.1016/S0140-6736(03)12658-X
13. Damiano, D, L., Vaughan, C. L., Abel, M. F. (1995) . Muscle response to heavy resistance exercise in children with spastic cerebral palsy. Dev Med Child Neurol. 37:731-9. doi:10.1111/j.1469-8749.1995.tb15019.x
14. Dan, B., Bouillot, E., Bengoetxea, A., Noël, P., Kahn, A., Cheron, G. (2000) . Head stability during whole body movements in spastic diplegia. Brain Dev. 22(2): 99-101. doi: S0387-7604(99)00123-0
15. Dodd, K. J., Taylor, N. F., Damiano, D. L. (2002) . A systematic review of the effectiveness of strength-training programs for people with cerebral palsy. Arch Phys Med Rehabil. 83(8):1157
16. Dong, V. A., Tung, I. H., Siu, H. W., Fong, K. N. (2012) . Studies comparing the efficacy of constraint-induced movement therapy and bimanual training in children with unilateral cerebral palsy: A systematic review. Developmental Neurorehabilitation. (doi:10.3109/17518423.2012.702136) 2013, Vol. 16, No:2, Pages 133-143
17. Echols, K., DeLuca, S. C., Ramey, S. L. (2002) . Constraint-induced movement therapy versus traditional therapy services for young children with CP. Dev Med Child Neurol. 91:44.
18. Eliasson, A. C., Krumlinde-Sundholm, L., Rösblad, B., Beckung, E. ( 2007) . Using the MACS to facilitate communication about manual abilities of children with cerebral palsy. Dev Med Child Neurol. 49 (2): 156-157.
19. Gaebler-Spira, D., Revivo, G. (2003) . The use of botulinum toxin in pediatric disorders. Phys Med Rehabil Clin N Am. 14 (4): 703-725.doi:10.1016/S1047- 9651(03)00043-3
20. Gracies, J. M. (2005) . Pathophysiology of spastic paresis. II: Emergence of muscle over activity. Muscle Nerve. 31(5): 552–571. doi: 10.1002/mus.20285
21. Günel, M. K, Mutlu, A., Tarsuslu, T., Livanelioğlu, A. (2009) . Relationship among the Manual Ability Classification System (MACS), the Gross Motor Function Classification System (GMFCS), and the functional status (WeeFIM) in children with spastic cerebral palsy. Eur J Pediatr.168: 477-85. Doi: 10.1007/s00431- 008-0775-1
22. Harris, S. R., Roxborough, L. (2005) . Efficacy and effectiveness of physical therapy in enhancing postüral control in children with cerebral palsy. Neural Plast.12: 2090-5904. doi:10.1155/NP.2005.229
23. Helders, P. J. M., Raoul, H., Engelbert, H., Custers, J. W. H., Gorter. J. W., Takken, T., Van Der Net, J. (2003) . Creating and being created: the changing panorama of pediatric rehabilitation. Pediatr Rehabil. 6(1): 5-12. doi: 10.1080/1363849031000095260
24. Hof, A.L. (2001) . Changes in muscles and tendons due to neural motor disorders: implications for therapeutic intervention. Neural Plast. 8(1-2): 71-81. doi:10.1155/NP.2001.71
25. Jacobson, L. K., Dutton, G. N. (2000) . Periventricular leukomalacia: an important cause of visual and ocular motility dysfunction in children. Surv Ophthalmol. 45(1): 1-13. doi:10.1016/S0039-6257(00)00134-X
26. Kerem Günel M. (2011) . Physiotherapy for Children with Cerebral Palsy Epilepsy in Children - Clinical and Social Aspects, ISBN: 978-953-307-681-2.
27. Kerem Günel, M. (2005) . Prematüre bebekte erken fizyoterapi. Katkı Pediatri Dergisi. 485-491.
28. Kerem Günel, M. (2009) . The view on pediatric rehabilitation with the title of cerebral palsy from the perspective of a physiotherapist. Acta Ortopaedica Et Traumatologia Turcica .43(2): 173-181. doi:10.3944/AOTT.2009.173
29. Kerem Günel, M. (2010) . Neurodevelopmental therapy approach on pediatric physiotherapy and rehabilitation appliying, Turkiye klinikleri J PM&R-special topics. 3(3): 1-8.
