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Characteristics of the Oropharyngeal Swallowing Impairment in Stroke Patient using the Modified Barium Swallowing Impairment Profile

MBSImP에 따른 뇌졸중 환자의 삼킴 장애 양상 분석

  • Im, Ikjae (Graduate Program in Speech-Language Pathology, Yonsei University)
  • 임익재 (연세대학교대학원 언어병리학 협동과정)
  • Received : 2019.04.30
  • Accepted : 2019.07.05
  • Published : 2019.07.31
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Abstract

Swallowing impairment is a frequent complication following stroke. The characteristics of swallowing impairment with stork patient can facilitate identification of individuals at risk of dysphagia would be of great helpful. The present study examined oropharyngeal swallowing impairment with subacute stroke patients using the Modified Barium Swallowing Impairment Profile(MBSImP). The 49 consecutive patients with the supratentorial stroke met inclusion criteria for the present study. A retrospective review was performed of patients who underwent the videofluoroscopic swallowing study(VFSS). Of Stroke patients, 95.9% exhibited abnormal function of lip closure. 98% and 57.1 % shown abnormal tongue function and lingual motion, respectively. Oral residue was present in 51% and delayed pharyngeal response was present in 89.9%. In addition, abnormal laryngeal and hyoid excursion was seen in 42.9% and 87.8%, respectively. Abnormal function of soft palate elevation was present in 18.4% and abnormal epiglottic movement was seen in 4.1%. 30.6% of 30.6% of these patients exhibited abnormal laryngeal closure. All of the stroke patients(100%) in this study exhibited abnormal pharyngeal stripping wave and pharyngoesophageal segment opening. Abnormal tongue base retraction and oral reside were present 91.8%, respectively. The results suggest that stroke patient is more likely to exhibit reduced swallowing functions including lip closure, tongue control, initiation of pharyngeal swallow, anterior hyoid motion, tongue base retraction, pharyngeal residue and pharyngoesophageal contraction. Therefore, these data could provide valid and precise information regarding physiological evidence to delineate symptoms of dysphagia in this stroke cohort. Future studies should explore the bolus effect in the swallowing impairment.

본 연구는 뇌졸중 환자들의 대표적인 후유증인 삼킴 장애의 양상을 14개의 하위 항목으로 분류하고 그 특징을 조사하는데 그 목적이 있다. 연구 대상자는 소뇌 천막을 기준으로 천막상 병변의 소견을 보이는 아급성 뇌졸중 환자 49명 이었다. 삼킴 문제의 양상을 조사하고 그에 따른 생리학적 근거를 조사하기 위해 모든 피검자에게 비디오투시조영 삼킴 검사를 시행하였으며 삼킴 장애 평가에는 삼킴 장애 프로파일(The Modified Barium Swallowing Impairment Profile, MBSImP)이 사용되었다. 조사 결과, 뇌졸중 환자의 95.9%는 입술 조절기능에서 문제가 있었고 98%는 혀 조절 기능에서 문제가 있었다. 또한 환자의 57.1%는 음식물을 인두쪽으로 이동시키는데 문제가 있었으며 51%는 구강에 음식물의 일부를 남기는 증상을 나타내었다. 음식물이 인두족으로 유입됨과 동시에 일어나는 인두 삼킴 반사의 경우에는 89.8%의 환자가 지연된 삼킴 반사 증상을 보였으며 후두와 설골의 운동은 각각 42.9 %와 87.8% 환자가 문제가 있는 것으로 조사되었다. 또한 연구개는 환자의 18.4%가 이상 소견을 보였고 후두개의 경우에는 단지 4.1%만이 이상 소견을 보여 대체로 후두개 기능은 잘 보전되어 있는 것으로 조사되었다. 뇌졸중 환자의 30.6%는 후두 폐쇄 기능에 문제가 있었고, 식도 근육의 경우에는 모든 환자(100%)가 이 근육의 상부를 적절히 조절하지 못하는 것으로 조사되었다. 혀 기저부 움직임 또한 환자의 91.8%에게서 문제가 있는 것으로 나타났으며 인두에 음식물을 남기는 증상도 91.8%의 환자에게서 관찰되었다. 본 연구의 결과로부터 뇌졸중 환자의 삼킴 문제의 구체적 양상들에 대해 살펴보았으며 이는 삼킴 장애 중재 및 치료 개발을 위한 기초 자료로 활용 될 수 있을 것이다.

Keywords

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Fig. 1. Lateral view of a videofluoroscopic image. The image shows the oropharyngal anatomy, and includes the evidence of normal posture for lip closure

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Fig. 2. Videofluoroscopic image. The red arrow indicates bolus that escape beyond mid-chin (A). The red arrows indicate oral residue collection on oral structures (B).

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Fig. 3. The summary of a VFSS accoriding to MBSImP.

Table 1. Patient Characteristics

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Table 2. The number of patients with swallowing impairment

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