Are sucking patterns and early spontaneous movements related to later developmental functioning outcomes? A cohort study.

Sucking patterns and early spontaneous movements have an important role in the determination of later developmental problems, but the relationship of the two together with long-term outcomes has not been investigated. The objectives of this study were to (i) examine the relationship between sucking patterns using the Neonatal Oral Motor Assessment Scale (NOMAS) and fidgety movements and other movement patterns using detailed General Movements Assessment (GMA), and (ii) investigate the relationship between these early assessment methods and developmental functioning outcomes at later ages. We analyzed the NOMAS from 34 weeks' postmenstrual age up to 10 weeks post-term and GMA between 9 and 20 weeks post-term age, and the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) was applied for the developmental functioning outcomes to 62 infants (61%, 62/102) between 12 and 42 months of age. Among 102 infants at-risk, 70 (69%) showed a normal sucking pattern, and 85 (83%) had fidgety movements. The median Motor Optimality Score-Revised (MOS-R), as determined by GMA, of all infants was 24. The NOMAS was related to the MOS-R and its subcategories (p < 0.05) in all infants at-risk. The NOMAS, MOS-R and its subcategories were also related to cognitive, language, and motor development at later ages according to Bayley-III (p < 0.05).   Conclusion: This longitudinal study showed that the quality of sucking patterns, fidgety movements, and MOS-R were related to later developmental functioning, indicating that abnormal sucking patterns, aberrant fidgety movements, and lower MOS-R might predict developmental disorders. What is Known: • Sucking patterns and early spontaneous movements in which central pattern generators play an important role are related. • Sucking patterns and early spontaneous movements might be used separately to predict developmental outcomes. What is New: • Sucking patterns and early spontaneous movements, when used together, were related to later developmental functioning, including cognitive, language, and motor development in at-risk infants. • Predictive value of sucking patterns was lower for each developmental functioning outcome than early spontaneous movements.

Is Chewing Performance Related to Dietary Intake in Children with Cerebral Palsy?

To examine the relationship between chewing performance and dietary intakes in children with Cerebral Palsy (CP). Forty children with CP aged between 2 and 6 years were included. The Karaduman Chewing Performance Scale (KCPS) and the Mastication Observation and Evaluation (T-MOE) instruments were used to evaluate chewing performance. Daily dietary intakes were measured from a 24-h food record with digital photographs including the amount and textures of all foods consumed during the meal. Chewing function was impaired in 70% of children. There was a negative low-to-moderate correlation between KCPS scores and daily protein intake (r = -0.32, p = 0.04), but not with energy and other macronutrients. The percentage of daily dietary intakes from 'liquid-blenderized' foods were positively correlated with KCPS, and negatively correlated with T-MOE scores (p < 0.001). There was a significant negative association between the percentage of daily dietary intakes from 'easy to chew & regular solid' foods and KCPS scores, and a significant positive association was found with T-MOE scores. In conclusion, the amount of daily protein intake decreased, and daily intake ratios of energy and macronutrients from liquid-blenderized foods increased as chewing performance decreased in children with CP. Timely diagnosis and treatment of chewing dysfunction can serve as a useful treatment option to ensure adequate dietary intake in children with CP, and also to decrease the burden of their parents and improve their quality of life.

How do visual, auditory and motor dual-tasking each affect swallowing and chewing function?

