Title (croatian) Smjernice (re)habilitacije djece s neurorazvojnim poremećajima
Title (english) (Re)habilitation guidelines for children with neurodevelopmental disorders
Author Valentina Matijević
Author Jelena Marunica Karšaj
Author's institution (Sestre milosrdnice University Hospital Center)
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Physical Medicine and Rehabilitation
Abstract (croatian) Središnji interes smjernica (re)habilitacije djece s neurorazvojnim poreme-ćajima jest identifikacija neurorizične djece. Neurorizična djeca nisu uvijek i djeca s neuromotoričkim odstupanjem. Neurorizična djeca čine 10 do 15% novorođenih. Kod 50% djece s neurorizikom dolazi do neurorazvojnog odstupanja s mogućim trajnim posljedicama. Smjernice (re)habilitacije djece s neurorazvojnim poremećajima temelje se na sljedećem: dječji fizijatar voditelj je programa (re)habilitacije; vrši rani probir novorođenčadi sa simptomima neurorizika (neuromotoričko odstupanje) u rodilištu; vrši procjenu spontane motorike, aktivnih pokreta, kvalitativnu analizu općih pokreta, procjenu mišićne snage i tonusa, palpaciju i ispitivanje pasivne pokretljivosti, refleksa; testiranje po Vojta principu; vrši testiranja pomoću dijagnostičkih testova. Isključivo dječji fizijatar indicira kojim će kineziterapijskim postupkom dijete biti stimulirano; donosi odluku o provođenju ambulantnog i stacionarnog liječenja; prema potrebi uključuje logopeda, defektologa, psihologa i drugih specijalista u tim. Zbog nepostojanja subspecijalizacije iz dječje (re)habilitacije, kazuistikom tog područja trebaju se baviti fizijatri koji imaju radnog iskustva u navedenom području minimalno 5 godina ili završen tečaj iz Bobath koncepta ili Vojta principa. Potrebno je uvođenje adekvatne nomenklature za određene neurorazvojne poremećaje vezano za samu patologiju bolesti i dob kada se pojavljuje. Neuromotoričko odstupanje treba se identificirati na prvom pregledu i pri svakom kontrolnom pregledu evaluirati radi li se o 1. vrlo blagom, 2. blagom, 3. umjerenom ili 4. teškom odstupanju, te shodno nalazu primijeniti adekvatnu stimulaciju. Stoga predlažemo da u DTS postupnik uvrstimo dvije nove vodeće dijagnoze Neuromotoričko odstupanje i Neurorizično dijete. koje bi bile indikacijama za stacionarno liječenje, a obračunavale bi se jednakovrijedno kao već postojeće Distoni sindrom i Parapareza. Klinička slika neuromotoričkog odstupanja može se brže ili sporije mijenjati jer je ovisna o maturaciji, neuroplasticitetu i primijenjenim terapijskim postupcima. Pristigao je potvrdan odgovor iz HZJZ za pokretanje Nacionalnog registra neurorizične djece, putem kojeg bi se organizirano i stručno pratila djeca, što ne bi isključivalo mogućnost da koordinator bude dječji fizijatar.
Abstract (english) The central interest of (re)habilitation guidelines for children with neurodevelopmental disorders is to identify children at neurorisk. Children at neurorisk are not always children with neurodevelopmental disorders. Those children make 10 to 15% of newborns. About 50% of children at neurorisk might develop potential disorder with lasting consequences. (Re)habilitation guidelines for children with neurodevelopmental disorders are based on the following: children’s physiatrist is the head of the (re)habilitation program; he or she performs early screening of newborns with symptoms of neurorisk in the maternity ward; evaluates spontaneous and active movements, provides qualitative analysis of the general movements, does assessment of muscle strength and tone, performs palpation and testing passive mobility, reflexes; performs diagnostics by Vojta principle; evaluates using other diagnostic tests. Only a children’s physiatrist indicates specific kinesiotherapeutic procedure for stimulation; makes a decision on the implementation of ambulatory and stationary treatment; if necessary, a defectologist, speech therapist, psychologist and other specialists are included in the team. Due to the absence of subspecialisation in children’s (re)habilitation, the casuistry of the area should be address by a physiatrist who has experience in this area for at least 5 years or certificate in Bobath concept or Vojta principle course. It is necessary to maintain appropriate nomenclature for certain neuromotoric disorders related to the varying pathology disease and age when it occurs. Neurodevelopmental disorder should be identified at baseline and at each follow-up examination to evaluate whether it is a 1) very mild, 2) mild, 3) moderate or 4) severe disorder, and according to the findings apply adequate stimulation. Therefore, we suggest that the DTS checklist admit two new leading diagnosis: neurodevelopmental disorder and child at neurorisk, which would be the indication for inpatient treatment, and accounted equally as existing dystonia syndrome and paraparesis. The clinical presentation of neurodevelopmental disorders can change slowly or rapidly, because of its dependenence upon maturation, neuroplasticity and applied therapeutic procedures. To sum up, we received a positive answer from HZJZ for the launch of the National register of children at neurorisk, through which children would be monitored in a professional and organized manner, which would not exclude the possibility that its coordinator might be a children’s physiatrist.
Keywords (croatian)
dječji fizijatar
neuromotoričko odstupanje
neurorizično dijete
(re)habilitacija djece
registar
Keywords (english)
children’s physiatrist
neurodevelopmental disorder
children at neurorisk
children’s (re)habilitation
register
Language croatian
Language english
Publication type Professional paper - Review paper
Publication status Published
Peer review Peer review - domestic
Publication version Published version
Journal title Fizikalna i rehabilitacijska medicina
Numbering vol. 27, no. 3-4, pp. 302-329
p-ISSN 1846-1867
e-ISSN 1848-171X
URN:NBN urn:nbn:hr:220:813741
Publication 2015
Document URL https://hrcak.srce.hr/163313
Type of resource Text
Access conditions Open access
Terms of use
Created on 2024-09-20 06:59:34