Serebral Palsi tanısı ile izlediğimiz çocuklarda kullandığımız ortezler ve fonksiyonel durum ile ilişkisi
Öz
Amaç:
Polikliniğimize Serebral Palsi tanısı ile başvuran hastaların kullanmakta
olduğu ortez çeşitlerini belirlemek, SP tipinin ve Kaba Motor Fonksiyonel
Sınıflama Sisteminin (KMFSS) ortezleme ile ilişkisini değerlendirmek.
Gereç ve Yöntem: SP
tanısı olan 2-16 yaş arası hastalar retrospektif olarak incelendi ve ortez
kullanımı saptanan 60 hasta çalışmaya dahil edildi. Hastaların yaş, cinsiyet, akraba evliliği öyküsü, konuşma
bozukluğu, mental bozukluk, görme bozukluğu, işitme bozukluğu, epilepsi, yutma
bozukluğu ve kullandığı ortez kaydedildi. Klinik sınıflama Swedish
klasifikasyonuna göre yapıldı. Hastaların kaba motor fonksiyonlarındaki
bozukluğun ciddiyetini sınıflandırmak için Kaba Motor Fonksiyon Sınıflandırma
Sistemi (KMFSS) kullanıldı.
Bulgular:
Hastaların ortalama yaşı 88.05±50.44 ay idi. Olguların’33 ü erkek 27’si kızdı. Hastaların
%96.7’si (n=58) spastik tip, %3.3’ü (n=2) diskinetik tip SP idi. Spastik tip
SP’lerin %36.7’si diplejik, %36.7’si tetraplejik, %20’si hemiplejik, %3.3’ü monoplejik
idi. KMFSS’ye göre yapılan sınıflamada %35 (n=21) ile en fazla KMFSS 3
düzeyinde hasta olduğu belirlendi. KMFSS 1 olan 7 hasta solid AFO, KMFSS 2 olan
10 hastanın 3’ü GRAFO, 7’si solid AFO kullanıyordu. KMFSS 3 olan 21 hastanın 3
tanesi KAFO, 2’si GRAFO, biri eklemli AFO, 17’si solid AFO kullanıyordu. KMFSS
4 olan 15 hastanın 6’sı KAFO, biri GRAFO, 8’i solid AFO kullanıyordu. KMFSS 5
olan 7 hastanın 3’ü KAFO, 4’ü solid AFO kullanıyordu.
Sonuç: KMFSS
1,2 ve 3 olan hastalar daha çok AFO ve GRAFO kullanırken KMFSS 4 ve 5 olan
hastaların yaklaşık yarısında KAFO kullanımı vardı. KMFSS 4 ve 5 olan çocuklar
kendi kendilerine hareketleri sınırlı ve sıklıkla taşındıkları için yürüme
amaçlı AFO yerine pozisyonlamaya ve eklem hareket açıklığını korumaya yönelik
KAFO kullanımı daha fazladır.
Anahtar Kelimeler
Kaynakça
- KAYNAKLAR1. Çağlıyan Türk A, Özel S. Serebral Palsi Tanısı ile İzlediğimiz Hastaların Demografik ve Klinik Özellikleri. Journal of Physical Medicine Rehabilitation Sciences 2018;21:71-77. 2. Danino B, Erel S, Kfir M, Khamis S, Batt R, Hemo Y, et al. Influence of orthosis on the foot progression angle in children with spastic cerebral palsy. Gait Posture 2015; 42:518-522. 3. Balaban B, Yasar E, Dal U, Yazicioglu K, Mohur H, Kalyon TA. The effect of hinged ankle-foot orthosis on gait and energy expenditure in spastic hemiplegiccerebral palsy. Disabil Rehabil. 2007;29:139-144.4. Sankar C, Mundkur N. Cerebral palsy-definition, classification, etiology and early diagnosis. Indian J Pediatr 2005;72:865–868.5. Aboutorabi A, Arazpour M, Ahmadi Bani M, Saeedi H, Head JS. Efficacy of ankle foot orthoses types on walking in children with cerebral palsy: A systematic review. Ann Phys Rehabil Med 2017;60:393-402.6. Tıkız C. Ortezler. In: Hepgüler SA, Gökben S, ed. Serebral Palsi. İstanbul: Nobel Tıp Kitabevleri, 2017;147-1697. Ofluoğlu D. Orthotic management in cerebral palsy. Acta Orthop Traumatol Turc 2009;43:165-172.8. Dilek B, Gözde G, Yakut Y. Serebral palsili çocuklarda ayak-ayak bileği ortezi kullanım süresini etkileyen faktörlerin incelenmesi: pilot çalışma. Journal of Exercise Therapy and Rehabilitation 2015;2:47-52.9. Morris C. Orthotic management of cerebral palsy. Dev Med Child Neurol 2007;49:791-796.10. Hagberg B, Hagberg G, Olow I. The Changing Panaroma of Cerebralpalsy in Sweden. I. Prevelance and Origin during the Birth Year Period 1983-1986. Acta Paediatrica 1993;82:387-393.11. