Farfadowar bugun jini

Manufofin farko na sarrafa bugun jini shine don rage raunin kwakwalwa da haɓaka matsakaicin farfadowa na haƙuri. Ganowa na gaggawa da kulawar gaggawa suna da mahimmanci don inganta sakamakon lafiya. Idan akwai, ana shigar da marasa lafiya zuwa sashin bugun jini mai tsanani don magani. Waɗannan rukunin sun ƙware wajen ba da kulawar likita da tiyata da nufin daidaita yanayin lafiyar majiyyaci. name=Duncan2> Hakanan ana yin daidaitattun ƙima don taimakawa wajen haɓaka tsarin kulawa da ya dace.Lindsay MP, Gubitz G, Bayley M, Hill MD, Davies-Schinkel C, Singh S, and Phillips S. Canadian Best Practice Recommendations for Stroke Care (Update 2010). On behalf of the Canadian Stroke Strategy Best Practices and Standards Writing Group. 2010; Ottawa, Ontario Canada: Canadian Stroke Network. Bincike na yanzu ya nuna cewa sassan bugun jini na iya yin tasiri wajen rage yawan mace-mace a asibiti da kuma tsawon zaman asibiti. 
Da zarar majiyyaci ya sami kwanciyar hankali a likitanci, hankalin farfadowar su ya koma ga gyarawa. Wasu marasa lafiya ana canjawa wuri zuwa shirye-shiryen gyara marasa lafiya, yayin da wasu ana iya tura su zuwa sabis na marasa lafiya ko kulawa na gida. Shirye-shiryen cikin-haƙuri yawanci ana sauƙaƙe ta hanyar ƙungiyar interdisciplinary wanda zai iya haɗawa da likita, ma'aikacin jinya, likitan magunguna, mai ilimin hanyoyin kwantar da hankali, mai ilimin hanyoyin kwantar da hankali, mai ilimin likitancin magana da harshe, masanin ilimin halayyar ɗan adam, da mai ilimin motsa jiki. Lindsay MP, Gubitz G, Bayley M, Hill MD, Davies-Schinkel C, Singh S, and Phillips S. Canadian Best Practice Recommendations for Stroke Care (Update 2010). On behalf of the Canadian Stroke Strategy Best Practices and Standards Writing Group. 2010; Ottawa, Ontario Canada: Canadian Stroke Network. Masu haƙuri da danginsu/masu kula da su kuma suna taka muhimmiyar rawa a wannan ƙungiyar. Iyali / masu kulawa waɗanda ke da hannu a cikin kulawar mai haƙuri sun kasance a shirye don aikin kulawa yayin da mai haƙuri ya canza daga cibiyoyin gyarawa. Yayin da yake a cibiyar gyarawa, ƙungiyar ƙwararrun maƙwabta suna tabbatar da cewa mai haƙuri ya sami iyakar aikin su a kan fitarwa. Manufofin farko na wannan ƙaramin lokaci na murmurewa sun haɗa da hana rikice-rikice na kiwon lafiya na biyu, rage rauni, da cimma burin aiki waɗanda ke haɓaka 'yancin kai a cikin ayyukar rayuwar yau da kullum.

A cikin matakai na baya na farfadowa na bugun jini, ana ƙarfafa marasa lafiya su shiga shirye-shiryen rigakafi na biyu don bugun jini. Babban mai ba da kulawa na farko na majiyyaci ne ke sauƙaƙe bibiya. 

Matsalolin farko na nakasu da halaye na mutum ɗaya, kamar motsa jiki, goyon bayan zamantakewa, da ikon ilmantarwa, sune mahimmin tsinkaya na sakamakon dawo da bugun jini.  Amsoshi ga jiyya da dawo da aikin gaba ɗaya sun dogara sosai ga mutum. Shaidu na yanzu sun nuna cewa mafi yawan manyan nasarorin farfadowa za su faru a cikin makonni 12 na farko bayan bugun jini. 
 Tarihin bugun jini na neuro-rehabilitation 
A cikin 1620, Johann Jakob Wepfer, ta hanyar nazarin kwakwalwar alade, ya haifar da ka'idar cewa bugun jini ya haifar da katsewar jini zuwa kwakwalwa. Bayan haka, mayar da hankali ya zama yadda za a bi da marasa lafiya da bugun jini.

