The goal of this research was to examine and compare articulation and phonological abilities in children with cerebral palsy and their typically developing peers. An examination was conducted on a ...sample of 15 children with cerebral palsy and 15 typically developing children. The two groups were equalized by gender and age. The measuring instruments used were the Articulation Test and phonological ability tasks. The data were analysed using the robust discriminative analysis, t-test, chi-square test, as well as the Cohran-Cox test. The results showed a signifycant statistical difference in articulation and phonological abilities between children with cerebral palsy and typically developing children. The difference between the groups is for the most part due to the variables deletion of consonants and number of articulation errors. The variables first voice segregation, phonemic analysis, and rhyme searching are also signifi cant in creating this discriminant function. The results also confirm statistical differences in articulation and phonological abilities that are related to the type of cerebral palsy. A group of children with a spastic type of cerebral palsy was more successful in phoneme analysis, syllable analysis, consonant deletion tasks, and rhyme searching tasks. They also had better articulation abilities.
Spastic cerebral palsy (CP) is the most common type of CP. Up to 80% of all individuals with cerebral palsy suffer from some degree of spasticity. Spasticity adversely affects muscles and joints of ...the extremities, causing abnormal movements, and it is especially harmful in growing children.
Several methods have been developed and used to assess spasticity. The most commonly used test in clinical practice is the Modified Ashworth Scale (MAS). The test is based on the assessment of resistance to passive strech of muscle group at one nonspecified velocity.
Management of spasticity in CP involves multidisciplinary intervention intended to increase functionality, sustain health, and improve quality of life for children and their carers. This may include: oral medications, intrathecal medications, physiotherapy, occupational therapy, orthoses, surgical interventions, and pharmacological agents such as botulinum toxin.
Najčešći tip cerebralne paralize (CP) je spastički tip. Kod oko 80% posto svih obolelih od CP registruje se izvestan stepen spasticiteta. Spasticitet nepovoljno deluje na lokomotorni aparat dovodeći do abnormalnog kretanja i deformacija, što remeti normalno funkcionisanje deteta.
Postoji više metoda za kliničku evaluaciju spasticiteta. U kliničkoj praksi najčešće je u upotrebi modifikovana Ashworth-ova skala (MAS). Test se zasniva na proceni otpora mišića na pasivno istezanje, pri čemu se brzina izvođenja pasivnog pokreta ne uzima u obzir.Tretman spasticiteta sprovodi se timski, multidisciplinarno, sa ciljem da se poboljša funkcionalni status i kvalitet života deteta i njegovih roditelja.
Tretman uključuje: lekove za oralnu, muskularnu i intratekalnu primenu, fizikalnu terapiju, primenu ortoza, hirurške intervencije.
Quality of life (QOL) in families can be affected when a child has cerebral palsy (CP). The aim of this research was to determine the effect of a child’s disability on the mother’s quality of life by ...comparing mothers of children with CP and mothers of normal children. Two sample groups were chosen from a total of 42 mothers to answer a short-form health survey (SF-36) questionnaire. The first group included 21 mothers of children with cerebral palsy who were referred to the speech therapy clinic of Jundishapur University of Medical Sciences in Ahvaz. The second group consisted of 21 mothers of normal children living in Ahvaz. T-tests by SPSS were used for statistical analysis. There were significant differences in all domains of QOL between mothers of healthy children and mothers of children with cerebral palsy (p=0.001). This research found that the quality of life of mothers of children with CP was significantly different compared to mothers of healthy children. Therefore, appropriate planning is necessary to improve their quality of life in different domains.
Kvalitet života porodica koje imaju dete obolelo od cerebralne paralize (CP) može biti značajno izmenjen. Cilj ovog istraživanja bio je da se ispita uticaj invaliditeta deteta na kvalitet života majke tako što su upoređivane majke dece sa cerebralnom paralizom i majke zdrave dece.
