嚥下障害リハビリテーション入門I 嚥下障害入門:―原因，症状，評価（スクリーニング，臨床評価）とリハビリテーションの考え方―
スポンサーリンク
概要
- 論文の詳細を見る
Dysphagia is a syndrome associated with many diseases and is emerging as a big problem in the Japanese aged society. It is important to observe the symptoms and realize the causes of dysphagia. Swallowing disorders are often caused by organic etiology such as tumors and traumas, but many patients suffer from functional disorders after stroke and neuromuscular diseases. Nasogastric tube placement and medications can also iatrogenically cause swallowing problems. When making a diagnosis, it is important to understand the mechanisms and signs of pseudobulbar palsy and bulbar palsy. Whereas bulbar palsy occurs following a lesion in the brain stem swallowing center, pseudobulbar palsy relates to bilateral corticobulbar tract damage. Interestingly, some clinicians report that dysphagia can be caused by unilateral cortical lesions including lesions in the insular cortex. To detect dysphagia, questionnaires and screening tests are helpful, as are water swallow tests, RSST, cervical auscultation and so on, but clinical observation of the swallowing session is most valuable. Videofluoroscopic and videoendoscopic examinations are required for precise diagnosis and further management. To know the gap between the capability function and performance state of swallowing, it is good to establish treatment goals. It is also important to know if the disease is progressive or not. For patients with progressive disease such as ALS, compensatory management should be a priority. We use functional training including muscle strengthening and swallowing technique for non progressive disorders. Medical treatments using ACE inhibitors and so on are options which might be effective to prevent aspiration pneumonia, and also, surgical treatments such as cricopharyngeal myotomy and laryngeal suspension are indispensable in treating patients with severe dysphagia.
著者
関連論文
- 嚥下障害の評価とリハビリテーション
- 摂食・嚥下障害における理学療法の役割とEBPT(セミナーI, EBPTの構築を目指して, 第44回日本理学療法学術大会(東京))
- 人工呼吸管理後の嚥下障害の頻度と臨床的特徴
- 469. 放線冠梗塞の臨床症状と歩行能力
- 摂食・嚥下障害患者における体位の違いが唾液誤嚥に及ぼす影響 (シンポジウム 呼吸理学療法の検証 呼吸リハビリテーションの現状と将来展望--作業療法士の積極的な参加と活用が望まれる)
- 4 椅子すり抜けテストを用いた脳卒中片麻痺患者の実用的歩行機能の評価(主題)
- 203. 呼吸器感染症に起因する急性呼吸不全の呼吸理学療法に関する臨床的検討
- 272. 理学療法を施行した呼吸器感染症患者の臨床的検討
- 191. 片脚立ち上がりテスト運動負荷法の検討
- 嚥下内視鏡からみた摂食・嚥下の運動学 (2009年/第4回リハビリテーション科専門医会学術集会 学術集会/諏訪 シンポジウム--摂食・嚥下の運動学)
- 食事療法 摂食・嚥下障害患者さんの経管栄養剤
- 嚥下造影検査後の消化器合併症および消化管内バリウム残留の検討
- 当院の現状と問題(2)(リハビリテーション卒後教育における初期研修必修化の功罪,2008年/第45回日本リハビリテーション医学会学術集会/横浜)
- ヘルペス脳炎後の嚥下障害に対し，喉頭蓋管形成術 (Biller変法) を施行した1例
- 印象に残ったリハビリテーション事例 オーイー法にまつわる思い出の患者さんたち
- 嚥下障害
- 嚥下障害と構音障害 : 病巣部位と経過
- 嚥下障害リハビリテーション入門I 嚥下障害入門:―原因，症状，評価（スクリーニング，臨床評価）とリハビリテーションの考え方―
- 精神疾患を持つ患者における向精神薬の内服種類数・総量と摂食・嚥下障害の帰結との関係－高齢者を主な対象とした事後的検証－