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Yıl:2017; Cilt: 54; Sayı: 1>> Özet
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Nöropsikiyatri Arşivi; 2017;54(1):33-37
Serebral Palsili Çocuklarda Entelektüel Gelişim ve İlişkili Faktörler
G Türkoğlu, S Türkoğlu, C Çelik, H Uçan
Konya Eğitim ve Araştırma Hastanesi, Konya
Amaç: Serebral Palsi (SP) çocukluk çağında en sık görülen ciddi motor bozukluktur. SP’li çocuklarda her ne kadar entelektüel bozukluk yaygın olsa da, SP primer olarak postür ve hareket bozukluğu olarak tanımlanır. Bu çalışmanın amacı, epilepsi gibi eşlik eden komorbid durumların varlığı, SP tipi ve kaba motor fonksiyon ve el fonksiyonu ile ilişkili entelektüel düzeyi incelemektir. Yöntem: SP’li 107 çocuk çalışmaya alındı. Tüm hastaların yaş, cinsiyet, prenatal/natal/postnatal risk faktörleri, SP tipi, diğer nörogelişimsel bozuklukları kaydedildi. Çocukların entelektüel fonksiyon düzeyleri; klinik muayene, günlük yaşamda uyumsal işlevselliğin değerlendirilmesi ve bireye uygulanan, kabul gören bir zeka ölçümü ile doğrulamayla belirlendi. Çocukların kaba motor fonksiyon ve el fonksiyonları “Kaba Motor Fonksiyon Sınıflama Sistemi (KMFSS)” ve “Bimanuel İnce Motor Fonksiyon (BİMF)” ölçümü kullanılarak sınıflandırılmıştır. Bulgular: Yaş ortalamaları 8,10±3,43 yıl (2-16 yaş) olan 107 olgu çalışmaya alındı. Olguların 63’ü (%58,9) erkek, 44’ü (%41,1) kızdı. Klinik tiplendirmede, spastik tip %80,4, mikst tip %11,2, diskinetik tip %4,7 ve ataksik tip %3,7 olarak bulundu. Çocukların %26,2’si normal entelektü- el gelişim düzeyine sahip iken, %10’unda sınır, %16’sında hafif, %17’sinde orta ve %30,8’sinde ağır düzeyde entelektüel yetiyitimi saptandı. SP tipi ile entelektüel düzey arasında anlamlı ilişki bulunmadı (p>0,05). Entelektüel düzey, el fonksiyonları ve motor düzeyin ikisi ile de korele bulundu (p<0.001). Konvülsiyon, epilepsi ve konuşma bozukluğu varlığının, entelektüel kapasite ile ilişkili olduğu bulundu. Sonuç: Entelektüel değerlendirme, SP ile ilişkili değerlendirmenin ve araştırmaların temel parçasıdır. SP'li çocuklarda entelektüel düzeyi değerlendirmek için güvenilir ve fikir birliği sağlanmış geçerli veriler ve toplumlara spesifik normlar yeterli değildir. SP’li çocuklarda entellektüel değerlendirmenin doğru yapılmasına yönelik araştırmalara gereksinim vardır.
Intelligence, Functioning, and Related Factors in Children with Cerebral Palsy
Introduction: Cerebral palsy (CP) is the most common significant motor impairment in childhood. CP is defined as a primary disorder of posture and movement; however, intellectual impairment is prevalent in children with CP. The purpose of this study was to examine the intelligence level associated with gross motor function and hand function, type of CP, the presence of comorbid disorders such as epilepsy, and other factors. Methods: In total, 107 children with CP were included. Age, gender, prenatal/natal/postnatal risk factors, type of CP, and presence of other neurodevelopmental disorders were recorded as demographic findings. Intellectual functions of the patients were determined by clinical assessment, adaptive function of daily life, and individualized, standardized intelligence testing. The gross motor function and hand function of the patients were classified using the “Gross Motor Function Classification System” and “Bimanual Fine Motor Function” measurements, respectively. Results: The mean age of the patients was 8.10±3.43 years (2–16 years). The study included 63 (58.9%) male patients and 44 (41.1%) female patients. During clinical typing, 80.4% of the patients were spastic, 11.2% were mixed, 4.7% were dyskinetic, and 3.7% were ataxic. Intellectual functioning tests found 26.2% of the children within the intellectual norm and that 10% of the children had a borderline intellectual disability, 16% of them had a mild intellectual disability, 17% of them had a moderate intellectual disability, and 30.8% of them had a severe intellectual disability. No significant relationship was determined between the CP type and intellectual functioning (p>0.05). Intellectual functioning was found to be significantly correlated with hand functions and motor levels (p<0.001). Factors related with intellectual functioning were neonatal convulsion, epilepsy, and speech disorders. Conclusion: Intelligence assessment should be an essential part of CP evaluation and research. There is not enough reliable knowledge, unanimity regarding validity data, and population-specific norms in the intelligence assessments of children with CP. Research is required to assess properly intelligence for children with CP.

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