Ömer DİKİCİ, Alper Murat ULAŞLI, Aylin DİKİCİ, HASAN TOKTAŞ, ÜMİT DÜNDAR

Fiziksel tıp ve rehabilitasyon asistan hekimlerinin botulinum toksin enjeksiyon tekniği seçimleri

Amaç: Fiziksel tıp ve rehabilitasyon kliniklerinde inme, travmatik beyin, spinal kord yaralanması, multipl skleroz ve serebral palsi gibi hastalıklarda ortaya çıkan fokal spastisite tedavisinde botulinum toksin tip-A enjeksiyonu sıklıkla uygulanmaktadır. Botulinum toksin tip-A uygulamalarında manuel enjeksiyon, elektromiyografi-elektriksel stimülasyon ve ultrasonografi eşliğinde yapılan enjeksiyonlar sıklıkla kullanılan tekniklerdir. Bu çalışmadaki amacımız, fiziksel tıp ve rehabilitasyon kliniğinde çalışan asistan hekimlerin botulinum toksin tip-A enjeksiyonunda tercihlerini ve bunun nedenlerini değerlendirmektir.Yöntem: Bu tekniklerinden her birini hastalara en az 5 kez öğretim üyesi eşliğinde uygulayan 12 asistan hekime hazırladığımız formdaki sorular yöneltildi.Bulgular: Uygulama tekniği tercih edilirken en çok dikkat edilen konular etkinlik, uygulanacak kasın lokalizasyonu kısa sürede uygulayabilme, uygulanacak kasın ebatı ve tekniğin güvenilirliğiydi. Üst ekstremite uygulamalarında en sık tercih edilen ultrasonografiydi. Ultrasonografinin ilk tercih edilmesinde güvenilirlik ön plandaydı. Ancak alt ekstremite uygulamalarında asistan hekimlerin ilk tercihi manuel enjeksiyon iken, ultrasonografi ikinci sırada tercih edilmekteydi. Pediatrik hastalarda da ilk tercih ultrasonografiydi. Kasların lokalizasyonu ve ebatlarına bağlı olarak uygulanacak tekniğin seçimi değişmekteydi. Asistan hekimler gastro-soleus ve biseps için manuel enjeksiyonu, tibialis posterior ile önkol ve el kasları için ultrasonografiyi kullanmayı tercih etmekteydiler.Sonuç: Asistan hekimlerin tercihleri kasların lokalizasyonu ve ebatlarından, uygulama için gereken zamandan ve tekniğin güvenilirliğinden etkilenmektedir. Her ne kadar önkol ve el kasları ile bacağın zor lokalize edilen kasları için ultrasonografiyi tercih etmelerine rağmen, kolayca lokalize edilen bacak kasları için manuel enjeksiyonu tercih etmektedirler. Çünkü manuel enjeksiyonun pratik ve hızlı uygulanabilen bir yöntem olduğunu düşünmektedirler

The preferences of physical medicine and rehabilitation residents regarding botulinum toxin injection techniques

Objective: Botulinum toxin type-A is frequently injected for focal treatment of spasticity which appears in post-stroke, traumatic brain, spinal cord injury, multiple sclerosis and cerebral palsy at the physical therapy and rehabilitation clinics. Manual injections , electromyographyelectrical stimulation and ultrasonography guided interventions are commonly used in botulinum toxin type A applications. In this study, we aimed to evaluate preferences and relevant reasons of the residents working in the clinics of physical therapy, and rehabilitation for botulinum toxin type A injection techniques.Methods: Twelve physical medicine and rehabilitation residents who had applied each of these techniques at least five times under the supervision of instructors completed survey questionnaires. Results: The application techniques were preferred mostly for their effectiveness, size, and location of the muscle to be injected, reliability, and rapidity of application, During upper extremity applications mostly ultrasonographic guidance was preferred. Reliability was in the forefront for the first preference of ultrasonography. However, in lower extremity injections, the residents’ first choice was manual injection, and ultrasonography was the second alternative. In pediatric patients, the first choice was ultrasonography. The choice of the technique to be applied differed depending on the location and size of the muscle. Residents preferred manual injection for gastrocnemius-soleus and biceps, and ultrasonography for tibialis posterior, forearm and hand muscles.Conclusion: The residents preferences were affected from the muscle size and location, the time required for the application , the reliability of the methods. Accordingly, they preferred ultrasonography for forearm and hand muscles, and difficultly localized leg muscles. For easily localized leg muscles, they preferred manual injection technique because they found it as a practical and quick method

Tam Metin

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