Background: Alterations in bodily functions following a stroke exhibit a complex relationship with functional activities. Although deficits related to walking and balance have been extensively documented, the overlap and influence of changes in bodily structures and motor functions, in general, complicate the determination of intervention priorities. Objectives: The primary goal of this study is to identify a functional profile of chronic hemiparetic patients by applying a physiotherapeutic assessment protocol. The secondary goal is to examine potential correlations between walking performance and evaluated motor functions to provide physiotherapists with valuable insights for the planning of rehabilitative treatments. Materials and Methods: A total of 20 chronic hemiparetic subjects were recruited from the IRCCS E. Medea "La Nostra Famiglia" in Pieve di Soligo. Functional evaluations included assessments of sensitivity, pain, muscle tone, muscle strength, balance skills, walking, perception of fatigue, and dyspnea. An assessment protocol was administered, which included a clinical examination of sensitivity, NRS (pain), goniometric examination (Range Of Movement), isokinetic testing (muscle strength: peak torque, work, power), MAS (muscle tone), and the Berg Balance Scale. Walking analysis comprised the 6-Minute Walk Test (6MWT), the Ten meter Walk Test (10mWT), and the Timed Up and Go (TUG) test. The Borg scale was employed for evaluating the perception of fatigue and dyspnea. Statistical analysis was performed using Pearson's correlation test and the Student's t-test, with a significance level set at p< 0.05. Results: The most significant deficits were found in muscle tone (90%), muscle strength (80%), and balance (75%). The plantar flexor muscles were the most affected by hypertonia, while the plantar flexors and knee flexors exhibited the most notable deficits. Walking performance, as assessed by the 6MWT, was strongly negatively correlated with the 10mWT (ρ= -0.857, p< 0.005) and TUG (ρ=-0.808; p< 0.005), and positively correlated with the Berg Balance Scale (ρ= 0.669; p< 0.005). A strong negative correlation was observed between walking (6MWT) and deficits in muscle strength of knee flexors and extensors. Furthermore, a statistically significant relationship was found between moderate to severe hypertonia and a deficit in muscle strength of the plantar flexors. In our sample, there was a tendency towards a greater overall motor deficit (including balance, strength, and walking) in left hemiparetic patients. Conclusions: Tone, strength, PROM (Passive Range of Motion), and balance are the functions primarily altered in chronic hemiparetic patients. They are strongly correlated with gait: strength of knee and ankle flexor-extensor muscles, tibiotarsal PROM, and balance. In order to improve the ambulatory competence of hemiparetic patients, therefore, it is important that physiotherapeutic treatment pays particular attention to these aspects, both in terms of prevention and treatment.
Introduzione: Le alterazioni delle funzioni corporee, in seguito ad ictus, presentano una relazione complessa con le attività funzionali. Sebbene i deficit riguardanti il cammino e l’equilibrio siano ben documentati, la sovrapposizione e l'influenza delle alterazioni delle strutture corporee e delle funzioni motorie in generale rende difficile stabilire le priorità degli interventi Obiettivi: Obiettivo primario del presente studio è di individuare, tramite l’applicazione di un protocollo di valutazione fisioterapica, un profilo funzionale del paziente emiparetico, in fase cronica. Obiettivo secondario è di verificare l’esistenza di correlazioni tra la performance del cammino e le funzioni motorie valutate al fine di fornire al fisioterapista informazioni utili nella pianificazione del trattamento riabilitativo. Materiale e metodi: Sono stati reclutati 20 soggetti emiparetici cronici presso l’IRCCS E. Medea “La Nostra Famiglia” di Pieve di Soligo. Per la definizione del funzionale sono stati valutati: sensibilità, dolore, tono muscolare, forza muscolare, competenze di balance, cammino, sensazione di fatica e di dispnea. È stato somministrato un protocollo di valutazione costituito da: esame clinico della sensibilità, NRS (dolore), esame goniometrico (Range Of Movement), test isocinetico (forza muscolare: picco di coppia, lavoro, potenza), MAS (tono muscolare) e scala di Berg (equilibrio). Per l’analisi del cammino sono applicati: 6MWT, 10mWT, TUG. Per la valutazione della sensazione di fatica e di dispnea è stat utilizzata la scala di Borg. L’analisi statistica è stata condotta mediante il test di correlazione di Pearson ed il test di confronto della t di Student. È stata considerata significativa una p< 