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ORIJINAL ARAŞTIRMA
İnmeli Hastalarda Erken Yoğun Çok-Yönlü Rehabilitasyon: En Etkili Rehabilitasyon Süresi Nedir?
Early Intensive Multi-Faceted Rehabilitation in Stroke Patients: What is the Best Effective Rehabilitation Time?
Received Date : 23 Feb 2021
Accepted Date : 07 May 2021
Available Online : 25 May 2021
Özet PDF Benzer Makaleler
Azize SERÇEa, Ebru KARACA UMAYb, Fatma Aytül ÇAKÇIb
aClinic of Physical Medicine and Rehabilitation, Malatya Yeşilyurt Hasan Çalık State Hospital, Malatya, TURKEY bClinic of Physical Medicine and Rehabilitation, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, TURKEY
Doi: 10.31609/jpmrs.2021-82546 - Makale Dili: EN
J PMR Sci. 2021;24(3):267-76
ÖZET
Amaç: Bu çalışma ile inme sonrası ilk 3 hafta içinde uygulanan yoğun ve çok yönlü rehabilitasyon programının hastalardaki etkilerini değerlendirmeyi ve tedaviye başlamak için en etkili zamanı belirlemeyi amaçladık. Gereç ve Yöntemler: Kliniğimizde tedavi gören 42 hasta çalışmaya dâhil edildi. Hastaların demografik özellikleri, Ulusal İnme Enstitüsü Şiddet Ölçeği [National Stroke Institute Severity Scale (NIHSS)] ile değerlendirilen inme şiddeti seviyesi, Brunstrom ve Chedocke McMaster Ölçeği (CMMÖ) ile değerlendirilen fonksiyonel evreler ve Fonksiyonel Bağımsızlık Ölçümü skoru kaydedildi. Tüm hastalara toplamda 20 seans çok yönlü ve yoğun rehabilitasyon programı uygulandı. Hastalar rehabilitasyona başlama zamanlarına göre ilk 9 gün (grup 1), 10-14 gün (grup 2) ve 15-21 gün (grup 3) olarak 3 gruba ayrıldı. Tedavi öncesi, 4. hafta ve 3. ay değerlendirilen değerlendirme parametreleri gruplar içi ve gruplar arası karşılaştırıldı. Bulgular: Tedaviye başlama süresine göre; CMMÖ el, kol, bacak ve postüral kontrol skorları, Brunstroom üst, alt ekstremite ve el ve NIHSS skorundaki değişim ilk 9 günde tedaviye alınan grupta diğer 2 gruba göre daha yüksek bulundu. Sonuç: Erken yoğun ve çok yönlü rehabilitasyon programı, iskemik inmeli hastalarda motor ve fonksiyonel iyileşme için etkilidir. Üstelik tedaviye ilk 9 gün içinde başlanması en fazla iyileşmeyi sağlar.
Anahtar Kelimeler: İskemik inme; rehabilitasyon; erken rehabilitasyon
ABSTRACT
Objective: We aimed to evaluate the effects of the intensive and multi-faceted rehabilitation program in patients during the first 3 weeks after stroke, and to determine the most effective time to initiate treatment. Material and Methods: 42 patients who were treated in our clinic were included in study. The demographic characteristics of the patients, the level of stroke severity assessed by the National Stroke Institute Severity Scale (NIHSS), the functional stages assessed by the Brunstrom and Chedocke McMaster Stroke Assesment (CMSA) Scale and the disability levels assessed by the Functional Independence Measure scale were recorded. All patients received a multifaceted and intensive rehabilitation program 20 sessions in total. The patients were divided into 3 groups according to the times of initiation of rehabilitation i.e during the first 9 days (group 1), between days 10 and 14 (group 2) and between days 15 and 21 (group 3). The evaluation parameters assessed before the treatment, 4th weeks and 3th months were compared within and between the groups. Results: According to the treatment start times; the change in CMMS hand, arm, legand postural control scores, Brunstroom upper, lower limbs and hand levels and the NIHSS score was found to be higher in the first 9 days compared to the other 2 groups in the beginning of treatment. Conclusion: Early intensive and multi-faceted rehabilitation program is effective for motor and functional recovery in ischemic stroke patients. Moreover, the start of treatment with in the first 9 days provides the most improvement.