BACKGROUND: It can be challenging to perform a second task at the same time as swallowing. OBJECTIVE(S): The study aimed to investigate the effect of visual, auditory and motor dual-tasking on swallowing and chewing function in healthy young adults. METHOD: Right-handed healthy adults without any psychological and cognitive problems were included in the study. Swallowing was evaluated based on the dysphagia limit in different liquid textures such as water and nectar consistencies, and chewing was evaluated by the Test of Masticating and Swallowing Solids. For the second task, visual and auditory performance was assessed using reaction time, and the motor performance was assessed using a bilateral tapping task. Assessments were performed in two steps: baseline and dual-task. For baseline, all evaluation methods were applied individually. After completing the baseline assessment, dual-task assessment were carried out the following day. For dual-task assessment, the swallowing and chewing tasks were performed simultaneously with visual, auditory and motor tasks. RESULTS: Results showed a significant decrease in dysphagia limit in the nectar consistency, and significant increase in chewing time, visual reaction time and tapping rate (right-left) when compared to baseline and dual-task conditions (χ2(3) = 9.61, p = .02; χ2(3) = 9.02, p = .02; χ2(3) = 28.09, p < .001; χ2(3) = 28.97, p < .001; χ2(3) = 21.56, p < .001, respectively). However, there were no differences in dysphagia limit in the water and auditory reaction time compared to baseline and dual-task conditions (χ2(3) = 3.18, p = .36; χ2(3) = 2.56, p = .50, respectively). CONCLUSION: Results shedding light on how simultaneous dual tasks can influence swallowing and chewing. Dual-tasking cause a decrease in both swallowing/chewing and the visual/motor performances. These results may provide valuable information for designing interventions or strategies aimed at improving or maintaining optimal swallowing and chewing during in various populations during daily life.

The effect of early childhood caries on chewing function and tolerated food texture levels in preschool children.

BACKGROUND: The early form of caries can affect solid food consumption. OBJECTIVE: The aim of the study was to evaluate the effect of oral health status on chewing performance, and tolerated food texture among preschool children suffering from early childhood caries (ECC). METHODS: A cross-sectional study was conducted with a sample of 109 children aged between 3 and 6 years, who were allocated to three groups (severe-ECC (s-ECC), ECC and control) on the basis of their caries. Chewing function was evaluated by using the 'Karaduman Chewing Performance Scale (KCPS)' and the Turkish version of the 'Mastication Observation and Evaluation instrument (T-MOE)', and the tolerated food texture was determined by the 'International Dysphagia Diet Standardization Initiative (IDDSI)'. Carious lesions, oral hygiene and gingival health status were evaluated by using the 'decayed, missing, filled tooth/surface indices (dmft/s)', 'plaque and gingival indices'; respectively. RESULTS: A total of 56 children (51.4%) had s-ECC, 39 (35.8%) had ECC and 14 (12.8%) had no caries (control group). KCPS showed that 26 (86.7%) children suffering from s-ECC were at level 1, and 11 (100%) children were at level 2. Seven (100%) children with s-ECC had IDDSI level-5. All children with healthy oral status had IDSSI level-7. Compared to the ECC and control groups, the s-ECC group had significantly lower scores from the T-MOE total and subscale scores (p < .001). CONCLUSION: The evaluation of chewing performance during routine dental examinations of children with ECC (especially s-ECC) may considerably contribute to the early diagnosis of chewing problems and the provision of necessary oral rehabilitation.

Chewing and swallowing training in Coffin-Lowry syndrome: A case report.

Chewing and Swallowing Training in Coffin-Lowry Syndrome: A Case Report.

Do We Know the Long-Term Effects of the Most Popular Traditional Swallow Maneuvers on the Submental Muscles?

BACKGROUND: Various trainings focus on the submental muscles (SMs) for dysphagia rehabilitation because of their importance for swallowing safety and efficiency. According to the current literature, swallow-specific tasks may be optimal exercises for dysphagia. The effortful swallow (ES) and the Masako maneuver (MM) are the most commonly used swallow-specific tasks in the clinical settings for dysphagia for years, but long-term effects for these trainings is insufficient. OBJECTIVES: This study aims to investigate and compare the effects of ES and MM on SM activity, strength and thickness. METHODS: Thirty-seven healthy adults were randomised to ES, MM and control groups, and ES and MM groups completed 6 weeks of swallowing training. Participants in both training groups performed a total of 120 swallows in each session, while control group did not participate in any swallowing training. Surface electromyography was used to evaluate SM activity, digital dynamometer for SM strength and ultrasonography for SM thickness. RESULTS: Both trainings did not change SM activity (p > 0.05), but increased SM strength (p < 0.05). MM increased the thickness of all SM (p < 0.05), and ES increased the thickness of mylohyoid (right, left) and digastric muscle (right) (p < 0.05), and there was no change in all evaluation parameters in the control group (p > 0.05). Also, trainings were not superior to each other in any parameter (p > 0.05). CONCLUSION: The results of this study provided new evidence to the literature to show that ES and MM trainings are effective for improving SM strength and thickness. Considering that SM is important in terms of swallowing safety and effectiveness, it is thought that both trainings may be promising by increasing the strength and mass of SM, especially in individuals with reduced SM strength and mass.

