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Objective: Awareness of deglutition disorders is essential for prevention of deglutition-related complications and improving quality of care.The study examined the current knowledge, attitude and practice regarding deglutition disorders among healthcare professionals in Turkey.Methods: Healthcare professionals who worked in hospitals and special education schools were included. A survey examining knowledge,attitudes, and practices regarding deglutition disorders, originally designed by Farpour and colleagues (2019), was adapted and administered tohealthcare professionals working in hospitals and special education schools in Turkey.Results: A total of 270 healthcare professionals were responded (72.7% response rate). 254 participants (94.1%) were familiar with theterm deglutition disorders. 223 participants (82.6%) defined their professions as a management team member. All participants supporteda multidisciplinary approach. 216 (80%) participants met a patient with deglutition disorders. 212 participants (78.5%) used at least oneevaluation method to evaluate swallowing function, and 147 participants (54.5%) used at least one treatment method for treatment. Mostparticipants (73.7%) were interested in attending a workshop about deglutition disorders.Conclusion: The present study showed that knowledge about deglutition disorders is high among healthcare professionals in Turkey, and theybelieve the necessity of multidisciplinary approach in deglutition disorders. However, it is not understood if they follow an individualized andstandardized evaluation and management procedures. Therefore, more detailed questionnaires especially focus on evaluation and managementof deglutition disorders should be developed and healthcare professionals could be trained to improve management of deglutition disordersin Turkey.

The aim of this study was to examine the relationship between dysphagia severity and head and neck proprioception in patients with neurological diseases.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.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).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.

Amaç: Serebral Palsili (SP) çocuklarda oral motor problemler ve yutma bozukluğu yaygın olarak görülmektedir. Bu çalışma, SP’li çocukların oral motor ve yutma bozukluğu ile ilgili tanımlayıcı özelliklerini incelemek amacı ile planlandı. Yöntem: Bu çalışma, yaş ortalaması 70.35±28.30 ay olan 90 SP’li çocuk (39 kız, 51 erkek) ile gerçekleştirildi. Motor fonksiyonel seviye için Kaba Motor Fonksiyon Sınıflandırma Sistemi (KMFSS) kullanıldı. Dil itme şiddetinin değerlendirilmesi için Dil İtme Derecelendirme Ölçeği (TTRS), salya problemi için Salya Şiddet ve Frekans Ölçeği, çiğneme performans seviyesi için Karaduman Çiğneme Performans Ölçeği (KCPS) ve yutma bozukluğu için Pediatrik Yeme Değerlendirme Aracı (PEDI-EAT-10) kullanıldı. Sonuçlar: KMFSS’ye göre çocukların % 55,6'sı seviye V düzeyindeydi. Çocukların %87,8'inde patolojik dil itme refleksi vardı. Ortalama PEDI-EAT-10 skoru 15,42±11,41 idi. SP’li çocukların %87,8'inde çiğneme bozukluğu ve % 87,8'inde salya problemi saptandı. GMFCS düzeyi, klinik SP tipi, open mouth varlığı, besin kıvamı ve pnömoni sayısı tüm oral motor ve yutma değerlendirmeleri ile korelasyon gösterdi (p

Background and study aims Wilson’s disease (WD) is a complex disorder related to copper metabolism and neurological involvement may lead to swallowing disorders . The purpose of this study was to evaluate swallowing function in pediatric patients with WD by using videofluoroscopic swallowing study (VFSS). Patients and methods A total of 21 patients were included in the study, prospectively. The VFSS was conducted to evaluate swallowing function of the patients. The penetration-aspiration scale (PAS) was used to assess penetration-aspiration severity. Results According to the VFSS, abnormal results were detected in nine patients (42.9%) with WD. Of these nine patients, oral phase dysfunction was present in one patient, laryngeal penetration was present in one patient and moreover, abnormal esophageal body function was detected in all nine patients. Of these nine patients, five had neurological presentation at the time of diagnosis, and remaining four patients had hepatic presentation. Mean PAS score of the patients was 1. Conclusion The current study results suggest that subclinical swallowing dysfunction may be observed in patients with either neurological or hepatic WD. Further studies are necessary to reveal the real incidence of esophageal phase problems of swallowing function in pediatric patients with WD.

Purpose: The aim of this study is to examine the effects of body mass index above normal limits on forward head posture and deep cervical flexor muscle endurance, which are considered to be predisposing factors of mechanical neck pain.Methods: Twenty-four individuals (mean age of 20.50 ± 2.02 years) with a body mass index (BMI) between 19.9 kg /m2 and 24.9 kg /m2 were included in the Normal Body Mass Index (N-BMI group) and 24 individuals with a BMI over 24.9 kg /m2 (mean age of 24.41 ± 2.90 years) were included in the Owerweight-Obese (OW-O group). Cranicervical Angles (CCA) of individuals was measured digitally to determine forward head posture. Deep Cervical Flexor Muscle Endurance Test (DCFMET) was used for endurance of deep cervical flexor muscles.Results: The CCA values of the OW-O group were less than in the N-BMI group, indicating an increased forward head posture (p = 0.043). There was no statistically significant difference in terms of the endurance of the deep cervical flexor muscles between the groups (p = 0.817). A moderate negative correlation was found between the BMI values and CCA of all individuals participating in the study (p = 0.012, r= -0.503). There was no correlation between BMI and DCFMET (p=0.887, r = 0.031). Conclusion: Knowing that overweight and obese young people are in the risk group for mechanical neck pain and various cervical pathologies, plays a very important role in increasing awareness about preventive approaches such as postural correction exercises and weight management strategies., Amaç: Bu çalışmanın amacı, normal sınırların üzerindeki vücut kitle indeksinin, mekanik boyun ağrısına zemin hazırlayan faktörler olarak kabul edilen baş ileri poziyonu ve derin servikal fleksör kasların enduransı üzerindeki etkilerini incelemektir.Yöntem: Vücut Kütle İndeksleri (VKİ) 19.9 kg /m2 and 24.9 kg /m2 arasında olan yirmi dört birey (ortalama yaş: 20.50 ± 2.02 yıl) Normal Vücut Kütle İndeksi grubuna (N-VKİ grubu), Vücut Kütle İndeksleri (VKİ) 24.9 kg /m2 üzerinde olan 24 birey (ortalama yaş: 24.41 ± 2.90 yıl) Aşırı kilolu-Obes grubuna dahil edildi (AK-O grubu). Baş ileri postürünü tespit etmek için, bireylerin Kranioservikal Açıları (KSA) dijital olarak ölçüldü. Derin servikal fleksör kasların enduransını ölçmek için Derin Servikal Fleksör Kasların Endurans Testi (DSFKE) kullanıldı.Bulgular: AK-O grubunun KSA değerleri N-VKİ grubuna göre statistiksel olarak daha düşüktü (p=0.043). Bu durum da artmış baş ileri postürünü işaret etmekteydi. Gruplar arasında derin servikal fleksör kasların enduransında istatistiksel olarak fark yoktu (p=0.817). Çalışmaya katılan tüm bireylerin VKİ ile KSA değerleri arasında negative yönde orta düzey korelasyon bulundu (p = 0.012, r= -0.503). VKİ ile DSKE arasında bir korelasyon yoktu (p=0.887, r = 0.031).Sonuç: Aşırı kilolu ve obez gençlerin mekenik boyun ağrısı ve çeşitli servikal patolojiler açısından risk grubunda olduğu bilmek, postural düzgünlük egzersizleri ve kilo control stratejileri gibi önleyici yaklaşımlar hakkında farkındalığın artaması için çok önemli bir rol oynamaktadır.

