Disfaji Rehabilitasyonunda Hemşirenin Rolü

Yutma bozukluğu ya da yutma yeteneğinin kaybolması olarak tanımlanan disfaji, serebral korteksin yutma fonksiyonuile ilişkili alanlarındaki lezyonlar veya nöromüsküler iletimdeki sorunlar nedeniyle ortaya çıkmaktadır. Zamanlamalnütrisyon, dehidratasyon, aspirasyon pnömonisi, hastanede yatış süresinin uzaması gibi komplikasyonlara ve ölümeyol açabilmektedir. Bu olumsuz sağlık sonuçlarının önlenmesi için erken tanı, tedavi ve etkin disfaji yönetimigerekmektedir. Etkin disfaji yönetimi için de rehabilitasyon uygulamalarına gereksinim bulunmaktadır. Yutmafonksiyonunun iyileşmesinde önemli bir rol oynayan disfaji rehabilitasyonu için uygulamada çeşitli yöntemler veegzersizler kullanılmaktadır. Disfajinin yönetimi multidisipliner olmakla birlikte, hastayla sık ve yakın temasta bulunanve yutma güçlüklerini en iyi şekilde gözlemleyebilen ve tanımlayabilen ekip üyeleri hemşirelerdir. Hemşireler kanıtadayalı uygulamalar doğrultusunda bakım yönetimi sürecini yönlendirdiklerinde olumlu sağlık sonuçlarının eldeedilmesine katkı sağlamaktadır.Bu derleme makalenin amacı; hemşirelerde disfaji kavramını ve yönetimini tanımlayarak bir farkındalık oluşturmak,güncel araştırma bulguları ile disfaji rehabilitasyonunun yararlarından bahsetmek, hemşirelerin kanıta dayalırehabilitasyon girişimlerini multidisipliner ekip çalışması ile birlikte uygulamasını sağlamaktır.

The Role of Nurse in Dysphagia Rehabilitation

Dysphagia defined as swallowing disorder or loss of swallowing ability, is caused by lesions in areas of the cerebral cortex associated with swallowing function or problems in neuromuscular transmission. By time, it can lead to complications such as malnutrition, dehydration, aspiration pneumonia, prolonged hospital stay, and death. Early diagnosis, treatment and effective dysphagia management are required to prevent these negative health consequences. Rehabilitation practices are needed for effective dysphagia management. Various methods and exercises are used in practice for dysphagia rehabilitation, which plays an important role in the recovery of swallowing function. Although the management of dysphagia is multidisciplinary, the team members who have frequent and close contact with the patient and can best observe and define swallowing difficulties are nurses. Nurses contribute to achieving positive health outcomes when they guide the care management process in line with evidence-based practices. The purpose of this review article; to create awareness by defining the concept and management of dysphagia in nurses, to talk about the benefits of dysphagia rehabilitation with current research findings, to enable nurses to implement evidence-based rehabilitation interventions with multidisciplinary teamwork.

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  • 1. Pede CD, Mantovani ME, Felice AD, Masiero S. Dysphagia in the elderly: focus on rehabilitation strategies. Aging Clin Exp Res. 2016;28:607-17.
  • 2. Meng P, Zhang S, Wang Q, Wang P, Han C, Gao J et al. The effect of surface neuromuscular electrical stimulation on patients with post-stroke dysphagia. J Back Musculoskelet Rehabil. 2018;31:363-70.
  • 3. Gao J, Zhang HJ. Effects of chin tuck against resistance exercise versus shaker exercise on dysphagia and psychological state after cerebral infarction. Eur J Phys Rehabil Med. 2017;53:426-32.
  • 4. Sun SF, Hsu CW, Lin HS, Sun HP, Chang PH, Hsieh WL, et al. Combined neuromuscular electrical stimulation (NMES) with fiberoptic endoscopic evaluation of swallowing (FEES) and traditional swallowing rehabilitation in the treatment of strokerelated dysphagia. Dysphagia. 2013;28:557-66.
  • 5. Fernandez MG, Huckabee ML, Doeltgen SH, Inamoto Y, Kagaya H, Saitoh H. Dysphagia rehabilitation: similarities and differences in three areas of the world. Current Physical Medicine and Rehabilitation. 2013;1:296-306.
  • 6. Çopur EÖ, Kuru N, Seyman ÇC. Hemşirelikte Kanıta Dayalı Uygulamalara Genel Bakış. Sağlık ve Hemşirelik Yönetimi Dergisi. 2015;1:51-5.
