Serebral Palsi Rehabilitasyonu
Özet
Serebral palsi (CP); fetüs veya infantın gelişmekte olan beyninde meydana gelen, ilerleyici olmayan bir hasar neticesinde kas tonusu, duruş ve hareketi olumsuz etkileyen heterojen ve kalıcı bir motor gelişim bozukluğudur. Çocukluk döneminde motor özürlülüğe yol açan en yaygın neden olan bu klinik tablonun prevalansı, yapılan toplum tabanlı çalışmalarda 1000 canlı doğumda 1,5 ila 2,5 arasında bildirilmektedir. CP'nin etyolojisi çoğunlukla multifaktöriyel olup; prenatal (%75-80), perinatal (<%10) ve postnatal (%10-20) dönemlerdeki olumsuz etkenlere bağlı gelişir; özellikle prematürite ve periventriküler lökomalazi en güçlü belirleyiciler arasındadır. Klinik tanı; detaylı gelişim öyküsü, nörolojik muayene bulguları ve MRG gibi radyolojik yöntemlerin kombinasyonuyla konulmaktadır. Tedavide temel amaç, hastanın günlük yaşam aktivitelerinde bağımsızlığını optimize etmek ve kalıcı deformiteleri önlemektir. Spastisite ve hipertoni yönetiminde baklofen, diazepam gibi oral ajanların yanı sıra botulinum toksini enjeksiyonları ve dirençli vakalarda intratekal baklofen pompası, selektif dorsal rizotomi ve derin beyin stimülasyonu gibi nöroşirürjikal yaklaşımlardan oluşan multidisipliner bir rehabilitasyon süreci yürütülür.
Cerebral palsy (CP) is a permanent, non-progressive motor development disorder affecting muscle tone, posture, and movement, resulting from an underlying developmental anomaly or injury to the fetal or infant brain. Recognized as the most frequent cause of motor disability in childhood, its prevalence is generally estimated between 1.5 and 2.5 per 1,000 live births in population-based studies. The etiology of CP is highly multifactorial, classified into prenatal (75-80%), perinatal (<%10), and postnatal (10-20%) periods, where prematurity and periventricular leukomalacia represent the strongest predictors of subsequent brain damage. Diagnosis is established clinically through a comprehensive evaluation of prenatal and postnatal medical history, physical neurological examination, and neuroimaging techniques such as MRI. The ultimate goal of management is to minimize secondary musculoskeletal deformities, improve mobility, and enhance functional independence. Spastisity and hypertonia management requires a well-structured, multidisciplinary rehabilitation team utilizing oral pharmacological agents like baclofen and diazepam, focal botulinum toxin injections, and specialized neurosurgical procedures such as intrathecal baclofen pumps, selective dorsal rhizotomy, and deep brain stimulation for severe cases.
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