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Modifiye zorunlu kullanım terapisi hemipleji hastalarında motor performansı iyileştirmede etkili midir?

Yıl 2023, Cilt: 28 Sayı: 1, 48 - 55, 20.01.2023
https://doi.org/10.21673/anadoluklin.1085612

Öz

Amaç: Bu çalışmanın amacı, inmeye bağlı hemipleji gelişmiş hastalarda konvansiyonel rehabilitasyona ek olarak modifiye zorunlu kullanım terapisinin (mZKT) üst ekstremite motor iyileşme, performans ve fonksiyonel bağımsızlık üzerindeki etkisini araştırmaktı.

Yöntemler: Çalışmaya; çalışma grubu (64,45±9,18 yıl) 20 olgu, kontrol grubu (64,45±9,18 yıl) 20 olgu olacak şekilde toplam 40 kronik inme olgusu dâhil edilmiştir. Çalışma grubu düzenli fizyoterapi ile mZKT alırken, kontrol grubu sadece düzenli fizyoterapi aldı. Hastalar tedavi öncesi, tedavi sonrası ve tedavi sonrası 3. ayda Motor Aktivite Günlüğü-28 (MAG-28), Fonksiyonel Bağımsızlık Ölçümü (FBÖ) ve Fugl-Meyer Üst Ekstremite Skalası (FMÜES) ile değerlendirildi.

Bulgular: MAG-28 ve FBÖ skorları tedavi sonrası ve üçüncü ay takibinde başlangıç değerlerine kıyasla her iki grupta da istatistiksel açıdan anlamlı olarak arttı (p<0.05). Tedavi sonrası ve üçüncü ay takibinde, FMUES skorları başlangıç değerlerine göre her iki grupta da anlamlı olarak arttı (p<0.001).

Sonuç: Bu çalışma, konvansiyonel tedaviye eklenen mZKT’nin kronik inmeli hastalarda üst ekstremite motor fonksiyonunu, performansını ve fonksiyonel bağımsızlığını iyileştirdiğini göstermiştir; ancak, mZKTnin geleneksel tedaviye kıyasla ek bir faydası olmamıştır.

