Parkinson Hastalığında Motor İmgeleme ve Eylem Gözleminin Yürüme, Denge ve Donma Fenomeni Üzerine Etkisi- Literatür Derlemesi

Öz

Amaç: Parkinson Hastalığı (PH) sonucu ortaya çıkan yürüme ve denge bozuklukları, motor donma atakları düşme riskini arttırarak fonksiyonel bağımsızlığın ve yaşam kalitesinin azalmasına neden olmaktadır. Motor imgeleme (Mİ) ve eylem gözlemi (EG) stratejileri son yıllarda PH’de fizyoterapi ve rehabilitasyon girişimleri içinde sıklıkla kullanılan yöntemlerdir. Bu derlemenin amacı; PH rehabilitasyonunda donma fenomeni, yürüme ve denge bozukluklarının azaltılması amacıyla kullanılan Mİ ve EG stratejilerinin etkinliğini araştıran klinik araştırmaların sonuçlarını incelemekti. Yöntem: Bu amaçla 2000-2021 yılları arasında PH rehabilitasyonunda Mİ ve EG stratejilerine yer veren randomize kontrollü çalışmalar ele alındı. Literatür taraması Medline (PubMed), Physiotherapy Evidence Database (PEDro), Web of Science ve Cochrane veri tabanlarında gerçekleştirildi. Bulgular: Literatür taraması sonucu 9 çalışmanın (n=267) dahil edilme kriterlerini sağladığı tespit edildi. Bu çalışmaların 4 tanesinde Mİ stratejisi, 4 tanesinde EG stratejisi tek başına kullanılırken; 1 tanesinde ise her iki stratejinin beraber uygulandığı görüldü. Çalışmaların 2 tanesinde ev-temelli tedavi programları uygulanmıştı. Uygulanan tedavi süreleri 5-45 dk/ seans, 1-3 seans/hafta ve 8 gün-12 hafta arasında idi. Parkinson hastalarında EG ve Mİ stratejilerinin egzersiz uygulamalarına ek olarak kullanıldığında yürüyüş ve mobilite üzerinde olumlu etkisi olduğu gözlemlendi. Donma fenomeni ve denge performansını iyileştirmeyi amaçlayan çalışmaların sonuçları ise çelişkiliydi. Sonuç: EG ve Mİ stratejilerinin Parkinson hastalarında yürüyüş ve mobilite üzerine olumlu etkileri olduğu görülürken; denge ve donma fenomeni üzerindeki etkilerine dair kesin bir yargıya varmak için çalışmaların sayısı yetersizdir. Bu stratejilerin kliniklerde kullanımının yanı sıra ev-temelli olarak da uygulanabildiği görüldü. Gelecek çalışmalarda Mİ ve EG stratejilerinin özellikle donma fenomeni ve denge performansı üzerine etkileri araştırılmalıdır.

Anahtar Kelimeler

• Görüntü
• Gözden Geçirme
• Gözlem
• Nörolojik Rehabilitasyon
• Parkinson Hastalığı

The Effect Of Action Observation And Motor Imagery On Gait, Balance And Motor Freezing In Parkinson’s Disease - Literature Review

Öz

Aim: Gait and balance disorders and motor freezing attacks resulting from Parkinson's Disease (PD) increase the risk of falling, resulting in a decrease in functional independence and quality of life. Motor Imagery (MI) and Action Observation (AO) strategies have been frequently used in physiotherapy and rehabilitation interventions for PD patients in recent years. Methods: The purpose of this review was to examine the results of clinical trials investigating the effectiveness of MI and AO strategies used to reduce motor freezing attacks, gait, and balance disorders in PD rehabilitation. Randomized controlled studies that were published between 2000-2021 and included MI and EG strategies for PD rehabilitation were discussed in this review, The literature search was performed in Medline (PubMed), Physiotherapy Evidence Database (PEDro), Web of Science, and Cochrane databases. Results: As a result, it was determined that 9 studies (n=267) met the inclusion criteria. While the MI strategy was used in 4 of these studies and the AO strategy was used in 4 of them; it was observed that both strategies were applied in 1 of them. Home-based therapy programs were applied in 2 of the studies. The treatment durations were 5-45 minutes/session, 1-3 sessions/week, and 8 days-12 weeks. It has been observed that EG and MI strategies have a positive effect on gait and mobility when used in addition to exercise practices in Parkinson's patients. The results of studies aiming to improve the freezing phenomenon and balance performance were inconsistent. Conclusion: EG and MI strategies have positive effects on gait and mobility in Parkinson's patients, whereas the number of studies is insufficient to make a definite judgment about the effects on balance and freezing phenomenon. It has been observed that these strategies can be applied at home-based as well as in clinics. Further research is needed to investigate the effects of MI and EG strategies on freezing phenomenon and balance performance.

Anahtar Kelimeler

• Imagery
• Review
• Observation
• Neurological Rehabilitation
• Parkinson's Disease

Kaynakça

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