Effect of Cervical Orthosis upon Swallowing

OBJECTIVE: To investigate the effect of cervical orthosis upon swallowing and the differences of bracing effect between normal people and spinal cord injured patients. METHOD: 12 normal adults and 32 cervical cord injured patients who were wearing one of the three common cervical orthoses (soft neck collar, Philadelphia brace, and Minerva brace) were recruited. Swallowing function was evaluated by videofluoroscopic swallowing study (VFSS) without cervical bracing for the baseline data and with cervical bracing to compare with baseline data. The parameters observed were oropharyngeal diameter, initiation point of swallowing, hyoid bone movement, laryngeal penetration, aspiration, and residual volume after swallowing. RESULTS: Cervical orthoses decreased oropharyngeal diameter, reduced hyoid bone movement, increased residual volume, and changed initiation point of swallowing. Minerva brace revealed to give more influence than other braces. Normal adult group and patient group showed no difference in cervical bracing effect. CONCLUSION: Attention should be paid to swallowing function when cervical bracing is needed because cervical bracing itself can increase the risk of aspiration.

Comparison of Esophageal Acidity between Nasogastric Tube Feeding and Percutaneous Endoscopic Gastrostomy Tube Feeding in Brain Injured Patients

OBJECTIVE: The aim of this study is to evaluate the change of esophageal acidity when feeding via nasogastric tube is replaced by via percutaneous endoscopic gastrostomy (PEG) tube. METHOD: Fourteen patients with brain injury participated in the study. 24-hour pH monitoring was performed during nasogastric tubal feeding. After PEG tube insertion, 24-hour pH monitoring was followed up. There was no difference in medication affecting to esophageal acidity in same patient at both pH monitorings. The results of pH monitorings analyzed with Wilcoxon signed rank test. RESULTS: The total time below pH 4.00 was 135.43+/-190.69 minutes for the patients with nasogastric tube and 25+/-42.74 minutes for PEG tube (p=0.013). The numbers of acid reflux was 42.07+/-47.03 and 21.93+/-22.77 respectively (p=0.074). Of the 14 patients, 9 had acid reflux in nasogastric tubal feeding, which was improved in all 9 patients after PEG. Of the 14 patients, 5 had no acid reflux in nasogastric tubal feeding but 3 of the 5 developed new acid reflux in PEG tubal feeding. CONCLUSION: Percutaneous endoscopic gastrostmy tube feeding was better for acid reflex control. But careful observation is needed after PEG because PEG can develop new acid reflux.

The Influence of Stimulation Site on the Conduction Study of Palmar Cutaneous Branch of Median Nerve

OBJECTIVE: Nerve conduction study of palmar cutaneous branch of median nerve is infrequently evaluated in spite of its importance because of perceived technical difficulties. This study reports the different nerve conduction responses of palmar cutaneous branch of median nerve by change of stimulation site. METHOD: Conduction study of palmar cutaneous branch of median nerve was performed in 42 normal individuals stimulated at the site of 7 cm proximal to the recording electrode. Results were compared to those of stimulated at the site of 10 cm proximal to the recording electrode with t-test by SPSS 7.5. RESULTS: Values of conduction study stimulated at the site of 10 cm proximal to the recording electrode were 2.37+/-0.48 msec (mean+/-SD) for peak latency, 15.67+/-8.31 micro V for amplitude and 34.52+/-5.97 mA for supramaximal intensity.Those values stimulated at 7 cm proximal were 1.72+/-0.33 msec for peak latency, 24.48+/-11.41 micro V for amplitude and 12.82+/-2.18 mA for supramaximal intensity. Amplitude stimulated at the site of 7 cm was significantly larger than that stimulated at the site of 10 cm (p<0.01). Supramaximal intensity stimulated at the site of 7 cm was significantly smaller than that stimulated at 10 cm (p<0.01). CONCLUSION: The different stimulation site influences on the nerve conduction study of the palmar cutaneous branch of median nerve. Conduction study of palmar cutaneous branch of median nerve with stimulation at 7 cm proximal is a more reliable and convenient method compared to 10cm proximal in respect of larger amplitude and smaller supramaximal intensity.