小野木 啓子

This study used 320-row area detector computed tomography (320-ADCT) to determine whether kinematic swallowing events and bolus movement through the oropharynx are affected by bolus consistency and angle of recline. Fourteen healthy adults (4 men, 10 women; age, 22-90 years) underwent 320-ADCT assessment during three 10-mL barium swallow tests, with honey-thick liquid at 60° recline (60°thick), thin liquid at 60° recline (60°thin), and thin liquid at 45° recline (45°thin). The times of swallowing events were measured and compared among the different tests. Bolus propulsion, onset time of true vocal cord (TVC) closure, and upper esophageal sphincter opening were significantly earlier for 60°thin than for 60°thick. Onset time did not significantly differ between 60°thin and 45°thin; however, greater variability was noted for onset of TVC closure with 45°thin, as the TVC started to close before onset of swallowing in 30% of participants. Modulation of TVC closure depends on bolus transport in different reclining positions. The 45° reclining position elicited pre-swallow TVC closure in some participants, which suggests that excessive recline can increase perceived risk of airway invasion during swallowing.

Onogi K, Kondo I, Asagai Y, Saitoh E. Differences in evaluation of functional skills of the Pediatric Evaluation of Disability Inventory (PEDI) between normally developing children and children with cerebral palsy. Jpn J Compr Rehabil Sci 2017; 8: 37-43.<br>Objective: The Pediatric Evaluation of Disability Inventory (PEDI) provides functional skills scales based on the data obtained from normally developing children. In the present study, we performed an analysis of children with cerebral palsy using the same methodology as set originally to examine differences in discrete skill items between the two groups of children.<br>Methods: Six hundred and two children with cerebral palsy were divided into groups based on the severity of disorder as described in the Gross Motor Function Classification System (GMFCS). The scaled scores for the PEDI functional skills were computed by Rasch analysis.<br>Results: Correlation coefficients between the scaled scores of children with cerebral palsy and those presented in the PEDI original data were r = 0.890 for self-care, r = 0.795 for mobility, and r = 0.943 for social function. In children in GMFCS level I, discrete scores increased with age, whereas in children in levels III, IV, and V, scores for mobility almost reached the plateau in the age band of 4 to <6 years.<br>Discussion: In the difficulty level of functional skills, the greatest difference was observed in mobility, suggesting the need to establish a difficulty level of functional skills that is adapted to the abilities of children with cerebral palsy.

【目的】習熟した看護師が臨床所見やスクリーニングテストから摂食嚥下障害臨床的重症度分類(DSS)を判定し,嚥下内視鏡検査を用いたDSS評価と比較すること.【方法】2011年7月から2012年3月までに摂食・嚥下障害看護認定看護師(CNDN)1名がDSSを臨床的に評価し,その後に,多職種が嚥下内視鏡検査を行ってDSSを最終的に評価した摂食嚥下障害患者45例(平均年齢75歳)を対象とした.自作プロトコールから自動的に行ったDSS判定,CNDNによるDSS判定,嚥下回診で嚥下内視鏡検査を用いたDSS判定の三つを比較した.【結果】プロトコールと嚥下回診の判定一致は64%,CNDNと嚥下回診の判定一致は91%,プロトコールとCNDNの判定一致は69%であった.【結論】習熟したCNDNは,臨床所見とスクリーニングテストを用いて十分正確にDSSを判定できる可能性が示された.(著者抄録)

【目的】入院患者の摂食嚥下障害に対する摂食機能療法回診の効果を後方視的に検討した.【方法】当院では病棟看護師や各科からの依頼により,専従の摂食・嚥下障害看護認定看護師が全身状態の確認,摂食嚥下障害のスクリーニングを行っている.精査が必要と判断された患者に,多職種から成る嚥下チームが病棟回診を行い,原則として嚥下内視鏡検査による評価を行っている.2006年9月から2010年3月までに摂食機能療法回診が行われた患者の介入時,介入後,最終時の食事形態と栄養摂取状況(ESS),介入時,最終時の臨床的重症度分類(DSS),介入中の肺炎発症を調査した.【結果】1,330例中精査が必要と判断された998例に対して摂食機能療法回診を行った.介入により食事形態,ESS,DSSの有意な改善をみた.肺炎発症率は3.7%であった.【考察】摂食機能療法回診により食事形態,ESS,DSSの有意な改善を得た.(著者抄録)

