Predictive Factors Associated with Achieving Oral Intake in Patients with Dysphagia / 대한연하장애학회지

Objective@#The purpose of this study was to determine oral intake predictors, including videofluoroscopic swallow study (VFSS) and Charlson Comorbidity Index (CCI), in patients with diseases/conditions requiring nasogastric (NG) tube feeding for dysphagia. @*Methods@#We retrospectively extracted the clinical or radiological medical records of 501 patients with internal medicine diseases who were referred for VFSS to evaluate dysphagia between January 2012 and August 2021. Our study analyzed 310 (61.9%) subjects using the NG tube out of 501 patients surveyed. The demographic features of the subjects, comorbidities, including CCI, and the VFSS results were extracted. Immediately after the VFSS test, the subjects were categorized into two groups: 153 who removed the NG tube and 157 who retained it. The chi-square test, Fisher’s exact test, and the independent t-test were used to analyze the data. We used the logistic regression analysis to determine the independent predictors of NG tube removal. The receiver operating characteristic (ROC) curve analysis was used to determine the best cut-off value of the Functional Dysphagia Scale (FDS) score for NG tube removal. @*Results@#The FDS score, the Penetration-Aspiration Scale (PAS) score, the diagnosis of aspiration pneumonia, and the presence of hemiplegia affected the NG tube removal. The optimal cut-off value for the NG tube removal was a score of 36.5 based on the FDS. @*Conclusion@#We clarified factors that may affect the NG tube removal in patients hospitalized for internal medicine disease. This study will assist in the future development of an oral intake strategy for patients with medical conditions receiving NG tube feeding.

Influence of Nasogastric Tubes on Swallowing in Stroke Patients: Measuring Hyoid Bone Movement With Ultrasonography

OBJECTIVE: To investigate the influence of a nasogastric tube (NGT) on swallowing simulated saliva in stroke patients. METHODS: Three groups of participants were enrolled into the study: group A (20 stroke patients with a NGT), a control group B (25 stroke patients without a NGT), and group C (25 healthy adults with no brain lesions or dysphagia). Participants swallowed 1 mL of water to simulate saliva. Patients in group A were tested twice: once with a NGT (group A1) and once after the NGT was removed (group A2). The distance of hyoid bone movement was measured by subtracting the shortest distance between the mandible and hyoid bone (S) from the distance at resting state (R) measured with ultrasonography. The degree of the movement was calculated by (R–S)/R. The trajectory area of hyoid bone movement (Area) and the interval between the beginning of hyoid bone movement and the moment of the shortest hyoid−mandible approximation (Interval) was calculated by a computer program. RESULTS: From group A: R–S and (R–S)/R of group A2 at 1.14±0.36 cm and 0.30±0.09 cm and were significantly greater than those of group A1 at 0.81±0.36 cm and 0.22±0.08 cm (p=0.009 and p=0.005). After removing the NGT as seen in group A2, R–S and (R–S)/R were improved to the level of those of group B at 1.20±0.32 cm and 0.30±0.09 cm (p=0.909 and p=0.997). The Area of group A2 was larger and the Interval of group A2 was shorter than those of group A1 though a comparison of these factors between A2 and A1 did not show a statistically significant difference. CONCLUSION: A NGT interferes with the movement of the hyoid bone when swallowing 1 mL of water in stroke patients though the movement is restored to normal after removing the NGT.

Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016

“Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” is the 3rd edition of clinical practice guideline (CPG) for stroke rehabilitation in Korea, which updates the 2nd edition published in 2014. Forty-two specialists in stroke rehabilitation from 21 universities and 4 rehabilitation hospitals and 4 consultants participated in this update. The purpose of this CPG is to provide optimum practical guidelines for stroke rehabilitation teams to make a decision when they manage stroke patients and ultimately, to help stroke patients obtain maximal functional recovery and return to the society. The recent two CPGs from Canada (2015) and USA (2016) and articles that were published following the 2nd edition were used to develop this 3rd edition of CPG for stroke rehabilitation in Korea. The chosen articles' level of evidence and grade of recommendation were decided by the criteria of Scotland (2010) and the formal consensus was derived by the nominal group technique. The levels of evidence range from 1++ to 4 and the grades of recommendation range from A to D. Good Practice Point was recommended as best practice based on the clinical experience of the guideline developmental group. The draft of the developed CPG was reviewed by the experts group in the public hearings and then revised. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” consists of ‘Chapter 1; Introduction of Stroke Rehabilitation’, ‘Chapter 2; Rehabilitation for Stroke Syndrome, ‘Chapter 3; Rehabilitation for Returning to the Society’, and ‘Chapter 4; Advanced Technique for Stroke Rehabilitation’. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” will provide direction and standardization for acute, subacute and chronic stroke rehabilitation in Korea.

Effect of Radial Extracorporeal Shock Wave Therapy in Patients With Fabella Syndrome

The fabella is a small sesamoid bone generally located in the tendon of the lateral head of the gastrocnemius behind the lateral condyle of the femur. Fabella syndrome is the occurrence of posterolateral knee pain associated with the fabella. It is a rare cause of knee pain that is often misdiagnosed. Fabella syndrome can be managed with conservative or surgical treatment. We applied radial extracorporeal shock wave therapy as a new treatment strategy for fabella syndrome and achieved a successful outcome.

