• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.7
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• pp.36-44
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• 2019

Swallowing impairment is a frequent complication following stroke. The characteristics of swallowing impairment with stork patient can facilitate identification of individuals at risk of dysphagia would be of great helpful. The present study examined oropharyngeal swallowing impairment with subacute stroke patients using the Modified Barium Swallowing Impairment Profile(MBSImP). The 49 consecutive patients with the supratentorial stroke met inclusion criteria for the present study. A retrospective review was performed of patients who underwent the videofluoroscopic swallowing study(VFSS). Of Stroke patients, 95.9% exhibited abnormal function of lip closure. 98% and 57.1 % shown abnormal tongue function and lingual motion, respectively. Oral residue was present in 51% and delayed pharyngeal response was present in 89.9%. In addition, abnormal laryngeal and hyoid excursion was seen in 42.9% and 87.8%, respectively. Abnormal function of soft palate elevation was present in 18.4% and abnormal epiglottic movement was seen in 4.1%. 30.6% of 30.6% of these patients exhibited abnormal laryngeal closure. All of the stroke patients(100%) in this study exhibited abnormal pharyngeal stripping wave and pharyngoesophageal segment opening. Abnormal tongue base retraction and oral reside were present 91.8%, respectively. The results suggest that stroke patient is more likely to exhibit reduced swallowing functions including lip closure, tongue control, initiation of pharyngeal swallow, anterior hyoid motion, tongue base retraction, pharyngeal residue and pharyngoesophageal contraction. Therefore, these data could provide valid and precise information regarding physiological evidence to delineate symptoms of dysphagia in this stroke cohort. Future studies should explore the bolus effect in the swallowing impairment.

• The Journal of the Korea institute of electronic communication sciences
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• v.11 no.10
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• pp.995-1002
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• 2016

The aim of this study was investigated the effect of orofacial exercise program using smart phone on swallowing function and tongue strength in acute stroke patients with dysphagia. This study participated in sixteen acute stroke patients with dysphagia. All subjects allocated that randomized each eight patients in experimental and control groups. Subjects of both group received to conventional dysphagia therapy during 30 min/day, 5 times per week, for 4 weeks. Experimental group performed additionally that orofacial exercise program using smart phone, supervised under caregivers, during 30 min/day. The outcome measures were the IOPI(: Iowa Oral Performance Instrument), VR(: Vellecula Residue), PSR(: Pyriform Sinuses Residue), MIP(: Maximum Isometric Pressures). In results of study. Both group showed significant improvements after intervention in all assessments(p<.05). In comparison of change score between two groups, experimental group showed significant improvements than control group in PSR and MIP(p<.05). Orofacial exercise program using smart phone suggested that expected to positive effects the reduction of residue in pharynx and improvements of tongue strength in acute stroke patients with dysphagia.

• Therapeutic Science for Rehabilitation
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• v.7 no.4
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• pp.43-55
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• 2018

Objective: This study aims to discover how tongue self-resistance exercise affects the swallowing function of patients with stroke. Method: The subjects of this study were two patients who were treated at the Y hospital in Gyeonggido. Data were gathered by VFSS regarding the degree of swallowing disability and oral intake before and after intervention. This study analyzed case studies of two patients. One patient's intervention was applied in September 2012 for three weeks. The other's intervention was applied in February 2014 for three weeks. At the first session, the VFSS examination was administered. Then, intervention began after the patients gave their consent for participation. Each session was practiced 10 times per set, but one session had 3 sets. Intervention frequency consisted of five sessions per week, and it was conducted for three weeks. Tongue self-resistance exercise included tongue protrusion, tongue lateralization, and tongue elevation on the hard palate. Results: The first tongue self-resistance exercise had a positive effect on swallowing function because of the decrease in VFS score. The second tongue self-resistance exercise showed improved oral intake based on FOIS scores. Conclusion: This study's results suggest that there are many benefits of tongue self-resistance exercise on the swallowing function when it is applied to patients with stroke.