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997;39:214-223.12. Scrutton D, Damiano DL, Mayston M. Management of the motor disorders of children with cerebral palsy. 2nd edition. Cambridge: Cambridge University Press, 2004;9-146. 13. Blair E, Watson L. Epidemiology of cerebral palsy. Semin Fetal Neonatal Med 2006;11:117-125.14. Öneş K, Çelik B, Çağlar N, Gültekin Ö, Yılmaz E, Çetinkaya B. Serebral palsi polikliniğine müracaat eden hastaların demografik ve klinik özellikleri. Türk Fiz Tıp Rehab Derg 2008;54:13-16.15. Özel S, Çulha C, Delialioğlu SÜ, Sarı İF, Köklü K. The relationship between the Gross Motor Function Classification System and treatment modalities in children with cerebral palsy. Turk J Phys Med Rehab 2016;62:116-122.16. Sanger TD, Delgado MR, Gaebler-Spira D, Hallett M, Mink JW; Task Force on Childhood Motor Disorders. Classification and definition of disorders causing hypertonia in childhood. Pediatrics 2003;111:89-97.17. Öztürk B, Uygur F, Yakut Y. Effect of ankle-foot orthoses on functional performance and physiological cost index in children with cerebral palsy. Journal of Exercise Therapy and Rehabilitation 2015;2:86-9218. Houltram J, Noble I, Boyd RN, Corry I, Flett P, Graham HK. Botulinum toxin type A in the management of equinus in children with cerebral palsy: an evidencebased economic evaluation. Eur J Neurol 2001;8:194–202.19. Chen W, Liu X, Pu F, Yang Y, Wang L, Liu H, et al. Conservative treatment for equinus deformity in children with cerebral palsy using an adjustable splint-assisted ankle-foot orthosis. Medicine (Baltimore) 2017;96:e8186.20. White H, Jenkins J, Neace WP, Tylkowski C, Walker J. Clinically prescribed orthoses demonstrate an increase in velocity of gait in children with cerebral palsy: a retrospective study. Dev Med Child Neurol 2002;44: 227-232.21. Radtka SA, Skinner SR, Johanson ME. A comparison of gait with solid and hinged ankle-foot orthoses in children with spastic diplegic cerebral palsy. Gait Posture 2005;21:303-310.
Öz
Purpose: To determine the types of orthoses
used by patients with cerebral palsy and to evaluate the relationship between Cerebral
Palsy (CP) type and the Gross Motor Function Classification System (GMFCS) with
the orthoses.
Material-Methods: Patients aged between 2 and 16
years who were diagnosed with CP were retrospectively evaluated and sixty
patients with orthotic use were included in the study. Age, sex, and orthosis were
assessed. Clinical classification was
based on Swedish classification. The GMFCS was used to classify the severity of
impairment in gross motor functions of patients.
Results: The mean age of the patients was 88.05±50.44
months. 55% of the patients were female, 45% were male. 96.7% of the patients
were spastic CP, 3.3% were dyskinetic type CP. According to GMFCS, 35% was the
most common patient with GMFCS 3. Seven patients with GMFCS 1 had solid AFO.
Three patients with GMFCS 2 had GRAFO and seven patients had solid AFO. Of the
twenty-one patients with GMFCS 3, 3 had KAFO, 2 had GRAFO, one had hinged AFO
and seven-teen had solid AFO. Of the fifteen patients with GMFCS 4, 6 had KAFO,
one had GRAFO and 8 had solid AFO. Three patients with GMFCS 5 had KAFO and 4
patients had solid AFO.
Conclusion: The patients with GMFCS 1-2-3 had
mostly use AFO and GRAFO, approximately half of patients with GMFCS 4-5 had
KAFO. Since the children in GMFCS 4-5 have limited self-movements and are often
transported, it is expected that the use of KAFO for positioning rather than
walking AFO.
