Japanese

Title	嚥下障害に対する理学療法の即時効果を認めた胸部食道癌術後長期経過の1例
Subtitle	症例報告
Authors	中川翔太1), 小田原守1), 今田道生1), 村野武志1), 山口祐二1), 鶴田豊1), 宮本恵美2), 大塚裕一2)
Authors (kana)
Organization	1)医療法人社団鶴友会鶴田病院, 2)熊本保健科学大学
Journal	日本摂食嚥下リハビリテーション学会雑誌
Volume	26
Number	1
Page	39-46
Year/Month	2022 / 4
Article	報告
Publisher	日本摂食嚥下リハビリテーション学会
Abstract	「要旨」【緒言】胸部食道癌術後長期経過し不良姿勢に起因する嚥下障害患者に対して, 理学療法(以下, 嚥下理学療法)を行い即時改善が認められた症例を経験したので報告する. 【症例】70歳代後半の男性. 5年前に胸部食道癌の手術を施行. 食事摂取量低下での低栄養や臥床時間の延長による低活動, 嚥下機能低下のため在宅生活困難となり入院. 呼吸数は24回/分. 筋力は舌骨上筋機能グレード(GSグレード)でGr.2. 筋緊張は後頭下筋群や舌骨上筋群, 舌骨下筋群, 胸鎖乳突筋, 大胸筋などが過緊張. 関節可動域は頭頸部屈曲位にてオトガイ-胸骨柄間距離9cm. 姿勢は頭部前方位の背臥位にて頭部-ベッド間距離が19cm, 肩甲骨外転位と胸椎後弯増強位は背臥位にて肩峰-ベッド間距離が9cm. 主観的飲み込みやすさに関する質問紙は2. 食事摂取量は7割. 食事中の咳込みあり. 【経過】嚥下理学療法により不良姿勢に対してストレッチやモビライゼーションを施行し, 改善効果の持続を目的に筋再教育練習や呼吸練習を行った. 単回の介入で, 呼吸数は22回/分. 筋力はGSグレードでGr.2, 筋緊張は上記筋群の過緊張が軽減. 関節可動域は頭頸部屈曲位にてオトガイ-胸骨柄間距離9cmから6cmに改善. 姿勢は頭部-ベッド間距離が19cmから9cm, 肩峰-ベッド間距離が9cmから6cmに改善. 主観的飲み込みやすさに関する質問紙は5. 食事摂取量は全量摂取. 食事中の咳込みなし. 【考察】関節可動域の拡大と筋緊張の緩和に伴う姿勢変化や呼吸機能向上により嚥下状態が改善し, 食事中の咳込みが消失したのではないかと推測した. GSグレードは介入後もGr.2で変化はなかったが嚥下状態は改善していた. このことから, 嚥下機能を低下させている可動域制限や筋長, 過緊張などの因子を多角的に評価し, 的確な介入を行うことで単回でも嚥下状態の改善を図ることができると考えた.
Practice	医療技術
Keywords	胸部食道癌術後, 不良姿勢, 嚥下理学療法, post-operative thoracic esophageal carcinoma, poor posture, swallowing physical therapy

English

Title	A Case of Immediately Effective Physical Therapy for Swallowing Difficulty Observed in a Long-Term Patient Following Thoracic Esophageal Carcinoma Surgery
Subtitle
Authors	Shota NAKAGAWA1), Mamoru ODAHARA1), Michio IMADA1), Takeshi MURANO1), Yuji YAMAGUCHI1), Yutaka TSURUTA1), Megumi MIYAMOTO2), Yuichi OTSUKA2)
Authors (kana)
Organization	1)Medical Corporation Kakuyukai Tsuruta Hospital, 2)Kumamoto Health Science University
Journal	The Japanese Journal of Dysphagia Rehabilitation
Volume	26
Number	1
Page	39-46
Year/Month	2022 / 4
Article	Report
Publisher	The Japanese Society of Dysphagia Rehabilitation
Abstract	[Abstract] [Preface]: We report a case of ingestion dysphagia in a patient due to poor posture after undergoing surgery for thoracic esophageal carcinoma exhibited immediate improvement following physical therapy (hereafter, "swallowing physical therapy"). [Case]: The patient was a male in his late 70s who had undergone surgery for thoracic esophageal carcinoma 5 years prior. Decrease in food intake (resulting in undernutrition), poor physical activity due to extended periods of bedrest, and difficulty swallowing made living at home difficult, so he was hospitalized. His respiratory rate was 24 breaths per minute. Cervical muscle strength (GS scale) was Grade 2. Regarding muscle tone, there was hypertonia in suboccipital muscles, suprahyoid muscles, infrahyoid muscles, sternocleidomastoid, pectoralis major, etc. Regarding range of motion, chin-to-sternum distance with the neck bent was 9 cm. In the forward head posture, the head-to-bed distance when supine was 19 cm, and in the supine position with scapulae protracted and spine bent forward, the acromia-to-bed distance was 9 cm. The subjective assessment of ease of swallowing was 2. Food intake was at 70%. Coughing during eating was observed. [Progress]: As part of physical therapy for swallowing, stretching and mobilization to alleviate poor posture were performed. To maintain the effects of improvement, muscle re-education and breathing practice were performed. With a single intervention, respiratory rate was 22 breaths per minute, muscle strength was Grade 2 on the GS scale, and, for muscle tone, hypertonia had decreased in the muscle groups listed above. Regarding range of motion, the chin-to-sternum distance with the neck bent improved from 9 cm to 6 cm. Posture improved from 19 cm to 9 cm for head-to-bed distance and from 9 cm to 6 cm for acromia-to-bed distance. The subjective assessment of ease of swallowing was 5. Food intake was complete and there was no coughing during eating. [Discussion]: It is speculated that increased range of motion along with postural changes and improved breathing resulting from relaxed muscle tone improved swallowing ability and contributed to the disappearance of coughing during eating. GS grade was still Grade 2 following the intervention but swallowing had improved. This is evidence that, by evaluating various factors that inhibit swallowing ability (such as limited range of motion, muscle extension, hypertonia, etc.) and performing proper intervention, even a single intervention can result in improvement in swallowing ability.
Practice	Medical technology
Keywords	post-operative thoracic esophageal carcinoma, poor posture, swallowing physical therapy

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