Turkiye Klinikleri Journal of Pediatrics

.: REVIEW
Gelişimsel Koordinasyon Bozukluğunda Fizyoterapist Bakışından Bütüncül Değerlendirme
Comprehensive Evaluation of Developmental Coordination Disorder from a Perspective of Physiotherapist
Gökçe LEBLEBİCİa,b, Ela TARAKCIc
aİstanbul Medeniyet Üniversitesi Sağlık Bilimleri Fakültesi, Fizyoterapi ve Rehabilitasyon Bölümü, İstanbul, TÜRKİYE
bİstanbul Üniversitesi-Cerrahpaşa Lisansüstü Eğitim Fakültesi, Fizyoterapi ve Rehabilitasyon ABD, İstanbul, TÜRKİYE
cİstanbul Üniversitesi-Cerrahpaşa Sağlık Bilimleri Fakültesi, Fizyoterapi ve Rehabilitasyon Bölümü, İstanbul, TÜRKİYE
Turkiye Klinikleri J Pediatr. 2020;29(2):99-106
doi: 10.5336/pediatr.2019-71673
Article Language: TR
Full Text
ÖZET
 Gelişimsel koordinasyon bozukluğu (GKB); çocuklarda sıklıkla motor yetersizlikle karakterize, günlük yaşamı etkileyen ve çocuğun akademik başarısını düşüren bir durumdur. Bu çocuklar genellikle, sakar hareketleri olan ve motor koordinasyon güçlüğü çeken çocuklar olarak tanımlanır. Erken dönemde motor gelişim basamaklarındaki gerilikle fark edilirken, 3-5 yaş aralığında genellikle ailenin sık düşme şikâyetiyle kliniğe başvurulur. Ayrıca, tüylü kumaşlara, meyvelere dokunamama gibi duyusal hassasiyetlerin bulunması da bebeklik çağındaki duyusal belirtilerdir. Motor ve duyusal yetersizlik her çocukta farklı belirtilerle görülebileceğinden, GKB tanısı almış çocuklar bütüncül biçimde değerlendirilmeli ve çocuğun günlük yaşam aktivitelerinin sürdürülebilirliği ve sosyal hayata katılımı sağlanmalıdır. Bu çalışmanın amacı, GKB tanılı çocuklarda fizyoterapistler açısından bütüncül değerlendirmeyi sağlayacak yol haritası oluşturmaktır. GKB tanılı çocuklarda motor gelişim için sıklıkla Bruininks-Oseretsky Motor Yeterlik Testi ve Movement Assesment Battery for Children test bataryası kullanılırken, denge için vestibüler değerlendirme, primer reflekslerin katılımının değerlendirilmesi ve işitsel algının değerlendirilmesi ön plandadır. Yürüme değerlendirmesi için iki ve üç boyutlu yürüme analizinden yararlanılmaktadır. Günlük yaşam aktiviteleri Pediatrik Fonksiyonel Bağımsızlık Ölçümü ve Do-Eat Skalaları ile kognitif değerlendirme Wechsler Çocuklar için Zekâ Ölçeği formu ve Dynamic Occupational Therapy Cognitive Assesment for Children ile değerlendirilmektedir. Duyu değerlendirmesinde sıklıkla Sensory Integration and Praxis Tests, katılım için ise Kanada Aktivite Performans Ölçümü kullanılır. Bunların dışında klinikte pratik olarak yapılabilen fonksiyonel testlerden de yararlanılmaktadır. GKB tanılı çocuklarda, duyu ve motor problemler her çocuğa özgün tablo çizmektedir. Bu nedenle değerlendirmede, 'İşlevsellik, yetiyitimi ve sağlığın uluslararası sınıflandırması' temel alınarak, geniş kapsamlı değerlendirme yapılmalı ve değerlendirmeye mutlaka aktivite ve katılım eklenerek, bütüncül bakış sağlanmalıdır.

Anahtar Kelimeler: Gelişimsel koordinasyon bozukluğu; gelişimsel gerilik; fizyoterapi; bütüncül değerlendirme
ABSTRACT
 Developmental coordination disorder (DCD) is a condition that is often characterized by motor insufficiency in children, affecting daily life and decreasing the academic achievement of the child. These children are often described as children with clumsy movements and motor coordination difficulties. While it is recognized by the delay in motor development stages in the early period, the family is often referred to the clinic with complaints of frequent falls between the ages of 3-5. In addition, sensory sensitivities may also occur. Since motor and sensory insufficiency can be seen in every child with different symptoms, DCD should be evaluated in a comprehensive manner and the childs sustainability of daily life activities and participation in social life should be ensured. The aim of this review is to create a roadmap for comprehensive evaluation of DCD for physiotherapists. Bruininks-Oseretsky Motor Proficiency Test and Movement Assesment Battery for Children are frequently used for children with DCD. Two and three-dimensional gait analysis is used for gait evaluation. Daily life activities were measured by Pediatric Functional Independence Measure and Do-Eat Scale; cognitive assessment is assessed by Wechsler Intelligence Scale for Children and Dynamic Occupational Therapy Cognitive Assesment for Children. Sensory integration and Praxis Tests are frequently used for sensory evaluation, and Canada Activity Performance Measurement is used for participation. In addition, functional tests that can be practiced in the clinic are also utilized. For DCD, sensory and motor problems are specific to each child. Therefore, the comprehensive assessment should be based on the International Classification of Function.

Keywords: Developmental coordination disorder; developmental delay; physiotherapy; comprehensive assesment
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