Saitoh Eiichi
Department of Rehabilitation Medicine, School of Medicine, Fujita Health University.
Rinsho Shinkeigaku. 2008 Nov;48(11):875-9. doi: 10.5692/clinicalneurol.48.875.
Recently, many medical professionals become to realize eating problem affect deeply patient's quality of life (QOL), and they are very interested in dysphagia rehabilitation. I overviewed dysphagia rehabilitation along with the followings; (1) impact of dysphagia, (2) assessment of dysphagia, and (3) management of dysphagia. Eating is the most enjoyable activity. Dysphagia changes this enjoyable activity to the most fearful one. Dysphagia makes three major problems: risk of aspiration pneumonia and suffocation, risk of dehydration and malnutrition, and depriving enjoyable activity. As a recent conceptualization of eating, the Process model is the most important, that reveals eating (chew-swallow) is very different from just chewing plus swallowing in physiologically. In assessment, standardized functional tests such as the Repetitive saliva swallowing test, the Modified water swallowing test, and the Graded food test are used. The most important point in clinical assessment is identifying indication of direct therapy using food or starting period of oral feeding. Videofluorographic and videoendoscopic examinations are used as precise diagnostic and management-oriented assessment tools. In management, exercise, posture adjustment, and modification of food promote eating possibility. Oral care is essential in dysphagic patients. Surgical intervention is effective method if a patient has severe dysphagia.
最近,许多医学专业人员开始意识到饮食问题对患者生活质量(QOL)有深远影响,并且他们对吞咽困难的康复非常感兴趣。我将从以下几个方面概述吞咽困难的康复:(1)吞咽困难的影响,(2)吞咽困难的评估,以及(3)吞咽困难的管理。进食是最令人愉悦的活动。吞咽困难将这种愉悦的活动变成了最可怕的活动。吞咽困难会引发三个主要问题:误吸性肺炎和窒息风险、脱水和营养不良风险,以及剥夺愉悦活动。作为进食的一种最新概念化模型,过程模型最为重要,该模型揭示了进食(咀嚼 - 吞咽)在生理上与单纯咀嚼加吞咽有很大不同。在评估方面,会使用标准化功能测试,如重复唾液吞咽测试、改良水吞咽测试和分级食物测试。临床评估中最重要的一点是确定使用食物进行直接治疗的指征或开始经口喂养的时期。电视荧光吞咽造影检查和视频内镜检查用作精确的诊断和以管理为导向的评估工具。在管理方面,锻炼、姿势调整和食物改良可提高进食的可能性。口腔护理对吞咽困难患者至关重要。如果患者有严重的吞咽困难,手术干预是一种有效的方法。