Oropharyngeal Dysphagia in Children with Eosinophilic Esophagitis.

Dysphagia is the most troublesome symptom of eosinophilic esophagitis (EoE). This study aimed to investigate oropharyngeal dysphagia in children with EoE and possible related factors. Children with a definite diagnosis of EoE were included in the study. Medical and feeding histories were recorded. A disease control level was determined for each child. An oral structure examination, the Turkish version of the Mastication and Observation Evaluation (T-MOE), the Pediatric version of the Eating Assessment Tool-10 (PEDI-EAT-10) and the 3-oz water swallow test were applied in screening for oropharyngeal dysphagia. Fifty-two children participated in the study. Oropharyngeal dysphagia took the form of abnormal swallowing (PEDI-EAT-10 score ≥ 4) and increased aspiration risk (PEDI- EAT-10 score ≥ 13) in 51.9% and 25.0% of the children, respectively. Seven children failed the 3-oz water swallow test. Abnormal swallowing and aspiration risk were significantly higher in children with prolonged mealtimes, impaired chewing function, and uncontrolled disease (p < 0.05). Chewing function was the most important risk factor for abnormal swallowing and increased aspiration (R2 = 0.36, R2 = 0.52, p < 0.001, respectively). Oropharyngeal dysphagia is common in children with EoE and associated with increased aspiration risk in a subpopulation. Uncontrolled disease, prolonged mealtimes, and impaired chewing function may provide clues for oropharyngeal dysphagia in EoE.

Dietary intakes of individuals with temporomandibular disorders: A comparative study.

OBJECTIVE: There are some studies regarding the potential effects of temporomandibular disorders (TMD) on food intake and eating habits, however the comparison of nutritional intakes and status of individuals with and without TMD have not been adequately reported. Thus, the study aimed to assess the dietary intakes of individuals with TMD, and investigate if there is a difference in nutritional intakes between healthy individuals with and without TMD. METHODS: Individuals were grouped as 'study group (with TMD)' versus 'control group (no TMD)' according to Fonseca Anamnestic Index. The Oral Health Impact Profile-14 (OHIP-14) was used to assess oral health-related quality of life. Chewing function was evaluated with the Test of Masticating and Swallowing Solids (TOMASS). A 24-h dietary recall method was used to measure daily dietary intakes of the participants, and daily energy, macro- and micronutrient intakes were calculated. In addition, all drinks and foods in dietary records were classified under a specific modification level as 'Liquid-blenderized', 'Minced-moist & soft' and 'Easy-to chew & regular solid foods'. RESULTS: The participants in the study group (30 participants) had higher OHIP-14 score (p < .01) than control group (30 participants). According to TOMASS, number of bites (p = .003) and total time (p = .007) were both higher in the study group than control group. There was no difference in the number of chewing cycles (p = .100) and number of swallowing (p = .764) between groups. No difference was detected between groups in terms of energy, protein, carbohydrate and fat intake. There was no significant difference between groups in mean percentage of energy and macronutrient intakes from modified and regular food textures (p > .05). CONCLUSION: This study showed that there was no difference between individuals with and without TMD in terms of dietary intakes. The study results suggest that nutritional status of individuals with TMD is similar with healthy individuals without TMD.

Surface electromyographic activity of submental muscles during different types of swallow-specific tasks: A comparative study.

