Objectives : To introduce a rare case of a patient with Progressive Bulbar Palsy (PBP) and suggest the possibility of treatment using electroacupuncture and Korean Medicine. Methods : A 61-year-old man with PBP, complaining of dysarthria, was treated with electroacupuncture and Korean Medicine, from...
Objectives : To introduce a rare case of a patient with Progressive Bulbar Palsy (PBP) and suggest the possibility of treatment using electroacupuncture and Korean Medicine. Methods : A 61-year-old man with PBP, complaining of dysarthria, was treated with electroacupuncture and Korean Medicine, from June 16 to July 10, 2015. Improvements in symptoms were measured using the speech mechanism screening test (SMST), measurement of tongue and orbicularis oris motility, and speech handicap index (SHI). Results : The scores of SMST, motility of tongue and orbicularis oris showed a tendency for gradual improvement with 25 days of Korean Medicine Treatment after admission, but conversation was still impossible. In SHI scores, one point increased in the speech domain and one point decreased in the psycho-social domain, and three points increased in the other domain. Conclusion : Electroacupuncture and Korean Medicine Treatment improved dysarthria caused by PBP, but not completely. Korean Medicine Treatment seems effective in the management of accompanying symptoms such as black hairy tongue, dry mouth, and general condition. The symptoms of PBP are similar to those of amyotrophic lateral sclerosis and there is controversy regarding the classification of PBP. The most important aspect of treating a patient with PBP is an early diagnosis and devising appropriate rehabilitation strategies.
Objectives : To introduce a rare case of a patient with Progressive Bulbar Palsy (PBP) and suggest the possibility of treatment using electroacupuncture and Korean Medicine. Methods : A 61-year-old man with PBP, complaining of dysarthria, was treated with electroacupuncture and Korean Medicine, from June 16 to July 10, 2015. Improvements in symptoms were measured using the speech mechanism screening test (SMST), measurement of tongue and orbicularis oris motility, and speech handicap index (SHI). Results : The scores of SMST, motility of tongue and orbicularis oris showed a tendency for gradual improvement with 25 days of Korean Medicine Treatment after admission, but conversation was still impossible. In SHI scores, one point increased in the speech domain and one point decreased in the psycho-social domain, and three points increased in the other domain. Conclusion : Electroacupuncture and Korean Medicine Treatment improved dysarthria caused by PBP, but not completely. Korean Medicine Treatment seems effective in the management of accompanying symptoms such as black hairy tongue, dry mouth, and general condition. The symptoms of PBP are similar to those of amyotrophic lateral sclerosis and there is controversy regarding the classification of PBP. The most important aspect of treating a patient with PBP is an early diagnosis and devising appropriate rehabilitation strategies.
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문제 정의
Thus, there have been only a few case reports dealing with PBP, and there have been no reports of treating dysarthria as one of the representative symptoms of PBP. In this paper, we report the results of applying electroacupuncture and Korean Medicine treatment to a patient suffering from dysarthria caused by PBP.
제안 방법
After checkingfor allergic reactionsusinga skin test, a single dose of 1:30,000, 0.1cc of bee-venom pharmacopuncture was performed using a single-use syringe was administered in the posterior neck and back regions,once a day from June 16 to July 10.
In total, 13 items for evaluating structure and 17 items for evaluating function, divided into face, lips, tongue, jaw and tooth, soft and hard palate, pharynx, and respiration area. All items were evaluated using audiovisual observation. Each item was rated on a scale of zero to two, with zero indicating‘serious abnormality’, one indicating‘slightly abnormal’, and two indicating‘normal’.
The method of measuring the protrusion distance of the tongue was based on the method of Lee et al11) which evaluated the tongue mobility in patients with ankyloglossia. In their research, the evaluator measured the distance from the edge of the upper lipto the tip of the tongue after protruding the tongue for wardas far as possible. However, the patient was unable to protrude his tongue with the mouth shut, so the distance was measured from the corner of the mouth to the tip of the tongue(Fig.
Among them, only the items evaluating the structure and function of the articulators were evaluated because the patient had problems with articulation. In total, 13 items for evaluating structure and 17 items for evaluating function, divided into face, lips, tongue, jaw and tooth, soft and hard palate, pharynx, and respiration area. All items were evaluated using audiovisual observation.
Ten acupuncture needles using single-use stainless steel 0.25 × 40 millimeter needles (DongBang acupuncture Inc, Korea) were inserted 1 millimeter inposterior cervical muscles and the upper trapezius muscle including Pungji(GB20), Pungbu(GV16), Gyeonjeong(GB21),Daechu(GV14) once a day from June 16 to July 10 for 20 minutes.
To evaluate the motility of orbicularis oris, the length between the two corners of the lips was measured and the patient was asked to encirclehis mouth. The evaluation was performed every 3-4 days, and the patient was placed in front of a wall in a standing posture (Fig. 2).
1).The evaluation was performed every 3-4 days, and the patient was placed in front of a wall in a standing posture.
25 ×40 millimeter needles (DongBang acupuncture Inc, Korea). The patient lied down supine and the acupoints Sugu (GV26) and Seungjang (CV24) were used to target orbicularis oris muscle, and two points 5 millimeter beside Yeomcheon (CV23) were used to target genioglossus muscle. The needle was inserted in Sugu(GV26) and Seungjang(CV24) 15 millimeter obliquely, and Yeomcheon (CV23) 20 millimeter perpendicularly.
The treatment was performed from June 16 to July 10, 2015 for a total of 25 days, using single-use stainless steel 0.25 ×40 millimeter needles (DongBang acupuncture Inc, Korea).
The needle was inserted in Sugu(GV26) and Seungjang(CV24) 15 millimeter obliquely, and Yeomcheon (CV23) 20 millimeter perpendicularly. Two-hertz electroacupuncture (STN-111, Stratek, Korea) treatment was performed once a day for 30 minutes.
대상 데이터
Repetitive nerve stimulation (2, 3, 5, 30 hertz) was performed in the ulnar, spinal accessory, and facial nerves. The recordings were performed on the abductor digiti minimi, trapezius, and orbicularis oculi. There was no equivocal electrophysiologic dysfunction.
이론/모형
Tongue motility evaluation was based on Bachher’s seven methods10) for evaluating tongue motility, to see the recovery process after partial glossectomy.
성능/효과
In neurological examination, no upper neuron signs wereobservedclinically. The functions of the peripheral nerves, glossopharyngeal nerve (Ⅸ), vagus nerve (Ⅹ), and hypoglossal nerve (XII) were decreased. This is consistent with the characteristics of PBP.
참고문헌 (17)
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