How Does Botulinum Toxin Injection and Physiotherapy Complement Each Other in Cerebral Palsy?

Cerebral Palsy (CP) is a clinical condition that describes impairments of motor and sensory systems due to a lesion in immature brain. CP‐related disorders effect movements, balance and posture of the child. Spasticity is most frequent motor disorder seen in CP and effects 70–80% of the children with CP. Spasticity can lead to abnormalities in all motor system levels involving muscles, joints, bones and tendons. If spasticity exists for long period of time, immobilization of muscles in short position and changes in the connective tissue around joints lead to shortening of the muscles and connective tissue. Various methods are used for spasticity management in children with CP. Botulinum neurotoxin (BoNT) injections, oral medications, selective dorsal rhizotomy and intrathecal baclofen applications are the foremost among them. BoNT injections are most prevalently used one among these applications. BoNT, which is a neurotoxin obtained from Clostridium botulinum bacteria, is frequently used in children with CP to decrease muscle tone for a certain period in the selected muscles, prevent contractures, postpone surgery and decrease frequency of surgeries. During this time frame that muscle tone decreased, it is very important to increase activity and participation levels of children. For achieving better motor outcomes and functional independence, BoNT injections should be combined with physiotherapy (PT) and occupational therapy (OT)

Assessments and Outcome Measures of Cerebral Palsy

In cerebral palsy (CP), numerous primary problems are observed including muscle tone problems, muscle weakness, insufficient selective motor control, postural control, and balance problems. In the persistence of these problems for a long period, secondary problems including torsional deformities, joint contractures, scoliosis, and hip dysplasia can occur in time, and strategies formed by children to cope with these problems make up the tertiary problems. Hence, the most accurate and brief assessment of all of these problems mentioned above is crucial to determine an effective and precise physiotherapy program. In the assessment of children with CP, it is very important to receive a detailed story consisting of the birth story, to question underlying medical situations and to carry out physical assessment. In clinics, gross motor function, muscle tone, muscle length, muscle strength, and joint range of motion assessments are the most preferred ones

Spastik Serebral Palsili Çocuklarda Fonksiyonel Gövde Eğitiminin Üst Ve Alt Ekstremite Motor Fonksiyonları Üzerine Etkisinin Araştırılması

