Yutma Bozukluklarında Telesağlık Uygulamaları

Yutma bozukluğu birçok hasta grubunu etkileyebilen ve yarattığı komplikasyonlar nedeniyle erken dönemde sağlık hizmetlerine erişim gerektiren bir durumdur. Uzaklık, ekonomik kısıtlılıklar, hastalara ait hareket engeli, pandemi gibi bulaş riski yüksek durumlar yutma değerlendirmesi ve tedavisine erişimde engellere sebep olabilmektedir. Bu nedenle günümüzde, yutma bozukluklarında tele-sağlık uygulamalarının önemi artmıştır. Tele-sağlık uygulamaları hastalara bilgi ve iletişim teknolojileri kullanarak uzak mesafeden sağlık hizmeti sağlanmasını ifade etmektedir. Bu uygulamalar yutma bozukluklarının değerlendirme ve tedavisinde hastalar ve klinisyenler açısından kolaylık sağlayabildiği gibi sağlık harcamalarında ciddi ölçüde azalmaya sebep olmaktadır. Tele-değerlendirme, klinik ve aletsel yutma değerlendirme basamaklarının çevrimiçi ortama adapte edilmesi yolu ile yapılabilmektedir. Farklı hasta gruplarında yapılan tele-değerlendirme çalışmalarında hasta memnuniyet düzeyleri ve yüz yüze değerlendirmeyle uyumun yüksek olduğu görülmektedir. Tele-rehabilitasyon alanında yapılan çalışmalar az sayıda olsa da klinisyenlere yol göstermesi açısından ümit vericidir. Sonuç olarak, yutma bozukluklarında tele-sağlık uygulamaları gelişmekte olan bir alan olup bu alanda yapılan çalışmaların standardizasyona, yaygınlaştırılmaya ve kanıt düzeylerinin artırılmasına ihtiyaç vardır.Dysphagia is a condition that can affect several patient groups, and requires access to health in the early period due to its complications. Distance, economical constraints, patients mobility obstacles, high risk of transmission such as pandemic may cause obstacles in accessing dysphagia assesment and treatment. Therefore, recently the importance of tele-health practices in dysphagia has increased. Tele-health practices refers to providing healthcare services to patients remotely by using information and communication technologies. These practices can provide convenience for patients and clinicians in the evaluation and treatment of dysphagia, as well as causing a significant reduction in health expenditures. Tele-assessment is performed by adapting clinical and instrumental swallowing assessment steps to online environment. In teleassessment studies conduction in different patient groups, patients’ satisfaction levels and agreement with face to face assessments were found to be high. Although there are few studies in tele-rehabilitation, it is promising to guide clinicians. In conclusion, tele-health practices in dysphagia is a developing field, and there is a need for standardization, dissemination and increasing the level of evidence in the field

The Status of Dysphagia Clinics During the COVID-19 Pandemic.

The study aimed to determine the status of dysphagia clinics and procedures applied in dysphagia clinics during the COVID-19 pandemic. Clinicians working in an outpatient dysphagia clinic were included. A 30-question survey inquiring about the descriptive information of the participants and their clinics, their clinical practice, and the tele-health applications during the COVID-19 pandemic. The survey was administered via Google forms. The participants were asked to fill out the survey on behalf of their clinics. One survey was completed per dysphagia clinic. Twenty-three clinicians responded on behalf of their clinics. The number of patients and dysphagia evaluations decreased during the COVID-19 pandemic (p < 0.05). The COVID-19 screening procedures mostly performed before dysphagia evaluations were temperature check (n = 14, 60.9%), nasopharyngeal swab test (n = 9, 39.1%), anamnestic risk assessment (n = 6, 26.1%), and saturation test (n = 6, 26.1%). Protective equipments mostly used while dysphagia evaluations were surgical mask, FFP3 mask, standard gloves, glasses, and face shield. It was found that 69.6% (n = 16) of the dysphagia clinics were reported to be suitable for working under pandemic conditions, and 30.4% (n = 7) were reported to be unsuitable. The use of tele-health applications significantly increased from 13.0% (n = 3) to 52.2% (n = 12) (p = 0.003). The present study provides a general overview of the status of dysphagia clinics and procedures applied in dysphagia clinics during the COVID-19 pandemic period. The study showed that working conditions, the number of patients, and the total number of evaluations have changed throughout the pandemic, and the use of tele-health applications increased

The Relationship Between Patient Reported Dysphagia Symptom Severity And Swallowing Related Quality Of Life In Patients With Neurological Disorders

