Hemiplejili Bir Bireyde Paralimpik Boccia Sporunun Etkilerinin İncelenmesi: Olgu Sunumu

Öz

Amaç: Bu çalışma, hemipleji tanılı bir bireyde Paralimpik Boccia sporunun etkilenen elin fonksiyonel kullanımı, depresyon ve mental durum üzerindeki etkilerini incelemek amacıyla gerçekleştirilmiştir. Gereç ve Yöntem: Araştırma kapsamında Eggers sınıflandırma sistemine göre devre 3’te yer alan iskemik orta serebral arter tutulumlu kronik hemipleji tanılı sağ eli etkilenmiş olan 69 yaşındaki erkek danışana uluslararası olimpiyatlarda yer alan Engelli Boccia Spor uygulamasına dahil edilmiştir. Birey Modifiye Ashworth skalasına göre 2. evrededir. Aktif dirsek ekstansiyon ve fleksiyonu yaparak objelere uzanabilmekte ve kavrama hareketlerini hafif tonus artışıyla gerçekleştirebilmektedir. Huzurevinde gerçekleştirilen araştırmada danışanın depresyon durumunu değerlendirmek için Geriatrik Depresyon Ölçeği; el fonksiyon değerlendirmesinde Jebsen el fonksiyon testi, mental durum için standart mini-mental test kullanıldı. Paralimpik Boccia sporu haftada 4 gün, 45 dakikalık seanslar halinde toplam 8 hafta süreyle uygulandı. Müdahale sonrasında testler tekrarlandı. Sonuçlar: Müdahalenin öncesinde bireyde orta derecede depresyon olduğu görüldü. Müdahale sonrası geriatrik depresyon ölçeği sonucunda olumlu gelişme kaydedildi. Mental fonksiyon açısından yalnızca bir puanlık artış sağlandı. Jebsen el fonksiyon testinde ise Boccia Sporu öncesi ve sonrası skorlar karşılaştırıldığında, testleri tamamlama sürelerinin azaldığı görüldü. Tartışma: Paralimpik Boccia Sporunun hemipleji tanısı almış bu bireyin, mental ve psikolojik durumunu geliştirdiği ve üst ekstremitenin fonksiyonel kullanımı üzerinde olumlu etkilerinin olduğu ve bu spora tamamlayıcı rehabilitasyon uygulamaları içinde yer verilebileceği sonucuna varılmıştır. Ayrıca sporun bir aktivite olarak kullanımı bu bireylerin sosyal katılımları üzerinde de olumlu etkiler meydana getirecektir.

Anahtar Kelimeler

• Hemipleji
• ergoterapi
• boccia sporu
• geriatri

Effects of Paralympic Boccia Sports in Hemiplegia Rehabilitation: A Case Report

Öz

Purpose: This study was carried out to examine the effects of Paralympic Boccia on the functional use of the affected hand, depression, and mental status in an individual with hemiplegia.
Material and Methods: Within the scope of the research, a 69-year-old male client with a diagnosis of chronic hemiplegia with ischemic middle cerebral artery involvement, which is in level 3 according to the Eggers classification system, was included in the Disabled Boccia Sports practice in the international Olympics. This individual, who was in stage 2 on the modified Ashworth scale, can reach objects by active elbow extension and flexion and can perform grasping movements with a slight increase in muscle tonus. In the study which was carried out in a nursing home, Geriatric Depression Scale was used to evaluate the depression status of the client, the Jebsen hand function test was used for hand function evaluation, and standard mini-mental test was used for mental status. Paralympic Boccia sport was performed 4 days a week, in 45-minute sessions, for a total of 8 weeks. After the intervention, the tests were repeated.

