Bio-psycho-social aspects in patients with disabilities who beneficiated from kinetic physical therapy.
In 2800 B.C. China, the usage of localized physical exercises is described by Chung-Fu in his writings. In Ancient Greece, Hippocrates (who is considered to be the father of medical gymnastics) and Herodicos bring front the first notions on how to practice physical exercises and massage and they describe their physiological effects on one's body. Practicing physical exercise as a therapy mean has known an important evolution during the Renaissance era. Leshaft from Russia methodizes the physical exercises used in order to correct certain physical deficiencies. During the beginning era of the XXth century, the practice of physical exercise is scientifically substantiated inside the educational and medical system. In our country, in 1922, The National Institute of Physical Education and Sport is founded in Bucharest, here being trained the first doctors in the domain of "medical gymnastics", using the term of Medical Physical Culture, one which has been afterwards replaced by the term of kinetic physical therapy. In kinetic physical therapy, the physical exercises have besides a therapeutic goal, also a prophylactic one. (1, 5)
The intellectual and emotional evolution of a child is tightly linked to their motor evolution. Deviations from normal are seized by the parents, doctors or kinetic physical therapists, by identifying some abnormal manifestations and the difficulty in doing certain physiological movements. They observe the lack of acquisitions correspondent with age, the lack of differentiating the spontaneous movements, the persistence of transitory reflexes and the precocious arrival of lateral dominance (2). The abnormality of a structure or anatomical, physiological and psychic functionality is highlighted by some tests, followed by an adequate treatment program (1). The neural and motor deficiencies are situated in the neurological disorders group: cerebral palsies, cerebral motor infirmities, cerebral spastic palsies, infantile cerebral scleroses, Little disease, etc. (2). The capacity to move of the mioarticular system and the analysis of the force of certain muscle groups are evaluated by two measurements: "the articular balance" and "the muscular balance". These techniques highlight dysfunctions, disabilities and the functional rest (3).
Sequelae of infantile encephalopathy's represented by a heterogeneous group of neuro-psycho-movement disabilities, stable, unprogressive, due to some aggressions on the immature brain that acted during the antepartum, perinatal and postnatal phase. These lesions manifest by affecting the posture tonus, disturbances in active movements, in locomotion, prehension, coordination, etc. (2, 4).
MATERIAL AND METHOD
This study is retrospective, data being obtained from the observation charts of pupils from the time they were admitted in the first grade, correspondent to the year 1998-2012. The lot is comprised by a number of 166 pupils with disabilities, educated at the "Ion Holban" Technical College Iasi. The pupils with deficiencies are enrolled in all forms of pre-university education, primary, secondary and high school. Likewise, external pupils (with families) and also those from the orphanage, beneficiate from medical attention, medication, special therapies and kinetic physical therapy.
The study lot was comprised by a number of 97 male pupils (58.4 %) and 69 female pupils (41.6 %), and the proportion M/F was of 1.4:1.
The age of the investigated lot ranged from 8 to 22 years, with a variance of 17 % of the value series, registering a mean value slightly higher in girls (16.09 years) than boys (15.86 years) with no significant differences between the sexes (p = 0.600). The study lot was homogenous by origin environment, the ratio of subjects from the rural environment exceeding slightly the frequency of 50 % (Fig. 1).
According to the social and familial status of the pupils, one observes a high balance of subjects from foster homes (42.8 %), half of the pupils live with their parents and only 7.2 % from children are raised by only one parent.
[FIGURE 2 OMITTED]
Pupils who came from foster homes, by epidemiological characteristics have had the following distributions:
--A slightly higher distribution of female pupils (50.7 %), than those who came from families (< 35 %), but the frequency distributions have not been significant from a statistical point of view (p = 0.118).
--It was highlighted the significantly higher frequency of pupils with deficiencies from the foster homes that came from the rural environment (approx. 65 %) than those from families (< 42 %).
--By age, it is noticed a significantly higher frequency of children from the 15 -18 years of age group (p = 0.027).
The status of pupils from the point of view of their family insertion shows the importance of family support by reassuring a psycho-protective climate inside the family and support in kinetic physical therapy.
