Temporomandibular eklem disfonksiyonu olan serebral palsili hastalarda temporomandibular eklem mobilizasyonunun salya kontrolü, yutma fonksiyonu ve yaşam kalitesi üzerine etkisi
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2019
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Bu çalışmanın amacı temporomandibular eklem disfonksiyonu olan Serebral palsili hastalarda, temporomandibular mobilizasyonun salya ve yutma fonksiyonları ve yaşam kalitesi üzerine etkisini incelemektir. Çalışmaya 1-18 yaş aralığındaki 20 kişi katılmıştır. Kontrol ve deney grubu 10 kişilik kız ve erkek karışık olarak oluşturulmuştur. Hastalara haftada 2 seans, 6 hafta boyunca tedavi uygulandı. Birinci gruba fizyoterapi programı ile beraber pasif normal eklem hareket açıklığı egzersizleri verildi. İkinci gruba ise fizyoterapi ile birlikte pasif normal eklem hareketi ve temporomandibular eklem mobilizasyonu yapıldı. Çalışmada yaşam kalitesini değerlendirmede; Pediatrik Fonksiyonel Bağımsızlık Ölçümü (PFBÖ): (Functional Independence Measure for Children= WeeFIM), salya değerlendirmede; Salya Kontrol Problemi Şiddet Sıklık Skalası kullanıldı. Yutmayı değerlendirmede; Yutma Yeteneği ve Fonksiyonun Değerlendirilmesi (Swallowing ability and function evaluation) SAFE kullanıldı. SAFE değişimi istatistiksel olarak anlamlı bulunmuştur (p<0,05). Tedavi öncesi SAFE ortancası 4,00 (0,00-6,00) iken tedavi sonrası 6,00 (3,00-9,00) olarak bulunmuş ve bu artış istatistiksel olarak anlamlı bulunmuştur. Tedavi öncesi WeeFIM ölçek skoru ile salya şiddet ve salya sıklık değerleri arasında negatif yönlü doğrusal ileri düzeyde anlamlı ilişki vardır (sırasıyla r=-0,902 p<0,001; r=-0,82 p=0,004). WeeFIM ölçek skoru arttıkça salya şiddet ve salya sıklık değerleri azalmaktadır. Salya sıklık ile salya şiddeti arasında pozitif yönlü doğrusal, ileri derecede anlamlı ilişki vardır (r=0,826 p=0,003). Salya şiddet ile mandibula lateral deviasyonu değeri arasında negatif yönlü ileri derecede anlamlı ilişki vardır (r=-0,685 p=0,029). Salya şiddet skoru arttıkça mandibula lateral deviasyonu değerleri azalmaktadır. Tedavi sonrası WeeFIM ölçek skoru ile salya şiddet ve salya sıklık değerleri arasında negatif yönlü ileri derecede anlamlı ilişki vardır (sırasıyla r=-0,755 p=0,012; r=-0,654 p=0,04). WeeFIM ölçek skoru arttıkça salya şiddet ve salya sıklık değerleri azalmaktadır. Salya sıklık ile salya şiddeti arasında pozitif yönlü ileri derecede anlamlı ilişki vardır (r=0,849 p=0,002). Salya şiddet ile mandibula lateral deviasyonu değeri arasında negatif doğrusal yönlü yüksek düzey ilişki vardır (r=-0,789 p=0,007). Salya şiddet skoru arttıkça mandibula lateral deviasyonu değerleri azalmaktadır. Salya sıklık ile mandibula protrüzyonu değeri arasında negatif doğrusal yönlü orta düzey ilişki vardır (r=-0,583 p=0,077). Salya sıklık skoru arttıkça mandibula protrüzyonu değerleri azalmaktadır. Sonuç olarak temporomandibular eklem disfonksiyonu olan Serebral palsili hastalardaki temporomandibular mobilizasyonun salya ve yutma fonksiyonları ve yaşam kalitesi üzerine olumlu bir etkisinin olduğu bulunmuştur.
