ORIJINAL ARAŞTIRMA
Akut İnmeli Hastalarda Disfaji Yönetimi: Prospektif Yakın Takip Tasarımının Sonuçları
Dysphagia Management in Patients with Acute Stroke: The Results of a Prospective Close Follow-Up Design
Received Date : 23 Sep 2024
Accepted Date : 13 Dec 2024
Available Online : 18 Dec 2024
Nazife KAPANa, Müyesser ARASb, Emre ADIGÜZELb,c, Merve KAPANd, Mariam KAVAKCIe, Melike URALd, Rojda ÖZALPd, Seher Merve TİRYAKİd, Hesna BEKTAŞf, Evren YAŞARg
aKırşehir Ahi Evran University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Kırşehir, Türkiye
bAnkara Yıldırım Beyazıt University Faculty of Medicine, Ankara Bilkent City Hospital, Department of Physical Medicine and Rehabilitation, Ankara, Türkiye
cUniversity of Health Sciences Gülhane Faculty of Medicine, Health Application and Research Center,
Department of Physical Medicine and Rehabilitation, Ankara, Türkiye
dAnkara Bilkent City Hospital, Clinic of Physical Medicine and Rehabilitation, Ankara, Türkiye
eAnkara Yıldırım Beyazıt University Faculty of Medicine, Ankara Bilkent City Hospital, Department of Physical Medicine and Rehabilitation, Ankara, Türkiye
fAnkara Bilkent City Hospital, Clinic of Neurology, Ankara, Türkiye
gUniversity of Health Sciences Gülhane Faculty of Medicine, Health Application and Research Center,
Department of Physical Medicine and Rehabilitation, Ankara, Türkiye
Doi: 10.31609/jpmrs.2024-105667 - Makale Dili: EN
Turkiye Klinikleri Journal of Physical Medicine and Rehabilitation Sciences. 2025;28(1):54-62
ÖZET
Amaç: Bu çalışma, akut inmeli hastalarda disfaji açısından erken rehabilitasyon
ve takip işlemlerinin sonuçlarını incelemek amacıyla yapıldı. Gereç ve
Yöntemler: Haziran 2020 ile Ocak 2021 tarihleri arasında akut inme tanısı konulan
ve yatak başı yutma testi ile disfaji tespit edilen 18-85 yaş arası 55 hasta
prospektif takip için çalışmaya dahil edildi. Bilinci kapalı ve koopere olmayan,
orofaringeal yapısal hasarı veya baş/boyun malignitesi olan hastalar çalışmadan
hariç tutuldu. Hastaların yutma değerlendirmeleri için Gugging Yutma Tarama
Testi ve Yeme Değerlendirme Aracı-10 kullanıldı. Yutma değerlendirmesi rehabilitasyondan
önce, taburcu olurken ve rehabilitasyondan sonra yapıldı. Hastalara
yutma değerlendirmesi sonrası diyet modifikasyonu, güvenli yutma önerileri,
oral hijyen ve egzersiz programından oluşan bireysel erken rehabilitasyon uygulanarak
akut inmeli hastalar hastanede yatış süreleri ve taburcu olduktan sonra da
1 ay süreyle yakın takip edilmiştir. Bulgular: Rehabilitasyondan sonra disfaji
skorlarında anlamlı iyileşme bulundu (p<0,05). Rehabilitasyondan sonra disfaji
skoru değişimi ile ağız hijyeni, inme öyküsü ve inme tipi arasında anlamlı ilişki
bulundu (p<0,05). Rehabilitasyon öncesi disfaji skoru ile Ulusal Sağlık Enstitüleri
İnme Ölçeği skoru arasında negatif korelasyon, beden kitle indeksi, Barthel
ve Fonksiyonel Ambulasyon Sınıflandırma skoru arasında ise pozitif korelasyon
bulundu (p<0,05). Sonuç: Bu çalışmada disfaji saptanan akut inme hastalarının
bireysel rehabilitasyon ile yakından takip edilmesinin disfaji skorlarını iyileştirdiği
ve hastalarda gelişebilecek morbiditeleri azalttığı gözlemlendi.
Anahtar Kelimeler: Disfaji; inme; disfaji rehabilitasyonu
ABSTRACT
Objective: This study was conducted to examine the results of
early rehabilitation and follow-up procedures in terms of dysphagia in acute stroke
patients. Material and Methods: A total of 55 patients aged 18-85 years who
were diagnosed with acute stroke between June 2020 and January 2021 and who
were detected to have dysphagia by bedside swallowing test were included for
prospective follow-up. Patients who were unconscious and uncooperative, had
oropharyngeal structural damage or head/neck malignancy were excluded from
the study. Gugging Swallow Screening Test and Eating Assessment Tool-10 were
used for swallowing evaluations of the patients. Swallowing evaluation was performed
before rehabilitation, at discharge and after rehabilitation. Patients were
given individual early rehabilitation consisting of diet modification, safe swallowing
recommendations, oral hygiene and exercise program and acute stroke
patients were closely followed up during their hospital stay and for 1 month after
discharge. Results: A significant improvement was found in dysphagia scores
after the rehabilitation (p<0.05). A significant relationship was found between
dysphagia score change and oral hygiene, stroke history, and stroke type after the
rehabilitation (p<0.05). A negative correlation was found between the dysphagia
score and the National Institutes of Health Stroke Scale score before the rehabilitation,
and a positive correlation was found between the body mass index, Barthel
and Functional Ambulation Classification score (p<0.05). Conclusion: In this
study, it was observed that close monitoring of acute stroke patients with dysphagia
with individual rehabilitation improved dysphagia scores and reduced morbidities
that may develop in patients.
Keywords: Dysphagia; stroke; dysphagia rehabilitation
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