Kronik İnmeli Hastalarda Ritmik İşitsel Uyarı İle Bilateral Kol Eğitim Tedavisinin Üst Ekstremite Fonksiyonlarına ve Günlük Yaşam Aktivitelerine Etkisinin Araştırılması

Yıl 2020, , 209 - 216, 02.10.2020

Ilgın Sade , Mehmet Aksu Çiğdem Çekmece

https://doi.org/10.30934/kusbed.784411

Öz

Amaç: Bu çalışma ile kronik inmeli hastalarda uygulanan ritmik işitsel uyarı ile bilateral kol eğitiminin (RİUBKE) üst ekstremite fonksiyonları, günlük yaşam aktivitelerine katılım ve ağrı üzerine etkilerinin incelenmesi amaçlanmıştır.
Yöntem: Randomize kontrollü bu çalışmaya 28 hasta dahil edildi. Hastalar RİUBKE (n=15) ve kontrol (n=13) olarak iki gruba ayrıldı. Tüm hastaların demografik verileri, Brunnstrom evreleri, Modifiye Ashworth Skalası (MAS) ve ağrı düzeyleri kaydedildi. Hastaların tümü 3 hafta süreyle konvansiyonel terapi programına alındı. Ek olarak RİUBKE grubundaki hastalara, RİUBKE cihazı ile haftanın 5 günü 3 hafta süreyle bilateral üst ekstremite eğitimi uygulandı. Plejik üst ekstremite motor fonksiyonları Jebsen Taylor El Fonksiyon Testi (JTEFT) ve Box and Block Test (BBT) ile, günlük yaşam aktiviteleri Modifiye Barthel İndeks (MBİ) ile, ağrı düzeyleri Görsel Analog Skala (GAS) ile Tüm değerlendirmeler tedavi öncesi ve tedaviden 3 hafta sonra değerlendirildi. Tüm veriler Mann Whitney U testi ve Wilcoxon testi kullanılarak analiz edildi.
Bulgular: BBT ve JTEFT’in bazı parametrelerinde (sayfa çevirme, büyük ağır obje kaldırma ve tavla pulu dizme) (p<0,05, tüm parametreler) gelişme kaydedildi. MBİ ve GAS parametrelerinde istatiksel olarak anlamlı fark saptanmadı (p>0,05).
Sonuç: RİUBKE ile üst ekstremite bilateral eğitiminin kronik inmeli hastalarda üst ekstremite fonksiyonları üzerine etkili olduğu kanaatine varıldı. Alınan bu sonuçlar inme rehabilitasyonunda RİUBKE ile bilateral eğitimin konvansiyonel tedavilerle birlikte kullanılabileceğini düşündürmektedir.

Anahtar Kelimeler

İNME, bilateral kol eğitimi, üst esktremite rehabilitasyonu, iş-uğraşı tedavisi

Destekleyen Kurum

KOCAELİ ÜNİVERSİTESİ BİLİMSEL ARAŞTIRMALAR PROJE BİRİMİ

Proje Numarası

2018/42HD

Teşekkür

Projemize yapmış oldukları destek nedeiyle KOÜ BAP birimine teşekkürlerimizi sunarız.

Bilateral Arm Trainıng with Rhythmic Audıtory Cueing (Batrac) on Upper Extremity Functions and Daily Living Activities with Chronic Stroke

Öz

Objective: In this study it is aimed to investigate the effect of bilateral arm training with rhythmic auditory cueing (BATRAC) on upper extremity functions, daily living activities and pain with chronic stroke patients.
Methods: This study was carried out as a randomized controlled experimental study in 28 patients with stroke were included in this study. The patients were randomly assigned into two groups as an BATRAC (n=15) and control group (n=13). The demographic characteristics, Brunnstrom stage, Modified Ashworth Scale (MAS) and pain degree were recorded in all patients. All patients participated in a conventional rehabilitation program for 3 weeks. The BATRAC group received 20 minute BATRAC for upper extremity for 5 days per week during 3 weeks. The plegic upper extremity motor functions were evaluated by Jebsen Taylor Hand Function Test (JTHFT), Box and Block Test (BBT), daily living activities by Modified Barthel Index (MBI) and pain degree by Visual analogue scale (VAS). All of those evaluations are done before treatment and after 3 weeks of therapy. The data were assessed by Mann Whitney U tests and Wilcoxon tests.
Results: Significant improvements were recorded in BBT and JTHFT parameters (turning page, lifting of large heavy objects and backgammon stamping) (p<0.05). No significant alteration was found in MBI and VAS (p>0.05 for all parameters).
Conclusion: In conclusion, BATRAC treatment was found effective on upper extremity motor functions in stroke patients. These results suggests that BATRAC treatment can use with conventional therapy in stroke rehabilitation.

