Investigation of the effects of different exercise methods on swallowingfunction in stroke patients

The study was planned as a single-blind randomized controlled study to investigate the effects of different exercise methods on swallowing function in stroke patients with dysphagia. A total of 42 individuals with dysphagia at least one month after stroke were randomly divided into three groups. The first group received conventional swallowing exercises, the second group received PNF (proprioceptive neuromuscular facilitation) exercises in addition to conventional swallowing exercises, and the third group received CTAR (chin-tuck against resistance) exercises in addition to conventional swallowing exercises. All groups received swallowing rehabilitation 2 days a week, 8 weeks, 16 sessions in total. Before and after the treatment, patients were evaluated for swallowing with Fiberoptic Endoscopic Swallowing Assessment (FEES) using the Penetration-Aspiration Scale (P-AS); suprahyoid muscle thickness, tongue base area, and hyolaryngeal elevation were measured with ultrasonography. In addition, National Institutes of Health (NIH) swallowing safety scale, Functional Oral Intake Scale (FOIS), eating assessment tool-10 (EAT-10), Barthel Index to determine functional independence levels and swallowing quality of life scale (SWAL-QOL) were used. Clinical and demographic characteristics of the participants were similar in the three groups at baseline (p>0,05). Positive improvements were found in all groups in terms of muscle thickness in the FEES evaluation of swallowing functions and ultrasound evaluations after treatment (p<0,05). According to the NIH swallowing safety scale and FOIS scale, the effect size of the PNF group (η2=0,728; η2=0,689) and CTAR (η2=0,647; η2=0,619) group was higher than the conventional group (η2=0,355; η2=0,343). According to the EAT-10 score, the effect sizes of CTAR (η2=0,745) and conventional group (η2=0,629) were close to each other and the effect size of PNF group (η2=0,865) was higher than these two groups. In the P-AS liquid food evaluation, the highest effect was found in the PNF group (η2=0,858). In all ultrasonographic evaluations, PNF and CTAR groups showed more improvement than the conventional group (p<0,05). Barthel index and SWAL-QOL scales also showed significant improvements in all groups after treatment (p<0,05). In our study, although all three groups contributed positively to swallowing rehabilitation, the PNF group showed the most improvement. The addition of PNF exercises applied by physiotherapists to swallowing rehabilitation programs is very important in terms of treatment effectiveness in swallowing rehabilitation. Key words: Chin tuck resitance exercise, dysphagia, proprioseptif neuromuscular facilitation, stroke, ultrasonography