BACKGROUND: Repetitive performance of a motor task has been proposed to increase the ability to perform that motor task. Therefore, exercise training including swallow-specific task may be an optimal training to improve swallowing function. OBJECTIVES: To determine the submental muscles activity during different types of swallow-specific tasks (effortful swallow, ES; tongue-hold swallow, THS; swallow with Kinesio taping, SwKT; and head extension swallowing exercise, HESE) compared to normal swallow (NS), and also compare these tasks within themselves. METHODS: Thirty-five healthy adults participated in this prospective experimental study with one participant group. The surface electromyography (sEMG) was used to evaluate submental muscles activity while performing swallow-specific tasks. RESULTS: While the greatest submental muscles activity was revealed during the ES, HESE, NS and THS tasks, respectively, the lowest was obtained during SwKT. When compared to NS, ES caused a statistically greater submental muscles activity (p1  = .000 and p2  = .000), although SwKT revealed a lower submental muscles activity (p1  = .002 and p2  = .000). When swallow-specific tasks were compared within themselves, ES caused the highest muscles activity (p < .005) than all other tasks, and HESE caused higher muscles activity than THS and SwKT (p < .005). CONCLUSION: Different swallow-specific tasks can cause increased or decreased submental muscles activity compared to NS task. Since ES and HESE are superior in selective submental muscles, they appear to be more promising in terms of submental muscles gains in long-term exercise training.

Relationship between dysphagia severity and head and neck proprioception in patients with neurological disorders.

PURPOSE: The aim of this study was to examine the relationship between dysphagia severity and head and neck proprioception in patients with neurological diseases. METHODS: Twenty-six patients with neurological diseases who received the modified barium swallowing study (MBSS) were included. Dysphagia severity was assessed with the penetration aspiration scale (PAS). Patients were divided into two groups according to their PAS scores as "with dysphagia" (n = 15) and "without dysphagia" (n = 11). Active range of motion (AROM) and muscle strength were measured. Proprioception measurement of the cervical region was performed with a laser marker placed on the head of the patients, and the deviation from the middle target was noted in centimeters. RESULTS: There was no difference between groups in terms of gender, age, height, weight, diagnosis, AROM, and the muscle strength of the cervical region (p > 0.05). A moderate, positive correlation was found between dysphagia severity and the results of proprioception in terms of neck flexion, extension, and left rotation (r = 0.48, p = 0.01; r = 0.58, p = 0.002; r = 0.42, p = 0.02, respectively). There was a statistically significant difference in proprioception measurements of neck flexion, extension, and left rotation between groups (p < 0.05). CONCLUSION: In conclusion, patients' decreased head and neck proprioception is related to severe dysphagia. Therefore, a holistic approach should be followed for swallowing function, and head and neck proprioception should be considered in dysphagia management.

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 cause of dysphagia in patients with esophageal atresia: a systematic review and meta-analysis.

PURPOSE: Dysphagia is the most common symptom in patients with esophageal atresia (EA) of all ages. There is no study addressing the direct relation between dysphagia and surgical results. Therefore, a systematic review was performed to define the relationship between surgical complications and dysphagia in patients with EA. METHODS: The systematic review was drafted under PRISMA guidelines. Systematic literature search was performed for the period 2000 (Jan) to 2019 (Dec)-20 years-in the databases: MEDLINE, EMBASE, and PubMed. Statistical analysis was performed using Comprehensive Meta-Analysis Version 3.0 software. RESULTS: Among 767 articles, 486 abstracts were screened for the inclusion criteria. The full-texts of 64 articles were assessed for eligibility. The sub-group analysis could be performed in 4 articles for anastomotic strictures. Heterogeneity was calculated by I2 statistic as 18,487 and pooled odds ratio was measured under the fixed effect model (Q = 3.68; P = 0.298, I2 = 18,487). There was no significant relationship with an odds ratio of 1.37 between anastomotic stricture (AS) and dysphagia (95% CI 0.631-2.973, p = 0.426). There was no publication bias for the data (Begg's test, p = 0.496; Egger's tests, p = 0.335). CONCLUSION: This meta-analysis did not reveal a significant relationship between AS and dysphagia in children with EA. Since many other factors contribute to dysphagia, comprehensive variable information such as detailed standardized registry systems for rare diseases for pooling analysis is needed regarding other potential factors including surgical complications.