Istraživanje je obuhvatilo dve grupe od ukupno 42 majke koje su odgovorile na kratak upitnik (SF- 36). Prva grupa je uključila 21 majku dece sa cerebralnom paralizom koja su bila upućena na Kliniku za terapiju govora u okviru Jundišapur Univerziteta Medicinskog fakulteta u Ahvazu. Drugu grupu je sačinjavala 21 majka zdrave dece koja su takođe živela u Ahvazu. Rezultati su obrađeni kompjuterskim programom za statističku analizu podataka (SPSS) i korišćen je T-test. Utvrđene su značajne razlike u svim domenima kvaliteta života između majki zdrave dece i majki dece sa cerebralnom paralizom (p=0.001).
Istraživanjem je utvrđeno da je kvalitet života majki dece sa cerebralnom paralizom značajno izmenjen u poređenju sa kvalitetom života majki zdrave dece. Stoga je potrebno uraditi detaljno planiranje kako bi se poboljšao njihov kvalitet života u različitim domenima.
The aim of this study was to explore the predictors of adjustment among parents of children with cerebral palsy in the context of risk and resistance model of adjustment to chronic disorders ...(Wallander and Varni, 1998). The participants were parents of 77 children with cerebral palsy who attend regular kindergartens and schools, and in some instances special institutions, from eight Croatian cities. There were 59 married couples and 18 parents without their partners in the group of parents of children with cerebral palsy. The results show that particular risk and resistance factors have significant direct effect on the mother's and father's psychical symptoms. Significant predictors, depending on the gender of parents, are child behavior problems, parental stress and neuroticism. Higher perception of child behavior problems, more intensive parental stress and higher neuroticism are related to worse parental adjustment. The results suggest significant moderational effect of pessimism and family functioning on the relationship between the intensity of parental stress and psychical symptoms among mothers and/or fathers of children with cerebral palsy: low pessimism and high family cohesion and adaptability have a protective role in a situation of intensive parental stress. The results also show mediational effect of parental stress in the relation between child behavior problems and adjustment of mothers. PUBLICATION ABSTRACT
OD FETALNE DO NEONATALNE NEUROLOGIJE Zaputović, Sanja; Stanojević, Milan; Mišković, Berivoj
Gynaecologia et perinatologia (Zagreb, Croatia),
03/2010, Letnik:
19, Številka:
1
Journal Article
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Posljednjih nekoliko godina sve se veći značaj pridaje mogućim prenatalnim čimbenicima oštećenja mozga u djece s neurološkim oštećenjem. Dokazano je da četvrtina djece umrle tijekom ranog neonatalnog ...razdoblja imaju prenatalno oštećenje mozga. Nadalje, postoje snažni dokazi da u većine terminske djece oboljele od cerebralne paralize nije razlog perinatalna asfiksija, nego uzroke treba tražiti još za vrijeme intrauterinog života. Praćenje i razvoj fetalnih, odnosno neonatalnih pokreta opisani su kao važan proces sazrijevnja i vrlo osjetljiv pokazatelj cjelokupnog neurološkog, odnosno budućeg kognitivnog statusa djeteta. Pojava visoko kvalitetnih 3D/4D ultrazvučnih aparata omogućila je napredak u analizi obrazaca fetalnih pokreta. Promatranje u stvarnom vremenu s dovoljno dinamike i s dobrom rezolucijom prikaza omogućilo je stvaranje novog prenatalnog KANET brojevnog testa. Parametri koji su korišteni u tom testu rezultat su prethodno provedenih multicentričnih istraživanja fetalnog ponašanja primjenom 2D ultrazvuka i neonatalnih znakova preporučenih od Amiel-Tison. Otkako je primjena 4D ultrazvuka omogućila prikaz i vrednovanje fetalnog lica i malih anatomskih struktura, pokreti usta, očiju i prstiju uvedeni su kao posebne varijable u vrednovanju testa. Prednost je također i primjena dijagnostičkih kriterija u fetalnom i neonatalnom razdoblju. Neonatalna neurologija je novo obećavajuće područje za mogućnost prenatalnog neurološkog testiranja.
Definition and classification of cerebral palsy (CP) are constantly reconsidered. The previous definitions have not emphasised non-motoric neurodevelopmental problems that often accompany CP, as well ...as the progression of musculoskeletal problems. Today, the limitations of person with CP in performing activities of daily living, are increasingly assessing. Thus, the level of functional limitation becomes a key criteria in the redefinition of CP.