Objective: The study aimed to compare motor functions and quality of life of children with cerebral palsy (CP), as well as anxiety and depression levels of caregivers according to the feeding types of the children. Methods: The study included children with CP aged between 5-17 years. There were two groups: children with oral feeding (n=19) and children with non-oral feeding (n=16). Gross Motor Function Classification System (GMFCS) to classify children according to gross motor function, Gross Motor Function Measurement (GMFM) to evaluate gross motor functions, and parent-reported Pediatric Quality of Life Inventory to evaluate the quality of life of children were used. Beck Depression Inventory and Beck Anxiety Inventory were used to measuring caregivers’ anxiety and depression levels. Results: Significant differences were found between groups regarding the GMFCS, GMFM, and parent-reported Pediatric Quality of Life scores of children in favor of children with oral feeding (p

The purpose of this study was to translate the Pediatric assessment scale for severe feeding Problems (PASSFP) into Turkish and investigate its validity and reliability. The study included Turkish translation of the PASSFP, and investigating its reliability and criterion validity in relation with Children’s eating behavior questionnaire (CEBQ). Cronbach Alpha reliability of T-PASSFP was 0.79, and of its subscales, i.e. Form A and B, were 0.67, and 0.73, respectively. Test-retest correlation was 0.99 for the scale and Form A, and 0.94 for Form B. There were positive correlations between total scale and Enjoyment of food and Food fussiness subscales of CEBQ. Form A had positive relationships with Food responsiveness, Enjoyment of food, and Food fussiness subscales. Form B had positive correlations with Enjoyment of food and negative correlations with Slowness in eating subscales. The Turkish PASSFP is valid and reliable in evaluating feeding in children with neurodevelopmental disorders. Form A is applied for all children, and Form B is used for partially or totally oral-fed children

The current study was aimed to verify whether pediatric dentists could determine chewing performance level in children by using Karaduman Chewing Performance Scale (KCPS). 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. 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

Objective:The aim of our study was to put forth the existing problems about oral structure/function and swallowing function in patients who have different pediatric nuromuscular diseases (NMD’s). Methods:Fourty five pediatric patients with NMD’s aged 10.22±3.32 years old were included in the study. Oral intake levels of patients were determined with Functional Oral Intake Scale (FOIS). Oral structural and functional examination, assesment of complaints related to swallowing problems, and three ounce water swallow test were perfomed to all patients. Reseults: In oral assessment, structural problems were determined at varying rates between 13.3% and 46.6%, problems related to oral functions between %4.4 and 26.6%, and complaints related to swallowing problems between 11.1% to 33.3%. Five patients (%11) were failed in three ounce water swallow test. Conclusion:The findings related to oral structure/function and swallowing function indicate a risk of swallowing dysfunction with different symptoms and problems in NMD’s. These symptoms may result in life-threatening complications added to their current neuromuscular problems. Keywords: Swallowing, Oral Examination, Aspiration Pneumonia

Chewing disorders (CD) may cause restrictions in solid food intake and can be seen in 37% of children with esophageal atresia-tracheoesophageal fistula (EA-TEF). The Functional Chewing Training (FCT) is a holistic approach to improve chewing function (CF) in children. The study aimed to evaluate the effects of FCT on CF in children with EA-TEF.Twenty children with CD were included. Patients received 12 weeks FCT including impairment-based and adaptive components. Chewing performance level was scored with Karaduman Chewing Performance Scale (KCPS), and tolerated food texture was determined by the International Dysphagia Diet Standardization Initiative (IDDSI). The baseline and final levels of KCPS and IDDSI were compared to evaluate the effects of FCT on CF.Forty-five percent of cases were isolated-EA, and 55% were EA-distal TEF with a median age of 31 (min = 25, max = 84) months, of which 65% (n = 13) were male. Baseline evaluation showed that 12 cases were in level-1, 6 cases in level-3 and 2 cases in level-4 according to KCPS. Eight children with CD (40%) had IDDSI level-3 and 12 (60%) had level-7. There was a significant improvement in KCPS scores and IDDSI scores after 12 weeks of training (p 0.01, p = 0.005,respectively). KCPS scores showed level-0 in 15 cases, and level-1 in 5 cases. All children had IDSSI level-7.The FCT is an effective method to improve chewing function in children EA-TEF who had CD.Single group treatment study.Level 4.

The aim of this study was to evaluate the effect of the Coronavirus Disease (COVID-19) on the use of health and rehabilitation services, physical and general health conditions of individuals with Duchenne Muscular Dystrophy (DMD) from the perspective of parents. A questionnaire consisting of 35 questions was created by the research team. The data were obtained from the parents/primary caregivers of individuals whose diagnoses were confirmed by genetic testing and accessed online via the DMD Families Association. It was reported that 5.5% of the 272 individuals with DMD (age: 10.43±6.42 years) included in the study were infected with COVID-19. It was observed that the major problems encountered during the pandemic were obtaining health services (81%) and stress management (42%). More than half of the individuals were found to be adversely affected in general health (52%), mobility (56%), range of motion (54%), mood (66%), and social dialogs (62%). Furthermore, it was determined that 71% of the individuals took a break from the center where they received outpatient physiotherapy for 3 months or more, and only 6% could receive telerehabilitation service and the level of satisfaction was relatively moderate (10-point visual analog scale: 6.3±2.6). The parents reported that the health care utilization and physical-general health status of individuals with DMD were significantly adversely affected during the COVID-19 pandemic. The present study has an exploratory feature regarding the problems faced by individuals with DMD during the COVID-19 pandemic. Therefore, we think that it will guide future studies in preventing the negative effects of situations such as pandemics or natural disasters.

Background A sedentary lifestyle has negative effects on many aspects of life. Objective The aim of this study was to determine the effects of physical activity on sleep quality, job satisfaction, and quality of life in office workers. Methods A convenience sample of office workers from administrative staff of a university was included. There were two groups; Group I did regular physical activity for at least eight weeks, and Group II did no regular physical activity. Sleep quality, job satisfaction, and quality of life were assessed using the Pittsburgh Sleep Quality Index, the Minnesota Job Satisfaction Scale, and the World Health Organization Quality-of-Life-Scale (WHOQOL-BREF), respectively. Results Group I included 59 individuals and Group II 50 individuals. No significant differences were found between groups in terms of age, height, weight, and the period of time worked (p > 0.05). Although no significant difference was found in terms of sleep quality (p = 0.52), the overall job satisfaction of Group I was higher than Group II (p = 0.03). All subscales of the WHOQOL-BREF for Group I was higher than Group II (p Conclusion Regular physical activity could increase job satisfaction and quality of life for office workers. Further studies investigating the effect of physical activity in terms of its type, duration should be performed.

