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1.
Article in English | WPRIM | ID: wpr-918229

ABSTRACT

Objective@#This study aimed to explore the myelin volume change in patients with mild traumatic brain injury (mTBI) with post-concussion syndrome (PCS) using a multidynamic multiecho (MDME) sequence and automatic whole-brain segmentation. @*Materials and Methods@#Forty-one consecutive mTBI patients with PCS and 29 controls, who had undergone MRI including the MDME sequence between October 2016 and April 2018, were included. Myelin volume fraction (MVF) maps were derived from the MDME sequence. After three dimensional T1-based brain segmentation, the average MVF was analyzed at the bilateral cerebral white matter (WM), bilateral cerebral gray matter (GM), corpus callosum, and brainstem. The Mann–Whitney U-test was performed to compare MVF and myelin volume between patients with mTBI and controls. Myelin volume was correlated with neuropsychological test scores using the Spearman rank correlation test. @*Results@#The average MVF at the bilateral cerebral WM was lower in mTBI patients with PCS (median [interquartile range], 25.2% [22.6%–26.4%]) than that in controls (26.8% [25.6%–27.8%]) (p = 0.004). The region-of-interest myelin volume was lower in mTBI patients with PCS than that in controls at the corpus callosum (1.87 cm3 [1.70–2.05 cm3 ] vs. 2.21 cm3 [1.86– 3.46 cm3 ]; p = 0.003) and brainstem (9.98 cm3 [9.45–11.00 cm3 ] vs. 11.05 cm3 [10.10–11.53 cm3 ]; p = 0.015). The total myelin volume was lower in mTBI patients with PCS than that in controls at the corpus callosum (0.45 cm3 [0.39–0.48 cm3 ] vs. 0.48 cm3 [0.45–0.54 cm3 ]; p = 0.004) and brainstem (1.45 cm3 [1.28–1.59 cm3 ] vs. 1.54 cm3 [1.42–1.67 cm3 ]; p = 0.042). No significant correlation was observed between myelin volume parameters and neuropsychological test scores, except for the total myelin volume at the bilateral cerebral WM and verbal learning test (delayed recall) (r = 0.425; p = 0.048). @*Conclusion@#MVF quantified from the MDME sequence was decreased at the bilateral cerebral WM in mTBI patients with PCS. The total myelin volumes at the corpus callosum and brainstem were decreased in mTBI patients with PCS due to atrophic changes.

2.
Article in English | WPRIM | ID: wpr-916050

ABSTRACT

These cases imply that the videofluoroscopic AP view helps the evaluation of the vocal fold movement in patients with vocal fold paralysis on laryngoscopy.

3.
Article in English | WPRIM | ID: wpr-925885

ABSTRACT

Background@#We aimed to examine the association between antihypertensive use and the incidence of hospitalized pneumonia in patients with a history of stroke. @*Methods@#In this case-crossover study, we obtained data from the Korean National Health Insurance Service–National Sample Cohort database. We included the data of patients with history of stroke who were admitted with a disease code of pneumonia. We analyzed the patients’ exposure to antihypertensives in the 30 (single case period), 90–120, and 150–180 days (2 control periods) before the onset of pneumonia using conditional logistic regression analysis. Additionally, sensitivity analysis and subgroup analysis according to diabetes status, age, and documented disability were performed. @*Results@#Angiotensin II receptor blocker (ARB) use was associated with a reduced risk of hospitalized pneumonia (adjusted odds ratio [OR] [95% confidence interval; 95% CI]: 0.718 [0.576–0.894]). However, the use of angiotensin converting enzyme inhibitors and other antihypertensives were not associated with a change in hospitalized pneumonia incidence (adjusted OR [95% CI]: 0.902, [0.603–1.350] and 0.788 [0609–1.018], respectively). Subgroup analysis revealed that ARB use was associated with a reduced incidence of hospitalized pneumonia in patients with a history of stroke who were older than 65 years, but not in younger (≤ 65 years) group (adjusted OR [95% CI]: 0.687 [0.536–0.880]). @*Conclusion@#ARB use is associated with a reduced incidence of hospitalized pneumonia in patients with a history of stroke, especially in older adults.

