Multiple Skleroz Hastalarında Spastik Gastroknemiusa Uygulanan Lokal Vibrasyonun Kasın Mimari ve Fonksiyonel Özelliklerine Etkisi

Abstract

This study was planned to compare the effects of 50 and 100 Hz local vibration applications in addition to an individualized exercise program on spastic gastrocnemius muscle on spasticity severity, architectural and viscoelastic properties of the muscle, proprioception, balance and gait in Multiple Sclerosis patients. Thirty three patients were included in the study and randomly divided into three groups as Exercise+50 Hz LV (Group 1), Exercise+100 Hz LV (Group 2) and Exercise group (Group 3). The patients were treated for 8 weeks, 3 days a week, one hour a day. Local vibration was applied to the right and left medial gastrocnemius for 5 minutes each. The severity of spasticity (Modified Ashworth Scale), the architectural features of the muscle (Ultrasonography), the viscoelastic properties of the muscle (Myotonometer), the ankle position sense (isokinetic dynamometer), the balance (Single Leg Stance Test and Static Posturography), the gait (GaitRite Analysis system), and satisfaction with the patients' expectations and goals (Goal Attainment Scale) were assessed. A patient from each Group 1 and Group 2 and four patients from Group 3 were excluded from the study for different reasons. Therefore, data of 27 patients were included in the analysis. The mean age of the groups was 37.70±9.70, 38.40±11.07, 33.86±6.74 years, respectively. The age, body mass index, disease duration and EDSS results of the patients in the groups were similar (p>0.05). In addition, values of spasticity, muscle architecture and viscoelastic properties, proprioception, balance, walking and the Goal Attainment Scale were similar between the groups before treatment (p>0.05). As a result of the study, the decrease in the severity of spasticity and the increase in the fascicle length and stiffness of the gastrocnemius muscle were found to be statistically significant in the 50 Hz group (p<0.05). Ankle joint position sense, one-leg stance durations, and mediolateral stability limits/postural sway range results were found to be significantly improved in both vibration groups (p<0.05). Anteroposterior balance results were found to be significantly improved in all groups (p<0.05). The 50 Hz group showed significant improvement in all gait parameters, the 100 Hz group in speed, step length and support surface, and the exercise group showed a significant improvement in the percentage of single support and stance phase (p<0.05). Significant improvements were obtained in the post-treatment results of the Goal Attainment Scale in all groups (p<0.05). The results of our study showed that LV application applied in addition to exercise therapy had positive effects on spasticity, muscle architecture, proprioception, balance and gait parameters. In detailed investigations, while 50 Hz LV application provides improvement in all of these parameters, it has been found that 100 Hz application is more effective in proprioception and static balance skills.