According to the psychiatric diagnosis, one observes the higher frequency of light mental retardation (29.5 %). The capacity of the pupil to understand the kinetic physical therapeutic programs is highly important --from this depends his/hers evolution in recuperation. A better compliance between the pupil and kinetic physical therapist results in a favourable evolution in his/hers therapy. Thus, their recuperation is burdened by the reduced capacity of the patient to understand its own psychiatric disorder. From the total of pupils with disabilities, one part presents with psychiatric disorders that result in a difficult collaboration with the kinetic physical therapist: pupils with liminary intelligence (16.9 %), light mental deficiency (29.5 %), moderate mental deficiency (11.4 %), severe mental deficiency (1.8 %), unspecified mental deficiency (4.2 %). Likewise, a percent of 4.2 is comprised of pupils with infantile autism, attachment disorder, cerebral organic syndrome, emotional disorder, behaviour disorder, conduit disorder (Fig. 3).
The distribution of subjects with mental retardation did not have significant differences between the sexes (p = 0.645), origin environments (p = 0.209) or age groups (p = 0.236).
The neurologic diagnosis is noticed by the higher frequency of epilepsy (12.7 %) and of spastic tetraplegia (12 %).
Of the pupils that beneficiated from kinetic physical therapy during their school education, most of them had: epilepsy (12.7 %), followed by spastic tetraplegia (12 %), spastic paraplegia (4.8 %), spastic hemiparesis (3.6 %), chronic infantile encephalopathy (4.2 %), diplegia (2.4 %), hydrocephaly (1.8 %), spina bifida (1.8 %), neurologic crooked leg (3.0 %), microcephaly (0.6 %), tetraplegia (4.2 %), paraplegia (2.4 %) and monoparesis (0.6 %).
From the most frequent rheumatologic diagnoses, one reminds of dorsal-lumbar scoliosis (12 %), followed by lumbar scoliosis (5.4 %), Scheuermann's disease (5.4 %), hyperlordosis (4.8 %), dorsal cifoscoliosis (1.8 %), dorsal kyphosis (3.6 %), dorsal scoliosis (1.8 %), genu flexum (0.6 %), vertebral anomalies (0.6 %).
According to the endocrine diagnosis, it is noticed that 7.2 % of investigated children have stature and ponder hypotrophy, and 2.4 %, pituitary dwarfism and rachitis. From the cases studied, one finds that most frequent is a diagnosis of a moderate degree of the handicap (39.2 %), but one also has to notice the presence of a severe handicap, that needs accompaniment in 36.1 % of pupils with deficiencies that were investigated.
Severe handicap was most frequently noted:
--In males (58.3 %) without registering significant differences compared with females (41.7 %), the frequency distributions were not significant from a statistical point of view (p = 0.999);
--In students from urban environment (53.3 % vs. 46.7 %) (p = 0.741);
--A significantly higher frequency of children with severe handicap with ages below 14 years (p = 0.026);
--Of children with severe handicap (76.7 %) presented neuro-motor deficiency, but high ratios of this deficiency are registered also in children with medium (66.2 %) or accentuated handicap (80.5 %) (p = 0.208).
The treatment of patients with mental disorders, and also of those with neurological disorders, has as adverse reactions sedation, which hinders the kinetic physical therapeutic program and the pupils' compliance.
Psychiatric treatment was used in 11.4 % of pupils who beneficiated from kinetic physical therapy. According to the epidemiological characteristics, no evidence was found for significant frequency distributions from a statistical point of view:
--The frequency of psychiatric treatment: it was used more in males (12.4 % vs. 10.1 %) (p = 0.844);
--The frequency of psychiatric treatment: it was used more in children from the urban environment (15.9 % vs. 7.1 %) (p = 0.129);
--By age groups, it was highly used in the age group of 10-14 years (18.9 %) and at ages above 19 years (20 %) (p = 0.097);
--According to the degree of the handicap, psychiatric treatment was instituted more in children with a severe degree (11.7 %), compared to those with a moderate degree (9.2 %) or an accentuated one (9.2 %) (p = 0.694).
Most frequently, psychiatric treatment consisted of any seizure medication usage (36.7 % from the total psychiatric treatment) in 6.6 % of total of children followed, and the ratio of antidepressants and anxiolytics was by 16.7 % of the total psychiatric treatment, used in 3 % of children monitored. Neuroleptic treatment was used in 2.4 % of children, representing a ratio of 13.3 % of used psychiatric treatments.
Neurologic treatment was used in 16.3 % of children, mainly being used cerebral trophic (92.6 % of neurologic treatment and 15.1 % of total lot).
According to the epidemiological characteristics, no significant differences were found:
--The frequency of the neurologic treatment: it was highly used in males (18.6 % vs. 13 %) (p = 0.462).