A yawancin ƙarni na ƙarshe, an hana mutane yin aiki bayan bugun jini. A cikin shekarun 1950, wannan hali ya canza, kuma ƙwararrun kiwon lafiya sun fara rubuta magungunan warkewa ga mai ciwon bugun jini tare da sakamako mai kyau. A wannan lokacin, an yi la'akari da sakamako mai kyau don samun matakin 'yancin kai wanda marasa lafiya zasu iya canzawa daga gado zuwa keken hannu ba tare da taimako ba. 

A farkon shekarun 1950, Twitchell ya fara nazarin tsarin farfadowa a cikin marasa lafiya na bugun jini. Ya ba da rahoton marasa lafiya 121 da ya lura da su. Ya gano cewa a cikin makonni hudu, idan akwai wasu farfadowa na aikin hannu, akwai damar Kashi 70 cikin dari 100 na samun cikakkiyar farfadowa ko mai kyau. Ya ba da rahoton cewa mafi yawan farfadowa yana faruwa a cikin watanni uku na farko, kuma ƙananan farfadowa ne kawai ke faruwa bayan watanni shida.  Binciken da aka yi kwanan nan ya nuna cewa za a iya samun ci gaba mai mahimmanci shekaru bayan bugun jini. 

Kusan lokaci guda, Brunnstrom kuma ya bayyana tsarin farfadowa, kuma ya raba tsarin zuwa matakai bakwai. Yayin da ilimin kimiyyar farfadowar kwakwalwa ya inganta, dabarun shiga tsakani sun samo asali. Ilimin bugun jini da tsarin farfadowa bayan shanyewar jiki ya bunkasa sosai a karshen karni na 20 da farkon karni na 21.

