İnmeli hastalarda erken dönem rehabilitasyonun öneminin difüzyon tensör traktografi verilerine dayanılarak gösterilmesi / Demonstration the importance of the early rehabilitation in stroke patients based on diffüsion tensor imaging data

Abstract

Demonstration the Importance of the Early Rehabilitation in Stroke Patients Based on Diffüsion Tensor Imaging Data Objective: The aim of our study was to investigate whether there is any difference between early rehabilitation program and late rehabilitation program benefits as motor and functional gains evaluating with clinical examination and and at the same time to evaluate this difference objectively with the measurement data of white matter pathways (corticospinal tracts) measured by Diffusion Tensor Tractography. Patients and methods: Twenty-eight patients who had a stroke were included in the study. The first group consisted of patients who applied to our clinic within the first 4 weeks after stroke; and the second group consisted of patients between the first 4-8 weeks after stroke. Both groups were administered the Brunstrom Motor Recovery Score, Fugl Meyer Scale, Functional Independence Scale and Barthel Index one day before treatment, two weeks after treatment and the day after the ending treatment. Before treatment, Standardized Mini Mental test and Modifiye Ashworth Scale were used for assessment cognitive function and spasticity. Patients were treated with neurophysiologic exercise program, combination of conventional exercise program and physical therapy modalities for 4 weeks, 5 days a week, 1 hour per day. For cranial imaging, one day before and one day after the ending treatment, Diffusion Tensor Imaging (DTI) was used. Fractional Anisotropy (FA) and Apparent Diffusion Coefficient (ADC)measurements of corticospinal tracts of patients were performed with DTG. Results: Fugl Meyer Lower Extremity, Fugl Meyer Total, Brunstrom Upper Extremity, Brunstrom Hand, Brunstrom Lower Extremity, FAS Scale, Barthell Index were evaluated in all patients and after rehabilitation program, the increases in the 2 nd week and 4 nd weekly averages were statistically significant according to the average of the points in each group. There was no statistically significant difference for functional gains between the two groups. The patients benefited from both early and late rehabilitation. There was no statistically significant difference between the two groups in the FA changes in the corticospinal tracts in the data obtained with DTI. However, in groups 1 and 2, pre-treatment FA values were similar, while post-treatment the mean value of FA increase in group 1 was found to be more than the group 2. Conclusions: That is, all patients who have stroke and are included in the study got functional benefits from both early and late term rehabilitation. The mean corticospinal FA values of patients who got early rehabilitation were increased after treatment compared to late treatment group, suggesting that early rehabilitation may increase cortical reorgasnizations. It was thought that early rehabilitation could be shown objectively as DTG for the patient's gains. Keywords: Early rehabilitation, diffusion tensor imaging, stroke, tractography