CCF 자세가 동일 연령대의 뇌졸중 환자와 일반 성인의 삼킴 관련 근육에 미치는 영향

Dept. of Occupational Therapy/박사The cranio-cervical flexion (CCF) is a common means of postural control in the clinical setting and is equivalent to head flexion. The CCF is a low-load posture to target the deep cervical muscles, longus capitis, and longus colli. This clinical posture has been designed to assess the tonic holding abilities of the deep neck flexors. Both longus capitis and longus colli, located deeply at the posterior airway and esophagus in pairs play a vital role in controlling cervical posture and maintaining stability. Weakening of these muscles decrease efficiency of muscles and leads to excessive movement of the chin and head during postural control and movement. Anatomically, swallowing-related muscles are located superficially in the same region as the SCM and anterior scalene. Based on such fact, we assumed that CCF may influence swallowing-related muscles as well as superficial neck flexors. The purpose of this study was to investigate changes in swallowing efficiency by applying CCF to stroke patients experiencing swallowing problems due to neurologic disorders in comparison with application of CCF to age-matched asymptomatic adults. Also, most of earlier studies on application of CCF investigated activation of superficial neck flexor following neck stabilization by placing subjects in the supine position. However, to associate the effects of CCF with swallowing-related muscles, investigation of the sitting position which is the actual eating position in the real world is essential. In this study, we investigated whether the effect is same by applying CCF in both the supine and sitting position. Through this study, we demonstrated that when CCF was applied, in both groups activation of swallowing-related muscles was significantly changed compared to the neutral neck position. More specifically, when CCF was applied, participants swallowed the same amount of liquid with less muscle activation in the swallowing-related muscles, and such findings were found across both the supine and sitting positions. This shows that swallowing-related muscles, located in the same area as the superficial neck flexor muscles, were also affected by the CCF. When it is applied to individuals with proper postural guidance and understanding of the mechanism of neck stabilization with CCF is fostered, it could be a more effective therapeutic approach for swallowing difficulties. The results of this study suggest that CCF can be recommended as a method which enhances the effectiveness of swallowing-related muscles in stroke patients with pharyngeal weakness and healthy adults in the same age range. When CCF is applied, the stability of deep flexor muscles can be secured after which superficially located muscles may better assist swallowing the same amount of liquid with less effort. As individuals with various dysphagic symptoms show decreased effectiveness of swallowing-related muscles, our results could be regarded as theoretical evidence for better safe swallowing methods.ope