Deprecated: mysql_connect(): The mysql extension is deprecated and will be removed in the future: use mysqli or PDO instead in /irehabilitujemy/config/database.php on line 13

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Analiza rozwoju motorycznego dzieci z przepukliną oponowo-rdzeniową i stosowane metody rehabilitacji - Fizjoterapeuta. Rehabilitacja. | iRehabilitujemy.pl
    • 02
      pa
      2013

    Analiza rozwoju motorycznego dzieci z przepukliną oponowo-rdzeniową i stosowane metody rehabilitacji

    Przepuklina oponowo-rdzeniowa zajmuje szczególne miejsce wśród wad wrodzonych układu nerwowego. Stwierdzona po urodzeniu, niesie konsekwencje dla dalszego rozwoju. Wadzie towarzyszy zniesienie lub osłabienie przewodzenia bodźców nerwowych od struktur centralnych na obwód ciała do mięśni, skóry i narządów wewnętrznych. Celem pracy była analiza rozwoju motorycznego pacjentów z przepukliną oponowo- rdzeniową oraz stosowanych metod usprawniania. Grupa badawcza obejmowała 86 pacjentów w wieku 1–17 lat (średnia 7 ± 4,4 lat) z rozpoznaną przepukliną oponowo-rdzeniową (42 dziewczęta i 44 chłopców), podopiecznych Kliniki Neurologii i Rehabilitacji Dziecięcej. Na podstawie badania klinicznego pacjentów podzielono na grupy w zależności od poziomu uszkodzenia rdzenia kręgowego. Analizowano rozwój motoryczny oraz metody terapeutyczne stosowane w rehabilitacji. 
     
    Wyniki. Statystycznie istotne różnice w zakresie opóźnienia funkcji raczkowania i siadania stwierdzono niemal u wszystkich pacjentów z uszkodzeniem piersiowym i w większości z lędźwiowym. W trzecim roku życia aż 86% grupy dzieci z piersiową lokalizacją przepukliny oponowo-rdzeniowej nie chodziło samodzielnie, natomiast z krzyżową wszystkie chodziły samodzielnie. Nie wykazano statystycznie istotnych różnic w rozwoju ruchowym między stosowanymi metodami rehabilitacyjnymi. 
     
    Wnioski. Przepuklina oponowo-rdzeniowa jest przyczyną znacznego opóźnienia rozwoju motorycznego. Stosowane metody rehabilitacji nie warunkują bezpośrednio ostatecznego efektu usprawniania, lecz wpływają na hamowanie patologicznych odruchów wczesnodziecięcych, ułatwiają powstawanie fizjologicznych wzorców ruchowych i stymulują rozwój psychoruchowy. Stopień osiągniętej lokomocji zdeterminowany jest w znacznej mierze poziomem uszkodzenia rdzenia kręgowego. 
     1. Wiek chodzenia u pacjentów z przepukliną oponowordzeniową jest uzależniony od poziomu uszkodzenia rdzenia kręgowego i ostatniego zachowanego neurosegmentu.Przy lokalizacji piersiowej wszyscy pacjenci wykazują opóźnienie rozwoju ruchowego, a przy lokalizacji krzyżowej prawidłowy rozwój motoryczny. 
      2. Metody neurofizjologiczne stosowane w programie leczenia pacjentów z przepukliną oponowo-rdzeniową ułatwiają osiągnięcie pełnej pionizacji i samodzielnego chodu, zwłaszcza przy lokalizacji lędźwiowej i krzyżowej uszkodzenia rdzenia kręgowego. Nie stwierdzono istotnych zależności między wybraną metodą usprawniania a tempem rozwoju motorycznego.
     3. Należy wziąć pod uwagę fakt, że w przepuklinie oponowo-rdzeniowej pewne uszkodzenia są nieodwracalne. Jednak duże możliwości kompensacyjne rozwijającego się mózgu stwarzają realną szansę na poprawę stanu psychofizycznego niepełnosprawnego dziecka, dlatego kompleksowe usprawnianie powinno rozpocząć się jak najwcześniej.
     Źródło: Bożena Okurowska-Zawada1, Wojciech Sobaniec2, Wojciech Kułak1, Krzysztof Sendrowski2, Dorota Otapowicz 2 Neurol Dziec 2008; 17, 33: 31-38 1Klinika Rehabilitacji Dziecięcej Akademii Medycznej w Białymstoku 2 Klinika Neurologii i Rehabilitacji Dziecięcej Akademii Medycznej w Białymstoku
     
