İnme Hastalarında Bobath Yöntemi ve Görev Odaklı Yaklaşım’ın Gövde Kaslarının Mimari Özellikleri ve Aktivasyonları ile Fonksiyonel Performans Üzerine Etkilerinin İncelenmesi

Abstract

Sütçü G., Investigation of the Effects of Bobath Method and Task-Oriented Approach on Architectural Features and Activations of Trunk Muscles and Functional Performance in Stroke Patients, Hacettepe University Graduate School Health Sciences Physical Therapy and Rehabilitation Program Doctor of Philosophy Thesis, Ankara, 2023. This study was planned to examine and compare the effects of the Bobath Method and Task-Oriented Approach (TOA) on the architectural features and activation of trunk muscles and functional performance in stroke patients. The 36 patients included in the study were randomly divided into two groups, the Bobath and the TOA. The patients were treated for 8 weeks, 3 days a week, 1 hour a day. Trunk function with Trunk Impairment Scale, motor performance with Stroke Rehabilitation Assessment of Movement Scale, level of goal attainment with Goal Attainment Scale, trunk muscle thicknesses with ultrasonography and muscle activations with surface electromyography, balance with static posturography and gait with GaitRite Gait Analysis System were evaluated. The study was completed with 34 patients. The mean age of the Bobath and the TOA groups were 55.76±17.23 and 48.88±12.43. The descriptive data, duration of disease, and values of all measurements before treatment were similar between the groups (p>0.05). After the treatment, trunk functions, motor performance and level of goal attainment improved statistically in both groups (p<0.05). Paretic and non-paretic rectus abdominis thickness increased only in the Bobath group, and the increase in muscle thickness provided superiority to the TOA group (p<0.05). In both groups, limits of stability increased in anteroposterior (AP) and mediolateral (ML) directions (p<0.05). Postural sway was decreased in the AP direction during the normal surface eyes open (NSEO), perturbed surface eyes open (PSEO) and closed (PSEC) balance tests in the Bobath group, and in the AP and ML direction during the PSEC test in the TOA group (p<0.05). Gait velocity increased in both groups (p<0.05). An increase in the paretic step length and a decrease in the double support period in the Bobath group, and an increase in the paretic and non-paretic step length, a decrease in the double support period and an increase in the Functional Ambulation Profile score were found in the TOA group (p<0.05). In the Bobath group, a decrease in the activation of the paretic latissimus dorsi was found only during the NSEO test (p<0.05). In the TOA group, there was a decrease in the activation of non-paretic rectus abdominis during all balance tests and a decrease in the activation of paretic latissimus dorsi during limits of stability, NSEO and gait tests (p<0.05). A correlation was not found between muscle thickness and activation (p>0.05). The results of our study show that the Bobath Method provides better improvements than the TOA in increasing the rectus abdominis thickness, and both methods have positive effects on trunk function, motor performance, goal attainment, balance, gait, and trunk muscle activation in stroke patients.