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Posterior dolaşım kaynaklı inme ve rehabilitasyonu: bir rehabilitasyon kliniğinin deneyimleri

Yıl 2019, Cilt 11, Sayı 4, 439 - 445, 01.12.2019
https://doi.org/10.21601/ortadogutipdergisi.520659

Öz

Amaç: Çalışmamızın amacı bilinç, dolaşım, solunum ve yutma gibi hayati fonksiyonları etkileyebilen ve yaşam beklentisi düşük olan posterior sirkulasyon kaynaklı inmeli hastalarımızın demografik ve hastalık özelliklerinin değerlendirilmesi ve deneyimlerimizin aktarılmasıdır.
Gereç ve Yöntem: Çalışmamızda, kliniğimizde yatarak takip edilen, posterior sirkulasyon kaynaklı inmeli 12 hasta alındı. Hastaların demografik özellikleri, koma ve yoğun bakım süresi, kliniğimize kabule kadar geçen süre, trakeostomi ve mekanik ventilasyon desteği varlığı ve süresi, Glaskow koma skalası (GKS) düzeyi gibi hastalık özellikleri kaydedildi.
Hastaların kabulündeki nörolojik ve kas iskelet sistemi ile konuşma, yutma, nütrisyon, bası yarası, mesane ve bağırsak muayene bulguları değerlendirildi. Hastalara uygulanan rehabilitasyon yöntemleri, kliniğimizde kalış süresi ile kliniğimize kabul ve taburculuk sırasındaki Brunnstrom motor fonksiyonel seviye (BMFS) ve fonksiyonel bağımsızlık ölçeği (FBÖ) düzeyi kaydedildi.
Bulgular: Çalışmaya alınan hastaların yaş ortalaması 53,75±12,77 yıldı. Hastaların 4’ünde (%33,3) sağ, 1’inde (%8,3) sol, 7’sinde (%58,4) ise hem sağ hem de sol taraf etkilenmişti. Kliniğimize kabule kadar geçen süre ortalama 33,5 gün olup uygulanan fizik tedavi süresi 39,5 gündü (15-126 gün). Hastalara uygulanan rehabilitasyon programı sonrasında; BMFS, GKS ve FBÖ düzeylerindeki değişim anlamlı olarak bulundu (sırasıyla p=0,001, p=0,005, p=0,002). Hastaların tedavi sonrasında 3’ü (%25) tekerlekli sandalye seviyesinde, diğerleri destekli/desteksiz ambule olarak taburcu edildi. Hastaların 3’ünde beslenmeye gastrostomi yöntemi ile devam edildi.
Sonuç: Yaşam beklentisi düşük olabilen ve ciddi medikal komplikasyonlarla seyredebilen posterior sirkulasyonu içeren inmeli hastaların demografik ve hastalık özelliklerinin değerlendirildiği çalışmamızda; erken dönem rehabilitasyon programına başlamanın diğer tüm hemiplejik hastalarda olduğu gibi motor fonksiyonlar, bilişsel fonksiyonlar ve fonksiyonel bağımsızlık yönünden önemli olabileceği sonucuna varıldı.

