Ingaba umntwana wakho uneCerebral Palsy? Masifunde ngolu tyando lwe-SDR (Selective Dorsal Rhizotomy)

Njengomzali, uziva udandathekile kangakanani xa ubona umntwana wakho ehlushwa yiCerebral Palsy, enengxaki yokuhamba, ukubaleka, ukutsiba, nokwenza imisebenzi yemihla ngemihla? Kunzima kakhulu ukubukela umntwana ehlushwa kukuqina kakhulu kwemilenze, oko kukuthi, ukuqina kwemisipha (spasticity), akunjalo? Namhlanje sithetha ngotyando olukhethekileyo olunokunceda abantwana abanjalo.

Yintoni i-Selective Dorsal Rhizotomy (SDR)?

Ngamafutshane, i-Selective Dorsal Rhizotomy (SDR) yinkqubo yotyando eyenziwayo ukunciphisa ukuqina kwemisipha ngokusisigxina (ukuxinana) kubantwana abaneCerebral Palsy.

Oku kuquka ukusika nokususa ezinye ze- sensory fibers kumqolo ongezantsi ezibangela ukuqina kwemilenze yomntwana. Kodwa ungakhathazeki, olu tyando aluyi kuyikhubaza imilenze yomntwana. Kwakhona aluyi kuchaphazela intshukumo yemilenze.

Kodwa into enye ekufuneka uyikhumbule: Ukuze ufumane iziphumo ezilungileyo kolu tyando, kufuneka wenze unyango oluqatha lomzimba kunye neenkqubo zokubuyisela impilo emva kotyando. Kwakhona, olu tyando alufanelekanga kubo bonke abantwana abane-cerebral palsy.

Zeziphi iimeko ezinyangwa ngotyando lwe-SDR?

Oogqirha basebenzisa olu tyando lwe-SDR ukunyanga ukuqina kwemisipha (i-spasticity) kubantwana abane-cerebral palsy.

I-Cerebral palsy ( CP ) yimeko echaphazela amandla omntwana okulawula izihlunu zakhe. Ibangelwa kukonakala kweendawo zengqondo ezilawula intshukumo kunye nokulungelelaniswa kwazo. Abantwana abaninzi abane-CP banemeko ebizwa ngokuba yi-spasticity . Oku kuthetha ukuba xa umntwana ezama ukushukuma, okanye ngamanye amaxesha eme nje, ezinye zezihlunu ziyafinyela ngequbuliso zize ziqine. Oku kunokwenza izinto ezifana nokuhamba kube nzima, kubangele iintlungu, kwaye kuphazamise imisebenzi yemihla ngemihla .

Utyando lwe-SDR lwenziwa ikakhulu kubantwana abane-Spastic Diplegic Cerebral Palsy, echaphazela imilenze emibini kuphela, kunye ne-Spastic Quadriplegic Cerebral Palsy, echaphazela kakhulu onke amalungu omane.

Lusebenza njani olu tyando?

Khawucinge nje, ukuqina okuqhelekileyo kwezihlunu emzimbeni wethu kulawulwa yinkqubo kwinkqubo yemithambo-luvo kwintambo yomqolo. Kule nto, imithambo-luvo izisa ulwazi oluvela kwimisipha ukuya kwintambo yomqolo, ize emva koko imithambo-luvo ibuyele kuloo msipha ize iwubangele ukuba unciphe.

Ngokwesiqhelo, le nkqubo ilawulwa yimiyalezo evela kwingqondo yethu. Oko kuthetha ukuba singazilawula izihlunu zethu ngendlela esifuna ngayo. Nangona kunjalo, kwi-cerebral palsy, amandla engqondo okulawula oku ayancipha. Ngenxa yoko, ezinye izihlunu zihlala zifinyezwa kwaye ziqinile.

