• 말소리와 음성과학
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• 제5권4호
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• pp.43-51
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• 2013

The purpose of this study is to survey Speech-Language Pathologists' perception on evaluation and treatment of "swallowing disorders". An online questionnaire was sent to the 279 subjects attending undergraduate/graduate programs in speech therapy department and/or SLPs who work in various settings. The survey consisted of three parts: 1) background information and educational/clinical experiences that are associated with dysphagia (swallowing disorder), 2) the current state of diagnosis and treatment of dysphagia of clinical practice (certified SLPs only), 3) the recognition of diagnosis, treatment, education for dysphagia. Each item of the survey was scaled by the participants on a five-point Likert scale of 1 to 5 (1 being not at all and 5 being extremely) or self-reported answers. The results of the survey showed that SLPs have high interest in "swallowing disorder", but most of them regarded them very difficult to diagnose and treat. The reason is that they have not been trained as a swallowing specialist. Therefore it is necessary to provide more opportunities for education and practice to establish the expertise of SLPs.

• 재활치료과학
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• 제7권1호
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• pp.11-26
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• 2018

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.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제12권sup1호
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• pp.77-84
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• 2009

Pediatric dysphagia comes from disturbances in swallowing process, which has 'preparatory phase', 'oral phase', 'pharyngeal phase', and 'esophageal phase', and mainly the causes are neuro-muscular discoor-dination. It is necessary to recognize clinical manifestation if they have accompanied organic disorder and diagnose accurately. Videofluoroscopic study evaluation is a valuable method to find out abnormal swallowing mechanism at each phases. Treatment should be diagnosis specific, and multidisciplinary team approach is desirable. We can use various behavioral techniques to facilitate normal swallowing mechanism including conditioning of oral and pharyngeal structures, bolus manipulation, postural compensation, and adaptive feeding utensils. Important point is that the diagnosis and treatment for pediatric dysphagia should not be delayed because children are under development.

• 대한통합의학회지
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• 제7권1호
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• pp.27-36
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• 2019

Purpose : The purpose of this study figures out how the biofeedback exercise combined with a Shaker exercise and a jaw-opening exercise affects the suprahyoid muscle activation of stroke with a swallowing disorder. Methods : The study period was from June, 2018 to September, 2018, to 45 patients who were suitable for selection criteria. Participants were divided into three groups: a visuoauditory biofeedback group (VABG), and a visual biofeedback group (VBG), and a self-exercise group (SG). The three groups were divided into the Shaker exercise and the jaw-opening exercise, and the biofeedback training by themselves. Three groups performed an intervention three times a day, five times a week, and four weeks long. Also, suprahyoid muscle activity was measured with a pre-test, a post-test and a follow-up test. Results : To know the suprahyoid muscle activity after the intervention, there were statistically significant differences between the pre-test and the post-intervention (p< .01). All three groups showed the improvement with the mean comparing followed by VABG, VBG and SG. Comparing between the post- test and the follow-up test, all three groups showed the reduction of suprahyoid muscle activity with the mean comparing, followed VABG, VBG and SG. Conclusion : It found that it was more effective when providing a double-sensory biofeedback than when training with a single-sensory biofeedback. Therefore, it is necessary to provide a multi-sensory input when applying the biofeedback in rehabilitation of the swallowing disorder.

• 대한임상전기생리학회지
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• 제11권1호
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• pp.45-52
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• 2013

