뇌졸중 후 연하장애 환자의 신경근 전기자극 강도 차이에 따른 효과 : 무작위, 단일 맹검 연구

국문 초록 (Abstract)

목적 : 본 연구는 뇌졸중 후 연하장애 환자를 대상으로 신경근 전기자극치료(Neuromuscular ElectricalStimulation; NMES)의 강도 차이에 따른 효과를 알아보고자 하였다. 연구방법 : 본 연구는 뇌졸중 발병 6개월 이하의 아급성기 환자 56명을 대상으로 두 집단 사전-사후 검사로 진 행되었다. 두 집단을 운동자극군과 감각자극군으로 무작위로 나눈 후 하루 30분간, 주 5회, 6주간 서로 다른 강도의 신경근 전기자극치료를 받았으며 동일기간 동안 전통적 연하재활치료를 함께 중재 받았다. 연하기능의 평가는 비디오 투시 조영검사(Videofluoroscopic Swallowing Study; VFSS)를 기반으로 비디오 투 시 연하장애 척도(Videofluoroscopic Dysphagia Scale; NDS)와 침습-흡인 척도(Penetration-Aspiration Scale; PAS)를 사용하였으며 L-tube 제거율을 확인하였다. 결과 : 본 연구 결과 두 집단 모두 연하의 인두기와 침습-흡인 척도에서 통계학적 유의한 차이를 보였으며(p<.05) 중재 후, 두 집단의 결과를 비교한 결과 역시 연하의 인두기와 침습-흡인 척도에서 통계학적 차이를 보였다(p<.05). 또한 중재 전과 후의 변화량의 결과 운동자극군은 인두기에서 12.58±8.15, 감각자극군 은 4.00±5.07로 두 집단간 통계학적 유의한 차이를 보였다(p<.05). L-tube 제거율은 운동자극군의 경우 52%, 감각자극군에서 29%를 보였다. 결론 : 본 연구를 통해 신경근 전기자극의 운동자극과 감각자극을 받은 두 집단 모두 연하의 인두기 향상을 보 였으나 두 집단의 비교 결과 운동자극군에서 더욱 효과적임을 확인하였다.

다국어 초록 (Multilingual Abstract)

Objective : The purpose of this study was to investigate the effect of treatment according to the neuromuscularelectrical stimulation intensities in dysphagic patients. Methods : Fifty-six patients suffering from a subacute stroke were randomly assigned to either a motor stimulationgroup or a sensory stimulation group. Both groups underwent conventional dysphagia treatment, and differentintensities of the electrical stimulation was applied for 30 minutes, five days a week for six weeks. Theirswallowing function was evaluated using the VDS (Videofluoroscopic Dysphasia Scale) and PAS (Penetration-Aspiration Scale), and the L-tube removal rate was confirmed. Results : Both groups showed a statistically significant difference in the pharyngeal stage and PAS (p<.05), and theresult of the comparison of the two groups also showed a significant difference in the pharyngeal stage and PASafter the intervention (p<.05). Before and after intervention, the result of the change showed that the motorstimulation group was 12.58±8.15, the sensory stimulation group was 4.00± 5.07 in the pharyngeal stage, andthere were significant differences between the two groups (p<.05). The L -tube removal rate was 52% in themotor stimulation group, and 29% in the sensory stimulation group. Conclusion : This study showed that both motor and sensory stimulation are effective interventions for thepharyngeal stage in the swallowing function of dysphagic patients, and that motor stimulation is more effectivethan sensory stimulation.

목차 (Table of Contents)

• 국문초록
• Ⅰ. 서론
• Ⅱ. 연구 방법
• 1. 연구 대상
• 2. 연구 도구
• 3. 연구 절차 및 연구 방법
• 4. 분석 방법
• Ⅲ. 연구 결과
• 1. 중재 전 운동자극군과 감각자극군의 동질성 검증
• 2. 운동자극군의 중재 전과 후의 VDS와 PAS의 변화
• 3. 감각자극군의 중재 전과 후의 VDS와 PAS의 변화
• 4. 중재 후 운동자극군과 감각자극군의 VDS와 PAS의 점수 비교
• 5. 중재 전, 후의 운동자극군과 감각자극군의 VDS와 PAS의 변화량 비교
• Ⅳ. 고찰
• Ⅴ. 결론
• References
• Abstract

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