Objective: The aim of this study was to determine the relationship between patient reported dysphagia symptom severity and swallowing relatedquality of life (SRQOL) in patients with neurological disorders.Methods: Patients with a diagnosis of neurological disorders who aged between 25 to 60 years were included. The dysphagia symptom severity wasassessed with the Turkish Eating Assessment Tool (T-EAT-10). SRQOL was assessed by the Turkish version of the Swallow Quality of Life Questionnaire(T-SWAL-QOL).Results: Eighty-four patients with neurological disorder were included. The mean T-EAT-10 score was 19.59 ± 11.16 (min = 0, max = 40), and themean total score of T-SWAL-QOL was 50.63 ± 23.52 (min = 0, max = 90). A negative, good, statistically significant correlation between T-EAT-10 andtotal T-SWAL-QOL was found (p < 0.05).Conclusion: Higher patient reported dysphagia symptom severity is associated with lower scores of SRQOL. Therefore, appropriate managementstrategies which also focus on patient reported symptoms may be necessary to minimize negative SRQOL issues of patients with neurogenicdysphagia.

Amaç: Bu çalışmada serebral palsili (SP) çocuklarda çiğneme performans seviyesinin belirlenmesinde ebeveynler ve klinisyenler arasındaki uyumun incelenmesi amaçlandı.Yöntem: Bu kesitsel çalışmaya SP'li 50 çocuk ve anneleri dahil edildi. Çocuklarda çiğneme performans seviyesini belirlemek için Karaduman Çiğneme Performans Skalası (KÇPS) kullanıldı. SP'li çocukların anneleri, çocuklarının çiğneme performans seviyesini en iyi tanımlayan düzeyi birer hafta arayla iki kez puanladı. Çiğneme ve yutma bozuklukları konusunda deneyimli bir fizyoterapist de KÇPS’yi kullanarak çiğneme performans seviyesini puanlandı.Sonuçlar: Fizyoterapist ve anneler, 50 çocuğun 41'inde (%82) tamamen aynı KÇPS seviyesi üzerinde anlaştılar. Fizyoterapist ve annelerin KÇPS puanları arasında mükemmel, pozitif yönde korelasyon vardı (r=0,959, p, Purpose: The study was aimed to examine the agreement between parents and clinicians for determining chewing performance level in children with cerebral palsy (CP).Methods: This cross sectional study included 50 children with CP and their mothers. The Karaduman Chewing Performance Scale (KCPS) was used to determine chewing performance level in children. Mothers of children with CP scored the level that best describes their child’s chewing performance level twice with one-week interval. An experienced physical therapist in terms of chewing and swallowing disorders was also scored chewing performance level by using the KCPS. Results: The physical therapist and mothers agreed on exactly the same KCPS level in 41 of 50 children (82%). There was an excellent positive correlation between the KCPS scores of the physical therapist and the mothers (r=0.959, p

BACKGROUND: Patellofemoral pain (PFP) is a common knee problem. The foot posture in a relaxed stance is reported as a distal factor of PFP. However, the effects of short foot exercise (SFE) on the knee and functional factors have not yet been investigated in patients with PFP. OBJECTIVE: This study aimed to investigate the additional effects of SFE on knee pain, foot biomechanics, and lower extremity muscle strength in patients with PFP following a standard exercise program. METHODS: Thirty patients with a ‘weak and pronated’ foot subgroup of PFP were randomized into a control group (ConG, n= 15) and a short foot exercise group (SFEG, n= 15) with concealed allocation and blinded to the group assignment. The program of ConG consisted of hip and knee strengthening and stretching exercises. SFEG program consisted of additional SFE. Both groups performed the supervised training protocol two times per week for 6 weeks. Assessment measures were pain visual analog scale (pVAS), Kujala Patellofemoral Score (KPS), navicular drop test (NDT), rearfoot angle (RA), foot posture index (FPI), and strength tests of the lower extremity muscles. RESULTS: Both groups displayed decreases in pVAS scores, but it was only significant in favor of SFEG. NDT, RA, and FPI scores decreased in SFEG whereas they increased in ConG. There was a significant group-by-time interaction effect in hip extensor strength and between-group difference was found to be significantly in favor of SFEG. CONCLUSIONS: An intervention program consisting of additional SFE had positive effects on knee pain, navicular position, and rearfoot posture. An increase in the strength of the hip extensors may also be associated with improved stabilization by SFE.

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.

Aims:The study was aimed to investigate the difference between boys with Duchenne muscular dystrophy (DMD) and healthy peers in terms of gross and fine motor proficiency, and determine the relationship between motor proficiency and ambulation. Methods:A total of 24 boys with DMD and 22 healthy peers were evaluated. Demographics and physical characteristics were recorded. The Bruininks Oseretsky Test of Motor Proficiency-Short Form (BOTMP-SF) was administered to evaluate gross and fine motor proficiency in both groups. The 6-minute walk test (6MWT) was performed to evaluate functional walking capacity and North Star Ambulatory Assessment (NSAA) was used to determine ambulatory status of boys with DMD. Results:The gross motor proficiency score was significantly lower in boys with DMD (p = 0.001). No difference was found between the groups in terms of fine motor proficiency (p = 0.962). The gross motor function of BOTMP-SF was significantly related to 6MWT distance (r = 0.696,p = 0.001) and NSAA (r = 0.738,p = 0.001). No relationship was found between BOTMP-SF fine motor proficiency and 6MWT distance (r = 0.210,p = 0.361), and NSAA (r= -0.020,p = 0.928). There were significant correlations between running speed and agility with 6MWT distance (r = 0.585,p = 0.005) and NSAA (r = 0.650,p = 0.056). Conclusions:Boys with DMD were more affected in aspects of gross motor proficiency than healthy peers, while fine motor proficiency were found same. The gross motor proficiency was found more related to the level of ambulation.

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

Amaç: Çalışmanınamacı; genç bireylerde fiziksel aktivite düzeyinin akademik başarı ve depresyonüzerine etkisini belirlemektir. Gereç ve Yöntem: Katılımcılarınyaş ve cinsiyet bilgileri kaydedildi. Akademik başarı için not ortalamalarısorgulandı. Fiziksel aktivite düzeyi, Uluslararası Fiziksel AktiviteDeğerlendirme Anketi kısa formu kullanılarak belirlendi. Depresyon düzeyi iseBeck Depresyon Envanteri ile değerlendirildi. Sonuçlar: Çalışmaya%69.3’ü kız olmak üzere yaş ortalaması 21.64±0.97 yıl olan 140 lisans düzeyindeolan genç birey katıldı. Katılımcıların akademik başarı ortalaması 2.98±0.41,ve haftalık fiziksel aktivite ortalaması 2587.40±2279.83 MET-dk/hafta’idi. BeckDepresyon Envanteri ortalama puanı 11.39±8.47’idi. Fiziksel aktivite düzeyi ileakademik başarı arasında pozitif yönde, zayıf (p=0.02, r=0.19) ve depresyonarasında negatif yönde, zayıf ilişki bulundu (p=0.01, r=-0.21).Tartışma: Genç bireylerde fiziksel aktivite düzeyininarttırılmasının akademik başarıyı artırma ve depresyonu azaltma üzerine olumluetkileri olabileceği düşünülmektedir. Bu nedenle gençlerde fiziksel aktiviteyiteşvik eden olanakların sağlanması sağlıklı ve başarılı bir nesil içinönemlidir., Purpose: The aim of this study was to determine the effect of physical activity level on academic success and depression in young individuals. Materials and Methods: The information including age and gender was recorded. The mean grade-point for academic success was questioned. Physical activity level was determined by using the short form of the International Physical Activity Questionnaire. The level of depression was assessed with the Beck Depression Inventory. Results: One hundred-forty young individuals at the undergraduate level with a mean age of 21.64±0.97 years, of whom 69.3% were girls were included. The mean grade-point was 2.98±0.41, and the mean weekly physical activity level of the participants was 2587.40±2279.83 MET-min/week. The mean score of Beck Depression Inventory was 11.39±8.47. A poor, positive correlation between physical activity level and academic degree (p=0.02, r=0.19) and poor, negative correlation between physical activity level and depression (p=0.01, r= -0.25) were found. Discussion: In conclusion, it is thought that increasing the level of physical activity of young individuals may have positive effects on academic achievement and reducing depression. Thus, provision of opportunities to promote physical activity in young ages is important for a healthy and successful generation.

