Tesis

Kesulitan makan pada anak palsi serebral: prevalensi, faktor risiko, dan pengaruh intervensi = Feeding difficulties in children with cerebral palsy: prevalence, risk factor, and intervention.

Latar belakang. Palsi serebral (PS) adalah gangguan fungsi motorik dan postur, akibat gangguan perkembangan otak. Anak PS sering mengalami kesulitan makan yang disebabkan gangguan tersebut. Anak dengan gangguan fungsi motorik yang berat akan lebih besar kemungkinan mengalami kesulitan makan. Kesulitan makan akan menyebabkan capaian kalori berkurang yang dapat mengakibatkan terjadinya malnutrisi. Tujuan. Mengetahui prevalensi dan hubungan antara skala GMFCS dengan kesulitan makan pada anak PS Metode. Penelitian ini merupakan studi potong lintang terhadap pasien palsi serebral yang datang di poliklinik neurologi anak RSUD Dr. Moewardi pada Januari sampai September 2015. Anak PS akan diperiksa skala GMFCS, status gizi dan kesulitan makan. Skala GMFCS diukur menggunakan instrument pengukuran Gross Motor Function Measure-88 (GMFM-88). Status gizi antropometri diukur menggunakan kurva CDC NCHS 2000. Pasien PS dengan tipe spastik kuadriplegi dilakukan pengukuran antropometri ulang menggunakan kurva Krick. Penentuan status gizi berdasarkan kriteria klasifikasi Waterlow. Capaian kalori diukur dengan analisis diet recall selama 3 hari dan dinilai cukup apabila memenuhi 13,9 kkal/cm TB ± 10%. Kesulitan makan dinilai dari anamnesis, pemeriksaan fisik, dan observasi kemampuan makan. Hasil. Didapatkan 80 anak PS pada penelitian ini, sebagian besar subjek adalah PS tipe spastik (96%) dengan tipe spastik kuadriplegi dan spastik diplegi dan mempunyai skala GMFCS V. Prevalensi malnutrisi pada anak PS sebesar 68%. Tujuh puluh delapan persen diantaranya mengalami kesulitan makan, 30% dari yang menderita kesulitan makan adalah anak PS dengan skala GMFCS V. Simpulan. Prevalensi gizi kurang pada anak PS di RSUD Dr Moewardi sebesar 68% dan prevalensi gizi buruk sebesar 10%. Terdapat hubungan antara skala GMFCS dan kesulitan makan pada anak.
Kata kunci. palsi serebral, kesulitan makan, skala GMFCS



Background. Cerebral palsy (CP) is a motor and postural disorder due to an insult on the developing brain. Children with CP often have feeding difficulties due to their disabilities. Children with severe motor impairment are likely to experience greater feeding difficulties. This results in inadequate calorie intake which finally leads to malnutrition. Objective. To determine the prevalence and the relationship between the GMFCS and feeding difficulties in CP. Methods. A cross-sectional study was done from January to September 2015 in the neurology pediatric outpatient clinic of Dr. Moewardi Hospital. Children with CP underwent the GMFCS scale, nutritional and feeding difficulties assessment. The GMFCS was evaluated by Gross Motor Function Measure-88 (GMFM-88). Nutritional status was determined by the ratio of body weight to body height standardized to CDC-NCHS 2000 growth curve and were classified based on Waterlow. Spastic quadriplegics CP patients were also compared to CP growth curve of Krick. Calorie intake was evaluated by dietary analysis and defined as adequate if it reached 13,9 kcal/cm BH ± 10%. Feeding difficulties assessment included history taking, physical examination and observation of feeding skill in the outpatient clinic. Results. Eighty children with CP were included in this study, most of them were spastic type (96%), mainly spastic quadriplegic and diplegic CP, and were in GMFCS level V. Malnutrition was found in 78% subject. Feeding difficulties were found in 78% subject, 30% with GMFCS level V. Conclusion. The prevalence of undernourished and severe malnutrition in children with CP is 68% and 10% respectively. There is an relationship between the GMFCS and feeding difficulties in CP.
Keywords : cerebral palsy, feeding difficulties, the GMFCS