대한연하장애학회지 창간 10주년 기념호를 발간하며

Sung Bom Pyun 대한연하장애학회 2020 대한연하장애학회지 Vol.10 No.1

대한연하장애학회 구인두 연하장애 권고안

Young-Ah Choi,고성화,Jong Moon Kim,박은정,Jong Bum Park,이경희,이자호,임상희,조정해,Eun Young Han,김민욱 대한연하장애학회 2020 대한연하장애학회지 Vol.10 No.1

Oropharyngeal dysphagia is a clinical condition caused by various underlying diseases and is characterized by difficultyin swallowing. Diagnosis and treatment of oropharyngeal dysphagia require multidisciplinary consultations. Thisposition statement for oropharyngeal dysphagia was developed by The Korean Dysphagia Society (KDS) to outlineits position on oropharyngeal dysphagia. The clinical practice guideline, position statements, a recent meta-analysis,a systematic review, and randomized controlled trials for oropharyngeal dysphagia were all performed. An expertDelphi survey was also done to achieve a consensus of opinion on this position statement. This position statementfor oropharyngeal dysphagia aims to help make evidence-based decisions in clinical practice, improve clinical evaluationand manage oropharyngeal dysphagia in Korea.

연하 장애 환자를 위한 연하 식사 개발 및 관능적 특성 평가

최귀정,박영숙,성민용,오병모,신원선 대한연하장애학회 2021 대한연하장애학회지 Vol.11 No.1

Objective: Thickening agents used in dysphagia diets to adjust the viscosity of foods adversely affect the inherent food flavors and colors. Chopped and ground foods have unfamiliar flavors, colors and textures, causing a loss of appetite. Therefore, this study aimed to develop a savory and easy-to-make dysphagia diet without changing the appearance and taste of foods, and evaluate the suitability of the newly developed diet for patients with dysphagia. Methods: Twenty participants aged 55-85 years (8 patients with dysphagia and 12 healthy elderly) were recruited. The diet consisted of fried rice, hamburger steak, and soybean paste soup, where the solid foods were categorized as International Dysphagia Diet Standardisation Initiative (IDDSI) Level 5 (Minced and Moist), and the liquid foods were categorized as IDDSI Level 2 (Mildly Thick). To develop the dysphagia diet, textural modifications to the ingredients and viscosity adjustments were applied. A sensory evaluation was conducted by the panel to measure the extent of chewing, swallowing, adhesiveness, choking, and overall flavor and preference. Results: No significant differences in textural properties, such as chewing, swallowing, adhesiveness and choking, were observed between the control and patient groups, but the flavor and preferences in the patient group were statistically significant.Conclusion: The modified and newly designed dysphagia foods positively impacted easy swallowing for patients with dysphagia. Therefore, customized dysphagia foods should be considered in terms of flavor-enhancement to provide tailored diets for patients with dysphagia.

음식물의 부피, 질감, 맛에 따른 혀의 압력 비교

Young-Jin Song,변은미,Eun-Mi Byun,Ji-Woong Lee,우희순 대한연하장애학회 2019 대한연하장애학회지 Vol.9 No.2

Objective: This study examined how changes in the volume, texture, and taste of food affect the variation oftongue pressure during the swallowing of food in healthy adults. Methods: Fifty-four healthy subjects participated in this study. The tongue pressure was measured using an IowaOral. Performance Instrument (IOPI) during swallowing of food in 54 healthy adults. The food bolus with modifiedvolumes (3, 5, 10, and 15 ml), textures (water, puree, and cracker), and tastes (pure water, sour taste, sweet taste,and salty taste) were provided and the variation of the tongue pressure was traced during the swallowing of food. Results: The tongue pressure changed significantly when the volume of food chunks increased. When the texture offood was modified, the tongue pressure was significantly different when swallowing a cracker than when swallowingwater and puree. In addition, the tongue pressure was increased more by a sour taste liquid than pure water or sweettaste liquid. Conclusion: When swallowing food, the tongue pressure at the appropriate level is essential for safe swallowing. Because modification of the volume, texture, and taste of food can induce the variation of tongue pressure, it can berecommended as an effective therapeutic method that can move food in the mouth.

치매 환자에서의 연하장애

이주강 대한연하장애학회 2016 대한연하장애학회지 Vol.6 No.2

Dysphagia is a frequent problem in dementia as Alzheimer’s disease. Changes of swallowing function can be started even in the early stages of dementia. Structural and physiologic changes of oral/dental functions in the elderly underlies in persons with dementia. Cognitive based dysphagia is caused by impairment of consciousness and attention, memory, perception, and goal management related with feeding activities. Behavioral and psycholocal symptoms of dementia (BDSD) often results in dysphagia and eating disorders. Dysphagia in dementia should be approached individually. The goals of the program are the maintenance of the optimal nutrition and the prevention of complication such as aspiration pneumonia. Close observation by medical staffs and caregivers is the key to detect early signs of eating disorders in dementia patients. Assessment includes medical history, oral/dental function, swallowing function, and nutritional status. Sensory stimulation methods, adaptive equipment and utensil, diet modification, behavioral and environmental modification are the strategies for managing the problem. Enteral tube feeding is not proven to improve survival of end state dementia patients. (JKDS 2016;6:66-69)

Effect of Hand-free “Chin Tuck against Resistance (CTAR)” Exercise on Hyoid Bone Movement and the Degree of Aspiration in Stroke Patients with Dysphagia: A Report of 2 Cases

