Erken ve Orta Evredeki Parkinson Hastalarında Omuz Postürü ve Dengenin İncelenmesi: Bir Pilot Çalışma

Yıl 2021, Cilt: 2 Sayı: 2, 19 - 28, 24.06.2021

Ayşe Balbaba , Nezehat Özgül Ünlüer , Yeşim Sücüllü

Öz

Amaç: Bu çalışmanın amacı, erken ve orta evredeki Parkinson hastalarında (PH) omuz postürü ve dengeyi incelemekti.
Yöntem: Çalışmaya erken ve orta evredeki PH (n=14) ve sağlıklı kontrol grubu (n=14) dahil edildi. Katılımcılar Haziran-Aralık 2019 tarihleri arasında değerlendirildi. Katılımcıların demografik ve fiziksel özellikleri kaydedildi. Çalışmamızda postür değerlendirilmesi, Android sisteme sahip cihazla PostureScreen Mobile uygulaması kullanılarak yapıldı. Denge, gözler açık ve kapalı olarak Biodex-BioSway™ Denge Sistemi ile değerlendirildi. İstatistiksel analiz için Parkinson grubu ile kontrol grubunun ölçüm sonuçlarının karşılaştırılmasında Bağımsız İki Örneklem T Testi, Mann Whitney U testinden uygun olan test kullanıldı. Parkinson hastalarında değişkenler arasındaki ilişkiyi incelemek amacıyla; Spearman korelasyon analizi kullanıldı. İstatistiksel hata düzeyi p<0,05 olarak belirlendi.
Bulgular: PostureScreen Mobile uygulamasında PH’da postüral değişikliklerin kontrol grubuna göre daha fazla olduğu görüldü (p<0,05). PH’da erken ve orta dönemde kontrol grubuna göre gözler açık ve kapalı dengenin azalmış olduğu görüldü (p<0,05). PH’da gözler açık toplam salınım ile lateralde başın yer değişimi (p=0,000, r=0,842), lateralde omuzun yer değişimi (p=0,001, r=0,768) arasında mükemmel derecede, anteriorda omuzun yer değişimi (p=0,004, r=0,713), anteriorda başın yer değişimi (p=0,005, r=0,705) arasında çok iyi derecede ilişki bulundu (p<0.05). Gözler kapalı toplam salınım ile lateralde başın yer değişimi (p=0,001, r=0,767) arasında mükemmel derecede, anteriorda omuzun yer değişimi (p=0,002, r=0,749) arasında çok iyi derecede, lateralde omuzun yer değişimi (p=0,006, r=0,695) arasında iyi derecede ilişki bulundu (p<0.05). Gözler kapalı toplam salınım ile anteriorda başın yer değişimi arasında ilişki bulunamadı (p>0.05).
Sonuç: Bu çalışmada, erken ve orta evredeki PH’da tremorun başladığı taraftaki omuzda postüral değişikliklerin kontrol grubuna göre daha fazla olduğu ve PH’da dengenin azalmış olduğu görüldü. PH’da omuz ve baş postürü ile denge arasında ilişki olduğu görüldü. Kliniklerde erken ve orta dönemlerdeki PH’da omuz ve baş postürünün dengeyi etkileyebileceğini ve yaralanmalara daha açık hale getirebileceğini göz önünde bulundurarak asimetrik postürü önlemeye yönelik müdahalelere rehabilitasyon programının erken döneminden itibaren dahil edilmesi gerektiğini düşünmekteyiz.
ABSTRACT
Aim: The aim of this study was to investigate the shoulder posture and balance in patients with mild to moderate Parkinson's disease (PD).
Methods: The study were included mild to moderate PD patients (n=14) and healthy volunteers (n=14) of similar age and gender. The individuals were evaluated between June to December 2019. The demographic and physical characteristics of the individuals were recorded. The individuals' posture were evaluated with PostureScreen Mobile and Biodex-BioSway™. Balance System was used to measure the balance under the eyes opened (EO) and eyes closed (EC) conditions. Independent sample t-test, Mann-whitney U test and Spearman correlation test were used for statistical analysis. Statistical error level was set as p <0,05.
Results: In the PostureScreen Mobile application, it was found that postural changes in PD increased than the healthy volunteers (p<0,05). EO and EC balance decreased at PD in the early and middle stages compared to the healthy volunteers (p<0,05). There was a perfect correlation between head (p=0,000, r=0,842) and shoulder (p=0,001, r=0,768) displacement with EO at the lateral position. There was a very strong correlation between shoulder (p=0,004, r=0,713) and head (p=0,005, r=0,705) displacement at the anterior position with EO (p<0,05). There was a perfect correlation between head displacement at the lateral position with EC (p=0,001, r=0,767). There was a very strong correlation between shoulder displacement at the anterior position with EC (p=0,002, r=0,749). There was a strong correlation between shoulder displacement at the lateral position with EC (p=0,006, r=0,695). There wasn’t any correlation between head displacement at the anterior position with EC (p>0,05).
Conclusion: In this study, it was seen that in the early and mid-stages the postural changes in the shoulder on the side where the tremor started were more distinctive than the healthy volunters and the balance decreased at PD. It was observed that there was a relationship between shoulder and head posture with balance at PD. In clinics, it should be taken into account that the shoulder and head posture may affect the balance and cause to injuries in early and mid-stage PD. We think that interventions aimed at preventing asymmetric posture should be included in the early period of the rehabilitation program.