Hanyoyi na yanzu da hanyoyin warkewa
Maganin motsi na ƙuntatawa

Tunanin maganin takurawa ya kasance aƙalla shekaru 100. Robert Oden ne ya gudanar da bincike mai mahimmanci. Ya iya kwaikwayon bugun jini a cikin kwakwalwar biri, yana haifar da hemiplegia. Daga nan sai ya daure hannun akuyar, ya tilasta wa akin ya yi amfani da mugun hannunsa, ya lura da abin da ya faru. Bayan makonni biyu na wannan jiyya, birai sun sami damar sake amfani da hannayensu da suka yi dahuwa. Wannan shi ne saboda neuroplasticity. Ya yi irin wannan gwajin ba tare da daure makamai ba, kuma ya jira watanni shida da rauninsu. Birai ba tare da shiga tsakani ba sun kasa yin amfani da hannun da abin ya shafa ko da watanni shida bayan haka. A cikin 1918, an buga wannan binciken, amma ba a kula da shi ba.[9] 
Daga ƙarshe, masu bincike sun fara amfani da fasaharsa ga masu fama da bugun jini, kuma an kira shi maganin motsa jiki na ƙuntatawa. Musamman ma, binciken farko ya mayar da hankali ga marasa lafiya na bugun jini waɗanda suka wuce watanni 12 da suka wuce bugun jini. Wannan ya kalubalanci imanin da aka yi a wancan lokacin cewa ba za a sake farfadowa ba bayan shekara guda. Maganin ya haɗa da sanya mitt mai laushi a hannu mai kyau na kashi 90% na sa'o'in farkawa, tilasta amfani da hannun da abin ya shafa. Marasa lafiya suna shan magani mai tsanani daya-daya na sa'o'i shida zuwa takwas a kowace rana har tsawon makonni biyu.[10]
Shaidar da ke goyan bayan yin amfani da takurawar motsa jiki ta kasance tana girma tun lokacin da aka gabatar da ita a matsayin madadin hanyar jiyya don ƙarancin motsin hannu na sama da aka samu a cikin yawan bugun jini.[11] Kwanan nan, an nuna ƙuntatawa da aka haifar da motsa jiki don zama ingantacciyar dabarar gyaran gyare-gyare a matakai daban-daban na farfadowa na bugun jini don inganta aikin motsa jiki na babba da kuma amfani da su yayin ayyukan rayuwar yau da kullum. Waɗannan na iya haɗawa, amma ba'a iyakance ga, ci, tufafi, da ayyukan tsafta ba.[12] CIMT na iya inganta lalacewar mota da aikin motsa jiki, amma ba a sami fa'idodin don rage nakasa mai gamsarwa ba, tare da ƙarin bincike da ake buƙata.[13] An nuna amfani da ayyukan aiki a matsayin wani ɓangare na maganin CIMT don haɓaka sakamakon aiki a cikin ayyukan mutum na rayuwar yau da kullum.[14] Masu aikin kwantar da hankali na sana'a sun cancanci na musamman don samar da jiyya na tushen aiki tare da tsarin CIMT.[14] Ana ganin mafi girman riba a tsakanin masu fama da bugun jini waɗanda ke nuna ɗan hannu da ƙara yatsa a cikin abin da ya shafa.[15] Ƙwararrun maganadisu na magnetic transcranial da nazarin hotunan kwakwalwa sun nuna cewa kwakwalwa tana yin canje-canjen filastik a cikin aiki da tsari a cikin marasa lafiya waɗanda ke yin tasirin motsa jiki. Waɗannan canje-canje suna biye da nasarorin da ake samu a aikin motsa jiki na babban gaɓa. Duk da haka, babu wata kafaffen hanyar haɗin kai tsakanin canje-canjen da aka lura a cikin aikin kwakwalwa/tsarin jiki da kuma ribar motar saboda takurawar motsa jiki.[11][16]
Kwanan nan an gyaggyara magungunan motsa jiki na ƙuntatawa don magance aphasia a cikin marasa lafiya bayan CVA kuma. Ana kiran wannan saƙon jiyya da Constraint Induced Aphasia Therapy (CIAT). Shugabanni na gaba ɗaya suna aiki, duk da haka a wannan yanayin, abokin ciniki yana takura daga yin amfani da dabarun ramawa don sadarwa kamar motsin motsi, rubutu, zane, da nuni, kuma ana ƙarfafa su yin amfani da sadarwa ta baki. Yawanci ana yin magani ne a rukuni kuma ana amfani da shinge don haka hannu, kuma ba a ganin kowane dabarun ramawa.[17]

Ayyukan tunani / hoto na hankali

Ayyukan tunani na motsi, an nuna a cikin bincike da yawa don yin tasiri wajen inganta farfadowa na duka hannu da ƙafafu bayan bugun jini. Sau da yawa masu ilimin motsa jiki na jiki ko na sana'a suna amfani da shi a cikin yanayin gyarawa ko lafiyar gida, amma kuma ana iya amfani da shi azaman wani ɓangare na shirin motsa jiki na gida mai zaman kansa na majiyyaci. Magungunan Motsi na Tunani samfuri ɗaya ne da ake samarwa don taimakawa marasa lafiya tare da jagorar tunanin tunani.

Gyaran kwakwalwa
Ƙarfafawa na wutar lantarki

Irin wannan aikin yana wakiltar canjin yanayi a cikin tsarin gyarawa na kwakwalwar da ke fama da bugun jini nesa da ambaliya ta hanyar magunguna na masu karɓar neuronal kuma a maimakon haka, zuwa ga kuzarin physiologic da aka yi niyya.[20] A cikin sharuddan layman, wannan ƙarfafawar lantarki tana kwaikwayon aikin tsoka mai lafiya don inganta aiki da taimako a cikin sake horar da tsoka mai rauni da motsi na yau da kullun. Ƙarfafawar Lantarki na Aiki (FES) yawanci ana amfani dashi a cikin 'digon ƙafa' bayan bugun jini, amma ana iya amfani dashi don taimakawa sake horar da motsi a hannu ko ƙafafu.