Exercise studies in neuromuscular diseases like spinal muscular atrophy (SMA), a devastating disease caused by survival of motor neuron 1 ( SMN1) gene mutations, are drawing attention due to its beneficial effects. In this study, we presented a constructed arm cycling exercise protocol and evaluated the benefits on SMA patients. Five SMA type II patients performed 12 weeks of supervised arm cycling exercise. The physical functions were evaluated together with the SMN2 copy numbers, SMN protein levels, insulin-like growth factor 1(IGF1) and binding protein 3 (IGFBP3) levels. The active cycling distance and duration of patients significantly improved. Significant changes could not have detected either SMN or IGF1 and IGFBP3 levels in response to exercise. The findings demonstrated that the patients tolerated the exercise protocol and gained a benefit from arm cycling but benefits could not be associated with SMN2 copy number, SMN protein level, IGF1, or IGFBP3 levels.

Objectives: To compare the fatigue levels and energy expenditure of children with Duchenne Muscular Dystrophy (DMD) at different functional levels with healthy children. Methods: The cross-sectional study was carried out in the Unit of Pediatric Neuromuscular Diseases in the Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Hacettepe University between March 2015 and January 2016. Fifty two children diagnosed with DMD in Level I-III according to the Brooke Functional Classification Scale and 17 healthy children were included in the study. The Six Minute Walk Test (6MWT), Northstar Ambulatory Assessment Scale (NSAA), Physiological Cost Index (PCI), and Timed performance tests were used to assess the children. Results: Comparison in terms of PCI indicated a difference between Levels 2 and 3, and Levels 1 and 3 (p

Background/Aims Dysphagia is common in patients with neurological disorders. There is a need to identify patients at risk early by a useful clinical tool to prevent its serious complications. The study aims to determine the ability of the Turkish version of Eating Assessment Tool-10 (T-EAT-10) to detect aspiration in patients with neurological disorders. Methods Two hundred fifty-nine patients with neurological disorders who had complaints about swallowing difficulty and referred for a swallowing evaluation were included. Oropharyngeal dysphagia was evaluated with the T-EAT-10 and videofluoroscopic swallowing study in the same day. The penetration-aspiration scale (PAS) was used to document the penetration and aspiration severity. Results The mean age of the patients was 59.72 ± 17.24 years (minimum [min] = 18, maximum [max] = 96), of which 57.1% were male. The mean T-EAT-10 of patients who had aspiration (PAS > 5) was 25.91 ± 10.31 (min = 1, max = 40) and the mean T-EAT-10 of patients who did not have aspiration (PAS < 6) was 15.70 ± 10.54 (min = 0, max = 40) (P < 0.001). Patients with a T-EAT-10 score higher than 15 were 2.4 times more likely to aspirate. A linear correlation was found between T-EAT-10 and PAS scores of the patients (r = 0.416, P < 0.001). The sensitivity of a T-EAT-10 higher than 15 in detecting aspiration was 81.0% and the specificity was 58.0%. A T-EAT-10 score of higher than 15 has a positive predictive value of 72.0% and a negative predictive value of 69.0%. Conclusion The T-EAT-10 can be used to detect unsafe airway protection in neurology clinics to identify and refer dysphagic patients for further evaluation. (J Neurogastroenterol Motil 2017;23:550-554)

To develop and evaluate the psychometric properties of the Pediatric version of the caregiver administered Eating Assessment Tool.The study included developmental phase and reported content, criterion validity, internal consistency and test-retest reliability of the Pediatric Eating Assessment Tool. Literature review and the original Eating Assessment Tool were used for line-item generation. Expert consensus assessed the items for content validity over two Delphi rounds. Fifty-one healthy children to obtain normative data and 138 children with cerebral palsy to evaluate test-retest reliability, internal consistency, and criterion validity were included. The Penetration-Aspiration Scale was used to assess criterion validity.All items were found to be necessary. Content validity index was 0.91. The mean score of Pediatric Eating Assessment Tool for healthy children and children with cerebral palsy was 0.26 ± 1.83 and 19.5 ± 11, respectively. The internal consistency was high with Cronbach's alpha =0.87 for test and retest. An excellent correlation between the Pediatric Eating Assessment Tool and Penetration-Aspiration score for liquid and pudding swallowing was found (p 0.001, r = 0.77; p 0.001, r = 0.83, respectively). A score4 demonstrated a sensitivity of 91.3% and specificity of 98.8% to predict penetration/aspiration.The Pediatric Eating Assessment Tool was shown to be a valid and reliable tool to determine penetration/aspiration risk in children. Implications for rehabilitation The pediatric eating assessment tool: a new dyphagia-specific outcome survey for children. The Pediatric Version of the Eating Assessment Tool is a dysphagia specific, parent report outcome instrument to determine penetration/aspiration risk in children. The Pediatric Version of the Eating Assessment Tool has good internal consistency, test-retest reliability and criterion-based validity. The Pediatric Version of the Eating Assessment Tool may be utilized as a clinical instrument to assess the need for further instrumental evaluation of swallowing function in children.

Purpose To investigate if chewing side preference (CSP) can be used as an indicator of hemispheric laterality in healthy adults. Materials and methods Seventy-five individuals were included. The visual analogue scale (VAS) was used to determine CSP and laterality test for preferred peripheral organs. Results Significant correlation between CSP and hand, foot, ear, and eye side preference was found (r = .41, p

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.

Purpose: Anatomical and physiological changes due to aging decrease the efficiency of swallowing and increase the risk of aspiration pneumonia. One of the underlying causes of recurrent pneumonia is swallowing dysfunction, with aspiration. This study aimed to compare the swallowing function in elderly patients with and without pneumonia and to investigate its association with malnutrition. Methods: A total of 44 elderly individuals with 22 aspiration pneumonia history (age=73.00±7.93 years) (study group) and 22 without aspiration pneumonia history (age=70.00±6.39 years) (control group) were included in the study. The swallowing function was evaluated using the Swallowing Ability Function Evaluation (SAFE) and water-swallowing test. Nutritional assessment was performed using the Turkish version of the Mini-Nutritional Assessment. Results: Decreased swallowing ability was observed in 59.1% of the study group and 9.1% of the control group (p, Amaç: Yaşlanma ile birlikte oral motor yapılardaki zayıflık, reflekslerde yavaşlama gibi anatomik ve fizyolojik değişimler yutma etkinliğinde azalmaya yol açarak aspirasyon pnömonisi riski oluşturmaktadır. Tekrarlayan pnömoninin altında yatan nedenlerden biri, aspirasyon ile birlikte yutma disfonksiyonudur. Bu çalışmada pnömoni öyküsü olan ve olmayan yaşlılarda yutma fonksiyonlarının karşılaştırılması ve malnutrisyon ile ilişkisini incelenmesi amaçlandı. Yöntem: Çalışmamıza 22 aspirasyon pnömoni öyküsü bulunan (yaş=73,00±7,93 yıl) (çalışma grubu) ve 22 aspirasyon pnömoni öyküsü bulunmayan (yaş=70,00±6,39 yıl) (kontrol grubu) toplam 44 yaşlı birey dahil edildi. Yutma fonksiyonu değerlendirmesinde Yutma Yeteneği ve Fonksiyonu Değerlendirmesi (SAFE) ve su yutma testi kullanıldı. Beslenme değerlendirmesi, Mini-Nutrisyonel Değerlendirme'nin Türkçe versiyonu ile yapıldı. Sonuçlar: Çalışma grubunun % 59,1’inde yutma becerisinde azalma bulunurken, kontrol grubunda bu oran % 9,1’di (p

