Clinical Practice Guidelines for Oropharyngeal Dysphagia / 대한연하장애학회지

Objective@#Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. @*Methods@#Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. @*Results@#Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. @*Conclusion@#This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

Correlation of Videofluoroscopic Swallowing Study Findings With Radionuclide Salivagram in Chronic Brain-Injured Patients

Objective@#To investigate the correlation between videofluoroscopic swallowing study (VFSS) and radionuclide salivagram findings in chronic brain-injured patients with dysphagia. @*Methods@#Medical records of chronic brain-injured patients who underwent radionuclide salivagram and VFSS were retrospectively analyzed. Patients were divided into two groups according to salivagram findings. Differences in patient characteristics and clinical factors, including Mini-Mental State Examination (MMSE), Modified Barthel Index (MBI), Functional Ambulatory Category (FAC), feeding method, tracheostomy state, and VFSS findings between the two groups were investigated. @*Results@#A total of 124 patients were included in this study. There were no significant differences in MMSE, MBI, FAC, feeding method, and presence of tracheostomy between the two groups. However, the incidence of aspiration pneumonia history was significantly higher in the positive salivagram group. The Functional Dysphagia Scale (FDS) was significantly associated with positive salivagram findings, especially in the pharyngeal phase. A multivariate logistic regression analysis showed that laryngeal elevation and epiglottic closure was statistically significant FDS parameter in predicting salivary aspiration on a salivagram (odds ratio=1.100; 95% confidence interval, 1.017–1.190; p=0.018). The receiver operating characteristic (ROC) curve of FDS in the pharyngeal phase showed that an optimum sensitivity and specificity of 55.1% and 65.4%, respectively, when the cut-off value was 39. @*Conclusion@#In chronic brain-injured patients, inappropriate laryngeal elevation and epiglottic closure is predictive variable for salivary aspiration. Therefore, performing a radionuclide salivagram in patients with FDS of 39 or less in the pharyngeal phase for prevents aspiration pneumonia from salivary aspiration.

Correlation of Videofluoroscopic Swallowing Study Findings With Radionuclide Salivagram in Chronic Brain-Injured Patients

Objective@#To investigate the correlation between videofluoroscopic swallowing study (VFSS) and radionuclide salivagram findings in chronic brain-injured patients with dysphagia. @*Methods@#Medical records of chronic brain-injured patients who underwent radionuclide salivagram and VFSS were retrospectively analyzed. Patients were divided into two groups according to salivagram findings. Differences in patient characteristics and clinical factors, including Mini-Mental State Examination (MMSE), Modified Barthel Index (MBI), Functional Ambulatory Category (FAC), feeding method, tracheostomy state, and VFSS findings between the two groups were investigated. @*Results@#A total of 124 patients were included in this study. There were no significant differences in MMSE, MBI, FAC, feeding method, and presence of tracheostomy between the two groups. However, the incidence of aspiration pneumonia history was significantly higher in the positive salivagram group. The Functional Dysphagia Scale (FDS) was significantly associated with positive salivagram findings, especially in the pharyngeal phase. A multivariate logistic regression analysis showed that laryngeal elevation and epiglottic closure was statistically significant FDS parameter in predicting salivary aspiration on a salivagram (odds ratio=1.100; 95% confidence interval, 1.017–1.190; p=0.018). The receiver operating characteristic (ROC) curve of FDS in the pharyngeal phase showed that an optimum sensitivity and specificity of 55.1% and 65.4%, respectively, when the cut-off value was 39. @*Conclusion@#In chronic brain-injured patients, inappropriate laryngeal elevation and epiglottic closure is predictive variable for salivary aspiration. Therefore, performing a radionuclide salivagram in patients with FDS of 39 or less in the pharyngeal phase for prevents aspiration pneumonia from salivary aspiration.

Hypothermia Presenting in Wernicke Encephalopathy: A Case Report

Wernicke encephalopathy (WE) is a neurologic disorder characterized by clinical symptoms, such as nystagmus, ataxia, and mental confusion. Hypothermia in patients with WE is a rare complication, and its pathogenic mechanism and therapy are yet to be ascertained. Herein, we presented a case of a 61-year-old man who was diagnosed with WE 3 months earlier. We investigated the cause of hypothermia (35.0℃) that occurred after an enema (bowel emptying). Brain magnetic resonance imaging revealed mammillary body and hypothalamus atrophy. In the autonomic function test, the sympathetic skin response (SSR) test did not evoke SSR latencies on both hands. In addition, abnormal orthostatic hypotension was observed. Laxative and stool softener medication were administered, and his diet was modified, which led to an improvement in constipation after 2 weeks. Moreover, there was no recurrence of hypothermic episode. This is the first reported case of late-onset hypothermia secondary to WE.

