Cansın MEDİN CEYLAN, Ekin İlke ŞEN, Tugce KARAAGAC, Tuğba ŞAHBAZ, Ayse YALIMAN

Sağ/Sol Kol Parezisi Olan İnmeli Hastalarda Modifiye Zorunlu Kullanım Tedavisinin Üst Ekstremite Fonksiyonu Üzerine Etkisi: Tek Kör Randomize Kontrollü Çalışma

Amaç: İnme, fonksiyonel, bilişsel ve psikolojik sorunlar nedeniyle engelliliğin en yaygın nedenlerinden biridir. Etkilenen üst ekstremitedeki motor kusurlar, inme geçirenlerin yaklaşık %50'sini etkiler. Çalışmanın amacı modifiye Zorunlu Kullanım Tedavisinin (mZKT) hemiparetik sağ/sol üst ekstremite fonksiyonları ve yaşam kalitesi (QOL) üzerindeki etkilerini değerlendirmektir. Araçlar ve Yöntem: Bu prospektif, randomize, kontrollü ve tek kör çalışmada, 40 hasta sağ-mZKT (n=10), sol-mZKT (n=10) ve kontrol (n=20) olarak gruplanmıştır. mZKT 4 saat/gün, 2 hafta, 10 seans uygulanmıştır. Tüm hastalara konvansiyonel rehabilitasyon programı uygulanmıştır. Hastalar Fugl-Meyer Motor Skala (FMS), Motor Aktivite Günlüğü (MAG), İnme etki ölçeği (İEÖ), Kutu Blok Testi (KBT), şekillendirme egzersizlerindeki tekrar sayısı ve görev egzersiz süresi kullanılarak değerlendirilmıştır. Bulgular: Sol mZKT grubunun FMS'sında istatistiksel olarak anlamlı bir iyileşme saptanmıştır (p=0.040). Her iki mZKT grubu, MAG kullanım miktarında ve MAL kullanım kalitesinde, şekillendirme egzersizlerinin tekrar sayısında ve KBT'de (p<0.05) istatistiksel olarak anlamlı gelişmeler göstermiştir. İEÖ'nün günlük yaşam aktivitesi, el fonksiyonu ve inme iyileşme alanları her iki grupta da anlamlı olarak artmıştır (p<0.01). Sol-ZKT grubunda İEÖ'nün kuvvet alanında istatistiksel olarak anlamlı bir artış saptanmıştır (p=0.037). Sonuç: mZKT, sağ/sol kol parezisi olan hastalarda motor fonksiyonları, el becerisini ve yaşam kalitesini iyileştirmede etkili saptanmıştır. Bu olumlu etkiler üç aya kadar devam etmiştir. mZKT' nin sol üst ekstremitede kol motor bozukluğu üzerinde olumlu bir etkisi olmasına rağmen, daha fazla araştırmaya ihtiyaç vardır.

Anahtar Kelimeler:

zorunlu kullanım tedavisi, inme, rehabilitasyon, üst ekstremite, yaşam kalitesi

Effect of Modified Constraint-Induced Movement Therapy on Upper Extremity Function for Stroke Patients with Right/Left Arm Paresis: A Single-Blind Randomized Controlled Trial

Purpose: Stroke is one of the most common causes of disability because of functional, cognitive, and psychological issues. Motor deficits in the afflicted upper extremity affect about 50% of stroke survivors. This study aimed to evaluate the effects of modified constraint-induced movement therapy (mCIMT) on hemiparetic right/left upper limb functions and quality of life (QOL). Materials and Methods: In this prospective, randomized, controlled and single-blind study, 40 patients were assigned to the right-mCIMT (n=10), left-mCIMT (n=10), and control (n=20). mCIMT was applied 4h/day, 2 weeks, 10 sessions. A conventional rehabilitation program was applied to all patients. Patients were evaluated using the Fugl-Meyer Motor Assessment (FMA), Motor Activity Log (MAL), Stroke Impact Scale (SIS), Box-Block Test (BBT), the number of repetitions in shaping exercises, and the duration of task exercise. Results: There was a statistically significant improvement in the FMA of the left-mCIMT group (p=0.040). Both mCIMT groups showed statistically significant improvements in the MAL-amount of use (AoU) and MAL-quality of use (QoU), the number of repetitions in the shaping exercises, and the BBT (p<0.05). The activity of daily living, hand function, and stroke recovery domains of the SIS were increased significantly in both groups (p<0.01). There was a statistically significant increase in the strength domain of the SIS in the left-CIMT group (p=0.037). Conclusions: mCIMT was effective in improving motor functions, dexterity, and QOL in patients with right/left arm paresis. These positive effects continued for 3 months. Although left mCIMT had a positive effect on arm motor impairment, further research is needed.

Keywords:

constraint-induced movement therapy, stroke, rehabilitation, upper limb, quality of life,

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