Hemiplejik omuz ağrısında TENS tedavisinin etkileri: Plasebo kontrollü bir çalışma

AMAÇ: Hemiplejik hastalardaki omuz ağrısı ve üst ekstremite fonksiyonel durumu üzerinde transkutanöz elektriksel stimulasyon (TENS) tedavisinin etkinliğini değerlendirmek. MATERYAL-METOD: Omuz ağrılı toplam 19 hemiplejik hasta ardışık olarak rasgele 2 gruba ayrıldı. Grup 1’de (n=10) 20 dakika için TENS uygulandı ve grup 2’ de (n=9) yalancı uygulama yapıldı. Konvansiyonel rehabilitasyon programı her iki grupta üç haftalık bir periyod süresince uygulandı. Omuz ağrısını değerlendirmek için visual analog skala (VAS), Günlük yaşam aktiviteleri (GYA) için Barthel indeksi (Bİ) kullanıldı. Omuzun pasif eklem hareket açıklıkları (PEHA) ve motor iyileşmenin Brunnstrom evrelemesi ölçüldü. BULGULAR: Klinik parametreler başlangıçta benzerdi. Her iki grupta tedavi sonrası VAS ve Bİ anlamlı iyileşmeler gözlendi (grup 1: p

Efficiency of TENS treatment In hemiplegic shoulder pain: A placebo controlled study

OBJECTIVE: To evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) therapy on shoulder pain and upper extremity functions in hemiplegic patients. MATERIAL-METHODS: Total of 19 hemiplegic patients with shoulder pain were as consecutive randomly assigned into two groups. TENS was applied in group 1 (n = 10) for 20 minutes and group 2 (n = 9) received placebo stimulation. Conventional rehabilitation program were applied total 15 sessions during a period of 3 week in both groups.The visual analog scale (VAS) to evaluate shoulder pain, Barthel Index (BI) for daily-life activities (DLA) were used. The shoulder passive range of motions (PROMs) and Brunnstrom stage of motor recovery were measured. RESULTS: Clinical parameters were similar at baseline. In both groups, significant improvements were observed in VAS and BI (group 1: p<0.001; group 2: p<0.05). In VAS (p<0.001), and BI (p<0.05) were showed significant improvements in favor of group 1, when compared with the groups. In PROMs of abduction and external rotation of shoulder significant improvements were observed in only group 1 (p<0.001, p<0.001 respectively). There was not any significant improvement on Brunnstrom stage of motor recovery in both groups (p>0.05). CONCLUSION: In conlusion that TENS therapy together with conventional rehabilitation could be used as a good alternative therapy in patients with hemiplegic shoulder pain.

Kaynakça

Ada L. and Foongchomcheay A.: Efficacy of electrical stimulation in preventing or reducing subluxation of the shoulder after stroke: A meta-analysis. Aust J Physiother 2002; 48: 257-67.

Ancliffe J: Shoulder pain in hemiplegia: incidence and influence on movement and recovery of function. Proceedings 3rd International Physiotherapy Congress. Hong Kong, 1990, pp: 187-92.

Aras MD, Gokkaya NK, Comert D, Kaya A, Cakci A: Shoulder pain in hemiplegia: results from a national rehabilitation hospital in Turkey. Am J Phys Med Rehabil. 2004;83: 713-9.

Barthels MN: Pathophysiology and medical management of stroke. Gillen G, Burkhardt A, edts. Stroke rehabilitation.2nd ed. Mosby, St Louis , 2004,pp:1-31.

Bayram A: Hemiplejide omuz ağrsı ile üst ekstremite fonksiyonları arasındaki ilişki. Nörol Bil D 1998; 15: 207-13.

Brunnstrom S: Movement therapy in hemiplegia: A neurophysiological approach. Newyork, Harper Row. 1970. pp:34-56.

Carroll D, Tramer M, McQuay H, Nye B, Moore A: Transcutaneous electrical nerve stimulation in labour pain: a systematic review. Br J Obstet Gynaecol. 1997; 104:169-75.

Chae J, Yu DT, Walker ME, Kirsteins A, Elovic EP, Flanagan SR,Harvey RL, Zorowitz RD, Frost FS, Grill JH, Fang ZP:Intramuscular electrical stimulation for hemiplegic shoulder pain: a 12-month follow-up of a multiplecenter, randomized clinical trial. Am J Phys Med Rehabil. 2001; 84: 832-42.

