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Halliwick Yönteminin İnmeli Geriatrik Hastada Denge ve Fonksiyonel Düzey Üzerine Etkileri

Yıl 2020, Cilt: 5 Sayı: 1, 41 - 45, 31.01.2020

Barış Gürpınar Hülya Tuna Özgür Bozan Nursen İlçin

Öz



Halliwick Yönteminin İnmeli Geriatrik Hastada Denge ve
Fonksiyonel Düzey Üzerine Etkileri

 

Özet

Bu çalışmanın amacı inmeli geriatrik bir olguda Halliwick yönteminin denge ve fonksiyonel düzey üzerine etkilerini incelemektir. Kronik iskemik inme tanılı konvansiyonel tedaviye uyum sağlayamamış ve bağımlılık düzeyi artmış 82 yaşında bir kadın hasta olgu olarak seçildi. Olgunun fonksiyonel düzeyi Zamanlı Kalk Yürü Testi (ZKY) ile denge düzeyi Berg Denge Ölçeği (BDÖ) ile ve günlük yaşam aktivitelerindeki bağımsızlık düzeyi ise Barthel İndeksiyle değerlendirildi. Olguya sekiz hafta boyunca haftada iki gün 45 dakika, 1.30 cm derinliğinde ve 320 C sıcaklığında bir havuzda Halliwick yönteminin zihinsel uyum ve farklı rotasyon kontrol adımları uygulandı. Yapılan ilk değerlendirmede olgunun ZKY testi 102 saniye, BDÖ ve Barthel İndeksinin sonuçları ise sırasıyla 6 ve 15 puan olarak kaydedildi. Olgu; tedavi sonrasında ZKY testini 80 saniyede tamamlarken, BDÖ’den 16 puan, Bathel İndeksin’den ise 40 puan aldı.

Halliwick yöntemi bu olguda herhangi bir yan etki oluşturmadan güvenle uygulanmıştır. Bununla birlikte uygulanan tedavi sonrası olgunun gövde kontrolü ve dengesinde anlamlı gelişmelere neden olmuştur.

Anahtar
Kelimeler: Halliwick, İnme, Geriatri, İmmobil

 


The Effects of the Halliwick Method on Balance and Functional Level in a Immobile Stroke Geriatric Case 

 

Abstract

The purpose of this study is to examine the effects of the Halliwick method on balance and functional level in a immobile stroke geriatric case. An 82-year-old woman with a diagnosis of chronic ischemic stroke was unable to adapt conventional treatment, and her independency decreased. She received Halliwick exercise for 45-minutes two days per week in eight weeks. Timed Up and Go (TUG) test was used for functional level, balance was evaluated with Berg Balance Scale (BBS) and Barthel was used to measure performance in activities of daily living. Mental adjustment and variation of rotational control steps of Halliwick method were used in a 1.30 cm depth and 320 C the water temperature pool. In the initial assessment the scores of TUG test was 102 seconds whereas BBS and Barthel index were 6 and 15 consecutively. Following the treatment TUG test was completed in 80 seconds, while BBS and Barthel scores were 16 and 40.

Aquatic treatment methods have been applied safely without any side effect in this case. Additionally the trunk control and balance of the case were significantly increased.


Keywords: Halliwick, Stroke, Geriatrics, Immobile.