Purpose : The goal of this study is to estimate the effect of SSP electrical stimulation applied to acupoints as conducted in oriental medicine on the swallowing function of patients with swallowing difficulties caused by stroke. Methods : Twenty-two hemiplegic stroke patients with swallowing difficulties were divided into an intervention-only group (Group I; n=11) and an intervention-SSP electrical stimulation group (Group II; n=11). Therapeutic intervention was performed on participants in the intervention-only group and the intervention-SSP electrical stimulation group, for 20 minutes per session, three times per week, for four weeks. In this study, SSP electrical stimulation to the acupoints (Cheondol, Yomchon, Budol, Pungji, and Sanyinjian) of stroke patients with swallowing difficulties was applied, and to investigate the effects of SSP electrical stimulation, Clinical dysphagia scale (CDS) and ultrasonography assessment was used to measure pre and post-intervention scores. Results : In the clinical dysphagia scale assessment, the post-intervention score for group II had significant enhancement unlike group I. In the ultrasonography assessment, the hyolaryngeal movement in group II showed significant increase in the swallowing function unlike group I. Conclusion : From the above results, significant effects came from SSP electrical stimulation of 3Hz, biphasic wave, continuous current when applied to the acupoints as conducted in oriental medicine to improve the swallowing function of stroke patients.

• 재활복지공학회논문지
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• 제8권2호
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• pp.109-118
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• 2014

본 연구는 급성기 뇌졸중 환자에서 연하장애 재활치료를 받은 환자와 받지 않은 환자의 회복정도를 비교하기 위함이다. 뇌졸중으로 진단받고 연하장애를 가지는 환자(n=98)에서 치료를 받은 군과 받지 않은 군으로 나누어 실험군과 대조군사이 연하장애 재활치료중재전-후 비교 연구 설계에 의해 실험군(n=52)에는 8주간의 연하장애 재활치료를 시행하였고 대조군(n=46)에는 아무런 처치를 하지 않았다. 두 집단 모두를 대상으로 중재 전-후 Video Fluoroscopy Swallowing Study(VFSS), Dysphagia Outcome and Severity Scale(DOSS), Dysphagia Severity Scale(DSS), Functional Outcome Swallowing Scale(FOSS)로 평가를 하였으며 평가값의 변화량은 paired t-test 및 ANCOVA를 통해 분석 하였다. 실험군의 중재전-중재후의 점수 변화비교에서 DOSS를 제외한 나머지 평가도구에서 연하기능이 회복되었다(p<0.05). 대조군의 전-후의 점수 변화비교에서는 모든 평가도구에서 점수값의 변화가 통계학적으로 유의하여 연하기능의 유의한 변화가 있었다(p<0.05). 실험군과 대조군 각각의 2차 평가를 비교한 결과 DOSS를 제외한 나머지 평가도구에서 변화가 통계학적으로 유의한 수준을 보였다(p<0.05). 본 연구 결과 대상자들은 평균적으로 급성기 8주 동안 연하기능의 회복을 보였고, 대조군에서는 세 평가도구 모두에서 유의하게 평가항목간의 점수가 상승하였다. 대상군들의 전-후 검사값의 차를 비교하였을 때 대조군에서 더 높은 점수의 상승을 보여 시간의 경과에 따른 자연적 신경학적 회복을 시사했다.

• 재활복지
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• 제20권4호
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• pp.265-281
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• 2016

본 연구는 삼킴장애를 가진 뇌졸중 환자의 특성에 따른 삼킴기능, 식이수준, 인지기능, 일상생활의 비교와 상관관계를 알아보고자 하였다. 본 연구의 대상자들은 삼킴장애가 있는 뇌졸중 환자 56명이었다. 결과측정은 기능적 삼키장애 척도(FDS), 미국언어청각협회 삼킴척도(ASHA NOMS), 한국판 간이 정신상태 검사(K-MMSE), 한국판 수정바델지수(K-MBI)를 사용하였다. 수집한 자료는 대상자들의 일반적 특성에 따른 각 평가들의 차이를 비교하기 위하여 독립 t 검정을 이용하여 분석하였고 각 평가들의 상관관계를 알아보기 위하여 피어슨 상관분석을 수행하였다. 연구 결과, 대상자들의 손상위치에 따른 삼킴기능은 유의한 차이가 있었다. 발병기간에 따른 인지기능은 유의한 차이가 있었다. 대상자들의 나이는 식이수준, 인지기능과 유의한 상관이 있었다. 삼킴기능은 식이수준, 인지기능과 유의한 상관이 있었다. 인지기능은 식이수준, 일상생활과 유의한 상관이 있었다. 본 연구의 결과를 기반으로 삼킴장애가 있는 뇌졸중 환자에 대한 삼킴재활 치료는 환자들의 특성과 인지기능을 고려하여 수행해야 할 것으로 사료된다.