Chantraine A, Baribeault A, Uebelhart D, Gremion G: Shoulder pain and dysfunction in hemiplegia: effects of functional electrical stimulation. Arch Phys Med Rehabil. 1999; 80: 328-31.

Dekker JH, Wagenaar RC, Lankhorst GJ, de Jong BA: The painful hemiplegic shoulder: effects of intra-articular triamcinolone acetonide. Am J Phys Med Rehabil.1997; 76: 43-8.

Denktaş H: Serebrovasküler hastalıklar. Özekmekçi S, Apaydın H edt: Nöroloji. Cerrahpaşa tıp fakültesi yayınları.İstanbul, 1995, pp: 141-56.

Faghri PD, Rodgers MM, Glaser RM, Bors JG, Ho C, Akuthota P:The effects of functional electrical stimulation on shoulder subluxation, arm function recovery, and shoulder pain in hemiplegic stroke patients. Arch Phys Med Rehabil. 1994; 75: 73-9.

Folstein MF, Folstein SF, McHugh PR: Mini-Mental state: a practical method for grading the cognitive state for the clinician. J Psychiatr Res 1975; 12: 189-98.

Griffin JW: Hemiplegic shoulder pain. Phys Ther 1986;12:1884-93.

Hakuno A, Sashika H, Ohkawa T, Itoh R: Arthrographic findings in hemiplegic shoulders. Arch Phys Med Rehabil 1984;65: 706-11

Kaada B: Vasodilation induced by transcutaneous nerve stimulation in peripheral ischemia (Raynaud's phe nomenon and diabetic polyneuropathy). Eur Heart J 1982; 3: 303-14.

Leandri M, Brunetti O, Parodi CI: Telethermographic findings after transcutaneous electrical nerve stimulation. Phys Ther. 1986; 66: 210-3.

Leandri M, Parodi CI, Corrieri N, Rigardo S: Comparison of TENS treatments in hemiplegic shoulder pain. Scand J Rehabil Med. 1990; 22: 69-71.

Lo SF, Chen SY, Lin HC, Jim YF, Meng NH, Kao MJ: Arthrographic and clinical findings in patients with hemiplegic shoulder pain. Arch Phys Med Rehabil 2003; 84:-1786-91.

Mahoney FI and Barthel DW: Functional evaluation: the Barthel index. Md State Med J 1965; 14: 61-5.

Özcan O: Hemipleji rehabilitasyonu. Oğuz H ed. Tıbbi Rehabilitasyon. Nobel Tıp kitabevleri. istanbul, 1995, pp: 385-406.

Renzenbrink GJ, IJzerman MJ: Percutaneous neuromuscular electrical stimulation (P-NMES) for treating shoulder pain in chronic hemiplegia. Effects on shoulder pain and quality of life. Clin Rehabil. 2004; 18: 359-65.

Resende MA, Sabino GG, Candido CR, Pereira LS, Francischi JN: Local transcutaneous electrical stimulation (TENS) effects in experimental inflammatory edema and pain.Eur J Pharmacol. 2004; 19: 217-22.

Rizk TE, Christopher RP, Pinals RS, Salazar JE, Higgins C:Arthrographic studies in painful hemiplegic shoulders. Arch Phys Med Rehabil 1984; 65: 254-6.

Roy CW, Sands MR, Hill LD: The effect of shoulder pain on outcome of acute hemiplegia. Clin Rehabil 1995;9: 21-7.

Snels IA, Beckerman H, Lankhorst GJ, Bouter LM: Treatment of hemiplegic shoulder pain in the Netherlands: results of a national survey. Clin Rehabil 2000; 14: 20-7.

Şahin L, Özoran K, Gündüz OH, Uçan H, Yücel M: Bone mineral density in patients with stroke. Am J Phys Med Rehabil 2001; 80: 592-6.

Van Langenberghe HVK, Hogan BM: Degree of pain and grade of subluxation in the painful hemiplegic shoulder. Scand J Rehabil Med 1986; 20: 161-6.

Van Ouwenaller C, Laplace P, Chantraine A: Painful shoulder in hemiplegia. Arch Phys Med Rehabil 1986; 46: 23-6.

Wanklyn P, Forster A, Young J: Hemiplegic shoulder pain (HSP): Natural history and investigation of associated features. Disabil Rehabil 1996; 18: 497-501.

Williams J: Electromyographic feedback and the painful hemiplegic shoulder. Michel T, ed. Pain. Edinburgh: Churchill Livingstone, 1985, pp:183-206.

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