Best Practice Recommendations for Dysphagia Management in Intensive Care Unit (ICU): A Delphi Study from Multidisciplinary Experts in Turkey.

There is no study about all aspects of oropharyngoesophageal (OPE) dysphagia from diagnosis to follow-up in a multidisciplinary manner in the world. In order to close this gap, we aimed to create a recommendation study that can be used in clinical practice, addressing all aspects of dysphagia in the ICU in detail with the opinion of experienced multidisciplinary experts. This recommendation paper was generated by a multidisciplinary team, using the seven-step process and a three-modified Delphi round via e-mail. Firstly, 15 open-ended questions were created, and then detailed recommendations including general principles, management, diagnosis, rehabilitation, and follow-up were created with the answers from these questions, Each recommendation item was voted on by the experts as overall consensus (strong recommendation), approaching consensus (weak recommendation), and divergent consensus (not recommended).In the first Delphi round, a questionnaire consisting of 413 items evaluated with a scale of 0-10 was prepared from the opinions and suggestions given to 15 open-ended questions. In the second Delphi round, 55.4% were accepted and revised suggestions were created. At the end of the third Delphi round, the revised suggestion form was approved again and the final proposals containing 133 items were created. This study includes comprehensive and detailed recommendations, including a broad perspective from diagnosis to treatment and follow-up, as detailed as possible, for management of dysphagia in patients with both oropharyngeal- and esophageal-dysphagia in ICU.

Assessment of the quality and reliability of the information on spasticity on youtube.

BACKGROUND: Youtube has become an influential source of health. This study aimed to evaluate the reliability and quality of YouTube videos on spasticity. METHODS: The keywords " spasticity, spasticity treatment, spasticity exercises" were used to search for videos. According to the search results, 180 videos were analyzed, videometric characteristics of the videos were recorded, and 2 groups were formed as health professionals and non-health professionals according to the video source. In addition, low, medium and high quality groups were formed using the global quality score (GQS). The reliability of the videos was evaluated using the modified DISCERN (mDISCERN) scale. Video popularity was assessed using the video power index (VPI). RESULTS: After excluding videos that met the exclusion criteria, the remaining 68 videos were analyzed. The videos were uploaded by healthcare professionals (n = 47, 69.1%) and non-healthcare professionals (n = 21, 30.9%). The popularity (VPI), reliability (mDISCERN) and quality (GQS) of videos uploaded by healthcare professionals were significantly higher (p = 0.002, p = 0.001, p = 0.021, respectively). Most of the videos were of high quality according to GQS (n = 40, 58.8%). All of the high quality videos were of healthcare professionals. The number of sources from healthcare professionals was significantly higher in high quality videos than in both low (p = 0.001) and medium (p = 0.001) quality videos. CONCLUSION: We can conclude that most of the YouTube videos on spasticity are reliable and of high quality. However, it should be kept in mind that patients may be exposed to low-quality and unreliable videos with misleading content.

Effects of diaphragm thickness on rehabilitation outcomes in post-ICU patients with spinal cord and brain injury.

BACKGROUND: Intensive care unit (ICU) complications affect outcomes but it remains unknown if the diaphragm thickness affects rehabilitation outcomes after ICU. We conducted a pilot study to evaluate the effect of diaphragm thickness on rehabilitation outcomes of post-ICU patients with spinal cord injury (SCI) and traumatic brain injury (TBI) and to evaluate factors that may be associated with diaphragm atrophy. MATERIALS AND METHODS: Fifty-one patients (26 SCI, 25 TBI) who admitted to the rehabilitation clinic from the ICU included in this study. All demographic data were recorded. All participants underwent diaphragmatic ultrasonography evaluation before and after 12 weeks of neurologic rehabilitation program. The diaphragm thickness and outcome parameters were compared in all patient groups and in each patient subgroups. Evaluation parameters of patients before and after treatment were compared in patient subgroups. RESULTS: Diaphragm atrophy was found in 14 patients (64%) in TBI group and 12 patients (46%) in SCI group. The diaphragm thickness negatively correlated with the ICU length of stay and positively correlated with the before/after rehabilitation functional scores and the change in functional independence measure scores (p < 0.05). According to the regression analysis; the change in functional independence measure scores was found to be affected by the diaphragm thickness (p < 0.05). CONCLUSIONS: The diaphragm thickness may be an effective factor on the rehabilitation process.

