Publication: İnmeli hastalarda spesifik el rehabilitasyonunun fonksiyonellik ve spastisite üzerine etkisi
Abstract
İnme, günümüzde hala önemli ve uzun süreli disabilite nedenlerinden biri olarak karşımıza çıkmaktadır. Hastaların yaklaşık yarısında üst ekstremite problemleri rehabilitasyona rağmen kalıcı olabilmektedir. Defisit çoğunlukla elde olup bu fiziksel limitasyon hastaların günlük yaşam aktivitelerine katılımını engeller. Robot yardımlı üst ekstremite tedavisi inmeli hastaların rehabilitasyonunda yeni ve umut vaat eden bir tedavi seçeneği gibi görünmektedir. Çalışmamızda subakut ve kronik 33 inmeli hasta 16’sı çalışma grubu, 17’si kontrol grubu olmak üzere iki gruba randomize edildi. Her iki grup 3 saatlik seanslar halinde haftada 2 gün, 5 hafta süre ile konvansiyonel rehabilitasyon alırken çalışma grubundaki hastalar ek olarak her seansın sonunda 1 saat süre ile robotik yardımlı tedavi (RYT) aldılar. Hastalar Fugl-Meyer değerlendirme ölçeği, modifiye Ashworth spasitisite skalası, kutu blok testi, dokuz delikli tahta testi, Jebsen Taylor el fonksiyon testi, el dinamometresi ve Barthel indeksi kulanılarak tedavi öncesi, tedavi sonrası, tedavi sonrası 1.ay ve 3.ayda değerlendirildiler. İki grupta da tedavi öncesine göre tedavi sonrası ve izlemlerde istatistiksel olarak anlamlı düzelme gözlendi (p<0,05). Çalışma grubundaki hastalarda kontrol grubuna göre el beceri ve distal kas gücü değerlendirmelerinde anlamlı artış vardı (p<0,05). Fugl-Meyer değerlendirme ölçeği, modifiye Ashworth spastisite skalası ve Barthel indeksinde gruplar arasında anlamlı düzelme gözlenmedi. Konvansiyonel rehabilitasyon ile karşılaştırıldığında RYT, 3 aylık izlemde uzun süreli kazanımlar ile ilişkili bulundu. Bu nedenle RYT’nin konvansiyonel rehabilitasyona eklendiğinde yararlı olabileceğini düşünmekteyiz. ANAHTAR SÖZCÜKLER: inme, üst ekstremite rehabilitasyonu, robot yardımlı tedavi
Stroke is still one of the leading cause of long term disability. Approximately half of the patients remain permanent upper extremity problem inspite of rehabilitation programme. Deficits are especially prevalent in the hand and these physical limitations affect activities of daily living directly. Robot asissted upper limb theraphy provides a new possibility for improving the outcome of rehabilitation of stroke patients. In our study, thirty three subjects with subacut-chronic hemiparesis were divided randomly into two groups: robotic (n=16) and control (n=17). Both groups received conventional rehabilitation 3 hours a day, twice a week for 5 weeks; the study group received additional one hour robot assisted theraphy (RAT). The primary outcome measure was the Fugl-Meyer assessment scale and the secondary outcome measures were modified Ashworth scale, box and block test, nine hole peg test, Jebsen Taylor hand function test, grip and pinch strength and Barthel index. Patients were assesed at before and after treatment, first month and third month follow-up. Both groups had statistically significant improvement in all of the parameters (p<0,05). At third month follow-up, compared with the patients in the control group the study group showed significant difference in hand dexterity and distal muscle strength after robot assisted theraphy, as measured by box and block test, nine hole peg test, some parameters of Jebsen Taylor hand function test and hand dinamometer (p<0,05). We found no significant changes in Fugl-Meyer Assessment, modified Ashworth scale and Barthel Index between groups. Robot assisted theraphy was associated with permenant gains at 3 month follow-up when compared with the conventional rehabilitation programme. We have suggested that RAT may therefore be helpful when added in conventional rehabilitation programme. KEY WORDS: stroke, rehabilitation of upper limb, robot asissted theraphy
Stroke is still one of the leading cause of long term disability. Approximately half of the patients remain permanent upper extremity problem inspite of rehabilitation programme. Deficits are especially prevalent in the hand and these physical limitations affect activities of daily living directly. Robot asissted upper limb theraphy provides a new possibility for improving the outcome of rehabilitation of stroke patients. In our study, thirty three subjects with subacut-chronic hemiparesis were divided randomly into two groups: robotic (n=16) and control (n=17). Both groups received conventional rehabilitation 3 hours a day, twice a week for 5 weeks; the study group received additional one hour robot assisted theraphy (RAT). The primary outcome measure was the Fugl-Meyer assessment scale and the secondary outcome measures were modified Ashworth scale, box and block test, nine hole peg test, Jebsen Taylor hand function test, grip and pinch strength and Barthel index. Patients were assesed at before and after treatment, first month and third month follow-up. Both groups had statistically significant improvement in all of the parameters (p<0,05). At third month follow-up, compared with the patients in the control group the study group showed significant difference in hand dexterity and distal muscle strength after robot assisted theraphy, as measured by box and block test, nine hole peg test, some parameters of Jebsen Taylor hand function test and hand dinamometer (p<0,05). We found no significant changes in Fugl-Meyer Assessment, modified Ashworth scale and Barthel Index between groups. Robot assisted theraphy was associated with permenant gains at 3 month follow-up when compared with the conventional rehabilitation programme. We have suggested that RAT may therefore be helpful when added in conventional rehabilitation programme. KEY WORDS: stroke, rehabilitation of upper limb, robot asissted theraphy