--The frequency of the neurologic treatment: it was mainly used in the age group of 10-14 years (27 %) (p = 0.201).
--According to the degree of the handicap, neurologic treatment was mostly instituted in children with an accentuated (17.1 %) and severe degree of disease (15 %), in comparison to those with a moderate degree (6.9 %) (p = 0.946).
As a synthesis, it must be noted the higher frequency of the neurologic treatment in both sexes, origin environment and in children aged less than 19 years with an accentuated or severe degree of handicap.
The presented data highlighted the structure of the lot in accordance to the followed objectives. It is important to know and to diseases find in a timely manner in order to be treated from the first moments of a child's life. Kinetic physical therapy is hindered by reduced disease recognition or by the absence of drugs that sedates pupils while their therapeutic program is being carried out, thus resulting in lowered therapy compliance.
Carolina CRACIUN--Drd., "Grigore T. Popa" University of Medicine and Pharmacy, kinetic physical therapist of "Ion Holban" School Iasi, Romania
Ostin C. MUNGIU--M.D., Ph. D., Professor, Department of Pharmacology, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Romania
Georgiana CRACIUN--M.D., Drd., "Grigore T. Popa" University of Medicine and Pharmacy, Resident in neurology at "Prof. Dr. N. Oblu" Hospital, Iasi, Romania
Petronela NECHITA--M.D., Ph. D., Junior Psychiatrist "Socola" Clinical Psychiatric Hospital, Research Assistant --Forensic Medicine, Medical Deontology and Bioethics, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Romania
ACKNOWLEDGMENTS AND DISCLOSURE
The authors declare that they have no potential conflicts of interest to disclose.
1. Albu, A., Albu, C. Psihomotricitate. Editura Spiru Haret, Iasi, 1999
2. Pastai, Z. Kinetoterapie in neuropediatrie, 2004
3. Szbenghe, T. Kinetologie profilactica, terapeutica si de recuperare. Ed. Medicala, Bucuresti, 1987
4. Motet D. Kinetoterapia in beneficiul copilului. Ed. Semne, Bucuresti, 2011
5. Albu, A., Albu, C. Asistenta psihopedagogica si medicala a copilului deficient fizic. Editura Polirom, Iasi, 2000
GEORGIANA CRACIUN "GRIGORE T. POPA" UNIVERSITY OF MEDICINE AND PHARMACY No 16 str. Universitatii, zip code 700115, Iasi, Romania Phone: +40749086940
Figure 1. Lot distribution by sex and origin environment Girls 41.6% Boys 58.4% Urban 49.4% Rural 50.6% Note: Table made from pie chart. Figure 3. Lot distribution by mental retardation unspecified light moderate mental mental menta retardation retardation retardation Female 4 17 7 Male 3 32 12 Urban 2 28 9 Rural 5 21 10 < 14 years 2 13 8 > 14 years 5 36 11 severe liminal mental intellect retardation Female 2 12 Male 1 16 Urban 3 12 Rural 16 < 14 years 2 5 > 14 years 1 23 Note: Table made from bar graph. Figure 5. Grade handicap distribution according to epidemiological characteristics severe accentuated medium Female 25 17 27 Male 35 24 38 Urban 32 19 31 Rural 28 22 34 < 14 years 22 7 12 > 14 years 38 34 53 neuro-motor 46 33 43 motor 14 8 22 Note: Table made from bar graph. Figure 6. Distribution of psychiatric treatment usage according to epidemiological characteristics Female 10,1 Male 12,4 Urban 15,9 Rural 7,1 10-14 ys 18,9 15-19 ys 7 > 19 ys 20 moderate 9,2 accentuated 9,2 severe 11,7 Note: Table made from bar graph. Figure 7. Distribution of psychia psychiatric treatment antidepressants 3 anxiolytics 3 neuroleptics 4.4 antiseizure medication 6.6 other drugs 1.8 psychotherapy 1.2 Note: Table made from bar graph. Figure 8. Distribution of neurologic treatment usage according to the epidemiological characteristics Female Male Urban Rural 10-14 ys 13 18.6 20.7 11.9 27 15-19 ys > 19 ys moderate accentuated severe 14 12 6.9 17.1 15 Note: Table made from bar graph.
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|Author:||Craciun, Carolina; Mungiu, Ostin C.; Craciun, Georgiana; Nechita, Petronela|
|Publication:||Bulletin of Integrative Psychiatry|
|Date:||Jun 1, 2015|
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