İNMELİ HASTALARDA EKSPİRATUAR KAS EĞİTİMİNİN STOMATOGNATİK SİSTEME ETKİSİ

Abstract

Amaç: Bu çalışmanın amacı ekspiratuar kas eğitiminin inmeli hastaların stomatognatik sistemine etkisini incelemekti. Yöntem: Çalışmaya kontrol grubuna 16 inmeli hasta (yaş=66.63±8.35, boy=166.38±8.59, BKİ=28.09±4.81), çalışma grubuna 15 inmeli hasta (yaş=65.60±7.62, boy=168.20±8.78, BKİ=28.95±6.42) olmak üzere toplam 31 inmeli hasta dahil edildi. İnmeli hastaların temporomandibular eklem hareket açıklığı ve disfonksiyonu, çiğneme kasları ağrı eşiği, fasiyal asimetri varlığı, baş postürü, oral hijyen ve oral hijyen alışkanlıkları, çiğneme performansı, intraoral pH, yutma ve derin boyun fleksör kasları enduransı değerlendirildi. Değerlendirme yöntemleri sırasıyla; dijital kaliper, Fonseka Anketi, algometre, labial kommissür ve kranioservikal açı ölçümü, genel oral sağlık değerlendirme indeksi ve anket, elek testi, dijital pH ölçer, tekrarlı saliva yutma testi, yeme değerlendirme envanteri ve derin boyun fleksörleri endurans testiydi. Çalışma grubundaki inmeli hastalar konvansiyonel fizyoterapi programına ek olarak üç hafta süresince, haftada her gün 5 set 10 tekrardan oluşan ekspiratuar kas eğitimi programına, kontrol grubuysa konvansiyonel fizyoterapi programına alındı. Çalışma grubundaki inmeli hastalar haftada iki gün aranarak, ekspiratuar kas eğitimi programına olan uyumları değerlendirildi. Bulgular: Grup içi karşılaştırmada kontrol grubundaki bireylerin sol masseter inferior parçası ağrı eşiklerinde ve protrüzyon hareketinde artış, labial kommissür açılarında ve Fonseka Anketi skorlarında ise azalma gözlendi (p<0.05). Çalışma grubunda yer alan inmeli hastaların ise mandibular depresyonunda artış bulundu (p<0.05). Grup içi karşılaştırmada gruplar benzer intraoral pH, çiğneme performansı, kranioservikal açı ve derin boyun fleksörleri enduransı değerlerine sahipti (p>0.05). Gruplar arası karşılaştırmada ise lateral deviasyon, yeme değerlendirme envanteri ve labial kommissür açısında anlamlı fark bulunurken (p<0.05), diğer parametreler benzerdi (p>0.05). Labial kommissür açısındaki iyileşme kontrol grubu lehineydi (p<0.05) Sonuç: Ekspiratuar kas eğitimi sub akut ya da kronik dönem inme hastalarında mandibular lateral deviasyonun arttırılmasında ve yutmanın iyileştirilmesinde tercih edilebilir.

Keywords

• Çiğneme
• Yutma
• Temporomandibular Eklem

EFFECT OF EXPIRATORY MUSCLE TRAINING ON STOMATOGNATHIC SYSTEM IN PATIENTS WITH STROKE

Abstract

Objective: The aim of this study was to assess the effect of expiratory muscle training on the stomatognathic system in patients with stroke. Method: A total of 31 patients with stroke were included in the study: 16 patients with stroke (age=66.63±8.38, height=166.38±8.59, BMI=28.09±4.81) as the control group and 15 patients with stroke (age=65.60±7.62, height=168.20±8.78, BMI=28.95±6.92) as the study group. Temporomandibular joint range of motion and dysfunction, pressure pain threshold of masticatory muscles, facial asymmetry existence, head posture, oral hygiene, oral hygiene habit, masticatory performance, intraoral pH, deglutition, and deep neck flexor muscle endurance of the patients with stroke were assessed. Assessment methods were in order by digital caliper, the Fonseca Questionnaire, algometry, labial commissure and craniocervical angle measurement, general oral health assessment index, and questionnaire, sieve test, digital pH gauge, repetitive saliva swallow test, Eating Assessment Tool, and deep neck flexor endurance test. Patients with stroke in the study group were enrolled in an expiratory muscle training program consisting of 5 sets of 10 repetitions daily for three weeks in addition to conventional physiotherapy; the control group enrolled in the conventional physiotherapy program. Patients with stroke in the study group were called twice a week to assess their compliance with the expiratory muscle training. Results: In intragroup comparison significant increase was found in the inferior portion of the left masseter, mandibular protrusion, and a decrease in labial commissure angle and Fonseca Questionnaire score of the control group (p<0.05). In the study group a significant increase was observed in mandibular depression (p<0.05). In intragroup comparison, both groups had similar intraoral pH, masticatory performance, craniocervical angle and neck flexor muscle endurance (p>0.05). While significant difference was found in lateral deviation, eating assessment inventory and labial commissure angle in intergroup comparison (p<0.05), other parameters were similar (p>0.05). Improvement in labial commissure angle was in favor of the control group (p<0.05). Conclusion: Expiratory muscle training might be preferred to increase mandibular lateral deviation and improve deglutition in subacute or chronic-stage patients with stroke.

Keywords

• Mastication
• Deglutition
• Temporomandibular Joint

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