Anahtar Kelimeler

Halliwick İnme Geriatri immobil

Kaynakça

  • Andersson, Åsa G, Kamwendo, Kitty, & Appelros, Peter. (2008). Fear of falling in stroke patients: relationship with previous falls and functional characteristics. International Journal of Rehabilitation Research, 31(3), 261-264.
  • Becker, B. E. (2009). Aquatic therapy: scientific foundations and clinical rehabilitation applications. PM R, 1(9), 859-872. doi: 10.1016/j. pmrj.2009.05.017
  • Becker, Bruce E, Hildenbrand, Kasee, Whitcomb, Rebekah K, & Sanders, James P. (2009). Biophysiologic effects of warm water immersion. International Journal of Aquatic Research and Education, 3(1), 24-37.
  • Berg, Katherine, Wood-Dauphine, Sharon, Williams, JI, & Gayton, David. (1989). Measuring balance in the elderly: preliminary development of an instrument. Physiotherapy Canada, 41(6), 304-311.
  • Carolei, Antonio, Marini, Carmine, Di Napoli, Mario, Di Gianfilippo, Giacinto, Santalucia, Paola, Baldassarre, Massimo, Di Orio, Ferdinando. (1997). High stroke incidence in the prospective community-based L’Aquila registry (1994–1998): first year’s results. Stroke, 28(12), 2500-2506.
  • Cha, Hyun-Gyu, Shin, Young-Jun, & Kim, Myoung-Kwon. (2017). Effects of the Bad Ragaz Ring Method on muscle activation of the lower limbs and balance ability in chronic stroke: A randomised controlled trial. Hong Kong Physiotherapy Journal, 37, 39-45.
  • Cole, Andrew J, & Becker, Bruce E. (2004). Comprehensive aquatic therapy: Butterworth-Heinemann.
  • Dehlendorff, Christian, Andersen, Klaus Kaae, & Olsen, Tom Skyhøj. (2014). Early case‐fatality rates in elderly stroke patients do not increase when age increases. Geriatrics & gerontology international, 14(4), 786-792.
  • Feigin, Valery L, Lawes, Carlene MM, Bennett, Derrick A, & Anderson, Craig S. (2003). Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. The Lancet Neurology, 2(1), 43-53.
  • Flansbjer, Ulla-Britt, Blom, Johanna, & Brogårdh, Christina. (2012). The reproducibility of Berg Balance Scale and the Single-leg Stance in chronic stroke and the relationship between the two tests. PM&R, 4(3), 165-170.
  • Furnari, Anna, Calabrò, Rocco Salvatore, Gervasi, Giuseppe, La FauciBelponer, Francesca, Marzo, Antonio, Berbiglia, Fabio, Bramanti, Placido. (2014). Is hydrokinesitherapy effective on gait and balance in patients with stroke? A clinical and baropodometric investigation. Brain injury, 28(8), 1109-1114.
  • Grosse, Susan J. (2001). The halliwick method: applications for individuals with orthopedic conditions. Aquatic Consulting & Education Resource Services.
  • Han, Seul Ki, Kim, Myung Chul, & An, Chang Sik. (2013). Comparison of effects of a proprioceptive exercise program in water and on land the balance of chronic stroke patients. Journal of physical therapy science, 25(10), 1219-1222.
  • Hiengkaew, Vimonwan, Jitaree, Khanitha, & Chaiyawat, Pakaratee. (2012). Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed “Up & Go” Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone. Archives of physical medicine and rehabilitation, 93(7), 1201-1208.
  • Hsieh, Yu-Wei, Wang, Chun-Hou, Wu, Shwu-Chong, Chen, Pau-Chung, Sheu, Ching-Fan, & Hsieh, Ching-Lin. (2007). Establishing the minimal clinically important difference of the Barthel Index in stroke patients. Neurorehabilitation and neural repair, 21(3), 233- 238.
  • Johan Lambeck, BPT, Stanat, Fran Coffey, Kinnaird, Douglas W, & NCTMB, ATRIC. (2004). The Halliwick Concept. Comprehensive Aquatic Therapy, 73.
  • Kelly, B. T., Roskin, L. A., Kirkendall, D. T., & Speer, K. P. (2000). Shoulder muscle activation during aquatic and dry land exercises in nonimpaired subjects. J Orthop Sports Phys Ther, 30(4), 204-210. doi: 10.2519/jospt.2000.30.4.204