• 국제물리치료학회지
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• 제12권1호
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• pp.2267-2271
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• 2021

Background: Recently, a new home-based dysphagia rehabilitation method using information and communications technology (ICT) has been reported, but clinical evidence is still lacking. Objectives: To investigate the effects of home-based dysphagia rehabilitation using ICT on tongue muscle strength and volume in patients with developed dysphagia after stroke. Design: Randomized controlled trial design. Methods: Twenty patients who developed dysphagia after stroke were enrolled. The experimental group received dysphagia rehabilitation in the form of ICT-based home care. In contrast, the control group received traditional rehabilitation based on swallowing under the supervision of occupational therapists. All interventions were conducted five times a week for four weeks. Results: Both groups showed statistically significant increases in tongue muscle strength and volume after the intervention (P<.05, both). However, there were no significant differences in tongue strength or volume between the two groups after the intervention (P>.05, both). Conclusion: Home-based dysphagia rehabilitation using ICT showed effects similar to those of conventional swallowing rehabilitation in patients who developed dysphagia after stroke. These findings suggest that dysphagia rehabilitation can be conducted at home without the help of a therapist.

• 대한장애인치과학회지
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• 제9권1호
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• pp.56-65
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• 2013

I participated in Academic Exchange Program(Action plan II) between KADH(Korean Association for Disability and Oral Health) and JSDH(Japanses Society for Disability and Oral Health) for 2 months from 3rd July 2012 to 2nd september 2012 in the Department of Hygiene and Oral Health, School of Dentistry, Showa University at Tokyo, Japan. I have observed their operation process and learned what dysphagia is and how it is consulted and taken care of as a therapy for patients with eating and swallowing disorders for two months in The department of special needs dentistry at Showa University Dental Hospital, Jonan Branch of Tokyo Metropolitan Kita Medical Rehabilitation Center for the Disabled, Smile Nakano Center, Tokyo metropolitan center for persons with disabilities in Lidabashi for one week, Eating and swallowing functional therapy workshop for disabled children, Tokyo metropolitan Tobu medical center for Persons with Developmental/Multiple Disabilities located in Minamisunamitchi for one week and on The 17-18th JSDR(Japanese Society of Dysphagia rehabilitation) in Sapporo. Through Action Plan II program, I learned how precious eating, drinking and swallowing with ease are and observed how they do and what they do as a dentist or a dental hygienist in Japan for dysphagia patients. Therefore, I want to present the dental approaches of children with dysphagia in Japan, based on my experience for two months.

• 대한물리의학회지
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• 제13권4호
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• pp.43-50
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• 2018

PURPOSE: The purpose of this study is to examine the effect of proprioceptive neuromuscular facilitation (PNF) neck flexion exercise and the Shaker exercises on the activity of the suprahyoid muscles in chronic stroke patients with dysphagia and to show what exercise methods are effective for swallowing rehabilitation. METHODS: This study was conducted at F hospital in Daegu from August 2014 to February 2017 with 60 participants who understood the purpose of the study and desired to participate. The 60 participants were randomly divided into an experimental group (PNF neck flexion exercise) (n=30) and a control group (Shaker exercise) (n=30). PNF neck flexion exercise was performed in the experimental group and the Shaker exercise was performed in the control group for 30 minutes, 5 times a week for 6 weeks. The activity of the suprahyoid muscles was measured before and after treatment. RESULTS: Both the experimental group and the control group showed a statistically significant change in the activity of the suprahyoid muscles before and after the treatment. The changes were also statistically significant when compared by group. CONCLUSION: In conclusion, PNF neck flexion exercise should be used in addition to Shaker exercise when rehabilitating a patient with a swallowing disability.