cerebral palsy
A. BACKGROUND
Every parent would want his son was born with perfect, get an education and decent work. When it is not met, often among those who are disappointed not even want to send their children with special needs.
Actually there is no disabled children but children with special needs, because children are considered disabled it is the same with children in general, have advantages and disadvantages. But because some people who lack understanding, then the society that label disabilities that.
For that we need to understand an approach to society that those who have limitations in their environment, both have the same rights as normal children in general.
If we see children who have mental disabilities, we may assume that they are experiencing the same kind of mental disability. But we must know the mental disability experienced by children differently in this case the cause is cerebral palsy.
Although the developments and progress in the field of obstetrics and perinatologi will lead to lower infant mortality rate is rapid, but can not prevent an increase in the number of children with disabilities. This is due, even though the baby was rescued from the state of emergency, but usually leave residual symptoms due to brain tissue damage whose symptoms may appear immediately or later in life.
Cerebral Palsy is one of its sequelae are quite often found. The term Cerebral Palsy (CP) was first suggested by Phelps. Cerebral: related to the brain; Palsy: imperfection muscle function. In literature, the CP is often also called spastic diplegia, but this name is not quite right, because not only manifest spastic CP and the two limbs, but can also be found in other forms and can be about the 4 limbs. Other names are: Little's disease, because the physician John Little was the first in the mid-19th century, describes the clinical picture of CP.
This paper outlines: definition, incidence, etiologik, neurofisiologik and pathological, clinical picture and classification, diagnosis, differential diagnosis, special examinations, treatment, prevention and prognosis of CP.
B. THEOLOGICAL PROBLEMS
From the description above background papers, we want to outline some of the problem formulation as follows:
What is the definition of Cerebral Palsy?
How does the incidence of cases of Cerebral Palsy?
What is the aetiology of Cerebral Palsy?
What are the clinical symptoms in clients who have Cerebral Palsy?
How is its management?
How Nursing in clients with Cerebral Palsy?
C. PURPOSE
The purpose of writing papers in the literature study are:
1. In order for students to understand and know about the problems that arise in the case of Cerebral Palsy.
2. Gain an understanding of the true concept of Cerebral Palsy that can later be applied in providing nursing care to clients.
3. Nursing care that we provide will be of higher quality when there is a balance between theory and skills pengetaahuan praktice.
4. Courses to fulfill the task of Pediatric Nursing.
A. DEFINITION
Various definitions have been put forward by scholars. Clark (1964) argues, is the CP is a condition of brain tissue damage in the central
motor or the connecting network, which is eternal and not progressive, which occurs during the prenatal, during delivery or before the central nervous system becomes sufficiently mature, characterized by paralysis, paresis, coordination disturbances or abnormalities of motor function. In 1964 the World Commission on Cerebral Palsy suggested the following definition of CP: CP is a disorder of function of movement and posture caused by abnormalities or defects in the brain tissue that has not finished growing. While Gilroy et al (1975), defines CP as a syndrome, abnormalities in the cerebral control of motor function as a result of developmental disruption or damage to motor centers or network connecting the central nervous system.
Another definition: CP is a condition lasting damage to brain tissue and non-progressive, occurs at a young (since birth), and impede normal brain development with a clinical picture that can change during life, and showed abnormalities in the attitude and movement, accompanied by abnormalities neurologic form of spastic paralysis, disorders of the basal ganglia and cerebellum.
B. Incidence
Researchers from different countries report varying incidence are: 1.3 per 1000 births in Denmark (Erik Hansen); 5 per 1,000 children in the United States (Gilroy), and 7 per 100,000 births in the U.S. (Phelps); 6 per 1,000 live births in the U.S. (Ingram, 1955 and Kurland, 1957). In Indonesia, there are no data regarding the incidence of CP. In KONIKA V Field (1981), R. Suhasim and Titi Sularyo reported 2.46% of the total population of Indonesia holds a disability, and in between ± 2 million are children. CP is a type of defect in children who ever encountered. In Jaipur, Meenakshi Sharma et al (1981) investigated the CP 219, 150 of whom were male and 69 female. Consisted of 42 children aged less than 1 year, 113 were between 1-5 years, 52 between 50-10 years and 12 over 10 years.