Is superficial radial nerve affected in patients with hand osteoarthritis?

INTRODUCTION: Patients with superficial radial neuropathy (SRN) have pain and abnormal sensation on the hand similar to hand osteoarthritis (HOA). PURPOSE OF THE STUDY: The aim of the present study was to evaluate the presence of SRN in patients with HOA and to determine the factors associated with electrophysiological parameters of the radial nerve. STUDY DESIGN: This is a case-control study. METHODS: A total of 138 patients were included in this study. Only the dominant hand of each patient was evaluated. Patients were divided into 2 groups: Group 1 (without SRN) or Group 2 (with SRN) by electrophysiological examination. The presence of osteoarthritis in the first carpometacarpal (1st CMC) joint was investigated. Radiological features of the hands were evaluated with Kellgren-Lawrence grading system. Sonographically, the presence of synovitis in the 1st CMC joint was examined with gray scale and synovial blood flow signal by power Doppler imaging. Erosion and osteophyte scoring were performed for 15 joints. The 1st extensor compartment of wrist's cross-sectional area was measured. RESULTS: SRN was detected in 68.8% of the patients. High Kellgren-Lawrence scores (P = .027), presence of synovitis in the 1st CMC joint (P = .003), and increased cross-sectional area of the 1st extensor compartment of wrist (P = .005) were found to be independent risk factors for reduced superficial radial nerve conduction velocity. CONCLUSIONS: Sensory symptoms in patients with HOA might be due to the involvement of the superficial branch of the radial nerve.

Esophageal dysphagia in neuromuscular disorder patients with validity and reliability study of the brief esophageal dysphagia questionnaire.

Esophageal dysphagia (ED) is often underestimated in neuromuscular disorders (NMD) and it is important to evaluate the esophageal phase of swallowing with an easy and rapid screening test. We aimed both to assess the prevalence of ED in NMD and to perform validity and reliability study of the brief easophageal dysphagia questionnaire (BEDQ) screening test in NMD patients. This prospective cross-sectional clinical study was performed on NMD patients. Demographic features and disease characteristics were recorded. Endoscopic evaluation for oropharyngeal dysphagia (OD) and high-resolution esophageal manometry for ED were performed. In addition, the BEDQ and the 10-item eating assessment tool (EAT-10) were used to all subjects. Cronbach's α and principle components factor analysis (PFCA) with varimax rotation were used for reliability. The Chicago Classification version 3 (CCv3) level (high-resolution esophageal manometry) and EAT-10 was used for validity. A total of 50 patients were included in the study. Thirty-four (68%) patients were diagnosed with myasthenia gravis and 16 (32%) patients were diagnosed with myopathy. Esophageal dysphagia according to the CCv3 was found in 33 (66%) of patients. While the Cronbach's α was excellent as 0.937 for test overall the T-BEDQ scale. The PCFA included all scale items and resulted in a single factor (eigenvalue = 5.72, 71.5%). The all BEDQ scores were demonstrated good correlation with EAT-10 score and very good correlation with CCv3 level. Evaluation of swallowing in patients with NMD should include not only the oropharyngeal phase of swallowing, but also esophageal phase. For this purpose, the BEDQ can be used as a rapid, valid, and reliable test for the evaluation of ED.

Predisease Physical Activity Level and Current Functional Capacity in Patients With COVID-19: Relationship With Pneumonia and Oxygen Requirement.

BACKGROUND: During the COVID-19 pandemic, restrictive measures can reduce physical activity. The purpose of this study was to evaluate predisease physical activity and current functional capacity in patients with and without the presence of pneumonia and oxygen requirement in Turkish survivors of COVID-19. METHODS: Among the COVID-19 patients admitted to the hospital, 100 patients were selected. Data about predisease physical activity (by short-form International Physical Activity Questionnaire), oxygen requirement and presence of pneumonia, and current functional capacity (by the 6-min walking test) were collected. Continuous and categorical variables were compared with the Mann-Whitney U and χ2 test, respectively (P < .05). RESULTS: The predisease physical activity levels and current functional capacity of patients with pneumonia and oxygen requirement were significantly lower than patients without pneumonia and oxygen requirement (P < .05). However, there was no significant difference between males and females (P > 0.05). Pneumonia and oxygen requirement was more common in the older adults (P < .05). Also, a significant correlation was found between age with predisease physical activity (r = .530, P = .000) and current functional capacity (r = -.346, P = .000) and predisease physical activity level with current functional capacity (r = .523, P = .001). CONCLUSION: The physical activity level may be related to the severity of COVID-19 disease.

