VISUAL PERCEPTION OF THE CHILDREN WITH PLEXUS BRACHIALIS DAMAGE –

Преку

For the research purposes, we used The Test for Visual Perception Assessment.By analyzing the results, we concluded that in both, in the first and the second measuring there was a statistically significant correlation between
. Способноста за пре-During the first years of life children are getting their first experience through the motor activity and establish contacts and communication with the objective world and the social environment.That activity leads to mental organization of the child (1).In the second year of life the child through satisfying its tremendous need for mobility, conquering space as well as learning about the objects in the environment and manipulating them, experiences the joy of motor play through scribbling, noticing that some of those objects leave traces behind.The child holds the pencil with the whole hand and moves it sharply and energetically, by using the whole arm and body as well, without the intention to show something, or to scribble.First, as a type of pattern, both the vertical and horizontal lines are appearing to be often intersect, then bundles of crossed lines can be seen, and that is often caused by hitting the surface with the pencil.The Circle which the child uses as a symbol for drawing the head or an apple originated in the stage of scrabbling as a sensory-motor scheme (2,3).For a child to draw shapes it is necessary to gain enough physical control over the pencil, so that it could force the pencil to produce exactly the shapes that are wanted.Also, a child should understand what it means to "copy" a drawing i.e. that it is required to reproduce the model and that its drawing should look the same as the model (4).
presence of sequelae in terms of reducing the mobility of the forearm and the elbow function after the pre-school period (13,14).The success of the early intervention is directly dependent of the early detection and assessment, and it is also based on creating individual programs and evaluating the effects of the treatment (15).The development as a continuous process of establishing the function and qualitative changes in the structures of the organization and functioning of the physically disabled and chronically ill children is inseparable from the treatment.The preschool treatment of these children is a system of special procedures and methods that affects the management and forming of development.Given the intensity of growth and development, and the plasticity of the nervous system, a child of preschool age is extremely sensitive to the overall impacts, which in this period are the most durable and effective (2).After a careful treatment, psychological nerve and motor structures testing within the functional range of the psychomotor coupling, the speech therapist reveals the shortcomings of the individual functions and their level of functioning.This will be considered as a starting point for the beginning of a special education treatment.An appropriate exercise program is planned for the "mental" and the "motor" age acting on the functions contained in the "zone of proximal development" (16).The aim of this study was to investigate the level of visual perception and influence of the somatopedic treatment over the increase of the level of visual perception in patients with trauma of the plexus brachialis that occurred at birth.The study included 60 children from both genders.The inclusion criteria were: a diagnosis of injury of plexus brachialis that occured solely at birth; average level of intelligence and aged between three to seven years.The study sample was divided into two groups: the experimental (treatment) group consisted of 30 subjects who were treated in a hospital or had a spa treatment.The control group included 30 subjects who for some тролната група опфаќа 30 испитаници, кои од одредени причини имале поголеми прекини во терапијата -дисконтинуитет, и доаѓале на периодични лекарски прегледи.Програмата на соматопедскиот третман е структурирана во однос на возраста и моторните способности, а применета е на експерименталната група (во понатамошниот текст: Е-група) во траење од 12 недели.Третманот не е применуван на контролната група (во понатамошниот текст: К-група) а нивните моторни способности се проценувани по 12 недели.

Methodology of researching
reason had more interruptions in the therapythey had discontinuity in the treatment and only occasional (periodical) medical examinations etc.A program of somatopedic treatment was structured in relation to the age and the motor skills, and was applied in the experimental group (hereinafter referred to as the group E) in a duration of 12 weeks.The same treatment was not applied in the control group (hereinafter referred to as the group C), and their motor skills were assessed after 12 weeks on completion.
The study was carried out during 2010 and 2011, at The Pediatric Department of The Rehabilitation Centre "Dr Miroslav Zotović" in Belgrade.