4.
Article in English | WPRIM | ID: wpr-925494

ABSTRACT

Objective@#To develop a set of reference standards for tibial motor, common peroneal motor, sural sensory, and superficial peroneal sensory nerve conduction studies (NCSs) with expanded uncertainty in a healthy Korean population. @*Methods@#Standardized procedures were conducted for individual lower extremity NCSs of 199 healthy participants in their 20s (n=100) and 50s (n=99). Mean values and expanded uncertainties for parameters were analyzed with thorough consideration of multiple uncertainty factors under the International Guide to the Expression of Uncertainty in Measurement. In addition, side-to-side differences in onset latency, amplitude, and nerve conduction velocity (NCV) were analyzed. @*Results@#Mean (reference range) for distal onset latency, baseline to negative peak amplitude, NCV of tibial motor nerve in males in their 20s were 4.3 ms (3.1–5.4 ms), 7.1 mV (3.4–10.9 mV), and 50.7 m/s (42.2–59.3 m/s), respectively; sural sensory nerve baseline to negative peak amplitude in males in their 20s was 21.7 μV (8.3–35.2 μV). Including the aforementioned data, we present a vast dataset of normative mean values and expanded uncertainties for NCSs of the leg in a healthy Korean population. Furthermore, upper limits for normal side-to-side differences for onset latency, amplitude, and NCV of each nerve are suggested. @*Conclusion@#To our knowledge, this is the first study to present the reference standards of leg NCSs with consideration for multifactorial uncertainties in an Asian population. We expect these results to help practitioners make reliable and reproducible clinical decisions.

5.
Article in English | WPRIM | ID: wpr-893076

ABSTRACT

Objective@#To evaluate the reliability of suprahyoid and infrahyoid electromyography (EMG) measurement during swallowing. @*Methods@#In all, 10 healthy volunteers were evaluated for the following surface EMG (sEMG) parameters in the suprahyoid and infrahyoid muscles during swallowing: onset latency, offset latency, duration, peak latency, maximal amplitude during swallowing, and the area under curve (AUC) of the rectified EMG signal. The sEMG was recorded while the participants swallowed five times each of the four fluid volumes (saliva, 2 ml, 5 ml, and 20 ml of water), totaling to 20 swallows. Moreover, the intra-participant variability per parameter was evaluated using the coefficient of variation (CV). @*Results@#Suprahyoid muscles were activated 0.095 s (95% CI, 0.062-0.128) earlier than the infrahyoid muscles.Maximal amplitudes during the 20 ml swallow were 17.484 (−1.543-36.512) and 13.490 (1.254-25.727) μV higher than values obtained during the 2 ml swallow in the suprahyoid and infrahyoid muscles, respectively. Furthermore, the AUC of the rectified EMG signal increased with the volume of swallow in both muscle groups (P=0.003, suprahyoid; P<0.002, infrahyoid). The intra-individual variabilities of offset latency, duration, and maximal amplitude were relatively low (<30% CV) in both muscle groups with respect to other parameters. The assessment of each parameter using EMG was highly reliable, with an intraclass correlation coefficient of >0.8. @*Conclusion@#Among the variable sEMG parameters assessed, the offset latency, duration, and maximal amplitude were the least variable. Although reliability on the rater side showed good results, the swallow-to-swallow variability of the parameters need to be considered in swallowing studies using sEMG.

