Serebral Palsili Çocuklarda Üst Ekstremite Fonksiyonelliğinin İncelenmesi
Çalşmann amac 7-18 yaşlar arasndaki hemiplejik ve quadriplejikserebral palsili (SP) çocuklarda üst ekstremite fonksiyonelliğinin ve derinduyularnn değerlendirilmesidir. Çocuklarn yaş ve cinsiyet gibi temeldemografik özelliklerinin yannda aldklar tedaviler sorguland. Üstekstremitede stereognozi ve pasif hareket duyusu ile birlikte, kavramafonksiyonelliğini değerlendirmek için Modifiye Green ve BanksSnflamas kullanld. Fonksiyonel değerlendirme için Jebson-Taylor ElFonksiyon Testi (JEFT) uyguland. Çalşmaya yaş ortalamalar 13,6±3,95yl olan 25 çocuk alnd. Çocuklarn 13’ü (%52) erkek, 12’si (%48) kzd.16’snn (%64) dominant eli sağ, 9’unun (%36) soldu. 13 (%52) çocukhemiplejik SP, 12 (%48) çocuk ise quadriplejik SP tansna sahipti.Çocuklarn 12 (%48)’sinin sol, 13(%52)’ünün sağ elinde Modifiye Greenve Banks Snflamas’na göre el fonksiyonellikleri 2. düzeyde (zayf)bulundu. Stereognozi ve pasif hareket duyular iyi düzeyde bulunurken,JEFT alt testlerinin ikisinde iki SP tipi arasnda anlaml farkllğa (p<0,05)rastlan
___
- [1] Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M,
Damiano D, et al. A report: the definition and classification of
cerebral palsy. Dev Med Child Neurol Suppl 2007; 109:8-14.
[2] Mark T. Jobe. Campbell's Operative Orthopaedics. 12. Edition.
Mosby; 2013, 3535-3554.
[3] Sakzewski L, Ziviani J, Boyd R. Systematic review and metaanalysis
of therapeutic management of upper-limb dysfunction in
children with congenital hemiplegia. Pediatrics, 2009; 123 6:
e1111-e1122. doi:10.1542/peds.2008-3335.
[4] Kinnucan E, Van Heest A & Tomhave W. Correlation of motor
function and stereognosis impairment in upper limb cerebral palsy.
Journal of Hand Surgery 2010; 35(8), 1317–1322.
[5] Himmelmann K, Beckung E, Hagberg G & Uvebrant P. Gross and
fine motor function and accompanying impairments in cerebral
palsy. Developmental Medicine & Child Neurology 2006; 48,
417–423.
[6] DeLuca PA. The Musculoskeletal management of children with
cerebral palsy. Pediatric Clinics of North America 1996; 43: 1135-
1150.
[7] Flett PJ. Rehabilitation of spasticity and related problems in
childhood cerebral palsy. J Paediatr Child Health 2003; 39:6-14.
[8] Schneider JW, Gurucharri LM, Gutierrez AL, Gaebler-Spira DJ.
Health-related quality of life and functional outcome measures for
children with cerebral palsy. Dev Med Child Neurol. 2001;
43(9):601- 608.
[9] Williams LA. A suggested method for evaluating proprioception,
stereognosis, and body scheme in adult patients with cerebral
vascular accident for occupational therapists. (Master’s project).
San Jose state College, 1964.
[10] Muen WJ, Bannister CM. Hand function in subject with spina
bifida. Eur. J. Pediatr.Surg 1997; 7(1):18-22.
[11] Hwang R, Kentish M, Burns Y. Hand positioning sense in children
with spina bifida myelomeningocele. Australian Journal of
Physiotherapy 2002; 48: 17-22.
[12] Green WT, Banks HH. Flexor carpi ulnaris transplant and its use
in cerebral palsy. J Bone Joint Surg Am 1962; 44:1343-52.
Aydın Sağlık Dergisi - Yıl 2 Sayı 2 - 2016 (37-50) 49
[13] Samilson RL, Morris JM. Surgical improvement of the cerebralpalsied
upper limb: Electromyographic studies and results of 128
operations. J Bone Joint Surg Am. 1964; 46:1203–16.
[14] Jansen J, Taudorf K, Pedersen H, et al. Upper extremity function
in spina bifida. Child's Nervous System 2005; 7(2): 67-71.
[15] Muen WJ, Bannister CM. Hand function in subject with spina
bifida. Eur. J. Pediatr.Surg 1997; 7(1):18-22.
[16] Wai E, Young N, Feldman B. The relationship between function
and self-perception and spinal deformity. J Pediatr Orthop 2005;
25:64–69.
[17] Chin TYP, Duncan JA, Johnstone BR, Graham HK. Management
of the upper limb in cerebral palsy. J Pediatr Orthop 2005;14:389.
[18] Van Heest AE, Ramachandran V, Stout J, et al. Quantitative and
qualitative functional evaluation of upper extremity tendon
transfers in spastic hemiplegia caused by cerebral palsy. J Pediatr
Orthop 2008; 28:679.
[19] Langan J, Kern K, Hurvitz E, Brown S. Upper-limb position sense
deficits in adults with cerebral palsy. Am. J. Phys. Med. Rehabil.
2014; Vol. 93, No. 9 774 - 781.
[20] Green D, Schertz M, Gordon A, Moore A, et al. A multi-site study
of functional outcomes following a themed approach to hand-arm
bimanual intensive therapy for children with hemiplegia.
Department of Occupational Therapy, Faculty of Medicine, Tel
Aviv University, Israil 2013.
[21] Crajé C, Aarts P, Nijhuis-van der Sanden M & Steenbergen B.
Action planning in typically and atypically developing children
(unilateral cerebral palsy). Research in Developmental Disabilities
2010; 31(5), 1039-1046.
[22] Bolanos AA, Bleck EE, Firestone P, et al. Comparison of
stereognosis and two-point discrimination testing of the hands of
children with cerebral palsy. Developmental Medicine & Child
Neurology. 1989; 31: 371–376.
[23] Gordon AM, Duff SV. Relation between clinical measures and fine
manipulative control in children with hemiplegic cerebral palsy.
Developmental Medicine & Child Neurology 1999; 41: 586–91.
[24] Wilson BC, Wilson JJ. Sensory and perceptual functions in the
cerebral palsied. II. Stereognosis. Journal of Nervous and Mental
Disease. 1967; 145:61–68.
[25] Van Heest AE, House J, Putnam M. Sensibility deficiencies in the
hands of children with spastic hemiplegia. Journal of Hand Surgery
– American Volume. 1993; 18:278–81.
[26] Krumlinde-Sundolm L, Elliasson A. Comparing tests of tactile
sensibility: aspects relevant to testing children with spastic
hemiplegia. Developmental Medicine & Child Neurology. 2002;
44: 604–612.