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Düşük Ayaklı İnmeli Hastalarda Fonksiyonel Elektrik Stimülasyonu ve Denge Ağırlıklı Rehabilitasyon Tedavisinin Etkinliği: Pilot Çalışma
The Efficiency of Functional Electrical Stimulation and Balance-Weighted Rehabilitation Therapy in Stroke Patients with Foot-Drop: A Pilot Study
Received Date : 08 Feb 2021
Accepted Date : 08 Nov 2021
Available Online : 22 Nov 2021
Doi: 10.31609/jpmrs.2021-82149 - Makale Dili: EN
J PMR Sci. 2022;25(1):1-10
ÖZET
Amaç: Düşük ayağı olan inmeli hastalarda, konvansiyonel rehabilitasyon tedavisine ek olarak fonksiyonel elektrik stimülasyonu (FES) ve denge ağırlıklı rehabilitasyon uygulanmasının; motor fonksiyon, ambulasyon, postür, denge, fiziksel yetersizlik, yürüme kalitesi ve günlük yaşam aktiviteleri üzerine etkilerinin değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Çalışmaya düşük ayağı olan 35 inmeli hasta alındı. Hastaların motor fonksiyonları, fonksiyonel dizabiliteleri, ambulasyon seviyeleri, günlük yaşam aktiviteleri, postürleri, denge ve düşme riskleri değerlendirildi. Hastaların motor fonksiyonları, Brunnstrom motor evrelemeleri ile değerlendirildi. Ayrıca fonksiyonel dizabilite Fonksiyonel Bağımsızlık Ölçeği, yürüyüş performansı Fonksiyonel Ambulasyon Sınıflandırılması, fonksiyonel denge ve düşme riski Berg Denge Ölçeği ve Postür Gövde Kontrol Testi ile değerlendirildi. Hastalara 10 m için video destekli görsel yürüme analizi yapıldı. Salınım ve basma olarak 2 ayrı fazda inceleme yapıldı. Yürüme hızı (m/sn) ve yürüme ritmi (adım/dk) belirlendi. Tüm hastalara ortalama 4 hafta süre ile haftada 5 gün olmak üzere konvansiyonel rehabilitasyon, FES ve denge ağırlıklı rehabilitasyon programı uygulandı. Tedavinin 2 ve 4. haftasında tekrar değerlendirilme yapıldı ve bu parametreler karşılaştırıldı. Bulgular: Tekrarlayan ölçümler arasında; tedavi öncesi ve 4. hafta arasında fonksiyonel dizabilite ile değiştirilmesini, denge, üst ve alt ekstremite motor fonksiyonları, yürüme hızı ve ritminde anlamlı olarak iyileşme saptandı. Sonuç: Düşük ayağı olan inmeli hastalarda konvansiyonel rehabilitasyon programına ek olarak FES ve denge ağırlıklı rehabilitasyon, fonksiyonel ambulasyonu geliştirerek günlük yaşam aktivitelerindeki bağımsızlık düzeyini artırdığı için hemiplejik ayak rehabilitasyonunda etkili bir tedavi yöntemidir.
ABSTRACT
Objective: This study aimed to evaluate the effects of FES and balance-weighted rehabilitation therapy in addition to conventional rehabilitation in stroke patients with foot-drop on motor function, ambulation, posture, balance, physical disability, gait quality and activities of daily living. Material and Methods: This study included 35 stroke patients with foot-drop. The patients were evaluated in respect of motor function, activities of daily living posture, balance and risk of falling. Brunnstrom stages of motor recovery was administered to assess motor function. The functional disability were assessed by Functional Independence Measure. Functional Ambulation Category was used to assess the patients’ gait performance. Berg Balance Scale was used in functional balance and risk of falling. Posture were assessed using the Trunk Control Test. Video-assisted visual gait analysis (VGA) over a distance of 10 m was also applied to patients. The two gait phases of swing and stance were analysed. Walking speed (m/sn) and walking rhythm (step/min) were determined. All patients received conventional rehabilitation, FES and balance-weighted rehabilitation therapy 5 days a week for 4 weeks. The evaluation parameters were repeated in weeks 2 and 4 and these parameters were compared. Results: From the baseline values to the end of week 4, a significant improvement was determined in respect of functional disability, balance, upper and lower extremity functions, walking speed and rhythm. Conclusion: FES and balance-weighted rehabilitation therapy in addition to conventional rehabilitation is an effective treatment method for hemiplegic foot rehabilitation as it improves functional ambulation and increases the level of independence in daily living activities.
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