老年痴呆患者吞咽障碍的健康教育

目的探讨健康教育对老年痴呆患者吞咽障碍的作用。方法对78例合并有吞咽障碍的老年痴呆患者进行健康教育,内容包括心理干预、吞咽技巧训练、吞咽功能恢复训练、摄食训练等,比较健康教育前后患者的吞咽功能和营养状况。结果健康教育1年后,患者的吞咽功能和营养状况均比之前明显好转,差异有统计学意义(P<0.01)。结论健康教育能明显改善老年痴呆患者的吞咽障碍,有效提高其吞咽功能,从而使患者的营养状况好转。     

Tactile, gustatory, and visual biofeedback stimuli modulate neural substrates of deglutition

It has been well established that swallowing kinematics are modified with different forms of exogenous and endogenous input, however the underlying neural substrates associated with these effects are largely unknown. Our objective was to determine whether the swallowing BOLD response is modulated with heightened sensory modalities (taste, cutaneous electrical stimulation, and visual biofeedback) compared to water ingestion (control) in healthy adults across the age span. Habituation and sensitization were also examined for each sensory condition. Our principal findings are that each sensory swallowing condition activated components of the swallowing cortical network, plus regions associated with the particular sensory modality (i.e. primarily frontal motor planning and integration areas with visual condition). Overall, the insula was most commonly active among the sensory modalities. We also discuss gradual increases and decreases in BOLD signal with repeated exposures for each condition. We conclude that both stimulus- and intention-based inputs have unique cortical swallowing networks relative to their modality. This scientific contribution advances our understanding of the mechanisms of normal swallowing cortical control and has the potential to impact clinical uses of these modalities in treatments for neurogenic dysphagia.     

Reproducibility and validity of patient-rated assessment of speech, swallowing, and saliva control in Parkinson's disease

Kalf JG, Borm GF, de Swart BJ, Bloem BR, Zwarts MJ, Munneke M. Reproducibility and validity of patient-rated assessment of speech, swallowing, and saliva control in Parkinson's disease.

Objective

To report on the development and psychometric evaluation of the Radboud Oral Motor Inventory for Parkinson's Disease (ROMP), a newly developed patient-rated assessment of speech, swallowing, and saliva control in patients with Parkinson's disease (PD).

Design

Reliability and validity study.

Setting

Tertiary-care Parkinson center for multidisciplinary assessment.

Participants

Consecutive community-dwelling patients with PD (n=129) or atypical parkinsonism (AP; n=49; mean ± SD age, 64±9.8y; mean ± SD disease duration, 7y; median Hoehn and Yahr [HY] stage, 2.5).

Interventions

Not applicable.

Main Outcome Measures

To evaluate reproducibility, 60 patients completed the ROMP twice within a mean of 24±12 days. To study validity, another cohort of 118 patients who had completed the ROMP was assessed by both a neurologist (HY stage, Unified Parkinson's Disease Rating Scale III) and speech-language pathologist (severity of dysarthria, dysphagia, drooling) who were blinded to ROMP scores.

Results

Confirmatory factor analysis identified the 3 a priori–designed ROMP domains of speech, swallowing, and saliva control. Internal consistency was .95 for the total ROMP and .87 to .94 for the 3 domains or subscales. Intraclass correlation coefficients for reproducibility were .94 and .83 to .92 for the subscales. Construct validity was substantial to good with correlations ranging from .36 to .82. The ROMP differentiated significantly (P<.001) between patients indicated for speech therapy (based on independent assessment) and those who were not and between mild, moderate, and severe PD according to HY stage.

Conclusions

The ROMP provides a reliable and valid instrument to evaluate patient-perceived problems with speech, swallowing, and saliva control in patients with PD or AP.     

