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Pediatric Rehabilitation

What is Cerebral Palsy?

It is a disease that occurs with a disorder that affects a person's ability to move, maintain balance and posture. It is mostly characterized by motor disorders in childhood. It is the condition of experiencing a series of problems and disorders related to the control ability of the muscles related to the brain. It is caused by normal brain development or damage to the developing brain. The disease can occur at birth or in early infancy.

Traffic accident traumas, neurological problems (blood flow problems, etc.) in the fetus in the mother's womb, the mother's health status affecting the fetus (fever, inflammatory conditions), viruses such as syphilis, Zika, viral encephalitis, bacterial meningitis are risk factors for cerebral palsy. This disease can trigger osteoporosis, calcification, deterioration in mental and mental health, and deterioration in heart health. 

What are the Symptoms of Cerebral Palsy? 

People with cerebral palsy suffer from intellectual disability, problems with vision, hearing or speech, and problems with the spine and joints. Unbalance in walking, problems with movement and posture are encountered. Symptoms such as drooling, eating problems, swallowing and sucking problems, some motor disorders (buttoning clothes, tidying a room, etc.), ataxia (balance and coordination problems) are seen. 

What are the Cerebral Palsy Treatment Methods? 

For success in cerebral palsy rehabilitation, it is important to determine the problem related to the movement system and to plan and apply physical therapy rehabilitation methods correctly. The aim of physical therapy and rehabilitation is to help relax the muscles with excessive contraction, to help the loose muscles that cannot be contracted enough, to increase the balance and coordination abilities, and to reveal maximum mobility. It is very important to start physical therapy and rehabilitation early. The aims of early treatment are to prevent the development of abnormal posture reactions and abnormal contractions, to develop normal contraction, to prevent joint movement limitation and deformity development, to give the child a functional movement in self-care activities such as feeding and dressing. All these activities affect the quality of life positively, albeit slowly. In order to improve the patient's quality of life, rehabilitation practices are successfully performed by physiotherapists in our hospital. 

What is Hydrocephalus? 

Cerebrospinal fluid is made and reabsorbed continuously throughout the day. This fluid surrounds the brain and spinal cord and has a continuous circulation. It has three main functions: to reduce the harmful effects of blows to the brain and spinal cord, to help the brain to feed and to transport wastes, to regulate the pressure changes in the brain by circulating between the brain and spinal cord. Hydrocephalus is a combination of the words hydro=water and cephali=head. It is commonly known as excessive accumulation of water in the brain. The water referred to here is "cerebrospinal fluid". The increase in the amount of this fluid in some chambers of the brain causes the pressure in the head to rise and the brain to be damaged. Hydrocephalus can occur at any age, but often occurs in children and the elderly (over 60 years of age). Hydrocephalus is seen in approximately one in 500 children. Most of these patients are diagnosed at birth, prenatally or in early infancy. Although rare, it may be due to genetic (inherited) disorders or developmental disorders. Common causes; intracerebral hemorrhages, head traumas, brain tumors, hemorrhages due to preterm birth and meningitis. 

What are the Causes of Hydrocephalus? 

The causes of hydrocephalus vary according to the age group. Newborn (0-2 months): Congenital: These patients constitute the largest group. It may be only hydrocephalus or may be associated with other congenital anomalies (meningomyelocele) developing in the spine. Intra-cerebral hemorrhages: Brain chambers enlarge after spontaneous hemorrhages. Children and adults: Brain infections, brain hemorrhages, brain tumors and head injuries. Elderly: Normal pressure hydrocephalus; enlargement of the brain chambers after decreased absorption of cerebrospinal fluid. 

What Are the Symptoms of Hydrocephalus?

Symptoms of hydrocephalus vary from person to person. Common findings are listed below according to age groups. in newborn (0-2 months); Overgrowth of the head, thinning of the scalp, prominent veins on the head, vomiting, restlessness, drooping eyes, seizures, or inability to communicate. in children (2 months and above); Abnormal growth of the head, headache, nausea, vomiting, fever, double vision, restlessness, regression in walking or speaking, communication disorder, loss of sensory-motor functions, seizures. Older children may have difficulty staying awake or waking up. In middle-aged adults; Headache, difficulty in waking up or staying awake, balance disorder, urinary incontinence, personality disorder, dementia, visual impairment In the elderly; Communication disorder, gait instability, difficulty remembering, headache, urinary incontinence.

What are the Treatment Methods of Hydrocephalus?

It is not possible to treat hydrocephalus with drugs. Hydrocephalus can be corrected only with surgical interventions by neurosurgeons. The types of surgical intervention to be chosen will differ according to the underlying cause of hydrocephalus. If there is an obstruction that causes the circulation of the cerebrospinal fluid to deteriorate, surgical treatment can be performed for the obstruction (tumor, cyst, etc.). If the obstruction cannot be cleared, the intracranial circulation paths of the cerebrospinal fluid can be changed with surgical interventions. Since it is not possible to restore the circulation of the cerebrospinal fluid in the majority of patients, the fluid must be transferred from the brain to another body cavity. A thin long elastic silicone tube called a "shunt" is used for this transfer. There is a part of the system called the "pump" under the scalp for one-way and controlled speed operation.

Excess cerebrospinal fluid is transported to another part of the body through this thin tube. Thus, the increase in pressure in the brain is prevented. However, since water is continuously produced in the brain, this system has to work continuously. Because the shunt is under the skin, it can only be noticed in babies when viewed from the outside. In children and adults, the tube under the skin can be felt when palpated. The most common method for babies diagnosed while in the womb is to perform the surgery as early as possible. The shunt is surgically placed under general anesthesia.

A small hole is made in the skull and the tip of the shunt is placed in the chamber in the brain where the cerebrospinal fluid is located. Then, a tunnel is opened under the skin of the head, neck and abdomen, and the other end of the shunt is directed into the heart or abdominal cavity, where this fluid can be easily absorbed. Short-term antibiotics can be used to prevent post-operative infection. After surgery, the patient is observed in the hospital for a while. Usually, the patient's complaints resolve after a while.

However, if there is permanent damage to the brain tissue, some functions of the patient may not improve. The most important reason why functions such as vision and intelligence do not improve is the delay in treatment. The length of stay in the hospital varies according to the patient's recovery status. These patients need long-term follow-up to monitor whether the shunt is working. A significant portion of patients treated for hydrocephalus can lead a normal life. The shunt may not work and may need to be replaced in cases of infection.


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