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Spinal Kord Yaralanmalı Hastalarda Pulmoner Rehabilitasyon Yaklaşımları

Year 2020, Volume: 5 Issue: 3, 299 - 305, 30.09.2020

Abstract

Özet

Spinal kord yaralanması sonrası, pulmoner komplikasyonlar, akut dönemde morbidite ve mortalitenin ana sebebidir. Bu dönemde hastaların yarıdan fazlasında atelektazi, pnömoni ve solunum yetmezliği gibi yaşamı tehdit eden solunumla ilişkili sorunlar gelişmektedir. Solunum fonksiyon bozukluğunun derecesi, nörolojik hasarın kapsamı ve seviyesine bağlı olup, yüksek servikal ve torasik lezyonu olan bireylerin daha yüksek risk taşıdığı bilinmektedir. Hastalar solunum semptomları açısından kapsamlı olarak değerlendirilmelidir. Hastalarda sekresyonları azaltmak ve dışarıya atılımını sağlamak, ventilasyonu artırmak için yaygın olarak kullanılan teknikler, postüral drenaj, perküsyon, vibrasyon, diyafragmatik solunum, segmental solunum, öksürük teknikleri ve aspirasyon gibi yaklaşımları içermektedir. Uygulanan pulmoner rehabilitasyon yaklaşımları ile hastaların mekanik ventilasyondan kurtarılması, sekresyonların atılması, solunum kaslarının kuvvetlendrilmesi, öksürüğün geliştirilmesi ve ventilasyonun artırılmasıyla birlikte günlük yaşama katılımlarında artışla birlikte yaşam kalitelerinin geliştiği görülmektedir.

Anahtar Kelimeler: Spinal kord yaralanması, spirometre, solunum egzersizleri, rehabilitasyon.