Anahtar Kelimeler

STROKE, UPPER EXTREMITY REHABILITATION, OCCUPATIONAL THERAPY, bilateral arm training

Proje Numarası

2018/42HD

Kaynakça

• Ingall T. Stroke-Incidence, mortality, morbidity and risk. J Insur Med. 2004;36:143-152.
• Brandstater EM. Stroke rehabilitation. İçinde: Delisa JA, Gans BM, ed. Rehabilitation Medicine Principles and Practice. Philadelphia: Lippincott-Raven Publishers; 1998:1165-1189.
• Utku U. İnme tanımı, etyolojisi, sınıflandırma ve risk faktörü. Türk Fiz Tıp Der. 2007;53(1):1-3.
• Walsh K. Management of shoulder pain in patients with stroke. Postgrad Med J. 2001;77(12):645-649. doi:10.1136/pmj.77.912.645
• Wanklyn P, Forster A, Young J. Hemiplegic shoulder pain (HSP): natural history and investigation of associated features. Disabil Rehabil. 1996;18(10):497-501.
• Snels IA, Beckerman H, Twisk JW, et al. Effect of triamcinolone acetonide injections on hemiplegic shoulder pain: A randomized clinical trial. Stroke. 2000;31(10):2396-2401. doi:10.1161/01.str.31.10.2396
• Gilmore PE, Spaulding SJ, Vandervoort AA. Hemiplegic shoulder pain: implications for occupational therapy treatment. Can J Occup Ther. 2004;71(1):36-46. doi:10.1177/000841740407100108
• Yavuzer G, Sonel B, Tuncer S, Süldür N. İnmeli hastalarda üst ekstremite ve el fonksiyonlarının değerlendirilmesi. Türk Fiz Tıp Der. 2001;47(3):38-43.
• Pollock A, Farmer SE, Brady MCJ, et al. Interventions for improving upper limb function after stroke. Cochrane Systematic Review. 2014(11):CD010820 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010820.pub2/full 20 Ağustos 2020’de erişildi.
• Raghavan P. Upper limb motor ımpairment post stroke. Phys Med Rehabil Clin N Am. 2015;26(4):599-610. doi:10.1016/j.pmr.2015.06.008
• Hendricks HT, Van Limbeek J, Geurts AC, Zwarts MJ. Motor recovery after stroke: a systematic review of the literature. Arch Phys Med Rehabil. 2002;83(11):1629-1637. doi:10.1053/apmr.2002.35473
• Nakayama H, Jørgensen HS, Raaschou HO, et al. The influence of age on stroke outcome. The Copenhagen Stroke Study. Stroke. 1994;25(4):808-813. doi:10.1161/01.str.25.4.808
• Mudie MH, Matyas TA. Can simultaneous bilateral movement involve the undamaged hemisphere in reconstruction of neural networks damaged by stroke? Disability and rehabilitation. 2000;22(1-2):23-37. doi:10.1080/096382800297097
• Waller SM, Whitall J. Bilateral arm training: why and who benefits? NeuroRehabilitation. 2008;23(1):29-41.
• Chollet F, DiPiero V, Wise RJS, et al. The functional anatomy of motor recovery after stroke in humans: a study with positron emission tomography. Ann Neurol.1991;29(1):63-71. doi:10.1002/ana.410290112
• Stinear JW, Byblow WD. Rhythmic bilateral movement training modulates corticomotor excitability and enhances upper limb motricity poststroke: a pilot study. J Clin Neurophys. 2004;21(2):124-131. doi:10.1097/00004691-200403000-00008
• Cauraugh, JH, Lodha N, Naik, Summers JJ. Bilateral movement training and stroke motor recovery progress: a structured review and meta-analysis. Hum Mov Sci. 2010;29(5):853-870. doi:10.1016/j.humov.2009.09.004
• Summers JJ, Kagerer FA, Garry MI, et al. Bilateral and unilateral movement training on upper limb function in chronic stroke patients: a TMS study. J Neurol Sci. 2007;252(1):76-82. doi:10.1016/j.jns.2006.10.011
• Whitall J, Waller SM, Silver KH, et al. Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke. Stroke. 2000;31(10):2390-2395. doi:10.1161/01.str.31.10.2390
• Calautti C, Baron JC. Functional neuroimaging studies of motor recovery after stroke in adults: a review. Stroke. 2003;34(6):1553-1566. doi:10.1161/01.STR.0000071761. 36075.A6