Pulmonary rehabilitation principles in SARS-COV-2 infection (COVID-19): The revised guideline for the acute, subacute, and post-COVID-19 rehabilitation.

Coronavirus disease 2019 (COVID-19) is a contagious infection disease, which may cause respiratory, physical, psychological, and generalized systemic dysfunction. The severity of disease ranges from an asymptomatic infection or mild illness to mild or severe pneumonia with respiratory failure and/or death. COVID-19 dramatically affects the pulmonary system. This clinical practice guideline includes pulmonary rehabilitation (PR) recommendations for adult COVID-19 patients and has been developed in the light of the guidelines on the diagnosis and treatment of COVID-19 provided by the World Health Organization and Republic of Turkey, Ministry of Health, recently published scientific literature, and PR recommendations for COVID-19 regarding basic principles of PR. This national guideline provides suggestions regarding the PR methods during the clinical stages of COVID-19 and post-COVID-19 with its possible benefits, contraindications, and disadvantages.

Effectiveness of Functional Electrical Stimulation - Cycling Treatment in Children with Cerebral Palsy.

AIM: The purpose of this study was to evaluate the effects of functional electrical stimulation (FES) bicycle therapy system on motor function, gait pattern, spasticity, daily living activities, and aerobic capacity in children with cerebral palsy (CP) and to compare the results with sham stimulation and standard treatment. METHODS: Patients with cerebral palsy who received botulinum toxin type-A injections to lower extremities and those with Gross Motor Function Measure Classification System (GMFCS) levels I - III, were included in the study. Twenty-five patients were randomly assigned into three treatment groups for 4-weeks: Group 1, FES-cycling and standard treatment; Group 2, Sham stimulus FES-cycling and standard treatment; Group 3, Standard treatment. Clinical assessment tools included the Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS), Pediatric Functional Independence Measure (WeeFIM), GMFCS, Gross Motor Function Measure-88 (GMFM-88), selective motor control tests, 6-minute walk test, and Visual Gait Analysis (VGA). RESULTS: In all groups, there were significant improvements in MAS, MTS, WeeFIM, GMFM-88, 6-minute walk test, and VGA scores. No changes in GMFCS levels were observed in any group. At the end of the study, there was no significant difference among the groups in terms of any clinical assessment parameter. CONCLUSIONS: All groups showed statistically significant improvements in motor function, walking pattern, spasticity, daily living activities, and aerobic capacity in patients with CP following the rehabilitation period. Although FES-cycling demonstrated no superiority over the other approaches and provided no additional benefit to the results, FES appears to be safe and well-tolerated in children with CP, at least as much as standard exercise treatment.

Pulmonary rehabilitation principles in SARS-COV-2 infection (COVID-19): A guideline for the acute and subacute rehabilitation.

Coronavirus disease 2019 (COVID-19) is a contagious infection disease, which may cause respiratory, physical, psychological, and generalized systemic dysfunction. The severity of disease ranges from an asymptomatic infection or mild illness to mild or severe pneumonia with respiratory failure and/or death. COVID-19 dramatically affects the pulmonary system. There is a lack of knowledge about the long-term outcomes of the disease and the possible sequelae and rehabilitation. This clinical practice guideline includes pulmonary rehabilitation (PR) recommendations for adult COVID-19 patients and has been developed in the light of the guidelines on the diagnosis and treatment of COVID-19 provided by the World Health Organization and Republic of Turkey, Ministry of Health, recently published scientific literature, and PR recommendations for COVID-19 regarding basic principles of PR. In this guideline, the contagiousness of COVID-19, recommendations on limited contact of patient with healthcare providers, and the evidence about possible benefits of PR were taken into consideration.

Bone mineral density and serum vitamin D status in Parkinson's disease: Are the stage and clinical features of the disease important?