Effect of Radial Extracorporeal Shock Wave Therapy on Hemiplegic Shoulder Pain Syndrome

OBJECTIVE: To investigate the effect of radial extracorporeal shock wave therapy (rESWT) on hemiplegic shoulder pain (HSP) syndrome. METHODS: In this monocentric, randomized, patient-assessor blinded, placebo-controlled trial, patients with HSP were randomly divided into the rESWT (n=17) and control (n=17) groups. Treatment was administered four times a week for 2 weeks. The visual analogue scale (VAS) score and Constant-Murley score (CS) were assessed before and after treatment, and at 2 and 4 weeks. The Modified Ashworth Scale and Fugl-Meyer Assessment scores and range of motion of the shoulder were also assessed. RESULTS: VAS scores improved post-intervention and at the 2-week and 4-week follow-up in the intervention group (p<0.05). Respective differences in VAS scores between baseline and post-intervention in the intervention and control groups were -1.69±1.90 and -0.45±0.79, respectively (p<0.05), between baseline and 2-week follow-up in the intervention and control groups were -1.60±1.74 and -0.34±0.70, respectively (p<0.05), and between baseline and 4-week follow-up in the intervention and control groups were -1.61±1.73 and -0.33±0.71, respectively (p<0.05). Baseline CS improved from 19.12±11.02 to 20.88±10.37 post-intervention and to 20.41±10.82 at the 2-week follow-up only in the intervention group (p<0.05). CONCLUSION: rESWT consisting of eight sessions could be one of the effective and safe modalities for pain management in people with HSP. Further studies are needed to generalize and support these results in patients with HSP and a variety conditions, and to understand the mechanism of rESWT for treating HSP.

Effect of Radial Extracorporeal Shock Wave Therapy on Hemiplegic Shoulder Pain Syndrome

OBJECTIVE: To investigate the effect of radial extracorporeal shock wave therapy (rESWT) on hemiplegic shoulder pain (HSP) syndrome. METHODS: In this monocentric, randomized, patient-assessor blinded, placebo-controlled trial, patients with HSP were randomly divided into the rESWT (n=17) and control (n=17) groups. Treatment was administered four times a week for 2 weeks. The visual analogue scale (VAS) score and Constant-Murley score (CS) were assessed before and after treatment, and at 2 and 4 weeks. The Modified Ashworth Scale and Fugl-Meyer Assessment scores and range of motion of the shoulder were also assessed. RESULTS: VAS scores improved post-intervention and at the 2-week and 4-week follow-up in the intervention group (p<0.05). Respective differences in VAS scores between baseline and post-intervention in the intervention and control groups were -1.69±1.90 and -0.45±0.79, respectively (p<0.05), between baseline and 2-week follow-up in the intervention and control groups were -1.60±1.74 and -0.34±0.70, respectively (p<0.05), and between baseline and 4-week follow-up in the intervention and control groups were -1.61±1.73 and -0.33±0.71, respectively (p<0.05). Baseline CS improved from 19.12±11.02 to 20.88±10.37 post-intervention and to 20.41±10.82 at the 2-week follow-up only in the intervention group (p<0.05). CONCLUSION: rESWT consisting of eight sessions could be one of the effective and safe modalities for pain management in people with HSP. Further studies are needed to generalize and support these results in patients with HSP and a variety conditions, and to understand the mechanism of rESWT for treating HSP.

Impact of Sitting Time on Seat-Interface Pressure of Spinal Cord Injured Patients

OBJECTIVE: To examine changes in seat-interface pressure in wheelchair seated spinal cord injured patients. METHOD: Twenty-six spinal cord injured patients, who were motor complete tetraplegic and paraplegic patients, were included in this study. After 5 cm air-filled cushion (ROHO(R)) was placed on their own wheelchair seat, patients were seated on wheelchair with neutral position for sixty minutes. The interface pressure and contact area of buttock was measured every 5 minutes. RESULTS: Significant increases of interface pressure were found in maximal and mean interface pressure during 0 to 25 minutes of sitting (p<0.05). An increased tendency of contact area of buttock was observed during sitting time but it was not significant. CONCLUSION: There were no significant changes of interface pressure after 25 minutes of sitting in spinal cord injured patients. Therefore, twenty-five minutes may be a reasonable sitting time before interface pressure is recorded.

Validation of Gugging Swallowing Screen for Patients with Stroke Based on Videofluoroscopic Swallowing Study

OBJECTIVE: To evaluate the clinical validity of gugging swallowing screen (GUSS) scale in comparison with the findings of videofluoroscopic swallowing study (VFSS) for subacute and chronic stroke patients, though GUSS was developed in order to screen dysphagia in acute stroke patients. METHOD: The subjects of this study were thirty-five patients who had stroke for more than 3 months and were showing the symptom of dysphagia. GUSS, VFSS and clinical examination were performed respectively by three different physiatrists. These tests were performed at intervals of 24 hours or less. The result of GUSS was compared with videofluoroscopic dysphagia scale (VDS) based on VFSS, Clinical dysphagia scale (CDS), and ASHA scale based on clinical patterns. RESULTS: The result of GUSS was in a significant correlation with VDS, CDS, and ASHA scale (p<0.01). GUSS predicted aspiration very efficiently (area under the curve=0.928; 95% CI, 0.833 to 1.022). The cutoff value of 12 point showed sensitivity of 89.5%, specificity of 87.5%, and negative predictability of 87.5%. CONCLUSION: The GUSS is considered as an effective and convenient screening tool to evaluate stroke patients with dysphagia irrespective of stroke stages.