inme Hastalarında Manuel Terapinin Solunum Fonksiyonları ve Solunum Kas Kuvveti Üzerindeki Anlık Etkisi

Öz

Amaç: Manuel terapinin (MT) faydaları bilinmesine rağmen inme hastalarında etkisi ile ilgili çalışmalar sınırlıdır. Bu çalışmanın amacı, inme hastalarında MT'nin solunum fonksiyonu ve solunum kas kuvveti üzerindeki ani etkilerini araştırmaktır. Yöntem: Çalişmaya kırk yedi hasta (33 erkek, 14 kadın) dahil edildi ve katılımcılar randomize olarak MT grubuna (n = 31) ve kontrol grubuna (n = 16) ayrıldı. Tüm katılımcıların, başlangıçta solunum fonksiyonu ve solunum kas testi değerlendirildi ve ardından girişim öncesi 10 dakika boyunca sırtüstü dinlendiler. Girişimden hemen sonra solunum testleri tekrarlandı. Testler şunları içeriyordu: maksimum inspiratuar basınç (MIP) ve maksimum ekspiratuar basınç (MEP), zorlu vital kapasite (FVC), 1. saniyedeki zorlu ekspiratuar hacim (FEV1), FEV1/FVC ve tepe ekspiratuar akış (PEF). Sonuçlar: Grup içi karşılaştırmalarda MT grubunda ölçülen tüm parametrelerde anlamlı iyileşme gözlenirken (p<0,05), kontrol grubunda ise FEV1 ve FEV1/FVC değerleri dışında anlamlı değişiklik görülmedi(p>0,05). Gruplar arası karşılaştırmalarda FEV1, FEV1/FVC, PEF ve MEP değerlerinde istatistiksel olarak anlamlı fark bulundu(p<0,05). Tartışma: Bu çalışma, manuel tedavinin inmeli hastalarda solunum fonksiyonu ve solunum kas kuvveti üzerinde anlık olumlu etkisi olduğunu göstermektedir.

Anahtar Kelimeler

• Manuel Terapi
• Solunum Fonksiyon Testi
• Solunum Kasları
• İnme

Immediate Effect of Manual Therapy on Respiratory Functions and Respiratory Muscle Strength in Stroke Patients

Abstract

Purpose: Although the benefits of manual therapy (MT) are known, studies on its effect on stroke patients are limited. The aim of this study was to evaluate the immediate effects of MT on respiratory function and respiratory muscle strength in stroke patients. Methods: A total of forty-seven patients, comprising 33 men and 14 women, were enrolled in the study and then randomly assigned to either the MT group (n=31) or the control group (n=16). All participants met with initial pulmonary function and respiratory muscle testing and then rested supine for 10 minutes before the procedure. The respiratory tests were repeated immediately after the procedure. Tests included: maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC, and peak expiratory flow (PEF). Results: In intra-group comparisons, a significant improvement was observed in all measured parameters in the MT group (p<0.05), while no significant change was observed in the control group except FEV1 and FEV1/FVC values ​​(p>0.05). In comparisons between groups, a statistically significant difference was found in FEV1, FEV1/FVC, PEF and MEP values(p<0,05) Conclusions: This study demonstrated that manual therapy had a immediate positive effect on lung function and respiratory muscle strength in stroke patients.

Keywords

• Manual Therapy
• Pulmonary Function Test
• Respiratory Muscles
• Stroke

Kaynakça

1. 1. Hankey GJ. Stroke. Lancet. 2017;389(10069):641–54.
2. 2. Pozuelo-Carrascosa DP, Carmona-Torres JM, Laredo-Aguilera JA, Latorre-Román PÁ, Párraga-Montilla JA, Cobo-Cuenca AI. Effectiveness of respiratory muscle training for pulmonary function and walking ability in patients with stroke: A systematic review with meta-analysis. Int J Environ Res Public Health. 2020;17(15):1–22.
3. 3. Polese JC, Pinheiro MB, Faria CDCM, Britto RR, Parreira VF, Teixeira-Salmela LF. Strength of the respiratory and lower limb muscles and functional capacity in chronic stroke survivors with different physical activity levels. Brazilian J Phys Ther. 2013;17(5):487–93.
4. 4. Sutbeyaz ST, Koseoglu F, Inan L, Coskun O. Respiratory muscle training improves cardiopulmonary function and exercise tolerance in subjects with subacute stroke: A randomized controlled trial. Clin Rehabil. 2010;24(3):240–50.
5. 5. Lanza F de C, de Camargo AA, Archija LRF, Selman JPR, Malaguti C, Dal Corso S. Chest wall mobility is related to respiratory muscle strength and lung volumes in healthy subjects. Respir Care. 2013;58(12):2107–12.
6. 6. Gittler M, Davis AM. Guidelines for adult stroke rehabilitation and recovery. JAMA - J Am Med Assoc. 2018;319(8):820–1.
7. 7. Polkey MI, Lyall RA, Moxham J, Leigh PN. Respiratory aspects of neurological disease. J Neurol Neurosurg Psychiatry. 1999;66:5–15.
8. 8. Joo S, Shin D, Song C. The effects of game-based breathing exercise on pulmonary function in stroke patients: A preliminary study. Med Sci Monit. 2015;21:1806–11.