The purpose of this study is to broadly investigate the effect of individually structured trunk training on trunk control, upper and lower limb motor function of children with spastic Cerebral Palsy (CP). 38 bilaterally effected children with spastic CP whom receive routine physiotherapy program twice a week recruited for this study. Stratified random sampling used according to the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels to set two statistically equal groups. Motor functions of trunk, upper and lower extremities, daily living skills, activity and participation levels assessed with Trunk Control Measurement Scale (TCMS), Gross Motor Function Measurement (GMFM), Quality of Upper Extremity Skills Test (QUEST), Pediatric Balance Scale (PBS),Timed Up and Go Test (TUG),Surface Electromyography (sEMG), Modified Tardieu Scale (MTS), Physicians Rating Scale (PRS), 1 Minute Walk Test (1 MWT), Gillette Functional Assessment Scale (Gillette FAS), Functional Independence Measure for Children (WeeFIM), Impact on Family Scale (IPFAM) and Child Health Questionnaire Parent Form 50 (CHQ-PF 50) at baseline for both groups. After randomization one group received individually structured functional trunk training which includes trunk targeted neurodevelopmental treatment approach, other group set as control group. Children assessed with same outcome measures after 8 week intervention. According to the our results; TCMS, GMFM, QUEST, sEMG (Erector Spina), PBS, TUG, 1 MWT, PRS (Knee), Gilette Skill Test and WeeFIM scores showed improvement in intervention group with respect to the control group (p<0.05). This results show selected and adapted trunk training could be use for improving trunk, upper and lower extremity motor functions and activity levels of children with bilateral spastic CP.ONAY SAYFASI iii TEŞEKKÜR iv ÖZET v ABSTRACT vi İÇİNDEKİLER vii SİMGELER VE KISALTMALAR ix ŞEKİLLER xi RESİMLER xi GRAFİKLER xii TABLOLAR xiii 1. GİRİŞ 1 2. GENEL BİLGİLER 4 2.1. Serebral Palsi'nin Tanımı 4 2.2. Serebral Palsi'de Etyoloji 4 2.3. Serebral Palsi'de Epidemiyoloji 6 2.4. Diagnoz 6 2.5 Serebral Palsi'de Sınıflandırma, Ekstremite Dağılımı ve Klinik Tip 6 2.5.1. Spastik Tip Serebral Palsi 8 2.6. Serebral Palsi'de Gövde Etkilenimi 8 2.7. Serebral Palsi’de Değerlendirme 11 2.7.1. Hikâye 11 2.7.2. Gözlem 11 2.7.3. Fonksiyonel Seviye ve Motor Gelişimin Değerlendirilmesi 11 2.7.4. Refleks ve Reaksiyonların Değerlendirilmesi 12 2.7.5. Kas Tonusunun Değerlendirilmesi 12 2.7.6. Kas İskelet Sisteminin Değerlendirilmesi 13 2.7.7. Yürümenin Değerlendirilmesi 13 2.7.8. Dengenin Değerlendirilmesi: 14 2.7.9. Sağlıkla İlgili Yaşam Kalitesinin Değerlendirilmesi 14 2.7.10. Gövde Etkileniminin Değerlendirmesi 15 2.8. Serebral Palsi'de Genel Tedavi Yaklaşımları 16 2.8.1. Fizyoterapi ve Rehabilitasyon Uygulamaları 17 2.8.2. Adaptif Ekipman ve Ortezler 19 2.8.3. Tıbbı ve Cerrahi Yaklaşımlar 20 2.8.4. Destekleyici Yaklaşımlar 21 3. BİREYLER VE YÖNTEM 22 3.1. Bireyler 22 3.2. Yöntem 24 3.2.1. Değerlendirmeler 24 3.2.2. Gövde Eğitimi 42 3.3 İstatistiksel Analiz 45 4. BULGULAR 46 4.1. Olguların Demografik Özellikleri 46 4.2. Olguların Kaba Motor Fonksiyon ve El Becerileri Seviyeleri 48 4.3. Gövde Kontrolü ve Gövde Fonksiyonlarına Ait Bulgular 49 4.4. Kaba Motor Fonksiyonlara Ait Bulgular 53 4.5. Üst Ekstremite Motor Fonksiyonlarına Ait Bulgular 57 4.6. Kas Aktivasyonuna Ait Bulgular 61 4.7. Fonksiyonel ve Dinamik Denge Değerlendirmelerine Ait Bulgular 68 4.9. Kas Tonusuna Ait Bulgular 70 4.10. Yürüyüş Değerlendirmelerine Ait Bulgular 74 4.11. Fonksiyonel Bağımsızlık Değerlendirmesine Ait Bulgular 77 4.12. Ailelerin Etkilenimine Ait Değerlendirme Bulguları 80 4.13. Sağlıkla İlgili Yaşam Kalitesi Değerlendirmesine Ait Bulgular 82 5. TARTIŞMA 86 6. SONUÇLAR VE ÖNERİLER 102 KAYNAKLAR 104 EKLER Ek 1. Etik Kurul Kararı Ek 2. İzin Yazısı Ek 3. Değerlendirme FormuBu çalışmanın amacı spastik Serebral Palsili (SP) çocuklarda bireye özel yapılandırılmış gövde eğitiminin; üst ve alt ekstremite motor fonksiyonları ve gövde kontrolü üzerine etkilerini geniş kapsamlı olarak araştırmaktı. Bu amaçla; haftada iki gün rutin fizyoterapi programına devam eden, bilateral etkilenimi olan 38 Spastik Serebral Palsi'li çocuk çalışmaya dâhil edildi. Olgular Kaba Motor Fonksiyon Sınıflandırma Sistemine (GMFCS) ve El Beceri Sınıflandırma Sistemine (MACS)göre tabakalı randomizasyon ile istatistiksel olarak iki eşit gruba ayrıldı. Çalışmanın başında her iki grubun da gövde, üst ekstremite ve alt ekstremite motor fonksiyonları, günlük yaşam becerileri, aktivite düzeyleri ve katılımları; Gövde Kontrol Ölçüm Ölçeği (TCMS), Kaba Motor Fonksiyon Ölçümü (GMFM), Üst Ekstremite Beceri Kalitesi Testi (QUEST), Pediatrik Denge Ölçeği (PBS), Zamanlı Kalk Yürü Testi (TUG), Yüzeyel Elektromyografi (sEMG), Modifiye Tardieu Skalası (MTS), Klinik Yürüme Oran Testi (PRS), 1 Dakika Yürüme Mesafesi (1 MWT), Gillette Fonksiyonel Değerlendirme Anketi, Çocuklar İçin Fonksiyonel Bağımsızlık Ölçümü (WeeFIM), Aile Etki Ölçeği (IPFAM) ve Çocuk Sağlığı Anketi Anne Baba Formu (CHQ-PF 50) ile değerlendirdi. Randomizasyon sonrasında bir gruba bireysel yapılandırılmış, gövdeye yönelik nörogelişimsel yaklaşım uygulamaları içeren fonksiyonel gövde eğitimi verilirken diğer grup kontrol grubu olarak belirlendi. 8 hafta sonra çocuklar aynı değerlendirme araçları ile yeniden değerlendirildi. Bulgular incelendiğinde;TCMS, GMFM, QUEST, sEMG (Erector Spina), PBS, TUG, 1 MWT, PRS (Diz), Gillette Beceri Testi ve WeeFIM değerlendirmeleri açısından tedavi grubu lehine anlamlı fark bulundu (p<0.05). Bu bulgular özel seçilmiş ve uyarlanmış gövde eğitim programının bilateral etkilenimi olan spastik SP'li çocuklarda motor fonksiyonu ve aktivite düzeyini geliştirmek amacıyla kullanılabileceğini göstermektedir

