뇌졸중 후 신체 활동 및 운동

고성화 대한노인재활의학회 2023 Geriatric rehabilitation Vol.13 No.2

Physical activity and exercise reduce the risk of mortality and recurrence after stroke and improve physical function and quality of life after stroke. Several recent studies have shown that physical activity and exercise after stroke are associated with significant improvements in physical function, including gait function, muscle strength, and balance. Many stroke rehabilitation guidelines strongly recommend physical activity and exercise after stroke, including aerobic and strength exercises. However, the actual levels of physical activity and exercise among people with stroke are lower than recommended. Therefore, all healthcare providers caring for stroke patients should be fully informed of the evidence and guidelines on the effectiveness of physical activity and exercise after stroke and apply them in clinical practice. They should also be able to educate stroke patients adequately. In addition, physical activity and exercise after stroke should be personalized and include exercise prescriptions feasible for people with stroke. As a result, patients, carers, and healthcare providers should be actively involved in ensuring that people with stroke participate in physical activity and exercise to a sufficient level.

경두개 직류전기자극을 이용한 운동 학습 증진

고성화,신용일 대한뇌신경재활학회 2015 뇌신경재활 Vol.8 No.2

Motor learning is a relatively permanent change of improving motor skills, resulting from repetitive training and an important process of motor recovery in neurorehabilitation. There are various methods of physical therapies, medications, stem cell therapy, invasive and non-invasive neuromodulation techniques for recovery of motor function after stroke. In this review, we describe motor learning and transcranial direct current stimulation among noninvasive neuromodulation techniques to enhance the motor learning.

Evaluation and Treatment of Dysphagia

고성화 대한내과학회 2022 대한내과학회 춘계학술대회 Vol.2022 No.-

Rehabilitation Service for Traumatic Brain Injury in Korea: Increasing Burden and Challenges

고성화,Brain & Neurorehabilitation 대한뇌신경재활학회 2021 뇌신경재활 Vol.14 No.3

흡인의 위험인자와 평가

고성화 대한연하장애학회 2019 대한연하장애학회지 Vol.9 No.2

Aspiration is the entry of materials, such as pharyngeal secretions, food, or stomach contents, into the respiratorysystem. Dysphagia is the most common risk factor of aspiration, but there are many other risk factors. A single factor or multiple factors may be present to induce the aspiration, and the risk factors of aspiration should be considered multidimensional. The bedside water test is suitable as a screening test for an evaluation of aspiration. Videofluoroscopic swallowing study and flexible endoscopic evaluation of swallowing are the diagnostic tests of aspiration and the tests are required if the screening test shows signs of aspiration or silent aspiration is stronglysuspected. The diagnostic test should assess not only the presence of aspiration, but also the pathophysiologic riskfactors of aspiration.

Botulinum Toxin in the Treatment of Drooling in Tetraplegic Patients With Brain Injury

고성화,신용범,민지홍,신명준,장재혁,신용일,고현윤 대한재활의학회 2013 Annals of Rehabilitation Medicine Vol.37 No.6

Objective To investigate the effect of botulinum toxin type A (BTA) injection into the salivary gland and to evaluate the changes of drooling in varied postures in tetraplegic patients with brain injury.Methods Eight tetraplegic patients with brain injury were enrolled. BTA was injected into each parotid and submandibular gland of both sides under ultrasonographic guidance. Drooling was measured by a questionnaire-based scoring system for drooling severity and frequency, and the sialorrhea was measured by a modified Schirmer test for the patients before the injection, 3 weeks and 3 months after the injection. Drooling was evaluated in each posture, such as supine, sitting, and tilt table standing, and during involuntary mastication, before and after the injection. Results The severity and frequency of drooling and the modified Schirmer test improved significantly at 3 weeks and 3 months after the injection (p<0.05). Drooling was more severe and frequent in tilt table standing than in the sitting position and in sitting versus supine position (p<0.05). The severity of drooling was significantly increased in the patients with involuntary mastication (p<0.05).Conclusion Salivary gland injection of BTA in patients with tetraplegia resulting from brain injury who had drooling and sialorrhea could improve the symptoms for 3 months without complications. The severity and frequency of drooling were dependent on posture and involuntary mastication. Proper posture and involuntary mastication of the patients should be taken into account in planning drooling treatment.