BACKGROUND: Although it is well known that patients with Parkinson's disease (PD) have low bone mineral density (BMD) and serum vitamin D level, there are no studies evaluating their relationship with the stage and clinical features of the PD. OBJECTIVE: The purpose of this study was to evaluate the relationship between BMD and serum vitamin D level and stage or clinical features of the PD. MATERIALS AND METHODS: One hundred twenty-four patients with PD recruited from Movement Disorders Outpatient Clinic and age- and sex-matched 116 healthy controls were included in the study. BMD and serum vitamin D level of all participants were measured. After patients had been divided into four groups according to Hoehn and Yahr (H and Y) staging, a total of 5 groups with controls, BMD (lumbar and femoral) and serum vitamin D level were compared between groups. The relationship between the clinical features of the PD [disease duration, medication history, Unified Parkinson's Disease Rating Scale (UPDRS) part II and III, and subscores of UPDRS part III] and BMD or vitamin D was investigated. RESULTS: Lumbar and femoral BMD values and serum vitamin D level were significantly lower in patients with PD compared to controls. Low BMD and low serum vitamin D level were identified in the early stages of the disease (H and Y stage 1 and 1.5) and were marked by the progress of the stage of the disease. There was a negative relationship between the clinical features of the PD and both BMD and serum vitamin D level. CONCLUSION: All patients with PD should be screened for developing osteoporosis and for sufficient vitamin D level in the early stages of the disease. Preventive methods for bone quality should be taken into consideration at the onset of PD.

What happens to muscles in fibromyalgia syndrome.

BACKGROUND: The main somatic symptoms of fibromyalgia syndrome (FMS) are chronic musculoskeletal pain, stiffness, and fatigue, all of which are related to the muscle system and its functioning. AIMS: The aim of this study was to evaluate whether the asymptomatic upper and lower extremity muscles evaluated using ultrasonography (US) were different from healthy controls in both newly diagnosed and established FMS and to assess whether muscle measurements were related to fatigue and disease severity, as well as quality of life. METHODS: This study was conducted on 152 subjects (102 patients and 50 healthy controls) as a cross-sectional controlled trial. Real-time imaging of cross-sectional thickness (CST) (for deltoid, biceps brachii, triceps brachii, forearm flexor, tibialis anterior, and gastrocnemius medialis), and cross-sectional areas (CSAs) (quadriceps femoris (QF)) measurements were performed using US. Fatigue and disease severity as well as quality of life scales were given to all participants. RESULTS: In both patient groups, decreased QF muscle CSA was significantly correlated with increased fatigue severity and decreased overall quality of life and energy levels. Moreover, in patients with established disease, there was a significant correlation between the decrease in QF muscle CSA and increased social isolation and between the decrease in biceps brachii muscle CST and increased fatigue severity. CONCLUSIONS: Whether in newly diagnosed or established disease, muscle measurement values and quality of life parameters were significantly decreased in patients with FMS compared with healthy controls.

What Happens to Swallowing Muscles after Stroke?: A Prospective Randomized Controlled Electrophysiological Study.

BACKGROUND: Stroke is the most frequent reason of neurological dysphagia Electrophysiological studies can be used to evaluate oral, pharyngeal and initial phase of esophageal phase. AIMS: This study aims to noninvasively evaluate mastication, mimic, and tongue muscles of stroke patients, which play an important role in the oral phase of swallowing process and compare them with healthy individuals. SETTING AND DESIGN: This study was conducted at the Physical Medicine and Rehabilitation Clinic of our hospital between January 2014 and December 2016. MATERIALS AND METHODS: Fifty-one patients who were admitted to our clinic with stroke and 51 healthy individuals were evaluated for the study. Demographic features of individuals were recorded. The swallowing intervals and motor action potentials (MAPs) of trigeminal, facial and hypoglossal nerves were measured. After four weeks of treatment schedule, patients were re-evaluated. STATISTICAL ANALYSIS: The Wilcoxon Signed Rank test, the Mann-Whitney U test and Fisher exact test were used in this study. RESULTS: The all swallowing intervals were found prolonged compared to the healthy controls (P < 0.05). The MAPs of the masseter, orbicularis oculi, and intrinsic tongue muscles were significantly lower in patient group (P < 0.05). After treatment, we found significant improvement for all parameters in patient group, but the swallowing intervals were still significantly prolonged, and MAPs of these muscles were still lower (P < 0.05). CONCLUSION: Although swallowing is examined as different phases, the process is complicated and should be evaluated totally. In post-stroke dysphagia, oral phase of swallowing process is as important as phayngeal phase and perioral, mastication, and tongue muscles are influenced even in an early period as a month.