The number of events around 1-5 per 1000 children. Men more than women. Often found on the first child, first child may more frequently have difficulty pad at birth. The number of events was higher in LBW infants and the twins. Mother's age is often more than 40 years, more so in multiparas.
Frankie (1994) research in Sanglah Hospital in Denpasar, found that 58.3% of cerebral palsy patients studied were male, 62.5% first child, the mother of all under the age of 30 years, 87.5% came from the location of spontaneous labor heads and 75% of pregnancies.
C. Etiology
CP is not a single disease with one cause. CP is a group of diseases with the problem of governing the motion, but can have different causes. To determine the cause of CP, should be dug about it: the form of CP, a history of maternal and child health, and disease onset.
In the USA, approximately 10-20% due to illness after birth (percentage will be higher in countries with underdeveloped). CP can also be the result of brain damage in the first months or first years of life which is the remainder of the brain infection, such as bacterial meningitis or viral encephalitis, or is the result of head trauma often caused by traffic accidents, falls, or child abuse .
The causes which can cause CP in umulnnya chronologically can be grouped as follows:
{Prenatal:
· Impaired brain growth
· Metabolic diseases
· Placental disease
· Maternal disease: toxemia gravidarum, toksopiasmosis, rubella, syphilis and the radiation
{Christmas:
· Long parturition
· Birth trauma with subdural hemorrhage
· Prematurity
· Penumbungan or winding talipusat
· Persistent atelectasis
· Aspiration of gastric and intestinal contents
· Heavy sedation in the mother
{Post natal:
· Infectious diseases: encephalitis
· Lesions by trauma, such as skull fracture
· Hyperbilirubinemia / kernicterus
· Blood circulation disorders such as pulmonary embolism / cerebral thrombosis
RISK FACTORS
Risk factors that cause the greater the likelihood of CP are:
1. Location of breech.
2. The delivery process is difficult.
Vascular or respiratory problems selamaa child labor is an early sign that indicates a problem of brain damage or a baby's brain does not develop normally. These complications can cause brain damage permaanen.
3. Low Apgar scores.
Low Apgar score up to 10-20 minutes after birth.
4. LBW and prematurity.
Higher risk of CP among infants with birthweight <>
5. Multiple pregnancy.
6. CNS malformations.
Most babies born with CP showed significant CNS malformations, such as abnormal head circumference (microcephaly). This shows that the problem has occurred during the CNS development in the womb.
7. Perdarahaan maternal or heavy proteinuria at the end of pregnancy.
Vaginal bleeding during months 9 through 10 pregnancies and increase the amount of protein in the urine associated with an increased risk of CP in infants.
8. Hipertiroidism maternal, mental retardation and seizures.
9. Seizures in newborns.
D. NEUROFISIOLOGIK AND PATHOLOGIC
Neuropatologik changes in the CP depends on the pathogenesis, the degree and localization of damage in the central nervous system (CNS). All CNS tissues sensitive to oxygen deprivation. The most severe damage occurred in neurons, neuroglia and less on supporting networks (supporting tissue) and at least in brain blood vessels. The degree of damage to acute neuronal necrosis has to do without damage to the neuroglia. Healing occurs by phagocytosis of necrotic part, the proliferation of neuroglia and the formation of scar tissue followed by a secondary retraction. In more severe hypoxia, there is damage in both neurons and neuroglia, resulting in areas with perlunakan, slow healing, atrophy and extensive scar tissue formation. Damage that occurs in the most severe CNS is highly sensitive to hypoxic cerebral cortex, somewhat less in the basal ganglia and cerebellum, whereas the brainstem and spinal cord damage is lighter. Mild bleeding by birth trauma are usually absorbed without permanent damage. Subdural hematoma is usually unilateral common found in the sinus longitudinalis verteksi close, causing damage to brain tissue beneath it because of pressure necrosis, resulting in malaria ensefalo eventually happened atrophy and scar tissue formation. Intracerebral hemorrhage rarely produce porencephalic cavity.
