염증성 근육병증 환자에서의 연하장애

류주석,최경효,이창근,유빈,방희제 대한재활의학회 2004 Annals of Rehabilitation Medicine Vol.28 No.4

Objective: To determine the prevalence and phases of dysphagia in inflammatory myositis. Method: We surveyed 106 patients diagnosed with inflammatory myositis by rheumatologist. After applying exclusion criteria, 64 patients were studied. We performed chart review and questionnaire survey for current feeding status, underlying diseases, the prevalence and phases of dysphagia. Questionnaire was composed of 11 different questions, 7 for the evaluation of oral phase and 4 for pharyngeal phase. Results: There were 25 males and 39 females, and the average age was 45.1±15.9 years. The average age when diagnosed was 41.4±14.8 years. The proportion of dysphagia at onset was 50%; 34.4% in oral phase and 43.8% in pharyngeal phase. There was no significant difference between dermatomyositis and polymyositis regarding the proportion. The most common cause of dysphagia in oral phase was dry mouth (28.1%), and the second common causes were opening of mouth (12.5%), chewing (12.5%), and residual material in mouth (12.5%). The most common cause in pharyngeal phase was pharyngeal muscle weakness (35.9%), and the second common cause was choking sign indicating aspiration (29.7%). Conclusion: With the high proportion of dysphagia in inflammatory myositis, we should pay more attention to dysphagia, because we need to do swallowing training in these patients.

음성 분석을 이용한 기도 흡인의 예측

류주석,박서린,구정회,최경효 대한재활의학회 2003 Annals of Rehabilitation Medicine Vol.27 No.6

연하식이의 처방 시 고려해야 할 점과 주의점

류주석 대한연하장애학회 2011 대한연하장애학회지 Vol.1 No.2

Dysphagia refers to all types of anomaly that may occur at all courses of oral cavity, pharyngeal cavity, and esophageal cavity by ingestion of food material. Dysphagia may range from light issues such as delay in meal times, discomfort, and coughing when eating to more serious issues such as malnutrition, dehydration, and aspiration pneumonia, even leading to fatality and thus requires great caution. Therefore the diet provided to dysphagia patients requires extra caution, and efforts should be made to supply an appropriate amount. In order to provide food to dysphagia patients, the viscosity is controlled typically based on the videofluroscopic swallowing test. In order to prescribe the dysphagia diet, it would be necessary to accurately evaluate the deglutition function of the patient, understand the natural progress of basic disorder which led to dysphagia, and provide food of appropriate viscosity and texture. Also, a unified guideline must be prepared for the diet used in videofluroscopic swallowing study, the diet provided to actual patients, and the commercialized deglutition assisting additives to provide safe diet to the patients. Therefore, this report shall examine the points to consider when prescribing dysphagia diet to dysphagia patients and the commonly encountered issues when making such prescription. (JKDS 2011;1:80-84)

상부 식도 괄약근 수축의 생리

류주석 대한연하장애학회 2012 대한연하장애학회지 Vol.2 No.2

Upper esophageal sphincter is defined as the intra-luminal high-pressure zone separating the pharynx from the esophagus. This region is consisted of inferior pharyngeal constrictor, cricopharyngeus muscle and cranial cervical esophagus. The primary function of upper esophageal sphincter is to transmit bolus from pharynx to esophagus. Cricopharyngeus muscle is the most important muscle in upper esophageal sphincter. This muscle responds differently in diverse circumferences. It is necessary to know normal anatomy and physiology of upper esophageal sphincter to understand normal function of upper esophageal sphincter. In addition, to know normal function is prerequisite to know abnormal findings of this region. So I will review the normal anatomy and physiology of upper esophageal sphincter. I think this topic is important for doctors and therapists who want to investigate and practice dysphagia. (JKDS 2012;2:35-42)

Supplementary Motor Area Syndrome and Flexor Synergy of the Lower Extremities

류주석,전민호,유대상,정천기 대한재활의학회 2013 Annals of Rehabilitation Medicine Vol.37 No.5

Clinical presentation of supplementary motor area (SMA) syndrome includes complete akinesia of the contralateral side of the body and mutism, with secondary recovery of neurologic deficit. Multi-joint coordination is frequently impaired following the development of a brain lesion and is generally restricted by abnormal patterns of muscle activation within the hemiparetic limb, clinically termed muscle synergies. However, no work to date has confirmed this observation with the aid of objective methods, such as gait analysis, and the development of reflex pattern has not been suggested as a possible cause. We describe two unusual cases of flexor synergy after tumor resection of SMA lesions.

[특강] 연하장애의 재활치료

류주석 Asia association of Disability and Oral health 2012 International Journal of Disability and Oral Healt Vol.8 No.2

