MULTİPLE SKLEROZLU HASTALARDA TEKNOLOJİ DESTEKLİ GÖREV ODAKLI EĞİTİM VE TELEREHABİLİTASYONUN ETKİLERİNİN İNCELENMESİ

Abstract

This study aimed to investigate the effects of technology-assisted task-oriented training and mobile application based telerehabilitation on Multiple Sclerosis patients. The 34 patients included in the study were randomly divided into two groups. Patients in both groups were treated for 8 weeks, 3 days a week, 60 minutes a day. Task-oriented circuit training was applied to the first group. The patients received activity training in 5 minutes of exercise and 1 minute of rest at each station. Within the scope of the training, 10 different activity stations were used. The last three activity stations were applied with virtual reality games. Mobile application based telerehabilitation was applied to the second group by exercise videos. The difficulty level of the exercises for both groups was adjusted to 3-5 according to the Modified Borg Scale. All participants were assessed by a blinded assessor at the start and end of treatment. The following assessments were applied to all patients: Trunk Impairment Scale, Berg Balance Scale, International Cooperative Ataxia Rating Scale, Fatigue Severity Scale, Timed Up and Go Test, Multiple Sclerosis Walking Scale, Abilhand, Minnesota Hand Function Tests, Multiple Sclerosis Quality of Life Scale and Goal Attaintment Scale. The ten daily living activities were evaluated using XSens MVN Awinda System. The 32 patients completed the study. The mean age of the groups was 38.7+5.5 in the task-oriented training (T-GOE) group and 36±8.19 in the telerehabilitation (TR) group. Baseline values were similar in all clinical evaluations of the groups (p>0.05). In the T-GOE group, improvements were observed in the patients' trunk, balance, ataxia symptoms, functional mobility, gait, upper extremity functions, quality of life and participation parameters before and after treatment (p<0.05). In the TR group; trunk, balance, ataxia symptoms, functional mobility, upper extremity functions, quality of life and participation parameters were improved (p<0.05). The results obtained were supported by kinematics of daily living activities. In comparisons between groups, T-GOE was found to be more effective than TR in improving kinetic functions, dynamic balance of the trunk, mental and cognitive health-related quality of life, and goal attainment (p<0.05). Kinematic variables for the lower extremity and trunk also had similar results with clinical evaluations in favor of the T-GOE group (p<0.05). The results of our study showed that technology integration into physiotherapy approaches has positive effects on patient with Multiple Sclerosis' gait, balance, upper extremity skills, functional mobility, quality of life, participation and functional activity kinematics.