Uticaj strukturisanog tretmana na parametre hoda u rehabilitaciji obolelih od Parkinsonove bolesti

Abstract

Cilj: Glavni rehabilitacioni cilj u tretmanu bolesnika sa Parkinsonovom bolešću je da se unapredi, očuva i uspori propadanje funkcije hoda, održavanje bezbednog hoda za vreme različitih motornih i kognitivnih zadataka. Cilj ovog istraživanja je bio da ispita da li individualizovani strukturisani rehabilitacioni postupak, usmeren na različite patofiziološke mehanizme u osnovi poremećaja hoda obolelih od Parkinsonove bolesti, nezavisno poboljšava parametre hoda u poređenju sa optimalizovanom antiparkinsonom terapijom. Cilj je bio i da se utvrdi na koje specifične parametre hoda i na koji način deluje strukturisani rehabilitacioni tretman. Poseban cilj istraživanja je bio se ispita, da li repetitivna transkranijalna magnetna stimulacija suplementarne motorne areje moždane kore utiče na parametre hoda obolelih od Parkinsonove bolesti. Metodologija: Istraživanje, u formi otvorene prospektivne kliničke studije sprovedeno je na Klinici za neurologiju Kliničkog Centra Srbije u Beogradu. Istraživanjem su obuhvaćeni bolesnici sa Parkinsonovom bolešću (PB) koji su se ambulantno ili hospitalno lečili u periodu od 2010 do 2012 godine. U studiju su bila uključena 43 bolesnika sa PB, koji su bili randomizovani u dve studijske grupe metodom slučajnih brojeva: a) Grupa I, koja je bila podvrgnuta strukturisanom rehabilitacionom protokolu u trajanju od 21 dana, u režimu 6 terapijskih seansi nedeljno, ukupno 16 sati efektivnog vežbanja; b) Grupa II, koja je bila podvrgnuta tretmanu repetitivne transkranijalne magnetne stimulacije (rTMS) frekvencom od 10 Hz iznad suplementarne motorne areje (SMA) u trajanju od 10 dana ukupno 400 TMS pulseva tokom 20 minuta /dnevno. U našoj studiji sa dva protokola strukturisanim rehabilitacionim programom i rTMS, analiziranje efekata rTMS smo posmatrali odvojeno kako bismo dobili jasnije inicijalne rezultate. Dijagnoza PB postavljena na osnovu kriterijuma Britanske Banke mozgova i od strane neurologa specijalizovanog za bolesti nevoljnih pokreta. Na ispitanicima obe grupe su sprovedena identična testiranja. Sva testiranja kliničkih parametara bolesti, kao i testiranje hoda, sprovedena su tokom „ON“ perioda , u najvećem broju slučajeva 2 sata nakon uzimanja prve jutarnje doze L-dope...

Aim: The main rehabilitation aim in rehabilitation of patients with Parkinson’s disease is advancing, keeping up and slowing down decline the gait function, keeping up walking safety during different motor and cognitive tasks. The aim of our study was to examine if individual structural rehabilitation treatment, directed to different patophisiology mechanisms in the base of gait disorder of patients with Parkinson’s disease (PD), indipendently making better the gait parameters in comparing to optimal antiparkinsonic therapy. The aim was to determine to which specific gait parameters and how structural rehabilitation treatment functioned. Specific aim og study was to examine, if repetitive transcranial magnetic stimulation (rTMS) of supplementary motor area of brain cortex influences to gait parameters to patients with Parkinson’s disease. Methodology: The examination in the form of open prospective clinical study was carried out at the Clinic for neurology at Clinical Center of Serbia in Belgrade. Researching were included the patients with Parkinson’s disease who were treated outpatiently or in hospital in the period from 2010-2012. Forty three participants with PD were included in two study groups with the method of randomly numbers: a) Group 1 was under the structural rehabilitation protocol lasting 21 days, under the regime of 6 seance therapies per week, all together 16 hours effective exercises; b) Group 2, was under rTMS treatment frequency of 10Hz above supplementary motor area (SMA) lasting 10 days, all together 400 TMS pulses during 20 minutes daily. In our study with two protocols given with structural rehabilitation programme and rTMS, analysing the effects of rTMS we watched separately in order to get better initial results.The diagnosis of PB was made on the base of UK Brain Bank Criteria for the diagnosis of Parkinson's disease and by the neurologist specialized for the movement disorders.The same testing was done to both groups of participants. All clinical tests, as well as gait testing, were done during “On“ period, mostly 2 hours after the first morning dose of L-Dopa. Patients from the group 1 were tested the first day before the beginning of given rehabilitation protocol, and after finishing rehabilitation protocol which lasted 21 days. Patients from the group 2 (rTMS) were tested 1. day, before biginning of protocol, after the finishing of protocol stimulation which lasted 10 and 21th day from the beginning of testing...