Introduction Chewing disorders (CD) may cause restrictions in solid food intake and can be seen in 37% of children with esophageal atresia–tracheoesophageal fistula (EA-TEF).1 The Functional Chewing Training (FuCT) is a holistic approach to improve chewing function (CF) in children. The study aimed to evaluate the effects of FuCT on CF in children with EA-TEF. Materials and Methods Twenty children with CD were included. Patients received 12 weeks of FuCT, including impairment-based and adaptive components. Chewing performance level was scored with the Karaduman Chewing Performance Scale (KCPS), and tolerated food texture was determined by the International Dysphagia Diet Standardization Initiative (IDDSI). The baseline and final levels of KCPS and IDDSI were compared to evaluate the effects of FuCT on CF. Results 45% of cases were isolated-EA and 55% were EA-distal TEF with a median age of 31 (min = 25, max = 84) months, of which 65% (n = 13) were male. Baseline evaluation showed that 12 cases were in level-1, 6 cases in level-3 and 2 cases in level-4 according to the KCPS. Eight children with CD (40%) had IDDSI level-3 and 12 (60%) had level-7. There was a significant improvement in KCPS scores and IDDSI scores after 12 weeks of training (P Conclusions The FuCT is an effective method to improve chewing function in children EA-TEF who had CD.

Background: The most important airway protection mechanism during swallowing is adequate laryngeal elevation. Suprahyoid muscles are responsible for laryngeal elevation. There are many treatment approaches to improve laryngeal elevation in swallowing rehabilitation. The most common methods are exercises including Shaker exercises, Chin-Tuck Against Resistance (CTAR) exercise, Neuromuscular Electrical Stimulation of suprahyoid muscles and Expiratory Muscle Strength Training (1-4). Objectives: The aim of our study was to compare the effects of three different exercises including Shaker, CTAR and a new method Chin Tuck with TheraBand Exercises on suprahyoid muscles activity. Methods: Forty-two healthy subjects with a mean age of 27.92±5.02 years (min=18, max=40), of which 50% were male were included. All individuals were divided into three groups; Chin Tuck Against Resistance (CTAR); Group 1, Shaker exercise; Group 2, Chin Tuck Exercise with Theraband; Group 3, with computerized randomization. Surface EMG evaluation was performed to determine electrical activity of the suprahyoid muscles during maximal voluntary isometric contraction (Figure1) and during performing CTAR, Shaker exercise and Chin Tuck with Theraband (Figure 2-4). Normalized suprahyoid muscle activations were calculated as: Recorded Maximum Electrical Activity During Exercise (mV)/ Recorded Maximum Electrical Activity During Maximum Isometric Contraction (mV). Results: A statistically significant difference was found between three groups in terms of normalized suprahyoid muscle activitty(p Conclusion: In conclusion, primarily CTAR exercise should be included in rehabilitation to increase the suprahyoid muscle activation. In addition, chin tuck exercise with Therband can also be considered as an alternative to CTAR. References [1] Shaw GY, et al. Transcutaneous neuromuscular electrical stimulation (VitalStim) curative therapy for severe dysphagia: myth or reality?Annals of Otology, Rhinology & Laryngology.2007;116(1): 36-44. [2] Wheeler-Hegland KM, Rosenbek JC, Sapienza CM. Submental sEMG and hyoid movement during Mendelsohn maneuver, effortful swallow, and expiratory muscle strength training. J Speech Lang Hear Res. 2008;51(5):1072-1087. [3] Yoon WL, Khoo JK, Liow SJ. Chin tuck against resistance (CTAR): new method for enhancing suprahyoid muscle activity using a Shaker-type exercise. Dysphagia. 2014;29(2):243-248. Disclosure of Interests: None declared

Aim Children with esophageal atresia and tracheoesophageal fistula (EA-TEF) may experience feeding and swallowing difficulties, which result in stressful interactions between children and caregivers, and potentially impact the concerns of caregivers. The aim of this study was to assess concerns of caregivers of children with EA-TEF related to feeding–swallowing difficulties and compare the concerns according to type of atresia, repair time and time to start oral feeding. Methods Caregivers accompanying 24 children with EA-TEF were included. Age, sex, type of atresia, repair time, and time to start oral feeding of children were noted. Parents completed the Feeding/Swallowing Impact Survey (FS-IS) to assess the concerns of caregivers related to feeding–swallowing difficulties. It has three subscales, including daily activities, worry, and feeding difficulties. Average scores range between 1 and 5, of which increasing scores reflect more caregiver concern. Results The mean age was 3.41 ± 2.71 years, of which 66.7% were male. 56.3% of cases were isolated EA, and 43.8% were EA–distal TEF. 60.9% of cases received early repair ( Conclusions This study suggests that concerns of caregivers of children with EA-TEF related to feeding–swallowing difficulties are associated with the surgical outcome of EA. 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.

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

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

Amaç: Parkinson hastalarında ilerleyici şekilde yutma bozukluğu görülmektedir. Bu çalışma; kinezyo bantlamanın (KT) yutma bozukluğu şikayeti olmayan ancak risk altındaki Parkinson’lu hastaların yutma fonksiyonu üzerindeki etkisini elektrofizyolojik yöntemler ile incelemek amacıyla planlandı. Yöntem: Çalışmaya 65 yaş ve üzeri, kardiyopulmoner hastalık öyküsü ve aspirasyon/penetrasyon bulgusu olmayan 18 Parkinson hastası ve 15 sağlıklı yaşlı birey dahil edildi. Bireylere altı hafta boyunca ve haftada üç kez olmak üzere kas fasilitasyon tekniği ile KT uygulandı. KT öncesinde ve altı hafta sonrasında yüzeyel elektromiyografik (EMG) yutma değerlendirmesi olarak tek lokma analizi yapıldı. Sonuçlar: KT öncesi sonuçlara bakıldığında Parkinson hastası grubuna ait laringeal relokasyon (p=0,011) ve submental EMG (SM-EMG) toplam (p=0,009) süreleri daha uzun bulunmasına rağmen, KT uygulaması sonrasında sağlıklı yaşlılara göre fark yoktu (p>0,05). Ayrıca bu grubun KT öncesi ve sonrası grup içi karşılaştırmaları sonucunda laringeal relokasyon (p=0,013) ve SM-EMG toplam (p=0,011) sürelerinin kısaldığı bulundu. Tartışma: Çalışmamızın sonucunda altı haftalık KT uygulaması ile Parkinson hastalarında larinks hareket süresi ve submental kas aktivasyonunun gelişerek yutma fonksiyonunda ilerleme sağlandığı görüldü. KT, yutma bozukluğu olan hastalarda destekleyici tedavi yöntemi olarak kullanılabilir. Yutma bozukluğunun ileri evrelerinde ise, etkinliğinin araştırılması gerekmektedir., Purpose: Progressive swallowing disorder is seen in Parkinson's patients. This study was designed to investigate the effect of kinesio taping (KT) on swallowing function by electrophysiological methods in Parkinson patients who had not swallowing problem, however, under risk. Methods: Eighteen with Parkinson’s disease and 15 healthy elderly who were 65 years and older, with no cardiopulmonary history and airway aspiration/penetration symptom were included in this study. They were applied KT with muscle facilitation technique for six weeks and three times per week. Single bolus analysis as surface electromyographic (EMG) swallowing evaluation was performed before and six weeks after the KT procedure. Results: According to pre-KT results, laryngeal relocation (p=0.011) and submental EMG (SMEMG) total duration (p=0.009) were longer at Parkinson patients group although there was not any difference at post-KT (p>0.05). Furthermore, the before-after intragroup comparison showed that laryngeal relocation (p=0.013) and SM-EMG total duration (p=0.011) were found to be shorten. Conclusion: The result of our study shows that larynx movement time and submental muscle activation were improved with six weeks of KT application in Parkinson's patients. KT can be used as a complementary treatment method in patients with swallowing disorder. However, further research is needed to explore the efficiency in advanced stages of swallowing disorder.

