cerebruli dambla

cerebruli dambla
klinikuri mdgomareobis marTvis saxelmwifo
standarti
(protokoli)
1
cerebruli dambla
(sareabilitacio centri)
1. daavadebis definicia
cerebruli dambla aris heterogenuri jgufi klinikuri
romlebic xasiaTdeba anomaluri motoruli (moZraobiTi)
posturaluri meqanizmebiT.
sindromebisa,
aqtebiTa da
2. simptomebi da niSnebi
ZiriTadi damaxasiaTebeli niSnebia: spastiuroba, moZraobis darRvevebi,
kunTTa
sisuste,
ataqsia,
rigiduloba,
sirTuleebi
yoveldRiuri
cxovrebiseuli aqtivobebis ganxorcielebaSi.
cerebrul damblasTan asocirebuli darRvevebi motoruli disfunqciis garda
TiTqmis yovelTvis moicavs cerebruli funqciis sxva darRvevebs, maT Soris,
kognitur
(SemecnebiT),
mxedvelobis,
smenis,
metyvelebis,
qerquli
mgrZnobelobis, yuradRebis, qcevis darRvevebs, epilefsias. daaxloebiT 65%-s
cerebruli damblis mTeli populaciisa, aReniSneba sxvadasxva xarisxis
mentaluri retardacia da swavlis siZneleebi.
3. diagnostikur – laboratoriuli testebi
cerebruli damblis diagnostika saWiroebs Semdeg RonisZiebebs:
•
pacientis istoriis sruli kvleva – gestaciisa da perinataluri
movlenebis detaluri aRricxva; ganviTarebis etapebis dokumentaciuri
asaxva.
•
fizikuri gasinjva – pozis, aqtiur da pasiur moZraobaTa sifarTis,
mgrZnobelobis, Zalis, kunTTa tonusis (spastiurobis), moZraobaTa
darRvevis tipisa da xarisxis, kidurebis deformaciebis Sefaseba.
damatebiTi gamokvlevebi:
•
kraniuli ultrasonografia (saWiroebis
diagnostikisa da prognozisaTvis);
•
magnitur-rezonansuli gamosaxva (saWiroebis SemTxvevaSi – adreuli
diagnostikis, prognozis, rTulad sadiagnostiko SemTxvevebisa da
diferenciuli diagnostikisaTvis);
•
kompiuteruli tomografia (saWiroebis SemTxvevaSi – adreuli
diagnostikis, prognozis, rTulad sadiagnostiko SemTxvevebisa da
diferenciuli diagnostikisaTvis);
•
eleqtroencefalografia (saWiroebis SemTxvevaSi);
SemTxvevaSi
–
adreuli
2
•
genetikuri
kvleva
(saWiroebis
SemTxvevaSi
–
metabolizmis
Tandayolil defeqtebze da sxva genetikur darRvevebze, diferenciuli
diagnostikisaTvis).
Sefasebis instrumentebi:
•
globaluri funqciis Sefaseba – "funqciuri damoukideblobis sazomi
bavSvebisaTvis" (WeeFIM – Functional Independence Measure for Children);
•
msxvili motoruli funqciis Sefaseba – "msxvili motoruli funqciis
sazomi" (GMFM – Gross Motor Function Measure);
•
spastiurobis gazomva da analizi – "aSuorTis spastiurobis Skala"
(Ashworth Spasticity Scale);
•
simZimis Sefaseba – "cerebruli damblis simZimis rusmanis da geijis
Skala" (Severity of Cerebral Palsy by Russman and Gage);
•
janmrTelobasTan dakavSirebuli sicocxlis xarisxis Sefaseba
"bavSvis janmrTelobis kiTxvari" (CHQ – Child Health Questionnaire).
•
kognituri unarebisa da gonebrivi ganviTarebis Sefaseba (saWiroebis
SemTxvevaSi), sxvadasxva asakobrivi jgufebisaTvis – "Cvili bavSvis
ganviTarebis beilis Skala" (Bayley Scales of Infant Development); "kaufmanis
batarea bavSvis SefasebisaTvis" (Kaufmann Assessment Battery for Children);
"veqsleris inteleqtis Skala bavSvebisaTvis" (Wechsler Intelligence Scale for
Children). (rekomendaciis xarisxi B).
–
4. mkurnaloba (marTva)
ZiriTadi principi – multi(inter)disciplinuri, gunduri midgoma.
a) Terapiuli intervencia –
• fizikur Terapia;
• okupaciuri Terapia;
• metyvelebis da enis Terapia;
• fsiqologiuri koreqcia (saWiroebis SemTxvevaSi)
b) farmakologiuri (medikamenturi) Terapia –
• botulinis
neirotoqsinis
Semcveli
medikamentebi
(saWiroebis
SemTxvevaSi);
• antiepilefsiuri farmakoTerapia (saWiroebis SemTxvevaSi).
g) orTopediuli qirurgia – saWiroebis SemTxvevaSi;
d) damxmare (teqnologiuri) saSualebebi –
• orTezireba (saWiroebis SemTxvevaSi);
• gadaadgilebis, dgomis, jdomis, komunikaciisa da garemosTan
adaptaciisTvis saWiro damxmare saSualebebis gamoyenebis
swavleba.
e) mSobelTa an ZiriTad meurveTa ganaTleba da treningi movlisa da Terapiis
sakiTxebze.