• 재활복지
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• v.21 no.2
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• pp.217-231
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• 2017

We have to consider two parts of the evaluation and treatment for the patients with head and neck burns. The primary consideration is swallowing function for nutrition supply for them and the next is speech function for efficient communication and aesthetic impression of them. The purpose of this study is to summarize the preliminary questions of Communication Screening Protocols which can help understand comprehensively on swallowing disorder, motor speech disorder and voice disorder of patients with head and neck burns. We divided the evaluation into 4 evaluation areas including 'oral mechanism', 'respiration/voice', 'articulation', and 'swallowing' by referring to overseas studies dealing with various communication disorders caused by burns, and prepared the final questionnaires by conducting the content validity verification by five expert (speech & language pathologist). The range of Content Validity Index was shown relatively appropriate with .50~.84. There was a conflict of opinions in experts whether the items in the areas of respiration/voice and swallowing may be appropriate, whereas there was no different view of the oral mechanism and articulation area. Through the different characteristics of communication difficulties of patients with head and neck burns, we expect it will be modified appropriately according to the patients through evaluation of burn patients by type and severity.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.13 no.4
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• pp.1665-1671
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• 2012

The purpose of this study was to look into changes in voice using acoustic analysis during the process of neuromuscular electrical stimulation targeting dysphagia treatment. Fifteen man with dysphagia caused by stroke was treated neuromuscular electrical stimulation for two months and intensity of voice, $F_0$, Jitter, Shimmer, NNE were measured. The results of this study that improvement in functions of dysphagia and Jitter, Shimmer were stabilized. But there was not significantly changes of $F_0$. NNE was improved after the intervention, but still showed abnormal levels. This result suggests a possibility of effects that Neuromuscular electrical stimulation has on stabilization of Jitter, Shimmer and intensity of voice.

• 재활복지
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• v.20 no.3
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• pp.179-193
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• 2016

Chin Tuck Against Resistance Exercise(CTARE) and Shaker exercise is used to common for strengthening of suprahyoid muscle. No previous studies was compare of two exercises for patients with dyaphagia. This study investigated the effects of CTARE and Shaker exercise on suprahyoid, sternocleidomastoid muscle activity in stroke older patients with dysphagia. Ten stroke patients with dyaphagia voluntarily participated in this study. All subjects was performed in the order in the CTARE (isometric, isokinetic), Shaker (isometric, isokinetic), and repeated each ten trials. After CTARE was performed, subjects took a 5 min wash out period to minimize muscle fatigue. Activity of suprahyoid and sternocleidomastoid muscle during two training was analyzed using surface electromyography(sEMG). Wilcoxon signed rank test was used to assess differecences for muscles activity between the effects of the CTAR and Shaker exercise within group. CTARE and Shaker exercise showed no significant difference activity in suprahyoid muscle(p > .05). CTARE showed significantly lower muscle activity in sternocleidomastoid muscle than Shaker exercise(p < .05). CTARE in stroke older patients with dysphagia may be a effective intervention to improve swallowing function than Shaker exercise.

• Phonetics and Speech Sciences
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• v.6 no.3
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• pp.3-12
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• 2014

Larynx plays an important role in phonation and protection of the respiratory tract during swallowing. The reduced anatomical and physiological function in elevation of larynx and glottis closure can cause problems in voice and swallowing. The present study investigated the Korean version of handicap index of dysphagia in elderly Koreans. Therefore, 60 normal elderly Koreans ranged from 65 to 95 and 20 normal Korean young adults aged from 20 to 25 were participated in this study to compare total (T), physical (P), functional (F), and emotional (E) index scores between two groups as well as among sub groups (60s, 70s, 80s) in elderly. For swallowing, total and sub dysphagia handicap index (DHI) scores, voice quality during /a/phonation following swallowing (saliva and water), intensity of coughing, and L-DDK were measured. The results showed that functional (P), physical (P), emotional (E) scores as well as total (T) score were significantly different between young adults and old adults in DHI(p<.05). Additionally, there was a negative correlation between total DHI score and intensity of coughing (r=-.51) as well as L-DDK (r=-.70). These findings suggest that a slow rate in vocal fold adduction and reduced intensity of coughing in the elderly affect swallowing function. Thus, recently translated Korean version of DHI may be useful as supplement in evaluating the swallowing problems in elderly people.