  • Kim, Suk Bum, & O’sullivan, David Michael. (2013). Effects of aqua aerobic therapy exercise for older adults on muscular strength, agility and balance to prevent falling during gait. Journal of physical therapy science, 25(8), 923-927.
  • Kucukdeveci, AA, Yavuzer, Günes, Tennant, Alan, Suldur, N, Sonel, Birkan, & Arasil, Tansu. (2000). Adaptation of the modified Barthel Index for use in physical medicine and rehabilitation in Turkey. Scandinavian journal of rehabilitation medicine, 32(2), 87-92.
  • Langhorne, Peter, Bernhardt, Julie, & Kwakkel, Gert. (2011). Stroke rehabilitation. The Lancet, 377(9778), 1693-1702.
  • Mahoney, F. I., & Barthel, D. W. (1965). Functional evaluation: The Barthel Index. Md State Med J, 14, 61-65.
  • Marinho-Buzelli, A. R., Bonnyman, A. M., & Verrier, M. C. (2015). The effects of aquatic therapy on mobility of individuals with neurological diseases: a systematic review. Clin Rehabil, 29(8), 741-751. doi:10.1177/0269215514556297
  • Mehrholz, J., Kugler, J., & Pohl, M. (2011). Water-based exercises for improving activities of daily living after stroke. Cochrane database of systematic reviews (Online), 1.
  • Methajarunon, Pichanan, Eitivipart, Chachris, Diver, Claire J., & Foongchomcheay, Anchalee. (2016). Systematic review of published studies on aquatic exercise for balance in patients with multiple sclerosis, Parkinson’s disease, and hemiplegia. Hong Kong Physiotherapy Journal, 35, 12-20. doi: https://doi.org/10.1016/j. hkpj.2016.03.002
  • Montagna, Jéssica Cristine, Santos, Bárbara C, Battistuzzo, Camila R, & Loureiro, Ana Paula C. (2014). Effects of aquatic physiotherapy on the improvement of balance and corporal symmetry in stroke survivors. International journal of clinical and experimental medicine, 7(4), 1182.
  • Noh, Dong Koog, Lim, Jae-Young, Shin, Hyung-Ik, & Paik, Nam-Jong. (2008). The effect of aquatic therapy on postural balance and muscle strength in stroke survivors—a randomized controlled pilot trial. Clinical Rehabilitation, 22(10-11), 966-976.
  • Paolucci, Stefano, Antonucci, Gabriella, Troisi, Elio, Bragoni, Maura, Coiro, Paola, De Angelis, Domenico, . . . Grasso, Maria Grazia. (2003). Aging and stroke rehabilitation. Cerebrovascular Diseases, 15(1-2), 98-105.
  • Park, Byoung-Sun, Noh, Ji-Woong, Kim, Mee-Young, Lee, Lim-Kyu, Yang, Seung-Min, Lee, Won-Deok, . . . Kwak, Taek-Yong. (2016). A comparative study of the effects of trunk exercise program in aquatic and land-based therapy on gait in hemiplegic stroke patients. Journal of Physical Therapy Science, 28(6), 1904-1908.
  • Park, Jungseo, & Roh, Hyolyun. (2011). Postural balance of stroke survivors in aquatic and land environments. Journal of Physical Therapy Science, 23(6), 905-908.
  • Podsiadlo, Diane, & Richardson, Sandra. (1991). The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. Journal of the American geriatrics Society, 39(2), 142-148.
  • Shumway-Cook, Anne, Brauer, Sandy, & Woollacott, Marjorie. (2000). Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Physical therapy, 80(9), 896- 903.
  • Skinner, Alison, & Thomson, Ann. (2008). Aquatics Therapy and the Halliwick Concept. Exceptional Parent, 38(7), 76-77.
  • Sun, Jia-Hao, Tan, Lan, & Yu, Jin-Tai. (2014). Post-stroke cognitive impairment: epidemiology, mechanisms and management. Annals of translational medicine, 2(8).
  • Tripp, Florian, & Krakow, Karsten. (2014). Effects of an aquatic therapy approach (Halliwick-Therapy) on functional mobility in subacute stroke patients: a randomized controlled trial. Clinical rehabilitation, 28(5), 432-439.
  • Winstein, Carolee J, Stein, Joel, Arena, Ross, Bates, Barbara, Cherney, Leora R, Cramer, Steven C, . . . Harvey, Richard L. (2016). Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke, 47(6), e98-e169.