     
     Czym jest rozszczep kręgosłupa ?
    Jest to wada rozwojowa kręgosłupa. Polega ona na niewykształceniu (braku) tylnej części łuków kręgowych i często uszkodzeniu w obrębie rdzenia kręgowego. Powstaje w pierwszym miesiącu ciąży. Tkanka, z której powstaje skóra i układ nerwowy zagina się dogrzbietowo, aby zamknąć się w rynienką nerwową. Kiedy rynienka nerwowa nie zamknie się całkowicie powstaje właśnie rozszczep kręgosłupa (z nim związana jest przepuklina oponowo-rdzeniowa) - dalszy rozwój rdzenia kręgowego i kręgów kręgosłupa u dziecka będzie zachodził nieprawidłowo.
     Jak często występuje ta wada ?
    W Polsce ok 1 dziecko (0.92-0.94) na 1000 urodzeń obarczone jest tą właśnie wadą (około 500 noworodków rocznie). Częstość tą można porównać do częstości urodzeń dzieci z zespołem Downa. Regionami, gdzie liczba wystąpień jest znacznie większa od przeciętniej są białostockie, bielsko-podlaskie, łomżyńskie, siedleckie.
    Jak ta sytuacja wygląda w innych krajach ?
    Przykładowo w Wielkiej Brytanii rozszczep kręgosłupa występuje u 3.5 dzieci na 1000 (szczególnie dużo takich dzieci rodzi się w Walli), w Stanach Zjednoczonych u 1 dziecka na 1000. Nie jesteśmy więc krajem odosobnionym.
    Jaka jest przyczyna powstania tej wady ?
    Do powstania rozszczepu kręgosłupa dochodzi na skutek nałożenia się wielu czynników środowiskowych (infekcje, naświetlanie promieniami rentgenowskimi, zatrucie środowiska) i genetycznych. Związek z powstaniem tej wady może mieć niedobór kwasu foliowego i witamin z grupy B w organizmie matki.
    Czy można jej zapobiec ?
    Zmniejszenie ryzyka wystąpienia tej wady polega na przyjmowaniu przez przyszłe mamy 4 mg kwasu foliowego dziennie, przynajmniej na miesiąc przed planowanym zajściem w ciążę i do końca pierwszego trymestru ciąży (zmniejszenie ryzyka ok. 70%). W przypadku ciąż nieplanowanych trudno ochronić dziecko przed wystąpieniem tej wady. Są jednak mamy, które mimo przyjmowania kwasu foliowego przed zajściem w ciążę urodziły dziecko z rozszczepem kręgosłupa. Badania nad tą chorobą cały czas trwają.
    Jakie jest ryzyko powtórzenia tej wady u kolejnych dzieci ? 
    Jednym z czynników odpowiedzialnych za powstanie rozszczepu kręgosłupa jest prawdopodobnie czynnik genetyczny. Stąd w rodzinach, gdzie urodziło się dziecko z rozszczepem kręgosłupa wzrasta ryzyko wystąpienia tej wady do 4% i rośnie do 10% w przypadku poprzedniego urodzenia dwojga dzieci chorych.
    Jakie są skutki wystąpienia rozszczepu kręgosłupa u dziecka ? 
    Wiele zależy od stopnia i miejsca uszkodzenia rdzenia kręgowego. Najczęściej następstwami wady są: neurogenny pęcherz moczowy (uszkodzony ośrodek oddawania moczu), porażenie lub osłabienie mięśni odbytu i odbytnicy (zaparcia, tworzenie się kamieni kałowych), deformacje stawów kończyn dolnych i kręgosłupa (zaburzenie unerwienia mięśni i trudności w poruszaniu się), zaburzenia czucia skórnego (grozi powstawaniem odleżyn). U wielu dzieci (ponad 80%) występuje również wodogłowie. 
    Jakie są szanse, że dziecko będzie samodzielnie chodzić ?
