SPECIAL EDUCATION TREATMENT IN PREP ARIN G HEMIP ARETIC CHILDREN FOR SCHOOL ATTENDANCE

Hemiparetički oblik dječje cerebralne paralize posljedica je oštećenja centralnog nervnog sistema. Motoričku disfunkciju jedne strane tijela često prate specifične poteškoće u oblasti percepcije, govora, ponašanja, učenja. Posljedice ranih oštećenja mozga ovisne su zasigurno o vremenu nastanka, opsežnosti i lokaciji povrede, ali je presudan utjecaj sredinskih faktora kojima je odredena gornja razina razvoja i kvalitet unutar nje. Defektološki tretman, baziran na činjenici cjelovitosti dječje ličnosti, provodi se kroz individualizirane programe stimulacije pojednih funkcija. Intenzivan, kontinuiran tretman poka1.<~0 je pozitivne rezultate u adekvatnosti sveukupnog ponašanja djeteta obuhvaćenog tretmanom. Najbolji rezultati bili su u grafomotoričkim sposobnostima.Hemiparetic form of cerebral palsy is a consequence of the central nervous system lesion. M otorial dysfuntion of one side of the body is often accompanyed by specific difficulties in perception, speech, behaviour, and learning. Consequences of early cerebral lesions depend upon the time when they occurred as well as upon the extent and location of the lesion, but the influence of enviromental factors which determine the upper level of development and its quality are of utmost importance. Special education treatment, based on the integrity of the child\u27s personality, is done through individual programmes of stimulation of particular functions. Intensive continuous treatment had a very good outcome in adequacy of the overall behaviour of the child included in this programme. The best results were obtained io the graphomtor abilities

SEX AND CEREBRAL PALSY

U istraživanje je uključeno 39-ero djece s kliničkom slikom tetrapareze, parapareze i hemipareze muškog i ženskog spola. Uspoređivani su lateralizacija gornjih ekstremiteta, govorni razvoj i intelektualna razina prema spolu kod sva tri klinička oblika bolesti. Analizom rezultata uočava se relativno visok postotak djece s neizdiferenciranom lateralizacijom kod parapareze; iako razlika nije statistički značajna, upućuje na češću objerukost kod muške djece. Govorni razvoj zaostaje u visokom postotku kod djece s paraparezom ženskog spola, dok kod muške djece češće znatno zaostaje. Djeca s tetraparezom pokazuju upravo suprotne rezultate. U skupini djece s hemiparezom govorni razvoj zaostaje u većem postotku kod muške djece. Spol ne pokazuje tendenciju značajnijeg utjecaja na intelektualnu razinu kod parapareza i hemipareza, ali se tendencija značajnosti uočava kod tetrapareza.The research included the investigated group of 39 children of both sexes with a clinical picture of tetraparesis, paraparesis or hemiparesis. Lateralisation of the upper extremities, development of speech and intellectual development were compared according to sex of children with these clinical pictures. Analysis of the results shows that there is a relatively high percentage of children with non-differentiated lateralisation among those with paraparesis, and although this difference is not statistically significant, it shows that male children are more often ambidextrous. The development of speech is slowed down among a high percentage of female children with paraparesis, but speech is more often significantly slowed down among male children The results among children with tetraparesis are opposite. In the group of children with hemiparesis the development of speech is slowed down in a higher percentage among male children. Sex does not show a significant influence on the intellectual level among children with paraparesis and hemiparesis, but such a trend is significant among children with tetraparesis

Vještina crtanja kod djece s kašnjenjem u neuromotornom razvoju u dobi od 2-5 godina

In typically developing children, drawing development occurs in stages from uncontrolled strokes to complex drawing. In this study, we examined drawing development in children with neurodevelopmental delay (NDD). In order to do so, we observed the influence of age, intraventricular hemorrhage (IVH) and gender on the development of drawing skills. The sample consisted of 52 children with NDD, aged 2 years and 6 months to 5 years. All children were hospitalized for multidisciplinary team monitoring and developmental support. The evaluation of drawing development was administered by giving each child a blank A4 paper and the instruction to draw anything they wanted. All of the drawings were scored satisfactory or unsatisfactory. Descriptive statistics was employed on all relevant data to show results in frequencies and percentages. In order to determine differences between groups, the χ2-test was administered. The results showed greatest difference in drawing in children aged from 3 years to 3 years and 11 months. Children with lower IVH had better drawing scores than children with higher IVH levels. According to gender dissimilarities, a difference was found showing girls to have better drawing skills than boys. All study results pointed to the importance of early rehabilitation and continuous structured work with children with NDD.Kod djece urednog razvoja crtež se razvija kroz nekoliko faza koje se pojavljuju specifičnim redoslijedom od nekontroliranih pokreta olovkom do crtanja kompleksnih oblika. U ovom radu željeli smo istražiti postoje li odstupanja u razvoju crteža kod djece s neurorazvojnim odstupanjem. Promatrani su utjecaj dobi, intraventrikularnog krvarenja različitih stupnjeva i spola na razvoj crteža. Uzorak ispitanika činilo je 52 djece u dobi od 2,6 do 5 godina. Sva djeca bila su hospitalizirana radi praćenja cjelokupnog razvoja i potpore od strane multidisciplinarnog tima. Svoj djeci bio je dijagnosticiran neki oblik neurorazvojnog odstupanja. Ispitivanje razvoja crteža provedeno je na način da su djetetu dani olovka i prazan A4 list papira na kojem je mogao izraditi crtež po vlastitom izboru. Svaki crtež ocijenjen je kao adekvatan ili neadekvatan za dob. Prikupljeni podaci obrađeni su deskriptivnom analizom i prikazani u tablicama i grafikonima pomoću postotaka i frekventnosti. Razlike između skupina dokazane su χ2-testom. Rezultati su pokazali najveću razliku između zadovoljavajućeg i nezadovoljavajućeg razvoja crteža u skupini djece od 3 do 3,11 godina. Zatim, djeca koja nisu imala intraventrikularno krvarenje ili su imala krvarenje I. stupnja pokazala su najbolje vještine crtanja među djecom s neurorazvojnim odstupanjem, dok su sva djeca s krvarenjem II./III. stupnja imala veći broj neadekvatnih crteža za dob. Promatrajući razlike u crtežu s obzirom na spol zaključuje se da su vještine crtanja kod djevojčica bolje u odnosu na dječake. Dobiveni rezultati ukazuju na važnost rane rehabilitacije i kontinuirani strukturirani rad s djecom s neurorazvojnim odstupanjima