6.
Article in English | WPRIM | ID: wpr-875275

ABSTRACT

Objective@#This study aimed to investigate the blood-brain barrier (BBB) disruption in mild traumatic brain injury (mTBI) patients with post-concussion syndrome (PCS) using dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging and automatic whole brain segmentation. @*Materials and Methods@#Forty-two consecutive mTBI patients with PCS who had undergone post-traumatic MR imaging, including DCE MR imaging, between October 2016 and April 2018, and 29 controls with DCE MR imaging were included in this retrospective study. After performing three-dimensional T1-based brain segmentation with FreeSurfer software (Laboratory for Computational Neuroimaging), the mean Ktrans and vp from DCE MR imaging (derived using the Patlak model and extended Tofts and Kermode model) were analyzed in the bilateral cerebral/cerebellar cortex, bilateral cerebral/cerebellar white matter (WM), and brainstem. Ktrans values of the mTBI patients and controls were calculated using both models to identify the model that better reflected the increased permeability owing to mTBI (tendency toward higher Ktrans values in mTBI patients than in controls). The Mann-Whitney U test and Spearman rank correlation test were performed to compare the mean Ktrans and vp between the two groups and correlate Ktrans and vp with neuropsychological tests for mTBI patients. @*Results@#Increased permeability owing to mTBI was observed in the Patlak model but not in the extended Tofts and Kermode model. In the Patlak model, the mean Ktrans in the bilateral cerebral cortex was significantly higher in mTBI patients than in controls (p = 0.042). The mean vp values in the bilateral cerebellar WM and brainstem were significantly lower in mTBI patients than in controls (p = 0.009 and p = 0.011, respectively). The mean Ktrans of the bilateral cerebral cortex was significantly higher in patients with atypical performance in the auditory continuous performance test (commission errors) than in average or good performers (p = 0.041). @*Conclusion@#BBB disruption, as reflected by the increased Ktrans and decreased vp values from the Patlak model, was observed throughout the bilateral cerebral cortex, bilateral cerebellar WM, and brainstem in mTBI patients with PCS.

7.
Article in English | WPRIM | ID: wpr-874991

ABSTRACT

Objective@#Thickening agents used in dysphagia diets to adjust the viscosity of foods adversely affect the inherent food flavors and colors. Chopped and ground foods have unfamiliar flavors, colors and textures, causing a loss of appetite. Therefore, this study aimed to develop a savory and easy-to-make dysphagia diet without changing the appearance and taste of foods, and evaluate the suitability of the newly developed diet for patients with dysphagia. @*Methods@#Twenty participants aged 55-85 years (8 patients with dysphagia and 12 healthy elderly) were recruited.The diet consisted of fried rice, hamburger steak, and soybean paste soup, where the solid foods were categorized as International Dysphagia Diet Standardisation Initiative (IDDSI) Level 5 (Minced and Moist), and the liquid foods were categorized as IDDSI Level 2 (Mildly Thick). To develop the dysphagia diet, textural modifications to the ingredients and viscosity adjustments were applied. A sensory evaluation was conducted by the panel to measure the extent of chewing, swallowing, adhesiveness, choking, and overall flavor and preference. @*Results@#No significant differences in textural properties, such as chewing, swallowing, adhesiveness and choking, were observed between the control and patient groups, but the flavor and preferences in the patient group were statistically significant. @*Conclusion@#The modified and newly designed dysphagia foods positively impacted easy swallowing for patients with dysphagia. Therefore, customized dysphagia foods should be considered in terms of flavor-enhancement to provide tailored diets for patients with dysphagia.

