Ataksik Multipl Skleroz Hastalarında Spinal Stabilizasyon Eğitimi ile Birlikte Farklı Bölgelere Uygulanan Lokal Vibrasyonun Postüral Kontrol Üzerine Etkilerinin İncelenmesi

Abstract

This study was planned as a single-blind, randomized controlled trial to comparatively investigate the effects of local vibration (LV) applied to the gastrosoleus muscle complex and cervical-lumbar paraspinal muscles on postural control in addition to spinal stabilization training in ataxic Multiple Sclerosis patients. The 36 patients included in the study were randomly assigned to three groups: Gastrosoleus LV, Paraspinal LV and Exercise Group. Each group was treated 3 days a week for 8 weeks and one treatment session lasted 60 minutes. The exercise group received spinal stabilization training. In the gastrosoleus LV group, LV was applied to the right and left gastrosoleus muscle complex for 5 min each in addition to spinal stabilization training. In the paraspinal LV group, LV was applied to the cervical paraspinal muscles for 5 min and to the lumbar paraspinal muscles for 5 min in addition to spinal stabilization training. LV was applied with a frequency of 80 Hz and an amplitude of 1 mm in both groups. The trunk control, the severity of ataxia, the performance-based balance, the core endurance, limits of stability and postural sways and temporo-spatial parameters of gait were assessed. Two patients from each group were excluded for different reasons and 30 patients completed the study. Body mass index, disease duration, date of last attack and clinical types of the patients in the groups were similar (p>0.05). Age and EDSS scores of the Paraspinal LV group were lower than the Exercise group (p<0.05). As a result of the study, trunk control, severity of ataxia performance-based balance and core endurance parameters improved in all groups (p<0.05). It was observed that all groups improved the limits of stability in different directions. The Gastrosoleus LV group improved composite reaction time, movement velocity, endpoint excursion, and maximum excursion parameters; the Paraspinal LV group improved composite end point excursion and maximum excursion parameters; the Exercise group improved composite movement velocity, direction control, endpoint excursion, and maximum excursion parameters (p<0.05). LV groups were effective in improving gait variability, and the Exercise group was effective in improving gait velocity and stance phase (p<0.05). The results of our study showed that spinal stabilization training and LV in addition to spinal stabilization training had positive effects on postural control. In detailed investigations, it was found that LV applied to the gastrosoleus muscle complex was more effective in dynamic balance and gait parameters, while LV applied to the paraspinal muscles was more effective in static balance, coordination, and endurance parameters.