Ahmet İNANIR, Sevil OKAN, Behçet FİLİZ, Emre KUYUCU

Hemiplejili Hastalarda Konvansiyonel Rehabilitasyon Tedavisinin Postüral Denge ve Klinik Üzerine Etkinliği

Amaç: Bu çalışmada inmeli hastalarda konvansiyonel rehabilitasyonun klinik değerlendirilmesi yanında statik ve dinamik denge üzerine olan etkilerinin araştırılması amaçlanmıştır. Gereç ve yöntem: Çalışmaya yaşları 51 ile 75 yıl aralığında değişen ve Fiziksel Tıp ve Rehabilitasyon kliniğinde yatarak tedavi gören toplam 12 inmeli hasta dahil edildi. Bireyler tedavi öncesi (Grup 1) ve sonrası (Grup 2) denge testine tabi tutuldular. Hastalarımızın hepsine gövde için temel komponentin varolduğu bir problem çözme yaklaşımı olmasından dolayı bir fizyoterapist eşliğinde temel olarak nörogelişimsel amaca da yönelinerek multidisipliner konvansiyonel tedavi uygulandı. Denge düzeyi ve postüral kontrol Berg Denge Skalası (BDS), Gövde Kontrol Testi (GKT) ve Biodex Denge Sistemi (BDS) ile, motor seviye Brunnstrom Motor İyileşme Evrelemesi (BMİE) ile, ambulasyon durumu Fonksiyonel Ambulasyon Skalası (FAS) ile ve günlük yaşam aktivitelerindeki fonksiyonel durum Fonksiyonel Bağımsızlık Ölçeği (FBÖ) ile değerlendirildi. Bireyler taburcu olurken aynı testler tekrarlandı. Bulgular: Çalışmaya dahil edilen hastaların yaş ortalaması 65,83±4,38 yıl ve vücut kitle indeksi ortalaması 30,55±6,94 idi. Fonksiyonel Bağımsızlık ölçeği, Fonksiyonel Ambulasyon Skalası, Gövde Kontrol Testi, Berg Denge Skalası açısından değerlendirildiğinde iki grup arasında istatistiksel olarak anlamlı fark tespit edildi (sırasıyla, p=0.001, p=0.001, p=0.001 ve p=0.002). Ayrıca bireylerin tedavi öncesi ve sonrası denge testleri karşılaştırıldığında genel stabilite indeksi, antero-posterior stabilite indeksi ve medio-lateral stabilite indeksi açısından istatistiksel olarak anlamlı farklılık saptandı (sırasıyla, p=0.001, p=0.012 ve p=0.002). Sonuç: Konvansiyonel tedavi ile stroklu hastaların tedavisinde etkin bir gelişme sağlanması yanında statik ve dinamik dengenin yeniden kazanılmasında etkin bir tedavi yöntemi olarak etkin ve vazgeçilmez olduğu ifade edilebilir

Anahtar Kelimeler:

İnme, Rehabilitasyon, Postural Denge, Biodex Denge Sistemi

Effectiveness of Conventional Rehabilitation Therapy on Postural Stability and Clinic in Stroke Patients with Hemiplegia

Objective: The aim of the present study was to determine the effectiviness of conventional rehabilitation in patients with stroke on static and dynamic balance as well as clinical assessment Methods: Twelve patients with stroke, 7 (58.33%) of them being male and 5 (41.66%) female, ranging from 51 to 75 in age who were treated in Physical Medicine and Rehabilitation clinic were involved in this study. The patients were treated with conventional rehabilitation. All individuals were evaluated using balance tests before (Group 1) and after (Group 2) the treatment. Balance level and postural control has been assessed through Berg Balance Scale (BBS), Trunk Control Test (TCT) and Biodex Stability System (BSS), motor level through BMİE, ambulation state through Functional Ambulatory Scale (FAS) and functional state in daily activities through Functional Independence Measure (FIM). The same tests were repeated while the patients were being discharged. Results: The mean age of the study population was 65,83±4,38 years, the average Body Mas Index (BMI) was 30,55±6,94. In the evaluations according to FIM, FAS, TCT and BBS differences between the mean of patients before and after the rehabilitation were significantly higher for the post-treatment (p=0.001, p=0.001, p=0.001 and p=0.001, respectively). In the evaluations according to Overall Stability Index (OSI), Antero-Posterior Stability Index (APSI) and Medio-Lateral Stability Index (MLSI) differences between the mean of patients before and after the rehabilitation were significantly higher for the pre-treatment (p=0.001, p=0.001 and p=0.001, respectively). Conclusion: It can be stated that this approach is effective and useful in restoring static and dynamic balance as well as in obtaining an effective improvement in the treatment of patients with stroke through conventional treatment.