8.
Article in English | WPRIM | ID: wpr-900780

ABSTRACT

Objective@#To evaluate the reliability of suprahyoid and infrahyoid electromyography (EMG) measurement during swallowing. @*Methods@#In all, 10 healthy volunteers were evaluated for the following surface EMG (sEMG) parameters in the suprahyoid and infrahyoid muscles during swallowing: onset latency, offset latency, duration, peak latency, maximal amplitude during swallowing, and the area under curve (AUC) of the rectified EMG signal. The sEMG was recorded while the participants swallowed five times each of the four fluid volumes (saliva, 2 ml, 5 ml, and 20 ml of water), totaling to 20 swallows. Moreover, the intra-participant variability per parameter was evaluated using the coefficient of variation (CV). @*Results@#Suprahyoid muscles were activated 0.095 s (95% CI, 0.062-0.128) earlier than the infrahyoid muscles.Maximal amplitudes during the 20 ml swallow were 17.484 (−1.543-36.512) and 13.490 (1.254-25.727) μV higher than values obtained during the 2 ml swallow in the suprahyoid and infrahyoid muscles, respectively. Furthermore, the AUC of the rectified EMG signal increased with the volume of swallow in both muscle groups (P=0.003, suprahyoid; P<0.002, infrahyoid). The intra-individual variabilities of offset latency, duration, and maximal amplitude were relatively low (<30% CV) in both muscle groups with respect to other parameters. The assessment of each parameter using EMG was highly reliable, with an intraclass correlation coefficient of >0.8. @*Conclusion@#Among the variable sEMG parameters assessed, the offset latency, duration, and maximal amplitude were the least variable. Although reliability on the rater side showed good results, the swallow-to-swallow variability of the parameters need to be considered in swallowing studies using sEMG.

9.
Article in English | WPRIM | ID: wpr-913762

ABSTRACT

Acquired brain injury (ABI) is a leading cause of serious long-term disability resulting in substantial economic costs for post-ABI care. This study was conducted to estimate the socioeconomic burden of persons with ABI in Korea. We used a prevalence-based approach and societal perspective to estimate the direct medical, non-medical costs and indirect costs of ABI, including stroke, traumatic brain injury (TBI), and non-traumatic ABI (anoxia, brain tumor, encephalitis, meningitis, hydrocephalus, and other brain disorders) from 2015 to 2017. The study population included patients with ABI over 20 years of age and analyzed according to insurance types encompassing National Health Insurance and automobile insurance. The socioeconomic burden of ABI was 4.67, 5.18, and 5.73 trillion KRW (approximately 4,162, 4,612, and 5,106 million USD) from 2015 to 2017 and around 0.3% of Korea's GDP annually. Estimating by disease, the socioeconomic cost was 72.4% for stroke, 18.6% for TBI, and 9.0% for non-traumatic ABI. Calculated by cost component, medical costs and non-medical costs showed a slight increase every year. Through this study, establishment of rehabilitation systems maximizing the health and quality of life for injured persons remain the key public health strategy for ABI to reduce socioeconomic burden and financial policies to support patients should be needed.

10.
Article in English | WPRIM | ID: wpr-913756

ABSTRACT

This study aimed to estimate the trend of traumatic brain injuries (TBIs) and TBI-related medical usage in Korea. Patients first diagnosed with disease codes of TBIs were included.We calculated the crude incidence and age-adjusted incidence, as well as medical cost, length of stay (LOS), clinic visits, and the number of specialized rehabilitation therapy for 1 year. Patients first diagnosed as TBI was higher in national health insurance (NHI) than in automobile insurance (AUTO-I). In contrast with the gradual decrease of the crude incidence, total medical costs both in NH-I and AUTO-I were generally and steadily increased. For oriental medicine, total medical costs dramatically increased in both inpatient and outpatient. LOS, clinic visits, and the number of specialized rehabilitation therapy were higher in AUTO-I than in NH-I. The most frequent age groups in NH-I were the young (0–9) and old (70 or over), whereas in AUTO-I, the working age group was prominent. Our results show differences in the incidence of TBI and medical usage between NH-I and AUTO-I, which could be associated with the policy for strengthening health insurance coverage, automobile-related regulations to prevent accidents and injuries, as well as rapid changes in the structure of the population in Korea.