Kaynakça

  • Osborn AG. Diagnostic cerebral angiography. 2nd ed. Philadelphia: Lippincott Williams Wilkins; 1999.
  • Dalyan Aras M, Çakçı A. İnme rehabilitasyonu. In: Oğuz H, Dursun E, Dursun N ed. Tıbbi Rehabilitasyon. Nobel Tıp Kitabevi, İstanbul 2004:589-617.
  • Caplan L. Posterior circulation ischemia: then, now, and tomorrow. Stroke 2000;31:2011-2023.
  • Brandstater ME. In: Delisa JA, Gans BM, ed. Rehabilitation Medicine principles and practice. 3rd ed. Philedelphia: Lipincott; 1998.
  • Çoban O. Serebrovasküler Hastalıklar. In Öge EA, Bahar Zarko S. eds. Nöroloji Nobel Tıp Kitabevi, 2004; p: 20-1-193-9.
  • Robert T, Norine F, BASc, Timothy D, Hillel F. Clinical Characteristics of Patients with Brainstem Strokes Admitted to a Rehabilitation Unit. Arch Phys Med Rehabil 2002;83:1013-16.
  • Chua KS, Kong KH. Functional outcome in brainstem stroke patients after rehabilitation. Arch Phys Med Rehabil 1996;77:194-7.
  • Öztop P, Ayaş Ş, Ustaömer K, Saraçgil Coşar SN, Ümit Yemişci O. Functional Outcomes in Anterior and Posterior Circulation Ischemic Strokes. Turk J Phys Med Rehab 2013;59:13-7.
  • Wilson B, Cockburn J, Halligan P. Development of a behavioural test of visuo-spatialneglect. Arch Phys Med. 1987;68:98–102.
  • Karataş KD. Stroke, Ed: Beyazova M, Kutsal GY, Physical Medicine and Rehabilitation, İstanbul, 2011:2761-2788.
  • Kutlay Ş, Ed: Beyazova M, Kutsal YG, Special Kinesiotherapy Methods Used in Neurorehabilitation. Physical Medicine and Rehabilitation 2000:930-949.
  • Küçükdeveci AA, Yavuzer G, Elhan AH, Sonel B, Tennant BA. Adaptation of the Functional Independence Measure for use in Turkey. Clin Rehabil 2000;15:311-19.
  • Kidd D, Stewart G, Baldry J, et al. The Functional Independence Measure: A comparative validity and reliability study. Disabil Rehabil 1995;17:10–14.
  • Querol-Pascual MR. Clinical approach to brainstem lesions. Seminars in Ultrasound CT MRI. 2010;31:220-229.
  • Julie B, Helen D, Amanda T, Janice C, Geoffrey D. A Very Early Rehabilitation Trial for Stroke (AVERT) Phase II Safety and Feasibility. Stroke 2008; 39:390-396.
  • Robert T, Norine F, Norhayati H, Mark S. Evidence-Based Review of Stroke Rehabilitation. Topics in Stroke Rehabilitation 2007;14:56–64.
  • Ng YS, Stein J, Salles SS, Black Schaffer RM. Clinical characteristics and rehabilitation outcomes of patients with posterior cerebral artery stroke. Arch Phsy Med Rehabil 2005;86:2138-2143.
  • Sacco RL, Benjamin EJ, Broderick JP, et al. American Heart Association Prevention Conference. IV. Prevention and Rehabilitation of Stroke. Risk factors. Stroke 1997;28:1507-17.
  • Burkhead LM, Sapienza CM, Rosenbek JC. Strength training exercise in dysphagia rehabilitation: principles, procedures and directions for future research. Dysphagia 2007;22:251–265.

Posterior circulation stroke and rehabilitation: experiences in a rehabilitation clinic

Yıl 2019, Cilt 11, Sayı 4, 439 - 445, 01.12.2019
https://doi.org/10.21601/ortadogutipdergisi.520659

Öz

Objective: The aim of our study was to evaluate the demographic and disease characteristics of our patients with posterior circulation due to low life expectancy which may affect vital functions such as consciousness, circulation, respiration and swallowing and to convey our experience.
Materials and Methods: A total of 12 patients hospitalized in the Clinic of Physical Medicine and Rehabilitation with posterior circulation stroke were included in this study. Demographic characteristics, coma and intensive care duration and time period before the rehabilitation admission, the existence and duration of tracheostomy and mechanical ventilation support, Glasgow coma scale (GCS) was recorded. Neurological and musculoskeletal findings of all patients, swallowing and nutritional status, pressure ulcer existence, neurogenic bladder and bowel symptoms were evaluated. Rehabilitation protocol, rehabilitation clinic stay period, Brunnstrom motor functional status (BMFS) and functional independence measure (FIM) score on admission and discharge was reported.
Results: The mean age of the patients was 53.75 ± 12.77 years. Right side of the body in 4 (33%) patients, left side in 1 (8.3%) patients and both sides affected in 7 (58.4%) patients. Mean time until the admission to the rehabilitation clinic was 33.5 (7-78) days and rehabilitation clinic stay length was 39.5 (15-126) days. After the rehabilitation period BMFS, GCS and FIM scores changed significantly (p=0.001, p=0.005, p=0.002). At the rehabilitation discharge, 3 (25%) patients were wheelchair bound, rest of the patients were ambulatory with an assistance or independently. 3 patients continued with gastrostomy tube.
Conclusion: Early rehabilitation of severe posterior circulation (PC) stroke patients that has an essential role for the recovery; as well as in all hemiplegies, contributing to improved motor-cognitive status and better functional outcomes.
In our study, the demographic and disease characteristics of patients with stroke who had low life expectancy and posterior circulation with serious medical complications were evaluated. It was concluded that starting early rehabilitation program might be important in terms of motor functions, cognitive functions and functional independence as in all other hemiplegic patients.

