Ataksili Hastalarda Tüm Vücut Vibrasyonun Postüral Kontrol Üzerine Etkileri

This study was planned to evaluate the effects of an individual exercise programs supported by WBV on postural control components, ‘Biomechanical constraints’, ‘Movement strategies’, ‘Control of dynamics’, ‘Cognitive processing’, ‘Sensory strategies’, ‘Orientation in space’ and on the level of satisfaction with how well patients' expectations and goals. 20 cerebellar ataxic individuals whose mean age was 34.00 ± 9.15 were included in the study. In the study designed as cross-over, cases were separated into 2 groups and treated for 3 days in a week, 1 hour in each day for a total of 16 weeks (8 weeks × 2). In the first protocol, the whole body vibration and exercise program were applied together for 8 weeks and after the 1-week wash-out period, only the exercise program was applied for 8 weeks. In the second protocol, only the exercise program was applied for the first 8 weeks and after the 1-week wash-out period, the whole body vibration and the exercise program were applied together for 8 weeks. Stabilization, balance and functional exercises, which were created by considering the individual needs of the patients, were applied in the exercise program. The assessments were administered by a blind physiotherapist for four times, before and after both treatment programs. After recording demographic informations, pain and fatigue severity (Visual Analogue Scale 0-10) of individuals, postural control components were assessed by Computerized Dynamic Posturography, Sensory Organization Test (SOT), Adaptation Test (ADT), and Stability Limits Test (SLT). Also in the study disease severity (International Classification Ataxia Ratio Scale), trunk control (Trunk Impairment Scale), functional mobility skills (Timed Up and Go Test), stability limits (Functional Reach Test), walking performance (10-meter Walking Test), performance-based balance (Berg Balance Scale), daily living activities (Barthel Index), quality of life (Nottingham Health Profile), satisfaction with the patients' expectations and goals (Goal Attainment Scale) were assessed. Stability limits, adaptive reactions, three different versions of functional mobility skills, walking performance, pain and fatigue severity, and quality of life were improved only after exercise program with WBV (p<0,05). Disease severity, combined balance score of sensory organization test, trunk control, performance based balance, level of attainment of treatment goal and participation in daily life activities were improved after both exercise programs (p<0,05) but it was found that after exercise program with WBV, more improvement was observed (p <0.05). As a result; exercise programs supported by WBV has been shown to play an important role in the improvement of postural control of cerebellar ataxic patients and increasing levels of activity and participation.ONAY SAYFASI iii YAYIMLAMA VE FİKRİ MÜLKİYET HAKLARI BEYANI iv ETİK BEYAN v TEŞEKKÜR vi ÖZET vii ABSTRACT viii İÇİNDEKİLER ix SİMGELER ve KISALTAMALAR xii ŞEKİLLER xiii TABLOLAR xiv 1. GİRİŞ 1 2. GENEL BİLGİLER 3 2.1. Ataksi 3 2.1.1. Tanım 3 2.1.2. Etyolojik Sınıflandırma 3 2.2. Ataksi Tipleri 5 2.2.1. Duyusal Ataksi 5 2.2.2. Vestibüler Ataksi 5 2.2.3. Frontal Ataksi 6 2.2.4. Serebellar Ataksi 6 2.3. Atakside İşlevsellik, Yetiyitimi ve Sağlığın Uluslararası Sınıflandırılması (International Classification of Functioning, Disability and Health- ICF) 7 2.3.1. Serebellar Atakside Vücut İşlev ve Yapı Bozuklukları 7 2.3.2. Serebellar Atakside Aktivite ve Katılım Limitasyonları 12 2.4. Postüral Kontrol 16 2.5. Serebellar Atakside Fizyoterapi ve Rehabilitasyon 20 2.5.1. Serebellar Atakside Değerlendirme 20 2.5.2. Vücut İşlev ve Yapı Bozukluklarının Değerlendirilmesi 21 2.5.3. Aktivite ve Katılım Limitasyonlarının Değerlendirilmesi 25 2.5.4. Serebellar Atakside Fizyoterapi Yaklaşımları 26 2.6. Tüm Vücut Vibrasyonu (TVV) 40 2.6.1. TVV ve Kas Aktivasyonu ilişkisi 41 2.6.2. TVV ve Periferal Vaskülarizasyon 44 2.6.3. TVV ve Endokrin Sistem 45 2.6.4. TVV ve Kemik Formasyonu 46 2.6.5. TVV ve Propriosepsiyon (Duyusal sistem) 47 2.6.6. TVV Uygulamalarında Kontraendike