Purpose: Evaluation of swallowing and feeding types are essential in patients with head and neck cancer (HNC). This study aimed to evaluate the swallowing function of patients treated for HNC. Methods: One hundred fifty-seven patients with HNC who were referred for swallowing disorder were included. Descriptive information including age, gender, weight, height, diagnosis, and feeding type was recorded. Videofluoroscopic swallowing study (VFSS) was performed to assess swallowing function. Penetration and aspiration severity was determined using the Penetration and Aspiration Scale (PAS). Results: The mean age was 54.16±12.90 years, of which 66.9% was male. The 23.6% of patients were treated for oropharyngeal cancer, 17.2% for nasopharyngeal cancer, and 59.2% for hypopharyngeal cancer. The 26.75% of patients underwent surgery, and 25.5% received chemoradiotherapy, and 45.9% underwent surgery combined with chemoradiotherapy. The mean PAS score for liquid was 4.96±2.93, and the mean PAS score for pudding was 3.76±3.05 according to the VFSS. While only liquid aspiration was 70.1%, aspiration in liquid and pudding was 37.2%. A significant difference was found between referral and recommended feeding types (p=0.003). No difference was detected in terms of PAS score for liquids, PAS score for pudding, and recommended feeding type according to received treatment types (p>0.05). Conclusion: More than half of the patients had airway aspiration, and their referral feeding type was not appropriate. Therefore, swallowing function should be evaluated in patients with HNC, and appropriate feeding type should be determined in an early period., Amaç: Baş ve boyun kanserlerinde yutmanın ve beslenme şeklinin belirlenmesi önemlidir. Bu çalışmanın amacı, baş ve boyun kanseri (BBK) tedavisi almış hastaların yutma fonksiyonlarının değerlendirilmesi idi. Yöntem: Çalışmaya yutma bozukluğu şikâyeti ile başvuran 157 BBK'lı hasta dahil edildi. Hastaların yaş, cinsiyet, boy, vücut ağırlığı, tanı ve beslenme şekli gibi tanımlayıcı bilgileri kaydedildi. Yutma fonksiyonunun değerlendirilmesi için videofloroskopik yutma çalışması (VFYÇ) yapıldı. Penetrasyon ve aspirasyon şiddetini belirlemede Penetrasyon ve Aspirasyon Skalası (PAS) kullanıldı. Sonuçlar: Yaş ortalaması 54,16±12,90 yıl olan hastaların % 66,9'u erkekti. Hastaların % 23,6'sı orofarengeal kanser, % 17,2'si nazofarengeal kanser ve % 59,2'si hipofarengeal bölge kanseri için tedavi edilmişti. Hastaların % 26,7'si cerrahi tedavi, % 25,5'i kemoradyoterapi ve % 45,9'u cerrahi ve kemoradyoterapi tedavisini birlikte almıştı. Hastaların VFYÇ'ye göre ortalama PAS sıvı skoru 4,96±2,93 ve kıvamlı skoru 3,76±3,05 idi. Sadece sıvı aspirasyonu % 70,1 iken, kıvamlı gıdalarda aspirasyon % 37,2 idi. Başvuru beslenme şekli ile önerilen beslenme şekli arasında istatistiksel olarak anlamlı fark bulundu (p=0,003). Uygulanan tedavi tipine göre sıvı PAS skoru, kıvamlı PAS skoru ve önerilen beslenme şekli açısından anlamlı fark bulunamadı (p>0,05). Tartışma: BBK'lı hastaların yarısından fazlasında havayolu aspirasyonu olduğu ve mevcut beslenme şekillerinin uygun olmadığı tespit edildi. Bu nedenle, BBK'lı hastalarda yutma fonksiyonu değerlendirilmeli ve erken dönemde doğru beslenme şekli belirlenmelidir.

Objective(s) This study aimed to develop a scale called Tongue Thrust Rating Scale (TTRS), which categorized tongue thrust in children in terms of its severity during swallowing, and to investigate its validity and reliability. Methods The study describes the developmental phase of the TTRS and presented its content and criterion-based validity and inter-observer and intra-observer reliability. For content validation, seven experts assessed the steps in the scale over two Delphi rounds. Two physical therapists evaluated videos of 50 children with cerebral palsy (mean age, 57.9±16.8 months), using the TTRS to test criterion-based validity, inter-observer, and intra-observer reliability. The Karaduman Chewing Performance Scale (KCPS) and Drooling Severity and Frequency Scale (DSFS) were used for criterion-based validity. Results All the TTRS steps were deemed necessary. The content validity index was 0.857. A very strong positive correlation was found between two examinations by one physical therapist, which indicated intra-observer reliability (r = 0.938, p < 0.001). A very strong positive correlation was also found between the TTRS scores of two physical therapists, indicating inter-observer reliability (r = 0.892, p < 0.001). There was also a strong positive correlation between the TTRS and KCPS (r = 0.724, p < 0.001) and a very strong positive correlation between the TTRS scores and DSFS (r = 0.822 and r = 0.755; p < 0.001). These results demonstrated the criterion-based validity of the TTRS. Conclusions The TTRS is a valid, reliable, and clinically easy-to-use functional instrument to document the severity of tongue thrust in children. This article is protected by copyright. All rights reserved

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.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.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).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.