11.
Article | WPRIM | ID: wpr-836372

ABSTRACT

Objective@#The purpose of this study was to understand the mechanism of normal hyoid movement during swallowing by calculating the activity of each muscle involved in the hyoid movement and propose a new kinetic modeling of hyoid movement using videofluoroscopy images. @*Methods@#Eight healthy volunteers with an average age of 56.8 swallowed 2-ml of diluted barium under videofluoroscopy. A video image was digitized to analyze the movement of the hyoid bone. The activity of the muscles acting on the hyoid bone was calculated from the movement of the hyoid bone using kinetic modeling. A surface electromyogram was measured simultaneously with videofluoroscopy, and the muscle force calculated by kinetic modeling was compared with the muscle force measured by surface EMG. @*Results@#The muscles acting on the hyoid bone were divided into three groups according to the direction of force and analyzed. The contraction of the retractor muscle group was observed as a median of 433 ms (95% CI 264-602, P=0.012) earlier than the contraction of protractor muscle group in all subjects. Generally, the peak activity of each muscle group was observed in the order of retractor (0 ms), protractor (592 ms, 95% CI 429-755), and depressor (717 ms, 95% CI 535-899) muscle group. The contraction of the protractor muscle measured by surface electromyography showed an earlier onset latency with a median of 82 2 ms (95% CI 615-102 9, P=0.012 ) compared to the contraction of the protractor muscle calculated by kinetic modeling. @*Conclusion@#Kinetic modeling reflects the pattern of contraction in the order of retractor, protractor, depressor muscle groups, as previously known. And it was possible to evaluate the activity of the retractor muscle, which is difficult to evaluate by electromyogram.

12.
Article | WPRIM | ID: wpr-836360

ABSTRACT

Objective@#To analyze the rheological and biochemical properties of saliva in healthy adults. @*Methods@#The subjects were seven healthy young adults (20-39 years). The whole saliva was collected by the spitting method between 9:00 am and 12:00 am. Unstimulated saliva was collected first, which was followed by the collection of stimulated saliva using citric acid was collected. The viscosity was measured using a capillary viscometer to examine the rheological properties. The MUC5B concentration was analyzed using an enzyme-linked immunosorbent assay (ELISA) for the biochemical properties. @*Results@#Ten and five minutes were required on average for unstimulated saliva and stimulated saliva, respectively, to collect the minimum amount needed for analysis (8 ml). The flow rate increased from 1.037±0.323 ml/min to 1.823± 0.660 ml/min after stimulation (P=0.018). Citric acid stimulation also increased the MUC5B concentration in the saliva from 3.706±3.575 μg/ml to 6.928±2.03 μg/ml (P=0.028). The viscosity of saliva, however, did not show a significant difference between with (1.1±0.164 cSt) or without (1.019±0.08 cSt) stimulation (P=0.128). A positive correlation was observed between the flow rate and MUC5B concentration (Spearman’s rho=0.547, P=0.043). On the other hand, there was no significant correlation between the MUC5B concentration and viscosity both in the unstimulated and stimulated saliva (P=0.939 and 0.819, respectively). @*Conclusion@#No significant correlation was observed between the MUC5B concentration and viscosity. Considering the time required to collect samples, an analysis of the stimulated saliva appears feasible in various research settings.The feasibility of these analysis methods should be examined in a patient population.

13.
Article | WPRIM | ID: wpr-833770

ABSTRACT

Toxoplasma gondii is an obligate intracellular protozoan parasite that can invade various organs in the host body, including the central nervous system. Chronic intracranial T. gondii is known to be associated with neuroprotection against neurodegenerative diseases through interaction with host brain cells in various ways. The present study investigated the neuroprotective effects of chronic T. gondii infection in mice with cerebral ischemia experimentally produced by middle cerebral artery occlusion (MCAO) surgery. The neurobehavioral effects of cerebral ischemia were assessed by measurement of Garcia score and Rotarod behavior tests. The volume of brain ischemia was measured by triphenyltetrazolium chloride staining. The expression levels of related genes and proteins were determined. After cerebral ischemia, corrected infarction volume was significantly reduced in T. gondii infected mice, and their neurobehavioral function was significantly better than that of the uninfection control group. Chronic T. gondii infection induced the expression of hypoxia-inducible factor 1-alpha (HIF-1α) in the brain before MCAO. T. gondii infection also increased the expression of vascular endothelial growth factor after the cerebral ischemia. It is suggested that chronic intracerebral infection of T. gondii may be a potential preconditioning strategy to reduce neural deficits associated with cerebral ischemia and induce brain ischemic tolerance through the regulation of HIF-1α expression.

