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혀 운동(tongue exercise)이 연하장애를 가진 뇌졸중 환자에게 미치는 효과 : 체계적 고찰

Effect of Tongue Exercise on Stroke Patients With Dysphagia : A Systematic Review

최유임|손영수
대한신경계작업치료학회 (Korean Society for Neurological Occupational Therapy)|2022.08|재활치료과학 (Therapeutic Science for Rehabilitation)|제11권 제3호|pp. 7-22|DOI https://doi.org/10.22683/tsnr.2022.11.3.007

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참고문헌

키워드

뇌졸중StrokeDysphagia연하장애연하재활치료혀운동Swallowing rehabilitationTongue exercise

초록

목적 : 본 연구는 연하장애를 가진 뇌졸중 환자에게 적용된 혀 운동을 체계적으로 분석한 논문이다. 혀운동에 대한 전반적인 효과를 검증하고, 현재 이루어지고 있는 혀 운동에 대한 경향을 파악하는데그 목적을 가지고 근거를 제공하고자 한다. 연구방법 : PRISMA(Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 체크리스트및 흐름도를 이용하여 체계적 고찰을 시행하였다. 데이터베이스는 PubMed, MEDLINE, CINAHL, RISS, e-article 을 통해 문헌 검색을 진행하였다. 본 연구에 사용된 문헌의 수는 총 6편이었고, 문헌의 질을평가하기 위하여 PEDro scale(Physiotherapy Evidence Database scale)을 사용하였다. 결과 : 분석된 논문 6편에서 3가지의 중재 방법이 포함되었다. 혀 운동의 종류로는 혀 근력훈련 3편, 혀 근력 및 정확도 훈련 2편으로 모두 아이오와 구강 수행 도구를 통한 중재를 시행하였고, 혀 신장훈련을 적용한 논문이 1편이었다. 조사된 문헌에서 시행한 중재 별 치료 효과는 모두 효과가 있는 것으로확인되었다. 하지만 대부분 표본수가 적어 일반화 시키기는 어려울 것으로 생각되며, 실험군과 대조군비교 시 몇몇 그룹 간에 유의한 차이가 발견되지 않은 결과들이 있는 만큼 전통적 연하재활치료도구강기 연하장애를 가지고 있는 환자들에게 적절한 치료 방법으로 판단된다. 결론 : 본 연구는 작업치료사들이 연하장애를 가진 뇌졸중 환자들에게 혀 운동을 적용함에 있어 효율적인연하재활치료를 제공하는데 도움을 줄 수 있을 것이며, 혀 운동의 효과를 알아보기 위해 더 많은 연구축적이 이루어져야 할 것으로 생각된다.

Abstract

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.

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