Background It was well known that patellofemoral pain (PFP) has multifactorial aetiology. Increased navicular drop measures and especially more pronated foot posture in stance phase have been reported as distal factors.1,2 Foot orthosis are recommended as distal interventions but remained passive.3 For this reason, short foot exercise (SFE),4 as an active approach, may be of significant benefit in patients with PFP. Objectives The aim of this study was to investigate the effects of SFE on pain, knee and foot biomechanics in patients with PFP. Methods Twenty-two patients with PFP, mean age was 40.91±10.73, included in this study. They were randomly divided into two groups. The first group (KHE) was followed under the exercise program including knee and hip exercises, and the second group (SFE) was followed under SFE in addition to the same exercise program 2 days per a week for 6 weeks. At the beginning and the end of the study, for pain at walking, sitting, squatting, climbing stairs Visual Analogue Scale (VAS) and Kujala Patellofemoral Symptom Scale (KPSS); for knee and foot biomechanics measurement of Q angle, Navicular Drop Test (NDT), Calcaneo-tibial angle (CTA) and Foot Posture Index (FPI) were performed. Results As a result of this study, it was found that all parameters were improved in both groups, whereas the improvements in the pain intensity (VAS) of sitting and stair activities, values of Q angles, NDT, CTA and FPI were statistically significant in SFE group compared to KHE group (p Conclusions In conclusion, it was shown that SFE has positive effects on pain, knee and foot biomechanics in patients with PFP. At this point, SFE is an exercise approach in order to increase the success of the rehabilitation program in patients with PFP. References [1] Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Risk factors for patellofemoral pain syndrome: a systematic review. J Orthop Sports Phys Ther. 2012;42(2):81–94. [2] Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Factors associated with patellofemoral pain syndrome: a systematic review. Br J Sports Med. 2013;47(4):193–206. [3] Crossley KM, Stefanik JJ, Selfe J, Collins NJ, Davis IS, Powers CM, et al. 2016Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br J Sports Med. 2016;50(14):839–43. [4] McKeon PO, Hertel J, Bramble D, Davis I. The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br J Sports Med. 2015;49(5):290. Disclosure of Interest None declared

Epiglottis laringeal elevasyon sirasinda vestibulu kapatarak, yutma esnasinda hava yoluna besin kacmasini engellemede onemli bir rol oynamaktadir. Epiglottisin olmadigi durumda, hava yolu kapanisi sekteye ugrayabilir. Pierre Robin Sendrom’lu (PRS) hastalarda epiglottis yoklugu nadir gorulmektedir. Burada epiglottis’i olmayan bir PRS vakasini ve tedavi uygulamalarinin sonucunu sunulacaktir. PRS teshisi konmus erkek infant 3 kg dogum agirligina ve sezaryen dogum hikayesine sahipti. Vaka 11 aylikken aspirasyon pnomonisi hikayesi sebebiyle Hacetttepe Universitesi Fizyoterapi ve Rehabilitasyon Bolumu, Yutma Bozukluklari Unitesine yonlendirilmistir. Ilk once fiberoptik endoskopik yutma degerlendirilmesi (FEYD) yapilmis ve epiglottis yoklugu farkedilmistir. FEYD sirasindaki rahatsizlik hissi nedeniyle, daha detayli bir yutma degerlendirilmesi icin videofluoroskopik yutma degerlendirilmesi (VFYD) gerceklestirilmis ve aspirasyon gorulmustur. VFYD’den sonra hastaya nazogastrik tup takilmis ve 2 aylik bir yutma rehabilitasyon programina baslanmistir. Program dahilinde yutma refleksini tetiklemek amaciyla termal taktil stimulasyon, hyolaringeal elevasyonu artirmak icin laringeal mobilizasyon ve noromuskuler elektrik stimulasyonu uygulanmistir. Rehabilitasyon sonrasi VFYD tekrarlanmistir. Sivi kivamlarda aspirasyonun devem ettigi ancak puding kivaminin tolere edildigi goruldu. Degerlendirme sonrasinda sivi kisitli oral alima baslandi. Epiglottisi olmayan hastalarda, erken teshis ve tedavi yaklasimlari cok onemlidir.

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

AMAÇ: Genç bireylerin fiziksel aktivitenin sağlık üzerine etkileri hakkındaki bilgi düzeylerinin ve farkındalıklarının artırılmasının fiziksel aktivite düzeylerine olan etkilerini incelemektir. GEREÇ VE YÖNTEM: Çalışmaya, yaşları 18-35 arasında ve fiziksel aktivite yapmasına engel bir sağlık problemi olmayan gönüllüler dâhil edilmiştir. 6 Dakika Yürüme Testi(6DYT), Uluslararası Fiziksel Aktivite Anketi, Nottingham Sağlık Profili, Beck Depresyon Anketi, Pittsburgh Uyku Kalitesi İndeksi değerlendirmeleri yapılmıştır. Aktivite günlüğü ve anketine göre, 10 bin adım kriter alınarak bireyler 10 bin altı ve üstü adım atanlar olmak üzere iki gruba ayrılmıştır. Bireyler ilk değerlendirmelerin ardından, egzersiz ve yürüme eğitimi programına alınmışlar ve 1 ay sonra ikinci kez değerlendirilmişlerdir. SONUÇLAR: 6DYT sonuçları incelendiğinde, her bir grubun eğitim öncesi ve sonrası değerlerinin anlamlı değişiklik gösterdiği(p0.05). Fiziksel aktivite, yaşam kalitesi, depresyon ve uyku değerlendirme anket sonuçlarının, eğitim ile birlikte her iki grupta olumlu yönde gelişim gösterdiği(p0.05). TARTIŞMA: Sonuçlar gençlerin inaktif olduğunu göstermiştir. Yürüme mesafesinin düşük ve oksijen tüketiminin başlangıçta fazla olduğu, ancak verilen yürüme eğitimi ile değerler gelişmiştir. İnaktiviteye bağlı ortaya çıkan depresyon, uyku bozukluğu gibi durumların orta derecede etkilendiği, yaşam kalitesi değerlerinin de düşük olduğu, ancak eğitim ile sonuçların daha memnun edici olabildiği gösterilmiştir.

Introduction Feeding problems are common in children with esophageal atresia and tracheoesophageal fistula (EA–TEF); however, chewing disorders, which may cause inability to intake solid food, have not been evaluated. Therefore, we aimed to evaluate the chewing function in children with repaired EA–TEF. Materials and Methods Age, sex, the type of atresia, the type of repair, and the time to start oral feeding were recorded. The level of the chewing performance was scored according to the Karaduman Chewing Performance Scale (KCPS). The International Dysphagia Diet Standardization Initiative (IDDSI) was used to determine the tolerated food texture in children. Results A group of 30 patients were included, of which 53.3% was male. The percentages of the isolated-EA and that of the EA–distal TEF were 40% and 60%, respectively. The median value for the time to start oral feeding was 4.5 weeks (min = 1, max = 72). Eleven (36.7%) children had chewing disorder. The KCPS scores showed level I in six cases, level III in four cases, and level IV in one case. Five children with chewing disorder had IDDSI level 3 and six had level 7, along with the sensation of stuck food. We found no significant difference between the KCPS scores according to the repair type (p = 0.07). The median values of the KCPS scores of children with primary repair, delayed repair, and colon interposition were 0 (min = 0, max = 4), 0.5 (min = 0, max = 3), 2 (min = 0, max = 3), respectively. A significant positive correlation was found between the time to start oral feeding and the KCPS scores (r = 0.63, p = 0.001). Conclusion Chewing disorders can be observed in children with EA–TEF, and the type of repair and the delay in oral feeding may be related to chewing disorder. Therapeutic maneuvers are needed to improve the chewing function in children with EA–TEF.

