Serebrovasküler olay sonrası hemipleji gelişen hastalarda üst ekstremite robotik rehabilitasyon etkinliğinin konvansiyonel rehabilitasyon ile karşılaştırılması
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Dosyalar
Tarih
2019
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu tek kör randomize, prospektif çalışmanın amacı; Hemiplejik hastalara uygulanan robot aracılı rehabilitasyonun (Serebrovasküler olay sebebiyle fonksiyonunu kaybetmiş olan tarafa robot yardımlı egzersiz yaptırılarak eski fonksiyonlarının kazandırılmaya çalışılması ) yaşam kalitesi, üst ekstremite ve genel motor fonksiyonlara, günlük yaşam aktivitelerine olan etkinliğini araştırmaktır. Gereç ve Yöntem: Ege Üniversitesi Tıp Fakültesi Fiziksel Tıp ve Rehabilitasyon Anabilimdalı poliklinik/ ayaktan tedavi birimine Nisan 2016 ile Nisan 2019 tarihleri arasında başvuran, 18-85 yaşları arasında, anamnez, fizik muayene ve radyolojik değerlendirmesi ile ilk Serebrovasküler olay (SVO) sonrası hemipleji tanısı almış, çalışmaya katılmayı kabul eden 37 hasta alınmıştır. Çalışmaya alınan hastaların demografik ve klinik verileri kayıt edildikten sonra randomize edilerek 2 gruba ayrılmıştır. Robotik rehabilitasyon grubuna 17, konvansiyonel rehabilitasyon grubuna 20 kişi dahil edilmiştir. Gruplardan biri konvansiyonel tedavi alırken diğer grup konvansiyonel tedaviye ek olarak robot aracılı rehabilitasyon almıştır. Konvansiyonel tedavi haftada 5 gün olacak şekilde 4 hafta boyunca uygulanan eklem hareket açıklığı, germe, güçlendirme, denge egzersizleri ve yürüme eğitimini içermektedir. Robot aracılı rehabilitasyon bu tedaviye ek olarak haftada 5 gün 30-45 dakika olacak şekilde düzenlenmiştir. Tüm hastalar tedavi başında ve 4. haftanın sonunda Brunnstrom motor evrelemesi, el kavrama ve parmak kas gücü, Modifiye Ashworth Skalası (MAS), inmeye özgü yaşam kalitesi ölçeği (SS-QOL- Stroke Specific Quality of Life Scale), Motor Aktivite Günlüğü-28 (MAG-28), Fugl Meyer Değerlendirme Ölçeği (FMDÖ), Purdue peg test, Minnesota el becerisi testi, Montreal bilişsel değerlendirme ölçeği (MOBİD), Nottingham genişletilmiş günlük yaşam aktiviteleri indeksi (NGGYA), Fonksiyonel bağımsızlık ölçeği (FBÖ), Fonksiyonel ambulasyon skalası (FAS) ve CES-Depresyon ölçeği ile değerlendirilmiştir. Bulgular: Robotik rehabilitasyon grubundaki hastaların motor fonksiyon ölçekleri, genel fonksiyon, yaşam kalitesi, spastisite, ambulasyon ve bilişsel değerlendirme ölçekleri kontrol grubuna göre daha iyi sonuçlar alınmasına rağmen gruplar arasında anlamlı istatistiksel fark saptanmadı (p>0,05). CES – Depresyon Ölçeğinde ise robotik rehabilitasyon grubunda kontrol grubuna göre istatistiksel olarak anlamlı fark saptandı. (p=0,018). Sonuç: Araştırmamız sonucunda robotik rehabilitasyon grubunda konvansiyonel tedavi grubuna göre motor fonksiyon kazanımlarında artış olsa da anlamlı fark saptanmamıştır. Bununla birlikte hem konvansiyonel nörolojik rehabilitasyonun, hem de buna eklenen robotik rehabilitasyonun hemiplejinin yönetiminde etkili olduğu saptanmıştır. Avantajları göz önüne alındığında psikolojik iyileşme de sağlayabildiği için inme sonrasında robotik rehabilitasyon konvansiyonel tedavilere ek olarak kullanılabileceği düşünülmüştür. Robotik rehabilitasyon teknoloji ile birlikte ilerlemekte olan ve yeni teknolojiler ile çok daha etkili ve üstün yöntemlerin ortaya çıkmasının beklendiği bir alandır. Bu alanda yapılacak yeni çalışmalara ihtiyaç vardır ve bu çalışmalar sayesinde yeni yöntemlerin kanıta dayalı tıp çerçevesinde klinikteki kullanımları mümkün olacaktır.