Dysphagia in Children with EA-TEF From the Perspective of Pediatric Surgeons in Clinical Settings.

The current study was aimed to define clinical practice, knowledge and awareness, and best practice regarding dysphagia in children with esophageal atresia with/without tracheoesophageal fistula (EA-TEF) from the perspective of pediatric surgeons in Turkey. Pediatric surgeons practice EA repair were included. A survey related to clinical practice, knowledge and awareness, and best practice regarding dysphagia in EA-TEF was used. The survey was electronically sent to potential participants. Seventy-two pediatric surgeons with a mean professional experience of 14.73 ± 9.66 years (min = 1, max = 41) completed the survey. 19.4% (n = 14) had a standardized protocol for dysphagia screening and %51.4 (n = 37) provided swallowing rehabilitation to their patients. Most of the participants (80.6%) reported that they do not have an appropriate team approach for dysphagia management. The mean knowledge and awareness score was 11.04 ± 1.27 (min = 7, max = 12). The mean VAS score related to the need for standardized protocol in dysphagia management was 9.23 ± 1.44 (min = 3, max = 10). The mean VAS score related to the need for routine screening for dysphagia after surgery was 8.67 ± 2.17 (min = 1, max = 10). The mean score for the degree of the contribution of diagnosis and management of dysphagia to the surgical treatment in children operated for EA-TEF was 7.98 ± 2.08 (min = 3, max = 10). The participants mostly suggested the necessity of a standardized protocol in dysphagia and routine dysphagia screening in children with EA-TEF. Knowledge and awareness is found to be high among pediatric surgeons in Turkey. However, their clinical practice does not include a standardized protocol regarding dysphagia screening and management.

A Comparative Analysis of Chewing Function and Feeding Behaviors in Children with Autism.

The present study was aimed to compare chewing performance level and feeding behaviors of children with autism to their typically developing peers. A total of 56 children (37 children with autism, 19 typically developing children) participated in the study. Feeding-related characteristics and observational oral-motor characteristics of children were recorded. The Karaduman Chewing Performance Scale (KCPS) was used to assess chewing performance level, the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) was used to assess feeding behaviors of children, and the Turkish version of the Feeding/Swallowing Impact Survey (T-FS-IS) was used to evaluate the effect of the child's feeding and swallowing problem on their parents. Results showed that transition time to solid food intake for children with autism was later than typically developing children (p = 0.014), and they had more tongue thrusting (p = 0.009). There were differences between groups in terms of KCPS (p = 0.002), BPFAS (Total frequency score, p = 0.008; Child frequency score, p = 0.017; Parent frequency score, p = 0.021; Restriction score, p = 0.004), and T-FS-IS (Daily activities, p = 0.004; Worry, p = 009; Feeding difficulties, p = 0.031; Total score, p = 0.001). The present study shows that children with autism had worse chewing function and worse mealtime functioning compared to typically developing children. Their parents perceived mealtime behavior as more problematic, and parents' quality of life related to feeding/swallowing disorders was worse compared to parents of typically developing children. The study results reveal the importance of early assessment and intervention of chewing function and feeding behaviors in children with autism.

Pediatric dentists can determine chewing performance level in children.

OBJECTIVES: The current study was aimed to verify whether pediatric dentists could determine chewing performance level in children by using Karaduman Chewing Performance Scale (KCPS). MATERIALS AND METHODS: Typical developing children and children with cerebral palsy (CP) who were referred to pediatric dentistry above the age of 2 years were included in the study. The chewing performance level was scored according to KCPS. One experienced physical therapist and three pediatric dentists independently assessed the chewing videos of the children and scored each child's chewing function. The correlation between the KCPS scores of the physical therapist and the pediatric dentists was used for reliability. The agreement between the scorings of the physical therapist and pediatric dentists was assessed using Fleiss kappa statistics. RESULTS: Fifty-four typical developing children and 43 children with CP were included. A strong positive correlation between the KCPS scoring of the physical therapist and pediatric dentists was found (r=0.911-0.939, p<0.001). An excellent agreement in the KCPS scoring between the physical therapist and the 1st and 3rd dentists (p<0.001, κ 0.754-0.763), and a good agreement in the KCPS scoring between the physical therapist and the 2nd dentist was detected (p<0.001, κ 0.687). CONCLUSIONS: The study results show that the KCPS is reliable for pediatric dentists in determining the chewing performance level in children. Therefore, it could be suggested that pediatric dentists could use the KCPS in their clinical settings and research studies. CLINICAL RELEVANCE: The study may have clinical implications in the evaluation of children with chewing difficulty in dental practice. CLINICAL TRIAL NUMBER: NCT04407455.