9. 9. Engel R, Vemulpad S. The role of spinal manipulation, soft-tissue therapy, and exercise in chronic obstructive pulmonary disease: A review of the literature and proposal of an anatomical explanation. J Altern Complement Med. 2011;17(9):797–801.
10. 10. Mustafaoğlu R, Bi̇ri̇nci̇ T, Kaya Mutlu E, Razak Özdi̇nçler A, Mutlu KE, Özdinçerler Torakal RA. Torakal manipülasyonun torakal mobilite, solunum fonksiyonları ve fonksiyonel kapasite üzerine etkisi: pilot çalışma. J Exerc Ther Rehabil [Internet]. 2019;6(2):93–103. Available from: https://dergipark.org.tr/en/pub/jetr/issue/48176/470594
11. 11. Dougherty PE, Engel RM, Vemulpad S, Burke J. Spinal manipulative therapy for elderly patients with chronic obstructive pulmonary disease: A case series. J Manipulative Physiol Ther [Internet]. 2011;34(6):413–7. Available from: http://dx.doi.org/10.1016/j.jmpt.2011.05.004
12. 12. Noll D, Degenhardt B, Johnson J, Burt S. Immediate effects of osteopathic manipulative treatment in elderly patients with chronic obstructive pulmonary disease. J Am Osteopat Assoc. 2008;108(5):251–9.
13. 13. Yilmaz Yelvar GD, Çirak Y, Parlak Demir Y, Dalkilinç M, Bozkurt B. Immediate effect of manual therapy on respiratory functions and inspiratory muscle strength in patients with COPD. Int J COPD. 2016;11(1):1353–7.
14. 14. Joo S, Lee Y, Song CH. Immediate Effects of Thoracic Spinal Manipulation on Pulmonary Function in Stroke Patients: A Preliminary Study. J Manipulative Physiol Ther [Internet]. 2018;41(7):602–8. Available from: https://doi.org/10.1016/j.jmpt.2017.12.005
15. 15. Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26(5):948–68.
16. 16. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26(2):319–38.
17. 17. Gibson GJ, Whitelaw W, Siafakas N, Supinski GS, Fitting JW, Bellemare F, et al. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002;166(4):518–624.
18. 18. Portney L, Watkins M. Foundations of Clinical Research: Applications to Practice. Norwalk, CT: Appleton & Lange; 1193. 497 p.
19. 19. Engel RM, Vemulpad SR, Beath K. Short-term effects of a course of manual therapy and exercise in people with moderate chronic obstructive pulmonary disease: A preliminary clinical trial. J Manipulative Physiol Ther. 2013;36(8):490–6.
20. 20. Bockenhauer SE, Julliard KN, Lo KS, Huang E, Sheth AM. Quantifiable effects of osteopathic manipulative techniques on patients with chronic asthma. J Am Osteopath Assoc. 2002;102(7):371–5.
21. 21. Toprak N, Sen S, Yigit B. The role of diaphragmatic breathing exercise on urinary incontinence treatment: A pilot study. Vol. 29, Journal of Bodywork and Movement Therapies. 2022. p. 146–53.
22. 22. Johnson JD, Theurer WM. A stepwise approach to the interpretation of pulmonary function tests. Am Fam Physician. 2014;89(5):359–66.
23. 23. Martinez-Pitre PJ, Sabbula B, Cascella M. Restrictive Lung Disease. StatPearls; 2024.
24. 24. Ramos SM, da Silva DM, Buchaim DV, Buchaim RL, Audi M. Evaluation of respiratory muscular strength compared to predicted values in patients with stroke. Int J Environ Res Public Health. 2020;17(3).