Hemiplejik ayak rehabilitasyonunda nöromusküler elektriksel stimülasyonun etkinliğinin değerlendirilmesi
Küçük Resim Yok
Tarih
2006
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Serebrovasküler olay, dünyada en sık karşılaşılan nörolojik sorun olup, sakatlık veölümün en önemli nedenlerindendir. Serebrovasküler olay sonucu gelişen hemiplejirehabilitasyonunun esas amacı, hastaları fonksiyonel olarak bağımsız duruma getirebilmektir.Fonksiyonel bağımsızlığı engelleyen en önemli sorun, yürüme bozukluğudur. Hemiplejikhastalarda, baldır kaslarının spastisitesi veya ayağın dorsifleksör kaslarının paralizileriyürürken ayağın düşmesine neden olur. Hemiplejik hastaların yürüme rehabilitasyonundaBrunnstrom, Bobath ve proprioseptif nöromusküler fasilitasyon gibi nörofizyolojik tedaviyöntemlerinin yanında; ortezleme, biofeedback teknikleri ve elektriksel stimülasyon gibiyardımcı metodlardan da yararlanılır.Bu çalışmada, hemiplejik düşük ayak rehabilitasyonunda nöromusküler elektrikselstimülasyonun etkinliği araştırıldı. Bu amaçla, servisimizde yatarak tedavi gören kronikhemiparezili 40 olgu çalışmaya alındı ve olgular randomize olarak iki gruba ayrıldı. Tedavigrubundaki olguların hemiplejik ayak dorsifleksörlerine, peroneal sinirin yüzeyelleştiği ikinoktaya elektrot yerleştirilerek 4 hafta boyunca, haftada 5 gün, günde 1 seans olmak üzeretoplam 20 seans nöromusküler elektriksel stimülasyon uygulaması yapıldı. Çalışma ve kontrolgrubundaki tüm olgulara çalışma süresi boyunca konvansiyonel ve nörofizyolojikrehabilitasyon programları uygulandı. Olgular tedavi öncesi ve tedavi sonrası değerlendirildi.Çalışmanın sonucunda, kullandığımız değerlendirme ölçütlerinden alt ekstremiteBrunnstrom skoru, Rivermead bacak-gövde skoru ve Fonksiyonel bağımsızlık ölçeği-mobilite skorundaki düzelme, tedavi grubunda kontrol grubuna göre istatistiksel olarak dahaanlamlıydı (p<0,05). Ayrıca tedavi grubunda ayak bileği dorsifleksiyonu derecesinde anlamlıartma (p=0,000), spastisite derecesinde anlamlı azalma (p=0,000) saptanırken kontrolgrubunun bu değerlerinde anlamlı farklılık saptanmadı.Sonuç olarak, hemiplejik ayak rehabilitasyonunda nöromusküler elektrikselstimülasyon uygulanmasının motor ve fonksiyonel iyileşmeye katkısı olduğu kanısındayız.Ancak temel rehabilitasyon programlarına yardımcı bir teknik olarak kullanılması gerektiğinidüşünmekteyiz.Anahtar kelimeler: Hemipleji, nöromüsküler elektriksel stimülasyon, ayak rehabilitasyonu
Cerebrovascular accident, which is the most common neurolological disorder on earth,is one of the main causes of death and disability. The main aim of the hemiplegiarehabilitation caused by cerebrovascular accident is to make the patients functionallyindependent. The most important problem that prevents functional independency is gaitdisorders. For hemiplegic patients, the spasticity of the calf muscles or the paralysis ofthe foot dorsiflexor muscles causes drop foot while walking. Besides neurophysiologicaltreatment approachs such as Brunnstrom, Bobath and Proprioceptive NeuromuscularFacilitation, assistive methods such as orthotics, biofeedback techniques and electricalstimulation are also used in gait rehabilitation of the hemiplegic patients.In this study, the efficacy of neuromuscular electrical stimulation in hemiplegic dropfoot rehabilitation was investigated. For this purpose, 40 cases of chronic hemiparesic patientswho were hospitalized, were taken under study and were randomly separated into twogroups. During 4 weeks period, on 5 days a week, a total of 20 daily sessions of theneuromuscular electrical stimulation application were performed by locating electrodes ontwo areas where the peroneal nerve is superficial to stimulate dorsiflexor activity in the casesof treatment group. During the period of the study, conventional and neurophysiologicalrehabilitation programs were applied to the cases in both treatment and control groups. Thecases were assessed in pre-treatment and post-treatment.As a result of this study, the improvements in lower extremity Brunnstrom scores, inRivermead leg-trunk scores and in Functional Independence Measurement-mobility scoreswere statistically more significant in treatment group than in control group (p<0,05).Moreover, while a significant increase in the dorsiflexion degree of the ankle (p=0,000) and, asignificant decrease in the degree of spasticity (p=0,000) were determined in the treatmentgroup, no significant differences were found in these values of control group.Consequently, we think that the application of neuromuscular electrical stimulation inhemiplegic foot rehabilitation contributes to the motor and functional recovery. However wealso consider that neuromuscular electrical stimulation has to be used as an assistive methodto the basic rehabilitation programs.Key words: Hemiplegia, neuromuscular electrical stimulation, foot rehabilitation
Cerebrovascular accident, which is the most common neurolological disorder on earth,is one of the main causes of death and disability. The main aim of the hemiplegiarehabilitation caused by cerebrovascular accident is to make the patients functionallyindependent. The most important problem that prevents functional independency is gaitdisorders. For hemiplegic patients, the spasticity of the calf muscles or the paralysis ofthe foot dorsiflexor muscles causes drop foot while walking. Besides neurophysiologicaltreatment approachs such as Brunnstrom, Bobath and Proprioceptive NeuromuscularFacilitation, assistive methods such as orthotics, biofeedback techniques and electricalstimulation are also used in gait rehabilitation of the hemiplegic patients.In this study, the efficacy of neuromuscular electrical stimulation in hemiplegic dropfoot rehabilitation was investigated. For this purpose, 40 cases of chronic hemiparesic patientswho were hospitalized, were taken under study and were randomly separated into twogroups. During 4 weeks period, on 5 days a week, a total of 20 daily sessions of theneuromuscular electrical stimulation application were performed by locating electrodes ontwo areas where the peroneal nerve is superficial to stimulate dorsiflexor activity in the casesof treatment group. During the period of the study, conventional and neurophysiologicalrehabilitation programs were applied to the cases in both treatment and control groups. Thecases were assessed in pre-treatment and post-treatment.As a result of this study, the improvements in lower extremity Brunnstrom scores, inRivermead leg-trunk scores and in Functional Independence Measurement-mobility scoreswere statistically more significant in treatment group than in control group (p<0,05).Moreover, while a significant increase in the dorsiflexion degree of the ankle (p=0,000) and, asignificant decrease in the degree of spasticity (p=0,000) were determined in the treatmentgroup, no significant differences were found in these values of control group.Consequently, we think that the application of neuromuscular electrical stimulation inhemiplegic foot rehabilitation contributes to the motor and functional recovery. However wealso consider that neuromuscular electrical stimulation has to be used as an assistive methodto the basic rehabilitation programs.Key words: Hemiplegia, neuromuscular electrical stimulation, foot rehabilitation
Açıklama
Tıpta Uzmanlık
Anahtar Kelimeler
Fiziksel Tıp ve Rehabilitasyon, Physical Medicine and Rehabilitation
