Korean Journal of Occupational Therapy (대한작업치료학회지)

Korean Society of Occupational Therapy (대한작업치료학회)
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The Treatment of Dysphagia in Total Thyroidectomy Patients : A Case Study

갑상선 절제술 환자의 연하장애 재활치료: 사례연구

  • Jung, Jun-Sik (Dep. of Occupational Therapy, Seoul Medical Center) ;
  • Park, Ji-Hyuk (Dep. of Occupational Therapy, College of Health Science, Yonsei University)
  • 정준식 (서울특별시 서울의료원 작업치료실) ;
  • 박지혁 (연세대학교 보건과학대학 작업치료학과)
  • Received : 2014.04.30
  • Accepted : 2015.06.01
  • Published : 2015.06.30
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Abstract

Objective : This case study describes the effects of swallowing rehabilitation on total thyroidectomy patients with dysphagia. Methods : The subject was a 71-year old total thyroidectomy patient with dysphagia. She was assessed based on the Functional Dysphagia Scale (FDS) and Penetration-Aspiration Scale (PAS) using a Videofluoroscopic Study (VFSS), and on the American Speech-Language-Hearing Association National Outcome Measurements System (ASHA NOMS). From April 19th to May 16th, 2014, she received treatment once a day fives times a week, for a half an hour for each session. From May 19th to June 5th, she received treatment once a day three times a week. Her swallowing rehabilitation was implemented by an occupational therapist and included her range of motion and resistive exercises the of neck muscles, head lift exercises, swallowing techniques, vocal cord adduction, falsetto exercises, electrical stimulation, postural techniques, a diet modification, and a regulation of the quantity and speed of food consumption. Results : The patient's total FDS decreased from 42 to 20, and then to 16. Her PAS decreased from 6 to 4, and then to 2. Her ASHA NOMS level increased from 1 to 5, and then to 6, consecutively. Conclusion : The findings from this case study suggest that the swallowing function in a total thyroidectomy patient with dysphagia was improved from swallowing rehabilitation.

목적 : 본 사례연구는 갑상선 수술을 받은 환자의 연하장애 증상과 작업치료실에서 적용한 연하장애 재활치료의 효과에 대해 알아보고자 하였다. 연구방법 : 갑상선 수술 후 연하장애를 호소하는 71세 여성을 대상으로 비디오 투시 연하검사(Videofluoroscopic Swallowing Study; VFSS)를 통한 기능적 연하장애 척도(Functional Dysphagia Scale; FDS)와 침습-흡인 척도(Penetration-Aspiration Scale; PAS)를 평가하였고, 미국언어청각협회 연하 척도(American Speech-Language-Hearing Association National Outcomes Measurements System; ASHA NOMS)로 환자의 삼킴 기능을 검사하였다. 치료 기간은 2014년 4월 18일부터 6월 5일까지이며, 총 27회 연하장애 재활치료를 받았다. 교정적 치료로 목 관절가동범위 및 근력 운동, 고개 들기 운동, 삼킴 기법, 성대폐쇄훈련, 후두상승훈련-가성발성훈련, 전기 자극 치료를 받았고, 보상적 치료로 자세 기법, 음식 양과 속도 변경, 음식 농도 변경에 대한 치료를 받았다. 결과 : 치료 결과 비디오 투시 연하검사를 통한 기능적 연하장애 척도 점수가 42점에서 20점, 16점, 침습-흡인 척도는 6단계에서 4단계, 2단계로 각각 감소하였다. 미국언어청각협회 연하 척도는 1단계에서 5단계, 6단계로 상승하였다. 결론 : 본 연구 결과 연하장애 재활치료가 갑상선 수술 환자의 삼킴 기능에 긍정적인 영향을 미치는 것으로 나타났다.