Durumlar 48 2.6.7. Rehabilitasyon Yaklaşımlarında TVV 49 3. BİREYLER VE YÖNTEM 51 3.1. Bireyler 51 3.2. Yöntem 51 3.3. Değerlendirmeler 53 3.3.1. Demografik Bilgiler ve Hikaye 53 3.3.2. Vücut Yapı ve İ ş lev Bozukluklarının Değ erlendirilmesi 53 3.3.3. Aktivite Kısıtlılıklarının Değ erlendirilmesi 54 3.3.4. Katılımın Değ erlendirmesi 62 3.4. Tedavi 63 3.4.1. Tüm Vücut Vibrasyonu 64 3.4.2. Egzersiz Programı 64 3.5. İstatistiksel Analiz 65 4. BULGULAR 66 4.1. Tanımlayıcı Bulgular 66 4.2. Düşme ile İlgili Bulgular 67 4.3. Ağrı ve Yorgunluk ile İlgili Bulgular 67 4.4. Hastalık Şiddeti ile İlgili Bulgular 68 4.5. Gövde Kontrolü ile İlgili Bulgular 69 4.6. Performans Temelli Denge ile İlgili Bulgular 71 4.7. Stabilite Limitleri ile İlgili Bulgular 72 4.8. Yürüme Performansı ile İlgili Bulgular 72 4.9. Fonksiyonel Mobilite Becerileri ile İlgili Bulgular 73 4.10. Postüral Kontrol ile İlgili Bulgular 74 4.10.1. Duyu Organizasyon Testi Bulguları 74 4.10.2. Adaptasyon Testi Bulguları 78 4.10.3. Stabilite Limitleri Testi Bulguları 80 4.11. Tedavi Amacına Uaşma Düzeyi ile İlgili Bulgular 90 4.12. Günlük Yaşam Aktiviteleri ile İlgili Bulgular 92 4.13. Yaşam Kalitesi ile İlgili Bulgular 93 5. TARTIŞMA 94 6. SONUÇLAR 106 7. KAYNAKLAR 109 8. EKLER EK 1. Etik Kurul Onayı 9. ÖZGEÇMİŞBu çalışma TVV uygulaması ile desteklenen bireysel egzersiz programının postüral kontrolün bileşenleri olan ‘duyusal stratejiler’, ‘hareket stratejileri’, ‘biyomekaniksel yeterlilik’, ‘uzaysal oryantasyon’, ‘dinamiklerin kontrolü’ ve ‘kognitif süreçler’ ile hastaların beklenti ve hedeflerine ne kadar ulaşıldığı ile ilgili memnuniyet düzeyi üzerine etkilerini değerlendirmek amacıyla planlandı. Çalışmaya yaş ortalaması 34,00±9,15 olan 20 serebellar ataksili birey dahil edildi. Çapraz geçişli dizayn edilen çalışmada 2 gruba ayrılan olgular haftada 3 gün, günde 1 saat toplam 16 hafta (8 hafta × 2) süre ile tedaviye alındı. Birinci protokolde ilk 8 hafta tüm vücut vibrasyonu ve egzersiz programı birlikte uygulandı ve 1 haftalık arınma döneminden sonra 8 hafta sadece egzersiz programı uygulandı. İkinci protokolde ise ilk 8 hafta sadece egzersiz programı uygulandı ve 1 haftalık arınma döneminden sonra 8 hafta tüm vücut vibrasyonu ve egzersiz programı birlikte uygulandı. Egzersiz programında hastaların bireysel ihtiyaçları dikkate alınarak oluşturulan gövde stabilizasyonu, denge ve fonksiyonel egzersizler uygulandı. Değerlendirmeler, çalışmaya kör bir fizyoterapist tarafından her iki tedavi programından önce ve sonra olmak üzere toplam dört kez uygulandı. Bireylerin demografik bilgileri, ağrı ve yorgunluk şiddetleri (Görsel Analog Skalası 0-10) kaydedildikten sonra, postüral kontrolün bileşenleri Bilgisayarlı Dinamik Postürografi’nin Duyu Organizasyon testi (DOT), Adaptasyon Testi (ADT), Stabilite Limitleri Testi (SLT) ile değerlendirildi. Çalışmada ayrıca hastalık şiddeti (Uluslararası Ataksi Oranlama Ölçeği), gövde kontrolü (Gövde Bozukluk Ölçeği), fonksiyonel mobilite becerileri (Süreli Kalk ve Yürü Testi), stabilite limitleri (Fonksiyonel Uzanma Testi), yürüme performansı (10 metre Yürüme Testi), performans temelli denge (Berg Denge Ölçeği), günlük yaşam aktiviteleri (Barthel İndeksi), yaş am kalitesi (Nottingham Sağlık Profili), hastaların beklenti ve hedeflerine ne kadar ulaşıldığı ile ilgili memnuniyet düzeyi (Amaca Ulaşma Ölçeği) de değerlendirildi. Çalışmanın sonucunda, stabilite limitleri, adaptif reaksiyonlar, fonksiyonel mobilite becerilerinin üç farklı versiyonu, yürüme performansı, ağrı ve yorgunluk şiddeti ve yaşam kalitesinin sadece TVV ile birlikte uygulanan egzersiz programı sonrası geliştiği gözlendi (p<0,05). Her iki egzersiz programı sonrası hastalık şiddeti, duyu organizasyonunun birleşik denge puanı, gövde kontrolü, performans temelli denge, tedavi amacına ulaşma düzeyi ve günlük yaşam aktivitelerine katılımın geliştiği (p<0,05), ancak TVV ile birlikte egzersiz programı sonrası daha fazla geliştiği saptandı (p<0,05). Sonuç olarak; egzersiz programlarının TVV ile desteklenmesinin, serebellar ataksili hastaların postüral kontrolünün geliştirilmesi, aktivite ve katılım düzeylerinin artırılması açısından önemli bir rol oynayacağı gösterilmiştir