    Zależy to od miejsca wystąpienia wady oraz od konsekwencji i intensywności rehabilitacji. Wiele dzieci chodzi korzystając z zaopatrzenia ortopedycznego (łuski ortopedyczne, kule, ortezy), niektóre mają tylko wkładki ortopedyczne do butów, część porusza się jednak na wózkach inwalidzkich (szczególnie gdy wada wystąpiła w części piersiowej kręgosłupa).
    Jakiemu leczeniu musi być poddane dziecko ? 
    Większość dzieci w pierwszej dobie życia przechodzi operacyjne zamknięcie rdzenia i skóry na plecach w miejscu wystąpienia wady. Dzieciom, które mają czynne wodogłowie zakłada się zastawki, zapobiegające narastaniu wodogłowia i niszczeniu struktur mózgu. Ważne jest wczesne zbadanie uszkodzenia funkcji pęcherza moczowego i stanu nerek. Często aby chronić nerki przed uszkodzeniem i jednocześnie kontrolować oddawanie moczu stosowane jest u dzieci czyste okresowe cewnikowanie p?cherza moczowego. Niektóre dzieci później wymagają jeszcze operacji ortopedycznych w celu korekcji problemów dotyczących stawów biodrowych, kolan i stóp, czy skrzywień kręgosłupa. Zwykle dzieci wymagają opieki i stałej kontroli wielu specjalistów: neurochirurga, urologa, neurologa, ortopedy, rehabilitanta i innych w zależności od przypadku.
    Czy dziecko z tą wadą będzie mogło chodzić do normalnej szkoły ?
     Większość dzieci z rozszczepem kręgosłupa uczęszcza do zwykłych szkół wraz z innymi dziećmi, czasem wymagają one dodatkowej pomocy (najczęściej możliwej w ramach zwykłej szkoły).W wielu Polskich szkołach głównym problemem jest wózek inwalidzki.
    Jakie szanse mają dzieci na zwykłe dorosłe życie ?
    Informacje z USA i krajów Europy Zachodniej mówią, że coraz więcej dzieci z rozszczepem kręgosłupa dorasta i zakłada własne rodziny. Rodzą im się zdrowe maluchy. Zdobywają zawody, niektórzy kończą studia, podejmują pracę. Tak jak inni ludzie. Jednak okresowe cewnikowanie pęcherza, kontrole lekarskie, aktywna rehabilitacja, czasem wózek inwalidzki są w ich życie wpisane na stałe. Szansę na taką normalność mają dzięki fachowej opiece lekarskiej, dużej pracy swoich rodziców i sile własnego charakteru. 
     Trochę fachowej wiedzy w: 
    1. Zespołowa opieka nad dziećmi z wadami cewy nerwowej. 2001. Przedsiębiorstwo Wyd.-Reklam. Top-Art m. Jeziorko, Łazy, 64 s. ISBN 83-914217-3-2 Dostępne: w oddziałach Stowarzyszenia Chorych z Przepukliną Oponowo-Rdzeniową RP
    2. Wośko I.P. (red) 1995. Problemy ortopedyczno-rehabilitacyjne u dzieci z przepukliną oponowo-rdzeniową. Wyd. FOLIUM, Lublin, 156 s ISBN 83-86239-09-3 Dostępne: u wydawcy Wydawnictwo Folium sc, ul. Paganiniego 7/25, tel./fax 0 prefiks 81 714-333; 714-407; 303-42
    3. Klenk H., Laur S., Parsch K. 1995. Dziecko z przepukliną oponowo-rdzeniową. Postępowanie rehabilitacyjne i ortopedyczne.
     
    Wskazania dla rodziców. Wyd. Folium, Lublin 36s. ISBN 83-86239-16-6 Dostępne: u wydawcy Wydawnictwo Folium sc, ul. Paganiniego 7/25, tel./fax 0 prefiks 81 714-333; 714-407; 303-42 4. Sandler M.D 1997. Living with Spina Bifida. A Guide for Families and Professionals.The University of North Carolina Press, Cape Hill and London, 262 pp. ISBN 0-8078-2352-x (cloth: alk.paper.) - ISBN 0-8078-4657-o (pbk.: alk.paper) Dostępne: u wydawcy The University of North Carolina Press, można kupić lub zamówić przez internet. 
     
    Źródło: http://rozszczep.pl/
     
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