.
According to Perlstein and Barnett, a head trauma and intracranial bleeding in general will involve the pyramidal system, whereas anoxia especially regarding extrapyramidal system. Clinical manifestations of this disorder depend on the great and
localization of lesions that occur, whether he is in the cerebral cortex, basal ganglia or the cerebellum. Kernicterus causing damage to the nucleus are in, marked in yellow, the damage in the form of necrosis and lysis of neurons followed by proliferation of neuroglia and great shrinkage. In congenital brain abnormalities, such as agenesis / hipogenesis parts of the brain and hydrocephalus, developmental delay will occur.
E. CLINICAL FEATURES AND CLASSIFICATION
Clinical manifestations of CP depends on the localization and extent of brain tissue damage, whether in the cerebral cortex, basal ganglia or cerebellum. Thus, clinically indistinguishable three basic forms of motor disorders in CP are: spasticity, and ataxia atetosis.
a) Spasticity.
Spasticity occurs especially when the damaged pyramidal system, covering 50-65% of cases of CP. Spasticity is characterized by hipertoni, hiperrefleksi, klonus, positive pathological reflexes. Paralysis that occurs may monoplegi, diplegi / hemiplegi, triplegi or tetraplegi. Paralysis is not just about the arms and legs, but also the neck muscles that function to uphold the head.
b) Atetosis.
Atetosis covers 25% of cases of CP, an abnormal movements that arise spontaneously from the arm, leg or neck is marked with a circular motion around the axis "kranio-caudal", the movement grew when in a state of emotion. The damage lies in the basal ganglia and is caused by heavy asfiksi or jaundice.
c) Ataxia.
Infant / child with ataxia showed impaired coordination, impaired balance and presence of nystagmus. Children walk with wide steps, there
intention tremor include ± 5%. Localization of the lesions in the cerebellum.
d) Rigidity.
Is a mixed form of brain damage due to the diffuse. In addition to motor symptoms, may also be accompanied by symptoms rather than motor, such as impaired mental development, growth retardation, seizures, impaired sensibility, hearing, speech and eye disorders.
Hearing Loss
There pda 50-10% of children with Cerebral Palsy. Disorders of perception abnormalities neurogen especially high tones, making it difficult to capture in words.
Speech Disorders
Caused by hearing loss or mental retardation. Movement that occurs by itself on the lips and tongue makes it difficult to control these muscles so that the child is difficult to form words and frequently looked child salivating.
Eye disorders
Eye disorders is usually in the form of convergent strabismus and refractive abnormalities. In the state of severe asphyxia can occur cataracts. Nearly 25% of patients suffering from eye disorders Cerebral Palsy.
Based on the clinical manifestations of CP, the American Acedemy for Cerebral Palsy suggested classification as follows.
Classification neuromotorik
1. Spastic, is the addition of the stretch reflex and deep tendon reflex
elevated in the affected parts.
Atetosis, is characteristic of gentle movements resemble worms, involuntary, uncontrolled and aims.
Rigidity. If the affected part is moved there will be continuous custody, in both agonist and antagonist muscles. Describing the sensation membongkokkan "lead pipe" (lead pipe rigidity).
Ataxia. Showed a disturbance of balance in ambulation.
Tremor. Movements are involuntary, uncontrollable, reciprocal with a regular rhythm.
Mixed.
Topographic distribution of involvement neuromotorik
1. Paraplegi. Affected is the inferior extremity, always spastic type.
2. Hemiplegi. Exposed to only one inferior and one superior extremity on the same side. Almost always spastic, sometimes there are atetosis.