Kaynakça

  • Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet. 2011;377(9778):1693–702.
  • Coupar F, Pollock A, Rowe P, Weir C, Langhorne P. Predictors of upper limb recovery after stroke: a systematic review and meta-analysis. Clin Rehabil. 2012;26(4):291–313.
  • Shanthi Mendis.Stroke disability and rehabilitation of stroke: World Health Organization perspective. Int J Stroke. 2013;8(1):3-4.
  • Rathore S. S., Hinn A.R.,Cooper L.S., Tyroler H.A., Rosamond W.D.Characterization of incident stroke signs and symptoms findings from the atherosclerosis risk in communities study. Stroke. 2002;33(11):2718-21.
  • Langhorne P, Coupar F, Polloc A. Motor recovery after stroke: a systematic review. Lancet Neurol. 2009;8(8):741–54.
  • Stinear CM., Byblow WD. Predicting and accelerating motor recovery after stroke. Curr Opin Neurol. 2014;27(6):624-30.
  • Nakayama H, Jorgensen HS, Raaschou HO Olsen TS. Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil. 1994;75(4):394–8.
  • Özcan O, Turan B. Hemipleji rehabilitasyonu In: Özcan O, Arpacıoğlu O, Turan B. (ed). Nörorehabilitasyon. 2nd ed. Bursa: Güneş ve Nobel Tıp Kitabevleri; 2000:61-82.
  • Dalyan Aras M, Çakcı A. İnme rehabilitasyonu In Oğuz H, Dursun E, Dursun N. (ed). Tıbbi Rehabilitasyon. 2nd ed. İstanbul: Nobel Tıp Kitabevleri; 2004:589-617.
  • Veerbeek JM, Van Wegen E, Van Peppen R, et al. What is the evidence for physical therapy post stroke? A systematic review and meta-analysis. PLoS One. 2014;9(2): e87987.
  • Saposnik G, Levin M, Outcome Research Canada (SORCan) Working Group Virtual reality in stroke rehabilitation: A meta-analysis and implications for clinicians. Stroke. 2011; 42(5): 1380–6.
  • Dromerick AW, Edwards DF, Hahn M. Does the application of constraint-induced movement therapy for upper extremity after ischemic stroke. Stroke. 2000;31(12):2984-8.
  • Taub E, Uswatte G, King DK et al. A placebo-controlled trial of constraint-induced movement therapy for upper extremity after stroke. Stroke. 2006;37(4):1045-9.
  • Young JA, Tolentino M. Neuroplasticity and Its applications for rehabilitation. Am J Ther. 2011;18(1):70-80.
  • Gauthier LV, Taub E, Perkins C, Ortmann M, Mark VW, Uswatte G. Remodeling the brain: plastic structural brain changes produced by different motor therapies after stroke. Stroke. 2008;39(5):1520–5.
  • Liepert J, Bauder H, Miltner WHR, Taub E, Weiller C. Treatment-induced cortical reorganization after stroke in humans. Stroke. 2000;31(6):1210–6.
  • Kopp B, Kunkel A, Mühlnickel W, Villringer K, Taub E, Flor H. Plasticity in the motor system related to therapy-induced improvement of movement after stroke. Neuroreport. 1999;10(4):807-10.
  • Schaechter JD, Kraft E, Hilliard TS, et al. Motor recovery and cortical reorganization after constraint-induced movement therapy in stroke patients: a preliminary study. Neurorehabil Neural Repair. 2002;16(4):326-38.
  • Wittenberg GF, Chen R, Ishii K, et al. Constraint-induced therapy in stroke: magnetic-stimulation motor maps and cerebral activation. Neurorehabil Neural Repair. 2003;17(1):48-57.
  • Brady K, Garcia T. Constraint-induced movement therapy (CIMT): Pediatric applications. Dev Disabil Res Rev. 2009;15(2):102-11.
  • Harvey RL, Roth EJ, Yu DT, Celnik P. Stroke syndromes. In: Braddom RL (ed). Physical Medicine and Rehabilitation. China 4th ed. Elsevier Saunders; 2011:1177-222.
  • Kwakkel G, Veerbeek JM, Van Wegen EEH, Wolf SL. Constraint-induced movement therapy after stroke. Lancet Neurol. 2015;14(2):224-34.
  • Sirtori V, Corbetta D, Moja L, Gatti R. Constraint induced movement therapy for upper extremities in stroke patients. Cochrane Database Syst Rev. 2009;7(4): CD004433.
  • 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):2095–104.
  • Uswatte G, Taub E, Morris D, et al. The Motor Activity Log-28. Neurology. 2006;67(7):1189–94.
  • Ersöz Hüseyinsinoğlu B, Razak Özdinçler A, Erkan Oğul Ö, Krespi Y. Reliability and validity of Turkish Version of Motor Activity Log-28. Turk J Neurol. 2011;17(2):83–9.
  • Ottenbacher KJ, Hsu Y, Granger C V, Fiedler RC. The reliability of the functional independence measure: A quantitative review. Arch Phys Med Rehabil. 1996;77(12):1226–32.
  • Küçükdeveci AA, Yavuzer G, Elhan AH, et al. Adaptation of the Functional Independence Measure for use in Turkey. Clin Rehabil. 2001;15(3):311–9.
  • Page SJ, Fulk GD, Boyne P. Clinically Important Differences for the Upper-Extremity Fugl-Meyer Scale in People With Minimal to Moderate Impairment Due to Chronic Stroke. Physical Therapy. 2012;92(6):791–8.
  • Jacquin-Courtois S. Hemi-spatial neglect rehabilitation using non-invasive brain stimulation: or how to modulate the disconnection syndrome? Ann Phys Rehabil Med. 2015;58(4):251–8.
  • Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS. Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil. 1994;75(4): 394–8.
  • Sawaki L, Butler AJ, Leng X, et al. Constraint-induced movement therapy results in increased motor map area in subjects 3 to 9 months after stroke. Neurorehabil Neural Repair. 2008;22(5):505–13.
  • da Silva ESM, Santos GL, Catai AM, et al. Effect of aerobic exercise prior to modified constraint-induced movement therapy outcomes in individuals with chronic hemiparesis: a study protocol for a randomized clinical trial. BMC Neurol. 2019;19(1):196.
  • 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.
  • Wu C-Y, Chen C-L, Tsai W-C, Lin K-C, Chou S-H. A 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):273-8.
  • Dromerick AW, Lang CE, Birkenmeier RL, et al. Very Early Constraint-Induced Movement during Stroke Rehabilitation (VECTORS): A single-center RCT. Neurology. 2009;73(3):195-201.

Is modified constraint-induced movement therapy effective in improving motor performance in patients with hemiplegia?