Bobath (NDT)

A cikin marasa lafiya da ke fuskantar gyare-gyare tare da yawan bugun jini ko wasu cututtuka na tsarin juyayi na tsakiya (cerebral palsy, da dai sauransu), Bobath, wanda aka fi sani da Neurodevelopmental Treatment (NDT), sau da yawa maganin zabi a Arewacin Amirka. An fi kallon ra'ayin Bobath a matsayin tsarin fassara da warware matsala na gabatarwar mutum ɗaya, tare da yuwuwar su don ingantawa.[21] Abubuwan da aka yi amfani da su na sarrafa motar da aka jaddada musamman, sune haɗin kai tsaye na sarrafawa da aikin aiki, kula da motsi na zaɓi don samar da tsarin daidaitawa na motsi da gudummawar abubuwan da ke da hankali ga sarrafa mota da ilmantarwa.[21]. Ayyukan ɗawainiya wani ɓangare ne na babban tsarin kula da jiyya wanda ya haɗa da ƙima mai zurfi game da dabarun motsi da mai haƙuri ke amfani da shi don yin ayyuka, da kuma gano ƙayyadaddun nakasu na ayyukan jijiyoyi da neuromuscular.[21]
Duk da ana amfani da shi sosai, bisa ga wallafe-wallafen, NDT ta kasa nuna fifiko akan sauran dabarun jiyya da ake samu. A gaskiya ma, dabarun da aka kwatanta da NDT a cikin waɗannan nazarin sau da yawa suna haifar da sakamako iri ɗaya dangane da tasirin magani. Bincike ya nuna mahimmancin binciken ga duk waɗannan hanyoyin maganin idan aka kwatanta da batutuwa masu sarrafawa kuma ya nuna cewa gaba ɗaya, gyare-gyare yana da tasiri. Yana da mahimmanci a lura cewa falsafar NDT na "yin abin da ya fi dacewa" ya haifar da bambancin ra'ayi a cikin wallafe-wallafen dangane da abin da ya ƙunshi fasaha na NDT, don haka yana da wuya a kwatanta kai tsaye da sauran fasahohin.

Maganin madubi (Mirror therapy)

An yi amfani da maganin madubi (MT) tare da wasu nasara wajen magance masu fama da bugun jini. Nazarin asibiti waɗanda suka haɗu da maganin madubi tare da gyare-gyare na al'ada sun sami sakamako mafi kyau.[25] Duk da haka, babu wata cikakkiyar yarjejeniya kan ingancinsa. A wani bincike na baya-bayan nan na binciken da aka buga, Rothgangel ya kammala da cewa:
A cikin marasa lafiya na bugun jini, mun sami matsakaicin ingancin shaida cewa MT a matsayin ƙarin magani yana inganta farfadowa na aikin hannu bayan bugun jini. Ingancin shaida game da tasirin MT akan dawo da ayyukan ƙananan gaɓɓai har yanzu yana da ƙasa, tare da tasirin rahoton binciken guda ɗaya kawai. A cikin marasa lafiya tare da CRPS da PLP, ingancin shaidar kuma yana da ƙasa.[26]

Magungunan ƙwayoyin cuta (a cikin bincike)
Amfani da ƙwanƙolin ƙashi da aka samu mesenchymal stem cell (MSCs) a cikin maganin bugun jini na ischemic

Bambance-bambancen ƙarshe na wasu ƙwayoyin sel na somatic kwanan nan an kira su cikin tambaya [29] [30] bayan binciken da aka dasa sel hematopoietic ya nuna ci gaban myoblasts, [31] [32] [33] endothelium, [34] [35] Epithelium [36] da ƙwayoyin neuroectodermal, [37] [38] [39] [40] suna ba da shawara mai yawa. Wadannan binciken sun haifar da yin la'akari da MSCs don maganin bugun jini na ischemic, [41] musamman a cikin inganta haɓakar ƙwayoyin cuta kai tsaye da kuma tsarin neurorestorative na neurogenesis, angiogenesis da synaptic plasticity.