The Turkish Version Of The Physical Activity Scale For The Elderly (Pase): Its Cultural Adaptation, Validation, And Reliability

Background/aim: This study aimed to describe the cultural adaptation of the Turkish Physical Activity Scale for the Elderly (PASE) and to examine the reliability and validity of the scale in older Turkish adults. Materials and methods: Eighty elderly people were recruited for the study. The assessments included the PASE, the International Physical Activity Questionnaire (IPAQ), the Short Physical Performance Battery and Short Form-36 Quality of Life Questionnaire (SF-36), and the Mini Mental State Test. Outcome measures were conducted twice within a week (test-retest) for reliability. Results: Cronbach's a coefficient was 0.714 for the initial evaluation. The intraclass correlation coefficient for the test-retest reliability was 0.995 with a 95% confidence interval of 0.993-0.997. A high level of positive correlation (0.742, P < 0.001) was found between the total score of PASE and the total scores of IPAQ. There were strong positive correlations between the PASE and the total score of SPPB (0.622, P < 0.001), while an average level of positive correlation with SF-36 was found (0.432, P < 0.001). Conclusion: The results of the study suggest that the Turkish version of the PASE has powerful measurement qualities, which makes it a reliable and valid scale for the fields of research and practice.WoSScopu

Objective And Subjective Assessment Of Physical Activity In Adults With Muscle Diseases

Objective: The aim of this study was to investigate the physical activity of adults with muscle diseases relative to healthy controls. Materials and Methods: Individuals participated in this cross-sectional study by completing the International Physical Activity Questionnaire-Long Form and using SenseWear Armband Activity Monitor over a 5-day period to assess physical activity levels subjectively and objectively. Results: Forty healthy controls (16 males, 24 females) (aged 30.40 +/- 4.55 years) and 40 adults with muscle diseases (21 males, 19 females) (aged 32.67 +/- 6.57 years) participated in this study. We found that SenseWear Armband (step counts, duration of moderate and vigorous physical activity) and International Physical Activity Questionnaire (walking physical activity, vigorous physical activity, working physical activity, and total physical activity) parameters were significantly lower in the adults with muscle disease group than the healthy controls (p0.05). Conclusion: Adults with muscle diseases expend the same amount of energy as healthy controls, but over fewer steps. This difference between energy expenditure and number of steps could be due to the higher energy requirements for walking in adults with muscle diseases. These findings will help healthcare professionals plan treatment strategies for adults with muscle diseases.WoSScopu

Effect of taping on scapular kinematics of patients with facioscapulohumeral muscular dystrophy

WOS: 000475706000007PubMed: 30968229The aim of this study is to investigate the effects of scapular taping on scapular kinematics by three-dimensional electromagnetic system during shoulder elevation in facioscapulohumeral muscular dystrophy patients. A total of 11 patients with facioscapulohumeral muscular dystrophy were included in the study. Scapular anterior-posterior tilt, upward-downward rotation, and internal-external rotations were evaluated using the three-dimensional electromagnetic system during the elevation of the upper limbs in the scapular plane before and after kinesio taping. For maximum humerothoracic elevation, there were no differences between the patients before and after taping on both dominant (p=0.72) and non-dominant sides (p=0.64). For scapular internal rotation, upward rotation, and posterior tilt, there were no differences between patients before and after taping during humerothoracic elevation on both dominant and non-dominant sides (p>0.05). These results showed us that the excessive and abnormal movements of the scapula observed during the humeral elevation in facioscapulohumeral muscular dystrophy patients cannot be supported with flexible methods like kinesio taping. Therefore, we recommend to evaluate the scapula position by applying flexible and rigid taping to the patients who can reach over 90(o) in humerothoracic elevation in future studies

Effect of taping on scapular kinematics of patients with facioscapulohumeral muscular dystrophy (vol 40, pg 1583, 2019)

WOS: 000475706000008

The effect of two different aerobic training modalities in a child with spinal muscular atrophy type II

This study examined the effect of two different aerobic training modalities in a boy with spinal muscular atrophy type II. Motor functions were measured with Hammersmith Functional Motor Scale (HFMS) and Gross Motor Function Measure (GMFM). Spirometry was utilized for assessing pulmonary functions and PedsQL 3.0 Neuromuscular module was utilized for quality of life of child. Ergometer training was applied 3 times per week for the duration of 12 weeks. After 6 weeks of wash-out period, aquatherapy was applied for twice a week for the duration of 12 weeks. HFMS and GMFM scores, and pulmonary functions of the child and quality of life scores of his parents were improved during both modalities. These improvements were largely maintained during 1-year follow-up. This study showed that both modalities had similar effects on our case’s pulmonary, motor functions and quality life of himself and parents. It will be a guide for researchers working in the area of children with neuromuscular disorders regarding plan and diversification of therapy program.PubMedWoSScopu