?nmeli hastalarda denge e?itiminin n?rolojik rehabilitasyonda etkisinin de?erlendirilmesi

Ama? ve Hipotez: ?nme sonras? denge bozukluklar? kas g?c?nde azalma ve etkilenen bacaktan gelen duyusal bilgilerin azalmas?na ba?l?d?r. Hemiplejik hastalarda stabil ayakta durma pozisyonunun iyile?mesi rehabilitasyon s?recinde kritik bir basamakt?r. ?nme sonras? n?rofizyolojik, motor ??renme ve ortopedik prensipleri hedef alan ?e?itli terap?tik yakla??mlar vard?r. Bunlar?n hi?birisi dengeyi ?zel olarak hedef almaz ve post?ral kontrol?n iyile?mesinde bu yakla??mlardan hangisinin daha etkili oldu?una dair kan?t yoktur. Bu sebeple inmeli hastalarda dengeyi art?r?c? ?dev y?nelimli egzersiz e?itimi ve kullan?c?ya g?rsel girdi sa?layarak v?cudun a??rl?k merkezinin denge s?n?rlar? i?erisinde tutulmas?n? sa?layan, denge e?itimi veren ve denge de?erlendirmesinin yap?labildi?i bir cihaz olan denge e?itim cihaz? ile tedavi gibi yeni terap?tik yakla??mlar geli?tirilmi?tir. Bu ?al??man?n amac? inmeli hastalarda konvansiyonel inme rehabilitasyonuna ek olarak dengeye ?zel egzersiz e?itiminin veya Sport Kat Kinestethic Ability Trainer ile verilen e?itimin dengenin klinik ve laboratuar ?l??mleri ile lokomotor performans ve g?nl?k ya?am aktivitesi ?zerine etkilerini de?erlendirmektir. Ayr?ca ?al??mada dengenin klinik ve laboratuar ?l??mleri aras?ndaki korelasyonun da de?erlendirilmesi hedeflenmi?tir. Materyal Metod: ?al??mada Dokuz Eyl?l ?niversitesi Fiziksel T?p ve Rehabilitasyon Anabilim Dal? Hemipleji Poliklini?i'ne ba?vuran serebrovask?ler olaya ba?l? hemiplejisi olan 30 hasta ?al??maya dahil edildi. Serebrovask?ler olay ?zerinden en az 6 ay ge?mi? olan hastalar Brunnstrom'a g?re motor iyile?me d?zeyi, Modifiye Ashworth skalas?na g?re spastisite, hafif dokunma duyusu ve eklem pozisyon duyusu, serebellar bulgu varl???, y?ld?z silme testi ile ihmal fenomeni, Fonksiyonel Ambulasyon Skalas? (FAS) ile ambulasyon yetene?i ve Fonksiyonel Ba??ms?zl?k ?l??t? (FB?) ile g?nl?k ya?am aktivitesi a??s?ndan de?erlendirildi. Dengeleri klinik olarak Berg Denge ?l?e?i (BD?) ile, laboratuar olarak SportKat cihaz?yla balans indeks (B?) hesaplanarak de?erlendirildi. De?erlendirme sonras?nda hastalar ?? gruba randomize edildi. Her grup i?in rehabilitasyon program? sekiz hafta s?reyle, haftada iki kez olacak ?ekilde d?zenlendi. ?lk gruba (Grup 1) konvansiyonel egzersiz program?na ek olarak SportKat Kinestethic Ability Trainer cihaz?yla her seansta 15 dakika statik denge e?itimi verildi. ?kinci gruba (Grup 2) sadece konvansiyonel egzersiz program? verildi. ???nc? gruba (Grup 3) konvansiyonel egzersiz program?na ek olarak dengeye ?zel egzersizler i?eren ?dev y?nelimli program uyguland?. Hastalar sekiz hafta sonunda ayn? ?ekilde tekrar de?erlendirildi. Bulgular: ?al??mam?zda sekiz haftal?k rehabilitasyon periyodundan sonra her ?? grubun da kendi i?lerinde BD? de?erleri anlaml? olarak d?zelmi?tir. Ek olarak SportKat ile tedavi olan grupta B?'de de anlaml? d?zelme oldu?u, dengeye ?zel egzersizlerle tedavi olan gruptaysa BD? yan?nda FB? ve B?'de anlaml? d?zelme oldu?u g?zlenmi?tir. ?? grup birlikte de?erlendirildi?inde tedavi sonras?nda grup 1'in B? ve FAS'taki d?zelmesi grup 2'ye g?re anlaml? olarak fazlayd? ve grup 1 ve grup 3, grup 2'ye g?re BD? de?erinde de belirgin d?zelme g?stermi?tir. Tedavi ?ncesine g?re BD? ve FAS de?erlerinde olu?an de?i?imlerin fark?na bak?ld???nda ise ?? grubun birbirine ?st?nl?kleri olmad??? g?zlenmi?tir. Dolay?s?yla konvansiyonel inme rehabilitasyonun dengenin klinik ?l??m?nde anlaml? d?zelmeye yol a?t???, SportKat ile denge e?itiminin ve ?dev y?nelimli rehabilitasyonun denge ve GYA'y? g?steren parametrelerde birbirlerine istatistiksel olarak anlaml? ?st?nl?kleri olmadan d?zelme g?sterdikleri g?zlenmi?tir. Klinik olarak dengeyi de?erlendiren BD?, ambulasyonu skalas? FAS ve GYA'y? derecelendiren FB?'n?n objektif denge ?l??t? olan B? de?eriyle anlaml? bir korelasyon g?stermedi?i saptand?. Alt ekstremite Brunnstrom evresi y?ksek olan hastalar?n daha iyi dengesi