Kaynakça

  • Osborn AG. Diagnostic cerebral angiography. 2nd ed. Philadelphia: Lippincott Williams Wilkins; 1999.
  • Dalyan Aras M, Çakçı A. İnme rehabilitasyonu. In: Oğuz H, Dursun E, Dursun N ed. Tıbbi Rehabilitasyon. Nobel Tıp Kitabevi, İstanbul 2004:589-617.
  • Caplan L. Posterior circulation ischemia: then, now, and tomorrow. Stroke 2000;31:2011-2023.
  • Brandstater ME. In: Delisa JA, Gans BM, ed. Rehabilitation Medicine principles and practice. 3rd ed. Philedelphia: Lipincott; 1998.
  • Çoban O. Serebrovasküler Hastalıklar. In Öge EA, Bahar Zarko S. eds. Nöroloji Nobel Tıp Kitabevi, 2004; p: 20-1-193-9.
  • Robert T, Norine F, BASc, Timothy D, Hillel F. Clinical Characteristics of Patients with Brainstem Strokes Admitted to a Rehabilitation Unit. Arch Phys Med Rehabil 2002;83:1013-16.
  • Chua KS, Kong KH. Functional outcome in brainstem stroke patients after rehabilitation. Arch Phys Med Rehabil 1996;77:194-7.
  • Öztop P, Ayaş Ş, Ustaömer K, Saraçgil Coşar SN, Ümit Yemişci O. Functional Outcomes in Anterior and Posterior Circulation Ischemic Strokes. Turk J Phys Med Rehab 2013;59:13-7.
  • Wilson B, Cockburn J, Halligan P. Development of a behavioural test of visuo-spatialneglect. Arch Phys Med. 1987;68:98–102.
  • Karataş KD. Stroke, Ed: Beyazova M, Kutsal GY, Physical Medicine and Rehabilitation, İstanbul, 2011:2761-2788.
  • Kutlay Ş, Ed: Beyazova M, Kutsal YG, Special Kinesiotherapy Methods Used in Neurorehabilitation. Physical Medicine and Rehabilitation 2000:930-949.
  • Küçükdeveci AA, Yavuzer G, Elhan AH, Sonel B, Tennant BA. Adaptation of the Functional Independence Measure for use in Turkey. Clin Rehabil 2000;15:311-19.
  • Kidd D, Stewart G, Baldry J, et al. The Functional Independence Measure: A comparative validity and reliability study. Disabil Rehabil 1995;17:10–14.
  • Querol-Pascual MR. Clinical approach to brainstem lesions. Seminars in Ultrasound CT MRI. 2010;31:220-229.
  • Julie B, Helen D, Amanda T, Janice C, Geoffrey D. A Very Early Rehabilitation Trial for Stroke (AVERT) Phase II Safety and Feasibility. Stroke 2008; 39:390-396.
  • Robert T, Norine F, Norhayati H, Mark S. Evidence-Based Review of Stroke Rehabilitation. Topics in Stroke Rehabilitation 2007;14:56–64.
  • Ng YS, Stein J, Salles SS, Black Schaffer RM. Clinical characteristics and rehabilitation outcomes of patients with posterior cerebral artery stroke. Arch Phsy Med Rehabil 2005;86:2138-2143.
  • Sacco RL, Benjamin EJ, Broderick JP, et al. American Heart Association Prevention Conference. IV. Prevention and Rehabilitation of Stroke. Risk factors. Stroke 1997;28:1507-17.
  • Burkhead LM, Sapienza CM, Rosenbek JC. Strength training exercise in dysphagia rehabilitation: principles, procedures and directions for future research. Dysphagia 2007;22:251–265.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Bilimleri ve Hizmetleri
Bölüm Araştırma makaleleri
Yazarlar

Tuba ERDEM SULTANOĞLU (Sorumlu Yazar)
Şehitkamil State Hospital, Gaziantep, Turkey
0000-0003-0021-5952
Türkiye


Pınar BORA KARSLI Bu kişi benim
Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
0000-0003-3975-1373
Türkiye


Ebru KARACA UMAY
Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
0000-0002-4137-7731
Türkiye


Hasan SULTANOĞLU
Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
0000-0003-4099-572X
Türkiye


Fatma Aytül ÇAKCI Bu kişi benim
Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
0000-0002-2121-9330
Türkiye

Yayımlanma Tarihi 1 Aralık 2019
Yayınlandığı Sayı Yıl 2019, Cilt 11, Sayı 4

Kaynak Göster

Vancouver Erdem Sultanoğlu T. , Bora Karslı P. , Karaca Umay E. , Sultanoğlu H. , Çakcı F. A. Posterior circulation stroke and rehabilitation: experiences in a rehabilitation clinic. Ortadoğu Tıp Dergisi. 2019; 11(4): 439-445.

e-ISSN: 2548-0251

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