Supporting Institution

Yok

Project Number

Yok

Thanks

Yok

References

  • Ball, P. A. (2001). Critical care of spinal cord injury. Spine, 26(24S), S27-S30.
  • Baydur, A., Adkins, R. H., & Milic-Emili, J. (2001). Lung mechanics in individuals with spinal cord injury: effects of injury level and posture. Journal of Applied Physiology, 90(2), 405-411.
  • Berlly, M., & Shem, K. (2007). Respiratory management during the first five days after spinal cord injury. The journal of spinal cord medicine, 30(4), 309-318.
  • Berlowitz, D. J., Wadsworth, B., & Ross, J. (2016). Respiratory problems and management in people with spinal cord injury. Breathe, 12(4), 328–340.
  • Bhaskar, K. R., Brown, R., O’sullivan, D. D., Melia, S., Duggan, M., Reid, L. (1991). Bronchial mucus hypersecretion in acute quadriplegia: macromolecular yields and glycoconjugate composition. American Review of Respiratory Disease, 143(3), 640-648.
  • Brown, R., DiMarco, A. F., Hoit, J. D., & Garshick, E. (2006). Respiratory dysfunction and management in spinal cord injury. Respiratory care, 51(8), 853-870.
  • Claxton, A. R., Wong, D. T., Chung, F., & Fehlings, M. G. (1998). Predictors of hospital mortality and mechanical ventilation in patients with cervical spinal cord injury. Canadian journal of Anaesthesia, 45(2), 144-149.
  • Craven, D. E. (2000). Epidemiology of ventilator-associated pneumonia. Chest, 117(4), 186-187.
  • de Paleville, D. G. T., McKay, W. B., Folz, R. J., & Ovechkin, A. V. (2011). Respiratory motor control disrupted by spinal cord injury: mechanisms, evaluation, and restoration. Translational stroke research, 2(4), 463-473.
  • Devivo, M. (2012). Epidemiology of traumatic spinal cord injury: trends and future implications. Spinal cord, 50(5), 365-372.
  • DiMarco, A. F., Geertman, R. T., Tabbaa, K., & Kowalski, K. E. (2019). Complete Restoration of Respiratory Muscle Function in Three Subjects With Spinal Cord Injury: Pilot Interventional Clinical Trial. Am J Phys Med Rehabil, 98(1), 43-50.
  • Ditunno, J., Little, J., Tessler, A., & Burns, A. (2004). Spinal shock revisited: a four-phase model. Spinal cord, 42(7), 383-395.
  • Estenne, M., & De Troyer, A. (1987). Mechanism of the Postural Dependence of Vital Capacity in Tetraplegie Subjects. American Review of Respiratory Disease, 135(2), 367-371.
  • Estenne, M., Pinet, C., & De Troyer, A. (2000). Abdominal muscle strength in patients with tetraplegia. American journal of respiratory and critical care medicine, 161(3), 707-712.
  • Galeiras Vazquez, R., Rascado Sedes, P., Mourelo Fariña, M., Montoto Marqués, A., & Ferreiro Velasco, M. E. (2013). Respiratory management in the patient with spinal cord injury. BioMed Research International, 2013. 168757. doi: 10.1155/2013/168757.
  • Gay, P. C. (2013). Counterpoint: Should phrenic nerve stimulation be the treatment of choice for spinal cord injury? No. Chest, 143(5), 1203-1206.
  • Glenn, W. W., Hogan, J. F., Loke, J. S., Ciesielski, T. E., Phelps, M. L., & Rowedder, R. (1984). Ventilatory support by pacing of the conditioned diaphragm in quadriplegia. New England Journal of Medicine, 310(18), 1150-1155.
  • Gómez-Merino, E., Sancho, J., Marín, J., Servera, E., Blasco, M. L., Belda, F. J., Bach, J. R. (2002). Mechanical insufflation-exsufflation: pressure, volume, and flow relationships and the adequacy of the manufacturer’s guidelines. American journal of physical medicine & rehabilitation, 81(8), 579-583.
  • Harvey, L. (2008). Management of Spinal Cord Injuries E-Book: A Guide for Physiotherapists: Elsevier Health Sciences.
  • Jackson, A. B., & Groomes, T. E. (1994). Incidence of respiratory complications following spinal cord injury. Archives of physical medicine and rehabilitation, 75(3), 270-275.
  • Jarosz, R., Littlepage, M., Creasey, G., & McKenna, S. (2012). Functional electrical stimulation in spinal cord injury respiratory care. Topics in Spinal Cord Injury Rehabilitation, 18(4), 315-321.
  • Joshi, M., & Mathur, N. (2002). Pulmonary functions and effect of incentive spirometry during acute and post acute period in tetraplegia. IJPMR, 13, 28-34.
  • Kearon, M., Summers, E., Jones, N., Campbell, E., & Killian, K. (1991). Effort and dyspnoea during work of varying intensity and duration. European Respiratory Journal, 4(8), 917-925.