Keywords:

Stroke, Rehabilitation, Postural Balance, Biodex Stability System,

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Bakhai A. The burden of coronary, cerebrovascular and peripheral arterial disease. Pharmacoeconomics. 2004; 22:11-18.
Tiedemann A, Sherrington C, Dean CM, Rissel C, Lord SR, Kirkham C, O'Rourke SD. Predictors of adherence to a structured exercise program and physical activity participation in community dwellers after stroke. Stroke Res Treat. 2012; 2012:136525.
Cheung CM, Tsoi TH, Hon SF, Au-Yeung M, Shiu KL, Lee CN, Huang CY. Hong Kong stroke epidemiology. Hong Kong Med J. 2007; 13:95-9
Briggs RC, Gossman MR, Birch R, Drews JE, Shaddeau SA. Balance performance among non institutionalized elderly women. Phys Ther. 1989; 69:48-56.
Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in communitydwelling older adults using the timed up & go test. Phys Ther. 2000; 80:896-903.
Badke MB, Sherman J, Boyne P, Page S, Dunning K. Tongue-based biofeedback for balance in stroke: results of an 8-week pilot study. Arch Phys Med Rehabil 2011; 92:1364-70.
Hesse S, Reiter F, Jahnke M, Dawson M, SarkodieGyan T, Mauritz KH. Asymmetry of gait initiation in hemiparetic stroke subjects. Arch Phys Med Rehabil. 1997; 78:719-24.
Aruin AS, Hanke T, Chaudhuri G, Harvey R, Rao N. Compelled weightbearing in persons with hemiparesis following stroke: the effect of a lift insert and goal-directed balance exercise. J Rehabil Res Dev. 2000; 37:65-72.
Genthon N, Rougier P, Gissot A-S, Froger J, Pélissier J, Pérennou DA. Contribution of each lower limb to upright standing in stroke patients. Stroke. 2008; 39:1793-99
Geurts AC, de Haart M, van Nes IJ, Duysens J. A review of standing balance recovery from stroke . Gait Posture. 2005; 22:267-81
Fuzaro AC, Guerreiro CT, Galetti FC, Jucá RB, Araujo JE. Modified constraint-induced movement therapy and modified forced-use therapy for stroke patients are both effective to promote balance and gait improvements. Rev Bras Fisioter. 2012; 16:157 van de Port IG, Wood-Dauphinee S, Lindeman E, Kwakkel G. Effects of exercise training programs on walking competency after stroke: a systematic review. Am J Phys Med Rehabil. 2007; 86:935-51.
Hesse S. Treadmill training with partial body weight support after stroke: A review. Neurorehabilitation. 2008; 23:55-65.
Hesse S, Werner C, von Frankenberg S, Bardeleben A. Treadmill training with partial body weight support after stroke. Physical Medicine & Rehabilitation Clinics of North America. 2003; 14:111-23
Eng JJ, Tang PF. Gait training strategies to optimize walking ability in people with stroke: A synthesis of the evidence. Expert Review of Neurotherapeutics. 2007; 7: 1417-36
Hammer A, Nilsagard Y, Wallquist M. Balance training in stroke patients: A systematic review of randomized, controlled trials. Advances in Physiotherapy. 2008; 10:163-72.
Oliveira CB, Medeiros ÍR, Greters MG, Frota NA, Lucato LT, Scaff M, Conforto AB. Abnormal sensory integration affects balance control in hemiparetic patients within the first year after stroke. Clinics (Sao Paulo). 2011; 66:2043-8.
Baldwin SL, VanArnam TW, Ploutz-Snyder LL. Reliability of dynamic bilateral postural stability on the Biodex Stability System in older adults, Medicine and Science in Sport and Exercise. 2004; 36:530.