Yıl 2020, Cilt: 5 Sayı: 1, 41 - 45, 31.01.2020

Barış Gürpınar Hülya Tuna Özgür Bozan Nursen İlçin

Öz

Kaynakça

  • Andersson, Åsa G, Kamwendo, Kitty, & Appelros, Peter. (2008). Fear of falling in stroke patients: relationship with previous falls and functional characteristics. International Journal of Rehabilitation Research, 31(3), 261-264.
  • Becker, B. E. (2009). Aquatic therapy: scientific foundations and clinical rehabilitation applications. PM R, 1(9), 859-872. doi: 10.1016/j. pmrj.2009.05.017
  • Becker, Bruce E, Hildenbrand, Kasee, Whitcomb, Rebekah K, & Sanders, James P. (2009). Biophysiologic effects of warm water immersion. International Journal of Aquatic Research and Education, 3(1), 24-37.
  • Berg, Katherine, Wood-Dauphine, Sharon, Williams, JI, & Gayton, David. (1989). Measuring balance in the elderly: preliminary development of an instrument. Physiotherapy Canada, 41(6), 304-311.
  • Carolei, Antonio, Marini, Carmine, Di Napoli, Mario, Di Gianfilippo, Giacinto, Santalucia, Paola, Baldassarre, Massimo, Di Orio, Ferdinando. (1997). High stroke incidence in the prospective community-based L’Aquila registry (1994–1998): first year’s results. Stroke, 28(12), 2500-2506.
  • Cha, Hyun-Gyu, Shin, Young-Jun, & Kim, Myoung-Kwon. (2017). Effects of the Bad Ragaz Ring Method on muscle activation of the lower limbs and balance ability in chronic stroke: A randomised controlled trial. Hong Kong Physiotherapy Journal, 37, 39-45.
  • Cole, Andrew J, & Becker, Bruce E. (2004). Comprehensive aquatic therapy: Butterworth-Heinemann.
  • Dehlendorff, Christian, Andersen, Klaus Kaae, & Olsen, Tom Skyhøj. (2014). Early case‐fatality rates in elderly stroke patients do not increase when age increases. Geriatrics & gerontology international, 14(4), 786-792.
  • Feigin, Valery L, Lawes, Carlene MM, Bennett, Derrick A, & Anderson, Craig S. (2003). Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. The Lancet Neurology, 2(1), 43-53.
  • Flansbjer, Ulla-Britt, Blom, Johanna, & Brogårdh, Christina. (2012). The reproducibility of Berg Balance Scale and the Single-leg Stance in chronic stroke and the relationship between the two tests. PM&R, 4(3), 165-170.
  • Furnari, Anna, Calabrò, Rocco Salvatore, Gervasi, Giuseppe, La FauciBelponer, Francesca, Marzo, Antonio, Berbiglia, Fabio, Bramanti, Placido. (2014). Is hydrokinesitherapy effective on gait and balance in patients with stroke? A clinical and baropodometric investigation. Brain injury, 28(8), 1109-1114.
  • Grosse, Susan J. (2001). The halliwick method: applications for individuals with orthopedic conditions. Aquatic Consulting & Education Resource Services.
  • Han, Seul Ki, Kim, Myung Chul, & An, Chang Sik. (2013). Comparison of effects of a proprioceptive exercise program in water and on land the balance of chronic stroke patients. Journal of physical therapy science, 25(10), 1219-1222.
  • Hiengkaew, Vimonwan, Jitaree, Khanitha, & Chaiyawat, Pakaratee. (2012). Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed “Up & Go” Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone. Archives of physical medicine and rehabilitation, 93(7), 1201-1208.
  • Hsieh, Yu-Wei, Wang, Chun-Hou, Wu, Shwu-Chong, Chen, Pau-Chung, Sheu, Ching-Fan, & Hsieh, Ching-Lin. (2007). Establishing the minimal clinically important difference of the Barthel Index in stroke patients. Neurorehabilitation and neural repair, 21(3), 233- 238.
  • Johan Lambeck, BPT, Stanat, Fran Coffey, Kinnaird, Douglas W, & NCTMB, ATRIC. (2004). The Halliwick Concept. Comprehensive Aquatic Therapy, 73.
  • Kelly, B. T., Roskin, L. A., Kirkendall, D. T., & Speer, K. P. (2000). Shoulder muscle activation during aquatic and dry land exercises in nonimpaired subjects. J Orthop Sports Phys Ther, 30(4), 204-210. doi: 10.2519/jospt.2000.30.4.204