Yıl 2023, Cilt: 28 Sayı: 1, 48 - 55, 20.01.2023
https://doi.org/10.21673/anadoluklin.1085612

Öz

Aim: To investigate the effect of modified constraint-induced movement therapy (mCIMT) on upper extremity motor recovery, performance, and functional independence in addition to conventional rehabilitation in stroke patients.

Methods: The study included 40 participants, including 20 chronic stroke cases in the intervention group (IG) (64.45±9.18 years) and 20 chronic stroke cases in the control group (CG) (64.45±9.18 years) who met the selection criteria. IG received mCIMT with regular physiotherapy, while CG received only regular physiotherapy. The patients were evaluated with the Motor Activity Log-28 (MAL-28), the Functional Independence Measure (FIM), and the Fugl-Meyer Upper Extremity Scale (FMUES) before treatment, immediately after treatment (post-treatment), and at three months after treatment (follow-up).

Results: The MAL-28 and FIM scores significantly increased in both groups compared with the baseline values after treatment and at the third-month follow-up (p<0.05). After treatment and at the third-month follow-up, the FMUES scores significantly increased in both groups compared with the baseline values (p<0.001).

Conclusion: This study showed that mCIMT added to conventional therapy improved upper extremity motor function, performance, and functional independence in chronic stroke patients; however, mCIMT had no additional benefit to conventional therapy.