Aydog ST, Aydog EC, Cakci A, Doral MN. Reproducibility of postural stability score in blind athletes. Isokinetic Exerc Sci. 2004; 12:229-32.
Brunnstrom S. Motor testing procedures in hemiplegia: based on sequential recovery stages. Phys Ther. 1966; 46:357-75.
Lisinski P, Huber J, Gajewska E, Szlapinski P. The body balance training effect on improvement of motor functions in paretic extremities in patients after stroke. A randomized, single blinded trial. Clinical Neurology and Neurosurgery. 2012; 114:31-6
Holden MK, Gill KM, Magliozzi MR, Nathan J, PiehlBaker L. Clinical gait assessment in neurolgically impaired. Phys Ther. 1984; 64:35-40.
Rankin A. Functional independence measure. Physiotherapy. 1993;79:842-3.
Collin C, Wade D. Assessing motor impairment after stroke: a pilot reliability study. J Neurol Neurosurg Psychiatry. 1990; 53:576-9.
Franchignoni FP, Tesio L, Ricupero C, Martino MT. Trunk control test as an early predictor of stroke rehabilitation outcome. Stroke. 1997; 28:1382-5.
Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Phys Ther. 2008; 88:559-66.
Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health 1992; 83:7-11.
Cachupe JCW, Shifflet B, Kahanov L, Wughalter EH. Reliability of biodex balance system measures. Meas Phys Edu Exerc Sci. 2001; 5:97-108
Aydog E, Aydog ST, Cakci A, Doral MN. Dynamic Postural Stability in blind athletes using the biodex stability system. İnt J Sports Med. 2006; 27:415-18
Hankey GJ, Wardlaw JM (eds.) Vascular diseases of the nervous system. In: Clinical neurology 1st (ed). London: Manson publishing ltd; 2002;181-272.
Van Exel J, Koopmanschap MA, Van Wijngaarden JD, Scholte Op Reimer WJ. Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services. Cost Eff Resour Alloc. 2003; 6:2.
Fong KN, Chan CC, Au DK. Relationship of motor and cognitive abilities to functional performance in stroke rehabilitation. Brain Inj. 2001; 15:443-53.
Desrosiers J, Noreau L, Rochette A, Bravo G, Boutin C. Predictors of handicap situations following poststroke rehabilitation. Disabil Rehabil 2002; 15:774-85.
Forster A, Young J. Incidence and consequences of falls due to stroke: a systematic inquiry. BMJ. 1995; 8:83Johnson EO, Babis GC, Soultanis KC, Soucacos PN. . Functional neuroanatomy of proprioception J Surg Orthop Adv. 2008; 17:159-64
Srivastava A, Taly AB, Gupta A, Kumar S, Murali T. Post-stroke balance training: role of force platform with visual feedback technique. J Neurol Sci. 2009; 287:89-93
Geler Külcü D, Yanık B, Gülşen G. Hemiplejik hastalarda denge bozukluğu ve üst ekstremite fonksiyonları arasındaki ilişki. FTR Bil Der J PMR Sci. 2009; 12:1-6
Juneja G, Czyrny JJ, Linn RT. Admission balance and outcomes in acute inpatient rehabilitation. Am J Phys Med Rehabil 1998; 77:388-93.
Masiero S, Avesani R, Armani M, Verena P, Ermani M. Predictive factors for ambulation in stroke patients in the rehabilitation setting: a multivariate analysis. Clin Neurol Neurosurg. 2007; 109:763-9.
Wee JY, Wong H, Palepu A. Validation of the Berg Balance Scale as a predictor of length of stay and discharge destination in stroke rehabilitation. Arch Phys Med Rehabil. 2003; 84:731-5.
Nichols DS. Balance retraining after stroke using force platform biofeedback. Phys Ther. 1997; 77:5538