Participation Restriction Questionnaire: A New Tool to Evaluate Participation in Children

Objective: This study was planned to develop the Participation Restriction Questionnaire for children based on the International Classification of Functioning, Disability and Health: Children and Youth (ICF-CY). Materials and Methods: A total of 242 children; 209 typically developing (mean age:6.82±4.22 years) and 33 with chronic diseases (mean age:74±4.98 years) and their parents were included in the study. The processes followed were literature review, item pooling based on ICF-CY, eliciting and evaluating expert opinion, scoring the scale, collecting data (with google forms), and analyzing the data. Exploratory and confirmatory factor analysis was performed for scale validity, and Cronbach α and Intraclass Correlation Coefficients (ICC) were used for scale reliability. The re-test was applied to 33 volunteer families two weeks after the first test. Results: The final version of the scale was constituted of 23 items (after removing 7 items out of 30 items) and three subscales as body structures and functions, activity and participation, and environmental factors. The model fit was found acceptable (The Root Mean Square Error of Approximation=0.084, Goodness of Fit Index=0.779, Adjusted Goodness of Fit Index=0.732, Chi-Square/degrees of freedom=2.696,

The relation between sleep habits, fatigue, impact on family and quality of life in children with first-time cancer and recurrent cancer

Aim: This study was planned to determine the conditions related to sleep, fatigue, and impact on family in children with Acutelymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) who had cancer for the first time and children who had recurrentcancer.Material and Methods: The study included 74 children (41 girls, 33 boys) with a mean age of 8.11 ± 3.77 years. Children evaluatedwith child and parent report of Pediatric Quality of Life “and PedsQL Healthcare Satisfaction Generic Module” should be aded.Inventory (PedsQL) Cancer Module, Children’s Sleep Habits Questionnaire (CSHQ), Borg Scale and Impact on Family Scale (IPFAM).Results: There was a statistically significant difference, in terms of PedsQL parent report total score (p=0.003), between the childrenwho had cancer for the first time and children who had recurrence cancer, and the values of latter were higher. A positive correlationwas found between the PedsQL child and parent report scores for all children with cancer (p= 0.000).Conclusion: According to the results of our study, it was seen that children who have recurrent cancer had reported a better qualityof life and that children and parents have similar perceptions in terms of quality of life