14.
Article | WPRIM | ID: wpr-830506

ABSTRACT

Objective@#To evaluate the longitudinal changes of swallowing kinematics based on videofluoroscopic swallowing studies (VFSSs) in subacute stroke patients grouped according to the method of dietary intake. @*Methods@#Sixty-nine subacute stroke patients who had taken at least 2 successive VFSSs were included. Subjects were allocated into 3 groups according to the degree of swallowing function recovery—not improved group (tube feeding recommended to patients at both studies), improved group (tube feedings recommended initially to patients and oral feeding recommended at follow-up study), and well-maintained group (oral feeding at both studies recommended to patients). Initial VFSS was performed during the subacute stage of stroke, 1 to 12 weeks after the onset of stroke, and follow-up VFSS was performed at least once. Kinematic variables were calculated by two-dimensional motion analysis of multiple structures, including the hyoid bone, epiglottis, and vocal cord. Changes of kinematic variables were analyzed in serial VFSSs. @*Results@#At the initial VFSS, the well-maintained group showed significantly larger angles of epiglottic folding than the not improved group, while at the follow-up VFSS, the improved and the well-maintained groups showed significantly larger epiglottic folding angles than the not improved group. The distribution of epiglottic folding angles was in a dichotomous pattern, and each cluster was related to the swallowing function. @*Conclusion@#This study showed that improved epiglottic folding angles are associated with the recovery of the swallowing process and suitability for oral feeding among various kinematic variables in subacute stroke patients.

15.
Article in English | WPRIM | ID: wpr-764939

ABSTRACT

BACKGROUND: The gold standard in dysarthria assessment involves subjective analysis by a speech–language pathologist (SLP). We aimed to investigate the feasibility of dysarthria assessment using automatic speech recognition. METHODS: We developed an automatic speech recognition based software to assess dysarthria severity using hidden Markov models (HMMs). Word-specific HMMs were trained using the utterances from one hundred healthy individuals. Twenty-eight patients with dysarthria caused by neurological disorders, including stroke, traumatic brain injury, and Parkinson's disease were participated and their utterances were recorded. The utterances of 37 words from the Assessment of Phonology and Articulation for Children test were recorded in a quiet control booth in both groups. Patients were asked to repeat the recordings for evaluating the test–retest reliability. Patients' utterances were evaluated by two experienced SLPs, and the consonant production accuracy was calculated as a measure of dysarthria severity. The trained HMMs were also employed to evaluate the patients' utterances by calculating the averaged log likelihood (aLL) as the fitness of the spoken word to the word-specific HMM. RESULTS: The consonant production accuracy reported by the SLPs strongly correlated (r = 0.808) with the aLL, and the aLL showed excellent test–retest reliability (intraclass correlation coefficient, 0.964). CONCLUSION: This leads to the conclusion that dysarthria assessment using a one-word speech recognition system based on word-specific HMMs is feasible in neurological disorders.


Subject(s)
Brain Injuries , Child , Dysarthria , Humans , Nervous System Diseases , Parkinson Disease , Stroke
16.
Article in English | WPRIM | ID: wpr-762634

ABSTRACT

OBJECTIVE: To investigate the proportion of aspiration pneumonia cases among patients with community-acquired pneumonia in Korea. METHODS: This retrospective study included patients with community-acquired pneumonia who had been admitted to the emergency department of a university-affiliated tertiary hospital in Gyeonggi Province, Korea between January 1, 2016 and December 31, 2016. Among these patients, those with aspiration pneumonia were identified using ICD-10 codes (J69.*). Patients with recurrent pneumonia were excluded, as were those who were immunocompromised. The proportion of cases of aspiration pneumonia was calculated, and the characteristics and clinical outcomes of patients with aspiration pneumonia and non-aspiration pneumonia were compared. RESULTS: The proportion of aspiration pneumonia cases among patients with community-acquired pneumonia was 14.2%. Patients with aspiration pneumonia were significantly more likely to be older (p<0.001) and male (p<0.001), and to have a higher confusion, uremia, respiratory rate, blood pressure, and age ≥65 years (CURB-65) score (p<0.001) as compared to patients with non-aspiration pneumonia. They were also more likely to require admission to the intensive care unit (p<0.001) and a longer hospital stay (p<0.001). CONCLUSION: Aspiration pneumonia accounts for 14.2% of all cases of community-acquired pneumonia in Korea. These data may contribute to the establishment of healthcare strategies for managing aspiration pneumonia among Korean adults.