Can the First Web Space Angle Be Predictive of Carpal Tunnel Syndrome?

BACKGROUND: Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy in the upper limb. Although more objective methods for assessment have been reported in literature, there is a lack of evidence concerning the best methods for assessment of CTS. This study aimed to investigate whether there was a difference in the first web space in patients with different severities of CTS in relation to healthy controls as easy screen method. METHODS: This prospective controlled trial was conducted on 126 patients at the Physical Medicine and Rehabilitation Clinic, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Science, Ankara, Turkey, from January 2016 to January 2018. Hand grip and pinch strength of patients were determined. Also, first web angle were measured by goniometer. Patients were divided into 3 CTS groups as electrophysiologically: "mild: group 1", "moderate: group 2" and "severe: group 3". Patient and healthy groups were compared in terms of the evaluation parameters. Comparisons were also made between these groups. RESULTS: There was significant reduction in hand strengths and first web angle in patient groups compared to healthy groups (P<0.05). Moreover, the first web angle was significantly different between the CTS groups (P= 0.001). The cut-off value for CTS was <38.5°. CONCLUSION: The possibility of CTS can be evaluated by measuring the first web space angle with a simple goniometer as a easy and in-expensive method in outpatient clinics.

Which swallowing difficulty of food consistency is best predictor for oropharyngeal dysphagia risk in older person?

PURPOSE: The present study aimed to investigate which swallowing difficulty of food consistency in participants over 65 years of age who did not have any disease that might affect swallowing functions, and which symptoms were most likely related to oropharyngeal dysphagia (OD). METHODS: The cross-sectional and multicenter study was conducted at 12 hospitals including 883 participants aged ≥65 years who were fed orally and who were admitted to the physical medicine and rehabilitation outpatient clinics between September 2017 and December 2018. Demographic characteristics were recorded. Katz Daily Living Activities Index (KDLAI), swallowing-related quality of life scale (Swal-QoL) and 10-item Eating Assessment Tool (EAT-10) were used. The participants were asked the "yes" or "no" questions including swallowing difficulty of various types of food consistency with the face-to-face interview. RESULTS: Participants were divided into two groups as normal swallowing (EAT-10 < 3 group) (n = 639) and OD risk groups (EAT-10 ≥ 3 group) (n = 244) according to the EAT-10 scores. While there was no difference related to number of teeth and KDLAI scores between groups (p = 0.327 and p = 0.221, respectively), the significant difference was found between groups in terms of yes/no questions and Swal-QoL scores (p < 0.05). Receiver operating characteristic analysis revealed that eating difficulty of mixed content food provided maximum sensitivity (99%) and eating/drinking difficulty of thick liquid had maximum specificity (77%). The higher area under curve was in eating/drinking difficulty of thick liquid (0.891), and higher positive likelihood ratio (LR) was eating/drinking difficulty of thick liquid (4.26) as well as lower negative LR was eating difficulty of mixed content food (0.01). The higher diagnostic odds ratio was eating difficulty of mixed content food (367.0), and the higher posttest probability was eating/drinking difficulty of thick liquid (0.211). CONCLUSION: While eating difficulty of hard solid food is the most common symptom in healthy participants over 65 years of age, the eating difficulty of thick liquids is the highest predictive value related to oropharyngeal dysphagia risk. Also, the eating difficulty of mixed content food had the highest diagnostic ratio.

The GUSS test as a good indicator to evaluate dysphagia in healthy older people: a multicenter reliability and validity study.

