Nöromüsküler ve Fonksiyonel Elektriksel Stimülasyon
Özet
Bu bölüm, modern rehabilitasyon tıbbının vazgeçilmez modaliteleri olan Nöromüsküler Elektriksel Stimülasyon (NMES) ve Fonksiyonel Elektriksel Stimülasyonu (FES) kapsamlı şekilde incelemektedir. Luigi Galvani'nin 1790'daki öncü keşfinden başlayarak, Liberson'un 1961'deki düşük ayak düzeltme çalışması gibi önemli kilometre taşları ele alınmaktadır. Henneman'ın Boyut Prensibi ve elektriksel stimülasyon sırasında Tip II liflerin öncelikli olarak aktive edilmesiyle bu prensibin tersine çevrilmesi gibi nörofizyolojik temeller açıklanmaktadır. FES'in, elektriksel stimülasyonun istemli eforla senkronizasyonu yoluyla kortikal reorganizasyonu teşvik etmek için Hebbian plastisite prensiplerinden nasıl yararlandığı detaylandırılmaktadır. Dalga formu, puls genişliği (motor aktivasyon için 400-600 μs), frekans (optimal 30-50 Hz bandı) ve görev döngüsü dahil biyofiziksel optimizasyon parametreleri tartışılmaktadır. Klinik uygulamalar; inme rehabilitasyonu, spinal kord yaralanması, multipl skleroz, serebral palsi, ortopedik durumlar (diz protezi, ön çapraz bağ rekonstrüksiyonu, osteoartrit) ve kardiyovasküler/yoğun bakım ortamlarını kapsamaktadır. Bölüm, stimülasyonla indüklenen yorgunluk gibi klinik zorlukları ele alarak asenkron stimülasyon protokolleri, yapay zekâ destekli adaptif algoritmalar ve ev tabanlı telerehabilitasyon sistemleri gibi yenilikçi çözümlerle sonlanmaktadır.
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