The aim of this study is to investigate the effect of temporomandibular mobilization on saliva, swallowing functions and quality of life in patients with cerebral palsy with temporomandibular joint dysfunction. Twenty people aged 1-18 participated in the study. The control and experimental groups are divided into two groups. The patients were treated, including 2 sessions per week for 6 weeks. Passive normal range of motion was given to the first group with physiotherapy program. The second group underwent passive normal joint movement and temporomandibular joint mobilization with physiotherapy. To evaluate the quality of life in the study; Pediatric Functional Independence Measurement(WeeFIM), in the saliva assessment; Saliva Control Problem Severity Frequency Scale was used. In swallowing evaluation; Assessment of Swallowing Ability and Function SAFE was used. SAFE change was statistically significant (p<0,05). The pre-treatment SAFE median was 4,00 (0,00-6,00) but after treatment 6,00 (3,00-9,00) was found and this increase was statistically significant. There was a very high negative linear correlation between the WeeFIM scale score and the dribble intensity and dribble frequency values before treatment (r = -0.902 p <0.001; r = -0.82 p = 0.004, respectively). As the WeeFIM scale score increases, the intensity of drooling and drooling frequency decreases. There was a positive linear very high level relationship between drool frequency and drool intensity(r=0,826 p=0,003). There was a negative high linear relationship between the slobber intensity and the value of the lateral deviation of the mandible (r=-0,685 p=0,029). Mandibular lateral deviation values decreased as the saliva severity score increased. There was a negative high linear correlation between the WeeFIM scale score and the dribble severity and dribble frequency after treatment (r = -0,755 p = 0.012; r = -0.654 p = 0.04, respectively). As the WeeFIM scale score increases, the intensity of drooling and drooling frequency decreases. There was a positive linear very high level relationship between drool frequency and drool intensity(r=0,849 p=0,002). There was a negative high linear relationship between the slobber intensity and the value of the lateral deviation of the mandible(r=-0,789 p=0,007). Mandibular lateral deviation values decreased as the saliva severity score increased. There was a negative linear moderate correlation between dribble frequency and mandibular protrusion (r=-0,583 p=0,077). Mandibular protrusion values decrease with increasing saliva frequency score. As a result,it was found that temporomandibular mobilization in patients with cerebral palsy with temporomandibular joint dysfunction has a positive effect on saliva and swallowing functions and quality of life.
The aim of this study is to investigate the effect of temporomandibular mobilization on saliva, swallowing functions and quality of life in patients with cerebral palsy with temporomandibular joint dysfunction. Twenty people aged 1-18 participated in the study. The control and experimental groups are divided into two groups. The patients were treated, including 2 sessions per week for 6 weeks. Passive normal range of motion was given to the first group with physiotherapy program. The second group underwent passive normal joint movement and temporomandibular joint mobilization with physiotherapy. To evaluate the quality of life in the study; Pediatric Functional Independence Measurement(WeeFIM), in the saliva assessment; Saliva Control Problem Severity Frequency Scale was used. In swallowing evaluation; Assessment of Swallowing Ability and Function SAFE was used. SAFE change was statistically significant (p<0,05). The pre-treatment SAFE median was 4,00 (0,00-6,00) but after treatment 6,00 (3,00-9,00) was found and this increase was statistically significant. There was a very high negative linear correlation between the WeeFIM scale score and the dribble intensity and dribble frequency values before treatment (r = -0.902 p <0.001; r = -0.82 p = 0.004, respectively). As the WeeFIM scale score increases, the intensity of drooling and drooling frequency decreases. There was a positive linear very high level relationship between drool frequency and drool intensity(r=0,826 p=0,003). There was a negative high linear relationship between the slobber intensity and the value of the lateral deviation of the mandible (r=-0,685 p=0,029). Mandibular lateral deviation values decreased as the saliva severity score increased. There was a negative high linear correlation between the WeeFIM scale score and the dribble severity and dribble frequency after treatment (r = -0,755 p = 0.012; r = -0.654 p = 0.04, respectively). As the WeeFIM scale score increases, the intensity of drooling and drooling frequency decreases. There was a positive linear very high level relationship between drool frequency and drool intensity(r=0,849 p=0,002). There was a negative high linear relationship between the slobber intensity and the value of the lateral deviation of the mandible(r=-0,789 p=0,007). Mandibular lateral deviation values decreased as the saliva severity score increased. There was a negative linear moderate correlation between dribble frequency and mandibular protrusion (r=-0,583 p=0,077). Mandibular protrusion values decrease with increasing saliva frequency score. As a result,it was found that temporomandibular mobilization in patients with cerebral palsy with temporomandibular joint dysfunction has a positive effect on saliva and swallowing functions and quality of life.
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Fizyoterapi ve Rehabilitasyon, Serebral palsi, Temporomandibular eklem, Temporomandibular eklem disfonksiyon sendromu, Physiotherapy and Rehabilitation, Temporomandibular eklem hastalıkları, Cerebral palsy, Tükürük, Temporomandibular joint, Temporomandibular joint dysfunction syndrome, Tükürük, Temporomandibular joint disorders, Saliva, Tükürük bezleri, Saliva, Yaşam kalitesi, Salivary glands, Quality of life, Yutma, Deglutition
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68