Keywords

References

  1. 보건복지부 중앙암등록본부. (2011). 2009년 국가 암등록통계. 세종, 한국: 보건복지부.
  2. Baredes, S., Blitzer, A., Krespi, Y. P., & Logemann, J. A. (1992). Swallowing disorders and aspiration. In M. F. Brin, Y. P. Krespi, & J. A. Logeman (Eds.), Neurologic disorders of the larynx (pp. 201-213). New York, NY: Thieme Medical Publishers.
  3. Beahrs, O. H., & Vandertoll, D. J. (1963). Complications of secondary thyroidectomy. Surgery, Gynecology and Obstetrics, 117, 535-539.
  4. Bou-Malhab, F., Hans, S., Perie, S., Laccourreye, O., & Brasnu, D. (2000). Swallowing disorders in unilateral recurrent laryngeal nerve paralysis. Annales d'Oto-Laryngologie et de Chirurgie Cervico-Faciale, 117(1), 26-33.
  5. Calabro, S., Auguste, L. J., & Attie, J. N. (1987). Morbidity of completion thyroidectomy for initially misdiagnosed thyroid carcinoma. Head and Neck Surgery, 10, 235-238.
  6. De Jong, S. A., Demeter, J. G., Lawrence, A. M., & Paloyan, E. (1992). Necessity and safety of completion thyroidectomy for differentiated thyroid carcinoma. Surgery, 112, 734-739.
  7. Finck, C. (2006). Laryngeal dysfunction after thyroid surgery: Diagnosis, evaluation and treatment. Acta Chirurgica Belgica, 106, 378-387 https://doi.org/10.1080/00015458.2006.11679911
  8. Han, T. R., Paik, N. J., & Park, J. W. (1999). The functional dysphagia scale using Videofluoroscopic Swallowing Study in stroke patients. Journal of Korean Academy of Rehabilitation Medicine, 23, 1118-1126.
  9. Hirano, M., Nozoe, I., Shin, T., & Maeyama, T. (1987). Electromyography for laryngeal paralysis. In M. Hirano, J. Kirchner, & D. Bless (Eds.), Neurolaryngology: Recent advances (pp. 232-243). Boston, MA: College Hill Press.
  10. Hoffman, H. T., & McCulloch, T. M. (1996). Anatomic considerations in the surgical treatment of unilateral laryngeal paralysis. Head and Neck, 18, 174-187. doi:10.1002/(SICI)1097-0347(199603/04)18:2<174::AID-HED10>3.0.CO;2-F
  11. Jung, S. H., Lee, K. J., Hong, J. B., & Han, T. R. (2005). Validation of clinical dysphagia scale: Based on Videofluoroscopic Swallowing Study. Journal of Korean Academy of Rehabilitation Medicine, 29, 343-350.
  12. Kim, K. Y. (2012). Assessment of pain, paresthesia, voice and swallowing function after thyroidectomy (Master's thesis). Hanyang University, Seoul.
  13. Kim, Y. M., Cho, J. I., Choi, W. S., & Park, J. S. (1999). LASER medial arytenoidectomy in two patients of bilateral vocal cord palsy. Korean Journal of Otolaryngology-Head and Neck Surgery, 42, 791-794.
  14. Logemann, J. A. (1998). Evaluation and treatment of swallowing disorders (2nd Ed.). Austin, TX: Pro-ed.
  15. Lombardi, C. P., Raffaelli, M., D'Alatri, L., Marchese, M. R., Rigante, M., Paludetti, G., & Bellantone, R. (2006). Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries. Surgery, 140, 1026-1034. doi:10.1016/j.surg.2006.08.008
  16. Lombardi, C. P., Raffaelli, M., De Crea, C., D'Alatri, L., Maccora, D., Marchese, M. R., ... Bellantone, R. (2009). Long-term outcome of functional post-thyroidectomy voice and swallowing symptoms. Surgery, 146, 1174-1181. doi:10.1016/j.surg.2009.09.010
  17. McHorney, C. A., Robbins, J., Lomax, K., Rosenbek, J. C., Chignell, K., Kramer, A. E., & Bricker, D. E. (2002). The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity. Dysphagia, 17, 97-114. doi:10.1007/s00455-001-0109-1
  18. Mu, L., & Sanders, I. (2002). Muscle fiber-type distribution pattern in the human cricopharyngeus muscle. Dysphagia, 17, 87-96. doi:10.1007/s00455-001-0108-2
  19. Paik, N. J., Kim, I. S., Kim, J. H., Oh, B. M. & Han, T. R. (2005). Clinical validity of the Functional Dysphagia Scale based on Videofluoroscopic Swallowing Study. Journal of Korean Academy of Rehabilitation Medicine, 29(1), 43-49.
  20. Palmer, J. B., Kuhlemeier, K. V., Tippett, D. C., & Lynch, C. (1993). A protocol for the Videofluorographic Swallowing Study. Dysphagia, 8, 209-214. doi:10.1007/BF01354540
  21. Pereira, J. A., Girvent, M., Sancho, J. J., Parada, C., & Sitges-Serra, A. (2003). Prevalence of long-term upper aerodigestive symptoms after uncomplicated bilateral thyroidectomy. Surgery, 133, 318-322. doi:10.1067/msy.2003.58
  22. Randolph, G. W. (2003). Surgical anatomy of the recurrent laryngeal nerve. In G. W. Randolph (Ed.), Surgery of the thyroid and parathyroid glands (pp. 300-342). Philadelphia, PA: Elsevier Saunders.
  23. Rosenbek, J. C., Robbins, J. A., Roecker, E. B., Coyle, J. L., & Wood, J. L. (1996). A Penetration-Aspiration Scale. Dysphagia, 11, 93-98. doi:10.1007/BF00417897
  24. Scerrino, G., Inviati, A., Di Giovanni, S., Paladino, N. C., Di Paola, V., Re, G. L., ... Bonventre, S. (2013). Esophageal motility changes after thyroidectomy: Possible associations with postoperative voice and swallowing disorders preliminary results. Otolaryngology-Head and Neck Surgery, 148, 926-932. doi:10.1177/0194599813482299
  25. Schlumberger, M. J. (1998). Papillary and follicular thyroid carcinoma. New England Journal of Medicine, 338, 297-306. doi:10.1056/NEJM199801293380506
  26. Shaker, R., Easterling, C., Kern, M., Nitschke, T., Massey, B., Daniels, S., ... Dikeman, K. (2002). Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology, 122, 1314-1321. doi:10.1053/gast.2002.32999
  27. Wasserman, J. M., Sundaram, K., Alfonso, A. E., Rosenfeld, R. M., & Har-El, G. (2008). Determination of the function of the internal branch of the superior laryngeal nerve after thyroidectomy. Head and Neck, 30(1), 21-27. doi:10.1002/hed.20648
  28. Wax, M. K., & Briant, T. D. R. (1992). Completion thyroidectomy in the management of welldifferentiated thyroid carcinoma. Otolaryngology-Head and Neck Surgery, 107(1), 63-68. doi:10.1177/019459989210700110
  29. Woodson, G. E. (1993). Configuration of the glottis in laryngeal paralysis. I: Clinical study. Laryngoscope, 103, 1227-1234. doi:10.1288/00005537-199311000-00004
  30. Yi, K. H., Park, Y. J., Koong, S., Kim, J., Na, D. G., Ryu, J. ... Cho, B. Y. (2010). Revised Korean thyroid association management guidelines for patients with thyroid nodules and thyroid cancer. Journal of Korean Thyroid Association, 3(2), 65-96.
  31. Yoon, I. J., Park, M. J., (2009). The treatment of dysphagia in dermatomyositis patients: A case study. Journal of Korean Society of Occupational Therapy, 18(4), 77-92.