Anahtar Kelimeler

Parkinson hastalığı, Postür, Omuz, Postüral Denge

Kaynakça

• 1. Lorraine V Kalia and Dr Anthony E Lang. Parkinson's disease. The Lancet. 2015; 386 (9996): 896-912.
• 2. Hoehn MM and Yahr MD. Parkinsonism: onset, progression, and mortality. Neurology, 1967; 17(5):427-427.
• 3. Martin J, editor. The Basal Ganglia and Posture. Pitman Medical and JB. Lippincott Co: London; 1967. p. 52-53.
• 4. Doherty KM, van de Warrenburg BP, Peralta MC, et al. Postural deformities in Parkinson's disease. The Lancet Neurology, 2011; 10(6): 538-549.
• 5. Michelle H and Cameron LM, editors. Physical Rehabilitation for the Physical Therapist Assistant. Elseıver: Saunders, 2010. p. 28-29.
• 6. Beckley D, Bloem BR, Dijk JG, et al. Electrophysiological correlates of postural instability in Parkinson's disease. Electroencephalography and Clinical Neurophysiology/Evoked Potentials Section, 1991; 81(4): 263-268.
• 7. Horak F, Nutt J and Nashner L. Postural inflexibility in parkinsonian subjects. Journal of the neurological sciences, 1992; 111(1): 46-58.
• 8. Kandel ER SJ, Schwartz JH, Jessell TM, Siegelbaum SA, Hudspeth AJ, editors. Principles of neural science. 5th ed. McGraw-Hill Companies; 2013.
• 9. Kim SD, Allen NE, Canning CG, et al. Postural instability in patients with Parkinson’s disease. CNS drugs, 2013; 27(2): 97-112.
• 10. Kerr GK, Worringham CJ, Cole MH, et al. Predictors of future falls in Parkinson disease. Neurology, 2010; 75(2): 116-124.
• 11. Rahman S, Griffin HJ, Quinn NP, et al. Quality of life in Parkinson's disease: the relative importance of the symptoms. Movement disorders: official journal of the Movement Disorder Society, 2008; 23(10): 1428-1434.
• 12. Williams DR, Watt HC and Lees AJ. Predictors of falls and fractures in bradykinetic rigid syndromes: a retrospective study. Journal of Neurology, Neurosurgery & Psychiatry, 2006; 77(4): 468-473.
• 13. Stolze H, Klebe S, Zechlin C, et al. Falls in frequent neurological diseases. Journal of Neurology, 2004; 251(1): 79-84.
• 14. Riley D, Lang AE, Blair RD, et al. Frozen shoulder and other shoulder disturbances in Parkinson's disease. Journal of Neurology, Neurosurgery & Psychiatry, 1989; 52(1): 63-66.
• 15. Stamey W, Davidson A and Jankovic J. Shoulder pain: a presenting symptom of Parkinson disease. JCR: Journal of Clinical Rheumatology, 2008; 14(4): 253-254.
• 16. Hopkins BCB, Vehrs PR, Fellingham GW, et al. Validity of PostureScreen Mobile® in the measurement of standing posture. Journal Manipulative Physiological Therapeutics. 2014; 42(2):132-140.
• 17. Cosma G, Ilinca I, Rusu L, et al. Physical exercise and its role in a correct postural alignment. Discobolul Physcal Educ Sport Kinetother J, 2015; 11: 58-64.
