연하장애를 수반한 뇌졸중 환자의 삼킴 기능에 혀 압력 프로토콜과 구강인두운동의 병행적용이 미치는 효과
The Effects of Oropharyngeal Exercise Combined with Tongue Pressure Training Protocol on Swallowing Function in Stroke Patients with Dysphagia
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초록
본 연구는 혀 압력 훈련 프로토콜과 구강인두운동의 적용이 뇌졸중으로 인한 연하장애 환자의 구강단계와 인두단계의 삼킴 기능에 미치는 효과를 연구하였다. 연구 대상자는 혀 압력이 40KPa 미만이고, 혀 움직임 저하로 고임이 나타나는 14명을 두 그룹으로 배분하였다: (1) 치료군 1(7명, 혀 압력 훈련 프로토콜만 시행), (2) 치료군 2(7명, 압력 훈련 프로토콜과 구강인두운동의 적용). 치료적 중재는 8주간 적용하였고, 치료 전과 후에 등척성 혀 근력, 기능적 연하장애 척도, 침습과 흡인 발생 유무를 평가하였다. 치료군 1은 중재 후 등척성 혀 근력이 증가하고, 침습과 흡인이 감소하였으며, 구강 단계에서 기능적 연하장애 척도가 향상되었다. 혀 압력 훈련 프로토콜과 구강인두운동을 병행하여 적용할 경우는 등척성 혀 근력이 증가하고, 침습과 흡인이 감소하였으며, 구강 단계 뿐 아니라 인두단계까지 기능적 연하장애 척도가 향상 되었다. 또한, 침습과 흡인 감소는 치료군 2가 치료군 1보다 더욱 유의하게 나타났다. 따라서 본 연구는 혀 압력 훈련 프로토콜과 구강인두운동의 병행 적용이 뇌줄중에 의한 연하장애 환자의 구강단계와 인두단계의 삼킴 기능 향상에 더욱 효과적인 방법으로 사용될 수 있을 것으로 사료 된다.
Abstract
This study investigated the effects of oropharyngeal exercise (OE) combined with Tongue pressure training protocol (TPTP) on swallowing function in oral and pharyngeal phases of stoke patients with dysphagia. 14 subjects. Subjects with declined tongue pressure less than 40 kPa and pooling caused by decreased tongue movement were randomly allocated to two groups: (1) the treatment group 1 (n=7, TPTP conducted group), (2) the treatment group 2 (n=7, OE combined with TPTP conducted group). Intervention was given for 8 weeks. Isometric tongue strength, functional dysphagia scale and Penetration Aspiration scale (PAS) were assessed at before and after intervention. In the treatment group 1, isometric tongue strength and the scores of functional dysphagia scale in the oral phase were increased, and PAS scores were decreased. Similarly, the treatment group 2 showed the improved isometric tongue strength and functional dysphagia scale scores in the oral and pharyngeal phases of swallowing, and the decreased PAS scores. Especially, the scores of PAS in the treatment group 2 were more significantly decreased than the treatment group 1. We propose that OE combined with TPTP would be more effective to increase the swallowing function in the oral and pharyngeal phases of swallowing of stoke patients with dysphagia.
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