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Abstract Cerebral Palsy (CP) describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior, by epilepsy, and by secondary musculoskeletal problems. Children with cerebral palsy have complex healthcare needs and often require complex multidisciplinary care. It is important for clinicians to understand which approaches to healthcare service delivery for this population. Therefore, it is beneficial for children with CP to receive services in order to improve their health, and solve associated difficulties. One way a child with CP can receive services is through an early intervention program, which is treatment provided to children who have or at risk of having a developmental delay. Training parents will provide knowledge of typically developing children, as well as information regarding developmental delays and intervention programs for young children with Cerebral Palsy. The aim of this study was to support families with cerebral palsy child and training them how to deal with different difficulties that face their child. The current study was conducted on 75 patients 37males and 38 females already diagnosed with cerebral palsy with variable types and degrees diagnosed according to the criteria of diagnosis and the investigations, with age ranged from 2-15years,, attending the pediatric genetic and endocrinology clinic and impatient at Menoufia University Hospitals. Patients are classified as follows: 1. age group(< 3 years) ;20patient (8male and12 female) 2. age group( 3- < 6 years );23patients(13male and10 female) 3. age group( 6– < 12 years) ;24patiens(12male and12female) 4. age group(≥12years) ;8patients(5maleand3 female) All children were subjected to the following: 1. Detailed history taking (antenatal ,natal ,postnatal ,family ,developmental and past histories) 2. Family pedigree. 3. Anthropometric measurements (weight in Kg, length/height in cm, head circumference in cm and BMI) all measurements were plotted on CP growth charts. 4. Full clinical examination (general and systemic examination) 5. I.Q. assessment (Lewis Meleka, 1998). 6. Routine investigation (Urine analysis, Complete Blood Picture) and other investigations if needed. 7. Genetic counseling : good communication with parents and explain how we will apply appropriate early intervention system 8. Supportive aids : training stage: We trained mothers or caregivers to solve their child difficulties in weekly visit that sustained for four months - In first visit parents were learned about their child disease and determine existing difficulties and plane for supportive aids. - Then in the second visit we train parents for solving their child problems by applying our training program. - Followed by weekly visits where the same schedule was repeated. - We start to assess training, until be sure that mothers understood and knew how to apply our training program and retraining if needed. There was close and continuous contact with mothers and recall if anything needed Evaluation stage: First evaluation at the end of 4th month, assessment of the progress of the children every two months for one year, At the same time children and their caregivers keep in visiting the clinic every week for sharing of knowledge, helping and supporting other families with cerebral palsy child. Our training program assessed interventions for: Feeding difficulty : Good hygienic practices, balanced nutritious diet, food consistency, Positions for feeding, Utensils, independent feeding. locomotors disability: training mother simple maneuvers of physical therapy Bowel control : First step: conservative management (Behavioral modification including timing voiding, scheduled method and treatment of constipation) Second step: Biofeedback and pelvic muscle exercise for selected patients Management of convulsions. Some patients were referred for speech therapy and others for orthopedic surgery. 10. Statistical Analysis: The Results were statically analyzed by statistical package SPSS version 20.statistics were done in term of frequencies, mean, range, standard deviation ,percentage when for comparing categorical data ,chi square test, , a probability value (p value) less than 0.05 was considered statistically significant Most common associated problems with cerebral palsy patients were - Feeding difficulty: Suffering cases from this problem were 47patients, 80%of them in age group (<3years) - Bowel incontinence: Suffering cases from this problem were 63patients 87% of them were in age group (3<6years). - Speech difficulty: Suffering cases from this problem were 66cases, 42 of them no speech and 24of them with difficulty. - Convulsion: 20 patients were suffering from convulsion. - Recurrent chest infection: 31 cases were suffering from this problem. - Constipation: Suffering cases from these problem were53 patients After training the parents on the solutions of these difficulties, the results showed that: response of children with cerebral palsy to training program for feeding difficulty outcome of training for feeding difficulty: 30 out of 75 patients (40%) showed adequate position during feeding and jaw stabilization in first evaluation (at the fourth month) then at the second evaluation (at the sex month) the number increased to be 39 patients (52%), and at third evaluation number of them were 45 patients (60%) Among co operative mothers of patients there were 24 (32%) who start to give nutritious food to their children in first evaluation leading to improvement in general health of children, decrease frequency of infection, and that encourage more mother to follow our training program so number of patients increased to 41patients (54.7%) at the third evaluation Improved mother-child contact increase child cooperation and decrease child distress during feeding leading to shorter meal time .number of children showed cooperation and shorter meal time was 11 patients (14.7%) in first evaluation, increased to be 20 patients (26.7%) in second evaluation and to be 35 patients (46.7%) in third evaluation. Outcome of physiotherapy training: - Most of mothers learned how to apply physiotherapy at home, continuous physiotherapy lead to improvements in the form of movement of both hands actively, sitting, Standing with Support and walking without support .in percentage of 40%, 45.3%, 38.7%, 26.7% respectively. from our study we found that continuous scheduled training programs have a positive impact on CP children and their families Also the prognosis of patients in different problems depends on early intervention, degree of severity of cerebral palsy, education and cooperation of parents. |