  • 7. McCabe D, Ashford J, Hegland KW, Frymark T, Mullen R, Musson N et al. Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Part IV—Impact of dysphagia treatment on individuals’ postcancer treatments. J Rehabil Res Dev. 2009;46:205-14.
  • 8. Hsieh PL, Chen SH. Effectiveness of an evidence-based practice educational ıntervention among school nurses. Int J Environ Res. 2020;17(11).
  • 9. Dudik JM, Kurosu A, Coyle JL, Sejdik E. Dysphagia and its effects on swallowing sounds and vibrations in adults. Biomed Eng Online. 2018;17:9
  • 10. Bath PM, Lee HS, Everton LF. Swallowing therapy for dysphagia in acute and subacute stroke. Cochrane Database of Systematic Reviews. 2018;10:CD000323.
  • 11. Park YH, Bang HL, Han HR, Chang HK. Dysphagia screening measures for use in nursing homes: A systematic review. J Korean Acad Nurs. 2015;45:1-13.
  • 12. Vose A, Nonnenmacher J, Singer ML, Fernandez MG. Dysphagia management in acute and sub-acute stroke. Current Physical Medicine and Rehabilitation. 2014;2:197-206.
  • 13. Steele CM. Exercise- based approaches to dysphagia rehabilitation. Nestl Nutr Inst Workshop Ser. 2012;72:109-17.
  • 14. Garcia JM, Chambers E. Managing dysphagia through diet modifications. Am J Nurs. 2010;110:26-33.
  • 15. Tenekeci EG, Kara B, Çetiz A, Demirkaya Ş, Demir N, Açıkel C. Multipl sklerozda disfaji değerlendirme ölçeği türkçe formunun geçerlik ve güvenirliği. Arch Neuropsychiatr. 2016;55:243-7.
  • 16. Chen SC, Huang BS, Chung CY, Lin CY, Fan KH, Chang CT et al. Effects of a swallowing exercise education program on dysphagia-specific health-related quality of life in oral cavity cancer patients post-treatment: A randomized controlled trial. Support Care Cancer. 2018;26:2919-28.
  • 17. Jones K, Pitceathly RDS, Rose MR, MCGovan S, Hill M, Badrising UA et al. Interventions for dysphagia in long-term, progressive muscle disease. Cochrane Database of Systematic Reviews. 2016;2:CD004303.
  • 18. Abubakar SA, Jamoh BY. Dysphagia following acute stroke and its effect on short-term outcome. Niger Postgrad Med J. 2017;24:182-6.
  • 19. Bengisu S, Gerçek E. Türkiye’de yutma bozuklukları ile ilgili yapılmış lisansüstü tez çalışmalarının incelenmesi. Dil, Konuşma ve Yutma Araştırmaları Dergisi. 2019;2:77-103.
  • 20. Frost J, Robinson F, Hibberd J. A comparison of neuromuscular electrical stimulation and traditional therapy, versus traditional therapy in patients with longstanding dysphagia. Curr Opin Otolaryngol Head Neck Surg. 2018;26:167-73.
  • 21. Fredslund SV, Høgdal N, Christensen MB, Wessel I. Dysphagia training after head and neck cancer fails to follow legislation and national recommendations. Dan Med J. 2015;62:A5067.
  • 22. Clayton NA, Ward EC, Maitz PK. Intensive swallowing and orofacial contracture rehabilitation after severe burn: A pilot study and literature review. Burns. 2017;43:e7-e17.
  • 23. Rommel N, Hamdy S. Oropharyngeal dysphagia: manifestations and diagnosis. Gastroenterology & Hepatology. 2016;13:49- 59.
  • 24. McGinnis CM, Homan K, Solomon M, Taylor J, Staebell K, Erger D. et al. Dysphagia: ınterprofessional management, ımpact, and patient-centered care. Nutr Clin Pract. 2019;34:80-95.
  • 25. Selçuk B. İnmede yutma bozuklukları. Türk Fiz Tıp Rehab Derg. 2006;52:38-44.
  • 26. Cinel G, Demir N, Özçelik U, Karaduman AA. Çocuklarda yutma disfonksiyonu. Çocuk Sağlığı ve Hastalıkları Dergisi. 2013;56:89-96.
  • 27. Wang Z, Song WQ, Wang L. Application of noninvasive brain stimulation for post-stroke dysphagia rehabilitation. Kaohsiung J Med Sci. 2017;33:55-61.