PURPOSE: Dysphagia is known to be a disorder of the swallowing function, and is a growing health problem in aging populations. Swallowing screening tests have mostly been studied in comorbidities such as stroke associated with old age. There is no simple, quick and easy screening test to best determine the risk of oropharyngeal dysphagia in geriatric guidelines. We aimed to evaluate whether the Gugging Swallowing Screen (GUSS) test is an effective method for evaluating swallowing difficulty in healthy older people. METHODS: This cross-sectional and multicenter study was conducted at 13 hospitals between September 2017 and February 2019. The study included 1163 participants aged ≥65 years and who had no secondary dysphagia. Reliability was evaluated for data quality, scaling assumptions, acceptability, reliability, and validity as well as cutoff points, specificity and sensitivity. RESULTS: The age distribution of 773 (66.5%) patients was between 65 and 74 years and 347 (29.8%) of them were male and 767 (66%) patients were female. The average total GUSS score was 18.57 ± 1.41. The Cronbach's alpha was 0.968. There was a moderate statistically significant negative correlation between the total GUSS and 10-item Eating Assessment Tool scores as well as between the total GUSS score and quality of life. The cutoff point of the total GUSS score was 18.50, sensitivity was 95.5% and specificity was 94.4%. CONCLUSIONS: The GUSS test is a valid and reliable test to identify possible oropharyngeal dysphagia risk in healthy older people who had no secondary dysphagia. It is suitable as a screen test for clinical practice.

Effect of Primary Hypertension on Treatment Outcomes of Patients with Postmenopausal Osteoporosis: A 5 Year Follow Up Retrospective Study.

AIM: To investigate the efficacy of primary hypertension (HTN) on the treatment prognosis of patients with postmenopausal osteoporosis (PMOP). METHODS: 45 patients who were diagnosed as PMOP with lumbar and/or femur neck bone mineral density screening (BMD) but have no history of PMOP treatment including calcium and vitamin D, have comorbid primary HTN and treated with a vasodilator antihypertensive drug at least a year were included to the study. Control group was constituted with 44 patients with PMOP at same age but have no comorbidity. Demographic features including age, height, weight, occupation, educational level menarche and menopause age, clothing style, daily intake of calcium, smoking and/or alcohol consumption, daily physical activity level, personal history of fragility fracture or in mother and duration of primary HTN diagnosis were recorded. Biochemical parameters were also recorded. Patients were treated with bisphosphonate, calcium and vitamin D and same parameters were evaluated at the end of first and fifth year. RESULTS: Demographic and disease characteristics were not different between groups before treatment (p > 0.05). In group analysis, there was significant improvement in lumbar and femur neck T scores of PMOP + HT and PMOP groups after 1 and 5 years of treatment compared to baseline (p < 0.05) Lumbar and femur neck T score variations between the baseline, first and fifth years of treatment were not significantly different in PMOP + HT and PMOP groups (p < 0.05). CONCLUSIONS: Although the results vary between populations, primary HTN does not have an impact on the prognosis of PMOP treatment in Turkish population.

Reliability and validity of the pediatric feeding and swallowing disorders family impact scale for Turkish children with cerebral palsy by endoscopic evaluation.

Umay E, Gündogdu I, Öztürk EA. Reliability and validity of the pediatric feeding and swallowing disorders family impact scale for Turkish children with cerebral palsy by endoscopic evaluation. Turk J Pediatr 2019; 61: 741-748. The caregivers of children with cerebral palsy (CP) have high mood disorders and stress levels. This study was aimed to conduct validity and reliability of Turkish version of The Pediatric Feeding and Swallowing Disorders Family Impact Scale (PFSDFIS) by using an objective method. This study was performed in our physical medicine and rehabilitation (PMR) clinic between July 2016 and July 2018. This study was performed with 251 children with CP who had complaint of swallowing and/or feeding problems, and their primer caregivers. Cronbach`s alpha and corrected item-total correlations were used to assess internal consistency. Test and retest reliability studies were also conducted. The construct validity was assessed using the dysphagia level defined with flexible fiberoptic endoscopic evaluation of swallowing and Impact on Family Scale (IFS). Total score of T-PFSDFIS was correlated to the dysphagia level by using FEES. Results showed, Cronbach's alpha value of the scale to be 0.821. Corrected item-to-total correlations ranged from 0.729 to 0.911. Test-retest reliability coefficients was calculated with intra-class correlation coefficient (ICC), the total score was 0.989. A negative significant good level correlation was found between the dysphagia level by using endoscopic evaluation and the T- PFSDFIS total score as well as between total scores of IFS and T-PFSDFIS. In subgroup analysis; the lowest value was in normal swallowing and significantly different from all dysphagia levels. In conclusion; this scale is effective in reflecting the influence of caregivers on the severity of dysphagia measured objectively and T-PFSDFIS is a valid and reliable scale for Turkish children with CP.