Hanyoyi masu yuwuwa na farfadowa da neuroprotection ta MSCs bayan bugun jini

Canjawar MSCs zuwa sel masu kama da neuron mai ban sha'awa an nuna zai yiwu a cikin vitro[37] [39] kuma waɗannan ƙwayoyin suna amsawa ga masu watsa tsarin juyayi na gama gari.[42] Duk da haka, yana da wuya cewa wannan mataki na sauye-sauye ya faru a cikin vivo kuma <1% na allurar MSCs sun bambanta da gaske kuma suna haɗuwa a cikin yankin da aka lalace.[43] Wannan yana nuna cewa rarrabuwar kawuna na MSCs zuwa jijiyoyi ko sel-kamar jijiyoyi ba babbar hanyar da MSCs ke haifar da jijiyoyi ba. 

Ƙaddamar da neurogenesis (ci gaban sababbin ƙwayoyin cuta) wani nau'i ne mai yuwuwa na farfadowa; duk da haka dangantakarsa da ingantaccen aiki bayan bugun jini bai tabbata ba.[41] Kwayoyin da aka shigar suna iya samo asali daga yankin ventricular, yankin subventricular da choroid plexus, kuma suna yin ƙaura zuwa yankunan da ke cikin sassan su wanda ya lalace.[44] Ba kamar ƙaddamar da neurogenesis ba, ƙaddamar da angiogenesis (ci gaban sabbin hanyoyin jini) ta hanyar MSCs an haɗa shi da inganta aikin kwakwalwa bayan bugun jini na ischemic [48] [49] kuma yana da alaƙa da ingantaccen daukar ma'aikata.[50]. Bugu da ƙari, an nuna synaptogenesis (samuwar sababbin synapses tsakanin ƙananan ƙwayoyin cuta) don karuwa bayan jiyya na MSC; [49] [51] wannan haɗuwa da ingantaccen neurogenesis, angiogenesis da synaptogenesis na iya haifar da ingantaccen aiki mai mahimmanci a wuraren lalacewa a sakamakon haka. na maganin MSC.

Kodayake kunnawar neuroprotection na endogenous da neurorestoration mai yiwuwa yana da babban sashi a cikin haɓaka aikin kwakwalwa bayan bugun jini, yana iya yiwuwa haɓaka aikin da aka samu sakamakon jiyya na MSC saboda haɗakar aiki ta hanyar salon salula da ƙwayoyin ƙwayoyin cuta da yawa don shafar haɓakar haɓakawa da neuroprotection. , maimakon kawai inji guda. Hakanan ana daidaita waɗannan tasirin ta hanyar maɓalli masu mahimmanci, gami da adadin da nau'in MSCs da aka yi amfani da su, lokacin jiyya dangane da lokacin da bugun jini ya faru, hanyar isar da MSCs, da kuma masu canjin haƙuri (misali shekaru, yanayin ƙasa). [41]

Abin da wannan ke nufi ga masu fama da bugun jini da iyakoki ko damuwa tare da MSC a matsayin yuwuwar jiyya

Idan magani na MSC ya zama samuwa ga masu fama da bugun jini, yana yiwuwa yawan mace-mace na yanzu da kuma yawan cututtuka na iya ingantawa sosai saboda haɓakawa kai tsaye na neuroprotection da hanyoyin gyaran jijiyoyi maimakon kawai sauƙaƙewa kai tsaye ko rigakafin ƙarin lalacewa, misali. tiyata na decompressive. Duk da haka, don yin amfani da maganin MSC yadda ya kamata kuma a amince da shi a cikin asibiti, ana buƙatar ƙarin bincike don gudanar da bincike, musamman a cikin yankunan da ke ƙayyade tasirin tasiri na maɓalli masu mahimmanci (musamman masu canji na haƙuri) akan sakamakon haƙuri tare da ƙididdige haɗarin haɗari, misali. samuwar ƙari. Ko da yake matsalolin ɗabi'a galibi suna iyakance ga amfani da ƙwayoyin sel na amfrayo, [58] kuma yana iya zama mahimmanci don magance duk wata damuwa ta ɗabi'a (duk da haka ba zai yiwu ba) akan amfani da ƙwayoyin sel na somatic.

