Sağ/Sol Kol Parezisi Olan İnmeli Hastalarda Modifiye Zorunlu Kullanım Tedavisinin Üst Ekstremite Fonksiyonu Üzerine Etkisi: Tek Kör Randomize Kontrollü Çalışma

Year 2023, Volume: 7 Issue: 2, 155 - 164, 07.08.2023

Cansın Medin Ceylan , Ekin İlke Şen , Tugce Karaagac , Tuğba Şahbaz , Ayse Yalıman

https://doi.org/10.46332/aemj.1120884

Abstract

Amaç: İnme, fonksiyonel, bilişsel ve psikolojik sorunlar nedeniyle engelliliğin en yaygın nedenlerinden biridir. Etkilenen üst ekstremitedeki motor kusurlar, inme geçirenlerin yaklaşık %50'sini etkiler. Çalışmanın amacı modifiye Zorunlu Kullanım Tedavisinin (mZKT) hemiparetik sağ/sol üst ekstremite fonksiyonları ve yaşam kalitesi (QOL) üzerindeki etkilerini değerlendirmektir.

Araçlar ve Yöntem: Bu prospektif, randomize, kontrollü ve tek kör çalışmada, 40 hasta sağ-mZKT (n=10), sol-mZKT (n=10) ve kontrol (n=20) olarak gruplanmıştır. mZKT 4 saat/gün, 2 hafta, 10 seans uygulanmıştır. Tüm hastalara konvansiyonel rehabilitasyon programı uygulanmıştır. Hastalar Fugl-Meyer Motor Skala (FMS), Motor Aktivite Günlüğü (MAG), İnme etki ölçeği (İEÖ), Kutu Blok Testi (KBT), şekillendirme egzersizlerindeki tekrar sayısı ve görev egzersiz süresi kullanılarak değerlendirilmıştır.

Bulgular: Sol mZKT grubunun FMS'sında istatistiksel olarak anlamlı bir iyileşme saptanmıştır (p=0.040). Her iki mZKT grubu, MAG kullanım miktarında ve MAL kullanım kalitesinde, şekillendirme egzersizlerinin tekrar sayısında ve KBT'de (p<0.05) istatistiksel olarak anlamlı gelişmeler göstermiştir. İEÖ'nün günlük yaşam aktivitesi, el fonksiyonu ve inme iyileşme alanları her iki grupta da anlamlı olarak artmıştır (p<0.01). Sol-ZKT grubunda İEÖ'nün kuvvet alanında istatistiksel olarak anlamlı bir artış saptanmıştır (p=0.037).

Sonuç: mZKT, sağ/sol kol parezisi olan hastalarda motor fonksiyonları, el becerisini ve yaşam kalitesini iyileştirmede etkili saptanmıştır. Bu olumlu etkiler üç aya kadar devam etmiştir. mZKT' nin sol üst ekstremitede kol motor bozukluğu üzerinde olumlu bir etkisi olmasına rağmen, daha fazla araştırmaya ihtiyaç vardır.

Keywords

zorunlu kullanım tedavisi, inme, rehabilitasyon, üst ekstremite, yaşam kalitesi

Supporting Institution

yok

Project Number

yok

Effect of Modified Constraint-Induced Movement Therapy on Upper Extremity Function for Stroke Patients with Right/Left Arm Paresis: A Single-Blind Randomized Controlled Trial

Abstract

Purpose: Stroke is one of the most common causes of disability because of functional, cognitive, and psychological issues. Motor deficits in the afflicted upper extremity affect about 50% of stroke survivors. This study aimed to evaluate the effects of modified constraint-induced movement therapy (mCIMT) on hemiparetic right/left upper limb functions and quality of life (QOL).

Materials and Methods: In this prospective, randomized, controlled and single-blind study, 40 patients were assigned to the right-mCIMT (n=10), left-mCIMT (n=10), and control (n=20). mCIMT was applied 4h/day, 2 weeks, 10 sessions. A conventional rehabilitation program was applied to all patients. Patients were evaluated using the Fugl-Meyer Motor Assessment (FMA), Motor Activity Log (MAL), Stroke Impact Scale (SIS), Box-Block Test (BBT), the number of repetitions in shaping exercises, and the duration of task exercise.