The psychometric evaluation of the Turkish version of the Mann Assessment of Swallowing Ability in patients in the early period after stroke

Background/aim: The Mann Assessment of Swallowing Ability (MASA) is an efficient tool that allows physicians to determine the alertness, cooperation, and respiration of patients, which are important factors when assessing swallowing . This study aimed to translate the MASA into Turkish (T-MASA) and to assess its reliability and validity in patients during the early period after a stroke . Materials and methods: The scale was administered to 141 patients in the early period after a stroke. For reliability, both internal consistency (Cronbach's alpha and corrected item-to-total correlations) and interrater reliability were analyzed. The procedures were scored by two blinded independent expert observers. The validity was assessed using the convergent validity. The cut-off value of the T-MASA for dysphagia was accepted as 169 points. The correlation between the MASA and endoscopic evaluation was evaluated. Results: The T-MASA showed good internal consistency using Cronbach's alpha (0.899­0.901) and corrected item-to-total correlations. In addition, the intraclass correlation coefficient scores indicated excellent agreement. A significant moderate negative correlation was found between endoscopic evaluation and the T-MASA in terms of the presence of dysphagia (r: ­0.324, r: ­0.302, respectively, and both P = 0.001) Conclusion: Our results suggest that the Turkish version of the MASA is a valid and reliable instrument when determining dysphagia in patients in the early period after a stroke.

The effect of premorbid features on post-stroke rehabilitation outcome.

Background: A wide variety of factors influence stroke prognosis, including age, stroke severity, stroke mechanism, infarct location, comorbid conditions, clinical findings, and related complications. The aim of this study was to detect the prognostic determinants in patients with acute stroke for guiding rehabilitation. Methods: Patients with ischemic acute stroke were included in the study. Patients' age, sex, education level, and marital status, premorbid personality traits, comorbidities such as current smoking status and alcohol consumption, regular exercise habits, and sleeping disorder were recorded. Motor assessment and daily activity skills were evaluated according to the Brunnstrom staging and Functional Independence Measure (FIM), respectively. Results: A total of 85 patients were studied. All patients' motor and functional stages were significantly improved with the rehabilitation. The improvements in the upper extremity motor levels were less in whom over 76 years and smokers, in patients who had 4 and more comorbidities and sleep disorders. The functional improvement was less in whom over 76 years and men, and in patients who had 4 and more comorbidities and sleep disorders. Conclusion: The significant post-stroke predictor of insufficiency in functioning was having 4 or more risk factors.

Timing of rehabilitation in children with obstetric upper trunk brachial plexus palsy.

OBJECTIVES: The initiation timing of rehabilitation in children with obstetric brachial plexus palsy is controversial. The aim of the present study is to evaluate the effectiveness of rehabilitation timing to the functional outcomes of patients with obstetric upper trunk brachial plexus palsy. MATERIAL AND METHODS: Twenty-nine patients, who did not previously received any rehabilitation programme but attended our outpatient clinic, were included for the study. The electrophysiological findings, obstetric characteristics, and demographic features of the patients were recorded. The range of motion (ROM) of shoulders, elbows, and wrists and the strength of the muscles associated with these joints were evaluated. Modified Mallet Scale (MMS) was used for functional evaluation. A 4-week rehabilitation programme was performed twice at 2-month intervals. Patients were divided into three groups according to their ages as follows: 1-3 years old (group 1), 3-5 years old (group 2), and 5-7 years old (group 3). The ROMs, muscle strengths, and MMS scores of the patients were all evaluated. RESULTS: Two out of 29 patients were female (6.9%) and 27 were male (93.1%). All 29 patients had right upper extremity palsy (100%). The MMS scores, ROMs, and muscle strength of the upper extremities had improved in all the groups following the standardized rehabilitation programme. CONCLUSIONS: A rehabilitation programme is the best choice of treatment before surgical procedures in patients with mild to moderate obstetric upper trunk brachial plexus palsy regardless of age and the initiation time.