Objective: The aim of this study was to determine the relationship between patient reported dysphagia symptom severity and swallowing related quality of life (SRQOL) in patients with neurological disorders. Methods: Patients with a diagnosis of neurological disorders who aged between 25 to 60 years were included. The dysphagia symptom severity was assessed with the Turkish Eating Assessment Tool (T-EAT-10). SRQOL was assessed by the Turkish version of the Swallow Quality of Life Questionnaire (T-SWAL-QOL). Results: Eighty-four patients with neurological disorder were included. The mean T-EAT-10 score was 19.59 +/- 11.16 (min = 0, max = 40), and the mean total score of T-SWAL-QOL was 50.63 +/- 23.52 (min = 0, max = 90). A negative, good, statistically significant correlation between T-EAT-10 and total T-SWAL-QOL was found (p < 0.05). Conclusion: Higher patient reported dysphagia symptom severity is associated with lower scores of SRQOL. Therefore, appropriate management strategies which also focus on patient reported symptoms may be necessary to minimize negative SRQOL issues of patients with neurogenic dysphagia.Wo

The Effects of Different Exercise Trainings on Suprahyoid Muscle Activation, Tongue Pressure Force and Dysphagia Limit in Healthy Subjects.

Suprahyoid muscle activation and tongue pressure force play a critical role for swallowing function. In addition, dysphagia limit is one of most important factors indicating swallowing efficiency. The purpose of this study was to compare the effects of 8-week training sessions of three different exercises including chin tuck against resistance (CTAR), Shaker exercises and chin tuck exercise with theraband on suprahyoid muscle activity, anterior tongue pressure and dysphagia limit in healthy subjects. Thirty-six healthy volunteers aged between 18 and 40 years who scored below 3 points from Turkish version of Eating Assessment Tool (T-EAT-10) were included in the study, and all participants were divided into three groups randomly. Maximal suprahyoid muscle activations and dysphagia limit of participants were assessed by superficial electromyography. CTAR and chin tuck exercise with theraband increased the maximum suprahyoid muscle activation (p = 0.004, p = 0.018), whereas Shaker exercise did not increase maximal suprahyoid muscle activation (p = 0.507) after exercise training. CTAR and chin tuck exercise with theraband increased tongue pressure (p = 0.045, p = 0.041), while Shaker exercise did not increase anterior tongue pressure (p = 0.248). There was no statistically significant difference in dysphagia limits in three groups between before and after exercise training (p > 0.05). As a result, although CTAR seems to be the most effective exercise in most parameters, chin tuck exercise with theraband can also be used as an alternative to CTAR to improve suprahyoid muscle activity and tongue pressure

The Ability of the Eating Assessment Tool-10 to Detect Aspiration in Patients with Neurological Disorders

Background/Aims Dysphagia is common in patients with neurological disorders. There is a need to identify patients at risk early by a useful clinical tool to prevent its serious complications. The study aims to determine the ability of the Turkish version of Eating Assessment Tool-10 (T-EAT-10) to detect aspiration in patients with neurological disorders. Methods Two hundred fifty-nine patients with neurological disorders who had complaints about swallowing difficulty and referred for a swallowing evaluation were included. Oropharyngeal dysphagia was evaluated with the T-EAT-10 and videofluoroscopic swallowing study in the same day. The penetration-aspiration scale (PAS) was used to document the penetration and aspiration severity. Results The mean age of the patients was 59.72 ± 17.24 years (minimum [min] = 18, maximum [max] = 96), of which 57.1% were male. The mean T-EAT-10 of patients who had aspiration (PAS > 5) was 25.91 ± 10.31 (min = 1, max = 40) and the mean T-EAT-10 of patients who did not have aspiration (PAS < 6) was 15.70 ± 10.54 (min = 0, max = 40) (P < 0.001). Patients with a T-EAT-10 score higher than 15 were 2.4 times more likely to aspirate. A linear correlation was found between T-EAT-10 and PAS scores of the patients (r = 0.416, P < 0.001). The sensitivity of a T-EAT-10 higher than 15 in detecting aspiration was 81.0% and the specificity was 58.0%. A T-EAT-10 score of higher than 15 has a positive predictive value of 72.0% and a negative predictive value of 69.0%. Conclusion The T-EAT-10 can be used to detect unsafe airway protection in neurology clinics to identify and refer dysphagic patients for further evaluation.PubMedWoSScopu

A Description of Oral and Swallowing Characteristics in Pediatric Patients with Neuromuscular Diseases

Objective: The aim of our study was to put forth the existing problems about oral structure/function and swallowing function in patients with different pediatric neuromuscular diseases. Methods: Forty-five pediatric patients with NMD's aged 10.22 +/- 3.32 years were included in the study. Oral intake levels of patients were determined with Functional Oral Intake Scale. Oral structural and functional examination, assessment of complaints related to swallowing problems, and three-ounce water swallow test were performed to all patients. Results: In oral assessment, structural problems were determined at varying rates between 13.3% and 46.6%, problems related to oral functions between %4.4 and 26.6%, and complaints related to swallowing problems between 11.1% to 33.3%. Five patients (%11) failed the three-ounce water swallow test. Conclusion: The findings related to oral structure/function and swallowing function indicate a risk of swallowing dysfunction with different symptoms and problems in neuromuscular diseases. These symptoms may result in life-threatening complications added to their current neuromuscular problems