Utyando lwe-SDR lunokuphelisa oku kuqina okugqithisileyo (i-spasticity). Ugqirha ukhetha aze asike kuphela iingcambu zemithambo-luvo ezingaqhelekanga ezibangela oku kuqina. Yingakho kunokwenzeka ukunciphisa ukuqina ngaphandle kokuchaphazela eminye imisebenzi. Ngexesha lotyando, zonke ezi mithambo-luvo ziyavavanywa ukuze kufunyaniswe ukuba zeziphi iimithambo-luvo ezisebenzayo kakuhle kunye nokuba zeziphi iimithambo-luvo eziyingxaki.

Xa oku kuqina kuphelile, izihlunu ezingaphantsi zingaqala ukusebenza ngendlela eqhelekileyo. Emva koko, intshukumo yomntwana, njengokuhamba, iya kuphucuka. Kwakhona, ukuba oku kuqina kuyaqhubeka, amathuba okuba izihlunu zibe namanxeba kunye nokukhubazeka kwamalungu namathambo (ii-contractures) anokuthintelwa ngolu tyando.

Ungamlungiselela njani umntwana utyando lwe-SDR?

Ekubeni utyando lwe-SDR lungafanelekanga kubo bonke abantwana, umntwana wakho uza kuhlolwa ngokukodwa ukuze abone ukuba kuya kubanceda na. Ngenxa yesi sizathu, oogqirha abaninzi abaziingcali baza kumxilonga umntwana.

Bonke aba bantu bayamhlola umntwana baze basebenzisane njengeqela ukuze bagqibe ukuba utyando lwe-SDR lufanelekile na kumntwana. Ukongeza, kunokwenziwa ezinye iimvavanyo ezininzi:

• Ukucwangcisa unyango emva kotyando, iingcali zonyango lomzimba kunye nomsebenzi zirekhoda iintshukumo kunye nemisebenzi yomntwana ngevidiyo.
• I-MRI yobuchopho ukuqinisekisa ukuba akukho ezinye iingxaki zemithambo-luvo.
• Dibana nogqirha wezifo zengqondo ukuze umchazele iingozi zotyando kunye nenkqubo yokuchacha.
• Dibana nogqirha we-anesthesiologist ukuqinisekisa ukuba i-anesthesia ikhuselekile kumntwana.

Kwenzeka ntoni ngexesha lotyando?

La ngamanyathelo adla ngokwenzeka ngexesha lotyando lwe-SDR.

1. I-Anesthesia: Ingcali ye-anesthesia inika umntwana i-anesthesia. Oku kwenza umntwana alale kwaye angabi nantlungu ngexesha lotyando.

2. Ukusika: Ugqirha wemithambo-luvo wenza ukusika okuncinci embindini womqolo womntwana.

3. Ukuvezwa kwemithambo-luvo: Ngaloo nxeba, kwenziwa "ifestile" encinci phakathi kwamathambo omqolo kunye ne-membrane (dura) egubungela intambo yomgogodla, kwaye imicu yemithambo-luvo engaphantsi iyavezwa.

4. Ukwahlulwa kwemithambo-luvo: Okulandelayo, imithambo-luvo yemoto kunye nemithambo-luvo iyahlulwa. Imithambo-luvo yemoto ikhuselekile ukuthintela umonakalo.

5. Uvavanyo lwemithambo-luvo: Kusetyenziswa ii-electrodes, indlela ebizwa ngokuba yi -electromyography (EMG) isetyenziselwa ukuvuselela imithambo-luvo. Oku kunokunceda ekufumaneni ukuba zeziphi imithambo-luvo engaqhelekanga ebangela ukuqaqamba kwemithambo-luvo kunye neyiphi imithambo-luvo eqhelekileyo.

6. Ukusikwa kwemithambo-luvo:Emva koko, ipesenti ethile yemithambo-luvo engaqhelekanga efunyenweyo iyanqunyulwa. Ubungakanani bemithambo-luvo enqunyiweyo buyahluka kumntwana ngamnye.

