Development of Nursing Technique Using Respirographic Biofeedback for Elderly with Dysphagia

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As a basic study, we investigated the effects of aging on the changes of respiration during swallowing and the effects of bolus volume and temperature on coordination of breathing and swallowing. The subjects swallowed 10 ml water, and respirograms and surface electromyograms (EMGs) of the suprahyoid muscles were simultaneously recorded. The respiration patterns, duration of deglutition apnea, and EMGs of the muscle activity were compared among three groups : young group (n=20, mean age 19.5*2.7 years), presenile group (n= 10, 64.8*3.2 years) and senile group (n=17, 85.6*2.9 years). In respiration patterns, the frequency of the Expiration-Apnea-Expiration pattern (eae type) in the senile group (42.6%) was significantly lower than in the other groups (p<0.05). The duration of deglutition apnea in the senile group (1.36*0.46 sec) was significantly longer than in the other groups (p<O.O1). In the young group, the peak EMG was achieved 0.04*0.08 sec after the onset of apnea, In the senile … More group, the achievement of the peak EMG was significantly delayed (0.26*0.30 sec) (p<O.O1). As the bolus volume (10, 20 ml) and the bolus temperature (5, 25, 50ﾟC) were varied, respirograms and EMGs were simultaneously recorded in 15 normal subjects (mean age 20.4*3.1 years). In 10 ml bolus volume, the frequency of eae type (71.3%) was significantly increased (p<O.O5), and the duration of deglutition apnea was significantly shortened (0.85*0.17 sec) (p<O.O1). We also investigated the effects of respirographic biofeedback on supraglottic swallow. In experiment 1, supraglottic swallow was performed to reduce the frequency of the swallowing reflex for a subject (female, 21 years old) swallowing 10 ml water with 3.4 reflexes. In experiment 2, the supraglottic swallow was performed to modify the respiratory pattern by triggering the swallowing reflex at the beginning of expiration in another subject (female, 70 years old). These effects were judged by experimental design (ABA, ABAB), and the frequency of performed supraglottic swallow could be increased by respirographic biofeedback. Less