재활치료과학 (Therapeutic Science for Rehabilitation)

  • 제7권1호
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  • Pages.11-26
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  • 2018
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  • 2635-9340(pISSN)
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  • 2671-4329(eISSN)
대한신경계작업치료학회 (Korean Society of Neurological Occupational Therapy)
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자살시도로 인한 저산소성 허혈성 뇌손상 환자의 재활치료 - 인지 재활과 연하 재활을 중심으로: 사례연구

Occupational Therapy in Hypoxic-Ischemic Brain Injury Patient by Suicidal Attempt: Case Report

  • 이의연 (연세대학교 원주세브란스기독병원 재활의학과 작업치료실) ;
  • 박지혁 (연세대학교 보건과학대학 작업치료학과)
  • Lee, Eui-Yun (Dept. of Occupational Therapy, Wonju Severence Christian Hospital, Yonsei University) ;
  • Park, Ji-Hyuk (Dept. of Occupational Therapy, College of Health Science, Yonsei University)
  • 투고 : 2017.12.28
  • 심사 : 2018.02.12
  • 발행 : 2018.02.28
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초록

목적 : 본 사례연구는 자살시도로 인한 저산소성 허혈성 뇌손상 환자의 특징적 증상과 신경학적 회복 양상을 고려한 인지 및 연하 재활 중심의 작업치료 중재를 소개하고 중재 효과로 인한 회복 양상에 대해 알아보고자 하였다. 연구방법 : 연구 대상은 자살시도로 인한 저산소성 허혈성 뇌손상을 진단받은 32세 남성으로 치료기간은 2016년 9월 8일부터 12월 6일까지이며, 주 5회 하루 한 번 재활치료를 받았다. 작업치료는 신경학적 기전으로 인한 저산소 허혈성 뇌손상의 특징과 자살이라는 정신 건강학적 특징을 바탕으로 이루어 졌으며, 인지와 연화 재활 중심의 프로그램이었다. 인지기능은 Mini Mental State Examination-Korean(MMSE-K), Computerized Neurocognitive Function Test(CNT), 일상생활활동 수준은 Korean-Modified Barthel Index(K-MBI), 연하기능은 Videofluoroscopic Dysphagia Scale(VDS), American Speech-Language-Hearing Association National Outcomes Measurements System (ASHA-NOMS)로 평가하였다. 결과 : 저산소성 허혈성 뇌손상 환자의 지연성 뇌손상 기전에 따라 인지기능 평가인 MMSE-K, CNT와 일상생활활동 수준을 평가하는 K-MBI, 연하기능을 평가하는 VDS, ASHA NOMS 결과에서 초기 평가 결과에 비해 모든 기능에서 저하가 나타났으나 회복 기전과 함께 재활 치료가 병행되며 모든 기능이 회복되어 초기 평가 수준으로 호전되었다. 결론 : 본 연구 결과 자살시도로 인한 심리적 요인과 저산소성 허혈성 뇌손상으로 인한 인지 및 연하적 요인을 고려한 일반적인 작업치료 프로그램은 환자에게 긍정적 회복 양상을 나타냈다. 이를 바탕으로 저산소성 허혈성 뇌손상으로 인한 지연성 뇌손상이 발생한 환자에게 작업치료의 개입은 필요한 부분이며, 정신건강과 인지 및 연하기능의 중심 프로그램이 개발되어야할 것이다.

Objective : This case study was to verify effects of cognitive rehabilitation and swallowing rehabilitation on Hypoxic-Ischemic Brain Injury patient by Suicidal Attempt. Methods : The subject was a 32-year old Hypoxic-ischemic brain injury patient by suicidal attempt. He received treatment once a day five times a week, for a half an hour for each session from September 8th to December 16th, 2016. Treatment were cognitive and swallowing rehabilitation. He was assessed based on Mini-Mental State Examination-Korean (MMSE-K), Korean-Modified Barthel Index (K-MBI), Computerized Neurocognitive Function Test (CNT), Videofluoroscopic Dysphagia Scale (VDS), American Speech-Language-Hearing Association National Outcomes Measurements System (ASHA-NOMS). Results : The patient's total MMSE-K score increased from 25 to 27. His K-MBI score increased from 74 to 88. His memory, attention span, and executive function (DST, VST, SWCT, WCST) by CNT scores were improved. VDS score has no changes to 34, 44.5 and 34. ASHA-NOMS score also has no change to 6, 2 and 6. Conclusion : The study showed that the application of the treatment of cognitive and swallowing in hypoxic-ischemic brain injury patient by suicidal attempt results has positive effects on cognitive functions, and swallowing function.