The concept of unique definition and classification of CP is still evolving. New parameters in the definition and classification of this clinical entity should meet the needs of clinicians and scientists, but also families and the public, in order to create a common, international language and to improve mutual communication. Simplified SCPE (Surveillance of Cerebral Palsy in Europe) classification based on neurological symptoms, and classification systems for classification of gross (GMFCS - Gross Motor Function Classification System) and fine motor function (BFMF - Bimanual Fine Motor Function and MACS - Manual Ability Classification System) have become universally accepted instruments in working withpeople with CP.
Although the one of the proposed dimensions of classification is cause and time of occurrence of CP, the classification by the cause would be currently unrealistic. However, the latest findings in developmental neurobiology and neuroradiology play an important role in revealing the pathogenesis of CP, and thus facilitates planning and developing of the most appropriate therapy treatments and (re)habilitation intervention. The considerations behind the process of redefining and reclassifing CP are aimed towards unambiguously leading of national registries, easier monitoring of prevalence and comparison of the effects of interventions, and to more productive collaboration between experts in different fields.
Cerebralna paraliza (CP) najčešći je uzrok težih neuromotoričkih odstupanja u djece, a predstavlja klinički entitet koji označava skupinu neprogresivnih, no često promjenjivih motoričkih poremećaja ...uzrokovanih razvojnim poremećajem ili oštećenjem mozga u ranom stadiju razvoja djeteta. Prema Europskoj mreži registra djece s cerebralnom paralizom (SCPE – Surveillance of cerebral palsy in Europe), temeljna klasifikacija cerebralne paralize sastoji se od temeljnih neuroloških simptoma, pa tako postoji spastični, diskinetički i ataksični oblik.
Cilj ovog rada bio je prikazati značaj fizioterapije kod djece s cerebralnom paralizom, s pojačanim fokusom na bilateralni spastični tip cerebralne paralize. U fizioterapijskoj procjeni, uz uobičajene metode, primjenjuju se mnogi specifični testovi i mjerenja. Na temelju procjene, planira se daljnji tijek terapije individualno za svakog pojedinca, a neke su od najčešćih metoda intervencije: neurorazvojna terapija prema Bobathu i Vojtin princip. U svrhu izrade rada pretraženi su izvori baza podataka, zbog uvida u učinkovitost fizioterapije kod navedene teme.
U radu je također prikazan tijek fizioterapijske procjene i intervencije kod djeteta sa spastičnim bilateralnim tipom cerebralne paralize. Prikazan je slučaj djeteta s navedenom dijagnozom u dobi od pet godina. Fizioterapijski postupci provođeni su u razdoblju od dva tjedna u Specijalnoj bolnici za zaštitu djece s neurorazvojnim i motoričkim smetnjama, Goljak. Objektivni dio fizioterapijske procjene najviše se temelji na testu GMFM-66. Na temelju tih rezultata proveden je plan i tijek terapije djeteta u trajanju od dva tjedna.
Opisujemo bolesnika s akutnim encefalomijeloradikulitisom tijekom leptospiroze. Kao prvi neurološki deficit je 7. dana bolesti zabilježena unilateralna paraliza ošita. Bolesnik je od 7. dana bolesti ...liječen amoksicilin/klavulonskom kiselinom kroz 7 dana. Simptomi poliradikulitisa su se pojavili u drugoj fazi bolesti te su progredirali unatoč započetom liječenju visokim dozama deksametazona. Bolesnik se u konačnici potpuno oporavio.