• 18. Cachupe WJ, Shifflett B, Kahanov L, et al. Reliability of biodex balance system measures. Measurement in physical education and exercise science, 2001; 5(2): 97-108.
• 19. Wilczyński J, Pedrycz A, Mucha D, et al. Body posture, postural stability, and metabolic age in patients with Parkinson’s disease. BioMed research international, 2017; 2017.
• 20. Hayran M. Sağlık araştırmaları için temel istatistik: Omega Araştırma. Ankara 2011, p.403-416.
• 21. Tiple D, Fabbrini G, Colosimo C, et al. Camptocormia in Parkinson disease: an epidemiological and clinical study. Journal of Neurology, Neurosurgery & Psychiatry, 2009; 80(2): 145-148.
• 22. Kashihara K. and Imamura T. Clinical correlates of anterior and lateral flexion of the thoracolumbar spine and dropped head in patients with Parkinson’s disease. Parkinsonism & Related Disorders, 2012; 18(3): 290-293.
• 23. Seki M, Takahashi K, Koto A, et al. Camptocormia in Japanese patients with Parkinson's disease: a multicenter study. Movement Disorders, 2011; 26(14): 2567-2571.
• 24. Oeda T, Umemura A, Tomita S, et al. Clinical factors associated with abnormal postures in Parkinson's disease. PloS one, 2013; 8(9): e73547.
• 25. Kim YE and Jeon BS. Musculoskeletal problems in Parkinson’s disease. Journal of Neural Transmission, 2013; 120(4): 537-542.
• 26. Koh SB, Roh J-H, Kim JH, et al. Ultrasonographic findings of shoulder disorders in patients with Parkinson's disease. Movement Disorders: Official Journal of the Movement Disorder Society, 2008; 23(12): 1772-1776.
• 27. Kærgård H, Larsen TK, Rasmussen PS, et al. Impairment of postural stability following perivascular axillary block with mepivacaine. Acta anaesthesiologica scandinavica, 1984; 28(5): 508-510.
• 28. Lui D, Memon A, Kwan S, et al. Computerized dynamic posturography analysis of balance in individuals with a shoulder stabilization sling. European Journal of Trauma and Emergency Surgery, 2013; 39(6): 635-639.
• 29. Stylianou AP, McVey MA, Lyons KE, et al. Postural sway in patients with mild to moderate Parkinson's disease. International Journal of Neuroscience, 2011; 121(11): 614-621.
• 30. Błaszczyk JW. The use of force-plate posturography in the assessment of postural instability. Gait & Posture, 2016; 44: 1-6.
• 31. Coleman A and Clifft J. The effect of shoulder immobilization on balance in community-dwelling older adults. Journal of Geriatric Physical Therapy, 2010; 33(3): 118-121.
• 32. Souza L, Lemos T, Silva DC, et al. Balance impairments after brachial plexus injury as assessed through clinical and posturographic evaluation. Frontiers In Human Neuroscience, 2016; 9: 715.
• 33. Lee J-H., Effects of forward head posture on static and dynamic balance control. Journal of physical therapy science, 2016; 28(1): 274-277.