30. Kerem, M., Akı, E., Livanelioğlu, A., Aysun, S. (2001) . Normal zamanında doğan ve premature serebral paralizili çocuklarda ev egzersizi programının motor gelişim üzerine etkileri: Retrospektif bir çalışma. Fizyoterapi Rehabilitasyon; 12(3): 94- 98.
31. Kra¨geloh-Mann, I. (2004) . Imaging of early brain injury and cortical plasticity. Exp Neurol. 190:84–90. doi:10.1016/j.expneurol.2004.05.037
32. Kra¨geloh-Mann, I., Helber, A., Mader, I., Staudt, M., Wolff, M., Groenendaal. F., DeVries, L. (2002) . Bilateral lesions of thalamus and basal ganglia: origin and outcome. Dev Med Child Neurol. 44:477–84. doi:10.1111/j.1469- 8749.2002.tb00309.x
33. Krägeloh-Mann, I. Cans, C. (2009) . Cerebral palsy update. Brain Dev. 31 (7): 537- 544. doi:10.1016/j.braindev.2009.03.009
34. Kunz, R., Autti-Rämö, I., Anttila, H., Malmivaara, A., Mäkelä M, A. (2006) . Systematic review finds that methodological quality is better than its reputation but can be improved in physiotherapy trials in childhood cerebral palsy. J Clin Epidemiol. 59(12): 1239-1248. doi:10.1016/j.jclinepi.2006.03.009
35. Lance, J. W. (1980) . The control of muscle tone, reflexes, and movement: Robert Wartenberg Lecture. Neurology. 30(12):1303-13 PMid:7192811
36. Lin, J. P., Brown, J. K. (1992) . Peripheral and central mechanisms of hindfoot equinus in childhood hemiplegia. Dev Med Child Neurol. 34(11): 949-65. doi:10.1111/j.1469-8749.1992.tb11400.x
37. Livanelioglu, A., Kerem Günel, M., (2009) . Erken ve Geç Dönem Fizyoterapi. In: Serebral Palsi’de Fizyoterapi. Ankara: Yeni Özbek Matbaası; 109-114.
38. MacPhail, H. E., Kramer, J. F. (1995) . Effect of isokinetic strengthtraining on functional ability and walking efficiency in adolescents with cerebral palsy. Dev Med Child Neurol. 37: 763-75. doi:10.1111/j.1469-8749.1995.tb12060.x
39. Mattern-Baxter, K., Bellamy, S., Mansoor, J. K. (2009) . Effects of ıntensive locomotor treadmill training on young children with cerebral palsy. Pediatr Phys Ther. 308–319. doi: 10.1097/PEP.0b013e3181bf53d9
40. Matthews, J. D., Balaban, B. (2009) . Management of spasticity in children with cerebral doi:10.3944/AOTT.2009.81 Acta Orthop Traumatol Turc. 43: 81-6.
41. Mayston, M. (2005) . Evidence-based physical therapy for the management of children with cerebral palsy. Dev Med Child Neurol. 47:795-795 doi: 10.1017/S00121622050011672
42. Mayston, M. (2008) . Bobath Concept: Bobath@50: mid-life crisis--what of the future?. Physiother Res Int. 13(3): 131-136. Doi: 10.1002/pri.413
43. Mckearnan, K. A., Kieckhefer, G. M., Engel, J. M., Jensen, M. P., Labyak, S. (2004) . Pain in children with cerebral palsy: a review. J Neurosci Nurs. 36(5): 252-259. doi:10.1097/01376517-200410000-00004
44. Molenaers, G., Desloovere, K., De Cat, J., Jonkers, I., De Borre. L., Pauwels, P. T., Nijs, J., Fabry, G., De Cock, P. (2001) Single event multilevel botulinum toxin A treatment and surgery: similarities and differences. Eur J Neurol. 8:88-97. doi: 10.1046/j.1468-1331.2001.00041.x
45. Morrell, D. S., Pearson, J. M., Sauser, D. D. (2002) . Progressive bone and joint abnormalities of the spine and lower extremities in cerebral palsy. Radiographics. 22(2): 257-68.
