Fatih ÖZDER, Fatma ILGAZ, SELEN SEREL ARSLAN

Serebral Palsi’li Çocuklarda Çiğneme Bozukluğunun Klinik ve Nütrisyonel Değerlendirmesi: Olgu Sunumu

Bu olgu sunumunun amacı; katı besin alamayan Serebral Palsi (SP)’li bir çocukta çiğneme ve nütrisyonel durumdeğerlendirme sonuçlarını sunmak ve tedaviye yönelik öneriler vermektir. Üç yaş on bir aylık kuadriplejik kız olgununyaşa göre boy uzunluğu, yaşa göre vücut ağırlığı z-skoru-3.7 olduğu için ağır akut malnütrisyon olarak değerlendirilmiştir.Kaba Motor Fonksiyon Sınıflama Sistemi’ne göre seviye 5 düzeyinde olan olgunun Kaba Motor Fonksiyon Ölçütü A ve B altbölümlerinden aldığı skor %23.9’dur. Bu sonuçlar olgunun fonksiyonel motor seviyesinin düşük olduğunu göstermiştir.Çiğneme performansı değerlendirmesinde; olgu Karaduman Çiğneme Performans Skalası’na göre seviye 4 (ısırma ve çiğnemeyok)’tür. Çiğneme Fonksiyonu Gözlem ve Değerlendirme Aracı’ndan 13 puan almıştır. Her iki ölçekten elde edilen sonuç,olgunun şiddetli çiğneme bozukluğu olduğunu göstermektedir. Olgunun enerji ve besin ögesi alım miktarını belirlemekamacıyla 24-saatlik geriye dönük hatırlatma yöntemi ile besin tüketim kaydı alınmıştır. Olgunun diyeti ile günlük protein,vitamin ve mineral gereksinimlerinin çoğu karşılanabilirken, enerji, C vitamini ve posa gereksinimlerinin sırasıyla %78.6,%58 ve %15.8’inin karşılanabildiği saptanmıştır. Gereksinimlerinin tamamının ince sıvı ve ince püre içecek ve besinlerdenkarşılandığı, çiğneme gerektiren besinleri tüketmediği belirlenmiştir. Katı besin alamayan olguda enerji ihtiyacının önemlibir kısmı, protein ve vitamin-mineral ihtiyacının tamamı karşılanabilse de, ileri dönemde bu durum beslenme yetersizliğineyol açıp, hem çocuğun, hem de ailenin yaşam kalitesini olumsuz yönde etkileyebilir. Bu nedenle çiğneme bozukluğununerken dönemde ele alınması ve gerekli müdahale programlarının oluşturulabilmesi için olguların fizyoterapist ve diyetisyeniş birliğinde değerlendirilmesi gerekmektedir.

Clinical and Nutritional Evaluation of Chewing Dysfunction in Children with Cerebral Palsy: A Case Report

The aim of this case report is; to present the results of chewing and nutritional status evaluation in a child with Cerebral Palsy (CP) who cannot consume solid food and to give recommendations for treatment. A three-year- and eleven-month-old quadriplegic girl was considered to have severe acute malnutrition due to her height for age and weight for age z-score was -3.7. According to Gross Motor Function Classification System, the score of the case was at level 5 and in Gross Motor Function Criterion A and B subsections was 23.9%. These results showed that the functional motor level of the case was low. In the evaluation of chewing performance; the case was at level 4 (no biting and chewing) according to the Black Duman Chewing Performance Scale. The child received 13 points from the Chewing Function Observation and Evaluation Tool. The result obtained from both scales showed that the case had severe chewing disorder. In order to determine the amount of energy and nutrient intake of the case, dietary intake was determined with the 24-hour dietary recall method. While most of the daily protein, vitamin and mineral requirements could be met with the diet of the patient, it was determined that only 78.6%, 58% and 15.8% of the energy, vitamin C and fiber requirements could be met, respectively. It was determined that all of his needs were met from fine liquid and fine pureed beverages and foods, and he did not consume foods that require chewing. Although a significant portion of the energy, protein and vitamin-mineral needs could be met in the case who could not consume solid food and this situation might lead to nutritional deficiency in the future and negatively affect the quality of life of both the child and the family. For this reason, the child should be evaluated in cooperation with a physiotherapist and dietitian in order to deal with chewing disorder in the early period and to create the necessary intervention programs.

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