Turkish Version of the Mastication Observation and Evaluation (MOE) Instrument: A Reliability and Validity Study in Children.

The Mastication Observation and Evaluation (MOE) instrument is an objective assessment of the chewing process in children. This study aimed to translate the MOE into Turkish and to test its reliability and validity in children with cerebral palsy (CP). A total of 53 children with CP and 27 typical children were included in the study. The MOE was translated from Dutch into Turkish by using the forward, backward, forward translation method. The internal consistency, intra- and inter-observer reliability, criterion, and discriminant validity of the Turkish version of the MOE (T-MOE) were investigated. Internal consistency was excellent with a Cronbach's alpha value of 0.98. The Intraclass correlation coefficient ranged from 0.89 to 0.97 for intra-rater reliability and from 0.86 to 0.94 for inter-rater reliability. The median score from Karaduman Chewing Performance Scale (KCPS) was 7 (min = 1, max = 8). All of the items in the T-MOE and the total T-MOE score had a negative and strong correlation with the KCPS score. Typical children without chewing disorders had greater T-MOE scores than the children with CP suffering from chewing disorders (p < 0.01). The T-MOE is a reliable and valid instrument for evaluating the observed oral motor behaviors of chewing function in children. It can be used in clinical practice and research.Clinical trial number: NCT03811353.

Assessment of the Concerns of Caregivers of Children with Repaired Esophageal Atresia-Tracheoesophageal Fistula Related to Feeding-Swallowing Difficulties.

The study aimed to assess concerns of caregivers of children with EA-TEF related to feeding-swallowing difficulties, compare the concerns according to type of atresia and repair time, and investigate its relationship with time to start oral feeding. Caregivers accompanying 64 children with EA-TEF were included. Age, sex, type of atresia, repair time, and time to start oral feeding were noted. Parents completed the Turkish version of the Feeding/Swallowing Impact Survey (T-FS-IS) to assess the concerns of caregivers related to feeding-swallowing difficulties. The T-FS-IS has three subscales including daily activities, worry, and feeding difficulties. The median age of patients was 3 (min = 1, max = 12) years, of which 57.8% were male. 43.8% of cases were isolated-EA, and 56.3% were EA-distal TEF. 57.8% of cases received early repair, and 42.2% had delayed repair. The median time to start oral feeding was 4 weeks (min = 1, max = 128). The mean scores of daily activities, worry, feeding difficulties, and total score from the T-FS-IS were 2.43 ± 1.18, 2.73 ± 1.28, 2.10 ± 0.97, and 2.44 ± 1.09, respectively. Caregivers of children with isolated-EA reported more problems in total score and all subscales of the T-FS-IS than EA-distal TEF (p < 0.01). Caregivers of children who received delayed repair reported more problems in total score and all subscales of the T-FS-IS than children with early repair (p < 0.05). Moderate to strong correlations were found between the T-FS-IS and time to start oral feeding (p < 0.01, r = 0.55-0.65). This study suggests that caregivers of children with isolated-EA and/or delayed repair and/or delay in oral intake may have higher concerns related to feeding-swallowing difficulties.

Is the proprioceptive neuromuscular facilitation technique superior to Shaker exercises in swallowing rehabilitation?