Kaynakça

  • Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet. 2011;377(9778):1693–702.
  • Coupar F, Pollock A, Rowe P, Weir C, Langhorne P. Predictors of upper limb recovery after stroke: a systematic review and meta-analysis. Clin Rehabil. 2012;26(4):291–313.
  • Shanthi Mendis.Stroke disability and rehabilitation of stroke: World Health Organization perspective. Int J Stroke. 2013;8(1):3-4.
  • Rathore S. S., Hinn A.R.,Cooper L.S., Tyroler H.A., Rosamond W.D.Characterization of incident stroke signs and symptoms findings from the atherosclerosis risk in communities study. Stroke. 2002;33(11):2718-21.
  • Langhorne P, Coupar F, Polloc A. Motor recovery after stroke: a systematic review. Lancet Neurol. 2009;8(8):741–54.
  • Stinear CM., Byblow WD. Predicting and accelerating motor recovery after stroke. Curr Opin Neurol. 2014;27(6):624-30.
  • Nakayama H, Jorgensen HS, Raaschou HO Olsen TS. Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil. 1994;75(4):394–8.
  • Özcan O, Turan B. Hemipleji rehabilitasyonu In: Özcan O, Arpacıoğlu O, Turan B. (ed). Nörorehabilitasyon. 2nd ed. Bursa: Güneş ve Nobel Tıp Kitabevleri; 2000:61-82.
  • Dalyan Aras M, Çakcı A. İnme rehabilitasyonu In Oğuz H, Dursun E, Dursun N. (ed). Tıbbi Rehabilitasyon. 2nd ed. İstanbul: Nobel Tıp Kitabevleri; 2004:589-617.
  • Veerbeek JM, Van Wegen E, Van Peppen R, et al. What is the evidence for physical therapy post stroke? A systematic review and meta-analysis. PLoS One. 2014;9(2): e87987.
  • Saposnik G, Levin M, Outcome Research Canada (SORCan) Working Group Virtual reality in stroke rehabilitation: A meta-analysis and implications for clinicians. Stroke. 2011; 42(5): 1380–6.
  • Dromerick AW, Edwards DF, Hahn M. Does the application of constraint-induced movement therapy for upper extremity after ischemic stroke. Stroke. 2000;31(12):2984-8.
  • Taub E, Uswatte G, King DK et al. A placebo-controlled trial of constraint-induced movement therapy for upper extremity after stroke. Stroke. 2006;37(4):1045-9.
  • Young JA, Tolentino M. Neuroplasticity and Its applications for rehabilitation. Am J Ther. 2011;18(1):70-80.
  • Gauthier LV, Taub E, Perkins C, Ortmann M, Mark VW, Uswatte G. Remodeling the brain: plastic structural brain changes produced by different motor therapies after stroke. Stroke. 2008;39(5):1520–5.
  • Liepert J, Bauder H, Miltner WHR, Taub E, Weiller C. Treatment-induced cortical reorganization after stroke in humans. Stroke. 2000;31(6):1210–6.
  • Kopp B, Kunkel A, Mühlnickel W, Villringer K, Taub E, Flor H. Plasticity in the motor system related to therapy-induced improvement of movement after stroke. Neuroreport. 1999;10(4):807-10.
  • Schaechter JD, Kraft E, Hilliard TS, et al. Motor recovery and cortical reorganization after constraint-induced movement therapy in stroke patients: a preliminary study. Neurorehabil Neural Repair. 2002;16(4):326-38.
  • Wittenberg GF, Chen R, Ishii K, et al. Constraint-induced therapy in stroke: magnetic-stimulation motor maps and cerebral activation. Neurorehabil Neural Repair. 2003;17(1):48-57.
  • Brady K, Garcia T. Constraint-induced movement therapy (CIMT): Pediatric applications. Dev Disabil Res Rev. 2009;15(2):102-11.
  • Harvey RL, Roth EJ, Yu DT, Celnik P. Stroke syndromes. In: Braddom RL (ed). Physical Medicine and Rehabilitation. China 4th ed. Elsevier Saunders; 2011:1177-222.
  • Kwakkel G, Veerbeek JM, Van Wegen EEH, Wolf SL. Constraint-induced movement therapy after stroke. Lancet Neurol. 2015;14(2):224-34.
  • Sirtori V, Corbetta D, Moja L, Gatti R. Constraint induced movement therapy for upper extremities in stroke patients. Cochrane Database Syst Rev. 2009;7(4): CD004433.
  • 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):2095–104.
  • Uswatte G, Taub E, Morris D, et al. The Motor Activity Log-28. Neurology. 2006;67(7):1189–94.
  • Ersöz Hüseyinsinoğlu B, Razak Özdinçler A, Erkan Oğul Ö, Krespi Y. Reliability and validity of Turkish Version of Motor Activity Log-28. Turk J Neurol. 2011;17(2):83–9.
  • Ottenbacher KJ, Hsu Y, Granger C V, Fiedler RC. The reliability of the functional independence measure: A quantitative review. Arch Phys Med Rehabil. 1996;77(12):1226–32.
  • Küçükdeveci AA, Yavuzer G, Elhan AH, et al. Adaptation of the Functional Independence Measure for use in Turkey. Clin Rehabil. 2001;15(3):311–9.
  • Page SJ, Fulk GD, Boyne P. Clinically Important Differences for the Upper-Extremity Fugl-Meyer Scale in People With Minimal to Moderate Impairment Due to Chronic Stroke. Physical Therapy. 2012;92(6):791–8.
  • Jacquin-Courtois S. Hemi-spatial neglect rehabilitation using non-invasive brain stimulation: or how to modulate the disconnection syndrome? Ann Phys Rehabil Med. 2015;58(4):251–8.
  • Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS. Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil. 1994;75(4): 394–8.
  • Sawaki L, Butler AJ, Leng X, et al. Constraint-induced movement therapy results in increased motor map area in subjects 3 to 9 months after stroke. Neurorehabil Neural Repair. 2008;22(5):505–13.
  • da Silva ESM, Santos GL, Catai AM, et al. Effect of aerobic exercise prior to modified constraint-induced movement therapy outcomes in individuals with chronic hemiparesis: a study protocol for a randomized clinical trial. BMC Neurol. 2019;19(1):196.
  • 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.
  • Wu C-Y, Chen C-L, Tsai W-C, Lin K-C, Chou S-H. A 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):273-8.
  • Dromerick AW, Lang CE, Birkenmeier RL, et al. Very Early Constraint-Induced Movement during Stroke Rehabilitation (VECTORS): A single-center RCT. Neurology. 2009;73(3):195-201.
Toplam 36 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm ORJİNAL MAKALE
Yazarlar

Emre Sahin 0000-0002-4925-1295

Merve Akdeniz Leblebicier 0000-0002-6147-300X

İsmail Saracoglu 0000-0002-2621-2357

Aysun Özlü 0000-0002-1912-6039

Yayımlanma Tarihi 20 Ocak 2023
Kabul Tarihi 14 Ekim 2022
Yayımlandığı Sayı Yıl 2023 Cilt: 28 Sayı: 1

Kaynak Göster

Vancouver Sahin E, Akdeniz Leblebicier M, Saracoglu İ, Özlü A. Is modified constraint-induced movement therapy effective in improving motor performance in patients with hemiplegia?. Anadolu Klin. 2023;28(1):48-55.

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