46. Msall, M. E., Park, J. J. (2008) . Neurodevelopmental management strategies for children with cerebral palsy: optimizing function, promoting participation, and supporting 10.1097/GRF.0b013e31818a0431 Clin Obstet Gynecol. 51(4), 800-815. doi
47. Mutlu, A., Livanelioglu, A., Kerem Günel, M. (200 ) . Reliability of goniometric measurements in children with spastic cerebral palsy. Med Sci Monit. 13(7): 323-329. PMID: 17599027
48. Olsson, M. C., Kruger, M., Meyer, L. H., Ahnlund, L., Gransberg, L., Linke, W. A. (2006) . Fibre type specific increase in passive muscle tension in spinal cord- injured 10.1113/jphysiol.2006.116749 with spasticity. J Physiol. 577: 339-52. doi
49. Oppenheim, W. L. (2009) .Complementary and alternative methods in cerebral palsy, Developmental Medicine & Child neurology. (Suppl. 4): 122–129. doi: 10.1111/j.1469-8749.2009.03424.x
50. Pin, T. W. (2007) . Effectiveness of static weight-bearing exercises in children with cerebral 10.1097/PEP.0b013e3180302111 Pediatr Phys Ther. 19: 62-73. doi
51. Pozzo, T., Berthoz, A., Lefort, L., Vitte, E. (1991) . Head stabilization during various locomotor tasks in humans. II. Patients with bilateral peripheral vestibular deficits. Exp Brain Res. 85(1): 208-17.
52. Rose, S. A., DeLuca, P. A., Davis, R. B., Ounpuu, S., Gage, J. R. (1993) . Kinematic and kinetic evaluation of the ankle after lengthening of the gastrocnemius fascia in children with cerebral palsy. J Pediatr Orthop. 13(6):727-32. doi:10.1097/01241398-199311000-00007
53. Rosembaum, P., Panet, N., Leviton, A., Goldstein, M., Bax, M. (2007) . A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol. 49 (Suppl. 109): 8–14. doi:10.1111/j.1469-8749.2007.tb12610.x
54. Saavedra, S., Joshi, A., Woollacott, M., Van Donkelaar, P. (2009) . Eye hand coordination in children with cerebral palsy. Exp Brain Res. 192(2): 155-65. doi: 10.1007/s00221-008-1549-8
55. Smiley, S. J., Jacobsen, F. S. (2002) . A comparison of the effects of solid, articulated, and posterior leaf-spring ankle-foot orthoses and shoes alone on gait and energy expenditure in children with spastic diplegic cerebral palsy. Orthopedics. 25(4): 411-5
56. Sridharan, R. (2002) . Epidemiology of epilepsy. Curr Sci. 82(6): 664-669.
57. Styer-Acevedo J. (1999) . Physical Therapy for the Child with Cerebral Palsy. In: Pediatric Physical Therapy, 3rd ed., J. S. Tecklin, Lippincott Williams & Wilkins, Philadelphia. 07-162.
58. Tardieu, C., Lespargot, A., Tabary, C., Bret, M. D. (1988) . For how long must the soleus muscle be stretched each day to prevent contracture? Dev Med Child Neurol. 30: 3–10. doi: 10.1111/j.1469-8749.1988.tb04720.x
59. Uygur, F. Yakut, Y. Bek, N. (2010) . Orthotic applications and rehabilitation in children. Turkiye klinikleri J PM&R-special topics. 3(3): 70-78.
60. Velickovic, T. D., Velickovic, M. P. (2005) . Basic Principles Of The Neurodevelopmental Treatment. Medicina. 42(41): 112-120.
61. Weindling, A. M., Cunningham. C. C., Glenn, S. M., Edwards, R. T., Reeves, D. J. (2007) . Additional therapy for young children with spastic cerebral palsy: a randomised controlled trial. Health Technology Assessment.11: 16.
62. Wright, J., Rang, M. (1990) . The spastic mouse. And the search for an animal model of spasticity in human beings. Clin Orthop Relat Res.(253): 12-9.