Results: It was observed that the individual had moderate depression before the intervention. A positive improvement was noted as a result of the geriatric depression scale after the intervention. Only a one-point increase was achieved in terms of mental function. In the Jebsen hand function test, when the scores before and after Boccia Sport were compared, it was observed that the time to complete the tests decreased.
Discussion: It has been concluded that Paralympic Boccia Sport has improved the mental and psychological state of this individual diagnosed with hemiplegia and had positive effects on the functional use of the upper extremity, and this sport can be included in complementary rehabilitation practices. In addition, the use of sports as an activity will have positive effects on the social participation of these individuals.

Anahtar Kelimeler

• Hemiplegia
• occupational therapy
• boccia sports
• geriatrics

Kaynakça

1. Andiç, Ö. (2020). Bakım Evlerinde Bakım Hizmeti Alan Bireylerde Depresyon Ve Umutsuzluk İle İlişkili Faktörlerin İncelenmesi (Yüksek lisans tezi). İstanbul Gelişim Üniversitesi Lı̇sansüstü Eğı̇tı̇m Enstı̇tüsü, İstanbul.
2. Aran, O. T., & Kayıhan, H. (2019). İnmeli bireylerde serbest zaman aktivitelerine yönelik ergoterapi yaklaşımlarının aktivite performansına etkisi. Ergoterapi ve Rehabilitasyon Dergisi, 7(1), 1-10. https://doi.org/10.30720/ered.466696
3. Barak, S., Mendoza-Laiz, N., Gutiérrez Fuentes, M. T., Rubiera, M., & Hutzler, Y. (2016). Psychosocial effects of competitive Boccia program in persons with severe chronic disability. J Rehabil Res Dev, 53(6), 973-988. https://doi.org/10.1682/JRRD.2015.08.0156.
4. Blanchet, S., Chikhi, S. & Maltais, D. (2018). The benefits of physical activities on cognitive and mental health in healthy and pathological aging. Geriatr Psychol Neuropsychiatr Vieil, 16(2), 197-205. doi: 10.1684/pnv.2018.0734.
5. Cunningham, C., Wensley, R., Blacker, D., Bache, J., & Stonier, C. (2012). Occupational therapy to facilitate physical activity and enhance quality of life for individuals with complex neurodisability. Br J Occup Ther, 75(2), 106-110. https://doi.org/10.4276/030802212X13286281651234
6. Donkor, E. S. (2018). Stroke in the 21st century: a snapshot of the burden, epidemiology, and quality of life. Stroke Res Treat, 27(2018), 3238165. https://doi.org/10.1155/2018/3238165
7. Ertan, T., & Eker, E. (2000). Reliability, validity, and factor structure of the geriatric depression scale in Turkish elderly: are there different factor structures for different cultures?. Int Psychogeriatr, 12(2), 163-172. https://doi.org/10.1017/s1041610200006293
8. Gibson, J. W., & Schkade, J. K. (1997). Occupational adaptation intervention with patients with cerebrovascular accident: a clinical study. Am J Occup Ther, 51(7), 523-529. https://doi.org/10.5014/ajot.51.7.523