3. Triplegi. 3 exposed extremities, usually spastic.
4. Quadriplegia or tetraplegi. Exposed to all extremities.
Classification based on severity. gluttonous based on the severity of involvement neuromotorik that limit the ability of patients to perform activities for the purpose of life (activities of daily living).
1. Lightweight. Patients do not require treatment because he had no problem talking and able to do everyday purposes and can be moved without using helper tools.
2. Moderate. Patients require treatment because he is incompetent to maintain themselves, ambulation and speech. It requires a brace and self-help tools.
3. Weight. Patients require treatment. The degree of involvement so intense, so the prognosis for maintaining themselves, ambulation and speech are ugly.
F. DIAGNOSTIC EXAMINATION
Early diagnosis and proper presence of lesions in the brain are essential for the selection of therapeutic procedures to be taken.
In the history to know about the history of prenatal, childbirth and post natal which can be associated with the presence of brain lesions. Stages of physical development of children should be asked, for example when starting up, turn around, sitting, crawling, standing and walking.
On physical examination noted the existence of spasticity arm / leg, involuntary movements, ataxia and others. The existence of physiological reflexes such as the Moro reflex and
tonic neck reflex in children aged 4 months to be suspected of CP, as well as impaired vision, hearing, speech and swallowing, the asymmetry of a group of muscles, contractures and legs crossed like scissors.
DIAGNOSIS
CP needs to be distinguished by: the process of CNS degeneration, myopathy, neuropathy, spinal cord tumors, brain tumors, hydrocephalus, atypical poliomielitik, idiocy, brain or peripheral nerve trauma, Sydenham's Korea, higroma subdural and intracranial tumors.
G. SPECIAL EXAMINATION
To get rid of diagnosis and for treatment of patients, it takes some special examination. Frequent checkpoints, are:
Eye and hearing examinations conducted soon after the diagnosis of CP is established.
Lumbar puncture should be done to get rid of a degenerative process. On CP normal cerebrospinal liquor.
Electrical Inspection Ensefalografi performed in patients with seizures or hemiparesis in both convulsive groups or not.
Photos of the head (X-ray) and CT Scan.
Psychological assessment needs to be done to determine the level of education necessary.
Metabolic examination to rule out other causes of mental retardation.
In addition to the above, it is sometimes necessary examination and arteriography pneumoensefalografi individuals.
To obtain maximum results, people with CP need to be addressed by a
Team consisting of: pediatricians, neurologists, psychiatrists, orthopedic surgeons, physiotherapists, occupational therapists, outstanding teachers, parents, patients and if necessary, coupled with eye specialists, ENT specialists, nurses and other children.
H. MANAGEMENT
In general, the handling of patients with CP include:
1) re-education and rehabilitation.
Given the multifaceted nature of disability, someone with CP needs to get treatment in accordance with the disability. Evaluation of the objectives need to be made by each therapist. Objectives to be achieved should also be communicated to parents / families of sufferers, because then he can give up her child gets the appropriate treatment and care were also done earlier in his own neighborhood. Physio therapy aims to develop a range of motion necessary to independently acquire the skills to everyday activities. Physio therapy should be started immediately intensively. To prevent contractures to note the position of patients during rest or sleep. For patients who weight is recommended for temporary residence at a training center. Physio therapy is carried out throughout the person's life. In addition to physio therapy, patients with CP should be educated in accordance with the level of intelligence, in the School Extraordinary and where possible in regular schools together with children who are normal. At the Special School to do speech therapy and occupational therapy that are tailored to the circumstances of the patient. They should be treated as an ordinary boy who came home with a vehicle-bersanrm same so do not feel alienated, living in a normal atmosphere. Parents should not over-protect children and to the social worker can help at home with the view as necessary.
2) psycho therapy to children and their families.