Results: There was a statistically significant improvement in the FMA of the left-mCIMT group (p=0.040). Both mCIMT groups showed statistically significant improvements in the MAL-amount of use (AoU) and MAL-quality of use (QoU), the number of repetitions in the shaping exercises, and the BBT (p<0.05). The activity of daily living, hand function, and stroke recovery domains of the SIS were increased significantly in both groups (p<0.01). There was a statistically significant increase in the strength domain of the SIS in the left-CIMT group (p=0.037).

Conclusions: mCIMT was effective in improving motor functions, dexterity, and QOL in patients with right/left arm paresis. These positive effects continued for 3 months. Although left mCIMT had a positive effect on arm motor impairment, further research is needed.

Keywords

constraint-induced movement therapy, stroke, rehabilitation, upper limb, quality of life

Project Number

yok

References

• 1. Mohd Zulkifly MF, Ghazali SE, Che Din N, et al. A Review of Risk Factors for Cognitive Impairment in Stroke Survivors. Sci World J. 2016;3:1-16.
• 2. Langhorne P, Coupar F, Pollock A. Motor recovery after stroke: a systematic review. Lancet Neurol. 2009;8(8):741-754.
• 3. Pollock A, Farmer SE, Brady MC, et al. Interventions for improving upper limb function after stroke. Cochrane Database Syst Rev. 2014;2014(11): Cd010820.
• 4. Hatem SM, Saussez G, Della Faille M, et al. Rehabilitation of Motor Function after Stroke: A Multiple Systematic Review Focused on Techniques to Stimulate Upper Extremity Recovery. Front Hum Neurosci. 2016;10:442.
• 5. Taub E, Crago JE, Burgio LD, et al. An operant approach to rehabilitation medicine: overcoming learned nonuse by shaping. J Exp Anal Behav. 1994;61(2):281-293.
• 6. Morris DM, Taub E, Mark VW. Constraint-induced movement therapy: characterizing the intervention protocol. Eura Medicophys. 2006;42(3):257-268.
• 7. Kwakkel G, Veerbeek JM, Van Wegen EE, Wolf SL. Constraint-induced movement therapy after stroke. Lancet Neurol. 2015;14(2):224-234.
• 8. Liu P, Li C, Zhang B, et al. Constraint induced movement therapy promotes contralesional-oriented structural and bihemispheric functional neuroplasticity after stroke. Brain Res Bull. 2019;150:201-206.
• 9. Sterr A, Dean PJ, Szameitat AJ, et al.Corticospinal tract integrity and lesion volume play different roles in chronic hemiparesis and its improvement through motor practice. Neurorehab Neural Re. 2014;28(4):335-343.
• 10. Abdullahi A, Shehu S, Standardizing the Protocols of Constraint Induced Movement Therapy in Patients within 4 months post-stroke: A Pilot Randomized Controlled Trial. Int J Phys Med Rehabil. 2014;2(4):1000215.
• 11. Barzel A, Ketels G, Stark A, et al. Home-based constraint-induced movement therapy for patients with upper limb dysfunction after stroke (HOMECIMT): a cluster-randomised, controlled trial. Lancet Neurol. 2015;14(9):893-902.
• 12. Treger I, Aidinof L, Lehrer H, et al. Modified constraint-induced movement therapy improved upper limb function in subacute poststroke patients: a small-scale clinical trial. Top Stroke Rehabil. 2012;19(4): 287-293.
• 13. Yadav RK, Sharma R, Borah D, et al. Efficacy of Modified Constraint Induced Movement Therapy in the Treatment of Hemiparetic Upper Limb in Stroke Patients: A Randomized Controlled Trial. J Clin Diagnostic Res. 2016;10(11):YC01.
• 14. Taub E, Crago JE, Uswatte G. Constraint-induced movement therapy: A new approach to treatment in physical rehabilitation. Rehabil Psychol.1998;43(2): 152.
• 15. Brunnstrom S. Motor testing procedures in hemiplegia: based on sequential recovery stages. Physical therapy. 1966;46(4):357575.
• 16. Heinemann AW, Michael Linacre J, Wright BD, et al. Measurement characteristics of the Functional Independence Measure. Top Stroke Rehabil. 1994;1(3):1-15.
