Ataksik Multipl Skleroz Hastalarında Farklı Egzersiz Yaklaşımlarının Etkilerinin Karşılaştırılması

Abstract

The aim of this study was to investigate the effect of spinal stabilization exercise and task-oriented therapy that combined with conventional therapy approaches on postural control, coordination and gait in ataxic multiple sclerosis patient. 17 male, 25 female and totally 42 MS patient that have EDSS score between 3-5 was enrolled in this randomized controlled study. The patients were divided into 3 groups as control, spinal stabilization and task oriented group by simple randomized design. Patients in the control group received conventional physiotherapy approaches consisting of balance and coordination exercise and sensory training. Spinal stabilization group received lumbal stabilization exercise while task oriented group received task-oriented exercise in addition to conventional approaches. After obtaining demographic information, assessments were performed before treatment and at the end of the 18 seasons treatment program. According to the demographic data mean age was 35, 36±8.14 year in control group, 37,29±9, 75 year in spinal stabilization group, 34,36±7,90 year in task oriented group. Assessments consisted of Berg Balance Scale (BBS), International Cooperative Ataxia Rating Scale (ICARS), MS Trunk Impairment Scale, Functional Reach Test (FRT), 2 Minute Walk Test (2MWT), 12 item Multiple Sclerosis Walking Scale (MSWS-12), Computerized Dynamic Posturagraphy (CDP), Somatosensory Evoked Potentials (SEP). When before and after treatment values were compared within the groups BBS, ICARS, FRT, the CDP-composite score, 2MWT and MSWS-12 was developed statistically in three group (p <0.05) while the sub-assessment of ICARS kinetic functions did not change in control group after treatment (p>0,05). According to the SEP assessment results, significance was found in only spinal stabilization group in left limb cortical onset amplitude (p<0,05). When we compared the groups, ICARS total score, ICARSKF, CDP composite score, 2MWT was different between spinal stabilization group and control group and also right reaction time according to the limits of stability test of CDP was different between spinal stabilization group and task-oriented group in favour of spinal stabilization group (p<0,05). The groups were similar according to the other assessments (p<0,05). As a result, spinal stabilization exercises were found more effective in balance, coordination and sensation problems that cause ataxia compared to conventional physiotherapy approaches. However we could not find any advantage of task-oriented therapy according to the conventional approaches. In conclusion we agreed that spinal stabilization exercise that takes part in the rehabilitation program has beneficial effect on balance, coordination, walking distance and sensation.