社区脑卒中后患者营养现状的流行病学调查

目的 调查上海市虹口区社区医院住院的卒中后患者吞咽障碍、低白蛋白血症和营养不良的检出率以及进食情况.方法 采用横断面研究,以438例在社区医院住院的卒中后患者为研究对象,记录其人口学特征、洼田饮水试验评估结果、营养学指标(包括人体测量学指标和生化指标)和进食情况.结果 438例卒中后患者吞咽障碍、低白蛋白血症和营养不良的检出率分别为18.6%、42.7%和52.7%;376例患者经口进食,61例鼻饲肠内喂养,1例经皮内窥镜胃造瘘术.其中376例经口进食患者中32%进食量恢复正常,60%进食量为正常状态的一半以上,8%为正常状态的一半以下;62例肠内营养患者中46例能量需要量未按照"肠内肠外营养临床指南(2006版)"推荐的标准实施.结论 社区医院住院的卒中后患者中仍有相当大比例的患者存在吞咽障碍,低白蛋白血症及营养不良的检出率高;患者进食缺乏统一管理,饮食内容随意无序,进食缺乏监控;临床医生应关注卒中后患者的营养现状.     

光纤维内镜评估针刺治疗中风后吞咽障碍 1 例(英文)

目的:采用光纤维内镜观察针刺新穴位组方治疗中风后吞咽障碍的疗效。方法:选取 5 个新穴位治疗 1 例中风后吞咽障碍患者,治疗 4 星期后采用光纤维内镜观察疗效。结果:针刺治疗后患者的吞咽功能以及语言功能均有改善。结论:针刺新穴位对中风后吞咽困难有确切疗效。     

经口内镜下环形肌切开术治疗42例贲门失弛症

目的 探讨经口内镜下环形肌切开术（POEM）治疗贲门失弛症（AC）的疗效和可行性。方法回顾性分析2010年8月至2011年3月42例确诊为Ac并接受POEM治疗患者的临床资料。POEM的主要步骤包括：食管黏膜层切开;分离黏膜下层,建立黏膜下“隧道”;胃镜直视下切开环形肌：金属夹关闭黏膜层切口。结果42例患者平均年龄43．9（10～70）岁,病程3个月至50年。全组患者均顺利完成POEM术,手术时间（68．5±25．5）min,黏膜下隧道长度（10．5±1．5）cm,环形肌切开长度（9．5±2．5）cm,无一例出现与POEM相关的严重并发症。术后中位随访时间2．5（1-6）个月．41例吞咽困难明显得到解除：1例术后15d出现进食困难及呕吐,胃镜检查发现黏膜下窦道形成．行内镜下窦道切开。结论作为一种新的微创治疗方法,POEM治疗Ac短期疗效肯定,可以迅速解除AC患者吞咽困难．但其长期疗效及远期并发症仍有待随访和观察。     

Myosin heavy chain and fibre diameter of extrinsic tongue muscles in rhesus monkey

OBJECTIVE: The purpose of this investigation was to identify the myosin heavy chain (MHC) phenotype and fibre diameters of hypoglossal innervated extrinsic tongue muscles in rhesus monkey. METHODS: Genioglossus, styloglossus and hyoglossus muscle samples obtained from three female rhesus monkeys were analysed for MHC isoforms via gel electrophoresis and stained with MHC antibodies to measure least mean diameters. RESULTS: MHC phenotypes were consistent for all three muscles. Each muscle was predominantly composed of MHC type IIa and I. All three isoforms were significantly different from each other in fibre diameter for styloglossus and genioglossus (IIb>IIa and IIx>I; P<0.001). For hyoglossus, the MHC type II isoforms had larger diameters than the MHC type I isoform (P<0.001). CONCLUSIONS: While the extrinsic tongue muscle MHC and/or muscle fibre type composition may be different between mammalian species, there are consistent similarities between the intrinsic and extrinsic tongue muscles. We suggest this is necessary for the highly coordinated activities performed by the tongue such as mastication, respiration and swallowing. The differences in fibre diameters among MHC isoforms suggest a large force gradation, which would be consistent with the coordination of these activities. The similarities among primates in MHC and/or muscle fibre composition as well as similar cortical inputs to the hypoglossal nucleus, suggest that we could expect to see similar MHC phenotype for extrinsic tongue muscles in human.     