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참고문헌

  1. 대한작업치료사협회. (2002). 작업치료정의. Retrieved from https://www.kaot.org/start.asp
  2. 중앙자살예방센터. (2011). 자살률과 OECD 자살률 추이. Retrieved from http://www.spckorea.or.kr/index.php
  3. 한국자살예방협회. (2012). 자살시도자 사후관리를 위한 매뉴얼. http://suicideprevention.or.kr/new2/contents/sub0604.php
  4. Ahn, P. T. (2008). A Study on Relationship Between Environment and Suicide Method (Master's thesis). Kyungpook National University, Daegu.
  5. Choi, S. (1983). Delayed neurologic sequelae in carbon monoxide intoxication. Archives of neurology, 40(7), 433-435. https://doi.org/10.1001/archneur.1983.04050070063016
  6. FitzGerald, A., Aditya, H., Prior, A., McNeill, E., & Pentland, B. (2010). Anoxic brain injury: Clinical patterns and functional outcomes. A study of 93 cases. Brain Injury, 24(11), 1311-1323. https://doi.org/10.3109/02699052.2010.506864
  7. Freed, M., Christian, M. O., Beytas, E. M., Tucker, H., & Kotton, B. (2001). Electrical stimulation of the neck: a new effective treatment for dysphagia. Respiratory care, 46, 466-474.
  8. Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). "Mini-mental state": a practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research, 12(3), 189-198. https://doi.org/10.1016/0022-3956(75)90026-6
  9. Gorman, D. F., Clayton, D., Gilligan, J. E., & Webb, R. K. (1992). A longitudinal study of 100 consecutive admissions for carbon monoxide poisoning to the Royal Adelaide Hospital. Anaesthesia and intensive care, 20(3), 311-316.
  10. Ha, K. S., Kwon, J. S., Lyoo, I. K., Kong, S. W., Lee, D. W., & Youn, T. (2002). Development and standardization process, and factor analysis of the computerized cognitive function test system for Korea adults. Journal of Korean neuropsychiatric association, 41(3), 551-562.
  11. Han, T. R., Paik, N. J., Park, J. W., & Kwon, B. S. (2008). The prediction of persistent dysphagia beyond six months after stroke. Dysphagia, 23(1), 59-64. https://doi.org/10.1007/s00455-007-9097-0
  12. Henry, C. R., Satran, D., Lindgren, B., Adkinson, C., Nicholson, C. I., & Henry, T. D. (2006). Myocardial injury and long-term mortality following moderate to severe carbon monoxide poisoning. Jama, 295(4), 398-402. https://doi.org/10.1001/jama.295.4.398
  13. Hopkins, R. O., & Bigler, E. D. (2012). Neuroimaging of anoxic injury: implications for neurorehabilitation. NeuroRehabilitation, 31(3), 319-329. doi: http://dx.doi.org/10.3233/NRE-2012-0799
  14. Jung, H. Y., Park, B. K., Shin, H. S., Kang, Y. K., Pyun, S. B., Paik, N. J., ... & Han, T. R. (2007). Development of the Korean version of Modified Barthel Index (K-MBI): multi-center study for subjects with stroke. Journal of Korean Academy of Rehabilitation Medicine, 31(3), 283-297.
  15. Kang, Y., Na, D. L., & Hahn, S. (1997). A validity study on the Korean Mini-Mental State Examination(K-MMSE) in dementia patients. Journal of the Korean Neurological Association, 15(2), 300-308.
  16. Kii, Y., & Mizuma, M. (2014). Rehabilitation approaches to dysphagia that was developed for a patient who attempted to commit suicide by hanging: a case report. European journal of physical and rehabilitation medicine, 50(2), 185-188.
  17. Kim, C. K., & Yeo, I. S. (2009). The development and effects of group counseling programs to decrease the level of depression and prevent suicidal ideation in the elderly. Journal of the Korean Home Economics Association, 47(9), 111-124.
  18. Kim, D. H., Choi, K. H., Kim, H. M., Koo, J. H., Kim, B. R., Kim, T. W., ... & Park, J. W. (2012). Inter-rater reliability of videofluoroscopic dysphagia scale. Annals of rehabilitation medicine, 36(6), 791-796. https://doi.org/10.5535/arm.2012.36.6.791
  19. Kim, J. H., Chang, K. H., Song, I. C., Kim, K. H., Kwon, B. J., Kim, H. C., ... & Han, M. H. (2003). Delayed encephalopathy of acute carbon monoxide intoxication: diffusivity of cerebral white matter lesions. American Journal of Neuroradiology, 24(8), 1592-1597.
  20. Kim, Y. G. (2011). The effects of Korean computer-based cognitive rehabilitation program(CoTras) for the cognition and ADL in stroke. Journal of Korean Society of Occupational Therapy, 19(3), 75-88.
  21. Khot, S., & Tirschwell, D. L. (2006). Long-term neurological complications after hypoxic-ischemic encephalopathy. Seminars in neurology, 26(4), 422-431. https://doi.org/10.1055/s-2006-948323
