Koyama Yuji, Nitta Kayako, Tochikura Michi, Kasahara Takashi, Kametsu Yutaka, Toyokura Minoru, Masakado Yoshihisa
Department of Rehabilitation Medicine, Tokai University Oiso Hospital, 21-2 Gakkyo, Oiso-machi, Naka-gun, Kanagawa 259-0198, Japan.
Tokai J Exp Clin Med. 2016 Sep 20;41(3):143-6.
Bickerstaff's brainstem encephalitis is an autoimmune disease with the primary lesion situated in the brainstem and three cardinal signs: ophthalmoplegia; ataxia; and impaired consciousness. A 68-year-old man was started on rehabilitation exercise 3 months after onset of Bickerstaff's brainstem encephalitis, due to remnant dysarthria and dysphagia (Functional Oral Intake Scale, level 5) after the cardinal signs of Bickerstaff's brainstem encephalitis resolved. Exercise involved using a straw in the anterior midline between the dorsal tongue and hard palate. While the patient was inhaling through the straw, the straw was blocked. After strengthening suction as much as possible, the patient was asked to immediately dry swallow at the same time that suction was stopped. Effects of exercise were examined using videofluorographic swallowing studies before and after 6 weeks of training to compare posterior and superior velar displacements and the presence of nasopharyngeal reflux. No adverse effects of exercise were encountered, and Functional Oral Intake Scale improved to level 7, with significant increases in posterior and superior velar displacement during swallowing compared with before training. In addition, nasopharyngeal reflux that had consistently been seen on swallowing before training was absent after 6 weeks of exercise. This exercise method may prove useful.
比克斯塔夫脑干脑炎是一种自身免疫性疾病，主要病变位于脑干，有三个主要体征：眼肌麻痹、共济失调和意识障碍。一名68岁男性在比克斯塔夫脑干脑炎发病3个月后开始康复锻炼，原因是比克斯塔夫脑干脑炎的主要体征消失后仍残留构音障碍和吞咽困难（功能性经口进食量表，5级）。锻炼方法是在舌背与硬腭之间的前中线使用吸管。当患者通过吸管吸气时，将吸管堵住。在尽可能加强吸力后，要求患者在停止吸气的同时立即进行空吞咽。在训练6周前后，使用电视荧光吞咽造影研究来检查锻炼效果，以比较软腭后移和上移情况以及是否存在鼻反流。未发现锻炼有不良反应，功能性经口进食量表提高到7级，与训练前相比，吞咽时软腭后移和上移显著增加。此外，锻炼6周后，训练前吞咽时一直存在的鼻反流消失了。这种锻炼方法可能有用。
