臨床神経学

第49回日本神経学会総会

<教育講演8>
摂食・嚥下障害のリハビリテーション

才藤 栄一

藤田保健衛生大学医学部リハビリテーション医学講座〔〒470-1192 愛知県豊明市沓掛町田楽ヶ窪1-98〕

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.
Full Text of this Article in Japanese PDF (661K)

(臨床神経, 48:875−879, 2008)
key words:摂食・嚥下障害, リハビリテーション, プロセスモデル, 嚥下造影検査, 直接訓練

(受付日:2008年5月17日)