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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 a condition in which a number of problems and disorders related to the ability to control the muscles related to the brain are experienced. It is caused by normal brain development or damage to the developing brain.
Illness can occur during childbirth or early infancy. Traffic accident traumas, neurological problems in the fetus in the mother's abdomen (blood flow problems, etc.), maternal health condition affecting the fetus (fever, inflammatory conditions), viruses such as syphilis, zika, viral encephalitis, bacterial meningitis are risk factors for cerebral palsy. This disease may trigger osteoporosis, calcification, deterioration in mental and mental health, 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. Problems related to imbalance in walking, movement and posture are encountered. Symptoms such as drooling, problems in eating, swallowing and sucking problems, some motor disorders (buttoning clothes, tidying a room, etc.), ataxia (balance and coordination problems).

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 objectives of early treatment are to improve normal contraction by preventing the development of abnormal posture reactions and abnormal contractions, to prevent the development of joint movement limitation and deformity, and to provide the child with a functional movement in self-care activities such as feeding and dressing.
All these activities have a positive effect on the quality of life, albeit with slow development.
Rehabilitation practices are successfully performed by physiotherapists in our hospital to improve the quality of life of the patient.


What Is Hydrocephalus?

Cerebrospinal fluid is constantly made and reabsorbed throughout the day. This fluid surrounds the brain and spinal cord and has a constant circulation. It has three main functions: reducing the harmful effect of blows to the brain and spinal cord, helping to nourish the brain and transport waste, and regulating pressure changes in the brain by circulating between the brain and the spinal cord.
Hydrocephalus is a combination of hydro=water and cephala =head words. It is often known as excessive accumulation of water in the brain. The water mentioned 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 increase and the brain to be damaged.

Hydrocephalus can occur at any age, but it often occurs in children and the elderly (over 60 years of age). About one in 500 children has hydrocephalus. In most of these patients, the diagnosis is made at birth, before birth or in early infancy. Although rare, it may be due to genetic (hereditary) disorders or developmental disorders. Common causes are intracerebral hemorrhages, head traumas, brain tumors, premature birth-related hemorrhages and meningitis.

What Are The Causes of Hydrocephalus?

The causes of hydrocephalus vary according to age group.
Newborn (0-2 months): Congenital: These patients constitute the largest group. It can only be hydrocephalus or it can be accompanied by other congenital anomalies (meningomyelocele) that develop in the spine. Intracerebral hemorrhages: Usually, the brain chambers expand after spontaneous bleeding.
Children and adults: Brain infections, brain hemorrhages, brain tumors and head traumas.
Elderly: Normal pressure hydrocephalus is the enlargement of the brain chambers after decreased absorption of cerebrospinal fluid.

What Are The Symptoms of Hydrocephalus?

The symptoms of hydrocephalus vary from person to person. Common findings are listed below by age group.

In the newborn (0-2 months); Overgrowth of the head, thinning of the scalp, prominent veins in the head, vomiting, restlessness, shifting of the eyes down, seizures or inability to communicate.
In children (2 months and above); Abnormal growth of the head, headache, nausea, vomiting, fever, double vision, restlessness, decline 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 waking or staying awake, balance disorder, urinary incontinence, personality disorder, dementia, visual impairment,
In the elderly; communication disorder, imbalance in walking, difficulty in remembering, headache, urinary incontinence.

What Are The Treatment Methods of Hydrocephalus?

Treatment of hydrocephalus disease with drugs is not possible. Hydrocephalus can only be corrected with surgical interventions by neurosurgeons. The surgical interventions to be selected will differ according to the underlying cause of hydrocephalus.

If there is a blockage that causes disruption of the circulation of the cerebrospinal fluid, surgical treatment can be performed for the blockage (tumor, cyst, etc.) that causes it. If the obstruction cannot be opened, the intracerebral circulatory pathways of the cerebrospinal fluid can be changed by surgical interventions.
Since it is not possible to restore the circulation of cerebrospinal fluid in the majority of patients, the fluid should be transferred from the brain to another body cavity. For this transfer, a thin elongated elastic, silicone pipe called a "shunt" is used. For unidirectional and controlled speed operation, there is a part of the system called "pump" under the scalp. Excess cerebrospinal fluid is transported to another part of the body thanks to this thin tube. Thus, the pressure inside the brain is prevented from increasing. However, since water is produced continuously in the brain, this system has to work continuously. However, since water is produced continuously in the brain, this system has to work continuously. In children and adults, the tube under the skin can be felt when examined by hand.

The most common method in babies diagnosed in the womb is to perform the surgery in the earliest possible period.

The shunt is surgically placed under general anesthesia. A small hole is drilled into 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 may be used to prevent postoperative infection.

After surgery, the patient is observed in the hospital for a while. Usually, the patient's complaints improve 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 hospital stay of the patient varies according to the recovery status of the patient. These patients should be monitored for a long time to see if the shunt is working. A significant number of patients treated for hydrocephalus can continue their normal lives. The shunt may not work and may need to be replaced in cases of infection.

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