Effect of Hand-free “Chin Tuck against Resistance (CTAR)” Exercise on Hyoid Bone Movement and the Degree of Aspiration in Stroke Patients with Dysphagia: A Report of 2 Cases / 대한연하장애학회지

This study recruited two men with dysphagia after stroke, aged 57 and 62 years. They had difficulty using both hands properly due to paralysis of the left upper extremity and rheumatoid arthritis of the right hand in patient 1 and paralysis of both upper extremities in patient 2. This study examined the effects of 4 weeks of hand-free chin-tuck-resistance exercise on the hyoid movement and aspiration. The exercises involved isotonic and isometric parts. In isometric CTAR, the patients were asked to chin tuck against the device 3 times for 60 s each with no repetition. In isotonic CTAR, the patient performed 30 consecutive repetitions by strongly pressing against the resistance device and then releasing it. Based on a video fluoroscopic swallowing study, the degree of aspiration was measured using the Penetration-Aspiration Scale (PAS) and two-dimensional motion analysis of the hyoid bone. Post-intervention, the hyoid movements in both patients improved by 0.16 and 0.22 cm (anterior movement), and 0.26 and 0.28 cm (superior movement), and the PAS scores decreased by 2 and 2 points, respectively. This study confirms that hands-free chin-tuck resistance exercise is applicable and helpful for improving the hyoid movement and reducing aspiration in patients with dysphagia after stroke. Therefore, this exercise can be introduced as an intervention for improving the swallowing function in patients with dysphagia who have difficulty using both hands.

Early Periventricular Leukomalacia: MRI and Ultrasonographic Correlation on First one Month of Life

PURPOSE: To compare the findings of early periventricular leukomalacia on MR imaging and on US. MATERIALS AND METHODS: MR imaging was performed in 17 neonates in whom well-demarcated increased periventricular echogenicity was seen on sonography. One more patient was included during the same period because MR imaging of this patient showed a periventricular lesion not suspected on previous US. Initial sonography was performed within 6 days of birth and was followed up between one week and one month later. MR images were obtained within the first month of life. RESULTS: Twelve of 17 neonates showed abnormal periventricular signal intensities on MR imaging. Follow up sonography revealed cystic changes in two cases and heterogeneous hyperechogenicities in three. All patients except the two with cystic changes showed normal periventricular echogenicity on final sonography, On MR imaging,11 cases showed multifocal periventricular increased signals on T1-weighted images, and two cases showed mainly decreased signals representing cysts. Positive findings were more evident on T1-weighted than on T2-weighted image. CONCLUSION: on T1-weighted imaging, the characteristic finding of early periventricular leukomalacia was multifocal periventricular hyper or hypointensities, and hyperintense lesions were more common than hypointense. In the diagnosis of early noncystic periventricular leukomalacia, MR imaging was more objective than US.