뇌졸중 환자의 임상적 요인들과 비디오 투시 연하 검사결과와의 연관성
Clinical Factors Associated with Videofluoroscopic Swallowing Study Findings in Stroke Patients
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objective: To examine the clinical factors and brain lesion locations related to the patterns of dysphagia in stroke patients ina rehabilitation hospital. Methods: The medical records of 116 stroke patients who underwent a videofluoroscopic swallowing study (VFSS) betweenJanuary 2010 and January 2015 in a rehabilitation hospital were reviewed retrospectively. The swallowing-related parameterswere assessed using a VFSS. The brain lesion locations were classified as the cortex, basal ganglia, thalamus, midbrain, pons, medulla,cerebellum, and others (subarachnoid or intraventricular hemorrhage). The ambulation ability was assessed using functionalambulation categories (FACs). The independence in the activities of daily living and the degree of cognitive impairmentwere assessed using the Korean versions of the modified Barthel index (K-MBI) and Mini-Mental State Examination (K-MMSE),respectively. After adjusting for the potential confounding factors in multivariate analysis, the odds ratios and confidence intervalsof the stroke brain lesions were calculated and the clinical factors for predicting the VFSS findings were determined. Results: Among the 116 patients, 35 (27%) had an impaired oral stage and 58 (50%) had aspiration. The impaired oral stagewas associated significantly with the onset time, basal ganglia stroke, dietary and fluid intake methods at the time of theVFSS, symptoms of dysphagia, FACs, K-MBI, and K-MMSE. Aspiration was correlated with a pontine stroke, methods of dietaryand fluid intakes at the time of the VFSS, symptoms of dysphagia, FACs, and K-MBI. Multivariate analysis showed thatthe pontine stroke and methods of dietary and fluid intake at the time of VFSS predicted aspiration after adjusting for thepotential confounding factors. In subgroup analysis of the diet type, the liquid and semisolid aspirations were correlatedwith the dietary and fluid intake methods and pontine stroke, respectively. Conclusion: Patients with a pons lesion stroke, who are on a modified diet (fluid thickening and tube feeding), have higherrisks of aspiration. This provides evidence for precise clinical reasoning in this specific patient group.
Abstract
Objective: To examine the clinical factors and brain lesion locations related to the patterns of dysphagia in stroke patients ina rehabilitation hospital. Methods: The medical records of 116 stroke patients who underwent a videofluoroscopic swallowing study (VFSS) betweenJanuary 2010 and January 2015 in a rehabilitation hospital were reviewed retrospectively. The swallowing-related parameterswere assessed using a VFSS. The brain lesion locations were classified as the cortex, basal ganglia, thalamus, midbrain, pons, medulla,cerebellum, and others (subarachnoid or intraventricular hemorrhage). The ambulation ability was assessed using functionalambulation categories (FACs). The independence in the activities of daily living and the degree of cognitive impairmentwere assessed using the Korean versions of the modified Barthel index (K-MBI) and Mini-Mental State Examination (K-MMSE),respectively. After adjusting for the potential confounding factors in multivariate analysis, the odds ratios and confidence intervalsof the stroke brain lesions were calculated and the clinical factors for predicting the VFSS findings were determined. Results: Among the 116 patients, 35 (27%) had an impaired oral stage and 58 (50%) had aspiration. The impaired oral stagewas associated significantly with the onset time, basal ganglia stroke, dietary and fluid intake methods at the time of theVFSS, symptoms of dysphagia, FACs, K-MBI, and K-MMSE. Aspiration was correlated with a pontine stroke, methods of dietaryand fluid intakes at the time of the VFSS, symptoms of dysphagia, FACs, and K-MBI. Multivariate analysis showed thatthe pontine stroke and methods of dietary and fluid intake at the time of VFSS predicted aspiration after adjusting for thepotential confounding factors. In subgroup analysis of the diet type, the liquid and semisolid aspirations were correlatedwith the dietary and fluid intake methods and pontine stroke, respectively. Conclusion: Patients with a pons lesion stroke, who are on a modified diet (fluid thickening and tube feeding), have higherrisks of aspiration. This provides evidence for precise clinical reasoning in this specific patient group.