Keywords: Ischemic stroke; rehabilitation; early rehabilitation
REFERENCES
  1. Tomazin R. Task specificity and functional outcome: What is best for post-stroke rehabilitation?. Honors Projects. 2019. [Link] 
  2. Herisson F, Godard S, Volteau C, et al; SEVEL study group. Early sitting in ischemic stroke patients (SEVEL): A randomized controlled trial. PLoS One. 2016;11:e0149466. [Crossref] [PubMed] [PMC] 
  3. Teasell R, Salbach NM, Foley N, et al. Canadian Stroke Best Practice Recommendations: Rehabilitation, Recovery, and Community Participation following Stroke. Part One: Rehabilitation and Recovery Following Stroke; 6th Edition Update 2019. Int J Stroke. 2020; 15:763-88. [Crossref] [PubMed] 
  4. Lynch EA, Cumming T, Janssen H,et al. Early Mobilization after Stroke: Changes in Clinical Opinion Despite an Unchanging Evidence Base. J Stroke Cerebrovasc Dis. 2017;26:1-6. [Crossref] [PubMed] 
  5. Langhorne P, Stott D, Knight A, et al. Very early rehabilitation or intensive telemetry after stroke: a pilot randomised trial. Cerebrovasc Dis. 2010;29:352-60. [Crossref] [PubMed] 
  6. Wunderlich MT, Ebert AD, Kratz T, et al. Early neurobehavioral outcome after stroke is related to release of neurobiochemical markers of brain damage. Stroke. 1999;30:1190-5. [Crossref] [PubMed] 
  7. Gowland C, Stratford P, Ward M, et al. Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment. Stroke. 1993;24:58-63. [Crossref] [PubMed] 
  8. Alessandro L, Olmos LE, Bonamico L, et al. Rehabilitación multidisciplinaria para pacientes adultos con accidente cerebrovascular [Multidisciplinary rehabilitation for adult patients with stroke]. Medicina (B Aires). 2020;80:54-68. Spanish. [PubMed] 
  9. AVERT Trial Collaboration group. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet. 2015;386(9988):46-55. Erratum in: Lancet. 2015;386(9988):30. Erratum in: Lancet. 2017;389:1884. [Crossref] [PubMed] 
  10. Bernhardt J, Churilov L, Dewey H, et al; AVERT Collaborators. Statistical analysis plan (SAP) for A Very Early Rehabilitation Trial (AVERT): an international trial to determine the efficacy and safety of commencing out of bed standing and walking training (very early mobilization) within 24 h of stroke onset vs. usual stroke unit care. Int J Stroke. 2015;10:23-4. [Crossref] [PubMed] 
  11. Yen HC, Jeng JS, Chen WS, et al. Early mobilization of mild-moderate intracerebral hemorrhage patients in a stroke center: a randomized controlled trial. Neurorehabil Neural Repair. 2020;34:72-81. [Crossref] [PubMed] 
  12. Benhardt J, Dewey H, Thrift A, et al. A very early rehabilitation trial for stroke (AVERT): phase II safety and feasibility. Stroke. 2008;39(2):390-610. [Crossref] 
  13. Sorbello D, Dewey HM, Churilov L, et al. Very early mobilisation and complications in the first 3 months after stroke: further results from phase II of A Very Early Rehabilitation Trial (AVERT). Cerebrovasc Dis. 2009;28:378-83. [Crossref] [PubMed] 
  14. Poletto SR, Rebello LC, Valença MJ, et al. Early mobilization in ischemic stroke: a pilot randomized trial of safety and feasibility in a public hospital in Brazil. Cerebrovasc Dis Extra. 2015;5:31-40. [Crossref] [PubMed] [PMC] 
  15. Tanlaka E, King-Shier K, Green T, et al. Inpati ent Rehabilitation Care in Alberta: How Much Does Stroke Severity and Timing Matter? Can J Neurol Sci. 2019;46:691-701. [Crossref] [PubMed] 
  16. Hokstad A, Indredavik B, Bernhardt J, et al. Upright activity within the first week after stroke is associated with better functional outcome and health-related quality of life: A Norwegian multi-site study. J Rehabil Med. 2016;48:280-6. [Crossref] [PubMed] 
  17. Slotty PJ, Kamp MA, Beez T, et al. The influence of decompressive craniectomy for major stroke on early cerebral perfusion. J Neurosurg. 2015;123:59-64. [Crossref] [PubMed] 
  18. Momosaki R, Yasunaga H, Kakuda W, et al. Very early versus delayed rehabilitation for acute ischemic stroke patients with intravenous recombinant tissue plasminogen activator: A nationwide retrospective cohort study. Cerebrovasc Dis. 2016;42:41-8. [Crossref] [PubMed] 
  19. Moreno-Palacios JA, Moreno-Martinez I, Bartolome-Nogues A, et al. Factores pronosticos de recuperacion funcional del ictus al a-o [Prognostic factors of functional recovery from a stroke at one year]. Rev Neurol. 2017;64:55-62. Spanish. [Crossref] [PubMed] 
  20. Xu T, Yu X, Ou S, et al. Efficacy and safety of very early mobilization in patients with acute stroke: a systematic review and meta-analysis. Sci Rep. 2017;7:6550. [Crossref] [PubMed] [PMC] 
  21. Turner M, Barber M, Dodds H, et al; Scottish Stroke Care Audit. Stroke patients admitted within normal working hours are more likely to achieve process standards and to have better outcomes. J Neurol Neurosurg Psychiatry. 2016;87:138-43. [PubMed] [PMC] 
  22. Yelnik A, Andriantsifanetra C, Reinert P, et al. Active mobility early after stroke. A randomised controled trial (AMOBES). Annals of Physical and Rehabilitation Medicine. 2016;59S:e67. [Crossref] 
  23. Chippala P, Sharma R. Effect of very early mobilisation on functional status in patients with acute stroke: a single-blind, randomized controlled trail. Clin Rehabil. 2016;30:669-75. [Crossref] [PubMed] 
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