  • Kim, Suk Bum, & O’sullivan, David Michael. (2013). Effects of aqua aerobic therapy exercise for older adults on muscular strength, agility and balance to prevent falling during gait. Journal of physical therapy science, 25(8), 923-927.
  • Kucukdeveci, AA, Yavuzer, Günes, Tennant, Alan, Suldur, N, Sonel, Birkan, & Arasil, Tansu. (2000). Adaptation of the modified Barthel Index for use in physical medicine and rehabilitation in Turkey. Scandinavian journal of rehabilitation medicine, 32(2), 87-92.
  • Langhorne, Peter, Bernhardt, Julie, & Kwakkel, Gert. (2011). Stroke rehabilitation. The Lancet, 377(9778), 1693-1702.
  • Mahoney, F. I., & Barthel, D. W. (1965). Functional evaluation: The Barthel Index. Md State Med J, 14, 61-65.
  • Marinho-Buzelli, A. R., Bonnyman, A. M., & Verrier, M. C. (2015). The effects of aquatic therapy on mobility of individuals with neurological diseases: a systematic review. Clin Rehabil, 29(8), 741-751. doi:10.1177/0269215514556297
  • Mehrholz, J., Kugler, J., & Pohl, M. (2011). Water-based exercises for improving activities of daily living after stroke. Cochrane database of systematic reviews (Online), 1.
  • Methajarunon, Pichanan, Eitivipart, Chachris, Diver, Claire J., & Foongchomcheay, Anchalee. (2016). Systematic review of published studies on aquatic exercise for balance in patients with multiple sclerosis, Parkinson’s disease, and hemiplegia. Hong Kong Physiotherapy Journal, 35, 12-20. doi: https://doi.org/10.1016/j. hkpj.2016.03.002
  • Montagna, Jéssica Cristine, Santos, Bárbara C, Battistuzzo, Camila R, & Loureiro, Ana Paula C. (2014). Effects of aquatic physiotherapy on the improvement of balance and corporal symmetry in stroke survivors. International journal of clinical and experimental medicine, 7(4), 1182.
  • Noh, Dong Koog, Lim, Jae-Young, Shin, Hyung-Ik, & Paik, Nam-Jong. (2008). The effect of aquatic therapy on postural balance and muscle strength in stroke survivors—a randomized controlled pilot trial. Clinical Rehabilitation, 22(10-11), 966-976.
  • Paolucci, Stefano, Antonucci, Gabriella, Troisi, Elio, Bragoni, Maura, Coiro, Paola, De Angelis, Domenico, . . . Grasso, Maria Grazia. (2003). Aging and stroke rehabilitation. Cerebrovascular Diseases, 15(1-2), 98-105.
  • Park, Byoung-Sun, Noh, Ji-Woong, Kim, Mee-Young, Lee, Lim-Kyu, Yang, Seung-Min, Lee, Won-Deok, . . . Kwak, Taek-Yong. (2016). A comparative study of the effects of trunk exercise program in aquatic and land-based therapy on gait in hemiplegic stroke patients. Journal of Physical Therapy Science, 28(6), 1904-1908.
  • Park, Jungseo, & Roh, Hyolyun. (2011). Postural balance of stroke survivors in aquatic and land environments. Journal of Physical Therapy Science, 23(6), 905-908.
  • Podsiadlo, Diane, & Richardson, Sandra. (1991). The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. Journal of the American geriatrics Society, 39(2), 142-148.
  • Shumway-Cook, Anne, Brauer, Sandy, & Woollacott, Marjorie. (2000). Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Physical therapy, 80(9), 896- 903.
  • Skinner, Alison, & Thomson, Ann. (2008). Aquatics Therapy and the Halliwick Concept. Exceptional Parent, 38(7), 76-77.
  • Sun, Jia-Hao, Tan, Lan, & Yu, Jin-Tai. (2014). Post-stroke cognitive impairment: epidemiology, mechanisms and management. Annals of translational medicine, 2(8).
  • Tripp, Florian, & Krakow, Karsten. (2014). Effects of an aquatic therapy approach (Halliwick-Therapy) on functional mobility in subacute stroke patients: a randomized controlled trial. Clinical rehabilitation, 28(5), 432-439.
  • Winstein, Carolee J, Stein, Joel, Arena, Ross, Bates, Barbara, Cherney, Leora R, Cramer, Steven C, . . . Harvey, Richard L. (2016). Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke, 47(6), e98-e169.
Toplam 35 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Olgu Sunumu
Yazarlar