Subject(s)
Adult , Blood Pressure , Community-Acquired Infections , Delivery of Health Care , Emergency Service, Hospital , Humans , Intensive Care Units , International Classification of Diseases , Korea , Length of Stay , Male , Pneumonia , Pneumonia, Aspiration , Respiratory Rate , Retrospective Studies , Tertiary Care Centers , Uremia
17.
Article in Korean | WPRIM | ID: wpr-715942

ABSTRACT

OBJECTIVE: This study evaluated the temporal variables of hyolaryngeal movements during normal swallowing using kinematic analysis of the video fluoroscopic swallowing study (VFSS) to present the normal cut-off values of those variables. METHODS: Seventy-five healthy volunteers (17 men, 58 women) without swallowing dysfunctions were recruited to examine the swallowing of 2-ml diluted barium by a VFSS. Kinematic analysis was conducted by digitization of video files for movements of hyolaryngeal structures, including the vocal cords, hyoid bone, and epiglottis during normal swallowing. The time points and duration of hyolaryngeal movements were measured. The time points were the start point, maximal point, and the end point of the LE (Laryngeal Elevation), HE (Hyoid Excursion), and EF (Epiglottic Folding). The durations of LE, HE, and EF were obtained by subtracting the time of the start point from the time of the maximal point. The onset time of LE was defined as the reference time point (0 sec). The upper and lower limits of the 95% confidence interval were adopted as the normal cut-off values for the temporal variables of hyolaryngeal movements after transformation to a normal distribution. If a transformation formula to a normal distribution was not found in a variable, the values of the 2.5–97.5 percentile were adopted. RESULTS: The cut-off values of the maximal and end points of the LE were 0.281 to 0.916 sec, and 0.830 to 2.205 sec, respectively. The cut-off values of the start, maximal and end points of the HE were −0.233 to 0.400 sec, 0.320 to 0.874 sec, and 0.889 to 2.055 sec, respectively. The cut-off values of the start, maximal, and end points of the EF were 0.017 to 0.483 sec, 0.364 to 1.055 sec, and 0.774 to 1.773 sec, respectively. The cut-off values of the duration of LE, HE, and EF were 0.281 to 0.916 sec, 0.258 to 0.767 sec, and 0.255 to 0.787 sec, respectively. CONCLUSION: This study presented the normal cut-off values of temporal variables of hyolaryngeal movements during normal swallowing. This study can serve as a basis for classifying and analyzing the patterns of patients with dysphagia.


Subject(s)
Barium , Deglutition Disorders , Deglutition , Epiglottis , Healthy Volunteers , Humans , Hyoid Bone , Male , Vocal Cords
18.
Article in English | WPRIM | ID: wpr-715537

ABSTRACT

OBJECTIVE: To investigate the differences in hyolaryngeal kinematics at rest and during swallowing in the upright sitting (UP) and the lateral decubitus (LD) postures in healthy adults, and delineating any potential advantages of swallowing while in the LD posture. METHODS: Swallowing was videofluoroscopically evaluated in 20 healthy volunteers in UP and LD postures, based on the movements of hyoid bone, vocal folds, and the bolus head. Parameters included the Penetration-Aspiration Scale (PAS), horizontal and vertical displacement, horizontal and vertical initial position, horizontal and vertical peak position, time to peak position of the hyoid bone and vocal folds, and pharyngeal transit time (PTT). RESULTS: Nine participants were rated PAS 2 in the UP and 1 was rated PAS 2 in the LD (p=0.003) at least 1 out of 3 swallows each posture. The hyoid and vocal folds showed more anterior and superior peak and initial positions in the LD. In addition, swallowing resulted in greater vertical and smaller horizontal displacement of the hyoid in LD posture compared with UP. Time to peak position of the hyoid was shorter in LD. The maximal vertical and horizontal displacement of the vocal folds, and PTT were comparable between postures. CONCLUSION: The results showed that the peak and initial positions of the hyoid and larynx and the pattern of hyoid movement varied significantly depending on the body postures. This study suggests that the LD posture was one of the safe feeding postures without any increased risk compared with UP posture.