0,05. Risultati: I maggiori deficit riscontrati sono stati relativi a: tono muscolare (90%), forza muscolare (80%) ed equilibrio (75%). I mm. più interessati dall’ipertono sono stati i flessori plantari, quelli maggiormente deficitari sono risultati essere i flessori plantari ed i flessori di ginocchio. L’attività di cammino, valutata con 6MWT, è risultata strettamente correlata negativamente con il 10mWT (ρ= -0,857, p< 0,005) e con il TUG (ρ= -0,808; p< 0,005) e strettamente correlata positivamente con la scala di Berg (ρ= 0,669; p< 0,005). Forte correlazione negativa è risultata tra il cammino (6MWT) ed il deficit di forza muscolare dei flessori e degli estensori di ginocchio. Una relazione statisticamente significativa è risultata, inoltre, tra ipertono medio grave e deficit di forza dei mm. flessori plantari. Nel nostro campione si è riscontrato tendenzialmente un maggior deficit motorio globale (equilibrio, forza e cammino) dei pazienti emiparetici sinistri. Conclusioni: Il tono, la forza, il PROM ed il balance sono le funzioni principalmente alterate nei pazienti emiparetici cronici. Sono fortemente correlati al cammino: forza dei mm. flesso - estensori di ginocchio e di caviglia, PROM di tibiotarsica ed equilibrio. Al fine di migliorare la competenza deambulatoria del paziente emiparetico, quindi, è importante che il trattamento fisioterapico tenga in particolare considerazione questi aspetti, sia in termini di prevenzione che di trattamento.
VALUTAZIONE FISIOTERAPICA DEL PAZIENTE EMIPLEGICO CRONICO POST - STROKE: STUDIO OSSERVAZIONALE ORIENTATO ALL’INDIVIDUAZIONE DI PRINCIPI UTILI AL TRATTAMENTO RIABILITATIVO
VANELLA, LUCA
2022/2023
Abstract
Background: Alterations in bodily functions following a stroke exhibit a complex relationship with functional activities. Although deficits related to walking and balance have been extensively documented, the overlap and influence of changes in bodily structures and motor functions, in general, complicate the determination of intervention priorities. Objectives: The primary goal of this study is to identify a functional profile of chronic hemiparetic patients by applying a physiotherapeutic assessment protocol. The secondary goal is to examine potential correlations between walking performance and evaluated motor functions to provide physiotherapists with valuable insights for the planning of rehabilitative treatments. Materials and Methods: A total of 20 chronic hemiparetic subjects were recruited from the IRCCS E. Medea "La Nostra Famiglia" in Pieve di Soligo. Functional evaluations included assessments of sensitivity, pain, muscle tone, muscle strength, balance skills, walking, perception of fatigue, and dyspnea. An assessment protocol was administered, which included a clinical examination of sensitivity, NRS (pain), goniometric examination (Range Of Movement), isokinetic testing (muscle strength: peak torque, work, power), MAS (muscle tone), and the Berg Balance Scale. Walking analysis comprised the 6-Minute Walk Test (6MWT), the Ten meter Walk Test (10mWT), and the Timed Up and Go (TUG) test. The Borg scale was employed for evaluating the perception of fatigue and dyspnea. Statistical analysis was performed using Pearson's correlation test and the Student's t-test, with a significance level set at p< 0.05. Results: The most significant deficits were found in muscle tone (90%), muscle strength (80%), and balance (75%). The plantar flexor muscles were the most affected by hypertonia, while the plantar flexors and knee flexors exhibited the most notable deficits. Walking performance, as assessed by the 6MWT, was strongly negatively correlated with the 10mWT (ρ= -0.857, p< 0.005) and TUG (ρ=-0.808; p< 0.005), and positively correlated with the Berg Balance Scale (ρ= 0.669; p< 0.005). A strong negative correlation was observed between walking (6MWT) and deficits in muscle strength of knee flexors and extensors. Furthermore, a statistically significant relationship was found between moderate to severe hypertonia and a deficit in muscle strength of the plantar flexors. In our sample, there was a tendency towards a greater overall motor deficit (including balance, strength, and walking) in left hemiparetic patients. Conclusions: Tone, strength, PROM (Passive Range of Motion), and balance are the functions primarily altered in chronic hemiparetic patients. They are strongly correlated with gait: strength of knee and ankle flexor-extensor muscles, tibiotarsal PROM, and balance. In order to improve the ambulatory competence of hemiparetic patients, therefore, it is important that physiotherapeutic treatment pays particular attention to these aspects, both in terms of prevention and treatment.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/58548