단일 병원에서의 소아뇌졸중의 원인, 임상적 양상 및 기능회복에 대한 연구

류주석,박진홍,박은하,차은혜,성인영 대한재활의학회 2009 Annals of Rehabilitation Medicine Vol.33 No.3

Objective: To investigate the changes of causes, clinical features, and functional outcomes in childhood strokes. Method: This study included 152 patients, aged from 1 to 18 years, who were diagnosed with stroke and admitted to a tertiary hospital between January 2000 and April 2004. All medical records and neurologic images of the patients were reviewed. A parental questionnaire was used to investigate patients' functional outcomes. These results were compared with those of the previous study performed in the same hospital in 2001. Results: The number of hemorrhagic stroke was 78 (51.3%) and that of ischemic stroke was 74 (48.7%). When compared to the previous study, the incidence of hemorrhagic stroke especially above the age of 10 years decreased and that of ischemic stroke below the age of 10 years increased. The causes of stroke were arteriovenous malformation (AVM, 42.8%), Moyamoya disease (37.5%), vasculitis (5.3%), cardiac disease (3.9%), hematologic disease (2.0%), and undetermined (8.5%). Common clinical features were headache (53.8%), vomiting (43.6%) and loss of consciousness (28.2%) in the hemorrhagic stroke, and hemiparesis (94.6%), headache (35.1%) and speech disorder (31.1%) in the ischemic stroke. 86.0% of the hemorrhagic and 64.8% of the ischemic stroke patients were categorized in the ‘good' outcome group. Conclusion: The incidence of ischemic stroke increased to the similar level of hemorrhagic stroke. The most common causes were AVM in the hemorrhagic and Moyamoya disease in the ischemic stroke. Most of these patients showed good functional outcome, regardless of the causes of stroke. Objective: To investigate the changes of causes, clinical features, and functional outcomes in childhood strokes. Method: This study included 152 patients, aged from 1 to 18 years, who were diagnosed with stroke and admitted to a tertiary hospital between January 2000 and April 2004. All medical records and neurologic images of the patients were reviewed. A parental questionnaire was used to investigate patients' functional outcomes. These results were compared with those of the previous study performed in the same hospital in 2001. Results: The number of hemorrhagic stroke was 78 (51.3%) and that of ischemic stroke was 74 (48.7%). When compared to the previous study, the incidence of hemorrhagic stroke especially above the age of 10 years decreased and that of ischemic stroke below the age of 10 years increased. The causes of stroke were arteriovenous malformation (AVM, 42.8%), Moyamoya disease (37.5%), vasculitis (5.3%), cardiac disease (3.9%), hematologic disease (2.0%), and undetermined (8.5%). Common clinical features were headache (53.8%), vomiting (43.6%) and loss of consciousness (28.2%) in the hemorrhagic stroke, and hemiparesis (94.6%), headache (35.1%) and speech disorder (31.1%) in the ischemic stroke. 86.0% of the hemorrhagic and 64.8% of the ischemic stroke patients were categorized in the ‘good' outcome group. Conclusion: The incidence of ischemic stroke increased to the similar level of hemorrhagic stroke. The most common causes were AVM in the hemorrhagic and Moyamoya disease in the ischemic stroke. Most of these patients showed good functional outcome, regardless of the causes of stroke.

연하장애 식이 처방의 원칙과 고려할 점: 점도, 크기, 질감, 맛, 온도

류주석 대한연하장애학회 2014 대한연하장애학회지 Vol.4 No.2

Dysphagia is a dysfunction of the swallowing process. Providing adequate nutritional intake for patients with dysphagia is a challenge. Therefore the diet provided to the patients suffering from dysphagia requires extra caution, and efforts should be made to supply an appropriate amount. In order to prescribe the dysphagia diet, it would be necessary to accurately evaluate the deglutition function of the patient and understand the natural progress of basic disorder which led to dysphagia. Bolus manipulation is a primary ry treatment strategy in the management of dysphagia. There are several important factors that should be considered in bolus management. The factors include viscosity, texture, taste, temperature and size. Therefore, this report shall examine the points to consider when prescribing dysphagia diet to the patients suffering from dysphagia and the commonly encountered issues when making such prescription.

Effects of Head Rotation and Head Tilt on Pharyngeal Pressure Events Using High Resolution Manometry

김철기,류주석,송선홍,구정회,이경덕,박희선,오영율,민경훈 대한재활의학회 2015 Annals of Rehabilitation Medicine Vol.39 No.3

Objective To observe changes in pharyngeal pressure during the swallowing process according to postures in normal individuals using high-resolution manometry (HRM).Methods Ten healthy volunteers drank 5 mL of water twice while sitting in a neutral posture. Thereafter, they drank the same amount of water twice in the head rotation and head tilting postures. The pressure and time during the deglutition process for each posture were measured with HRM. The data obtained for these two postures were compared with those obtained from the neutral posture.Results The maximum pressure, area, rise time, and duration in velopharynx (VP) and tongue base (TB) were not affected by changes in posture. In comparison, the maximum pressure and the pre-upper esophageal sphincter (UES) maximum pressure of the lower pharynx in the counter-catheter head rotation posture were lower than those in the neutral posture. The lower pharynx pressure in the catheter head tilting posture was higher than that in the counter-catheter head tilting. The changes in the VP peak and epiglottis, VP and TB peaks, and the VP onset and post-UES time intervals were significant in head tilting and head rotation toward the catheter postures, as compared with neutral posture.Conclusion The pharyngeal pressure and time parameter analysis using HRM determined the availability of head rotation as a compensatory technique for safe swallowing. Tilting the head smoothes the progress of food by increasing the pressure in the pharynx.

신경근 전기자극치료의 원리

박동휘,류주석 대한연하장애학회 2016 대한연하장애학회지 Vol.6 No.1

Neuromuscular electrical stimulation (NMES) has been increasingly used on dysphagic patients with the aim of improving their swallowing ability. However, there were insufficient clinical and basic knowledge of NMES in regard to the selection of stimulation parameters, which optimize improvement in swallowing-related muscular function. This review summarizes the results of clinical and basic researches in terms of acute and chronic physiologic effects of different stimulation protocols, explains the role of the various parameters of stimulation in determining the effect of NMES training protocols, and gives clinical recommendations for the selection of stimulation parameters. We speculate that this topic is important for medical doctors and therapists who want to investigate and practice NMES.