9. Güngen, C., Ertan, T., Eker, E., Yaşar, R., & Engin, F. (2002). Standardize Mini Mental Testinin Türk toplumunda hafif demans tanısında geçerlik ve güvenilirliği. Türk Psikiyatri Dergisi, 13(4), 273-281.
10. Huang, P.C., Pan, P. J., Ou, Y. C., Yu, Y. C., & Tsai, Y. S. (2014). Motion analysis of throwing boccia balls in children with cerebral palsy. Res Dev Disabil, 35(2), 393–399. https://doi.org/10.1016/j.ridd.2013.11.017.
11. Hutzler, Y., Rodríguez, B. L., Laiz, N. M., Díez, I., & Barak, S. (2013). The effects of an exercise training program on hand and wrist strength, and function, and activities of daily living, in adults with severe cerebral palsy. Res Dev Disabil, 34(12), 4343-4354. https://doi.org/10.1016/j.ridd.2013.09.015
12. Jebsen, R. H. (1969). An objective and standardized test of hand function. Arch Phys Med Rehabil, 50(6), 311-319.
13. Lapresa, D., Santesteban, G., Arana, J., Anguera, M. T., & Aragón, S. (2017). Observation system for analyzing individual boccia BC3. J Dev Phys Disabil, 29(5), 721-734. https://doi.org/10.1007/s10882-017-9552-2
14. Martin Ginis, K. A., Ma, J. K., Latimer-Cheung, A. E., & Rimmer, J. H. (2016). A systematic review of review articles addressing factors related to physical activity participation among children and adults with physical disabilities. Health Psychol Rev, 10(4), 478-494. https://doi.org/10.1080/17437199.2016.1198240
15. Petruševičienė, D., & Kriščiūnas, A. (2008). Evaluation of activity and effectiveness of occupational therapy in stroke patients at the early stage of rehabilitation. Medicina, 44(3), 216. https://doi.org/10.3390/medicina44030028
16. Phillips, M., Flemming, N., & Tsintzas, K. (2009). An exploratory study of physical activity and perceived barriers to exercise in ambulant people with neuromuscular disease compared with unaffected controls. Clin Rehabil, 23(8), 746-755. https://doi.org/10.1177/0269215509334838
17. Radomski, M. V., & Latham, C. A. T. (2008). Occupational therapy for physical dysfunction (6th ed.). Baltimore, MD: Lippincott Williams & Wilkins.
18. Rimmer, P. (2012). Boccia-"follow your dream and you can do anything". Palaestra, 26(3), 31-34.
19. Shapiro, D. R., & Malone, L. A. (2016). Quality of life and psychological affect related to sport participation in children and youth athletes with physical disabilities: a parent and athlete perspective. Disabil Health J, 9(3), 385-391. https://doi.org/10.1016/j.dhjo.2015.11.007
20. Sigirtmac, İ. C., & Oksuz, C. (2021). Investigation of reliability, validity, and cutoff value of the Jebsen-Taylor Hand Function Test. J Hand Ther, 34(3), 396-403. https://doi.org/10.1016/j.jht.2020.01.004
21. Steultjens, E. M., Dekker, J., Bouter, L. M., Van de Nes, J. C., Cup, E. H., & Van den Ende, C. H. (2003). Occupational therapy for stroke patients: a systematic review. Stroke, 34(3), 676-687. https://doi.org/10.1161/01.STR.0000057576.77308.30
22. Stiekema, A. P., Nijsse, B., de Kort, P. L., Spikman, J. M., Visser-Meily, J. M., & van Heugten, C. M. (2021). The relationship between social cognition and participation in the long term after stroke. Neuropsychological Rehabil, 31(2), 278-292. https://doi.org/10.1080/09602011.2019.1692670
23. Suárez-Iglesias, D., Ayán Pérez, C., Mendoza-Laiz, N., & Villa-Vicente, J. G. (2020). Boccia as a rehabilitation intervention for adults with severe mobility limitations due to neuromuscular and other neurological disorders: feasibility and effects on upper limb impairments. Front Psychol, 11, 581. https://doi.org/10.3389/fpsyg.2020.00581
24. Warr, P., Butcher, V., Robertson, I., & Callinan, M. (2004). Older people's well‐being as a function of employment, retirement, environmental characteristics and role preference. Br J Psychol, 95(3), 297-324. https://doi.org/10.1348/0007126041528095
25. Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., et al. (1982). Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res, 17(1), 37-49. https://doi.org/10.1016/0022-3956(82)90033-4.
26. Yozbatiran, N., Baskurt, F., Baskurt, Z., Ozakbas, S., & Idiman, E. (2006). Motor assessment of upper extremity function and its relation with fatigue, cognitive function and quality of life in multiple sclerosis patients. J Neurol Sci, 246(1-2), 117–122. https://doi.org/10.1016/j.jns.2006.02.018.
27. Yücel, H., & Kayıhan, H. (2008). Huzurevinde ve evde çok amaçlı aktivite eğitiminin geriatrik depresyona etkisi. Fizyoterapi Rehabilitasyon, 19(2), 74-78.