Dysphagia: Etiology, Symptoms, Assessment and Clinical Management
10.2490/jjrmc.50.202
- VernacularTitle:嚥下障害リハビリテーション入門I 嚥下障害入門
- Author:
Ichiro FUJISHIMA
- Publication Type:Journal Article
- Keywords:
disease associated with dysphagia;
cough;
screening;
rehabilitation;
surgery
- From:The Japanese Journal of Rehabilitation Medicine
2013;50(3):202-211
- CountryJapan
- Language:Japanese
-
Abstract:
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.
