Frequency of joined disabilities of children with cerebral palsy in Tuzla canton

© 2013 Mirela Babajiæ et al.; licensee University of Sarajevo Faculty of Health Studies. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. UNIVERSITY OF SARAJEVO FACULTY OF HEALTH STUDIES ABSTRACT


INTRODUCTION
Cerebral palsy is a pathological condition characterised in the fi rst place by impairment of motor function to which other disorders such as: visual and hearing impairment, intellectual defi cit, emotional problems, behaviour disorder, speech disorder, epileptic seizures and similar can join.Martin Bax defi nes this entity as disorder of moves and postural balance due to defects or impairment of immature brain (1).Majority of previous research in the world was focused on the prevalence, determination of the motor abilities, and perinatal etiological factors of the cerebral palsy.Evidences indicated that 70-80 % of cerebral palsy is caused by the prenatal factors and that the birth asphyxia has a relatively minor role with the less than 10 % (2).Cerebral palsy occurs with frequency from 2-3 on 1000 live births (3).As per Institute for public health of Tuzla Canton, on the area of this Canton, 52 children with cerebral palsy of the age from 1 to 14 are registered (4).Multiple disabilities of persons with physical impairment represent a special problem in daily practice.Research done as per methodology of International Classifi cation of Impairment, Disabilities and Handicap (ICDH; WHO, Geneva, 1980) has shown that, as much as 95.8 % of children with cerebral palsy in specialized primary schools have multiply disabilities (4).Disability can occur together or separately from other mental or physical disorders.290 million people worldwide are estimated to have disabilities (5).It is considered that 50 to 90% of children with cerebral palsy have some ophthalmological abnormalities, such as strabismus, amblyopia and other.Other joined disabilities are: speech defect, cognitive defect, emotional defect as well as epileptic seizures (6).Approximately 25-35 % of children with cerebral palsy have epilepsy.Much smaller percentage of children with epilepsy has cerebral palsy (7).In Tuzla Canton, children with multiple disabilities are included in daily Centre "Steps of hope".Th e Centre focuses on social model of work with children, which connotes inclusion into community, introducing the parents of the children with their remaining abilities, introducing the community to children with disabilities, education and rehabilitation of children which includes education of parents for conducting physical therapy at home, and inclusion of children with disabilities in development into regular system of education where possible (8).Th e goals of education and rehabilitation in B&H, similar to most other countries of the world, are to work towards community inclusion, acceptance of diversity, optimal physical and mental health, and personal and social well-being.Th e focus of family quality of life is a step towards understanding how we can move closer to achieving these goals (9).Th e aim of this study is to determine frequency of joined disabilities of children with cerebral palsy in Tuzla Canton.

METHODS
Th e study included 48 children with cerebral palsy, age from 2-19 years, with the place of residence in Tuzla Canton, which have been treated in Centre for physical medicine, rehabilitation and spa treatment "Ilidža" Gradačac, in Bosnia and Herzegovina.Th e patients formed two groups: children with cerebral palsy whose mothers have had health problem/sickness during pregnancy, and children with cerebral palsy whose mothers have not had health problem/ sickness during pregnancy.Structural Questionnaire for the parents of children and adolescents with cerebral palsy was used (9).Structural Questionnaire consisted of 69 multiple choice or fi ll in questions.Questions can be divided into eight groups: -First group of questions (1)(2)(3)(4)(5)(6)(7)(8)

RESULTS
In the group of sickness during pregnancy, 20 (60.6 %) are of male examinees and 13 (39.4%) are of female examinees, which all together represent a to-tal of 33 examinees in the group with infl uence of prenatal ethological factors.In relation to the group without sickness during pregnancy, it is 10 (66.7 %) of male and 5 (33.3 %) of female.Achieved results show that there are no statistically important diff erences (h 2 =0.16; p≥0.05).With mothers with sickness during pregnancy, 23 (69.7 %) of children are with visual impairment, while with mothers with no sickness during pregnancy it is 10 (66.7 %) children.In relation to the group of mothers with no sickness during pregnancy it can be seen that 5 (33.3 %) of children are without visual impairment, while that percentage with mothers with sickness during pregnancy is 10 (30.3 %) children.As per calculated h 2 test, achieved results point out to the fact that there are no statistically important diff erences between the groups (h 2 =2.08; p≥0.05).Th e relation of risk is 1.01, both group of examinees have nearly the same possibility for their children to have visual impairment.In the group of mothers with sickness and without sickness during pregnancy, a percentage which shows that children have no hearing impairment is more expressed, and which is in proportion 97 % : 93.3 %.Th ere is one examinee in each group of mothers with sickness and without sickness during pregnancies that have hearing impairment.Results achieved by h 2 test show that there is no statistically important diff erence (h 2 =0.34; p≥0.05), the relation of risks show that mothers with sickness during pregnancy have 2.28 times higher chance that they will not have a child with hearing impairment.With mothers with sickness during pregnancy, 22 (66.7 %) of children are with speech disorder, whereas 11 (33.3 %) of children are without disorder.In relation to the group of mothers without sickness, percentage of children with speech disorder 13 (86.7 %) is more expressed, whereas 2 (13.3 %) of children are without disorder.Th ere are no statistically important diff erences in relation to sickness of mothers during pregnancy and speech disorder with children (h 2 =0.04; p≥0.05).Children from the group of mothers with sickness during pregnancy have 3.25 times higher possibility that they will not have children with speech disorder.19 (57.6 %) of examinees have epilepsy where mothers have sickness during pregnancy, whereas 14 (42.4 %) of examinees do not have it.Th e percentage of children who have epilepsy and whose mothers have

CONCLUSION
In research of frequency of joined disabilities of children with cerebral palsy in Tuzla Canton, most expressed are speech and visual disorders with children, then epilepsy, whereas a small percentage of children are with hearing disorder.

TABLE 2 .
Sickness during pregnancy and visual impairment

TABLE 3 .
Sickness during pregnancy and hearing impairment

TABLE 4 .
The relation of sickness during pregnancy and speech disorder

TABLE 1 .
(10)ness during pregnancy and gender Of the children with quadriplegic CP 44.8 % never had epilepsy, compared with 66.7 % of the children with spastic diplegia, triplegia and hemiplegia, and 37.5 % of the children with ataxia and dyskinesia(2).Out of 80 examinees, 33 (41.25 %) of examinees have epilepsy.Out of 30 examinees whose mothers have had sickness during pregnancy, 16 (53.3%) of examinees have epilepsy.Out of 50 examinees whose mothers were without sickness during pregnancy, 17 (34 %) of examines have epilepsy(10).After classifi cation of examinees as per frequency of joined disabilities was done, work results have shown that speech impairment occurred with 35.4 % of children, visual impairment 33.3 %, epilepsy 29.3 %, whereas hearing impairment occurred with 2 % of children.