Objective: The aim of this single-blind randomized propective study is to find out whether including robotic therapy (trying to gain the previous functions of the affected side after stroke by robotic rehabilitation) in addition to conventional rehabilitation program has an effect on quality of life, motor function and activities of daily living of the hemiplegic patients. Materials and Methods: Hemiplegic patients aged 18-85, diagnosed by anamnesis, physical examination and radiological analysis, which have been referred to the outpatient clinic of Ege University Faculty of Medicine Department of Physical Therapy and Rehabilitation between April 2016 and April 2019 have been taken to the study. The demographic and clinical data of the patients were recorded and they were randomized into 2 groups. 17 were assigned to the robotic rehabilitation group and 20 were assigned to the conventional rehabilitation group. One of the groups received conventional therapy while the other group received robot-assisted rehabilitation in addition to conventional treatment. Conventional therapy included 5 days a week for 4 weeks, Range of Motion (ROM) exercises, stretching, strengthening, balance exercises and gait training. Robotic-based rehabilitation is arranged to be 30-45 minutes five days a week. All patients were assessed at the beginning of therapy and at the end of 4th week with Brunnstrom stages of motor recovery, hand grip and finger muscle strength, Modified Ashworth Scale (MAS), Stroke Specific Quality of Life Scale (SS-QOL), Motor Activity log-28, Fugl Meyer Assessment (FMA), Purdue peg test, Minnesota manual dexterity test, Montreal Cognitive Asssessment (MoCA), Nottingham Extended Activities of Daily Living (NEADL) Scale, Functional İndependance Measure (FIM), Functional Ambulation Scale (FAS), Center for Epidemiological Studies Depression Scale (CES- D). Results: In our study, improvements in motor function scores, general functioning, activities of daily living, spasticity, ambulation, cognitive assessment scale are better in robotic group when compared with control group but this difference was not statistically significant (p>0,05). We have found statistically significant improvement in CES- Depression scale in robotic group compared with control group (p=0,018). Conclusion: Results of motor function gains are significantly improved before and after the treatment in both groups and this improvements are better in robotic group however no significant differences were observed between the groups after the treatment. Robotic rehabilitation provides a favorable alternative and its addition brings slight benefits, and it is advantageous in terms of work power and psychological recovery so robotic rehabilitation addition to conventional neurological rehabilitation is effective and useful in patient management after stroke. By devoloping new technologies more effective and superior systems are expected in robotic rehabilitation field. More studies must be done and these studies will enable the use of new therapeutic methods in clinical practice within the framework of evidence-based medicine in the future.
Objective: The aim of this single-blind randomized propective study is to find out whether including robotic therapy (trying to gain the previous functions of the affected side after stroke by robotic rehabilitation) in addition to conventional rehabilitation program has an effect on quality of life, motor function and activities of daily living of the hemiplegic patients. Materials and Methods: Hemiplegic patients aged 18-85, diagnosed by anamnesis, physical examination and radiological analysis, which have been referred to the outpatient clinic of Ege University Faculty of Medicine Department of Physical Therapy and Rehabilitation between April 2016 and April 2019 have been taken to the study. The demographic and clinical data of the patients were recorded and they were randomized into 2 groups. 17 were assigned to the robotic rehabilitation group and 20 were assigned to the conventional rehabilitation group. One of the groups received conventional therapy while the other group received robot-assisted rehabilitation in addition to conventional treatment. Conventional therapy included 5 days a week for 4 weeks, Range of Motion (ROM) exercises, stretching, strengthening, balance exercises and gait training. Robotic-based rehabilitation is arranged to be 30-45 minutes five days a week. All patients were assessed at the beginning of therapy and at the end of 4th week with Brunnstrom stages of motor recovery, hand grip and finger muscle strength, Modified Ashworth Scale (MAS), Stroke Specific Quality of Life Scale (SS-QOL), Motor Activity log-28, Fugl Meyer Assessment (FMA), Purdue peg test, Minnesota manual dexterity test, Montreal Cognitive Asssessment (MoCA), Nottingham Extended Activities of Daily Living (NEADL) Scale, Functional İndependance Measure (FIM), Functional Ambulation Scale (FAS), Center for Epidemiological Studies Depression Scale (CES- D). Results: In our study, improvements in motor function scores, general functioning, activities of daily living, spasticity, ambulation, cognitive assessment scale are better in robotic group when compared with control group but this difference was not statistically significant (p>0,05). We have found statistically significant improvement in CES- Depression scale in robotic group compared with control group (p=0,018). Conclusion: Results of motor function gains are significantly improved before and after the treatment in both groups and this improvements are better in robotic group however no significant differences were observed between the groups after the treatment. Robotic rehabilitation provides a favorable alternative and its addition brings slight benefits, and it is advantageous in terms of work power and psychological recovery so robotic rehabilitation addition to conventional neurological rehabilitation is effective and useful in patient management after stroke. By devoloping new technologies more effective and superior systems are expected in robotic rehabilitation field. More studies must be done and these studies will enable the use of new therapeutic methods in clinical practice within the framework of evidence-based medicine in the future.
