삼킴과 삶의 질

국문 초록 (Abstract)

삼킴은 음식물이 기도의 흡인 없이 입에서부터 위까지 도달하는 것을 의미한다. 삼킴 과정은 구강전기, 구강준비 기, 구강 이동기, 인구기, 식도기로 나뉘어져 있다. 정상인들은 정상적인 삼킴과정을 통해 문제없이 음식물을 섭취하고 있다. 하지만, 신경학적, 구조적인 손상 등의 문제로 인해 정상적인 삼킴에 문제가 될 수 있다. 삼킴장애는 여러 가지 이유로 정상인, 특히 노인들에게도 나타날 수 있다. 이러한 사람들은 입으로 먹는 즐거움이 없어지며, 사람들과의 관계 가 적어지고, 사회적 고립감과 동시에 삶의 질을 저하된다. 먹는 문제로 인해 타인과의 소통이 문제가 되거나, 스스로에게 짜증을 되는 심리적 증상을 호소하기도 한다. 삼킴기능 평가할 때는 신체적, 생리적인 면뿐만 아니라 개인의 주관적 부분도 함께 평가하여야 한다. 개개인의 흥미도 와 참여도를 높여서 치료 동기를 높이는 것이 중요하다. 개개인의 음식 및 장소에 대한 선호도를 파악하여 식사시간을 즐겁게 해주어야 한다. 환자가 본인이 먹을 수 있는 음식을 구분하여 음식물을 최대한 안전하게 섭취할 수 있도록 교육 해야 한다. 삼킴재활 전문가는 삼킴과 개인의 삶의 질의 상관성을 인식하여 지속적인 평가와 관리가 필요하다.

다국어 초록 (Multilingual Abstract)

Cancer of the head and neck is complicated after surgery, radiation therapy and chemotherapy, and various levels of dysphagia occur. Neuromuscular electrical stimulation strengthens muscle strength of oral pharyngeal muscles and promotes nerve plasticity. However, despite many studies on the positive effects of neuromuscular electrical stimulation, there is no report that neuromuscular electrical stimulation is more effective than traditional swallow rehabilitation. This may be due to the fact that the mechanism of muscle fiber mobilization during muscle contraction is different from the normal mechanism. Imagination training can activate the motor neurons of the brain by practicing the movements psychologically without actual body movements. Imaginary training can therefore complement muscle fiber mobilization problems of neuromuscular electrical stimulation. The purpose of this study was to investigate the effect of swallowing rehabilitation therapy combined with imagination training and neuromuscular electrical stimulation on swallowing function in patients with nasal dysfunction after nasal T-cell lymphoma diagnosis and radiation therapy. This is a case study. A 68 - year - old male patient was treated with imaginary training and neuromuscular stimulation for 40 minutes from August 23 to September 13, 2017, and medicated for 30 minutes after rehabilitation. Once a day for 70 minutes, and five times a week for a total of 15 times. After the 5 sessions, the evaluation of swallowing ability and the modified barium swallow test were carried out one time, four times, including the initial evaluation. There was improvement in swallowing ability evaluation and modified barium swallow test. The swallowing ability evaluation result was improved from 31.2 seconds to 15.2 seconds. In addition, self-excretion and pharyngeal pressure were improved. When the food was swallowed with various concentrations and textures, all that was observed in the seven foods disappeared, the aspiration was no longer observed, and the invasion was seen only in the two foods that were observed in the four foods. In particular, it has been observed that the aspiration during swallowing is significantly reduced in the course of the test. In the final examination, invasion was observed, but the invasion that was observed after swallowing and after swallowing was clearly reduced. The results of this study showed that the combination of imaginative training and neuromuscular stimulation applied to existing swallowing rehabilitation treatment positively affected the swallowing function of patients with nasal T-cell lymphoma.

목차 (Table of Contents)

• 요약
• I. 서론
• II. 본론
• 2.1 삼킴과 사회 환경과의 관계
• 2.2 삼킴장애와 삶의 질
• 2.3 질환 및 노화와 삼킴
• 2.4 삼킴관련 삶의 질 평가
• III. 결론
• References
• Abstract