PURPOSE: This prospective study was planned to investigate whether the combined isotonic technique of proprioceptive neuromuscular facilitation (PNF) is superior to Shaker exercises in improving the function of swallowing muscles. METHODS: Fifty individuals (30 females and 20 males; mean age 68 ± 3.89 years) with swallowing difficulties were separated into two groups randomly. The treatment groups were Shaker and PNF groups, which performed these exercises three times in a week for6 weeks. Swallowing difficulties were determined with the Turkish version of the eating assessment tool (T-EAT-10). The 100 ml-water swallow test was used to measure capacity, volume, and speed of swallowing. Contraction amplitude changes used as a universal measurement of motor unit activity during the muscle action were measured with superficial electromyography. RESULT: After 6 weeks of exercise training, T-EAT-10 scores decreased in both groups (p < 0.001). Water swallowing capacity and volume improved in both groups (p < 0.001). There was no change in swallowing speed in both groups (p > 0.05). Maximal voluntary contraction values of suprahyoid muscles were higher in PNF than the Shaker group (p < 0.05). CONCLUSION: Both the types of exercise can be used in the rehabilitation of swallowing difficulties. However, the PNF technique increased the contraction amplitude values that occur during maximum contraction more than the Shaker exercises. Different functional evaluations are needed to determine the effectiveness of PNF on swallowing difficulty.

Effects of Low-Frequency Repetitive Transcranial Magnetic Stimulation on Swallowing Function and Quality of Life of Post-stroke Patients.

Repetitive transcranial magnetic stimulation (rTMS) is one of the non-invasive techniques, which is used to modulate cortical regions in patients with stroke. The aim of this single blind, controlled study was to investigate the effect of rTMS on swallowing function and quality of life of mono-hemispheric post-stroke patients with dysphagia. Twenty-eight patients were randomized and split between study and control group. Each group received conventional dysphagia rehabilitation 3 days a week for 4 weeks, and study group also received 1 Hz rTMS to unaffected hemisphere in the final week. The descriptive information was noted. The clinical and radiological swallowing evaluation and quality of life assessment have been performed at four different times including before and after the treatment, 1 month and 3 months after the treatment. At baseline, no significant differences were observed between groups in terms of demographic and clinical features (p > 0.05). Swallowing function and quality of life of the patients were statistically improved in both groups towards the third month (p < 0.05). Swallowing function was comparable between two groups. However, a significant improvement was observed on appetite, fear of eating, and mental health parameters of quality of life assessment in the study group compared to the control group (p < 0.05). In conclusion, despite positive changes in some aspects of quality of life, rTMS did not enhance the swallowing function when compared conventional dysphagia rehabilitation. Therefore, the application of 1 Hz rTMS should be reconsidered to improve swallowing function in the chronic period.

The severity of chewing disorders is related to gross motor function and trunk control in children with cerebral palsy.

PURPOSE: The frequency of chewing disorders increases with decreasing level of gross motor function in children with cerebral palsy (CP). Besides its frequency, the severity of chewing disorders is also important. The aim of this study was to determine the relationship between chewing performance level and gross motor function, and trunk postural control in children with CP. MATERIALS AND METHODS: The study included 119 children with CP (age 2-10 years). Chewing performance level was determined by the Karaduman Chewing Performance Scale (KCPS). The Gross Motor Function Classification System (GMFCS) was used to determine the level of gross motor function. Segmental Assessment of Trunk Control (SATCo) was used to measure trunk control. RESULTS: Children with spastic CP with a median age of 4 years were evaluated, of which 50.4% were male. The percentages of patients classified to GMFCS levels I to V were 43.7%, 6.7%, 9.2%, 5.0%, and 35.3%, respectively. The median KCPS score was 3 (min = 0, max = 4). A good correlation was found between KCPS and GMFCS (p < .001, r = 0.70). Negative, excellent correlations between KCPS and SATCo static, SATCo active, and SATCo reactive postural controls were found (p < .001, r = -0.75, r = -0.77, r = -0.79; respectively). CONCLUSIONS: The severity of chewing disorders is related to the level of gross motor function and trunk postural control in children with CP. Clinical trial number: NCT03241160.