7. Ukuthungela i-incision: Emva kokuba ukusika kwemithambo-luvo kugqityiwe, i-incision ithungelwa ngasemva ivaliwe ngomaleko ngomnye nomnye.

8. Igumbi lokuchacha: Emva kotyando, umntwana ugcinwa ejongiwe kwiYunithi yoKhathalelo oluNzulu (ICU).

Olu tyando ludla ngokuthatha malunga neeyure ezine okanye ezintlanu.

Kwenzeka ntoni emva kotyando? Kwaye zithini iingenelo zalo?

Emva kotyando, umntwana kuya kufuneka ahlale esibhedlele kangangeentsuku ezintlanu. Kwiiyure zokuqala ezingama-24-48, umntwana kuya kufuneka ahlale ebhedini. Unyango lomzimba luya kuqala kwiintsuku ezimbalwa.

Iingenelo zabantwana abane-CP ezichaphazela imilenze kuphela (i-Spastic Diplegic CP):

• Ukuhamba kakuhle nokuhambahamba.
• Ukuqina komzimba okwandileyo.
• Ukuwa okunciphileyo kunye nokulinganisela okuphuculweyo.
• Ukuma kakuhle nokuma.
• Ukunciphisa iintlungu ezibangelwa yi-spasticity.

Iingenelo zabantwana abaneSpastic Quadriplegic CP:

• Ukukwazi ukuhlala kamnandi ixesha elide.
• Ukukwazi ukusebenzisa isihlalo esingena ebhodweni.
• Ukukwazi ukuqhuba isitulo esinamavili ngokuzimela.

Kwakhona, ngenxa yokuba izihlunu aziqinanga kangako, kuba lula kwabo banyamekela umntwana ukutshintsha inabukeni yakhe baze bamtyise.

Zithini iingozi zolu tyando?

Njengalo naluphi na utyando, ii-SDR zinemingcipheko emincinci.

Iingxaki zexesha elifutshane:

• Usulelo
• Ukopha
• Ukuvuza kolwelo lwe-cerebrospinal (CSF)

Iingxaki ezingapheliyo (ezinqabileyo kakhulu):

• Uvakalelo oluphezulu xa uchukumisa (hyperesthesia), ngamanye amaxesha luhamba nentlungu.
• Ukulahlekelwa lulawulo lomchamo (ukungakwazi ukuzibamba komchamo).
• Ukulahlekelwa kukulawula amathumbu (ukungakwazi ukuzibamba).
• Ubuthathaka okanye ukulahlekelwa bubuchule bokuhamba ngaphambili.

Ungakhathazeki, iqela lezonyango lomntwana wakho liza kukuchazela zonke ezi ngozi kakuhle ngaphambi kotyando.

Ixesha lokuchacha kunye nokubaluleka konyango lomzimba

Unyango lomzimba kunye nonyango lomsebenzi zibaluleke kakhulu emva kotyando. Le nkqubo yokubuyisela impilo ibalulekile ukuze kufunyanwe iziphumo zotyando.

Ingcali yezonyango zomzimba iza kwenza imithambo yokuqinisa, ukuzolula, nokuphucula izihlunu zomntwana. Ingcali yezonyango yomsebenzi iza kunceda umntwana ukuba azimele ngakumbi ekhaya nasesikolweni.

Ngaphambi kokuba umntwana wakho aphume esibhedlele, iingcali zonyango ziya kukunika ingcaciso ecacileyo malunga noqheliso kunye nonyango ekufuneka ulwenze ekhaya. Kuya kufuneka wenze olu nyango iintsuku ezininzi ngeveki kangangeenyanga ezi-3-6.

Ukuba ubona naziphi na iimpawu zengxaki emva kotyando lomntwana wakho, ezinje ngosulelo lwenxeba okanye ukulahlekelwa yindlela yokuchama, fowunela ugqirha wakho ngoko nangoko.