oldu?u g?zlendi. Sonu?: Sonu?ta konvansiyonel egzersizler ve buna ek olarak uygulanan ?dev y?nelimli denge egzersizleri veya SportKat ile verilen denge e?itimi ba??ms?z ambule olabilen kronik inmeli hastalarda denge rehabilitasyonunda katk? sa?lar, son iki yakla??m hastalar?n hem dengelerine hem de GYA'lar?na ek katk?da bulunur. Anahtar S?zc?kler: ?nme, denge, ?dev y?nelimli denge egzersizi, denge e?itim cihaz? Purpose And Hypothesis: Loss of balance after hemiplegia links with decreasing of proprioception and muscle strength. In a rehabilitation program, providing stable standing is an important step. Although there are variable theurapeutic managements which target neurophysiology, orthopedic principles and motor learning?? none of them is specific for balance and there is no evidence about which one is more effective for improving balance and postural control. For this reason, new theurapeutic evaluations developed for balance training like task spesific balance exercises and balance training devices which give feedback to patients to hold center of gravity in limit of balance. Aim of this study is to evaluate effects of task specific balance exercise education or balance education with Sport Kat Kinestethic Ability Trainer, according to clinical and laboratory measurements for locomotor performance and daily life acitivities when added to traditional rehabilitation program in stoke patients. Also, we aimed to evaluate correlation of clinic and laboratory balace measurements. Material And Methods: 30 stroke patients from hemiplegia policlinic of Physical Medicine and Rehabilitation are included in this randomised controlled study. At least six months after stroke asked for inclusion. All patients evaluated with Brunnstrom stages of motor recovery, spasticity with modified Ashworth scale, sense of touch, sense of joint position, cerebellar findings, neglect phenomen with star erasing test, ambulation with Functional Ambulation Scale (FAS) and daily life activities with Functional Independence Measurement (FIM). Their balance was assessed clinically with Berg Balance Scale (BBS) and for laboratory measurements of balance Sport Kat was used by calculating balance index (B?). All patients randomised into three groups after evaluation. All groups underwent rehabilitation program for eight weeks, two times in a week. First group was exercised 15 minutes with SportKat Kinestethic Ability Trainer in addition to traditional program. The patients in second group were exercised only with traditional program. Third group was exercised with task specific balance exercise in addition to traditional program. Patients were evaluated at the end of eight week. Results: In this study there was significiant improvement in BBS in all treatment groups after rehabilitation period of eight weeks. In addition to improvement in BBS, BI was significiantly reduced in Sport Kat group and FAS and BI was significantly better in group with balance specific exercises. When groups are compared together after treatment, FAS and BI values were significiantly better in group 1 from group 2, and group 1 and 3 were significantly better from group 2 according to BBS. But, when the difference in FAS and BBS compared with initial values before treatment, there were no predominance between groups. BBS for clinical evaluation of balance, FAS for ambulation, FIM for daily activities were not correlated significantly with BI which is an objective balance measurementI. We have found that, patients with better Brunnstrom motor recovery score in lower extremity had better balance. Conclusion: We observed that conventional stroke rehabilitation provides improvement in clinical parameters of balance. Sport Kat and task spesific balance exercise program were better in balance and in daily life activity parameters but there was no statistically significiant difference between each other. Key words: Stroke, balance, task spesific balance exercise, kinaesthetic ability training device