MUSCULOSKELETAL DISORDERS IN CAREGIVERS OF CHILDREN WITH CEREBRAL PALSY FOLLOWING MULTILEVEL SURGERY

摘要

BACKGROUND AND PURPOSE OF THE STUDY: Caregivers of children with cerebral palsy undergoing multilevel surgery are predisposed to various musculoskeletal disorders (MSD) because of the significant physical and psychological effort required of them while caring for the child. Post surgically, parents/caregivers had to transfer the child from bed to wheel chair, carry the child to the rehabilitation centre, on the staircase and at home till he/she was able to walk independently. The purpose of this study was to estimate the prevalence and risk factors of MSD in caregivers during the postoperative rehabilitation (non-ambulatory phase) of the child. SUBJECTS AND METHODS: Hundred consecutive parents or care givers of children with spastic diplegia, or spastic/athetoid quadriplegia who underwent multi level surgery, completed a questionnaire comprising of ten questions. Care givers who were found to have Musculoskeletal Symptoms were subsequently assessed by an Orthopaedic and Rehabilitation Specialist and treated. The control group consisted of a hundred care givers of children with other orthopaedic problems visiting our clinic, which were independently ambulant and did not need to be lifted or carried. RESULT: 90% of the care givers in the study group reported pain or discomfort, of which 72% had low back pain, 60% had neck pain and 35% had pain in the upper extremity. Excessive mental stress was documented in 85% of the care givers and sleep disturbance in 58%. It was found that lifting and carrying the child during the non-ambulatory phase was the chief cause of pain in symptomatic carers. The child's body mass index and carer's lack of knowledge of safe lifting techniques were found to be the major risk factors. The commonest Musculoskeletal Disorders identified were Myofascial Pain Syndrome (95%), Fibromyalgia (60%) and Thoracic Outlet Syndrome (55%). CONCLUSION: In view of the high prevalence of MSD in carers, we recommend routine training in safe transferring, lifting and carrying techniques to all parents and care givers during the preoperative period. In addition, psychological counseling, stress management and training regarding sleep hygiene are recommended.