Splošne teme / General themes Fizioterapija 2015, letnik 23, suppl 1 69 Krepitev mišic z elektrostimulacijo za izboljšanje funkcije pri osebah z okvaro zgornjega motoričnega nevrona Mateja Hiter dipl. fiziot. 1 ; doc. dr. Darja Rugelj, viš. fiziot.2 1 Univerzitetni rehabilitacijski inštitut Republike Slovenije - Soča, Ljubljana; 2Univerza v Ljubljani, Zdravstvena fakulteta, Ljubljana Korespondenca/Correspondence: Mateja Hiter, dipl. fiziot.; e-pošta: mateja.hiter@gmail.com Uvod: S krepitvijo mišic vplivamo na maksimalno silo, ki jo mišica lahko razvije. Zmožnost mišice ustvariti maksimalno silo se nanaša na mišično moč, ki predstavlja jakost mišice (1). Vadba za povečanje moči mora temeljiti na načelu nadobremenitve, kar pomeni, da mora predstavljati večji stres za telo, kot ga je telo sicer vajeno. To pomeni, da mora biti vadba zadovoljive intenzivnosti, frekvence in trajanja (2). Za pridobivanje mišične zmogljivosti obstaja več metod. Ena izmed njih je tudi električna stimulacija. Kots je že leta 1973 opisal vlogo električne stimulacije mišic pri povečanju mišične zmogljivosti. Trdil je, da so možnosti za povečanje mišične sile z električno stimulacijo večje kot pri običajni vadbi z utežmi. Njegove trditve so povzročile veliko zanimanje in sprožile nadaljnje raziskave, ki so potrdile omenjene učinke električne stimulacije (3). Namen pregleda literature pod mentorstvom doc. dr. Darje Rugelj je bil ugotoviti, ali električna stimulacija okrepi mišice pri osebah z okvaro zgornjega motoričnega nevrona. Metode: Pregled literature je vključeval pregled raziskav, ki so raziskovale vpliv električne stimulacije na izboljšanje funkcije pri osebah z okvaro zgornjega motoričnega nevrona (možganska kap, multipla skleroza, poškodbe hrbtenjače in cerebralna paraliza). Najdenih in pregledanih je bilo 124 raziskav, od tega je vključitvenim merilom ustrezalo 23 raziskav. Objavljene so bile od leta 1979 do 2011. Na temo električne stimulacije ter cerebralne paralize in multiple skleroze je bilo vključenih 8 raziskav. Pri raziskavah, narejenih na osebah po možganski kapi, jih je bilo vključenih 9, pri poškodbah hrbtenjače pa 6 raziskav. Rezultati: Rezultati študij pri cerebralni paralizi so pokazali izboljšanje moči v vseh preiskovalnih skupinah (kontrolna, z električno stimulacijo, placebo hotena vadba (krepitev mišic brez električne stimulacije)) znotraj študij, med skupinami ni prišlo do razlik. Pri multipli sklerozi so raziskave pokazale izboljšanje mišične moči samo v skupinah, ki so imele kombinacijo stimulacije s hoteno vadbo. Pri študijah, narejenih na osebah po možganski kapi, je prišlo do izboljšanja moči pri vseh preiskovanih skupinah, vendar je bilo izboljšanje moči največje pri skupini z električno stimulacijo. Rezultati v raziskavah na osebah po poškodbi hrbtenjače poročajo o nasprotujočih si rezultatih. Zaključki: Kljub dejstvu, da je pri vseh bolezenskih stanjih značilna okvara zgornjega motoričnega nevrona in da so študije med boleznimi uporabljale podobne metode in načela krepitve mišic, so samo študije, narejene na osebah po možganski kapi, imele boljše rezultate v prid električni stimulaciji. Potrebnih je več raziskav glede krepitve mišic z električno stimulacijo pri osebah z okvaro zgornjega motoričnega nevrona. Ključne besede: Električna stimulacija, krepitev, mišična moč, okvara zgornjega motoričnega nevrona. Splošne teme / General themes 70 Fizioterapija 2015, letnik 23, suppl 1 Strengthening of muscle with electrical stimulation to improve function in persons with spinal cord injury Introduction: When we strengthen the muscles, we influence the maximal force, which a muscle can develop. The ability of the muscle to create the maximum force refers to the muscular strength, which represents the intensity of the muscle (1). Strength training is based on overload principle, which means that the body has to be exposed to a bigger work stress than it is used to. The exercise has to be of sufficient intensity, duration and frequency. (2). There are several methods for muscle strengthening. One of them is electrical stimulation. As early as in 1973, Kots presented an article, in which he described the use of muscle electrical stimulation in muscle strengthening. He claimed that the possibilities for increasing muscle strength with electrical stimulation are greater than with regular exercise with weights. This caused a lot of interest and further research, which confirmed these effects of electrical stimulation (3). The purpose of the literature research under the mentorship of Darja Rugelj, PhD, was to find out if electrical stimulation strengthens the muscles after upper motor neuron injury. Methods: The literature research thesis is based on the expert and scientific literature research, which investigated whether muscle electrical stimulation improves function after motor neuron injury (brain stroke, multiple sclerosis, spinal cord injury, cerebral palsy). Based on the key words, I have found and researched 124 studies and 23 researches among them have met the criteria for integration. They were published from 1979 to 2011. The topics cerebral palsy and multiple sclerosis were included in eight researches. There were nine researches, which included the topic stroke, and six were adequate for spinal cord injuries. Results: The results of the cerebral palsy studies showed improvement in strength inside all researched groups (control, with electrical stimulation, placebo, strengthening exercise); there were no differences between the groups. The researches of multiple sclerosis have showed that the improvement of muscular strength has been done only in the groups, which had a combination of stimulation with weight training. The studies on the persons after brain stroke have showed improvement of strength with all groups. However, the improvement has been better with stimulation group. The studies on the persons with spinal cord injuries have shoved opposite results. Conclusion: Despite the fact that all diseases are caused by upper motor neuron injury, and that studies used similar methods and principles of muscle strengthening, only the studies on the persons after brain stroke achieved better results in the electrical stimulation group. However, the fact is that more studies should be done. Key words: Electric stimulation, strengthening, muscle strength, injury of upper motor neuron. Literatura/References: 1. Knuttgen HG, Komi PV (1994). Basic definitions for exercise. In: Komi PV, eds. Strength and power in sport. The encyclopaedia of sports medicine. Australia: Blackwell Science, 3–6. 2. Åstrand PO, Rodahl K (1986). Textbook of work physiology. Physiological bases of exercise. 3th ed. United States of America: McGraw-Hill. 3. Kocjan D (2002). Primerjava različnih oblik električne stimulacije skeletnih mišic. Diplomsko delo. Ljubljana: Visoka šola za zdravstvo.