Instruments and techniques
За For the purpose of the research we used the available medical records and The Assessment of Visual Perception Test (17).The results are shown in comparison to the age level-below, at the age level and above it.On a clean sheet of paper we draw a circle, square, triangle with the base down, triangle with the base up, rhomboid and rhomboid with a semicircle on the lower left corner.The candidate needs to replicate all the objects in a given order.If the examinee draws just a circle correctly, then we can assume that his/hers perception is at the age of a three-year old, with the square -the perception is at the age of a four-year old, the triangle with base downthe perception is at the level of a five-year old, a triangle with the base up-the perception is at a level for a six-year old, the rhomboid-at a level of a seven-year old and finally a rhomboid with a semicircle on the lower left corner-indicates a perception of a eight-year old.
The Program for somatopedic treatment was structurally designed in accordance with the age and the motor skills of the children from the experimental group with lesion of the plexus brachialis.The program was conducted over the period of twelve weeks; three times a week for twenty minutes for each session.Exercises were divided into three groups: the first group of exercises was the 12 exercises chosen from the група ја сочинува програма на вежби поделени во зависност од возраста, и тоа на возраст од три, четири, пет и шест години (16), и третата група ја сочинуваат вежби со рамки и шаблони (16).
"modified special education exercises II" system (18), the second group was consisted of an exercise program divided according to the age (3-6 years) (16), and the third group was consisted of exercises through frameworks and templates (16).
After collecting the empirical data, we used the method of description, the method of scaling and then we applied various models of statistical parametric tests.By using the mathematical algorithms, the SPSS v. 17 for Windows, we showed frequencies of investigated phenomena through the description of absolute and relative terms.Thereafter, we approached the statistical analysis and in the process of examining the interaction of the two variables, we used a statistical method of correlation analysis.

Слика 1. Дистрибуција на испитаниците од Е и К-групата при првото и при второто мерење
perception was below age level within the group E, 4 (13.3%)subjects were "in line with their age level" and 26 (86.7%) subjects were classified as "above the level for their age".In the group C, the situation after 12 weeks was as the following: "in line with their age level" category was consisted of 11 (36.7%)subjects," below the level for their age" was consisted of 10 (33.3%) subjects and "above the level for their age" category of 9 (30%) subjects.After statistical data analysis, we concluded that there is no significant correlation between E and C groups in the first measuring, i.e. the subjects from the E group were more successful (r = 0408), while in the second measuring this difference increased (p <0.001, r = 0.593).

Дискусија Discussion
Развојот  (10).The presence of side movements and the difficulty when using the arm affected by paresis/paralysis of plexus brachialis, limits the holding of the pencils, the paper, as well as the shape perception and overdrawing.
The aim of this study was to assess the level of visual perception and the effects of the somatopedic treatment in patients of pre-school age that have motor disorders as a result of plexus brachialis impairment at birth.Most of the subjects had the upper type of lesion occurred at birth -the Erb-Duchenov form, or 50 in total (83.3%) and least of the examinees -or 3 (5%), had total paralysis (table 1).This is consistent with other researches in the field of study (5,8) subjects from the control group (total 63.3%) i.e. subjects who had intermittent therapy.The lowest number of subjects from this category belonged to the 6.1-7 age group, which could be attributed to the positive impact of the obligatory pre-school education (10).After 12 weeks of applying of the somatopedic treatment, the experimental group had significantly progressed and the majority of the respondents redraw the given forms "above the level for their age", a total of 26 (86.7%), which is 36.8%more than in the first measuring (Table 2).Similar results can be found in the study conducted by Kljajić et al. ( 2011) regarding the assessment of the visuomotor control in subjects suffering from lesion of plexus brachialis.The subjects who had continuous therapy were statistically more successful, which also reflected the total number of side movements that accompanied the performance of the given action; body rotation, lateral flexion of the body, cirucumduction of the shoulder, shoulder protraction, movements of the other hand while performing the task, other hand's finger movements while performing the task, mimic muscles movements, tongue protrusion, oscillation of legs, squirming in chair (11).
Chart 1 shows the presence of statistically significant difference in the performance of redrawing given forms between the subjects in the experimental and the control group in the first (p <0.001, r = 0408) or in the second measuring (p <0.001, r = 0593).This indicates the importance of the continuity of the treatment later on and not only at the age of three, when the medical rehabilitation is most intensive.Continuous rehabilitation means staying in a hospital and spa centers along with the use of comprehensive therapy with multidisciplinary approach.Since the test of visual perception is applied as a triage test in the diagnostics in the field of special education and rehabilitation and has a high correlation with the Binet-Simon test (17), there is a need for further research in this area, which would include other components of graphomotor expression.

Заклучок Conclusion
Лекувањето The treatment of paresis/paralysis of the plexus brachialis is а very complex and uncertain and refers to the involvement of the whole team of experts and includes parents as well.Our study showed that the plexus brachialis impairment has negative influence over the visual perception at a certain number of examiners.Expressing the need of further follow-up and treatment during the entire pre-school period.Subjects that have continuity in their treatment, where the somatopedic treatment is integral part, show a high level of success in the field of visual perception.That indicates the importance of the somatopedic treatment as a part of integrated rehabilitation.Since the visual perception is a base for development of the graphomotor skills, further investigations should be directed toward the skills monitored in this population in order to timely prevent and apply appropriate treatments.

Figure 1 .
Figure 1.Distribution of the subjects from the E and C groups in the first and the second measuring

Table 1 .
Structure of the subjects in relation to the frequency of clinical forms of birth brachial plexus lesions