• 17. Fugl-Meyer AR, Jääskö L, Leyman I, et al. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med. 1975;7(1):13-31.
• 18. Singer B, Garcia-Vega J. The Fugl-Meyer Upper Extremity Scale. J Physiother. 2017;63(1):53.
• 19. Uswatte G, Taub E, Morris D, L et al. The Motor Activity Log-28: assessing daily use of the hemiparetic arm after stroke. Neurol. 2006;67(7):1189-1194.
• 20. Cakar E, Dincer U, Kiralp MZ, et al. Turkish adaptation of motor activity Log-28. Turk J Phys Med Rehabil. 2010;56:1-5.
• 21. Mathiowetz V, Volland G, Kashman N, et al. Adult norms for the Box and Block Test of manual dexterity. Am J Occup Ther. 1985;39(6):386-391.
• 22. Hantal AÖ, Doğu B, Büyükavcı R, Kuran B, Stroke impact scale version 3.0: study of reliability and validity in stroke patients in the Turkish population. Turk J Phys Med Rehabil. 2014;60(2):106-116.
• 23. Corbetta D, Sirtori V, Castellini G, et al. Constraint-induced movement therapy for upper extremities in people with stroke. Cochrane Database Syst Rev. 2015;2015(10):Cd004433.
• 24. Vidal AC, Banca P, Pascoal AG, et al. Bilateral versus ipsilesional cortico-subcortical activity patterns in stroke show hemispheric dependence. Int J Stroke. 2017;12(1):71-83.
• 25. Taub E, Uswatte G, Pidikiti R. Constraint-Induced Movement Therapy: a new family of techniques with broad application to physical rehabilitation--a clinical review. J Rehabil Res Dev. 1999;36(3):237-251.
• 26. Doussoulin A, Rivas C, Rivas R, et al. Effects of modified constraint-induced movement therapy in the recovery of upper extremity function affected by a stroke: a single-blind randomized parallel trial-comparing group versus individual intervention. Int J Rehabil Res. 2018;41(1):35-40.
• 27. Kim DG, Cho YW, Hong JH, S, et al. Effect of constraint-induced movement therapy with modified opposition restriction orthosis in chronic hemiparetic patients with stroke. Neuro Rehabil. 2008;23(3):239-244.
• 28. Myint JM, Yuen GF, Yu TK, et al. A study of constraint-induced movement therapy in subacute stroke patients in Hong Kong. Clin Rehabil. 2008;22(2):112-124.
• 29. Sunderland A, Tuke A. Neuroplasticity, learning and recovery after stroke: a critical evaluation of constraint-induced therapy. Neuropsychol Rehabil. 2005;15(2):81-96.
• 30. Wu CY, Chen CL, Tsai WC, et al. randomized controlled trial of modified constraint-induced movement therapy for elderly stroke survivors: changes in motor impairment, daily functioning, and quality of life. Arch Phys Med Rehabil. 2007;88(3):273-278.
• 31. Dettmers C, Teske U, Hamzei F, et al. Distributed form of constraint-induced movement therapy improves functional outcome and quality of life after stroke. Arch Phys Med Rehabil. 2005;86(2):204-209.
• 32. Yoon JA, Koo BI, Shin MJ, et al. Effect of constraint-induced movement therapy and mirror therapy for patients with subacute stroke. Ann Rehabil Med. 2014;38(4):458-466.
• 33. Wolf SL, Winstein CJ, Miller JP, et al. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. Jama. 2006;296(17):2095-2104.
• 34. El-Helow MR, Zamzam ML, Fathalla MM, et al. Efficacy of modified constraint-induced movement therapy in acute stroke. Eur J Phys Rehabil Med. 2015;51(4):371-379.
• 35. Stock R, Thrane G, Anke A, et al. Early versus late-applied constraint-induced movement therapy: A multisite, randomized controlled trial with a 12-month follow-up. Physiother Res Int. 2018;23(1):e1689.
• 36. Takebayashi T, Amano S, Hanada K, et al. A one-year follow-up after modified constraint-induced movement therapy for chronic stroke patients with paretic arm: a prospective case series study. Top Stroke Rehabil. 2015;22(1):18-25.
• 37. Kitago T, Liang J, Huang VS, et al. Improvement after constraint-induced movement therapy: recovery of normal motor control or task-specific compensation? Neurorehabil Neural Repair. 2013;27(2):99-109.