GENÇ BİREYLERDE BOYUN FLEKSÖR ENDURANSI, FONASYON ZAMANI VE TEPE EKSPİRATUAR AKIM HIZI ARASINDA İLİŞKİ VAR MIDIR?

Öz

Amaç: Çalışmamızın amacı, disfaji rehabilitasyonunda sıklıkla kullanılan, boyun fleksör kas
enduransı, fonasyon zamanı ve tepe ekspiratuar akım hızı arasında bir ilişki olup olmadığını
araştırmaktı.
Yöntem: Bu çalışmaya 61 sağlıklı birey (31 kadın, 30 erkek) dahil edildi. Çalışmaya katılan bireylerin
yaş ortalaması 20,7±1,33 (19-25) yıldı. Bireylerin demografik özellikleri kaydedildi. Boyun fleksör
kas enduransı sırtüstü yatar pozisyonda yapıldı. Hastalardan başlarını yatak üzerinde yaklaşık iki
parmak kadar kaldırmaları istendi. Hastaların pozisyonu koruyabildikleri süre kaydedildi. Fonasyon
süresi için, katılımcı dik pozisyonda otururken, derin inspirasyondan sonra güçlü ve uzun süre /a/
söylemesi istendi ve süre kaydedildi. PEFmetre ile tepe ekspiratuar akım hızı değerlendirildi.
Sonuçlar: İstatistiksel olarak, boyun fleksör kas enduransı ve fonasyon süresi arasında (r=0,475,
p<0,001), boyun fleksör kas enduransı ve tepe ekspiratuar akım hızı arasında (r=0,421, p=0,001),
fonasyon süresi ve tepe ekspiratuar akım hızı (r=0,421, p=0,001) arasında anlamlı pozitif bir ilişki
bulundu.
Tartışma: Boyun fleksör kas enduransı ve fonasyon süresi, boyun fleksör kas enduransı ve zirve
ekspiratuar akım oranı, fonasyon süresi ve tepe ekspiratuar akım hızı arasında orta derecede pozitif
yönlü ilişki vardı. Disfaji rehabilitasyonunda boyun fleksör kas endurans egzersizleri ve fonasyon
egzersizleri kullanılabilir. Bu egzersizlerin yutma güçlüğü çeken hastalar üzerinde de araştırılması
gereklidir. 

Anahtar Kelimeler

• Disfaji,Boyun Kasları,Fonasyon,Tepe Ekspiratuar Akım Hızı

IS THERE ANY RELATIONSHIP BETWEEN THE NECK FLEXOR MUSCLES ENDURANCE, PHONATION TIME AND PEAK EXPIRATORY FLOW RATE IN YOUNG INDIVIDUALS?

Abstract

Purpose: The aim of this study was to investigate the correlation between neck flexor muscle endurance, phonation time, and peak expiratory flow rate that are used very often in the
rehabilitation of dysphagia. Methods: Sixty-one healthy individuals participated in this study (31 females and 30 males). The mean age of the subjects was 20.7±1.33 (19 to 25) years. Demographic characteristics of individuals were recorded. Neck flexor muscles endurance test was performed in supine position. Subjects were asked to lift their head about two fingers above the bed. Time that subjects could maintain the position was recorded. Phonation time was measured while sitting upright position. After a strong inspiration the patients were asked to sustain a vowel sound /a/ as strong and long as possible. Peak expiratory flow (PEF) rate was evaluated using a peak flowmeter. Results: Statistically, there were positive relationships between neck flexor muscles endurance and phonation time (r=0.475, p<0.001), neck flexor muscles endurance and PEF (r=0.421, p=0.001), and phonation time and PEF (r=0.421, p=0.001). Conclusion: There were positive, moderate correlations between the flexor muscle endurance and phonation time, and between flexor muscle endurance and PEF and also between phonation time and PEF. Neck flexor muscle endurance exercises and phonation exercises could be used in dysphagia rehabilitation. These exercises also need to be investigated in patients with swallowing difficulty. In addition, to prevent patients from the negative effects of the aspiration, expiratory breathing exercises could be included in rehabilitation programs. 

Keywords

• Dysphagia,Neck Muscles,Phonation,Peak Expiratory Flow Rate

Kaynakça

1. Kiger M, Brown CS, Watkins L. Dysphagia Management: An Analysis of Patient Outcomes Using VitalStim_ Therapy Compared to Traditional Swallow Therapy. Dysphagia 2006:21(4);243–253.
2. Troche MS, Okun MS, Rosenbek JC, Musson N, Fernandez NH, Rodriguez R, et al. Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial. Neurology. 2010;75:1912–1919.
3. Ferdjallah M, Wertsch JJ, Shaker R Spectral analysis of surface EMG of upper esophageal sphincter opening muscles during head lift exercise. J Rehabil Res Dev. 2000;37(3):335–340.
4. Cook, IJ. Kahrilas, PJ. AGA tecnical review on management of oropharyngeal dysphagia. Gastroenterology. 1999;116:455-478.
5. Lang, IM. Brain stem control of the phases of swallowing. Dysphagia. 2009;24:333-348.
6. DeLegg, MH. Aspiration pneumonia: incidence, mortality, and at-risk population. J parenter enteral Nutr. 2002;26:19-25.
7. Matsuo K, Palmer JB. Anatomy and physiology of feeding and swallowing: normal and abnormal. Phys Med Rehabil Clin N Am. 2008;19:691–707.
8. Cook IJ, Dodds WJ, Dantas RO, Massey B, Kern MK, Lang IM, Brasseur JG, Hogan WJ. Opening mechanisms of the human upper esophageal sphincter. Am J Physiol Gastrointest Liver Physiol. 1989;257:748–759.

