Treatment for Swallowing Dysfunction in Elderly Person

吞咽困难和频繁的吸入与随后肺炎的风险增加有关。老年人吸入性肺炎可能是吞咽功能下降所致。为探讨体位对吞咽功能的影响，在知情同意的前提下，选择10名健康全齿男性(平均年龄29.5~3.6岁)作为研究对象。用通用型超声诊断仪观察和记录舌动和吞咽声。用数字化仪绘制舌动曲线的5个拐点(T1、T2、T3、T4、T5)和吞咽音的两个起点(S1、S2)，分析舌动和吞咽音。测试食品是将6g的Mousse Up(日本食品护理有限公司)溶解在30毫升水中制成的。受试者被要求在3种体位下吞咽一种食物：坐姿、30度卧位、卧位。用单因素方差分析(ANOVA)和Duncan检验进行统计学分析，从吞咽开始到T3、T4、S1和S2的时间显著延长(p&lt；0.05)。从S1到T4的时间显著延长(p&lt；0.005)。T4与S1、T4与S2在统计学上有显著相关性(p&lt；0.05)。在“舌期”，舌缘与硬板前侧接触。在我们的研究中，我们判断T4是这个阶段的结束，团状物将被挤压到口咽部。在“咽期”，舌头靠近后咽壁，形成紧密的腭咽闭合。会厌将关闭，以期待团注。在本研究中，我们将S1作为发声的起点，由此提出了身体位置对吞咽功能的影响，并提示我们的分析方法可用于吞咽功能的评估。

Dysphagia with frequent aspiration is associated with an increased risk for subsequent pneumonia. Aspiration pneumonia in the elderly may be caused by a decrease in the swallowing function. The aim of this study was to discuss the influence of body position on swallowing function.Following informed consent, 10 healthy, fully dentate males (average age : 29.5 3.6 years old) were selected as subjects. Tongue movements and swallowing sounds were observed and recorded using general-purpose ultra-sound diagnostic system. Tongue movement and swallowing sounds were analyzed by plotting five inflection points (T1, T2, T3, T4 and T5) of the tongue movement curve and two beginning points of swallowing sounds (S1 and S2) using a digitizer. The test food was made by dissolving Mousse Up (Food Care Ltd. Japan) of 6 g into 30 ml water. Subjects were directed to swallow a test food under 3 body positions ; sitting position, 30^o lying position, lying position. Statistical analysis was performed by one-way analysis of variance (ANOVA) and the Duncan test.The times from the beginning point of the swallowing to T3, T4, S1 and S2 were significant extended (p < 0.05). The time from S1 to T4 was significant extended (p < 0.005). There was a significant correlation between T4 and S1, T4 and S2 statistically (p < 0.05).In the "lingual stage", the lingual edges appose the hard plate anteriorly and laterally as tongue contact. In our study, we judged T4 to be the end of this stage and the bolus would be squeezed toward the oropharynx. In the "pharyngeal stage", the tongue approximates the posterior pharyngeal wall resulting in a tight velopharyngeal seal. The epiglottis will be shut in anticipation of the bolus. In our study, we judged S1 to be the beginning of this sound.From this study, it was suggested that the body positions influence on swallowing function, and also suggested that our analyzing method could be useful for evaluation of the swallowing function.