Hemiplejik hastalarda iş uğraşı tedavisi etkinliği

Yıl 2019, , 23 - 32, 18.01.2019

Ata Bora Ayna Mustafa Aziz Yıldırım , Kadriye Öneş

https://doi.org/10.31362/patd.407800

Cited By: 1

Öz

Amaç: Geleneksel tedaviye kombine edilen
tekrarlı amaca özgü egzersizi içeren iş uğraşı tedavisinin üst ekstremite motor
ve fonksiyonel gelişimi üzerine ek bir fayda sağlayıp sağlamadığını
araştırmaktır.

Gereç ve yöntem: Çalışma prospektif,
randomize, tek kör kontrollü bir klinik çalışma olarak planlandı. Çalışmaya
hemiparezi gelişmiş olan 51 hasta dahil edildi. Hastalar iki gruba ayrılarak,
1. gruba geleneksel rehabilitasyon (dört hafta boyunca haftada beş gün) ve iş
uğraşı tedavisi (dört hafta haftada beş gün, günde bir saat) , 2. gruba
yalnızca geleneksel rehabilitasyon uygulandı. Tüm hastalar tedavi öncesi ve bitiminde
değerlendirildi. Tedavi etkinliğini değerlendirmek için Vizüel Anolog Skalası
(VAS), Brunnstrom evrelemesi, Modifiye Ashworth Skalası, Nine Hole Peg Testi
(NHPT), Barthel İndeksi, Fugl Meyer Motor Fonksiyon Skalası üst ekstremite
bölümü ve Nottingham Sağlık Profili (NHP) kaydedildi.

Bulgular: Her iki grup arasında sonuç
parametrelerinde istatistiksel anlamlı bir fark yok idi. Ancak grup 1’de
Brunnstrom üst ekstremite evrelemesinde ve NHP duygusal reaksiyonlar alt
bölümünde elde edilen istatistiksel anlamlı gelişmeler grup 2’de görülmemiştir.

Sonuç: Sonuçlarımız kombinasyon
tedavisinin belirgin lehine olmamakla birlikte, literatür ve çeşitli tedavi
kılavuzları göstermektedir ki tekrarlı amaca özgü egzersizleri içeren iş uğraşı
tedavisi üst ekstremite inme rehabilitasyonunda tamamlayıcı bir yöntem olarak
yer almalıdır. Bu konuda hala yanıtlanması gereken sorular  olduğundan ileri çalışmalara ihtiyaç olduğu
kanısındayız. 

Anahtar Kelimeler

İnme, üst ekstremite

Effectiveness of occupational therapy in hemiplegic patients.

Öz

Introdoction:
This
study aimed to investigate whether combine application of conventional therapy
with occupational therapy in the content of repetitive task specific training
provided additional benefits to motor and functional outcome of upper extremity
in patients with stroke.

Material
and Method: The study was designed as prospective, randomized,
controlled, single blind clinical trial.51 inpatient who have had hemiparesis
related cerebrovascular accident involved to study. Patients were assigned into
two groups, conventional therapy (five days in a week, for four weeks) and
occupational therapy in the content of repetitive task specific training (an
hour once in a day, five days in a week, for four weeks) were performed for
group 1, only conventional therapy was performed for group 2. All patients were
evaluated before and after the treatment. To assess efficiency of treatment
Visual Analog Scale (VAS), Brunnstrom grades, Modified Ashworth Scale, Nine
Hole Peg Test (NHPT), Barthel Index, Fugl Meyer Motor Assessment upper
extremity component and Nottingham Health Profile (NHP) were performed.

Results:
There
was not a significant statistical difference between two group’s outcome
parameters. But improvements statistical significant at Brunnstrom grade upper
extemity and NHP emotional reactions in group 1 there was not seen in group 2.
Despite our results are not supporting combined therapy clearly.

Conclusion: According
to literature and treatment guidelines occupational therapy including
repetitive task specific training is suggested in upper extremity stroke
rehabilitation as a complemantary procedure. Because of still there are
questions that have to be answered, we think further studies are required on
this issue.