9. Sharkawi, A, Ramig, L, & Logemann, JA. Swallowing and voice effects of Lee Silverman Voice Treatment (LSVT(R)): A pilot study. Journal of Neurology Neurosurgery & Psychiatry 2002;72(1):31-36.
10. Argola N, Sampaio M, Pinho P, Melo A, Nobrega AC. Do swallowing exercises improve swallowing dynamic and quality of life in Parkinson’s disease? NeuroRehabilitation. 2013;32:949-955.
11. Logeman JA. Evaluation and treatment of swallowing disorders. 2rd ed. Austin, TX: Pro-ed. 1998.
12. Martin BJ, Logemann JA, Shaker R, Dodds WJ. Coordination between respiration and swallowing: respiratory phase relationship and temporal integration. J Appl Physiol. 1994;76:714–723.
13. Wheeler KM, Chiara T, Sapienza CM. Surface electromyographic activity of the submental muscles during swallow and expiratory pressure threshold training tasks. Dysphagia. 2007;22:108 –116.
14. Harris KD, Heer DM, Roy TC, Santos DM, Whitman JM, Wainner RS. Reliability of a Measurement of Neck Flexor Muscle Endurance. PHYS THER. 2005;85:1349-1355.
15. Maslan, J. Leng, X. Rees, C. Blalock, D. And Susan G. Butler, SG. Maximum phonation time in healthy older adults. J Voice. 2011;25(6):709–713.
16. Rodriguez-Parra MJ, Adrian JA, Juan C, Casado JC. Comparing voice-therapy and vocal-hygiene treatments in dysphonia using a limited multidimensional evaluation protocol. Journal of Communication Disorders. 2011;44:615–630.
17. Yılmaz Ö. Ekspiratuvar tepe akım hızı (PEF) ölçümü. Klinik pediatri. 2002;1(1):35-36.
18. Barber A. Upper cervical spine flexor muscles: age related performance in asymptomatic women. Australian Journal of Physiotherapy 1994;40(3):167-171.
19. Kahrilas PJ, Logeman JA, Lin S, Ergun GA. Pharyngeal clearance during swallowing: a combined manometric and videofluoroscopic study. Gastroenterology. 1992;103:128-136.
20. Barofsky I. Surface electromyographic biofeedback and the patient whith dysphagia: clinical opportunities and research questions. Dysphagia. 1995;10:19-21.
21. Nagaya M, Kachi T, Yamada T. Effect of swallowing training on swallowing disorders in Parkinson’s disease. Scand J Reh Med 2000;32(1):11-15.
22. Shaker R, Easterling C, Kern M, Nitschke T, Massey B, Daniels S, Grande B, Kazandjian M, Dikeman K. Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology. 2002;122:1314–1321.
23. Huckabe ML, Butler SG, Barclay M, Jit S. Submental surface electromygraphic measurement and pharyngeal presures during normal and effortful swallowing. Arch Phys Med Reh. 2005;86:2144-2149.
24. Okada S, Saitoh E, Palmer JB, Matsuo K, Yokoyama M, Shigeta R, et al. What is the chin-down posture? A questionnaire survey of speech language pathologists in Japan and the United States Dysphagia. 2007;22:204-209.
25. Bülow M, Olsson R, Ekberg O. Videomanometric analysis of supraglogtic swallow, effortful swallow, and ching tuck in patient with pharyngeal dysfunction. Dysphagia. 2001;16:190-195.
26. Ekberg O. Posture of the head and pharyngeal swallowing. Açta Radiol Diagn (Stockh) 1986;27:691-696.
27. Woo HS, Park SH, Jung MY, Yoo EY, Park JH. The effects of cranio-cervical flexion on activation of swallowing-related muscles. Journal of Oral Rehabilitation. 2012;39:805-811.
28. Savcı S, Savcı OS, Ince DI. Peak expiratory flow rate and relationship with smoking in males aged 16 to 21 years. Genel Tıp Derg. 2000;10(3):111-114.
29. Sgariboldi D, Pazzianotto-Forti EM. Predictive Equations for Maximum Respiratory Pressures of Women According to Body Mass. Respir Care. 2016;61(4):468-447.
30. Koziel S, Ulijaszek SJ, Szklarska A, Bielicki T. The effects of fatness and fat distribution on respiratory functions. Ann Hum Biol. 2007;34(1):123–131.
31. Grimmer K. Measuring the endurance capacity of the cervical short flexor muscle group. Aust J Physiother. 1994;40:251-254.