Kaynakça
- KAYNAKLAR1. Çağlıyan Türk A, Özel S. Serebral Palsi Tanısı ile İzlediğimiz Hastaların Demografik ve Klinik Özellikleri. Journal of Physical Medicine Rehabilitation Sciences 2018;21:71-77. 2. Danino B, Erel S, Kfir M, Khamis S, Batt R, Hemo Y, et al. Influence of orthosis on the foot progression angle in children with spastic cerebral palsy. Gait Posture 2015; 42:518-522. 3. Balaban B, Yasar E, Dal U, Yazicioglu K, Mohur H, Kalyon TA. The effect of hinged ankle-foot orthosis on gait and energy expenditure in spastic hemiplegiccerebral palsy. Disabil Rehabil. 2007;29:139-144.4. Sankar C, Mundkur N. Cerebral palsy-definition, classification, etiology and early diagnosis. Indian J Pediatr 2005;72:865–868.5. Aboutorabi A, Arazpour M, Ahmadi Bani M, Saeedi H, Head JS. Efficacy of ankle foot orthoses types on walking in children with cerebral palsy: A systematic review. Ann Phys Rehabil Med 2017;60:393-402.6. Tıkız C. Ortezler. In: Hepgüler SA, Gökben S, ed. Serebral Palsi. İstanbul: Nobel Tıp Kitabevleri, 2017;147-1697. Ofluoğlu D. Orthotic management in cerebral palsy. Acta Orthop Traumatol Turc 2009;43:165-172.8. Dilek B, Gözde G, Yakut Y. Serebral palsili çocuklarda ayak-ayak bileği ortezi kullanım süresini etkileyen faktörlerin incelenmesi: pilot çalışma. Journal of Exercise Therapy and Rehabilitation 2015;2:47-52.9. Morris C. Orthotic management of cerebral palsy. Dev Med Child Neurol 2007;49:791-796.10. Hagberg B, Hagberg G, Olow I. The Changing Panaroma of Cerebralpalsy in Sweden. I. Prevelance and Origin during the Birth Year Period 1983-1986. Acta Paediatrica 1993;82:387-393.11. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997;39:214-223.12. Scrutton D, Damiano DL, Mayston M. Management of the motor disorders of children with cerebral palsy. 2nd edition. Cambridge: Cambridge University Press, 2004;9-146. 13. Blair E, Watson L. Epidemiology of cerebral palsy. Semin Fetal Neonatal Med 2006;11:117-125.14. Öneş K, Çelik B, Çağlar N, Gültekin Ö, Yılmaz E, Çetinkaya B. Serebral palsi polikliniğine müracaat eden hastaların demografik ve klinik özellikleri. Türk Fiz Tıp Rehab Derg 2008;54:13-16.15. Özel S, Çulha C, Delialioğlu SÜ, Sarı İF, Köklü K. The relationship between the Gross Motor Function Classification System and treatment modalities in children with cerebral palsy. Turk J Phys Med Rehab 2016;62:116-122.16. Sanger TD, Delgado MR, Gaebler-Spira D, Hallett M, Mink JW; Task Force on Childhood Motor Disorders. Classification and definition of disorders causing hypertonia in childhood. Pediatrics 2003;111:89-97.17. Öztürk B, Uygur F, Yakut Y. Effect of ankle-foot orthoses on functional performance and physiological cost index in children with cerebral palsy. Journal of Exercise Therapy and Rehabilitation 2015;2:86-9218. Houltram J, Noble I, Boyd RN, Corry I, Flett P, Graham HK. Botulinum toxin type A in the management of equinus in children with cerebral palsy: an evidencebased economic evaluation. Eur J Neurol 2001;8:194–202.19. Chen W, Liu X, Pu F, Yang Y, Wang L, Liu H, et al. Conservative treatment for equinus deformity in children with cerebral palsy using an adjustable splint-assisted ankle-foot orthosis. Medicine (Baltimore) 2017;96:e8186.20. White H, Jenkins J, Neace WP, Tylkowski C, Walker J. Clinically prescribed orthoses demonstrate an increase in velocity of gait in children with cerebral palsy: a retrospective study. Dev Med Child Neurol 2002;44: 227-232.21. Radtka SA, Skinner SR, Johanson ME. A comparison of gait with solid and hinged ankle-foot orthoses in children with spastic diplegic cerebral palsy. Gait Posture 2005;21:303-310.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 18 Ocak 2019 |
| Gönderilme Tarihi | 28 Kasım 2018 |
| Kabul Tarihi | 28 Aralık 2018 |
| Yayımlandığı Sayı | Yıl 2019 Cilt: 12 Sayı: 1 |