  • Kerwin, A. J., Zuniga, Y. D., Yorkgitis, B. K., Mull, J., Hsu, A. T., Madbak, F. G., Crandall, M. L. (2020). Diaphragm pacing improves respiratory mechanics in acute cervical spinal cord injury. J Trauma Acute Care Surg. doi: 10.1097/ta.0000000000002809
  • Kulnik, S. T., MacBean, V., Birring, S. S., Moxham, J., Rafferty, G. F., & Kalra, L. (2015). Accuracy of portable devices in measuring peak cough flow. Physiol Meas, 36(2), 243-257.
  • Lemons, V. R., & Wagner, J. F. (1994). Respiratory complications after cervical spinal cord injury. Spine, 19(20), 2315-2320.
  • Liaw, M.-Y., Lin, M.-C., Cheng, P.-T., Wong, M.-K. A., & Tang, F.-T. (2000). Resistive inspiratory muscle training: its effectiveness in patients with acute complete cervical cord injury. Archives of physical medicine and rehabilitation, 81(6), 752-756.
  • Linn, W., Spungen, A., Gong Jr, H., Adkins, R., Bauman, A., & Waters, R. (2001). Forced vital capacity in two large outpatient populations with chronic spinal cord injury. Spinal cord, 39(5), 263-268.
  • Manning, H. L., Shea, S. A., Schwartzstein, R. M., Lansing, R. W., Brown, R., & Banzett, R. B. (1992). Reduced tidal volume increases ‘air hunger’at fixed PCO2 in ventilated quadriplegics. Respiration physiology, 90(1), 19-30.
  • Marsolais, E., Boninger, M., McCormick, P., Love, L., Mackelprang, R., Dalsey, W., Howard, M. (2005). Respiratory management following spinal cord injury: a clinical practice guideline for health-care professionals. Journal Of Spinal Cord Medicine, 28(3), 259-293.
  • Mateus, S., Beraldo, P., & Horan, T. (2007). Maximal static mouth respiratory pressure in spinal cord injured patients: correlation with motor level. Spinal cord, 45(8), 569-575.
  • Menter, R. R., Bach, J., Brown, D., Gutteridge, G., & Watt, J. (1997). A review of the respiratory management of a patient with high level tetraplegia. Spinal cord, 35, 805-808.
  • Pryor, J. A., & Prasad, A. S. (2008). Physiotherapy for respiratory and cardiac problems: adults and paediatrics: Elsevier Health Sciences.
  • Raurich, J., Rialp, G., Llompart-Pou, J., Ayestarán, I., Pérez-Bárcena, J., & Ibáñez, J. (2014). Respiratory CO 2 response in acute cervical spinal cord injury (CO 2 response in spinal cord injury). Spinal cord, 52(1), 39-43.
  • Roth, E. J., Lu, A., Primack, S., Oken, J., Nussbaum, S., Berkowitz, M., & Powley, S. (1997). Ventilatory function in cervical and high thoracic spinal cord injury: Relationship to Level of Injury and Tone1. American journal of physical medicine & rehabilitation, 76(4), 262-267.
  • Roussos, C., & Koutsoukou, A. (2003). Respiratory failure. Eur Respir J, 22(47), 3s-14s.
  • Schilero, G. J., Bauman, W. A., & Radulovic, M. (2018). Traumatic spinal ord injury: pulmonary physiologic principles and management. Clinics in chest medicine, 39(2), 411-425.
  • Schilero, G. J., Spungen, A. M., Bauman, W. A., Radulovic, M., & Lesser, M. (2009). Pulmonary function and spinal cord injury. Respiratory physiology & neurobiology, 166(3), 129-141.
  • Slack, R. S., & Shucart, W. (1994). Respiratory dysfunction associated with traumatic injury to the central nervous system. Clinics in chest medicine, 15(4), 739-749.
  • Slonimski, M., & Aguilera, E. J. (2001). Atelectasis and mucus plugging in spinal cord injury: case report and therapeutic approaches. The journal of spinal cord medicine, 24(4), 284-288.
  • Tamplin, J., & Berlowitz, D. J. (2014). A systematic review and metaanalysis of the effects of respiratory muscle training on pulmonary function in tetraplegia. Spinal cord, 52(3), 175-180.
  • Walker, J., & Fernandes, T. (2009). Spinal cord injuries: acute care management and rehabilitation. Nursing Standard (through 2013), 23(42), 47-56.
  • Wallbom, A., Naran, B., & Thomas, E. (2004). Acute ventilator management and weaning in individuals with high tetraplegia. Topics in Spinal Cord Injury Rehabilitation, 10(3), 1-7.
  • Winser, S. J., George, J., Stanley, P., & Tharion, G. (2009). A comparison study of two breathing exercise techniques in tetraplegics. Health, 1(02), 88-92.
  • Winslow, C., Bode, R. K., Felton, D., Chen, D., & Meyer Jr, P. R. (2002). Impact of respiratory complications on length of stay and hospital costs in acute cervical spine injury. Chest, 121(5), 1548-1554.
  • Winslow, C., & Rozovsky, J. (2003). Effect of spinal cord injury on the respiratory system. American journal of physical medicine & rehabilitation, 82(10), 803-814.

