Text

HUBUNGAN DERAJAT SPASTISITAS OTOT ADUKTOR PANGGUL, LEVEL GROSS MOTOR FUNCTION CLASSIFICATION SYSTEM (GMFCS) DAN NILAI MIGRATION PERCENTAGE (MP) PADA ANAK PALSI SEREBRAL = Associations among the Degree of Hip Adductor Spasticity, the Level of Gross Motor Function Classification System (GMFCS) and the Migration Percentage in Children with Cerebral Palsy

Latar Belakang : Palsi serebral adalah penyebab utama disabilitas fisik di negara berkembang. Penderita palsi serebral dengan ketidakmampuan ambulasi berpeluang mengalami kontraktur sendi dan kelainan postur, yang dapat memburuk. Kelainan postur yang dapat terjadi adalah skoliosis, pelvic obliquity dan subluksasi/dislokasi panggul dengan problem sekunder nyeri, hilangnya kemampuan mandiri, duduk, berdiri, berjalan, ulkus dekubitus, masalah dalam kebersihan perineal, kardiovaskular dan respirasi. Sehingga perlu dilakukan deteksi sejak dini kelainan postur terutama kejadian subluksasi/dislokasi panggul. Metode : Desain penelitian ini adalah studi potong lintang dengan tujuan melihat apakah terdapat hubungan antara derajat spastisitas otot aduktor panggul, level Gross Motor Function Classification System (GMFCS) dan nilai Migration Percentage (MP) untuk mendeteksi dislokasi panggul pada anak palsi serebral yang datang ke poli rawat jalan divisi pediatri Departemen Rehabilitasi Medik RSUPN Cipto Mangunkusumo. Spastisitas otot aduktor panggul dinilai menggunakan Modified Tardieu Scale (MTS) komponen R2, R1 dan R2-R1, level GMFCS dinilai dengan menggunakan panduan GMFCS dan nilai MP didapat dari pengukuran foto panggul AP oleh dokter spesialis Radiologi. Hasil : Dari 30 responden penelitian, 3 tungkai dieksklusi sehingga analisis spastisitas aduktor panggul dan MP dilakukan pada total 57 tungkai. Penelitian ini menunjukkan tidak ada korelasi antara derajat spastisitas otot aduktor panggul dengan nilai MP dalam mendeteksi dislokasi panggul (antara variabel R2 dan MP dengan nilai r = -0,060; p = 0,658. Antara variabel R1 dan MP dengan nilai r = - 0,136; p = 0,314) dan tidak ada perbedaan bermakna level GMFCS dengan nilai MP dalam mendeteksi dislokasi panggul (p = 0,831). Kesimpulan : Pada penelitian ini tidak didapatkan adanya korelasi antara derajat spastisitas otot aduktor panggul dengan nilai Migration Percentage dan tidak didapatkan adanya perbedaan bermakna level Gross Motor Function Classification System dengan nilai Migration Percentage dalam mendeteksi dislokasi panggul.
Kata kunci : Modified Tardieu Scale, R2, R1, level GMFCS, foto panggul AP, nilai MP.


Backgound : Cerebral palsy was the most common cause of physical disability in the developing country. A non-ambulant child with cerebral palsy was vulnerable to the development of joint contractures and postural deformity, which are often progressive. Postural deformities that can arise were scoliosis, pelvic obliquity and hip subluxation/dislocation with the secondary problems were pain, loss of ability to be independence, sitting, standing, walking, pressure ulcers, perineal hygiene and cardiorespiration. It was necessary to make early detection for postural deformities particularly hip subluxation/dislocation. Methods : This was a cross sectional study. The aim of this study to see there are any associations among the degree of hip adductor spasticity, the level of Gross Motor Function Classification System (GMFCS) and the Migration Percentage (MP) to detect the occurrence of hip dislocation in children with cerebral palsy who came to outpatient polyclinic pediatric division of Physical and Rehabilitation Departmen, RSUPN Cipto Mangunkusumo. The hip adductor spasticity was measured with Modified Tardieu Scale (MTS) R2, R1 dan R2-R1 component, The level of GMFCS was measured with GMFCS protocol and the MP has done by Radiolog on plain foto of pelvic AP. Results : From the 30 respondens, 3 legs were exclude, therefor just 57 legs were analized for hip adductor spasticity and MP. This study shows that there was no correlation between degree of hip adductor spasticity and MP (between variable R2 and MP with score r = -0,060; p = 0,658. Between variable R1 and MP with score r = -0,136; p = 0,314), there was no significant difference between level of GMFCS and MP (p = 0,831). Conclusion : This study shows that there is no correlation between degree of hip adductor spasticity and MP, there is no significant difference between level of GMFCS and MP to detect the occurance of hip dislocation in children with cerebral palsy.
Key word : Modified Tardieu Scale, R2, R1, level of GMFCS, Hip rontgent AP, MP value.