Publication: İnme hastalarında eşik değerinde elektrik stimulasyonu ile beraber uygulanan modifiye kısıtlayıcı zorunlu hareket tedavisinin etkinliği
Abstract
Amaç: Bu çalışmada Modifiye Kısıtlayıcı Zorunlu Hareket Tedavisi (MKZHT) ve Eşik Değer Elektrik Stimülasyonunun (EDS) beraber uygulanmasının inmeli hastaların üst ekstremite spastisite şiddeti, omuz ağrısı, yaşam kalitesi, hasta memnuniyeti, fonksiyonel durumu, taktil duyu, motor fonksiyonları, kas tonusu, sertlik ve elastisitesi üzerindeki etkileri araştırıldı. Gereç ve Yöntem: Bu çalışmaya dahil edilen 48 inme hastası randomize bir şekilde üç gruba ayrıldı. Her üç grup 4 hafta konvansiyonel rehabilitasyon gördü ek olarak grup-1 eş zamanlı olarak EDS ve MKZHT, grup-2 ise MKZHT aldı. Katılımcıların başlangıç ve dördüncü haftanın sonundaki üst ekstremite kas tonus, sertlik ve elastisite düzeyi MyotonPro dijital palpasyon cihazı; spastisite şiddeti Modifiye Tardieu Skalası (MTS); motor fonksiyonları Fugl-Meyer Üst Ekstremite Testi (FM-UE); taktil duyu Semmes-Weinstein Monofilament Testi (SWMT); omuz ağrısı Vizüel Ağrı Skalası (VAS); fonksiyonel durumu Wolf Motor Fonksiyon Testi (WMFT) ve Motor aktivite günlüğü-28 (MAG-28); memnuniyet düzeyi Pound Memnuniyet Ölçeği (PMÖ); yaşam kalitesi parametresi ise İnmeye Özgü Yaşam Kalitesi Anketi (İÖYKA) ile değerlendirildi. Bulgular: Grup içi analizler sonucunda her üç grubun VAS değerlerinde anlamlı azalma, İÖYKA, FM-UE, WFMT, MAG-28 skorlarında ise anlamlı artış saptanırken taktil duyu, distal kas tonus değerlerinde ise sadece grup-1’de anlamlı iyileşme saptandı (p<0,05). Gruplar arası analizlerde grup-1’in omuz ağrısı, taktil duyu, distal kas tonus ve sertlik değerlerindeki iyileşme grup-2 ve grup-3’e göre daha anlamlı (p<0,001) bulunmasına karşın grup 1 ve 2’inin WFMT ve MAG-28 skorlarındaki artış ve hasta memnuniyeti ise benzer bulundu (p>0,05). Sonuç: Bu çalışmanın bulgularına göre inmeli hastalarda konvansiyonel tedavinin yanında EDS ile MKZHT tedavisinin beraber uygulanması, üst ekstremite taktil duyusunu geliştirme, kas tonus ve sertlik değerlerini iyileştirmede etkili olabileceği görüldü.
Objective : The purpose of this study was to evaluate the effects of threshold electrical stimulation (TES) applied together with modified constraint-induced movement therapy (MCIMT) on upper extremity spasticity severity, shoulder pain, quality of life, patient satisfaction, functional status, tactile sense, motor function, muscle tonus, stiffness, and elasticity in stroke patients. Materials and Methods : A total of 48 stroke patients were included in this study and were randomly assigned to three groups. All three groups received conventional rehabilitation, in addition, the group 1 received TES and MCIMT simultaneously, and the group 2 received MCIMT for four weeks. The tonus, stiffness, and elasticity of the upper extremity muscles were assessed with the MyotonPro digital palpation device; spasticity severity was assessed with the Modified Tardieu scale (MTS); motor functions were assessed with the Fugl-Meyer Upper Extremity Test (FM-UE); tactile sense was assessed with the Semmes-Weinstein Monofilament Test (SWMT); functional status was assessed with the Wolf Motor Function Test (WMFT) and Motor Activity Log-28 (MAL-28); patient satisfaction was assessed with the Pound Satisfaction Scale (PSS); and quality of life was evaluated with the Stroke-Specific Quality of Life Questionnaire (SSQOL) of participants at the beginning and end of the fourth week. Results : In intra-group analyses, a significant decrease in VAS was observed in all groups, as well as a significant increase in SSQOL, FM-UE, WMFT, and MAG-28 (p<0.05). A significant improvement was determined in tactile sense, distal muscle tonus only in group 1 (p<0.05). In intergroup comparisons, the improvements in shoulder pain, tactile sense, distal muscle tonus, and stiffness in group 1 were statistically significant (p<0.001). The improvements in WMFT, MAG-28, and patient satisfaction were similar in groups 1 and 2 (p>0.05). Conclusion : According to the findings of this study, TES and MCIMT simultaneously were found to be effective in improving upper extremity tactile sense, muscle tonus, and stiffness in stroke patients in addition to conventional treatment.
Objective : The purpose of this study was to evaluate the effects of threshold electrical stimulation (TES) applied together with modified constraint-induced movement therapy (MCIMT) on upper extremity spasticity severity, shoulder pain, quality of life, patient satisfaction, functional status, tactile sense, motor function, muscle tonus, stiffness, and elasticity in stroke patients. Materials and Methods : A total of 48 stroke patients were included in this study and were randomly assigned to three groups. All three groups received conventional rehabilitation, in addition, the group 1 received TES and MCIMT simultaneously, and the group 2 received MCIMT for four weeks. The tonus, stiffness, and elasticity of the upper extremity muscles were assessed with the MyotonPro digital palpation device; spasticity severity was assessed with the Modified Tardieu scale (MTS); motor functions were assessed with the Fugl-Meyer Upper Extremity Test (FM-UE); tactile sense was assessed with the Semmes-Weinstein Monofilament Test (SWMT); functional status was assessed with the Wolf Motor Function Test (WMFT) and Motor Activity Log-28 (MAL-28); patient satisfaction was assessed with the Pound Satisfaction Scale (PSS); and quality of life was evaluated with the Stroke-Specific Quality of Life Questionnaire (SSQOL) of participants at the beginning and end of the fourth week. Results : In intra-group analyses, a significant decrease in VAS was observed in all groups, as well as a significant increase in SSQOL, FM-UE, WMFT, and MAG-28 (p<0.05). A significant improvement was determined in tactile sense, distal muscle tonus only in group 1 (p<0.05). In intergroup comparisons, the improvements in shoulder pain, tactile sense, distal muscle tonus, and stiffness in group 1 were statistically significant (p<0.001). The improvements in WMFT, MAG-28, and patient satisfaction were similar in groups 1 and 2 (p>0.05). Conclusion : According to the findings of this study, TES and MCIMT simultaneously were found to be effective in improving upper extremity tactile sense, muscle tonus, and stiffness in stroke patients in addition to conventional treatment.