Sang Hoon Jung,Dong-Hwan Oh,Doo-Ho Lee,황나경,Hee-Su Park,Hee-Jung Kim,Yong Hwa Kwon,YunHo Kim,한나미 대한연하장애학회 2018 대한연하장애학회지 Vol.8 No.2

This study recruited two men with dysphagia after stroke, aged 57 and 62 years. They had difficulty using both hands properly due to paralysis of the left upper extremity and rheumatoid arthritis of the right hand in patient 1 and paralysis of both upper extremities in patient 2. This study examined the effects of 4 weeks of hand-free chin-tuck-resistance exercise on the hyoid movement and aspiration. The exercises involved isotonic and isometric parts. In isometric CTAR, the patients were asked to chin tuck against the device 3 times for 60 s each with no repetition. In isotonic CTAR, the patient performed 30 consecutive repetitions by strongly pressing against the resistance device and then releasing it. Based on a video fluoroscopic swallowing study, the degree of aspiration was measured using the Penetration-Aspiration Scale (PAS) and two-dimensional motion analysis of the hyoid bone. Post-intervention, the hyoid movements in both patients improved by 0.16 and 0.22 cm (anterior movement), and 0.26 and 0.28 cm (superior movement), and the PAS scores decreased by 2 and 2 points, respectively. This study confirms that hands-free chin-tuck resistance exercise is applicable and helpful for improving the hyoid movement and reducing aspiration in patients with dysphagia after stroke. Therefore, this exercise can be introduced as an intervention for improving the swallowing function in patients with dysphagia who have difficulty using both hands.

도구를 이용한 연하 검사

김덕용,정수진 대한연하장애학회 2011 대한연하장애학회지 Vol.1 No.1

Swallowing difficulty is common, especially in the elderly, neurologic disorders, head & neck cancer and etc. It may cause dehydration, weight loss, malnutrition, and aspiration pneumonia. The bedside examination may be important to assess the swallowing difficulty. However, the instrumental assessments such as videofluoroscopic swallowing study, fiberoptic endoscopic examination of swallowing, dynamic CT and manometry are more informative to identify the pathophysiology of dysphagia and are also more helpful to make the therapeutic plans. The unique characteristics of each instrumental assessment of swallowing were reviewed.

소화기암 환자에서의 연하곤란

Cheal Wung Huh,윤영훈 대한연하장애학회 2017 대한연하장애학회지 Vol.7 No.1

Dysphagia is one of the common symptoms that are encountered in clinical practice. However, dysphagia is still crucial and must be thoroughly investigated because it may be a key symptom of several malignancies. There are two types of dysphagia, oropharyngeal and esophageal dysphagia. Esophageal dysphagia can be caused by esophageal neuromuscular motility disorder, various inflammatory disorders, and also extrinsic or intrinsic structural lesions such as esophageal cancer. This article focuses on malignant esophageal dysphagia, including its causes, risk factors, clinical symptoms, and management.

우리나라 입원환자의 영양상태 -연하곤란 위험 환자군을 중심으로

이호선 대한연하장애학회 2011 대한연하장애학회지 Vol.1 No.2

Dysphagia may contribute to the development of malnutrition resulting from impairment in swallowing efficacy and reduced oral intake. Nutritional status should be monitored and specific dietetic strategies are introduced to enhance calorie intake. Five published trials that had examined nutritional status in the hospitalized geriatric patients and the rehabilitation inpatients in Korea were reviewed. Among geriatric hospitalized patients, 22-51% of the elderly patients were malnutrition status which associated significantly with prolonged their hospital stay and compromised their ability of daily living. Prevalence of malnutrition increased in the studies of the geriatric hospitalized patients after stroke and further in the cases of complicated with dysphagia. It is needed larger prospective studies to know the prevalence and characteristics of malnutrition in the dysphagia patients according to their various medical conditions during acute and chronic phase. (JKDS 2011;1:75-79)

새로운 연하곤란 임상 척도의 개발과 타당도 평가

권찬혁,정일영,정세희,오병모,한태륜 대한연하장애학회 2013 대한연하장애학회지 Vol.3 No.1

Objective: To develop a new screening test for dysphagia patients with various etiologies. Method: We investigated 10 widely used screening tests based on previous studies. Contents of the screening tests were summarized into 76 items. By using modified Delphi technique, 23 items showing high average score (>3.5) were selected as candidates for the new Clinical Dysphagia Scale (nCDS). A total of 216 dysphagia patients with various etiologies were tested with these items and underwent videofluoroscopic swallowing study (VFSS) simultaneously. We analyzed these data in statistical and clinical aspects to determine which items were more correlated with VFSS findings and which items are more appropriate for the screening test. Content validity was re-evaluated by consensus in an expert meeting. Consequentially, 8 items were selected for the nCDS. Result: The nCDS included 8 items: swallowing difficulty, structural defect (oral cavity, pharynx, larynx, or esophagus), lip sealing, tongue movement (forward and side to side), saliva swallowing, wet voice or gurgling voice (pre-swallowing), 5 ml water swallowing test (2 times), and laryngeal elevation during swallowing. The sensitivity and specificity of the nCDS score for detecting necessity of food modification were 83.8% and 58.3%, respectively. It was also well correlated with the functional dysphagia scale derived from the VFSS (Pearson's coefficient 0.525, P <0.01). Conclusion: The nCDS is not only a good screening test for detecting necessity of food modification, but also a good diagnostic tool for evaluation of general swallowing function. Furthermore, it is simply applicable to dysphagic patients with various etiologies. (JKDS 2013;3:20-25)