  • 28. Krueger SS, Ringmaier C, Muhle P, Wollbrink A, Kemmling A, Hanning U et al. Randomized trial of transcranial direct current stimulation for poststroke dysphagia. Ann Neurol. 2018;83:328-40. 10
  • 29. Adkins C, Takakura W, Spiegel BMR, Lu M, Lionch MV, Williams J et al. Prevalence and characteristics of dysphagia based on a population-based survey. Clinical Gastroenterology and Hepatology. 2020;18:1970-9.
  • 30. Hines S, Kynoch K, Munday J. Identification and nursing management of dysphagia in individuals with acute neurological impairment: A systematic review (new update). JBI Database System Rev Implement Rep. 2014;12:195-236.
  • 31. Şansal E, Atalık G, Gölaç H, Yılmaz M. COVID-19 Pandemi sürecinde yutma bozukluklarının yönetimi: GÜTF KBB klinik tecrübesi. Kulak Burun Boğaz ve Baş Boyun Cerrahisi Dergisi. 2020;28:68-75.
  • 32. Fedder P. Review of evidenced-based nursing protocols for dysphagia assessment. Stroke. 2017;48:99-101.
  • 33. Cecconi E, Piero VD. Dysphagia – pathophysiology, diagnosis and treatment. Front Neurol Neurosci. 2012;30:86-9.
  • 34. Zhang L, Huang Z, Wu H, Chen W, Huang Z. Effect of swallowing training on dysphagia and depression in postoperative tongue cancer patients. Eur J Oncol Nurs. 2014;18:626-9.
  • 35. Hashimato H, Hirata M, Takahaski K, Kameda S, Katsuta Y, Yoshida F et al. Non-invasive quantification of human swallowing using a simple motion tracking system. Sci Rep. 2018;8:5095.
  • 36. Kang JH, Park RY, Lee SJ, Kim JY, Yoon SR, Jung KI. The effect of bedside exercise program on stroke patients with dysphagia. Ann Rehab Med. 2012;36:512-20.
  • 37. Bahçeci K, Umay E, Gündoğdu İ, Gürçay E, Öztürk E, Alıcura S. The effect of swallowing rehabilitation on quality of life of dysphagic patients with cortical ischemic stroke. Iran J Neurol. 2017;16:178-84.
  • 38. Beck AM, Kjaersgaard A, Hansen T, Poulsen I. Systematic review and evidence based recommendations on texture modified foods and thickened liquids for adults (above 17 years) with oropharyngeal dysphagia. An updated clinical guideline. Clin Nutr. 2018;37:1980-91.
  • 39. Zheng L, Li Y, Liu Y. The individualized rehabilitation interventions for dysphagia: a multidisciplinary case control study of acute stroke patients. Int J Clin Exp Med. 2014;7:3789-94.
  • 40. Khoja MA. Registered nurses’ knowledge and care practices regarding patients with dysphagia in Saudi Arabia. A crosssectional study. Int J Health Care Qual Assur. 2018;31:896-909.
  • 41. Sproson L, Pownall S, Enderby P, Freeman J. Combined electrical stimulation and exercise for swallow rehabilitation poststroke: A pilot randomized control trial. Int J Lang Commun Disord. 2018;53:405-17.
  • 42. Pulia NR, Robbins J. Approaches to the rehabilitation of dysphagia in acute poststroke patients. Semin Speech Lang. 2013;34:154-69.
  • 43. Park JS, An DH, Oh DH. Chang MY. Effect of chin tuck against resistance exercise on patients with dysphagia following stroke: A randomized pilot study. NeuroRehabilitation. 2018;42:191-7.
  • 44. Umemoto G, Furuya H. Management of dysphagia in patients with parkinson’s disease and related disorders. Int Med. 2020;59:7-14.
  • 45. Hien NM, Duc DP. The avant rehabilitation program and cerebrolysin for treatment of post-stroke dysphagia: A case report. J Med Life. 2019;12:236-8.
  • 46. Xia W, Zheng C, Zhu S, Tang Z. Does the addition of specific acupuncture to standard swallowing training improve outcomes in patients with dysphagia after stroke? A randomized controlled trial. Clin Rehab. 2016;30:237-46. 11
  • 47. Perry A, Lee SH, Cotton S, Kennedy J. Therapeutic exercises for affecting post-treatment swallowing in people treated for advanced-stage head and neck cancers. Cochrane Database of Systematic Reviews. 2016;8:CD011112.
