İnmeli Hastalarda Ayna Tedavisinin Üst Ekstremitede Motor İyileşme ve Fonksiyona Etkisi

Öz

İnmeli hastalarda üst ekstremite motor fonksiyonlarının iyileştirilmesinde ayna tedavisinin etkinliğini değerlendirmek. Çalışmaya kliniğimizde yatarak rehabilitasyona alınan 53 inme hastası dahil edildi. Hastalardan 30’u çalışma grubuna, 23’ü ise kontrol grubuna alındı. Tüm hastalar 4 hafta boyunca 60 dk süre ile, haftada beş gün konvansiyonel rehabilitasyon programına alındı. Çalışma grubunda yer alan hastalar ek olarak haftada beş gün, 4 hafta boyunca 30 dk ayna tedavisi aldı. Hastalar rehabilitasyon programının başlangıcında (tedavi öncesi), 4. hafta sonunda (tedavi sonrası) ve 12 hafta sonra (takip) değerlendirildi. Üst ekstremite ve el motor iyileşmesi Brunnstrom motor evrelemesi ile değerlendirildi. El bilek fleksör kas spastisite düzeyini belirlemek için Modifiye Ashworth Skalası (MAS) kullanıldı. Hastaların engellilik düzeyleri Fonksiyonel Bağımsızlık Ölçütü (FBÖ) ile değerlendirildi. Çalışmaya dahil edilen hastaların 30’u kadın, 23’ü erkekti ve yaş ortalaması 59.91±4.04 (55-66) yıl idi. Grupların zaman içindeki değişimi incelendiğinde, tedavi sonrası ve takipte hem çalışma grubunda hem de kontrol grubunda Brunnstrom üst esktremite ve el motor evresinin ve FBÖ motor ve total skorunun istatistiksel olarak anlamlı düzeyde arttığı saptandı (tümü için p<0.001). İki grupta Brunnstrom üst esktremite ve el motor evresinin ve FBÖ motor ve total skorunun tedavi sonu ve takipte elde edilen artışları birbiriyle karşılaştırıldığında istatistiksel olarak anlamlı fark saptanmadı (sırasıyla p=0.607, p=0.790, p=0.146, p=0.123 ). Tedavi sonrası ve takipte hem çalışma grubunda hem de kontrol grubunda el bilek fleksör spastisitesinde istatistiksel olarak anlamlı değişiklik saptanmadı (p=0.240). İki grupta el bilek fleksör kaslarının spastisitesinde tedavi sonu ve takipte elde edilen değişiklikler birbiriyle karşılaştırıldığında istatistiksel olarak anlamlı fark saptanmadı (p=0.731). Bu araştırmada kronik inme hastalarında konvansiyonel rehabilitasyona eklenen 4 haftalık ayna tedavisinin motor ve fonksiyonel iyileşmeye katkısının olmadığı saptanmıştır. Ayna tedavisinin inme rehabilitasyonunda gelecekte daha etkin olarak kullanılabilmesi için standardizasyonunu sağlayacak iyi planlanmış araştırmalara halen ihtiyaç bulunmaktadır.

Anahtar Kelimeler

• İnme,Rehabilitasyon,Ayna tedavis

The Effect of Mirror Therapy on Upper Extremity Motor Function and Motor Recovery in Stroke Patients

Öz

To evaluate the effectiveness of mirror therapy on improvement of motor functions of the upper extremity in patients with stroke. Fifty-three stroke patients were included this study. Patients were assigned to either an mirror therapy group (n=30) or a control group (n=20). All patients were enrolled in a conventional rehabilitation program for 4 weeks, 60 minutes, and 5 days a week. Patients in the study group received additional 30 minutes of mirror therapy for five days a week for four weeks. Patients were evaluated at the beginning of the rehabilitation program (pre-treatment), at the end of the 4th week (after the treatment) and 12 weeks (follow-up). Brunnstrom recovery stage of arm and hand, Functional Independence Measure (FIM) and Modified Ashworht Scale (MAS) were used to evaluate the patient’s upper extremity motor recovery, function and spasticity. After one month of treatment and follow-up evaluation patients of both groups showed statistically significant improvement in all the variables except spasticity (all for p<0.001). No significant differences in Brunnstrom stage, FIM were found between groups (Respectively sırasıyla p=0.607, p=0.790, p=0.146, p=0.123). There was no statistically significant change in wrist flexor spasticity in both the study group and the control group after treatment (p = 0.240). There was no statistically significant difference in the spasticity of the wrist flexor muscles were found between groups (p = 0.731). In our study, the superiority of mirror therapy to conventional therapy was not determined. There is still a need for well-planned studies to standardize mirror therapy so that it can be used more effectively in stroke rehabilitation in the future.

Anahtar Kelimeler

• Stroke,Rehabilitation,Mirror therapy

Kaynakça

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