针刺配合吞咽训练治疗脑卒中后吞咽障碍的疗效观察

目的观察针刺配合吞咽训练对脑卒中后吞咽障碍的疗效。方法将60例脑卒中后合并吞咽障碍的患者随机分为治疗组和对照组两组,治疗组给予系统吞咽训练及针刺疗法,对照组仅给予系统吞咽训练,治疗前后进行吞咽功能评价。结果两组患者治疗2月后吞咽功能均有所改善,吞咽功能达到优良的患者总数较治疗前明显增多,差异有显著性意义(P<0.05),而治疗组达到优良患者的总数要高于对照组,且差异有显著性意义(P<0.05)。结论针刺配合吞咽训练治疗脑卒中后吞咽障碍的疗效要优于单纯应用吞咽训练。     

Functional oral intake and time to reach unrestricted dieting for patients with traumatic brain injury

Hansen TS, Engberg AW, Larsen K. Functional oral intake and time to reach unrestricted dieting for patients with traumatic brain injury.

Objectives

To investigate the status of functional oral intake for patients with severe traumatic brain injury (TBI) and time to return to unrestricted dieting; and to investigate whether severity of brain injury is a predictor for unrestricted dieting.

Design

Observational retrospective cohort study.

Setting

Subacute rehabilitation department, university hospital.

Participants

Patients age 16 to 65 years (N=173) with severe TBI (posttraumatic amnesia from 7d to >6mo) admitted over a 5-year period. Patients are transferred to the brain injury unit as soon as they ventilate spontaneously.

Intervention

Facial oral tract therapy.

Main Outcome Measure

Unrestricted dieting assessed by the Functional Oral Intake Scale (FOIS).

Results

We found that 93% of all patients had problems with functional oral intake at admission. Within 126 days of rehabilitation, 64% recovered to unrestricted dieting before discharge. The chance of returning to total oral diet depends on the severity of the brain injury and can be predicted by Glasgow Coma Scale (GCS; measured the day after cessation of sedation; Wald χ²=42.78, P<.01), Rancho Los Amigos Scale (RLAS) level (Wald χ²=11.84, P=.01), FIM instrument (Wald χ²=44.40, P<.01), and FOIS score at admission (Wald χ²=82.93, P<.01).

Conclusions

Impairment in functional oral intake was found to be very common for patients with severe TBI admitted to a subacute rehabilitation department. For those who recovered during hospital rehabilitation, return to unrestricted dieting happened within 126 days of rehabilitation. The chance of returning to unrestricted dieting depends on the severity of the brain injury and can be predicted by GCS score, RLAS level, FIM score, and functional oral intake at admission. These results are important when planning rehabilitation, giving information to patients and relatives, and designing efficacy studies of facial oral tract therapy, which are highly recommended.     

缺血性卒中患者吞咽困难的一种异常吞咽方式

目的 明确卒中后吞咽困难患者一种异常吞咽方式的性质。方法 用电视透视检查观察21例卒中后吞咽困难患者吞咽5ml稀钡（60%w/v）过程中喉结构的运动轨迹。从入院至电视透视检查的时间为0～9d（中位数5d）。测量喉结构在每帧即0.03s（单位时间）内垂直方向上提升的距离x（mm）,以及同时在水平方向上前移的距离y（mm）,计算每0.03s内喉结构上提单位距离（1mm）时前置的距离（y/x mm）,以时间（帧）为横坐标,y/x为纵坐标,做出喉结构运动的曲线图。结果 21例吞咽困难患者的电视透视检查影像中有6例存在一种不同于其他患者的吞咽方式,表现为喉结构上提单位距离（1mm）内显著前移。有异常方式组和无异常方式组y/x最大值之间存在统计学差异（P =0.002）。曲线图上,异常方式组y/x最大值均大于1.5mm,无异常方式者均小于1.5mm。结论 在卒中后吞咽困难患者可能出现喉结构过度前置的异常方式,与舌骨上肌群在水平方向上代偿性收缩增强有关。