COVID-19 세계적 대유행 상황에서 연하장애의 진단과 치료

고성화 대한연하장애학회 2021 대한연하장애학회지 Vol.11 No.2

Dysphagia is a complication seen in patients with coronavirus disease 2019 (COVID-19). Even in a COVID-19 pandemic situation, the management of dysphagia caused by other diseases as well as dysphagia-related COVID-19 cannot be ignored. Because COVID-19 is transmitted via droplets, contact, and aerosol, there is fear of transmission to healthcare professionals. Due to this, it has not been possible to manage a COVID-19 dysphagia patient, in the same way as it was practiced prior to the COVID-19 pandemic. As a result, health professionals make a limited assessment of the patient with dysphagia. Healthcare professionals can use appropriate personal protective equipment to evaluate and treat a patient with COVID-19 associated dysphagia. Further, practice guidelines for dysphagia management should be established according to the presentation in different clinical situations and the status of the COVID-19 outbreak in various countries.

Nutritional Supplementation in Stroke Rehabilitation: A Narrative Review

고성화,신용일 대한뇌신경재활학회 2022 뇌신경재활 Vol.15 No.1

Malnutrition is associated with increased mortality and poor functional recovery after stroke. Most guidelines for stroke rehabilitation strongly recommend nutritional screening for malnutrition. Nutritional status after stroke is related to long-term outcomes, and nutritional supplementation is recommended for stroke patients with malnutrition and those at risk of malnutrition. However, routine nutritional supplementation in stroke patients, regardless of nutritional status, is not correlated with improved functional outcomes, and nutritional supplementation is not recommended if the nutritional status is adequate. Nutritional supplementation with protein, amino acids, vitamins, and minerals positively affects recovery after stroke, with improvements seen in motor function, cognition, activities of living, and mood. However, the evidence is insufficient due to the small number of studies and the lack of well-designed randomized controlled studies. Therefore, nutritional supplementation for stroke patients in rehabilitation should not be uniform, and individual nutritional interventions based on an assessment of the patient’s nutritional status should be provided.

방사선 치료에 의한 연하장애의 비디오투시연하검사

고성화 대한연하장애학회 2018 대한연하장애학회지 Vol.8 No.2

Dysphagia is a symptom of head and neck cancer itself and a significant complication of its treatments. Radiation therapy also causes dysphagia due to radiation toxicity. Therefore, it is necessary to evaluate patients who complain of dysphagia after radiation therapy. A video fluoroscopic swallowing study (VFSS) is an imaging tool that can diagnose dysphagia objectively from the oral to the esophagus phase. This tool is also used to evaluate to radiation-induced dysphagia. The abnormal findings in each swallowing phase are diverse. Interpreting each abnormal finding in relation to periodic complications caused by radiation toxicity is very important. A delayed pharyngeal transit time is the most characteristic abnormal finding of VFSS due to fibrosis, which is a chronic complication. To accurately assess the radiation-induced dysphagia, an evaluation of dysphagia prior to radiation therapy in head and neck cancer patients should be preceded. A multidisciplinary approach for evaluating dysphagia is needed throughout the entire period of head and neck cancer treatment.

이비인후과 질환의 구인두 연하장애에 대한 운동 기법

고성화 대한후두음성언어의학회 2023 대한후두음성언어의학회지 Vol.34 No.1

Dysphagia is a common symptom in otolaryngologic diseases. For the treatment of oropharyngeal dysphagia, conservative treatment is primarily considered, including behavioral Interventions, modified diet, and facilitation. Behavioral interventions include posture change, swallowing maneuvers, and excise. If a patient is diagnosed with dysphagia caused by oropharyngeal motor dysfunction, behavioral interventions should be actively considered. When applying treatment, it is necessary to apply the treatment tailored to each patient based on the biomechanics of dysphagia through diagnostic evaluations rather than uniform behavioral interventions depending on the disease.