Therefore, behavioral disturbances and social adaptation often accompany CP, then the psycho therapy should be given to both the patient and his family.
3) Correction surgery.
Aiming to reduce muscle spasm, equating the antagonist muscle strength, stabilize the joints and correcting deformity. Surgery more often done on the type of spastic than other types. Also more frequent in the lower limbs compared with the upper limbs. The surgical procedure performed tailored to the type of operation, whether the operation was performed on
motor nerve, tendon, muscle or bone.
4) Drugs.
Provision of drugs on the CP aims to improve behavioral disturbances, neuro-motor and to control seizures.
In patients with spastic CP. anti-seizure medication memeerkan good results in controlling seizures, but the type of spastic CP and atetosis drug is less successful. Similarly, drug muskulorelaksan less successful in reducing muscle tone in spastic CP type and atetosis. In patients with anti-convulsive seizures are given maintenance tailored to the characteristics of the seizures, such as luminal, dilantin and so on. In a state of excessive muscle tone, benzodiazepine class of drugs, for example: Valium, Librium or mogadon can be tried. In the circumstances given artane choreoathetosis. Tofranil (imipramine) is given in a state of depression. In patients who are hyperactive can be given dextroamphetamine 50-10 mg in the morning and from 2.5 to 5 mg at noon.
I. PREVENTION
Prevention is the best effort. CP can be prevented by eliminating the factors etiologik brain tissue damage during the prenatal, natal and post natal. Some of it can already be removed, but still many are also difficult to avoid. "Prenatal and perinatal care" which may either reduce the incidence of CP. Kernicterus caused 'haemolytic disease of the new born "can be prevented by an early exchange transfusions," Rh incompatibility "can be prevented by giving" anti-D immunoglobulin hyperimmun "on mothers who have a rhesus negative. Other preventive measures that can be done is that immediately on the state of hypoglycemia, meningitis, status epilepsy and others.
J. PROGNOSIS
The prognosis depends on many factors, among other things: the severity of CP, given the rapid treatment, the symptoms that accompany CP, attitude and cooperation of patient, family and community. According to Nelson WE et al (1968), only a small number of patients with CP who can live free and enjoyable, but Nelson KB et al (1981) in his study of 229 patients with CP yang.didiagnosis at 1 year of age, after age 7 years was 52% of them has been free from motor disturbances. It was reported that a mild form of CP, monoparetik, ataksik, diskinetik and diplegik more experienced improvement. Healing is also more common in group of black children compared with whites. In developed countries, for example diInggris and Scandinavia, there are 20-25% of patients with CP as a day laborer work full of 30-50% live in the "Institute of Cerebral Palsy". The more accompanying symptoms and more severe motor impairment, the worse the prognosis. Generally the intelligence of children is an indication prognosis, the more intelligent the better the prognosis. Patients are often seizures and can not be overcome by anti-seizure has a poor prognosis. In patients who did not receive treatment, a spontaneous clinical improvement can occur despite slow. With frequent child to move where, movement members receive training in moving and healing can occur in childhood. The sooner and the more intensive treatment of the results achieved increasingly better. In addition to the factors mentioned above, the role of parents / families and communities in determining prognosis. The higher the acceptance of cooperation and the better the prognosis.
NURSING CARE
A. ASSESSMENT
1. Biodata
Men more than women.
Common in children รจ difficulty at first childbirth.
Kejadin higher in low birthweight and infant twins.
Maternal age over 40 years, more so in multiparas.
2. Medical history.
Kesehaataan history associated with prenatal factors, natal and post natal as well as the circumstances surrounding the mempredisposisikan kelaahiran fetal anoxia.
3. Complaints and clinical manifestations
Observation of manivestasi cerebral palsy, especially those related to the achievement of development:
Slowing the development of gross motor
Common manifestations, motor slowing on all achievement, increases with growth.