Pulmonary Rehabilitation Approaches in Patients with Spinal Cord Injury

Year 2020, Volume: 5 Issue: 3, 299 - 305, 30.09.2020

Abstract

Abstract
Pulmonary complications after spinal cord injury are the main cause of morbidity and mortality in the acute period. In this period, more than half of patients develop life threatening respiratory problems such as atelectasis, pneumonia and respiratory failure. The degree of respiratory dysfunction depends on the extent and level of neurological damage, and individuals with high cervical and thoracic lesions are known to have a higher risk. Patients should be comprehensively evaluated for respiratory symptoms. Commonly used techniques to reduce secretions and increase ventilation include postural drainage, percussion, vibration, diaphragmatic breathing, segmental breathing, cough techniques, and aspiration. With the pulmonary rehabilitation approaches applied, it is observed that quality of life improves with the increase in their participation in daily life with the recovery of patients from mechanical ventilation, removal of secretions, strengthening of respiratory muscles, development of cough capacity and increasing ventilation.

Keywords: Spinal cord injury, spirometer, breathing exercises, rehabilitation.

Project Number

Yok

References

  • Ball, P. A. (2001). Critical care of spinal cord injury. Spine, 26(24S), S27-S30.
  • Baydur, A., Adkins, R. H., & Milic-Emili, J. (2001). Lung mechanics in individuals with spinal cord injury: effects of injury level and posture. Journal of Applied Physiology, 90(2), 405-411.
  • Berlly, M., & Shem, K. (2007). Respiratory management during the first five days after spinal cord injury. The journal of spinal cord medicine, 30(4), 309-318.
  • Berlowitz, D. J., Wadsworth, B., & Ross, J. (2016). Respiratory problems and management in people with spinal cord injury. Breathe, 12(4), 328–340.
  • Bhaskar, K. R., Brown, R., O’sullivan, D. D., Melia, S., Duggan, M., Reid, L. (1991). Bronchial mucus hypersecretion in acute quadriplegia: macromolecular yields and glycoconjugate composition. American Review of Respiratory Disease, 143(3), 640-648.
  • Brown, R., DiMarco, A. F., Hoit, J. D., & Garshick, E. (2006). Respiratory dysfunction and management in spinal cord injury. Respiratory care, 51(8), 853-870.
  • Claxton, A. R., Wong, D. T., Chung, F., & Fehlings, M. G. (1998). Predictors of hospital mortality and mechanical ventilation in patients with cervical spinal cord injury. Canadian journal of Anaesthesia, 45(2), 144-149.
  • Craven, D. E. (2000). Epidemiology of ventilator-associated pneumonia. Chest, 117(4), 186-187.
  • de Paleville, D. G. T., McKay, W. B., Folz, R. J., & Ovechkin, A. V. (2011). Respiratory motor control disrupted by spinal cord injury: mechanisms, evaluation, and restoration. Translational stroke research, 2(4), 463-473.
  • Devivo, M. (2012). Epidemiology of traumatic spinal cord injury: trends and future implications. Spinal cord, 50(5), 365-372.
  • DiMarco, A. F., Geertman, R. T., Tabbaa, K., & Kowalski, K. E. (2019). Complete Restoration of Respiratory Muscle Function in Three Subjects With Spinal Cord Injury: Pilot Interventional Clinical Trial. Am J Phys Med Rehabil, 98(1), 43-50.
  • Ditunno, J., Little, J., Tessler, A., & Burns, A. (2004). Spinal shock revisited: a four-phase model. Spinal cord, 42(7), 383-395.
  • Estenne, M., & De Troyer, A. (1987). Mechanism of the Postural Dependence of Vital Capacity in Tetraplegie Subjects. American Review of Respiratory Disease, 135(2), 367-371.
  • Estenne, M., Pinet, C., & De Troyer, A. (2000). Abdominal muscle strength in patients with tetraplegia. American journal of respiratory and critical care medicine, 161(3), 707-712.
  • Galeiras Vazquez, R., Rascado Sedes, P., Mourelo Fariña, M., Montoto Marqués, A., & Ferreiro Velasco, M. E. (2013). Respiratory management in the patient with spinal cord injury. BioMed Research International, 2013. 168757. doi: 10.1155/2013/168757.
  • Gay, P. C. (2013). Counterpoint: Should phrenic nerve stimulation be the treatment of choice for spinal cord injury? No. Chest, 143(5), 1203-1206.
  • Glenn, W. W., Hogan, J. F., Loke, J. S., Ciesielski, T. E., Phelps, M. L., & Rowedder, R. (1984). Ventilatory support by pacing of the conditioned diaphragm in quadriplegia. New England Journal of Medicine, 310(18), 1150-1155.
  • Gómez-Merino, E., Sancho, J., Marín, J., Servera, E., Blasco, M. L., Belda, F. J., Bach, J. R. (2002). Mechanical insufflation-exsufflation: pressure, volume, and flow relationships and the adequacy of the manufacturer’s guidelines. American journal of physical medicine & rehabilitation, 81(8), 579-583.
  • Harvey, L. (2008). Management of Spinal Cord Injuries E-Book: A Guide for Physiotherapists: Elsevier Health Sciences.
  • Jackson, A. B., & Groomes, T. E. (1994). Incidence of respiratory complications following spinal cord injury. Archives of physical medicine and rehabilitation, 75(3), 270-275.
