Beyin felcinde ortez uygulamaları

Beyin felçli (BF) çocuklarda, BF tipine göre değişen kas-iskelet sistemi deformiteleri ve sorunları bulunur. Bu deformiteler, (i) motor kontrol hasarı, (ii) anormal biyomekanik dizilim, (iii) kas aktivasyonu zamanlamasında bozukluk, (iv) normal agonist/antagonist kas dengesinde bozukluk, (v) güç üretme yetersizliği ve (vi) denge bozukluğu gibi sorunlardan kaynaklanabilir. Deformitelerin önlenmesinde ve düzeltilmesinde rehabilitasyon ve ortopedik cerrahi girişimler yanı sıra ilgili deformite için uygun ortez(ler) kullanılmaktadır. Bu yazıda temel olarak BF’de kullanılan alt ekstremite ortezleri ve kısaca üst ve spinal ortez uygulamaları anlatılmaktadır.

Anahtar Kelimeler:

Beyin felci, Ayak, Yürüyüş şekli, Ayak bileği, Ortotik aletler

Orthotic management in cerebral palsy

Children with cerebral palsy (CP) may have many muscu- loskeletal deformities depending on the type of CP. These deformities may result from (i) lack of motor control, (ii) abnormal biomechanical alignment, (iii) impairment in timing of muscle activation, (iv) impairment in normal ag- onist/antagonist muscle balance, (v) lack of power genera- tion, and (vi) balance disorder. Rehabilitation, orthopedic surgical intervention, and additional orthotic management can prevent and correct these deformities. In this review, mainly lower extremity orthoses are described, with brief explanation on upper and spinal orthotic applications.

Keywords:

Cerebral Palsy, Foot, Gait, Ankle, Orthotic Devices,

___

1. Diamond M, Armento M. Children with disabilities. In: DeLisa JA, Gans BM, editors. Physical medicine & rehabilitation principles and practice. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 1493-518.
2. Özaras N, Yalçın S, editörler. Yürüme analizi. İstanbul: Avrupa Tıp Kitapçılık, 2001.
3. Lin RS. Ankle-foot orthoses. In: Lusardi MM, Nielsen CC, editors. Orthotics and prosthetics in rehabilitation. Boston: Butterworth & Heinemann; 2000. p. 159-75.
4. Walker J, Stanger M. Orthotic management. In: Dormans JP, Pellegrino L, editors. Caring for children with cerebral palsy: a team approach. Baltimore: Paul H Brookes Publishing; 1998. p. 391-426.
5. Hylton NM. Postural and functional impact of dynamic AFOs and FOs in a pediatric population. J Prosthet Orthot 1990;2:40-53.
6. Romkes J, Brunner R. Comparison of a dynamic and a hinged ankle-foot orthosis by gait analysis in patients with hemiplegic cerebral palsy. Gait Posture 2002;15:18-24.
7. 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;44:227-32.
8. 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;21:303-10.
9. Van Gestel L, Molenaers G, Huenaerts C, Seyler J, Desloovere K. Effect of dynamic orthoses on gait: a retrospective control study in children with hemiplegia. Dev Med Child Neurol 2008;50:63-7.
10. Romkes J, Hell AK, Brunner R. Changes in muscle activity in children with hemiplegic cerebral palsy while walking with and without ankle-foot orthoses. Gait Posture 2006; 24:467-74.
11. Balaban B, Yaşar E, Dal U, Yazıcıoğlu K, Mohur H, Kalyon TA. The effect of hinged ankle-foot orthosis on gait and energy expenditure in spastic hemiplegic cerebral palsy. Disabil Rehabil 2007;29:139-44.
12. Lucareli PR, Lima Mde O, Lucarelli JG, Lima FP. Changes in joint kinematics in children with cerebral palsy while walking with and without a floor reaction ankle-foot orthosis. Clinics 2007;62:63-8.
13. Miller F. Durable medical equipment. In: Cerebral palsy. New York: Springer; 2005. p. 181-249.
14. Buckon CE, Thomas SS, Jakobson-Huston S, Moor M, Sussman M, Aiona M. Comparison of three ankle-foot orthosis configurations for children with spastic diplegia. Dev Med Child Neurol 2004;46:590-8.