연하장애 환자의 턱밑근 근력 운동이 연하기능에 미치는 효과

Effects of Lower Jaw Muscle Strength Training on the Swallowing Function in Swallowing Disorder of Patients

이 연구의 목적은 연하장애를 가진 뇌졸중 환자들의 턱밑근육집단 근력향상을 위한 턱밑근 근력훈련(Jaw Muscle Strength Training)을 하였을 때, 연하기능에 미치는 영향을 알아보았다. 연구대상은 2012년 6월에서 10월까지 강원도 소재 H병원에서 입원, 외래로 작업치료를 받는 연하장애를 가진 뇌졸중 환자 25명 중에서 턱밑근 근력 훈련 13명, 전통연하재활치료 12명의 중재 전, 후의 변화를 비교해 보았다. 대상자들은 8주간 주 3회, 30분간 턱밑근 근력훈련 도구(EMST 150 device)를 75% 압력으로 훈련을 실시 후 턱밑근육집단의 근 활성도 향상을 알아보기 위하여 중재전, 후에 SEMG(Surface Electromyographic)를 실시하고, 연하기능 향상을 알아보기 위해 비디오 투시연하검사(VFSS)를 통한 기능적 연하곤란척도(FDS scale)를 이용하여 검사하였다. 그 결과 턱밑근 근력훈련 후에 턱밑근육 집단의 근 활성도와 연하기능이 유의하게 향상된 결과를 보였다( p<.05). 따라서 연하장애를 가진 뇌졸중 환자들의 재활치료 시 턱밑근 근력훈련을 통한 턱밑근육 집단의 근 활성도 향상이 연하장애를 가진 환자에게 적용할 수 있는 효과적인 치료방법으로 사료된다.

The purpose of this study was to identify the effects of jaw muscle strength training in stroke patients with swallowing disorders. The exercises were aimed at improving the muscle strength of the lower jaw muscle group and the swallowing function. There were 25 stroke inpatients and outpatients with dysphagia at H hospital located in Gangwon-do from June to October 2012 and these patients were grouped into the jaw muscle muscle strength training group composed of 13 patients who went through 75% pressure training of EMST 150 device and traditional dysphagia therapy group composed of 12 patients who went through traditional dysphagia therapy. The training was conducted three times a week, for 30 minutes each time, over an 8 week period. Thereafter, improvements in the muscular activation of the lower jaw muscle group were identified by surface electromyography(SEMG). In addition, signs of improvement in the patients' swallowing function were examined by conducting the videofluoroscopic swallow study(VFSS) using the functional dysphagia scale(FDS). The muscular activation and swallowing function of the lower jaw muscle group exhibited a statistically significant improvement after the patients underwent jaw muscle strength training( p<.05). In conclusion, the improvement in the muscular activation of the lower jaw muscle group through lower jaw muscle strength training can be an effective treatment method for the rehabilitation of stroke patients with swallowing disorders.