• Winstein CJ, Rose DK, Tan SM, et al. A randomized controlled comparison of upper-extremity rehabilitation strategies in acute stroke: A pilot study of immediate and long-term outcomes. Arch Phys Med Rehabil. 2004;85(4):620-628. doi:10.1016/j.apmr.2003.06.027
• Schaechter JD. Motor rehabilitation and brain plasticity after hemiparetic stroke. Prog Neurobiol. 2004;73(1):61-72. doi:10.1016/j.pneurobio.2004.04.001
• Kwakkel G, Kollen BJ, van der Grond J, et al. Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke. 2003;34(9):2181-2186. Doi:10.1161/01.str.0000087172.16305.cd
• Ploughman M, Corbett D. Can forced-use therapy be clinically applied after stroke? An exploratory randomized controlled trial. Arch Phys Med Rehabil. 2004;85(9):1417-1423. doi:10.1016/j.apmr.2004.01.018
• Jorgensen HS, Nakayama H, Raaschou HO, et al. Neurologic and functional recovery the Copenhagen Stroke Study. Phys Med Rehabil Clin N Am. 1999;10(4):887-906. doi:10.1016/S1047-9651(18)30169-4
• Levy CE, Nichols DS, Schmalbrock PM, et al. Functional MRI evidence of cortical reorganization in upper-limb stroke hemiplegia treated with constraint-induced movement therapy. Am J Phys Med Rehabil. 2001;80(1):4-12. doi:10.1097/00002060-200101000-00003
• Ryerson SD. Hemiplegia in Neurological Rehabilitation, Umphred DA (ed). 4. Baskı. St. Louis: Mosby, 2001;741-789.
• Stinear CM, Barber PA, Coxon JP, et al. Priming the motor system enhances the effects of upper limb therapy in chronic stroke. Brain. 2008;131(5):1381-1390. doi:10.1093/brain/awn051
• Duque J, Hummel F, Celnik P, et al. Transcallosal inhibition in chronic subcortical stroke. Neuroimage, 2005;28(4):940-946. doi:10.1016/j.neuroimage.2005.06.033
• Stewart KC, Cauraugh JH, Summers JJ. Bilateral movement training and stroke rehabilitation: a systematic review and meta-analysis. J Neurol Sci. 2006;244(1-2):89-95. doi:10.1016/j.jns.2006.01.005
• Coupar F, Pollock A, Van Wijck F, et al. Simultaneous bilateral training for improving arm function after stroke. Cochrane Database of Systematic Reviews. 2010;(4):CD006432. doi:10.1002/14651858.CD006432.pub2
• Van Delden A EQ, Peper CE, Beek PJ, et al. Unilateral versus bilateral upper limb exercise therapy after stroke: a systematic review. J Rehabil Med. 2012;44(2):106-117. doi:10.2340/16501977-0928
• Stoykov ME, Corcos DM. A review of bilateral training for upper extremity hemiparesis. Occup Ther Int. 2009;16(3‐4):190-203. doi:10.1002/oti.277
• Kang N, Cauraugh JH. Bilateral movements increase sustained extensor force in the paretic arm. Disability and Rehabilitation. 2018;40(8):912-916. doi:10.1080/09638288.2017.1280092
• Richards LG, Senesac CR, Davis SB et al. Bilateral arm training with rhythmic auditory cueing in chronic stroke: not always efficacious. Neurorehabil Neural Repair. 2008;22(2):180-184. doi:10.1177/1545968307305355
• Song GB. The effects of task-oriented versus repetitive bilateral arm training on upper limb function and activities of daily living in stroke patients. J Phys Ther Sci. 2015;27(5):1353-1355. doi:10.1589/jpts.27.1353
• Lee, MJ, Lee JH, Koo HM, et al. Effectiveness of bilateral arm training for improving extremity function and activities of daily living performance in hemiplegic patients. J Stroke Cerebrovasc Dis. 2017;26(5):1020-1025. doi:10.1016/j.jstrokecerebrovasdis.2016.12.008
• Chuang LL, Chen YL, Chen CC, et al. Effect of EMG-triggered neuromuscular electrical stimulation with bilateral arm training on hemiplegic shoulder pain and arm function after stroke: a randomized controlled trial. J Neuroengin Rehabil. 2017;14(1):122. doi:10.1186/s12984-017-0332-0