3
dakvirveba
cerebruli dambliT daavadebuli bavSvis sareabilitacio mkurnaloba
xangrZlivi da sistematuria. saSualod yovel 6-12 TveSi saWiroa etapuri
Sefaseba
miznebisa
da
reabilitaciis
programis
gadafasebisaTvis.
mkurnalobis
xangrZlivoba,
sixSire
da
dasruleba
ganisazRvreba
individualurad calkeuli bavSvisaTvis, profesionalTa multidisciplinuri
gundis mier.
ZiriTad samiznes warmoadgens ganviTareba, funqciis optimizacia da masTan
dakavSirebuli klinikuri maxasiaTeblebi.
5. gaidlaini,
romelsac
eyrdnoba
aRniSnuli
protokoli
_
“cerebruli dambla”
6. adamianuri da materialur-teqnikuri resursi
materialur-teqnikuri
resursi
–
sareabilitacio
aRWurviloba;
gadaadgilebis, dgomis, jdomis, komunikaciisa da garemosTan adaptaciisTvis
saWiro damxmare saSualebebi; SefasebisTvis saWiro testebi da Skalebi.
adamianuri resursi – bavSvTa nevrologi an reabilitologi; fizikuri
Terapevti; okupaciuri Terapevti; metyvelebisa da enis Terapevti; fsiqologi;
orTezisti; eqTani-koordinatori.
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cerebruli damblis marTvis algoriTmi
damaxasiaTebuli niSnebi: spastiuroba, moZraobis darRvevebi, kunTTa sisuste, ataqsia, rigiduloba, moZraobis,
wonasworobisa da pozis darRveva, sirTuleebi yoveldRiuri cxovrebiseuli aqtivobebis ganxorcielebaSi.
asocirebuli darRvevebi: kognituri (SemecnebiTi), mxedvelobis, smenis, metyvelebis, qerquli mgrZnobelobis,
yuradRebis, qcevis darRvevebi; epilefsia; mentaluri retardacia; swavlis siZneleebi.
diagnozi
Ddiferenciuli diagnozi:
•
•
•
•
•
•
•
neirodegeneraciuli daaavadebebi;
metabolizmis Tandayolili defeqtebi;
zurgis
tvinis
ganviTarebiTi
an
dazianebebi;
nerv-kunTovani daavadebebi;
neoplazma;
progresirebadi hidrocefalia;
subduruli hematoma.
pacientis istoriis sruli kvleva:
•
gestaciisa da perinataluri periodi;
•
ganviTarebis etapebis dokumentacia;
fizikuri gasinjva:
•
pozis, aqtiuri da pasiuri moZraobis sifarTe;
•
mgrZnobelobis, Zalis, kunTTa tonusis Sefaseba;
•
moZraobaTa darRvevis tipisa da xarisxis, kidurebis
deformaciis Sefaseba
travmuli
damatebiTi gamokvlevebi:
•
kraniuli ultrasonografia*;
•
magnitur-rezonansuli gamosaxva*;
•
kompiuteruli tomografia*;
•
eleqtroencefalografia*;
•
genetikuri kvleva*.
multidisciplinuri gasinjva da Sefaseba
bavSvTa nevrologi –gasinjva,
diagnozi
Sefasebis instrumentebi:
•
fizikuri Terapevti – gasinjva,
problemaTa identificireba
•
okupaciuri Terapevti –gasinjva,
problemaTa identificireba
•
•
•
metyvelebisa da enis Terapevti –
gasinjva, problemaTa identificireba
•
•
fsiqologi* – problemaTa
identificireba
•
"funqciuri damoukideblobis sazomi bavSvebisaTvis"
(WeeFIM – Functional Independence Measure for Children);
"msxvili motoruli funqciis sazomi" (GMFM – Gross
Motor Function Measure) :
"aSuorTis spastiurobis Skala" (Ashworth Spasticity Scale)
"cerebruli damblis simZimis rusmanis da geijis
Skala" (Severity of Cerebral Palsy by Russman and Gage)
"bavSvis janmrTelobis kiTxvari" (CHQ – Child Health
Questionnaire);
"Cvili bavSvis ganviTarebis beilis Skala" (Bayley Scales
of Infant Development)*;
"kaufmanis batarea bavSvis SefasebisaTvis" (Kaufmann
Assessment Battery for Children)*;
"veqsleris inteleqtis Skala bavSvebisaTvis" (Wechsler
Intelligence Scale for Children)*.
orTezisti* – gasinjva, problemaTa
identificireba
mkurnalobis mTavari (saboloo) da Sualeduri
mimiznebis dasaxva
mkurnaloba (menejmenti)
fizikuri Terapia
orTezireba*
botulinis toqsini*
okupaciuri Terapia
damxmare saSualebebis
antiepilefsiuri farmakoTerapia*
gamoyenebis swavleba
metyvelebis da enis Terapia
orTopediuli qirurgia*
fsiqologiuri koreqcia*
sa
mSobelTa instruqtaJi da treningi
* saWiroebis SemTxvevaSi (ix. protokoli da gaidlaini).
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