Barış Gürpınar 0000-0003-3886-4819

Hülya Tuna Bu kişi benim 0000-0002-7093-7670

Özgür Bozan Bu kişi benim 0000-0001-8395-638X

Nursen İlçin 0000-0003-0174-8224

Yayımlanma Tarihi 31 Ocak 2020
Gönderilme Tarihi 28 Haziran 2018
Yayımlandığı Sayı Yıl 2020 Cilt: 5 Sayı: 1

Kaynak Göster

APA Gürpınar, B., Tuna, H., Bozan, Ö., İlçin, N. (2020). Halliwick Yönteminin İnmeli Geriatrik Hastada Denge ve Fonksiyonel Düzey Üzerine Etkileri. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, 5(1), 41-45.
AMA Gürpınar B, Tuna H, Bozan Ö, İlçin N. Halliwick Yönteminin İnmeli Geriatrik Hastada Denge ve Fonksiyonel Düzey Üzerine Etkileri. İKÇÜSBFD. Ocak 2020;5(1):41-45.
Chicago Gürpınar, Barış, Hülya Tuna, Özgür Bozan, ve Nursen İlçin. “Halliwick Yönteminin İnmeli Geriatrik Hastada Denge Ve Fonksiyonel Düzey Üzerine Etkileri”. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 5, sy. 1 (Ocak 2020): 41-45.
EndNote Gürpınar B, Tuna H, Bozan Ö, İlçin N (01 Ocak 2020) Halliwick Yönteminin İnmeli Geriatrik Hastada Denge ve Fonksiyonel Düzey Üzerine Etkileri. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 5 1 41–45.
IEEE B. Gürpınar, H. Tuna, Ö. Bozan, ve N. İlçin, “Halliwick Yönteminin İnmeli Geriatrik Hastada Denge ve Fonksiyonel Düzey Üzerine Etkileri”, İKÇÜSBFD, c. 5, sy. 1, ss. 41–45, 2020.
ISNAD Gürpınar, Barış vd. “Halliwick Yönteminin İnmeli Geriatrik Hastada Denge Ve Fonksiyonel Düzey Üzerine Etkileri”. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 5/1 (Ocak 2020), 41-45.
JAMA Gürpınar B, Tuna H, Bozan Ö, İlçin N. Halliwick Yönteminin İnmeli Geriatrik Hastada Denge ve Fonksiyonel Düzey Üzerine Etkileri. İKÇÜSBFD. 2020;5:41–45.
MLA Gürpınar, Barış vd. “Halliwick Yönteminin İnmeli Geriatrik Hastada Denge Ve Fonksiyonel Düzey Üzerine Etkileri”. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, c. 5, sy. 1, 2020, ss. 41-45.
Vancouver Gürpınar B, Tuna H, Bozan Ö, İlçin N. Halliwick Yönteminin İnmeli Geriatrik Hastada Denge ve Fonksiyonel Düzey Üzerine Etkileri. İKÇÜSBFD. 2020;5(1):41-5.
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