Therapeutic Science for Rehabilitation (재활치료과학)

Korean Society of Neurological Occupational Therapy (대한신경계작업치료학회)
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Treatment of Dysphagia in a Cardiac Transplantation Patient: A Case Study

심장 이식 수술 환자의 연하장애 재활치료: 단일 사례 연구

  • 이수정 (강북삼성병원 작업치료실) ;
  • 김두규 (강북삼성병원 작업치료실) ;
  • 서상민 (세명대학교 보건바이오대학 작업치료학과)
  • Received : 2024.06.21
  • Accepted : 2024.07.18
  • Published : 2024.08.31
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Abstract

Objective : This case study aimed to explore dysphagia symptoms in post-cardiac transplantation patients and evaluate the effectiveness of dysphagia rehabilitation therapy in an occupational therapy clinic. Methods : A patient with post-cardiac transplant dysphagia underwent videofluoroscopic swallowing studies to assess the Functional Dysphagia Scale (FDS), Penetration-Aspiration Scale (PAS), and Dysphagia Outcome and Severity Scale (DOSS). Assessments were performed three times at two-week intervals. The treatment, administered from July 19 to August 21, 2023, included eight sessions of 30 minutes each. Treatments included corrective techniques (tongue-hold maneuver, chin tuck against resistance, mendelsohn maneuver, effortful swallowing, and respiratory muscle exercise) and compensatory strategies (chin-tuck position, multiple swallowing, modification of volume, and viscosity), alongside caregiver education. Results : The FDS scores decreased from 50 to 30, PAS scores improved from 5 to 3, and DOSS scores improved from Stage 2 to Stage 4. Conclusion : Dysphagia rehabilitation therapy improved swallowing function in a post-cardiac transplantation patient. However, further studies are required to confirm these findings.

목적 : 사례연구를 통해 심장이식 수술 후 연하장애가 발생한 환자의 증상을 알아보고 작업치료실에서 적용한 연하장애 재활치료의 효과에 대해 알아보고자 하였다. 연구방법 : 심장 이식 수술 후 연하장애가 발생한 환자 1명을 대상으로 비디오 투시 연하검사를 통해 기능적 연하장애 척도와 침습-흡인 척도, 삼킴 곤란 결과 및 증증도 척도를 2주 간격으로 총 3회 실시하였다. 치료 기간은 2023년 7월 19일부터 8월 21일까지 회기당 30분씩 총 8회 실시하였다. 후두 상승과 상부식도조임근의 충분한 열림 및 잔여물의 감소를 위한 교정적 치료(혀-유지 기법, 저항성 턱 당기기 운동, 멘델슨 기법, 노력 삼킴, 호흠근육 운동)와 기도보호를 위한 보상적 치료(턱 당기기 자세, 여러 번 삼키기, 음식 양과 점도 변경) 및 보호자 교육을 실시하였다. 결과 : 기능적 연하장애 척도 검사의 점수가 50점에서 30점으로 감소하였으며, 침습-흡인 척도의 단계는 5단계에서 3단계로 향상되었다. 삼킴 곤란 결과 및 중증도 척도에서는 2단계에서 4단계로 향상되었다. 결론 : 심장 이식 수술 후 연하장애를 보이는 경우 연하재활치료가 환자의 삼킴 기능 향상에 도움을 주는 것을 확인하였다. 향후 심장 이식 수술 환자의 연하장애 재활치료의 효과에 대한 보완 연구가 필요할 것이다.

Keywords

Acknowledgement

본 연구는 대한연하재활학회의 지원을 받아 수행되었음.

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