뇌졸중 환자의 연하재활치료에 대한 체계적 고찰

국문 초록 (Abstract)

목적 : 본 연구는 뇌졸중 환자에게 적용한 연하재활치료를 체계적으로 분석한 논문이다. 연하재활치료에 영 향을 주는 요소들을 살펴보고, 연하장애 증상과 치료의 효과에 따른 연하재활치료 방법을 제시하였다. 이를 통하여 환자의 특성에 맞는 효과적인 치료 방법을 선택할 수 있도록 근거 자료를 제공하고자 한다. 연구방법 : PRISMA(Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 체크리스트 및 흐름도를 이용하여 체계적 고찰을 시행하였다. 데이터베이스는 PubMed, Medline Complete(EBSCOhost), 국회 도서관(national assembly library of Korea)을 이용하였다. 연구에 사용된 문헌의 수는 총 18편이었고, 문헌의 질을 평가하기 위하여 PEDro scale(Physiotherapy Evidence Database scale)을 사용하였다. 문헌에서 사용한 연하재활치료들은 치료의 효과와 연하장애 증상에 따라 각각 분류하였다. 결과 : 분석된 논문에서 병변 부위는 대뇌반구와 뇌간 부위가 혼합된 연구 10편, 대뇌피질 부위 연구는 6 편, 뇌간 부위 연구는 1편이었고, 병변 부위가 기록되지 않은 연구가 1편이었다. 발병 시기는 급성과 만 성이 혼합된 연구 13편, 3개월 미만의 급성기 환자를 대상으로 한 연구 3편, 3개월 이상의 만성기 환자 를 대상으로 한 연구 1편이었고, 발병 시기가 기록되지 않은 연구가 1편이었다. 총 14가지의 치료방법 중 인두기에 효과를 보인 치료가 14건, 구강기에 효과를 보인 치료와 식이 단계에 효과를 보인 치료가 각각 1건이었다. 연하장애의 임상 증상에 따라 치료방법을 분류하였다. 가장 많은 치료방법이 적용된 증 상은 구강인두 기능저하로 총 7가지의 치료 방법이 제시되었다. 설골과 후두의 앞-위쪽 움직임 저하는 6가지, 흡인과 침습은 4가지, 삼킴반사 지연은 3가지, 혀의 근력 약화, 후두개 잔여물, 음식덩이의 인두 통과시간 지연, 그리고 삼킬 때의 통증은 각각 1가지의 치료 방법이 제시되었다. 결론 : 본 연구는 작업치료사들이 뇌졸중 환자의 연하장애 증상에 따라 다양한 치료방법을 적용시킴으로써 효율적인 연하재활치료를 제공하는데 도움을 줄 수 있을 것이다.

다국어 초록 (Multilingual Abstract)

Objective: This study is a systematic analysis of swallowing rehabilitation treatment applied to stroke patients. The method of swallowing rehabilitation treatment according to the symptom of swallowing disorder and the effect of treatment was presented. The purpose of this study is to provide the data for selecting the effective treatment method according to the characteristics of the patients. Methods: A systematic review was conducted using the PRISMA checklist and flow charts. The database used PubMed, Medline Complete (EBSCOhost), and National Assembly Library of Korea. A total of 18 articles were used in the study and the PEDro scale (Physiotherapy Evidence Database scale) was used to evaluate the quality of the literature. In the literature, swallowing rehabilitation treatments were classified according to treatment effect and swallowing disorder symptoms. Results: In the analyzed study, 10 lesions were mixed with brain hemispheres and brainstem, 6 lesions were examined in cerebral cortex lesion, 1 brain lesion was examined, and 1 lesion was not recorded. There were 13 episodes of acute and chronic mixed episodes, 3 episodes of acute episodes of less than 3 months, and 1 episode of chronic episodes of 3 months or more. . Of the 14 treatments, 14 were effective on the irritation, and 1 was effective on the oral cavity and one on the diet. Methods of treatment were classified according to clinical symptoms of dysphagia. The most common treatment modalities were oral pharyngeal dysfunction and total 7 treatments. There are six different types of frontal and laryngeal movements of the hyoid and larynx, four types of aspiration and invasion, three delays in swallowing reflexes, weakness of the tongue, epiglottis residues, food pockets and temporal lag, Each treatment method was presented. Conclusion: This study may help occupational therapists to provide effective swallowing rehabilitation by applying various treatment modalities according to swallowing disorder symptoms of stroke patients.

목차 (Table of Contents)

• 국문초록
• Ⅰ. 서론
• Ⅱ. 연구 방법
• 1. 연구설계
• 2. 문헌검색전략
• 3. 문헌선택과정
• 4. 문헌의 질 평가
• 5. 분석방법
• Ⅲ. 연구 결과
• 1. 분석대상 논문의 특성
• 2. 치료방법의 분류
• Ⅳ. 고찰
• References
• Abstract

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