Purpose: The aim was to investigate the characteristics of oral structures and feeding in patients with Subacute Sclerosing Panencephalitis (SSPE).Methods: Twenty SSPE patients were included. Clinical evaluation of oral structures and oralhygiene were performed. Each patient was requested to take liquid, pudding and solid foodconsistencies during feeding evaluation. The Karaduman Chewing Performance Scale (KCPS)was used to determine the level of chewing function. The 3-ounce water swallow test was usedto screen patients for aspiration risk.Results: The mean age was 13.76±1.92 years, of which 55% were male. Seven children (35%)had open mouth posture at rest, 5 (25%) had open bite, 12 (60%) had high arched palate, and 8(40%) had tongue thrust. Eighteen children (90%) had oral hygiene problems. Feeding positionswere variable with 1 child fed in supine, 6 in semi-sitting position, and 13 in upright sitting position. Findings during clinical feeding evaluation revealed the following: food acceptance (20,100%), liquid intake (20, 80%), pudding intake (17, 85%), and solid food intake (5, 25%). Fivechildren (25%) were in level I, 7 children (35%) were in level II, 3 children (15%) were in levelIII, and 5 children (25%) were in level IV according to the KCPS. Four children (25%) failed in 3ounce water swallow test.Discussion: Problems with oral structures, oral hygiene, chewing and swallowing function canbe seen in SSPE patients. Thus, clinical oral structure and feeding functions should be considered to evaluate in routine evaluation procedure in patients with SSPE., Amaç: Amaç, Subakut Sklerozan Panensefalit (SSPE)’li hastalarda oral yapıların ve beslenmeözelliklerinin incelenmesidir.Yöntemler: Yirmi SSPE hastası dahil edildi. Oral yapılar ve oral hijyenin klinik değerlendirmesiyapıldı. Beslenme değerlendirmesinde her hastadan sıvı, puding ve katı besin kıvamlarını almasıistendi. Çiğneme fonksiyonu seviyesinin belirlenmesinde Karaduman Çiğneme PerformansıSkalası (KÇPS) kullanıldı. Hastalarda aspirasyon riskini belirlemek için 3 ons su yutma testikullanıldı.Sonuçlar: Ortalama yaş 13.76±1.92 yıldı ve %55’i erkekti. Yedi çocukta (%35) dinlenmedeaçık ağız postürü, 5 (%25)’inde açık ısırık, 12 (%60)’sinde yüksek damak, ve 8 (%40)’inde dilitme refleksi vardı. Onsekiz (%90) çocukta oral hijyen problemleri vardı. Beslenme pozisyonları;1’i sırtüstü, 6’sı yarı yatış pozisyonu, ve 13’ü dik oturma pozisyonu olmak üzere farklılıkgöstermekteydi. Klinik beslenme değerlendirmesi sonuçlarımız şöyleydi: besin kabulü (20,%100), sıvı alımı (20, %80), puding alımı (17, %85), ve katı besin alımı (5, %25). KÇPS’ye göre5 çocuk (%25) seviye I, 7 çocuk (%35) seviye II, 3 çocuk (%15) seviye 3 ve 5 çocuk (%25) seviyeIV’idi. Üç ons su yutma testinde 4 çocuk (%25) kaldı.Tartışma: SSPE hastalarında oral yapılar, oral hijyen, çiğneme ve yutma fonksiyonundaproblemler görülebilmektedir. Bu yüzden, SSPE hastalarının rutin değerlendirmesinde klinik oralyapı ve beslenme fonksiyonlarının değerlendirilmesi de düşünülmelidir.

This study was planned to compare the static and dynamic balance in children with Duchenne Muscular Dystrophy (DMD) at different functional levels with each other and with healthy peers.Sixty nine children between the ages of 6 and 11 were included in this study where 52 of them were diagnosed with DMD in Level I (18 patients), Level II (17 patients), and Level III (17 patients) according to Brooke Functional Classification Scale and 17 of them healthy peers were included. In order to assess static and dynamic balance pediatric functional reach test (PFRT) and timed up and go test (TUGT) were used.When compared in terms of the TUGT, differences were found between all groups, i.e. Level 1 and 2, Level 2 and 3, Level 1 and 3, Healthy peers and Level 1, Healthy peers and Level 2, and Healthy peers and Level 3 (p 0.0083). When compared in terms of the PFRT in the standing positions, there was difference between level 3 and healthy peers (p 0.0083), but not between the other groups.We found poor functional level in DMD to affect the dynamic and static balance parameters in this study. The dynamic balance of a child with DMD at Level 3 is decreased to a third of a healthy peer.

Cerebral palsy (CP) is a group of permanent sensorimotor impairments. Children with CP have various feeding difficulties including chewing disorder, which may affect their nutritional status. Functional Chewing Training (FuCT) was designed as a holistic approach to improve chewing function by providing postural alignment, sensory and motor training, and food and environmental adjustments. This study aimed to investigate the effect of FuCT on chewing function in children with CP. This study was designed as a double-blind, randomised controlled trial. Eighty CP children with chewing disorder were randomised and split between the FuCT group (31 males, 19 females; mean age 3·5 ± 1·9 years) and the control group (16 males, 14 females; 3·4 ± 2·3 years) receiving traditional oral motor exercises. Each group received the training programme for 12 weeks with weekly follow-up and with two evaluations at baseline and end of 12 weeks. Chewing function was evaluated by analysing video recordings and scored with the Karaduman Chewing Performance Scale (KCPS). The Behavioral Pediatrics Feeding Assessment Scale (BPFAS) was used to evaluate feeding behaviours of children. A significant improvement was observed in KCPS scores at 12 weeks after training in the FuCT group (P < 0·001), but no change was found in the control group (P = 0·07). A significant improvement was detected in all parameters of BPFAS at 12 weeks after training in the FuCT group (P < 0·001) and in four parameters of BPFAS in the control group (P = 0·02, P = 0·02). FuCT is an effective method to improve chewing function compared with traditional oral motor exercises.

INTRODUCTION One of the underlying causes of recurrent pneumonia in children is swallowing dysfunction, with aspiration syndrome. Swallowing dysfunction should be considered not only a problem of the oropharyngeal phase but also a problem of the esophageal phase. OBJECTIVES This study aimed to determine the relationship between findings from a swallowing study and a history of recurrent pneumonia in pediatric patients. METHODS A videofluroscopic swallowing study of 274 pediatric patients who had swallowing dysfunction was conducted. Information on a history of recurrent pneumonia during a 1-year period was obtained from hospital files. RESULTS The median age of the participants was 33 months (min =10, max = 180), of whom 51.8% were females. In the study, 83.2% of the patients had cerebral palsy, 7.7% had syndromic symptoms, 3.6% had muscular dystrophy, and 5.5% were classified as "other." During the 1-year period, 67.9% of the participants had a history of recurrent pneumonia history. Furthermore, 66.4% had oral dysfunction, 32.5% had laryngeal penetration, 46.4% had aspiration, 45.3% had abnormal esophageal body function, and 35.8% had reflux symptoms. There was no correlation between oral dysfunction and recurrent pneumonia (P = .902), but there was a positive correlation between recurrent pneumonia and laryngeal penetration (P

BACKGROUND The aim of this study was to determine the ability of the Pediatric version of the Eating Assessment Tool-10 (PEDI-EAT-10) to detect aspiration in children with neurological impairments. METHODS Two hundred and fifty-four children were included. Swallowing function was imaged with videofluoroscopic swallowing study (VFSS). The penetration and aspiration scale (PAS) was used to determine the penetration and aspiration severity. Parents completed the PEDI-EAT-10, which is a 10 item, reliable, and valid dysphagia symptom specific outcome instrument. KEY RESULTS The mean age of children was 59.91 ± 55.33 months (min = 18, max = 315), of which 52.8% were male. The mean PEDI-EAT-10 of children with airway aspiration (PAS > 5) was 22.32 ± 10.73 (min = 0, max = 40) and the mean PEDI-EAT-10 of children who did not have aspiration (PAS