Hasan Erkan Kilinç

Quadriceps and Hamstring Strength Recovery During Early Neuromuscular Rehabilitation After ACL Hamstring-Tendon Autograft Reconstruction

CONTEXT There is lack of information related to quadriceps and hamstring strength recovery during the early period of rehabilitation after anterior cruciate ligament reconstruction (ACLR) using hamstring-tendon graft (HTG). OBJECTIVE To investigate quadriceps and hamstring isometric strength at 4-, 8-, and 12-wk time points after ACLR and to document the strength changes of these muscles over time. DESIGN Longitudinal study. PARTICIPANTS 24 patients (age 28.1 ± 8.1 y) who underwent unilateral single-bundle anatomic ACLR with 4-strand semitendinosus and gracilis tendon graft. MAIN OUTCOME MEASURES The isometric strength of quadriceps and hamstring muscles was measured on an isokinetic dynamometer at a 60° knee-flexion angle 4, 8, and 12 wk after surgery. RESULTS Quadriceps and hamstring strength significantly increased over time for both the involved limb (quadriceps F2,46 = 58.3, P < .001; hamstring F2,46 = 35.7, P < .001) and uninvolved limb (quadriceps F2,46 = 17.9, P < .001; hamstring F2,46 =56.9, P = .001). Quadriceps and hamstring indexes significantly changed from 4 wk (QI 57.9, HI 54.4) to 8 wk (QI 78.8, HI 69.9) and from 8 wk to 12 wk (QI 82, HI 75.7) (P < .001); however, there was no difference between indexes at the 12-wk time point (P = .17). CONCLUSIONS The results of this study serve as a reference for clinicians while directing a rehabilitation protocol for HTG ACLR patients to better appreciate expected strength changes of the muscles in the early phase of recovery.

The Ability of the Eating Assessment Tool-10 to Detect Aspiration in Patients With Neurological Disorders

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.

Short Term Effects of Mobilization Techniques on Neck Pain and Deep Neck Flexor Muscle Endurance in Patients with Mechanical Chronic Neck Pain

Objectives: The aim of the study was to investigate short term effects of cervical and scapular mobilization techniques on neck pain and deep cervical muscles endurance in chronical mechanical neck pain patients. Methods: 22 chronical mechanic neck pain patients four male 18 female (mean age: mean±sd 35.59± 15.85) were included. Before treatment, neck pain level (visual analog scale) and deep neck flexor muscles endurance (in supine position with digital chronometer) of all patients were evaluated. Cyriax cervical mobilization for 10 minutes and scapular mobilization for 10 repetition 10 sets were performed to patients as treatment protocol. After treatment, 24 hours after and a week after evaluations of neck pain and deep cervical muscles endurance were repeated. Results: Before treatment Neck pain Visual Analog Scale scores was 5.78±1.43 point, 2.80±1.99 point after treatment, 24 hours later 3.36±2.12 point, one week later 3.91±2.24 point. This alteration was found significant statistically (p<0.01). Before treatment deep cervical flexor muscle endurance score was 27.25±17.74 sec, after treatment 39.46±25.20 sec, 24 hours later 38.67±28.43 and one week later 40.11±27.82 sec. This alteration was also found significant statistically (p=0.01). Conclusion: Initially neck pain scores in our subjects decreased quickly, after 24 hours these scores increased but last scores were below first neck pain level in a week follow-up. Deep neck cervical flexor muscles test scores also increased quickly, after 24 hours later this scores were stable along a week. Mobilization techniques are effective methods on neck pain and endurance in chronical mechanic neck pain patients.

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

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.

The pediatric version of the eating assessment tool-10 has discriminant ability to detect aspiration in children with neurological impairments

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.

Swallowing Therapy for a Case of Congenital Absence of the Epiglottis

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.

Knee Muscle Strength Recovery in the Early Period After ACL Reconstruction.

Objectives: The aim of this study was to investigate quadriceps and hamstrings isometric strength at 4, 8 and 12 week time points following ACL Reconstruction (ACLR) and to document the strength changes of these muscles over time. The primary hypothesis was that there would be significant increases in quadriceps and hamstring muscle strengths between the 4th, 8th and 12th weeks following ACLR. The secondary hypothesis was that the quadriceps index would be higher than hamstring index at 12th week after ACLR. Methods: Thirty patients (Mean ± SD [age, 29.1±2.3yrs; weight, 77.3±13.2kg; height, 172.1±7.1cm; BMI, 21.2±3.5kg/m2, time to surgery: 7.1±7.2 months]) who underwent ACLR with Hamstring Tendon Autograft (HTG) were enrolled in this study. The isometric strength of quadriceps and hamstring muscles was measured on an isokinetic dynamometer at 60° knee flexion angle at 4th, 8th and 12th weeks after surgery. The recovery of quadriceps and hamstring muscles strength following rehabilitation was expressed as a Quadriceps Index (QI) and Hamstring Index (HI) and calculated with the following formula:[(maximum voluntary isometric torque of the involved limb / maximum voluntary isometric torque by uninvolved limb) × 100]. Torque output of the involved and uninvolved limbs and quadriceps and hamstring indexes were used for the statistical analysis. A repeated measures of ANOVA was used to determine the strength changes of quadriceps and hamstrings over time. Results: Quadriceps and Hamstrings strengths significantly increased over time for both involved (Quadriceps: F (2,46)=58.3, p<0.001, Hamstring: F (2,46)=35.7, p<0.001) and uninvolved limb (Quadriceps: F(2,46)=17.9, p<0.001, Hamstring: F(2,46)=56.9, p=0.001 ). Quadriceps strength was higher at 12th week when compared to the 8 and 4 week time points for the involved limb (p<0.001), and it was higher at 8th week when compared to 4 week time point for the involved limb (p<0.001). For the uninvolved limb, quadriceps strength was also higher at 12th week when compared to the 8 (p=0.02) and 4 week time point (p<0.001), and higher at 8 week when compared to the 4 week time point (p=0.02). Hamstring strength was higher at 12 week when compared to the 8 and 4 week time points (p<0.001) and it was higher at 8 week when compared to 4 week time point for the involved limb (p<0.001). For the uninvolved limb hamstring strength was also higher at 12 week when compared to 4 week time point (p=0.01). There was no significant difference between the 4 and 8 week time points (p>0.05) or between the 8 and 12 week time points (p=0.07). Quadriceps and hamstring indexes significantly changed from 4th weeks (QI:57.9, HI:54.4 ) to 8th weeks (QI:78.8, HI:69.9 ) and from 8th weeks to 12th weeks (QI:82, HI:75.7 ) (p<0.001); however, there was no difference between indexes at the 12-week time point (p=0.17). Conclusion: Isometric strength of quadriceps and hamstring muscles for the involved and uninvolved limb increased during the early period of ACLR. The results of this study could be a baseline for clinicians while prescribing a rehabilitation protocol for ACLR patients with HTG to better appreciate expected strength changes of the muscles in the early phase.