Cilj ovog istraživanja je utvrditi glasovne karakteristike kod osoba s jednostranom paralizom glasnice prije i poslije terapije glasa. Procjena glasa odnosi se na perceptivnu procjenu te objektivnu, ...koja uključuje akustičku analizu i aerodinamičke testove fonacije. U istraživanju je sudjelovalo 9 osoba ženskog spola, u dobi od 27 do 66 godina. Zvučni zapisi spontanog govora korišteni su za perceptivnu procjenu glasa, koju su obavila tri stručna klinička logopeda s iskustvom u području patologije glasa. Snimljeni uzorci fonacije analizirani su u programu Praat za akustičku analizu glasa. Dobiveni podaci obrađeni su deskriptivnom statistikom i neparametrijskim testovima. Rezultati istraživanja pokazuju statistički značajne razlike u perceptivnoj procjeni glasa prije i poslije terapije, i to kao poboljšanje kvalitete glasa. Prema perceptivnoj procjeni, glas ispitanica poslije terapije bio je normalan ili blago promukao. Razlike su se pokazale i na rezultatima objektivne procjene glasa. Za varijable shimmer, jitter i maksimalno vrijeme fonacije, te su razlike pokazane statistički značajnima. Dobiveni rezultati perceptivne i objektivne procjene potvrđuju vrijednost glasovne terapije za osobe s jednostranom paralizom glasnice. Terapija glasa je neinvazivni oblik rehabilitacije i prvi je izbor osobama kojima je poremećaj glasa najteži simptom paralize glasnice.
The aim of this study is to determine the vocal characteristics of patients with unilateral vocal fold paralysis before and after voice therapy. Voice assessment refers to a perceptual and objective evaluation that includes acoustic analysis and aerodynamic voice measurements. This study included 9 female patients aged between 27 and 66 years. Recordings of conversational speech were used for the perceptual evaluation of voice, which was assessed by three speech and language therapists experienced in the field of voice pathology. Recorded samples of phonation were analyzed using the Praat programme for acoustic voice analysis. All collected data was analyzed using descriptive statistics and nonparametric tests. The results of this study demonstrate a significant difference between perceptual evaluations of voice before and after voice therapy in the form of improved voice quality. According to the perceptual evaluation, the voices of all patients were normal or slightly hoarse following therapy. Objective differences were also found before and after voice therapy. For shimmer, jitter and maximum phonation time values, these differences were statistically significant. The results of both perceptual and objective evaluations indicate the importance of voice therapy for people with unilateral vocal fold paralysis. Voice therapy is a noninvasive form of rehabilitation and should be the first choice for patients who experience dysphonia as the most severe symptom of unilateral vocal fold paralysis.
Cilj ove populacijske studije bio je procijeniti karakteristike cerebralne paralize (CP) u odnosu na predominantni uzorak na magnetskoj rezonanciji mozga prema klasifikacijskom sustavu Magnetic ...Resonance Imaging Classification System (MRI CS) koji je analogno primijenjen i na novorođenački/rani dojenački intrakranijski ultrazvuk (UZV). Istraživanje je uključivalo djecu rođenu od 2004. do 2007. godine iz hrvatskog dijela (C28 RCP-HR ) Registra Europskog projekta nadzora cerebralne paralize (Surveillance of Cerebral Palsy in Europe, SCPE). Ispitivane su grube i fine motoričke funkcije, pridružena odstupanja
i slikovni prikazi mozga u 227 djece s MRI mozga od kojih je 185 imalo i neonatalni/rani dojenački UZV. U odnosu na tip CP, 56% djece imalo je bilateralno spastičnu, 34% jednostrano spastičnu, 9% diskinetsku i 1% ataktičku CP. Prema funkcionalnoj klasifikaciji grubih motoričkih funkcija Gross Motor Function Classification System (GMFCS), 62,05% djece imalo je blaže motoričko oštećenje (GMFCS I-III ), a 37,85% teško motoričko oštećenje (GMFCS IV-V). Intrakranijski UZV pokazao je oštećenje bijele tvari mozga u 60%, ozljedu sive tvari u 12%, poremećaj razvoja mozga u 8%, razne promjene u 14% ispitanika, dok ih je 6% imalo normalan nalaz; MRI je pokazala značajnu podudarnost (κ=0,675, p<0,001). Poremećaji razvoja mozga i predominantne ozljede sive tvari mozga bile su povezane s težim stupnjem CP, no 7% djece s CP imalo je normalnu MRI mozga. Zbog vrlo dobre podudarnosti UZV i MRI nalaza u našem istraživanju UZV se preporučuje kod djece s povećanim rizikom od CP ako MRI nije dostupna.
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