• 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.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.12 no.1
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• pp.294-300
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• 2011

This study was performed to examine the presence of dysphagia and analyze characteristics of the symptoms in cerebrovascular accident(CVA) patients without awareness of dysphagia. A questionnaire for this study was given to CVA patients who had visited P rehabilitation medical center in Busan. Eleven patients (4 males and 7 females) who answered no awareness of dysphasia were given to VFSS, functional dysphasia scale, and NCSE. Descriptive statistics and Pearson correlation analysis were performed by SPSS 12.0. All of subjects without awareness of dysphasia showed characteristics of dysphasia symptoms. Prominent dysfunctions were problems in oral phase and delay of swallowing reflex in pharyngeal phase. For the aspect of cognition, they showed lower score in construction, memory, and similarity than other NCSE items. There was highly significant correlation between orientation, judgment and delay of swallowing reflex. Verbal comprehension and residual materials in oral cavity showed closed correlation. CVA patients without awareness had dysphagia with high probability. The early evaluation of dysphagia should be performed in CVA patients in order to prevent complications due to CVA, so it is necessary to increase the effectiveness of rehabilitation therapy.

• Journal of rehabilitation welfare engineering & assistive technology
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• v.8 no.2
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• pp.109-118
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• 2014

The purpose of this study was to compare the effectiveness of rehabilitation therapy with natural recovery in patients who had dysphagia due to stroke. Swallowing functions were examined on a total of 98 patients with stroke-caused dysphagia based on a videofluoroscopic swallowing study (VFSS) for 8 weeks. The each group was evaluated with DOSS, DSS and FOSS to assess swallowing ability in the first week and re-evaluated in the $8^{th}$ week during the session for investigating the recovery status. The author compared the above initial data and follow-up data using a Mann-Whitney U test, Kruskal-Wallis test and Wilcoxon's Signed Rank test, ANCOVA to confirm statistically controlling for the effects of other continuous variables, performed by IBM SPSS Statistics 20.0 for windows. There was statistically significant recovery in the experimental group except measure of DOSS (p>0.05). In the control group, it showed improvement in all the scales(p<0.05). After terminating each session, the comparison of the two group of patients showed statistical significant differences in DSS and FOSS(p<0.05). These results suggest that possibility of natural neurologic recovery has positive effects on early stage of dysphagia caused by stroke.

• The Journal of Korean Academy of Sensory Integration
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• v.21 no.3
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• pp.79-102
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• 2023

Objective : Autistic Spectrum Disorders(ASD) is a developmental disorder characterized by atypical sensory adaptation, communication problem, stereotyped behavior, and feeding disorders. The reasons for ASD feeding disorders are oral sensory motor, cognitive, behavioral, and social problems. Major symptoms include picky eating, selective eating, food refusal, food neophobia, limited food variety, and food aversion. ASD feeding disorders could be accompanied by various problems such as health and nutrition intake problems, feeding development, eating-related sociability, and family and caregiver stress. Feeding problems and disorders in ASD can present from birth. However, ASD is diagnosed by the age of 3, and there might be an appropriate treatment gap. Usually, symptoms of feeding disorders tend to decrease with age. However, the symptoms often remain, so early evaluation, intervention, and periodic checking are necessary. In this study, the general information about the feeding disorder characteristics of ASD, influencing factors, and intervention were described through a literature review. Conclusion : Sensory-based therapy and behavior-based therapies are generally used for feeding disorders in ASD. Sensory-based therapy is effective for food sensitivity and behavior-based therapy for food selection. As the symptoms of feeding disorders in ASD are diverse, a comprehensive approach includes play and participation, oral motor exercise, diet, and daily life. However, appropriate evaluation, intervention protocol, and guidelines for the treatment of feeding disorders in ASD are limited. Therefore, a complex approach based on a more systematic understanding is needed. Feeding rehabilitation specialists, such as occupational therapists, should provide appropriate evaluation and intervention.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.29 no.1
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• pp.14-18
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• 2018

Head and neck cancer patients are prone to dysphagia and aspiration, which are usually neglected due to treatment of the cancer itself. However, dysphagia and aspiration could cause malnutrition, dehydration, pneumonia, and moreover, have negative impact on the quality of life, morbidity, and mortality. Due to its multifactorial etiology, thorough clinical and instrumental evaluation are necessary. In managing head and neck cancer patients, it has become very important to identify the possibility of dysphagia and aspiration, and to start management as early as possible.

• Therapeutic Science for Rehabilitation
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• v.13 no.2
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• pp.9-25
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• 2024

Objective : Children with autism spectrum disorder (ASD) commonly suffer from feeding disorders. Major feeding problems include mealtime behavior problems, picky eating, and a lack of food variety can lead to nutritional problems, developmental and social limitations, and stress for the caregivers. A review of the latest literature was conducted to gain an in-depth understanding of assessment tools for feeding disorders in children with ASD. Method : This study analyzed assessments to identify feeding problems in ASD based on previous studies searched through keywords such as ASD, ASD feeding problem, and ASD feeding evaluation. Results : The ASD feeding disorder assessment was divided into direct and indirect assessments. Indirect assessment, in which caregivers measure a child's situation using questionnaires, is mainly used. The assessment of feeding disorders in children with ASD was divided into 1) mealtime behavior, 2) sensory processing, 3) food consumption, and 4) others. Conclusion : As the main feeding disorder characteristics of children with ASD are very diverse, a comprehensive evaluation is necessary but is still limited. Swallowing rehabilitation experts, such as occupational therapists, should apply comprehensive assessment tools based on a basic understanding of the feeding problems, behaviors, and sensations in ASD.

