EFFECT OF THE TEMPERATURE OF THE FOOD ON SWALLOWING IN PATIENTS WITH DYSPHAGIA
Y. Yamaguchi,RN, R.Asai,RN, T. Okinaka,RN, S.Shibata,RN, I.Sato,RN, T. Inoue,RN, T. Kachi,MD,PhD*
(Neuromuscular Unit and *Department of Neurology, Chubu National Hospital, Obu, Aichi Pref., Japan)
The management of dysphagia is one of the major problems in rehabilitation. Several techniques such as chin-down posturing and supraglottic swallowing have been tried. It is important for these techniques to trigger the swallowing reflex (SR). We have investigated the effect of the temperature of the food on the SR.
Four patients with Parkinsonism and two with multiple system atrophy, ranging in age from 49 to 80 years, were studied. The patients were asked to eat a teaspoonful of Japanese "egg-contained tofu". The temperature of the food was set at 55 ℃ (high), 36 ℃ (medium) or 10 ℃ (low). Three trials were performed at each temperature on separate days. The patients swallowed the food 5 times at each trial. Time from insertion of the food in the oral cavity to elevation of the larynx (laryngeai elevation time; LET) was measured, and compared between the three temperatures. Informed consent was obtained from all subjects.
There was no difference in LET between high and medium temperatures in any patients. The LET was significantly shortened at low temperature in 3 patients whose LET at high temperature was more than 10 s. The LET was not changed with the temperature of the food in the other 3 patients with LET less than 10 s.
It was suggested that the cold meal may trigger the SR properly and facilitate the effect of rehabilitation.
GASTROSTOMY FOR DYSPHAGIA IN A PARKINSON'S DISEASE PATIENT
- IT'S USEFULNESS FOR HOME HEALTH CARE -
Kishiko Yamamoto, Masako Hosotani, Akiko Furukawa, Tsutae Yoshino, and Yasuhiro Yamamura (Institute of Health Sciences, Hiroshima University School of Medicine, and Division of Nursing, Hiroshima University Medical Hospital, Hiroshima, Japan)
Dysphagia is a well-recognized complication of Parkinson's disease (PD). The difficulty in taking foods and oral medications, and the high incidence of bronchopneumonia as a cause of death prove the clinical importance of this problem. In a case of PD with dysphagia we observed excellent usefulness of gastrostomy in home health care.
A 74 year-old man with seven-year history of PD had been independent of his ADL until four months before admission, when he developed a severe difficulty in deglutition. Impaired intake of foods and antiparkinsonism drugs lead to rapid deterioration of his ADL. Percutaneous endoscopic gastrostomy (PEG) was undertaken, and subsequently his physical conditions including parkinsonism markedly improved. The patient and his family wished care at home, and we considered that they could administer the stoma for themselves. For ten days previous to the discharge, they actively learned the use of stoma and disinfection technique from experienced nurses of the ward. Follow-up study six months after discharge revealed that the patient's ADL had been largely improved without recurring respiratory infections. In the interim we cooperated with district doctor and public health nurse to relieve the patient from anxiety about taking bath or going out for a walk.
In PD patients with dysphagia, PEG feeding is a safe and effective method of long term nutrition and taking medicine, and thereby they can be cared for in their own home instead of in hospital. The results of our study, however, indicate that organized health services are indispensable to maintain the secure home care for patient s with PEG.