  • Jarosz, R., Littlepage, M., Creasey, G., & McKenna, S. (2012). Functional electrical stimulation in spinal cord injury respiratory care. Topics in Spinal Cord Injury Rehabilitation, 18(4), 315-321.
  • Joshi, M., & Mathur, N. (2002). Pulmonary functions and effect of incentive spirometry during acute and post acute period in tetraplegia. IJPMR, 13, 28-34.
  • Kearon, M., Summers, E., Jones, N., Campbell, E., & Killian, K. (1991). Effort and dyspnoea during work of varying intensity and duration. European Respiratory Journal, 4(8), 917-925.
  • Kerwin, A. J., Zuniga, Y. D., Yorkgitis, B. K., Mull, J., Hsu, A. T., Madbak, F. G., Crandall, M. L. (2020). Diaphragm pacing improves respiratory mechanics in acute cervical spinal cord injury. J Trauma Acute Care Surg. doi: 10.1097/ta.0000000000002809
  • Kulnik, S. T., MacBean, V., Birring, S. S., Moxham, J., Rafferty, G. F., & Kalra, L. (2015). Accuracy of portable devices in measuring peak cough flow. Physiol Meas, 36(2), 243-257.
  • Lemons, V. R., & Wagner, J. F. (1994). Respiratory complications after cervical spinal cord injury. Spine, 19(20), 2315-2320.
  • Liaw, M.-Y., Lin, M.-C., Cheng, P.-T., Wong, M.-K. A., & Tang, F.-T. (2000). Resistive inspiratory muscle training: its effectiveness in patients with acute complete cervical cord injury. Archives of physical medicine and rehabilitation, 81(6), 752-756.
  • Linn, W., Spungen, A., Gong Jr, H., Adkins, R., Bauman, A., & Waters, R. (2001). Forced vital capacity in two large outpatient populations with chronic spinal cord injury. Spinal cord, 39(5), 263-268.
  • Manning, H. L., Shea, S. A., Schwartzstein, R. M., Lansing, R. W., Brown, R., & Banzett, R. B. (1992). Reduced tidal volume increases ‘air hunger’at fixed PCO2 in ventilated quadriplegics. Respiration physiology, 90(1), 19-30.
  • Marsolais, E., Boninger, M., McCormick, P., Love, L., Mackelprang, R., Dalsey, W., Howard, M. (2005). Respiratory management following spinal cord injury: a clinical practice guideline for health-care professionals. Journal Of Spinal Cord Medicine, 28(3), 259-293.
  • Mateus, S., Beraldo, P., & Horan, T. (2007). Maximal static mouth respiratory pressure in spinal cord injured patients: correlation with motor level. Spinal cord, 45(8), 569-575.
  • Menter, R. R., Bach, J., Brown, D., Gutteridge, G., & Watt, J. (1997). A review of the respiratory management of a patient with high level tetraplegia. Spinal cord, 35, 805-808.
  • Pryor, J. A., & Prasad, A. S. (2008). Physiotherapy for respiratory and cardiac problems: adults and paediatrics: Elsevier Health Sciences.
  • Raurich, J., Rialp, G., Llompart-Pou, J., Ayestarán, I., Pérez-Bárcena, J., & Ibáñez, J. (2014). Respiratory CO 2 response in acute cervical spinal cord injury (CO 2 response in spinal cord injury). Spinal cord, 52(1), 39-43.
  • Roth, E. J., Lu, A., Primack, S., Oken, J., Nussbaum, S., Berkowitz, M., & Powley, S. (1997). Ventilatory function in cervical and high thoracic spinal cord injury: Relationship to Level of Injury and Tone1. American journal of physical medicine & rehabilitation, 76(4), 262-267.
  • Roussos, C., & Koutsoukou, A. (2003). Respiratory failure. Eur Respir J, 22(47), 3s-14s.
  • Schilero, G. J., Bauman, W. A., & Radulovic, M. (2018). Traumatic spinal ord injury: pulmonary physiologic principles and management. Clinics in chest medicine, 39(2), 411-425.
  • Schilero, G. J., Spungen, A. M., Bauman, W. A., Radulovic, M., & Lesser, M. (2009). Pulmonary function and spinal cord injury. Respiratory physiology & neurobiology, 166(3), 129-141.
  • Slack, R. S., & Shucart, W. (1994). Respiratory dysfunction associated with traumatic injury to the central nervous system. Clinics in chest medicine, 15(4), 739-749.
  • Slonimski, M., & Aguilera, E. J. (2001). Atelectasis and mucus plugging in spinal cord injury: case report and therapeutic approaches. The journal of spinal cord medicine, 24(4), 284-288.
  • Tamplin, J., & Berlowitz, D. J. (2014). A systematic review and metaanalysis of the effects of respiratory muscle training on pulmonary function in tetraplegia. Spinal cord, 52(3), 175-180.
  • Walker, J., & Fernandes, T. (2009). Spinal cord injuries: acute care management and rehabilitation. Nursing Standard (through 2013), 23(42), 47-56.
  • Wallbom, A., Naran, B., & Thomas, E. (2004). Acute ventilator management and weaning in individuals with high tetraplegia. Topics in Spinal Cord Injury Rehabilitation, 10(3), 1-7.
  • Winser, S. J., George, J., Stanley, P., & Tharion, G. (2009). A comparison study of two breathing exercise techniques in tetraplegics. Health, 1(02), 88-92.
  • Winslow, C., Bode, R. K., Felton, D., Chen, D., & Meyer Jr, P. R. (2002). Impact of respiratory complications on length of stay and hospital costs in acute cervical spine injury. Chest, 121(5), 1548-1554.
  • Winslow, C., & Rozovsky, J. (2003). Effect of spinal cord injury on the respiratory system. American journal of physical medicine & rehabilitation, 82(10), 803-814.
There are 46 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Derlemeler
Authors