• Journal of the Korean Society of Radiology
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• v.4 no.3
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• pp.19-25
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• 2010

Dysphagia is common and serious problems in post-stroke patients. The post-stroke dysphagia with aspiration is associated with dehydration, malnutrition, pneumonia, sepsis and death. Up to date, gag reflex and choking history used to decide the aspiration in clinical. The purpose of this study was to evaluate the aspiration and to choice the proper meal formation using by video fluoroscpic swallowing study(VFSS) with post-stroke dysphagia patients. 58 post-stroke patients and ten normal person participated to perform the VFSS with liquid type, puding, yoplait, rice mixed with barium(Ba). Two rehabilitation medicine doctors and a radiological technologist analysed the phase(oral, pharyngeal, esophageal phase)with video film, and checked the pharyngeal transition time(PTT). 38 patients showed abnormality in pharyngeal phase, 13 patients in oral and pharyngeal phase, 3 patients in oral phase, and 2 patients in pharyngeal and esophageal phase. 43 patients(65.2%) occured the aspiration, but 23 of 43 patients improved by the chin tuck position. Aspiration occured 34 patients in liquid type, 2patients in rice gruel and nothing in boiled rice. After VFSS, 13 of 23 patients change the intaking pathway from nasogastric tube(NGT) to oral, On the contrary with 3 of 42 patients from oral to NGT. Consequently VFSS is clearly effective to evaluate the aspiration with post-stroke dysphagia patients.

• The Journal of Korean Academy of Sensory Integration
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• v.19 no.1
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• pp.39-53
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• 2021

Objective : The purpose of this study was to systematically review dysphagia rehabilitation treatment for children with feeding disorders. Methods : The articles evaluated in this study were collected from the PubMed, Medline Complete, and CINAHL databases and subsequently reviewed using the PRISMA flow chart and PICOS approach. A total of 13 papers were analyzed for study quality, disease groups, evaluation tools, interventions, and post-intervention effects. Results : Of the reviewed papers, six (46.15%) related to autism spectrum disorder (ASD) and seven (53.85%) to cerebral palsy (CP) with age ranges of between 2 and 8 years for the ASD studies and between 12 months and 18 years for CP. In evaluating the types of feeding disorder involved, the ASD group exhibited predominantly behavioral conditions while the CP subjects had a larger number of functional oral and swallowing issues. In terms of interventions, behavior modifications were used most frequently with ASD while oral-sensory motor, texture modifications, and electrical stimulation were applied at the same frequency with children with CP. All interventions were found to be effective. Conclusion : In this study, research into children with feeding disorders was reviewed according to condition, evaluation tool, and method of intervention. It is expected that this review can be used as basic data for developing a protocol that will allow clinicians to efficiently apply condition-specific interventions for eating disorders without resorting to trial and error.

• Therapeutic Science for Rehabilitation
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• v.11 no.3
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• pp.7-22
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• 2022

Objectives : This study was a systematic review of tongue movements in stroke patients with dysphagia. This study aimed to provide a basis for verifying the effects of tongue movement and identifying the tendency of tongue movement. Methods : A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and flow chart. PubMed, MEDLINE, CINAHL, RISS, and e-articles databases were searched. A total of six documents were investigated, and the PEDro scale was used to evaluate the quality of the papers. Results : Three intervention methods were included in the six papers analyzed. Regarding the type of tongue exercise, three TPRT (Tongue to Palate Resistance Trainings) and two TSAT (Tongue Strength and Accuracy Training) were mediated through the IOPI (Iowa Oral Performance Instrument), and only one study applied TSE (Tongue Stretching Exercise). The treatment effects for each intervention implemented in the literature were confirmed to be effective. However, generalizability of findings is difficult because of the small sample size. Further, no significant difference was found between the experimental and control groups. Conclusions : This study can help occupational therapists provide efficient swallowing rehabilitation treatment by applying tongue exercises to stroke patients with dysphagia. More research should be conducted to determine the effects of tongue exercise.

• 재활복지
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• v.22 no.1
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• pp.169-194
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• 2018

The aim of this study is to examine changes in swallowing function and quality of life with therapeutic singing-based music therapy for patients with dysphagia. The music therapy program was based on the previous study (Kim, 2010), and designed to improve breathing, phonation, and swallowing functions focusing on laryngeal elevation. Three patients with dysphagia participated in this study and each participant received a total of 11 or 12 individual music therapy sessions and each session was conducted for 30 minutes. In this study, three kinds of measurements were used. First, the measures of maximum phonation time (MPT), fundamental frequency, average intensity, jitter, shimmer, noise to harmonics ratio (NHR) by Praat test, second, laryngeal-diadochokinesis (L-DDK) to investigate laryngeal elevation, and last, the Swallowing-Quality of Life (SWAL-QOL) was measured. These cases have shown improved breathing, phonation, swallowing function, and the scores of SWAL-QOL in all of the patients. It suggests that this music therapy intervention was effective on laryngeal elevation, and the music intervention with therapeutic singing can be effectively implemented in further research for patients with dysphagia.