Horar da tsokoki da ke fama da ciwo na neuron na sama

Jijiya ya shafi nau'ikan ƙwayar cuta na sama, da yawa suna da fasali mai yawa na daidaitawa ciki har da: rauni, raguwar motar tsoka, spacticty da rage jimorewa. Kalmar "spasticity" sau da yawa ana amfani da ita cikin kuskure tare da ciwo na neuron na sama, kuma ba sabon abu ba ne don ganin marasa lafiya da aka lakafta su a matsayin spastic wanda ke nuna jerin binciken UMN.[59] 

An kiyasta cewa kimanin kashi 65 cikin 100 na mutane suna tasowa bayan bugun jini, [60] kuma bincike ya nuna cewa kimanin kashi 40 cikin 100 na masu fama da bugun jini na iya samun ciwon bugun jini a watanni 12 bayan bugun jini.[61]. Canje-canje a cikin sautin tsoka mai yiwuwa ya haifar da sauye-sauye a cikin ma'auni na bayanai daga reticulospinal da sauran hanyoyi masu saukowa zuwa motsin motsa jiki da na ciki na kashin baya, da kuma rashin tsarin tsarin corticospinal.[62]. A wasu kalmomi, akwai lalacewa ga ɓangaren kwakwalwa ko kashin baya wanda ke sarrafa motsi na son rai. 

Daban-daban hanyoyi suna samuwa don maganin illar ciwon ƙwayar ƙwayar cuta ta babba. Waɗannan sun haɗa da: motsa jiki don inganta ƙarfi, sarrafawa da juriya, hanyoyin kwantar da hankali marasa magani, maganin maganin baka, maganin ƙwayar cuta, allurai, da tiyata.[60][62]

Hanyoyin kwantar da hankali na Nonpharmacologic

Ya kamata a yi la'akari da kima daga ƙwararrun ƙwararrun kiwon lafiya, kodayake akwai shaidar cewa masu kulawa suna amfani da al'ummomin kafofin watsa labarun don samo bayanan da suka shafi farfadowa da bugun jini.[68] Ga tsokoki masu rauni mai sauƙi zuwa matsakaici, motsa jiki ya kamata ya zama ginshiƙan gudanarwa, kuma yana iya buƙatar likitan ilimin lissafi ya rubuta shi. 

Ƙwayoyin da ke da nakasu mai tsanani suna iya zama mafi ƙayyadaddun ikon motsa jiki kuma suna iya buƙatar taimako don yin wannan. Suna iya buƙatar ƙarin saɓani, don gudanar da mafi girman nakasar jijiyoyi da kuma babban rikitarwa na biyu. Waɗannan ayyukan na iya haɗawa da simintin simintin gyare-gyare, motsa jiki na sassauƙa kamar shirye-shirye masu dorewa, kuma marasa lafiya na iya buƙatar kayan aiki, kamar amfani da firam ɗin tsaye don dorewar matsayi. Yin shafa tufafi na musamman na Lycra yana iya zama mai fa'ida[69].

Magance matsalolin gani da suka shafi shekaru a cikin marasa lafiya da bugun jini

Tare da yawaitar matsalolin hangen nesa da ke karuwa tare da shekaru a cikin marasa lafiya na bugun jini, gabaɗayan tasirin tsoma baki don matsalolin gani da suka shafi shekaru ba a halin yanzu. Har ila yau, ba a tabbatar da ko masu fama da bugun jini suna amsa daban-daban da sauran jama'a a lokacin da suke magance matsalolin ido[70]. Ana buƙatar ƙarin bincike a wannan yanki kamar yadda shaidun yanzu ba su da inganci sosai.