Extracorporeal Shock Wave Therapy for Painful Chronic Neurogenic Heterotopic Ossification After Traumatic Brain Injury: A Case Report

Neurogenic heterotopic ossification (NHO) is a process of benign bone formation and growth in soft tissues surrounding major synovial joints and is associated with central nervous system (CNS) injuries. It is a common complication in major CNS injuries, such as traumatic brain injury, spinal cord injury, and stroke. Here, we report the case of a 72-year-old male, who experienced a traumatic brain injury and painful chronic NHO around the left hip joint. Three applications of extracorporeal shock wave therapy (ESWT) were administered to the area of NHO, which resulted in pain relief and an improvement in the loss of motion in the left hip joint. Improvements were also noted in walking performance and activities of daily living, although the size of NHO remained unchanged. Therapeutic effects of ESWT lasted for 12 weeks.

The Relationship between Weight of Backpack and Backpain in Primary School Children in Korea

OBJECTIVE: To investigate school children's backpack loads, its association with backpack loads and backpain, school-children's perception of their backpack loads, school conditions, and personal factors that determine backpack loads in Korea. METHOD: We weighed the backpacks of 642 school children in three elementary schools in Suwon city. A validated questionnaire evaluating backpain, features of backpack carrying and subjective perceptions of backpack loads was administered to 450 schoolchildren. The data were divided into two groups, those who had experienced backpain and those who had not. Each group was analyzed according to backpack load, perception of backpack load, school condition and personal factors. RESULTS: The mean weight of the backpack was 2.65 kg, which was 7.85% of mean body weight. The number of children whose backpack loads exceeded 15% of their body weight was 3.3%. 34.5% of children experienced backpain and backpack weight and backpack weight/body weight ratio were significantly higher in the group who experienced backpain. Time spent carrying of backpacks was longer and more students reported heaviness and fatigue when carrying backpacks in the same group. There was a difference in manners of carrying of backpacks and locker usage between the two groups. An improper method of backpack carrying, which is more than 10 cm below the waistline was noted in 85% of the school children. CONCLUSION: Carrying a heavier backpack is related to backpain in schoolchildren and a wide investigation should be performed concerning backpack loads of school children in Korea. Adequate backpack load guidelines should be determined.

Superficial Radial Nerve and Cephalic Vein: An Anatomic Study by Cadaver Dissection

OBJECTIVE: To acquire normal anatomy of superficial radial nerve and cephalic vein and identify the optimal site for venipuncture of cephalic vein at wrist to decrease the damage of superficial radial nerve. METHOD: We examined anatomic relationships of the superficial radial nerve, cephalic vein, and styloid process of radius in 14 hands from 10 cadavers. The distances were measured from the styloid process of radius to the point at which the superficial radial nerve pierced fascia, and to the crossing point of superficial radial nerve with cephalic vein. RESULTS: The mean distance from the styloid process of radius to the point at which the superficial radial nerve pierced fascia was 79.9+/-9.84 (60~93) mm and from the styloid process of radius to the crossing point of superficial radial nerve with cephalic vein was 29.5+/-15.24 (13~55) mm. CONCLUSION: The most optimal injection site for venipuncture of cephalic vein at wrist was located 55 mm more proximal area from styloid process.

Prevalence of Denervation Potentials from Foot Intrinsic and Lumbosacral Paraspinal Muscles in Asymptomatic Persons in Korea

OBJECTIVE: To determine the prevalence of denervation potentials from the foot intrinsic and the lumbosacral paraspinal muscles in asymptomatic persons in Korea. METHOD: Nerve conduction studies were performed in 80 asymptomatic persons at sural, peroneal and tibial nerves. We excluded 15 persons with abnormal values of nerve conduction studies. In our study, 36 males and 29 females participated and the mean age of subjects was 52.9 years. We checked denervation potentials from unilateral lumbosacral paraspinal (L4-S1) and foot intrinsic muscles (abductor hallucis and extensor digitorum brevis muscle) by needle EMG. RESULTS: The prevalence of denervation potentials from foot intrinsic muscles was 3% (2 cases out of 65 asymptomatic subjects). Denervation potentials consisting of a positive sharp wave were seen from the abductor hallucis muscle. No subjects showed any denervation potentials from the lumbosacral paraspinal muscles in our study. Abnormal X-ray findings were seen in subjects who had denervation potentials from the foot intrinsic muscles. CONCLUSION: The prevalence of denervation potentials from the foot intrinsic and the lumbosacral paraspinal muscles in asymptomatic person was not as high as previously reported