Michael KM, Allen JK, Macko RF . Reduced ambulatory activity after stroke: the role of balance, gait, and cardiovascular fitness. Arch Phys Med Rehabil. 2005; 86:1552-6.
Kavounoudias A, Roll R, Roll JP. The plantar sole is a “dynamometric map” for human balance control. Neuroreport. 1998; 9:3247-52.
Karthikbabu S, Nayak A, Vijayakumar K, Misri Z, Suresh B, Ganesan S, Joshua AM. Comparison of physio ball and plinth trunk exercises regimens on trunk control and functional balance in patients with acute stroke: a pilot randomized controlled trial. Clin Rehabil. 2011;25:709-19.
Dickstein R, Shefi S, Marcovitz E, Villa Y. Anticipatory postural adjustments in selected trunk muscles in post-stroke hemiparetic patients. Arch Phys Med Rehabil. 2004; 85:261-73.
Tanaka S, Hachisuka K, Ogata H. Trunk rotatory muscle performance in post-stroke hemiplegic patients. Am J Phys Med Rehabil. 1997 ;76:366-9
Verheyden G, Nieuwboer A, Mertin J, Preger R, Kiekens C, De Weerdt W. The trunk impairment scale: a new tool to measure motor impairment of the trunk after stroke. Clin Rehabil. 2004;18:326-34.
An M, Shaughnessy M. The effects of exercisebased rehabilitation on balance and gait for stroke patients: a systematic review. J Neurosci Nurs. 2011; 43:298-307.
Saeys W, Vereeck L, Truijen S, Lafosse C, Wuyts FP, Heyning PV. Randomized controlled trial of truncal exercises early after stroke to improve balance and mobility. Neurorehabil Neural Repair. 2012; 26:23-8.
Rode G, Tiliket C, Boisson D. Predominance of postural imbalance in left hemiparetic patients. Scand J Rehab Med. 1997; 29:1-6
Wu SH, Huang HT, Lin CF, Chen MH. Effects of a program on symmetrical posture in patients with hemiplegia: a single-subject design. Am J Occup Ther. 1996; 50:17-23
Haart de M, Geurts A, Huidekoper SC, Fasotti L, Limbeek J. Recovery of standing balance in postacute stroke patients: a rehabilitation cohort study. Arch Phys Med Rehabil. 2004; 85:886-95.
Paillex R, So A. Changes in the standing posture of post-stroke patients during rehabilitation. Gait Posture. 2005; 2:403-09
Van Peppen RP, Kortsmit M, Lindeman E, Kwakkel G. Effects of visual feedback therapy on postural control in bilateral standing after stroke: a systematic review. J Rehabil Med. 2006; 38:3-9.
Pomeroy VM, King L, Pollock A, Baily-Hallam A, Langhorne P. Electrostimulation for promoting recovery of movement or functional ability after stroke. Cochrane Database Syst Rev. 2006 (2):CD003241.
Pollock A, Baer G, Pomeroy V, Langhorne P. Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke. Cochrane Database Syst Rev. 2003(2):CD001920.
Cakar E, Durmus O, Tekin L, Dincer U, Kiralp MZ. The ankle-foot orthosis improves balance and reduces fall risk of chronic spastic hemiparetic patients. Eur J Phys Rehabil Med. 2010; 46:363-8.
Wang RY, Yen L, Lee CC, Lin PY, Wang MF, Yang YR. Effects of an ankle-foot orthosis on balance performance in patients with hemiparesis of different durations. Clin Rehabil. 2005; 19:37-44.
Yazışma Adresi / Address for Correspondence: Dr. Ahmet İnanır Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Gaziosmanpaşa Üniversitesi, Tıp Fakültesi, 60100 TOKAT e-mail: ainanir@gmail.com geliş tarihi/received :24.09.2012 kabul tarihi/accepted:07.12.2012