  22. Kwon, Y. C., & Park, J. H. (1989). Korean version of Mini-Mental State Examination(MMSE-K). Part I: development of the test for the elderly. Journal of Korean Neuropsychiatric Association, 28(1), 125-135.
  23. Lee, T., Lee, A. R., Ahn, M. H., Jeong, S. Y., & Hong, J. P. (2014). Overview of suicide by charcoal burning and prevention strategies. Journal of Korean Neuropsychiatric Association, 53(1), 1-7. https://doi.org/10.4306/jknpa.2014.53.1.1
  24. Lee, J. S., Kang, D. H., & Park, S. H. (2016). Effects of a Small Group Occupational Therapy Program on Adolescents at Risk of Suicide: A Preliminary Study. Journal of Korean Society of Occupational Therapy, 24(1), 39-52. https://doi.org/10.14519/jksot.2016.24.1.04
  25. Leigh, J. H., & Oh, B. M. (2014). NeuroRehabilitation after Hypoxic-ischemic Encephalopathy. Brain & NeuroRehabilitation. 7(1), 16-20. https://doi.org/10.12786/bn.2014.7.1.16
  26. Lim, Y. G., Jeong, H. H., Park, E. J., Min, Y. G., & Choi, S. C. (2016). Characteristics of suicidal attempters with acute poisoning who discharged against psychiatric medical advice and emergency department admission as an acute intervention. Journal of the Korean Society of Emergency Medicine, 27(1), 75-81.
  27. Mahoney, F. I., & Barthel, D. W. (1965). Functional Evaluation: The Barthel index. Maryland State Medical Journal, 14, 61-65.
  28. Middelkamp, W., Moulaert, V. R., Verbunt, J. A., van Heugten, C. M., Bakx, W. G., & Wade, D. T. (2007). Life after survival: long-term daily life functioning and quality of life of patients with hypoxic brain injury as a result of a cardiac arrest. Clinical rehabilitation, 21(5), 425-431. https://doi.org/10.1177/0269215507075307
  29. Moulaert, V. R., Verbunt, J. A., van Heugten, C. M., & Wade, D. T. (2009). Cognitive impairments in survivors of out-of-hospital cardiac arrest: a systematic review. Resuscitation, 80(3), 297-305. doi: http://dx.doi.org/10.1016/j.resuscitation.2008.10.034
  30. Moulaert, V. R., van Haastregt, J. C., Wade, D. T., van Heugten, C. M., & Verbunt, J. A. (2014). 'Stand still..., and move on', an early neurologically-focused follow-up for cardiac arrest survivors and their caregivers: a process evaluation. BMC health services research, 14(1), 34. https://doi.org/10.1186/1472-6963-14-34
  31. Park, J. H., Kim H. B. (2017). A Study on the Standardization of Comprehensive Neurocognitive Function Test. Therapeutic Science for Neurorehabilitation, 6(1), 55-69.
  32. Parkinson, R. B., Hopkins, R. O., Cleavinger, H. B., Weaver, L. K., Victoroff, J., Foley, J. F., & Bigler, E. D. (2002). White matter hyperintensities and neuropsychological outcome following carbon monoxide poisoning. Neurology, 58(10), 1525-1532. doi: http://dx.doi.org/ 10.1212/WNL.58.10.1525
  33. Pulsipher, D. T., Hopkins, R. O., & Weaver, L. K. (2006). Basal ganglia volumes following CO poisoning: a prospective longitudinal study. Undersea & Hyperbaric Medicine, 33(4), 245.
  34. Sohn, Y. H., Jeong, Y., Kim, H. S., Im, J. H., & Kim, J. S. (2000). The brain lesion responsible for parkinsonism after carbon monoxide poisoning. Archives of Neurology, 57(8), 1214-1218. doi:10.1001/archneur.57.8.1214
  35. Thom, S. R. (1992). Dehydrogenase conversion to oxidase and lipid peroxidation in brain after carbon monoxide poisoning. Journal of Applied Physiology, 73(4), 1584-1589. https://doi.org/10.1152/jappl.1992.73.4.1584
  36. Weaver, L. K., Hopkins, R. O., Churchill, S. K., & Deru, K. (2008). Neurological outcomes 6 years after acute carbon monoxide poisoning. Retrieved from http://dspace.rubicon-foundation.org/xmlui/handle/123456789/7823
  37. Weaver, L. K. (2009). Carbon monoxide poisoning. New England Journal of Medicine, 360(12), 1217-1225. https://doi.org/10.1056/NEJMcp0808891
  38. Wesling, M., Brady, S., Jensen, M., Nickell, M., Statkus, D., & Escobar, N. (2003). Dysphagia outcomes in patients with brain tumors undergoing inpatient rehabilitation. Dysphagia, 18(3), 203-210. https://doi.org/10.1007/s00455-002-0098-8
  39. World Health Organization(WHO). (2013). Suicide prevention. Retrieved from: http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/.
  40. Yun, S. H., Jung, H. M., Kang, H. S., Kim, J. H., Han, S. B., Kim, J. S., & Paik, J. H. (2013). A Case of Delayed Carbon Monoxide Encephalopathy. Journal of the Korean Society of Clinical Toxicology, 11(1), 41-45.
  41. Zhang, J., & Piantadosi, C. A. (1992). Mitochondrial oxidative stress after carbon monoxide hypoxia in the rat brain. Journal of Clinical Investigation, 90(4), 1193. https://doi.org/10.1172/JCI115980