Subject(s)
Adult , Biomechanical Phenomena , Deglutition Disorders , Deglutition , Head , Healthy Volunteers , Humans , Hyoid Bone , Larynx , Posture , Swallows , Vocal Cords
19.
Article in English | WPRIM | ID: wpr-717776

ABSTRACT

Transcranial electrical stimulation-motor evoked potential (TES-MEP) is a valuable intraoperative monitoring technique during brain tumor surgery. However, TES can stimulate deep subcortical areas located far from the motor cortex. There is a concern about false-negative results from the use of TES-MEP during resection of those tumors adjacent to the primary motor cortex. Our study reports three cases of TES-MEP monitoring with false-negative results due to deep axonal stimulation during brain tumor resection. Although no significant change in TES-MEP was observed during surgery, study subjects experienced muscle weakness after surgery. Deep axonal stimulation of TES could give false-negative results. Therefore, a combined method of TES-MEP and direct cortical stimulation-motor evoked potential (DCS-MEP) or direct subcortical stimulation should be considered to overcome the limitation of TES-MEP.


Subject(s)
Axons , Brain Neoplasms , Brain , Evoked Potentials , Methods , Monitoring, Intraoperative , Motor Cortex , Muscle Weakness , Transcranial Direct Current Stimulation
20.
Article in Korean | WPRIM | ID: wpr-766397

ABSTRACT

OBJECTIVE: This study was conducted to evaluate the influence of supraglottic swallowing maneuver on swallowing kinematics using kinematic analysis of a videofluoroscopic swallowing study (VFSS). METHOD: Twenty healthy volunteers (10 in a young group ( < 40 years) and 10 in an elderly group (≥60 years)), participated in this study. After structured instruction by a skilled physician, the subjects swallowed 5 ml of diluted barium in the neutral position without any swallowing maneuvers, as well as with supraglottic swallow maneuver under digital videofluoroscopy, three times each. Kinematic analysis was conducted by digitization of video files for movements of hyolaryngeal structures, including the hyoid bone, larynx, arytenoid, and epiglottis. We measured the maximum displacements and velocities of the hyolaryngeal structures during swallowing. RESULT: The most remarkable change in supraglottic swallow was the maximum vertical displacement (mm) of the hyoid bone during swallowing in both groups (11.5±3.34–19.7±6.88 in the young group, P=0.009; 13.4±2.13–22.8±5.35 in the elderly group, P < 0.001). For velocity variables, patterns of change differed between the young and elderly groups. In the young group, the maximum vertical velocities of the larynx and arytenoid were decreased (P < 0.05), but in the elderly group, the maximum 2D velocity of hyoid bone, maximum horizontal and 2D velocity of the larynx and maximum horizontal velocity of the arytenoid were increased (P < 0.05). There were no significant differences in changes between the young and elderly groups. CONCLUSION: This study showed that supraglottic swallow could affect hyolaryngeal movements, particularly vertical hyoid movement, during swallowing. Beneficial kinematic changes in supraglottic swallow were more pronounced in the elderly group. Therefore, supraglottic swallow may contribute to swallowing improvement by enhancing hyolaryngeal movements during swallowing, in addition to laryngeal closure.


Subject(s)
Aged , Barium , Biomechanical Phenomena , Deglutition , Epiglottis , Healthy Volunteers , Humans , Hyoid Bone , Larynx , Methods
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