ISSN: 1309 - 3843 E-ISSN: 1307 - 7384
FİZİKSEL TIP VE REHABİLİTASYON
BİLİMLERİ DERGİSİ
www.jpmrs.com
Kayıtlı İndexler


ORIJINAL ARAŞTIRMA

Erken Dönemde Rehabilitasyon Programına Alınan İnmeli Hastalarda Dengedeki Gelişmenin Değerlendirilmesi
Evaluation of the Development in Balance in Patients with Stroke in the Rehabilitation Program in the Early Period
Received Date : 28 Mar 2023
Accepted Date : 11 May 2023
Available Online : 16 May 2023
Doi: 10.31609/jpmrs.2023-97040 - Makale Dili: EN
J PMR Sci 2024;27(1):33-9.
ÖZET
Amaç: İlk kez rehabilitasyon programı alan subakut ve kronik inmeli hastalarda denge gelişimini değerlendirmek amaçlandı. Gereç ve Yöntemler: Bu prospektif çalışmada, rehabilitasyon kliniğinde yatarak tedavi gören, ilk kez rehabilitasyon programı alan 25 hemiplejik hasta değerlendirildi. Hastaların demografik verileri (yaş, cinsiyet, inme sonrası süre, etkilenen ekstremite tarafı, inmenin etiyolojik faktörleri, komorbiditeler) kaydedildi. Hastalara konvansiyonel rehabilitasyon programı (nörofizyolojik egzersizler, eklem hareket açıklığı egzersizleri, denge ve koordinasyon egzersizleri, postür egzersizleri, yürüme egzersizleri, germe egzersizleri ve gevşeme egzersizleri) uygulandı. Hastalar Brunnstrom İyileşme Evresi (BİE), Gövde Kontrol Testi (GKT), Berg Denge Skalası (BDS) ve Barthel İndeksi (Bİ) ile değerlendirildi. Bulgular: Çalışmaya ortanca yaşı 66 (54,5-76,5) olan 8 (%32) kadın ve 17 (%68) erkek hasta dâhil edildi. Kontrol BDS, Bİ, GKT, BİE el, üst ekstremite ve alt ekstremitenin ortanca puanları ilk değerlendirme puanlarından daha yüksekti (tümü p<0,01). BDS farkı ile Bİ farkı, GKT farkı ve BİE alt ekstremite farkı arasında pozitif yönde anlamlı bir korelasyon saptandı (sırasıyla rs=0,578, p=0,002; rs=0,426, p=0,034, rs=0,622, p=0,001). Sonuç: Sonuç olarak, inme sonrası erken dönemde rehabilitasyon programına başlanması, denge değerlendirme verilerinin başlangıç değerlerine göre iyileşme göstermesine rağmen BDS sınıflamasına göre denge bozukluğu hâlâ devam etmektedir. Bu yüzden hastaların dengesi derinlemesine değerlendirilmeli ve rehabilitasyon programına denge eğitimi dâhil edilmelidir.
ABSTRACT
Objective: To evaluate the balance improvement in subacute and chronic stroke patients who received rehabilitation program for the first time. Material and Methods: This prospective study evaluated twenty-five hemiplegic patients who received a rehabilitation program for the first time in an inpatient rehabilitation clinic. Patients’ demographic datas (age, gender, post-stroke duration, affected extremity side, etiologic factors of stroke, comorbidities) were recorded. A conventional rehabilitation program (neurophysiological exercises, joint range of motion exercises, balance and coordination exercises, posture exercises, walking exercises, stretching exercises and relaxation exercises) was applied to the patients. The patients were evaluated with the Brunnstrom Recovery Stage (BRS), the Trunk Control Test (TCT), the Berg Balance Scale (BBS), and the Barthel Index (BI). Results: The study included 8 (32%) female and 17 (68%) male patients with a median age of 66 (54.5-76.5) years. The median scores of the control BBS, BI, TCT, BRS of the hand, upper extremity and lower extremity were higher than the initial evaluation scores (all p<0.01). A positive significant correlation was detected between BBS difference and BI difference, TCT difference and BRS lower extremity difference (rs=0.578, p=0.002; rs=0.426, p=0.034, rs=0.622, p=0.001, respectively). Conclusion: As a result, although the initiation of the rehabilitation program in the early poststroke period showed improvement according to the initial values of the balance assessment data, balance disorder still continues according to the BBS classification. Therefore, the balance of the patients should be evaluated in depth, and balance education should be included in the rehabilitation program.