Rüstem Mustafaoğlu 0000-0001-7030-0787

Ela Tarakcı 0000-0003-1330-2051

Project Number Yok
Publication Date September 30, 2020
Submission Date June 12, 2020
Published in Issue Year 2020 Volume: 5 Issue: 3

Cite

APA Mustafaoğlu, R., & Tarakcı, E. (2020). Spinal Kord Yaralanmalı Hastalarda Pulmoner Rehabilitasyon Yaklaşımları. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, 5(3), 299-305.
AMA Mustafaoğlu R, Tarakcı E. Spinal Kord Yaralanmalı Hastalarda Pulmoner Rehabilitasyon Yaklaşımları. İKÇÜSBFD. September 2020;5(3):299-305.
Chicago Mustafaoğlu, Rüstem, and Ela Tarakcı. “Spinal Kord Yaralanmalı Hastalarda Pulmoner Rehabilitasyon Yaklaşımları”. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 5, no. 3 (September 2020): 299-305.
EndNote Mustafaoğlu R, Tarakcı E (September 1, 2020) Spinal Kord Yaralanmalı Hastalarda Pulmoner Rehabilitasyon Yaklaşımları. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 5 3 299–305.
IEEE R. Mustafaoğlu and E. Tarakcı, “Spinal Kord Yaralanmalı Hastalarda Pulmoner Rehabilitasyon Yaklaşımları”, İKÇÜSBFD, vol. 5, no. 3, pp. 299–305, 2020.
ISNAD Mustafaoğlu, Rüstem - Tarakcı, Ela. “Spinal Kord Yaralanmalı Hastalarda Pulmoner Rehabilitasyon Yaklaşımları”. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 5/3 (September 2020), 299-305.
JAMA Mustafaoğlu R, Tarakcı E. Spinal Kord Yaralanmalı Hastalarda Pulmoner Rehabilitasyon Yaklaşımları. İKÇÜSBFD. 2020;5:299–305.
MLA Mustafaoğlu, Rüstem and Ela Tarakcı. “Spinal Kord Yaralanmalı Hastalarda Pulmoner Rehabilitasyon Yaklaşımları”. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, vol. 5, no. 3, 2020, pp. 299-05.
Vancouver Mustafaoğlu R, Tarakcı E. Spinal Kord Yaralanmalı Hastalarda Pulmoner Rehabilitasyon Yaklaşımları. İKÇÜSBFD. 2020;5(3):299-305.



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