Comparison of Rehabilitative Game Exercise and Body Awareness Therapy in Rotator Cuff Syndrome

Rotator cuff syndrome is one of the most common problems in the shoulder, starting as acute tendinopathy and progressing to partial and full thickness tears. Shoulder pain causes a decrease in shoulder joint movement, joint position sense, upper extremity function and quality of life. Among the most commonly used conservative treatment methods; Joint range of motion exercises, stretching exercises, strengthening exercises, mobilization and electrotherapy method are included.

Nowadays, with the widespread use of technology in rehabilitation, video-based games have begun to be used for rehabilitative purposes in addition to conservative approaches. Although the effectiveness of video-based games has been extensively studied in diseases such as cerebral palsy, stroke and parkinsonism, there are a limited number of studies in the field of orthopedic rehabilitation, especially in shoulder rehabilitation.

Basic body awareness therapy is used to treat chronic musculoskeletal-related painful conditions. In the literature, basic body awareness therapy has been studied in patient groups such as mental health, stroke patient groups, chronic musculoskeletal problems, chronic waist and neck pain, scoliosis and knee osteoarthritis. Studies have shown that the TBFT method provides improvements in individuals' body awareness, mobility in daily living activities, health-related quality of life, body image and pain intensity. However, no studies have been found in which basic body awareness therapy was used in the field of shoulder rehabilitation.

Our study aims to compare the effectiveness of a rehabilitative game exercise program and body awareness training in terms of pain, joint range of motion, shoulder functionality, proprioception, body awareness, shoulder-related quality of life, kinesiophobia and patient satisfaction in individuals with Rotator cuff syndrome.

It is one of the most common problems in the shoulder, which begins as acute tendinopathy in rotator cuff surgery and can progress to partial and full thickness tears. The most commonly affected muscle is supraspinatus and infraspinatus, followed in second place.

The shoulder joint is an important and complex joint in terms of both mobility and stability. Having a wide joint range of motion makes stabilization of this joint difficult. Passive (bone, capsule, ligament) and active (muscles) structures play an important role in ensuring stability. The stabilization mechanism is under the control of the central nervous system. The sensorimotor system is responsible for all proprioceptive information, motor or neuromuscular responses and central integration, and plays a role in maintaining the balance of static and dynamic stabilizers around the joint.Proprioceptive sensory input is one of the most important structures of the sensorimotor system. Insufficiency in proprioceptive sense is one of the factors that predispose to injuries, and studies have shown that proprioceptive deficit is present in common pathologies of the shoulder such as shoulder instability, impingement syndrome, rotator cuff injuries, adhesive capsulitis and osteoarthritis. The first symptom that usually occurs in rotator cuff injuries is pain, and its incidence increases significantly with age.Shoulder pain and increasing shoulder joint movement limitation cause a decrease in shoulder active joint position sense (proprioception), upper extremity function and quality of life. Exercise prescription in general; It focuses on increasing the range of motion of the glenohumeral joint and the flexibility of the muscles in the region, providing scapular control and increasing the muscle strength of the shoulder area. Among the most commonly used conservative treatment methods; Joint range of motion exercises, stretching exercises, strengthening exercises, mobilization and electrotherapy method are included.

Today, with the widespread use of technology in rehabilitation, video-based games have begun to be used for rehabilitative purposes in addition to conservative approaches.

Products such as Nintendo Wii, Microsoft Kinect and Fizyosoft can be given as examples of video-based games. Video-based game exercise programs are defined as a combination of physical movements and games designed to increase the physical activity level and functionality of individuals. Although the effectiveness of video-based games in neurorehabilitation has been extensively studied in diseases such as cerebral palsy, stroke and parkinsonism, there are a limited number of studies in the field of orthopedic rehabilitation, especially in the treatment protocols of patients with rotator cuff injury and subacromial impingment syndrome.

Basic Body Awareness Therapy is an existential treatment approach targeting mind-body integrity that is frequently used in the rehabilitation of patients with psychiatric disorders and chronic musculoskeletal problems. Basic body awareness therapy is used in the treatment of painful conditions related to the chronic musculoskeletal system. In the literature, it has been seen that basic body awareness therapy has been studied in patient groups such as mental health, stroke patient groups, chronic musculoskeletal problems, chronic waist and neck pain, scoliosis and knee osteoarthritis. It has been shown in the studies examined that the basic body awareness therapy method, which provides integration of mind-body integrity, provides improvement in individuals' body awareness, mobility in daily living activities, health-related quality of life, body image and pain intensity findings. However, no studies have been found in which basic body awareness therapy was used in the field of shoulder rehabilitation.

The aim of our study is to compare the effectiveness of a rehabilitative game exercise program and body awareness training in terms of pain, joint range of motion, shoulder functionality, proprioception, body awareness, shoulder-related quality of life, kinesiophobia and patient satisfaction in individuals with Rotator cuff syndrome. In addition to conventional methods, the rehabilitative game exercise programWe predict that body awareness training will bring a different perspective to the field of shoulder rehabilitation.

Eligibility Criteria:
Inclusion Criteria:

* Diagnosis of partial supraspinatus rupture by an Orthopedics and Traumatology specialist placement.
* Unilateral shoulder pain,
* Not having been involved in any physiotherapy program before due to shoulder problem,
* Body mass index (BMI) ≤ 30 kg/m²
* Cooperation of individuals

Exclusion Criteria:

* Having had previous shoulder surgery,
* Having received local corticosteroid injection/corticosteroid treatment in the last three months,
* Presence of a disease that will affect the neurological, cardiac, systemic, cognitive and visual systems,