  • 48. Konency P, Elfmark M. Electrical stimulation of hyoid muscles in post-stroke dysphagia. Biomed Pap Med Fac Univ Palack Olomouc Czech Repub. 2018;162:40-2.
  • 49. Chiang CF, Lin MT, Hsiao MY, Yeh YC, Liang YC, Wang TG. Comparative efficacy of noninvasive neurostimulation therapies for acute and subacute poststroke dysphagia: A systematic review and network meta-analysis. Arch Phys Med Rehabil. 2019;100:739-50.
  • 50. Savcı C. Disfaji gelişen akut inmeli hastalarda bireyselleştirilmiş hemşirelik bakımı. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi. 2020;23:423-9.
  • 51. Langmore SE, Pisegna JM, Efficacy of exercises to rehabilitate dysphagia: A critique of the literatüre. Int J Speech Lang Pathol. 2015;17:1-8.
  • 52. Li CM, Wang TG, Lee HY, Wang HP, Hsieh SH, Chou M et al. Swallowing training combined with game-based biofeedback in poststroke dysphagia. PM & R: The Journal Of İnjury, Function, And Rehabilitation. 2016;8:773-9.
  • 53. Choi JB, Shim SH, Yang JE, Kim HD, Lee DH, Park JS. Effects of shaker exercise in stroke survivors with orophagyngeal dysphagia. NeuroRehabilitation. 2017;41:753-7.
  • 54. Cabib C, Ortega O, Kumru H, Palomeras E, Vilardell N, Berdugo DA et al. Neurorehabilitation strategies for poststroke oropharyngeal dysphagia: from compensation to the recovery of swallowing function. Ann N Y Acad Sci. 2016;1380:121-38.
  • 55. Alali D, Ballard K, Bogaardt H. Treatment Effects for Dysphagia in Adults with Multiple Sclerosis: A Systematic Review. Dysphagia. 2016;31:610-8.
  • 56. Felix VN, Correa SMA, Soares RJ. A therapeutic maneuver for oropharyngeal dysphagia in patients with Parkinson’s disease. Clinics. 2008;63:661-6.
  • 57. Yakşi E, Kurul R, Avcı Ş, Öğün MN. Disfajik inmeli bireylerde kullanılan kompansatuvar postürün yutma üzerine etkisi. Konuralp Tıp Dergisi. 2018;10:61-4.
  • 58. Bengisu S, Turan Z. Baş boyun kanser cerrahisi uygulanmış hastalarda yutma terapisinin yutma bozukluğu şiddeti ve yaşam kalitesine etkisinin belirlenmesi. Dil, Konuşma ve Yutma Araştırmaları Dergisi. 2019;2:300-14.
  • 59. Kesik G, Özdemir L. Multiple skleroz hastalarinda disfaji ve disfajiye yönelik hemşirelik yaklaşımları. Mersin Univ Saglık Bilim Derg. 2020;13:437-43.
  • 60. Taylor C. Dysphagia and malnutrition in older adults. Br J Community Nurs. 2019;1;24:26-28.
  • 61. Akai M. Approaches to dysphagia rehabilitation. Dysphagia Rehabilitation Manuel. Japan: National rehabilitation center for persons with disabilities, 2015.
  • 62. Cichero J. Scope of practice. Dysphagia Clinical Guideline. Australia: The Speech Pathology Association of Australia Limited, 2012.
  • 63. Wells M, King E. Patient adherence to swallowing exercises in head and neck cancer. Curr Opin Otolaryngol Head Neck Surg. 2017;25:175-81.
  • 64. Omura K, Komine A, Yanagigawa M, Chiba N, Osada M. Frequency and outcome of post-extubation dysphagia using nurseperformed swallowing screening protocol. Nurs Crit Care. 2019;24:70-5.
  • 65. Simonelli M, Ruoppolo G, Iosa M, Morone G, Fusco A, Grasso MG et al. A stimulus for eating. The use of neuromuscular transcutaneous electrical stimulation in patients affected by severe dysphagia after subacute stroke: A pilot randomized controlled trial. NeuroRehabilitation. 2019;44:103-10. 12
  • 66. Alankaya N. İnme sonrası yeti yitimi ve rehabilitasyonda hemşirenin rolü. Yoğun Bakım Hemşireliği Dergisi. 2019;23:195-201.