Display abnormal motor
The use of unilateral terlaalu hand early, asymmetric merangkaak abnormal, or standing on tiptoes, involuntary movements or uncoordinated, poor sucking, difficulty makaan, tongue canker sores persist.
Changes in muscle tone
Increased resistance ataau decrease in passive movement, posture opistotonik (arch your back too much), feeling stiff in the holding or dressing, difficulty in using diapers, stiff or does not bend at the hip and knee joint when pulled to sitting position (early sign).
Posture abnormal
Keeping your hips higher than the body on the tummy, legs crossed ataau extends to the foot plantar flexion in the supine position, posture, persistent infantile sleep and rest, arm abduction at the shoulder, elbow flexion, the hand clenched.
Reflex abnormalities
Primitive reflex infantile persistent (tonic neck reflex exist at any age, do not settle over the age of 6 months), Moro reflex, plantar, and holding menetaap or hyperactive, Hiperefleksia, klonus ankle and stretch reflexes appeared on many muscle groups at a fast passive movements .
Comorbid disorders (bias exists, or may not).
Subnormal learning and reasoning (mental retardation in approximately two-thirds of individuals).
Damage behavior and interpersonal relationships
Other symptoms can also be found in the CP:- Below normal intelligence- Mental retardation- Seizures / epilepsy (mainly on the type of spastic)- Sucking or eating disorders- Breathing irregular- Impaired development of motor skills (eg reaching for something, sit, roll over, crawl, walk)- Impaired speech (dysarthria)- Impaired vision- Hearing loss- Joint contracture- Movement is limited.
4. Investigations
(Can be seen on the basic concept).
B. NURSING DIAGNOSIS
The risk of changes in nutrition: less than body requirements related to dysphagia secondary to oral motor disorders.
High risk of damage to skin integrity related to immobility.
The risk of injury associated with the inability to control the movements secondary to spasticity.
Verbal communication-related damage dengaan damage the ability to say words that relate to the involvement of secondary muscles of facial rigidity.
C. INTERVENTION, RATIONAL AND EVALUATION
1. The risk of changes in nutrition: less than body requirements related to dysphagia secondary to oral motor disorders.
Objectives:
Children participate in activities according to their ability to eat
Children consume an adequate amount
Intervention:
Provide nutrients in a manner consistent with the child's condition
Record the input and output
Monitor intravenous feeding (when instructed)
Give the formula foods determined by a nasogastric tube (as indicated)
Give him the child some autonomy in a passive way to eat
Lay the patient with head of bed 30-45 degrees, sitting position and neck straightened
R / ideal position while eating and thus reducing the risk of choking
Get involved in the selection and sequence of eating food that was served (in terms of diet and nutrition)
Give semisolid foods and liquids through a straw for a child who was lying on the tummy
R / prevent aspiration and make eating / drinking becomes easier
Provide high-calorie foods kudapaan differences and high protein
R / meet the needs of the body for metabolism and growth
Give foods that are preferred by children
R / encourage children to eat
Enrich your diet with nutritional supplements mis.susu powder or other supplements
R / maximize the quality of food intake
Monitor body weight and growth
R / intervention providing extra nutrients may diimpementasikan when growth starts to slow down and weight loss
Perform oral hygiene every 4 hours and after meals
Evaluation:
The client gets the input of nutrients to meet metabolic needs.
2. High risk of damage to skin integrity related to immobility.
Objectives:
Clients maintain the integrity of the skin.
Intervention:
Assess the skin every 2 hours and prn to depressed areas, reddish and pale.
R / appropriate assessment and early treatment will sooner best on problems that occur on the client
Place the child on the surface which reduces pressure
R / mencegaah tissue damage and necrosis due to pressure
Change position often, unless contraindicated
R / prevent dependent edema and stimulates circulation
Protect pressure points (eg: trikanter, sacrum, pergelangaan legs, shoulders and occiput)
Keep skin clean and dry skin in a state
Provide adequate fluids for hydration
Give the input of a dietary protein and carbohydrate are adequate.
