Seviye IV Desteksiz Uzun Oturma Destekli Uzun Oturma 19,05 11,39 1,67 (Büyük) Desteksiz Kısa Oturma Destekli Kısa Oturma 18,26 12,73 1,43 (Büyük)
6. SONUÇLAR VE ÖNERİLER
Çalışmamızın amacı doğrultusunda spastik kuadriplejik 41 SP’li çocuğu seviye III ve IV olarak iki gruba ayırarak destekli/desteksiz kısa ve uzun dört farklı oturma pozisyonuna yerleştirerek her oturma pozisyonunda üst ekstremite fonksiyonlarının kalitesini inceledik ve uygun istatistiksel analizler kullanılarak elde edilen verileri karşılaştırdık. Sonuç olarak;
1. GMFCS III ve IV arasında, yaş, kilo, boy, BMI gibi demografik verileri arasında anlamlı bir fark bulunmadı bu da değerlendirdiğimiz popülasyonun homojenliğini göstermektedir.
2. Seviye III’te yer alan çocukların GMFM, ECAB ve QUEST alt bölüm ve total skorları seviye IV’teki çocuklara göre daha yüksek çıktı. Motor fonksiyon seviyesi iyileştikçe postüral kontrol ve üst ekstremite becerilerinin kalitesi de arttı.
3. Adaptif oturma desteği ile kısa ve uzun oturma pozisyonunda QUEST değerleri desteksiz pozisyonlara göre her iki grupta da daha yüksek hesaplandı.
4. Kısa oturma pozisyonu (destekli > desteksiz) hem seviye III’te hem seviye lV’teki çocuklar için QUEST sonuçlarına göre üst ekstremitenin en fonksiyonel olduğu oturma pozisyonu olarak belirlendi.
5. QUEST toplam test skorları ile ECAB ve GMFM total puanları arasında yüksek pozitif bir ilişki çıktı. Postüral stabilitesi iyi olan çocuklarda farklı oturma pozisyonlarında üst ekstremite fonksiyonları daha iyi bulundu.
6. Kalça abduksiyon kemeri ve bantları, Seviye III ve IV’te yer alan kuadriplejik SP’li çocuklarda üst ekstremite selektif hareketlerini, kavrama ve bırakma gibi becerilerini artırmak için faydalı araçlar olarak değerlendirildi. 7. Gövde kontrolünde ve denge reaksiyonlarındaki yetersizliklerin, eklem
limitastonlarının, çocuğun fonksiyonelliğini olumsuz olarak etkilediği belirtildi.
Bu sonuçlar doğrultusunda araştırmacılara, klinisyenlere ve ailelere önerilerimizi aşağıdaki gibi sıralayabiliriz:
Fizyoterapi ve rehabilitasyon uygulamalarında spastik kuadriplejik SP’li çocuklarda bireysel değerlendirme sonucu uygulanacak terapi yaklaşımları, destekler, ortezler ve adaptif cihazlar ile aktivite ve katılımın artırılması sağlanabilir ve uzun dönemde ikincil problemler en aza indirilebilir.
Çocuğa özel yapılan bütüncül değerlendirmeler sonrası günlük yaşamda normale yakın vücut dizilimi ve kas tonusu ile üst ekstremite fonksiyonlarının sağlanabilmesi için yine çocuğa özel uygun oturma desteklerinin doğru pozisyonlarda kullanılmasının çocuk, aile ve fizyoterapist için çok önemli olduğunu düşünmekteyiz.
Spastik kuadriplejik SP’li çocukların ailelerine günlük yaşamda çocuklarını nasıl pozisyonladıkları sorgulanmalı, ailenin uyguladığı yanlışlıklar gösterilerek özellikle destekli oturma pozisyonlarının nasıl uygulanması, nelere dikkat edilmesi gerektiği aile eğitimi ve ev programı olarak verilmelidir.
Bağımsız oturma ve bu poziyonda bağımsız üst ekstremite fonksiyonları, gövde kuvveti ve dengenin artırılması için oturma fonksiyonunun ayrıntılı incelenmesi, gerekli durumlarda uygun pozisyon ve adaptif ekipmanların tarifi ve sonuçlarının klinisyenlerle paylaşılmasının SP’li çocuklarda fizyoterapi ve rehabilitasyon uygulamalarına yol gösterici olacağı düşüncesindeyiz.
Ülkemizde maliyeti düşük, pratik adaptif oturma düzeneklerinin geliştirilmesi, fizyoterapi yaklaşımlarına ışık tutması, ailelerin oturma pozisyonları hakkındaki kültürel yaklaşımlarını değiştirmeleri için farklı klinik tiplerdeki, farklı seviyelerdeki SP’li çocuklarla oturma pozisyonları üzerine daha ayrıntılı çalışmaların yapılması gerektiğini düşünmekteyiz.
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