مقایسه روش‌های تحریک الکتریکی و درمان آینه‌ای با توانبخشی رایج و نیز ترکیب آنها در بازتوانی حرکتی اندام فوقانی بیماران سکته‌ی مغزی: مطالعه فراتحلیل

نوع مقاله: مقاله مروری

نویسندگان

1 دانشجوی دکتری، دانشکده مهندسی پزشکی، دانشگاه صنعتی امیرکبیر، تهران، ایران

2 استادیار، دانشکده مهندسی پزشکی، دانشگاه صنعتی امیرکبیر، تهران، ایران

چکیده

مقدمه و اهداف
شایع‌­ترین اختلالات عملکردی در بیماران سکته‌ی‌‌ ‌مغزی، عدم توانایی در دست‌رسانی، گرفتن و مهارت کار با دست است که مشکلات بسیاری را برای انجام فعالیت‌های روزمره توسط این بیماران به همراه دارد. علی‌رغم تکنیک‌های متعدد در توانبخشی، میزان و سرعت بازتوانی عملکردهای حرکتی اندام فوقانی ضعیف می‌باشد؛ از این ‌رو استراتژی‌های درمانی جدیدی حاصل از ترکیب روش‌های درمانی مختلف پیشنهاد شده‌اند. با این فرض که بهبود بیشتری در اتصالات مجدد مدارات مغزی به واسطه به‌کارگیری هر دو جنبه شناختی و فیزیکی در توانبخشی حاصل می‌شود، در بازتوانی حرکتی اندام مبتلا، ترکیب روش درمان آینه‌ای و تحریک الکتریکی می‌تواند نسبت به مداخله هر یک به ‌طور مجزا تأثیرگذارتر باشد. در مطالعه حاضر به مقایسه اثربخشی هر یک از دو روش تحریک الکتریکی و درمان آینه‌ای به ‌طور مجزا با روش توانبخشی رایج و روش ترکیبی به صورت قبل و بعد از مداخله درمانی پرداخته‌ شد.
مواد و روش‌ها
مطالعه مروری و فراتحلیل حاضر بر روی سه روش درمان آینه‌ای، تحریک الکتریکی و روش ترکیبی آنها از پایگاه‌های PEDro، PubmedوRehabdata انجام گرفته است. بررسی فراتحلیل مبتنی بر مدل اثر تصادفی انجام گرفته و اندازه اثر نیز مبتنی بر اختلاف میانگین استانداردشده به ‌دست آمده است. نوع بیماری در فاز حاد و مزمن، نوع تحریک اکتیو و پسیو و نیز نوع پروتکل تمرینی در حرکات هماهنگ دوطرفه و دیگر حرکات تمرینی به عنوان عواملی تأثیرگذار مقایسه شده‌اند.
یافته‌ها
در مطالعه حاضر تعداد 35 مقاله شامل 903 بیمار سکته‌ی مغزی، بررسی شده‌اند. در مقایسه اثربخشی دو روش درمان آینه‌ای و تحریک الکتریکی با روش توانبخشی رایج، تفاوت معنا‌داری نتیجه شده است. همچنین وجود تفاوت معنا‌دار در اثربخشی روش ترکیبی قبل و بلافاصله بعد از درمان نیز تأیید شده است. از طرفی دیگر، وجود تفاوت معنا‌دار در مدت زمان بین شروع سکته تا مداخله درمانی برای روش تحریک الکتریکی تأیید شده است. نوع تحریک اکتیو و پسیو و نیز حرکات تمرینی با دو دست یا حرکات هماهنگ دوطرفه در مقایسه با دیگر حرکات تمرینی، به ترتیب وجود تفاوت معنا‌دار را در اثربخشی روش‌های تحریک الکتریکی و درمان آینه‌ای تأیید نکرده‌اند.
نتیجه‌ گیری
فرضیه بهبود سازماندهی مجدد مغز برای بیماران سکته‌ی مغزی، با به‌کارگیری هم­زمان هر دو جنبه شناختی و عملکردهای فیزیکی تأیید شده است. روش‌های تحریک الکتریکی و درمان آینه‌ای در مدت زمان اولیه از شروع سکته می‌توانند تأثیرگذارتر باشند. می‌توان وجود عواملی دیگر نظیر شدت تحریک، مدت زمان تحریک، فرکانس تحریک یا حتی پروتکل مربوط به اکتیو نمودن تحریک را در عدم تأیید اثربخشی بیشتر روش تحریک اکتیو نسبت به تحریک پسیو مؤثر دانست. از طرفی دیگر، به واسطه تعداد مقالات بیشتر، قابلیت اطمینان از نتایج مطالعات فراتحلیل افزایش می‌یابد.

کلیدواژه‌ها


عنوان مقاله [English]

Comparison of Electrical Stimulation and Mirror Therapy and Conventional Rehabilitation and Combining them for Rehabilitation of Upper Extremity in Stroke Patients: A Meta-Analysis

نویسندگان [English]

  • Mahdie Khalighfard 1
  • Farnaz Ghassemi 2
1 PhD Student, Department. of Bioelectrical Engineering, Amirkabir University, Tehran, Iran
2 Assistant Professor, Department of Bioelectrical Engineering, Amirkabir University, Tehran, Iran
چکیده [English]

Background and Aim: The most common functional disorders in stroke patients are disabilities in reaching and manipulation tasks which are associated with many problems for doing daily activities. Despite multiple techniques in rehabilitation, the amount and rate of recovery of upper extremity motor functions are weak, so new strategies have been suggested for combining different therapy methods. With the assumption that further improvement achieved through the use of both cognitive and physical aspects in the reorganization of neural circuits in the brain, in the rehabilitation of affected limb, the combination of mirror therapy and electrical stimulation can be more effective than using each of these methods separately. In the present study, we compared electrical stimulation and mirror therapy and conventional therapy and combination therapy in a pre-test/post-test study.
Materials and Methods: A systematic review with meta-analysis was performed on mirror therapy, electrical stimulation, and their combination from Pedro, Pubmed, and Rehabdata databases. A meta-analysis was performed based on random effect and effect size was obtained with the standard mean difference. The acute or sub-acute and chronic stroke, active/passive stimulation, and also protocol of training exercises in coordinated bilateral movement and other exercises are considered as affecting factors.
Results: In the present study, 35 articles with 903 stroke patients were studied. A significant difference was observed in comparing the efficacy of the two methods of mirror therapy and electrical stimulation and a conventional therapy. Also, a significant difference was confirmed between efficacies of pre-test/post-test in conventional therapy. Therewith, the existence of significant difference was confirmed between treatments of the early and late duration of the stroke. The type of active and passive stimulation, as well as bimanual or bilateral exercise movements in comparison with other exercise movements did not reveal a significant difference between the efficacy of electrical stimulation and mirror therapy, respectively.  
Conclusion: The hypothesis of improving brain reorganization for stroke patients is confirmed by simultaneously applying both cognitive aspects and physical functions. Electrical stimulation and mirror therapy can be more effective during the period early after the stroke. It can be concluded that other factors such as intensity of stimulation, duration, and frequency of excitation or even the active stimulation can be resulted in the lack of confirmation of the efficacy of the active stimulation method versus the passive stimulation. The reliability of the results in the meta-analysis could be increased if more articles are used.

کلیدواژه‌ها [English]

  • Electrical Stimulation
  • Mirror Therapy
  • Motor Rehabilitation
  • Upper Extremity
  • Meta-Analysis
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