• The Korean Journal of Health Service Management
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• v.7 no.1
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• pp.167-177
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• 2013

This study was to evaluate the influences of swallowing function on quality of life and activity of daily living of inpatients in geriatric hospital. The subjects were consisted of elderly patients over the age of 65, 50 people in geriatric hospital of gwangju and jeonnam area. The results are as follows: First, swallowing function score of the subjects is $29.90{\pm}5.27$, SWAL-QOL score is $158.12{\pm}33.36$, ADL score is $80.40{\pm}22.91$. Second, swallowing function, SWAL-QOL details and ADL details of each other showed a statistically significant correlation. Third, the items of swallowing function affecting on quality of life are 'oral cavity in residue', 'to eat solid food', and 'phlegm obstructs the throat'. In conclusion, this study showed that swallowing function of inpatients in geriatric hospital is closely associated with the quality of life and the activity of daily living. Therefore, future development of programs for the improvement of swallowing function is required in order to improve the quality of life of inpatients in geriatric hospital.

• Proceedings of the Korea Contents Association Conference
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• 2014.11a
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• pp.189-190
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• 2014

뇌경색, 뇌 신경장애 및 뇌졸중환자 중 급성기 환자는 의식이 없어 연하기능장애로 인한 흡인성 폐렴을 유발하기 때문에 비위관(nasogastric tube)을 삽입하고 영양공급을 한다. 재활훈련 후 회복기에 침상선별검사를 시행하지만 임상적 검사를 통해서는 무증상흡인은 발견할 수 없다. 그래서 연하장애로 비위관을 삽입한 연하재활치료 중인 환자 10명을 대상으로 VFSS를 시행하여 식이재료에 따른 삼킴 정도, 자세에 따른 삼킴을 재활의학과전문의가 평가 후, 흡인이 있거나 삼킴 곤란 등이 있으면 연하재활치료를 시행하여 환자의 상태에 따라 약 30일 ~ 50일후에 재평가를 시행한 후 흡인이 없을 시 비위관을 제거 하였다. 이때 VFSS 영상을 기능적 연하곤란척도를 이용, 분석하여 부여된 점수를 통계 산출 하였는데 비위관 유지군은 $49.79{\pm}9.431$을 보여 흡인의 위험을 나타내며, 비위관 제거군은 $11.20{\pm}1.932$로 흡인의 위험성이 낮아 비위관 제거관련 의미 있게 낮은 점수를 보였다. 두 군의 유의성을 평가하기 위해 Mann-Whitney test를 시행한 결과 p<0.001로 통계적으로 유의하다고 평가하였다. 결론적으로 VFSS는 구강, 인두, 식도의 구조적 이상과 움직임을 가장 효과적으로 평가, 기도흡인여부를 즉시 확인 및 환자에게 적합한 식이나 연하자세를 결정할 수 있어 비위관 제거를 위한 연하평가에 가장 확실한 표준검사로 제안할 수 있다.

• Therapeutic Science for Rehabilitation
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• v.11 no.4
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• pp.69-83
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• 2022

Objective : This study aimed to confirm the possibility of the clinical application of oral motor facilitation technique (OMFT) protocol and neuromuscular electrical stimulation (NMES) in patients with Wallenberg syndrome. Methods : One patient with Wallenberg syndrome was treated with OMFT and NMES applied 40 times each, 5 days a week, twice a day for 4 weeks. The Comprehensive Oral-Facial Function Scale (COFFS), Korean-Mann Swallowing Ability Assessment (K-MASA), and Penetration-Aspiration Scale (PAS) were used to compare the changes before and after the intervention. Data analysis was used to compare the score changes before and after the intervention. Results : Orofacial function and swallowing ability improved after the intervention in the individual who participated in this study. Among oral motor functions, relatively greater functional improvement was observed in tongue movement compared to other functions, which was evaluated to the extent that pharyngeal swallowing was possible. Conclusions : Early swallowing rehabilitation using systematic OMFT and NMES of exercise intensity confirmed the possibility of improving oral motor function and dysphagia. In the future, complementary studies on the effects of interventions applying the OMFT and NMES will be needed.