Serebral Palsi

 

Serebral palsi (SP) hareket ve vücudun duruş bozukluğudur. Serebral palsinin kelime anlamı beyin felcidir. Serebral palsi, kaslarımızı kullanmamızı sağlayan ve hareketlerimizi kontrol eden beyin kısımlarının harabiyeti sonucu gelişir. SP sadece bir hastalığa işaret etmez, birbirinden farklı bir grup hastalık tablosunu anlatır, ancak hareket bozukluğu temel bulgudur. Bazen öğrenme güçlüğü, zekâ geriliği, havale, görme ve işitme problemleri de eşlik edebilir. İlerleyici bir hastalık değildir, ancak sinir sisteminin olgunlaşmasıyla birlikte zaman içinde bazı değişiklikler görülebilir.

Doğumdan önce, doğum sırasında ya da sonrasında (ilk 5 yaşta) yaşanan olumsuz olaylar serebral palsiye neden olabilir. Beyindeki hasar ne kadar fazla ise serebral palsi de o oranda ciddi seyreder. Bazen de tüm incelemelere karşın serebral palsinin ortaya çıkma nedeni saptanamaz.

Serebral palsiye yol açan nedenler:

– Anne karnında geçirilen enfeksiyonlar (mikrobik hastalıklar)

– Gebelikte ilaç ve alkol kullanımı

– Gebelikte yetersiz beslenme

– Plasentanın (eşin) erken ayrılması veya göbek kordonunda sorun olması

– Ciddi preterm (erken) doğum -özellikle beyin kanaması geçirenler-

– Düşük doğum ağırlığı

– Doğum sırasında bebeğin beynine yeterli oksijen gitmemesi

– Anne ile bebek arasında kan uyuşmazlığı

– Çoğul gebelikler (ikiz, üçüz)

– Bebekte ciddi sarılık

– Menenjit (beyin zarının iltihabı)

– Beyin kanamaları

– Boğulma

– Kafa travması

– İnme (herhangi bir nedenle vücudun bir tarafının kullanılamaması).

 

Serebral Palsinin Tipleri

– Spastik: Kasların gerginliği belirgin olarak artmıştır. İstemli hareket sırasında gerginlik daha da artar; bu gerginlik kol ve bacaklarda daha belirgindir. Serebral palsinin en sık görülen şeklidir.

– Atetoik (diskinetik): Bu tipte, tüm vücudun hareketi etkilenir. Yavaş, istem dışı hareketler çocuğun yardımsız oturması ve yürümesine engel olur, hareketler birbirine karışır, çocuk hareketlerini kontrol edemez.

– Hipoton: Gevşeklik hakimdir. Önceleri hipotonik olan çocuklar daha sonra spastik olabilirler.

– Mikst: Birkaç tipin bir arada görülmesidir. SP’nin en ağır şeklidir.

 

Hareket bozukluğunun vücuttaki dağılımına göre sınıflandırılması:

– Kuadripleji (tetrapleji) (kuadri veya tetra “dört” anlamına gelir, pleji “felç” demektir): Kollar ve bacakların yani dört uzvun tutulduğu şekildir.

– Hemipleji  (hemi “yarım” anlamına gelir): Aynı taraftaki kol ve bacağın etkilenmesidir.

– Dipleji: Bacakların kollardan daha fazla etkilendiği şekildir. Özellikle ciddi preterm olanlar (yani beklenenden daha erken doğanlar) risk altındadır.

– Parapleji: Sadece bacakların tutulduğu tiptir.

 

Serebral Palsiyi Düşündüren bulgular:

  • Yaşıtlarına göre oturma, emekleme ya da yürümenin gecikmesi
  • Yaşıtlarına göre hareket yeteneğinin az olması
  • Kasların çok sert ya da çok gevşek olması
  • Kaslarda güçsüzlük olması ve kas kontrolünün yeterli olmaması
  • Bulunmaması gereken reflekslerin varlığı
  • 18 aydan önce el tercihinin olması
  • Denge sağlamada güçlük
  • Sürekli parmak ucunda yürüme
  • Emme ve yutma problemleri
  • Şaşılık

 

Serebral palsi giderek kötüleşen bir hastalık değildir. Ancak düzgün fizik tedavi görmeyen olgularda kalıcı eklem sertlikleri oluşabilir. Eğer çocuğunuzda düzenli fizik tedavi yapılmasına rağmen gerileme hissediyorsanız (örneğin oturma yeteneğini kazanmış bir çocuk oturamıyorsa) doktorunuzu bilgilendirin. Bu durumda çocuğunuzun yeniden değerlendirilmesi gerekmektedir.

Serebral Palsi’nin  kesin bir tedavisi yoktur. Ancak erken başlanan ve düzenli sürdürülen fizik tedavinin önemi tartışılmazdır. Fizik tedavinin amacı, hareketlerin kolaylaştırılması, yanlış pozisyonların düzeltilmesi  ve kalıcı deformitelerin, yani eklem sertliklerinin önlenmesidir. Çocuğa günlük yaşamında ihtiyaç duyduğu hareketlerin öğretilmesi hedeflenir, böylelikle bağımsızlık kazanmasına yardımcı olunur. Bunlar özellikle beslenme, tuvalet ihtiyacı, banyo, giyinme ve soyunmadır. Mümkün olan en iyi sonucu almak amacıyla yardımcı cihazlara da başvurulabilir.

Serebral palsili bir çocuğun takibi, (çocuk hekimi, çocuk nöroloğu, fizyoterapist, eğitim uzmanı, psikolog gibi uzmanların katılımıyla) birden fazla disiplinin bir arada çalışmasını gerektirir. Gerektiğinde, (ortopedi ve beyin cerrahisi gibi) diğer bilim dallarından da yardım alınır. Göz ve işitme problemleri ilgili hekimlerle çözümlenir.

Fizik tedavinin yanı sıra eğitim de tedavinin ayrılmaz bir parçasıdır.

 

Yararlanılan Kaynak:

Serebral Palsi ; Tanımı, nedenleri, tipleri ve eşlik eden sorunlar

Prof. Dr. Mine Çalışkan

 

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