Evaluation:
Client's skin remains intact, clean and dry
3. The risk of injury associated with the inability to control the movements secondary to spasticity.
Objectives:
Clients do not experience physical injury
Intervention:
Provide a safe physical environment:
Give pads on furniture. R / for protection.
Attach fence bed. R / to prevent falls.
Strengthen the furniture that is not slippery. R / to prevent falls.
Avoid polished floors and carpets are a mess. R / to prevent falls.
Select toys to suit the age and physical limitations. R / to prevent injuries.
Encourage adequate rest. R / because fatigue can increase the risk of injury.
Use restrein when children are in a chair or vehicle.
Do the right technique to drive, move the temptation to manipulate parts of the body paralysis.
Implement appropriate security measures to prevent thermal injury. R / there is a loss of sensation in an area hospital.
Provide protective helmets to children who tend to fall and push to use it. R / preventing head injuries.
Give anti-epilepsy drugs appropriate provisions. R / prevent seizures.
Evaluation:
Families provide a safe environment for children.
Children are free from injury.
4. Verbal communication-related damage dengaan damage the ability to say words that relate to the involvement of secondary muscles of facial rigidity.
Objectives:
Melakukaan client communication process within the limits of damage.
Intervention:
Tell a speech therapist with early
R / before the children learn the habit of poor communication.
Talk to the child slowly
R / allow time for children to understand speech padaa
Use the articles and pictures
R / circumstances push to talk reinforces the understanding
Use eating techniques
R / help make it easier to talk like using the lips, teeth and tongue movements.
Teach and use non-verbal communication methods (eg, sign language) for children with severe dysarthria.
Help families obtain electronic tools to facilitate non-verbal communication (eg, typewriter, microkomputer with sound processing).
Evaluation:
Children are able to communicate the needs of the caregiver.
CHAPTER V
CLOSING
A. CONCLUSION
Cerebral Palsy is a brain tissue damage that is permanent and not progressive. However, clinical picture can still change their way of life of patients. Incidence of the disease abroad varies between 0.07 - 6per 1,000 live births. In Indonesia is still unknown. Causative factor may lie in the prenatal, natal and post natal. Neuropatologik changes in CP are located in the motor cortex, basal ganglia and cerebellum. Clinical manifestations depend on the localization and extent of damage to brain tissue. Distinguished three basic forms of motor disorders in CP, ie spasticity, and ataxia atetosis. Diagnosis is made on a history relating to the possibility of brain tissue damage and physical disorder / neurological accordingly. Sometimes necessary investigation.
Handling includes: re-education / rehabilitation, psycho therapy, surgery and medication, which involves a team consisting of disciplines to share expertise. Prognosis depends on: the severity of CP, accompanying symptoms, rapid starts and intensipnya handling, attitude and cooperation of the patient / family and the community.
B. ADVICE
The treatment of these children requires skill and, if they are treated at home, then there must be effective support services. Specific maintenance actions aimed at:
© Prevention of decubitus
© Memperthankan airways are clean
© Finding the best way to provide food to children and ensure adequate food intake
© Determining a communication system so that children can express, needs, desires and longings, and
© Encourage children to use their skills and help children fully develop his abilities.
CP can not be cured, treatment is done to improve the capabilities of children. During its development, to this goal is to try the therapy in CP patients can live near normal life by managing the existing neurological problems as optimally as possible. Here there is no standard therapy that apply to all people with CP. Clinicians are expected to work together in teams, to identify the specific needs of each child and the abnormalities that exist and then determine a suitable individual therapy for each patient.
CP did not always disturb the patient's intelligence. There are patients that can precisely and school achievement. For instance, there are patients who are now six classes, even classes in the UI. Patients from Bandung for example, grade 5 class champion. Actually, about the intelligence on the CP, there are indeed taxable, some not, depending on the severity of his CP.
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