참고문헌 (41)
- Smith CH, "Incidence and patient characteristics associated with silent aspiration in the acute care setting", Dysphagia, 14, pp.1~7 (1999)
- Nilsson H, "Dysphagia in stroke: a prospective study of quantitative aspects of swallowing in dysphagic patients", Dysphagia, 13, pp.32~38 (1998)
- Daniels SK, "Aspiration in patients with acute stroke", Arch Phys Med Rehabil, 79, pp.14~19 (1998)
- DePippo K, "Dysphagia therapy following stroke a controlled trial", Neurology, 44, pp.1655~1660 (1994)
- Lundy DS, "Aspiration: cause and implications", Otolaryngology-Head and Neck Surgery, 120, pp.474~478 (1999)
- Perry L, "Screening for dysphagia and aspiration in acute stroke: a systematic review", Dysphagia, 16, pp.7~18 (2001)
- Smithard DG, "The natural history of dysphagia following a stroke", Dysphagia, 12, pp.188~193 (1997)
- Mann G, "Swallowing function after stroke: prognosis and prognostic factors at 6months", Stroke, 30, pp.744~748 (1999)
- Langdon PC, "Dysphagia in acute ischaemic stroke: severity, recovery and relationship to stroke subtype", J Clin Neurosci, 14, pp.630~634 (2007)
- Lee CK, "Pattern of post-stroke swallowing disorder according to the brain lesion", Journal of Korean Academy of Rehabilitation Medicine, 25, pp.193~201 (2001)
- Martin RE, "The role of the cerebral cortex in swallowing", Dysphagia, 8, pp.195~202 (1993)
- Yoon H, "Clinical survey of dysphagia in stroke", The Journal of Korean Academy of Rehabilitation Medicine, 14, pp.196~202 (1990)
- Alberts MJ, "Aspiration after stroke: lesion analysis by brain MRI", Dysphagia, 7, pp.170~173 (1992)
- 문현임, "Correlation between Location of Brain Lesion and Cognitive Function and Findings of Videofl uoroscopic Swallowing Study", Annals of Rehabilitation Medicine, 36(3), pp.347~355 (2012), 대한재활의학회[DOI]
- 전우현, "아급성 뇌졸중 환자의 비디오 투시 연하 검사 소견과 뇌병변 부위 및 임상적 요인들의 연관성 ···", 뇌신경재활, 7(1), pp.54~60 (2014), 대한뇌신경재활학회
- Mehrholz J, "Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke", Arch Phys Med Rehabil, 88, pp.1314~1319 (2007)
- Granger CV, "Stroke rehabilitation: analysis of repeated Barthel index measures", Arch Phys Med Rehabil, 60, pp.14~17 (1979)
- 정한영, "한글판 수정바델지수(K-MBI)의 개발: 뇌졸중 환자 대상의 다기관 연구", Annals of Rehabilitation Medicine, 31(3), pp.283~297 (2007), 대한재활의학회
- Kohn R, "The mini-mental state examination: age and education distribution for a Latin American population", Aging and Mental Health, 12, pp.66~71 (2008)
- Logemann JA, "Manual for the videofluorographic study of swallowing" (1993), Pro-ed Austin
- Han TR, "The functional dysphagia scale using videofluoroscopic swallowing study in stroke patients", Journal of Korean Academy of Rehabilitation Medicine, 23, pp.1118~1126 (1999)
- Rosenbek JC, "A penetration-aspiration scale", Dysphagia, 11, pp.93~98 (1996)
- Werner C, "Treadmill training with partial body weight support and an electromechanical gait trainer for restoration of gait in subacute stroke patients: a randomized crossover study", Stroke, 33, pp.2895~2901 (2002)
- Kwakkel G, "Long term effects of intensity of upper and lower limb training after stroke: a randomised trial", J Neurol NeurosurgPsychiatry, 72, pp.473~479 (2002)
- 정달영, "중소 사업장 근로자의 직무스트레스가 업무상 손상에 미치는 영향", Annals of Occupational and Environmental Medicine, 22(1), pp.37~47 (2010), 대한직업환경의학회
- Kuhlemeier KV, "Epidemiology and dysphagia", Dysphagia, 9, pp.209~217 (1994)
- Mosselman MJ, "Malnutrition and risk of malnutrition in patients with stroke: prevalence during hospital stay", J Neurosci Nurs, 45, pp.194~204 (2013)
- DePippo KL, "The Burke dysphagia screening test: validation of its use in patients with stroke", Arch Phys Med Rehabil, 75, pp.1284~1286 (1994)
- Gottlieb D, "Validation of the 50 ml3 drinking test for evaluation of post-stroke dysphagia", Disabil Rehabil, 18, pp.529~532 (1996)
- Falsetti P, "Oropharyngeal dysphagia after stroke:incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit", J Stroke Cerebrovasc Dis, 18, pp.329~335 (2009)
- Terre R, "Oropharyngeal dysphagia after the acute phase of stroke: predictors of aspiration", Neurogastroenterol Motil, 18, pp.200~205 (2006)
- Horner J, "Aspiration in bilateral stroke patients A validation study", Neurology, 43, pp.430~ (1993)[DOI]
- Han D-S, "Comparison of disordered swallowing patterns in patients with recurrent cortical", subcortical stroke and first-time brainstem stroke, 2005, pp.37, 189~
- Hammond CAS, "Predicting aspiration in patients with ischemic stroke: comparison of clinical signs and aerodynamic measures of voluntary cough", Chest, 135, pp.769~777 (2009)
- Miller AJ, "The search for the central swallowing pathway:the quest for clarity", Dysphagia, 8, pp.185~194 (1993)
- 이환태, "뇌졸중 병변에 따른 삼킴장애의 양상", 대한연하장애학회지, 4(1), pp.28~36 (2014), 대한연하장애학회[DOI]
- Hamdy S, "Explaining oropharyngeal dysphagia after unilateral hemispheric stroke", The Lancet, 350, pp.686~692 (1997)
- Ertekin C, "Mechanisms of dysphagia in suprabulbar palsy with lacunar infarct", Stroke, 31, pp.1370~1376 (2000)
- 신준현, "치매의 진단: 신경심리검사", Korean Journal of Family Medicine, 31(4), pp.253~266 (2010), 대한가정의학회
- 범재원, "뇌질환 환자에서의 연하곤란 치료법", 대한의사협회지, 56(1), pp.7~15 (2013), 대한의사협회
- Daniels SK, "The role of the insular cortex in dysphagia", Dysphagia, 12, pp.146~156 (1997)