Physiotherapy

Jiyya na motsa jiki yana da fa'ida a wannan yanki saboda yana taimaka wa mutane bayan bugun jini don ci gaba ta matakan dawo da mota.[71][72] Twitchell da Brunnstrom ne suka bayyana waɗannan matakan, kuma ana iya kiran su da Hanyar Brunnstrom.[7] [73] Da farko, mutanen da suka biyo bayan bugun jini suna da gurguwar gurguzu.[71] Yayin da farfadowa ya fara, kuma yana ci gaba, haɗin gwiwar motsi na asali zai bunkasa zuwa mafi hadaddun motsi da wahala.[7][73] A lokaci guda, spasticity na iya tasowa kuma ya zama mai tsanani kafin ya fara raguwa (idan ya yi gaba daya)[7][73]. Ko da yake gaba ɗaya tsarin dawo da mota ya wanzu, akwai sauye-sauye da yawa tsakanin dawo da kowane mutum. Kamar yadda aka bayyana a baya, rawar spasticity a gyaran bugun jini yana da rikici. Duk da haka, ilimin motsa jiki na iya taimakawa wajen inganta aikin motsa jiki, a wani ɓangare, ta hanyar kula da spasticity.[74] Horon aikin maimaitawa (RTT), wanda ya haɗa da aiki mai aiki na takamaiman ayyukan motsa jiki, yana haɓaka aikin babba da na ƙasa, tare da ci gaba da ci gaba na watanni 6 bayan jiyya. Ana buƙatar ƙarin bincike akan nau'in da adadin horon[75].

Ciwon kai wanda ba a magance shi ba zai haifar da kula da yanayin hutawa mara kyau wanda zai haifar da samuwar kwangila.[74] A hannu, wannan na iya tsoma baki tare da tsaftar hannu da sutura, yayin da a cikin kafa, yanayin hutawa mara kyau na iya haifar da wahalar canja wuri. Domin taimakawa wajen sarrafa spasticity, aikin motsa jiki ya kamata ya mayar da hankali kan gyara ko rage sautin tsoka.[71] Dabarun sun haɗa da tattara gaɓoɓin da abin ya shafa a farkon gyarawa, tare da haɓaka tsokar spastic da ci gaba da mikewa.[71] Bugu da kari, dabarar jujjuyawar rhythmic na iya taimakawa wajen haɓaka kewayon farko.[71] Kunna antagonist (tsoka) a cikin jinkirin motsi da sarrafawa hanya ce ta horarwa mai fa'ida wacce mutane bayan bugun jini za su iya amfani da su.[74]

Magungunan baka

Magungunan baka da ake amfani da su don maganin spasticity sun haɗa da: diazepam (Valium), dantrolene sodium, baclofen, tizanidine, clonidine, gabapentin, [60][62][63] har ma da mahadi irin na cannabinoid. ba a fahimta sosai ba, amma ana tunanin su yi aiki akan neurotransmitters ko neuromodulators a cikin tsarin juyayi na tsakiya (CNS) ko tsoka da kanta, ko don rage ƙaddamarwa. Matsalolin waɗannan magungunan shine yuwuwar illolinsu da kuma gaskiyar cewa, ban da rage raɗaɗi ko ɓarna spasms da matsayi na dystonic, kwayoyi gabaɗaya ba a nuna su don rage nakasu ko rage nakasa ba.[77]

Allurai
Allura sune jiyya mai mahimmanci da ake gudanarwa kai tsaye a cikin tsokar spastic. Magungunan da ake amfani da su sun haɗa da: Botulinum toxin (BTX), phenol, barasa, da lidocaine.[60][62][63] Phenol da barasa suna haifar da lalacewar tsoka ta gida ta hanyar hana furotin, kuma don haka shakatawa tsoka. Botulinum toxin ne neurotoxin kuma yana sassauta tsoka ta hanyar hana sakin wani neurotransmitter (acetylcholine). Yawancin bincike sun nuna fa'idodin BTX [60] kuma an nuna cewa maimaita allura na BTX yana nuna tasirin da ba ya canzawa.[78]

Tiyata
Maganin tiyata don spasticity ya haɗa da tsawo ko sakin tsoka da tsoka, hanyoyin da suka shafi ƙasusuwa, da kuma zaɓin rhizotomy na dorsal.[62][63]. Rhizotomy, yawanci ana ajiye shi don matsanancin spasticity, ya haɗa da yanke tushen jijiya mai zaɓaɓɓu, saboda wataƙila suna taka rawa wajen haifar da spasticity.

 Manazarta