Subakromial Sıkışma Sendromu Tedavisinde Farklı Proprioseptif Nöromuskuler Fasilitasyon Patern Uygulamalarının Etkinliğinin İncelenmesi
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ABSTRACT Demirdel E. Assesment of Effectiveness of Different Proprioceptive Neuromuscular Facilitation Patern Applications in Treatment of Subacromial Impingement Syndrome, Hacettepe University, Institute of Health Sciences, Philosophy of Doctorate Thesis in Physical Therapy and Rehabilitation Programme, Ankara, 2015. The effects of proprioceptive neuromuscular facilitation applications in different paterns were compared in treatment of Subacromial Impingement Syndrome (SIS) in this study. The study began with 60 patients and completed by 45 patients. Patients were divided into three groups randomly. In the first group (CP group), conventional physiotherapy including cold pack, ultrasound and TENS applications was applied and home exercises were given. Additionally, in the second group (CP+E-PNF group) only with extremity pattern; and in the third group (CP+ESB-PNF), together with extremity pattern, scapula and body patterns from PNF paterns were applied. This programme continued during 6 weeks and 3 day a week. Visual Analog Scale (VAS) was used for pain severity of patients and universal goniometer was used for shoulder and neck range of motion. Also, shortening test of pectoral muscles, anterior and lateral tilting of head, rounded shoulder and kyphosis measurements for posture analysis, Scapula Lateral Slide Test (SLST) and laser pointer assisted angle reproduction test for shoulder joint position sense were applied to patients. the pain, functional status and disability levels of the patients evaluated using Constant- Murley Scoring, Disabilities of the Arm, Shoulder and Hand (DASH), Shoulder Pain and Disability Index (SPADI). Patient satisfaction was determined with VAS. After treatment; activity, rest and night pain decreased in all three groups and night pain reduction was beter in PNF groups (p<0,05). Active motions increased in all groups (p<0,05). In comparison of SLST results of patients, difference in abduction position decreased in CP+ESB-PNF group (p<0,05); in the other groups, similar changes occurred in three assessment position (p>0.05). It was determined that improvements occurred in all groups in posture analysis (p<0,05). Total deviation and deviation in X and Y axis in shoulder joint position sense decreased significantly in CP+ESB-PNF group both flexion and abduction motions (p<0,05). Decreasing in this measurement in other groups was limited. Incresing in Constant Murley Score; and decreasing in DASH ve SPADI scores were determined in all groups (p<0,05). As a result of study, it was concluded that different PNF pattern applications addition to exercise programme together with conventional physiotherapy would be beneficial in reducing pain, increasing shoulder joint position sense and increasing functionality in the treatment of SIS. Key words: Subacromial Impingement Syndrome, Proprioceptive Neuromuscular Facilitation, Pain, Position Sense.
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