Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Farklı Fizyoterapi Uygulamalarının Spastisite Üzerine Kısa Dönem Etkilerinin Karşılaştırılması: Randomize Çapraz Çalışma
A Comparison of Immediate Effects of Different Physiotherapy Applications on Spasticity: Randomized Cross-Over Study
Güngör ÇOŞKUNa, Serkan TAŞb
aÜsküdar Üniversitesi Sağlık Bilimleri Enstitüsü, Fizyoterapi ve Rehabilitasyon ABD, İstanbul, Türkiye
bAlanya Alaaddin Keykubat Üniversitesi Sağlık Bilimleri Fakültesi, Fizyoterapi ve Rehabilitasyon Bölümü, Antalya, Türkiye
Turkiye Klinikleri J Health Sci. 2022;7(2):436-44
doi: 10.5336/healthsci.2021-84421
Article Language: TR
Full Text
ÖZET
 Amaç: Bu çalışmanın amacı, spastisite regülasyonunda kullanılan transkütanöz elektriksel sinir stimülasyonu [transcutaneous electrical nerve stimulation (TENS)], nöromusküler elektrik stimülasyonu (NMES) ve lokal vibrasyon uygulamalarının, kronik inmeli hastalarda spastisite üzerine anlık etkilerini incelemek ve uygulamaların etkilerini birbirleriyle karşılaştırmaktır. Gereç ve Yöntemler: Çapraz kontrollü olarak tasarlanan bu çalışma, 15 kronik inme hastasının katılımı ile gerçekleşti. Rastgele olarak 1 hafta arayla hastaların gastroknemius kasına TENS ve NMES, tibialis anterior kasına lokal vibrasyon uygulaması yapıldı. Uygulamalardan önce ve sonra hastaların gastroknemius kas tonusu Modifiye Ashworth Skalası (MAS); yürüyüş hızları Zamanlı Kalk ve Yürü Testi (ZKYT); dengeleri Berg Denge Ölçeği (BDÖ) ve ayak bileği eklem hareket açıklığı gonyometre ile değerlendirildi. Bulgular: TENS, NMES ve vibrasyon sonrası hastaların MAS skorları benzerdi (p>0,05). Tüm uygulamalardan sonra ZKYT skorlarının azaldığı bulundu (p<0,05); ancak uygulamalar arasında fark yoktu (p=0,655). TENS, NMES ve vibrasyon sonrası BDÖ skoru artsa (p<0,05) da fark, tüm gruplarda benzerdi (p=0,335). TENS sonrası hastaların aktif plantar fleksiyon, pasif dorsi fleksiyon ve aktif dorsi fleksiyon derecesinde; vibrasyon sonrası pasif plantar fleksiyon, aktif plantar fleksiyon ve pasif dorsi fleksiyon derecesinde artış vardı (p<0,05). Sonuç: Kronik inmeli hastalara uygulanan tek seanslık TENS, NMES ve vibrasyon uygulamalarının, hastaların kas tonusu üzerine etkisi olmazken; denge, yürüme hızı ve eklem hareket açıklığı üzerine istatistiksel olarak etkili olduğu bulundu. Bununla birlikte parametrelerin uygulama öncesi ve sonrası değerleri arasındaki farklar çok azdı. Tüm uygulamaların, incelenen parametreler üzerine etkileri benzerdi.

Anahtar Kelimeler: İnme; kas spastisitesi; elektriksel uyarı tedavisi; fizik tedavi modaliteleri
ABSTRACT
 Objective: To examine the immediate effects of transcutaneous electrical nerve stimulation (TENS), neuromuscular electrical stimulation (NMES), and local vibration applications used in spasticity regulation in patients with chronic stroke and to compare the effects of the applications with each other. Material and Methods: This cross-over and controlled study was conducted with the participation of 15 chronic stroke patients. Applications of TENS and NMES to the gastrocnemius muscle and local vibration to the tibialis anterior muscle of the patients were made randomly 1 week apart. Before and after each application, the gastrocnemius muscle tone of the patients via Modified Ashworth Scale (MAS), gait speed via Timed Up and Go Test (TUG), balance via Berg Balance Scale (BBS), and ankle range of motion via goniometer were evaluated. Results: MAS scores of patients were similar after TENS, NMES, and vibration (p>0.05). TUG scores decreased after all applications (p<0.05), but there was no difference between applications (p=0.655). The BBS score increased after TENS, NMES, and vibration (p<0.05), but the difference was similar in all groups (p=0.335). Patients' active plantar flexion, passive dorsi flexion, and active dorsi flexion increased after TENS, and their passive plantar flexion, active plantar flexion, and passive dorsi flexion increased after vibration (p<0.05). Conclusion: The single session TENS, NMES, and vibration applications in chronic stroke patients had no effect on muscle tone; however, these applications were statistically effective on balance, walking speed, and range of motion. The differences between parameters before and after the application were very small. The effects of all applications on the investigated parameters were similar.

Keywords: Stroke; muscle spasticity; electric stimulation therapy; physical therapy modalities
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