Anahtar Kelimeler

stroke, upper limb, occupational therapy

Kaynakça

• 1. Hankey GJ. Stroke treatment and prevention: an evidencebased approach. New York: Cambridge University Press, 2005;1-8.
• 2. Adams H, Adams R, Del Zoppo G, Goldstein LB. Guidelines for the early management of patients with ischemic stroke. Stroke 2005;36:916-923.
• 3. Wooster D, Woodward A, Brown L et al. Effectiveness of Mirror Therapy on Function for Chronic Stroke Patients. Am J Occup Ther 2015;69:77.
• 4. Documents A.O. Announcing the third edition of the occupational therapy practice framework: domain and process. Am J Occup Ther 2014;68:139.
• 5. Plautz EJ, Milliken GW, Nudo RJ. Effects of repetitive motor training on movement representations in adult squirrel monkeys: role of use versus learning. Neurobiol Learn Mem 2000;74:24-55.
• 6. Kucukdeveci AA, McKenna SP, Kutlay S, Gursel Y, Whalley D, Arasil T. The development and psychometric assessment of the Turkish version of the Nottingham Health Profile. Int J Rehabil Res 2000;23:31-38.
• 7. Malouin F, Richards CL, McFadyen B, Doyon J. New perspectives of locomotor rehabilitation after stroke. Med Sci 2003;19: 994-998.
• 8. Creek J, Occupational therapy and mental health. 5th edition. Elsevier Health Sciences. 2011.
• 9. Freburger JK, Li D,Johnson AM, Fraher EP. Physical and Occupational Therapy From the Acute to Community Setting After Stroke: Predictors of Use, Continuity of Care, and Timeliness of Care. Arch Phys Med Rehabil. 2017 doi: 10.1016/j.apmr.2017.03.007. [Epub ahead of print]
• 10. Alon G, Sunnerhagen KS, Geurts AC, Ohry A. A home-based, self-administered stimulation program to improve selected hand functions of chronic stroke. NeuroRehabilitation 2003;18:215-225.
• 11. Blennerhassett J, Dite W. Additional task-related practice improves mobility and upper limb function early after stroke: a randomised controlled trial. Aust J Physiother 2004;50:219-224.12. Lum PS, Mulroy S, Amdur RL, Requejo P, Prilutsky BI, Dromerick AW. Gains in upper extremity function after stroke via recovery or compensation: Potential differential effects on amount of real-world limb use. Top Stroke Rehabil. 2009;16:237-253
• 13. Woldag H, Stupka K, Hummelsheim H. Repetitive training of complex hand and arm movements with shaping is beneficial for motor improvement in patients after stroke. J Rehabil Med. 2010;42:582-587.
• 14. Van Peppen RP, Kwakkel G, Wood-Dauphinee S, Hendriks HJ, Van der Wees PJ, Dekker J. The impact of physical therapy on functional outcomes after stroke: what’s the evidence? Clin Rehabil 2004;18:833-862.
• 15. Wall JC, Turnbull GI. Evaluation of out-patient physiotherapy and a home exercise program in the management of gait asymmetry in residualstroke. J Neurol Rehabil 1987;1:115-123.
• 16. Hyvarinen J, Poranen A. Function of the parietal associative area 7 as revealed from cellular discharges in alert monkeys. Brain. 1974;97:673-692.
• 17. Florey LL. Intrinsic motivation: the dynamics of occupational therapy theory. Am J Occup Ther 1969;23:319-322.
• 18. King LJ. Toward a science of adaptive responses: Eleanor Clarke Slagle Lecture. Am J Occup Ther 1978;32:429-437.
• 19. Schontz FC. Evaluation of the psychological effects of occupational therapy: a demonstration project. Am J Phys Med Rehabil 1959;38:328-348.
• 20. Wu CY, Wong MK, Lin KC, Chen HC. Effects of task goal and personal preference on seated reaching kinematics after stroke. Stroke 2001;32:70-76.