REFERENCES
  1. Hatem SM, Saussez G, Della Faille M, et al. Rehabilitation of motor function after stroke: a multiple systematic review focused on techniques to stimulate upper extremity recovery. Front Hum Neurosci. 2016;10:442. [Crossref]  [PubMed]  [PMC] 
  2. Geurts AC, de Haart M, van Nes IJ, et al. A review of standing balance recovery from stroke. Gait Posture. 2005;22:267-81. [Crossref]  [PubMed] 
  3. Srivastava A, Taly AB, Gupta A, et al. Post-stroke balance training: role of force platform with visual feedback technique. J Neurol Sci. 2009;287:89-93. [Crossref]  [PubMed] 
  4. Loewen SC, Anderson BA. Predictors of stroke outcome using objective measurement scales. Stroke. 1990;21:78-81. [Crossref]  [PubMed] 
  5. Badke MB, Sherman J, Boyne P, et al. Tongue-based biofeedback for balance in stroke: results of an 8-week pilot study. Arch Phys Med Rehabil. 2011;92:1364-70. [Crossref]  [PubMed] 
  6. Stinear CM, Byblow WD, Ward SH. An update on predicting motor recovery after stroke. Ann Phys Rehabil Med. 2014;57:489-98. [Crossref]  [PubMed] 
  7. Gillen G, Burkhardt A. Balance impairment. In: Donato S, Pulaski KH, eds. Stroke Rehabilitation. 2nd ed. St Louis: Mosby; 2004. p.145-62.
  8. Berg KO, Maki BE, Williams JI, et al. Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil. 1992;73:1073-80. [PubMed] 
  9. Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Phys Ther. 2008;88:559-66. [Crossref]  [PubMed] 
  10. Chen IC, Cheng PT, Chen CL, et al. Effects of balance training on hemiplegic stroke patients. Chang Gung Med J. 2002;25:583-90. [PubMed] 
  11. Lopes PG, Lopes JA, Brito CM, et al. Relationships of balance, gait performance, and functional outcome in chronic stroke patients: a comparison of left and right lesions. Biomed Res Int. 2015;2015:716042. [Crossref]  [PubMed]  [PMC] 
  12. Brunnstrom S. Motor testing procedures in hemiplegia: based on sequential recovery stages. Phys Ther. 1966;46:357-75. [Crossref]  [PubMed] 
  13. Franchignoni FP, Tesio L, Ricupera C, et al. Trunk control test an early predictor of stroke rehabilitation outcome. Stroke. 1997;28:1382-85. [Crossref]  [PubMed] 
  14. Wade DT, Collin C. The Barthel ADL Index: a standard measure of physical disability? Disabil Rehabil. 1988;10:64-7. [Crossref]  [PubMed] 
  15. Mecagni C, Smith JP, Roberts KE, et al. Balance and ankle range of motion in community-dwelling women aged 64 to 87 years: a correlational study. Phys Ther. 2000;80:1004-11. [Crossref]  [PubMed] 
  16. Sandin KJ, Smith BS. The measure of balance in sitting in stroke rehabilitation prognosis. Stroke. 1990;21:82-6. [Crossref]  [PubMed] 
  17. Wade DT, Skilbeck CE, Hewer RL. Predicting Barthel ADL score at 6 months after an acute stroke. Arch Phys Med Rehabil. 1983;64:24-8.
  18. Wade DT, Langton-Hewer R, Wood VA, et al. The hemiplegic arm after stroke: measurement and recovery. J Neurol Neurosurg Psychiatry. 1983;46:521-24. [Crossref]  [PubMed]  [PMC] 
  19. Kurt EE, Ünsal-Delialioğlu S, Özel S. Balance in Stroke and Scales of Balance Assessmentme / Review. J PMR Sci. 2010;13:112-8.
  20. Kurt EE, Ünsal-Delialioğlu S, Özel S. Assessment of Balance in Patients with Stroke. Turk J Phys Med Rehab. 2010;56:56-61. [Crossref] 
  21. Geler-Külcü G, Yanık B, Gülşen G. The Relatıonshıp Betweeen Balance Dısorders and Upper Extremıty Functıon in Hemıplegıc Patıents. J PMR Sci. 2009;12:1-6.
  22. Genthon N, Rougier P, Gissot AS, et al. Contribution of each lower limb to upright standing in stroke patients. Stroke. 2008;39:1793-9. [Crossref]  [PubMed] 
  23. Daubney ME, Culham EG. Lower-extremity muscle force and balance performance in adults aged 65 years and older. Phys Ther. 1999;79:1177-85. [Crossref] 
  24. Eke-Okoro ST, Gregoric M, Larsson LE. Alterations in gait resulting from deliberate changes of arm-swing amplitude and phase. Clin Biomech. 1997;12: 516-21. [Crossref]  [PubMed] 
  25. Rafsten L, Meirelles C, Danielsson A, et al. Impaired Motor Function in the Affected Arm Predicts Impaired Postural Balance After Stroke: A Cross Sectional Study. Front Neurol. 2019;10:912. [Crossref]  [PubMed]  [PMC] 
  26. Ford MP, Wagenaar RC, Newell KM. The effects of auditory rhythms and instruction on walking patterns in individuals post stroke. Gait Posture. 2007;26:150-5. [Crossref]  [PubMed]