Najčešća odstupanja u razvoju motorike šake od rođenja do prve godine života

The early child development, from birth until the age of one year is, amongst other changes, characterized by intense motor learning. During that period, the voluntary learning patterns evolve from reflexive patterns to coordinated voluntary patterns. All of the child’s voluntary movements present active forms in which the child communicates with the environment. In this communication, the hand plays an important role. Its brain representation covers one-third of the entire motor region, situated in the close proximity to the speech region. For this reason, some authors refer to hand as a “speech organ”. According to numerous studies, each separate finger also has a relatively large representation in the cerebral cortex, which points to the importance of the fine motor skills development, or precise, highly differentiated movements of hand muscles following the principles of differentiation and hierarchical integration. Development of the fine motor skills in the hand is important for the overall child development, and it also serves as a predictor pointing to immaturity of the central nervous system. The aim of this paper is to present the development of hand motoricity from birth until the age of one year, as well as the most frequent deviations observed in children hospitalized at Children’s Department of Rehabilitation, Clinical Department of Rheumatology, Physical Medicine and Rehabilitation, Sestre milosrdnice University Hospital Center.Rani razvoj djeteta, od rođenja do prve godine života, obilježen je između ostalog i intenzivnim motoričkim učenjem kojim se obrasci voljnih pokreta od refleksnih obrazaca razvijaju u koordinirane voljne pokrete. Svi voljni pokreti djeteta njegovi su aktivni oblici komunikacije s okolinom. U toj komunikaciji veliku važnost ima ruka. Njezina reprezentacija u mozgu zauzima trećinu cjelokupnog prostora motorne regije koja se nalazi u neposrednoj blizini regije za govor. Stoga neki autori ruku nazivaju “organom govora”. Kako su pokazale različite studije, svaki prst zasebno također ima relativno veliku zastupljenost u moždanoj kori, što upućuje na važnost razvoja fine motorike, odnosno preciznih visokodiferenciranih pokreta muskulature šake po načelima diferencijacije i hijerarhijske integracije. Razvoj fine motrike šake važan je za cjelokupni razvoj djeteta, a također je i prediktor koji ukazuje na nezrelost središnjega živčanog sustava. Cilj ovoga rada je prikazati razvoj motorike šake od rođenja do prve godine života, kao i najčešća odstupanja koja su zapažena kod djece koja su boravila na Odsjeku za rehabilitaciju djece Klinike za reumatologiju, fizikalnu medicinu i rehabilitaciju Kliničkog bolničkog centra „Sestre milosrdnice“

SEX AND CEREBRAL PALSY

U istraživanje je uključeno 39-ero djece s kliničkom slikom tetrapareze, parapareze i hemipareze muškog i ženskog spola. Uspoređivani su lateralizacija gornjih ekstremiteta, govorni razvoj i intelektualna razina prema spolu kod sva tri klinička oblika bolesti. Analizom rezultata uočava se relativno visok postotak djece s neizdiferenciranom lateralizacijom kod parapareze; iako razlika nije statistički značajna, upućuje na češću objerukost kod muške djece. Govorni razvoj zaostaje u visokom postotku kod djece s paraparezom ženskog spola, dok kod muške djece češće znatno zaostaje. Djeca s tetraparezom pokazuju upravo suprotne rezultate. U skupini djece s hemiparezom govorni razvoj zaostaje u većem postotku kod muške djece. Spol ne pokazuje tendenciju značajnijeg utjecaja na intelektualnu razinu kod parapareza i hemipareza, ali se tendencija značajnosti uočava kod tetrapareza.The research included the investigated group of 39 children of both sexes with a clinical picture of tetraparesis, paraparesis or hemiparesis. Lateralisation of the upper extremities, development of speech and intellectual development were compared according to sex of children with these clinical pictures. Analysis of the results shows that there is a relatively high percentage of children with non-differentiated lateralisation among those with paraparesis, and although this difference is not statistically significant, it shows that male children are more often ambidextrous. The development of speech is slowed down among a high percentage of female children with paraparesis, but speech is more often significantly slowed down among male children The results among children with tetraparesis are opposite. In the group of children with hemiparesis the development of speech is slowed down in a higher percentage among male children. Sex does not show a significant influence on the intellectual level among children with paraparesis and hemiparesis, but such a trend is significant among children with tetraparesis