Although oropharyngeal and laryngeal structures are essential for swallowing, the three-dimensional (3D) anatomy is not well understood, due in part to limitations of available measuring techniques. This study uses 3D images acquired by 320-row area detector computed tomography ('320-ADCT'), to measure the pharynx and larynx and to investigate the effects of age, gender and height. Fifty-four healthy volunteers (30 male, 24 female, 23-77 years) underwent one single-phase volume scan (0.35 s) with 320-ADCT during resting tidal breathing. Six measurements of the pharynx and two of larynx were performed. Bivariate statistical methods were used to analyse the effects of gender, age and height on these measurements. Length and volume were significantly larger for men than for women for every measurement (P &lt; 0.05) and increased with height (P &lt; 0.05). Multiple regression analysis was performed to understand the interactions of gender, height and age. Gender, height and age each had significant effects on certain values. The volume of the larynx and hypopharynx was significantly affected by height and age. The length of pharynx was associated with gender and age. Length of the vocal folds and distance from the valleculae to the vocal folds were significantly affected by gender (P &lt; 0.05). These results suggest that age, gender and height have independent and interacting effects on the morphology of the pharynx and larynx. Three-dimensional imaging and morphometrics using 320-ADCT are powerful tools for efficiently and reliably observing and measuring the pharynx and larynx.

【目的】バルーンカテーテルを用いた食道入口部拡張法(以下バルーン法)は輪状咽頭筋弛緩不全による嚥下障害の治療法の一つである.本研究では,嚥下造影検査を用いてバルーン法による即時効果を検討した.【方法】嚥下造影検査にて嚥下後多量の咽頭残留を認め食道入口部開大不全が疑われた中枢神経系疾患の患者11例に対してバルーン法を施行し,拡張前後の咽頭残留量と食道入口部径を比較した.【結果】バルーン法前後の咽頭残留量は有意に減少し,病巣部位をテント上のみ,脳幹に病巣があるものの2群に分けて比較した場合,咽頭残留量はテント上病巣のほうが有意に減少した.食道入口部径には有意な変化を認めなかった.【結論】バルーン法は輪状咽頭筋弛緩不全による嚥下障害患者の咽頭残留量を減少させる即時効果があることを確認した.(著者抄録)

【目的】開発した嚥下評価訓練用椅子swallow chair(SC)の有効性を確認する目的で,実症例において,ベッド上で姿勢を調整した従来法とSC法とで単純性・簡便性・快適性を比較し検討した.【方法】対象は,嚥下造影検査によって,リクライニング,体幹回旋,頭部回旋が有効と判断された嚥下障害患者3症例.検査結果から推奨された代償姿勢をSCとベッド上とで調整し,2条件間での直接訓練をビデオ撮影し比較検討した.調査比較項目は,姿勢調整に要した物品と物品数(単純性),姿勢調整に要した時間(簡便性),疲労と疼痛の程度(快適性)とした.【結果】全症例においてSCではベッドに比し,準備物は少なく,調整時間は短く,主観的な疲労・疼痛程度は少なかった.また検査で推奨された代償姿勢を訓練・食事場面で直接的に用いることができ,姿勢調整変更や食事形態や頻度の改善を認めた.【結論】SCは,評価・訓練・食事場面での姿勢調整を単純,簡便,快適に行うことができる機器であることが分かった.(著者抄録)

Study design: Retrospective study of the degree of gait independence achieved by persons with spinal cord injury (SCI) using knee - ankle - foot orthosis with a medial single hip joint (MSH-KAFO). Objective: To examine the effects of the neurological level, degree of paresis, age, and inhibitory physical/other factors on the gait with a MSH-KAFO in patients with SCIs. Setting: Three university hospitals and two rehabilitation hospitals in Japan. Methods: The 45 patients (36 men, nine women) examined included 10 with injuries in the cervical cord between C6 and C8 (group C), 20 with injuries in the upper-middle thoracic cord between T4 and T10 (group UT), and 15 with injuries in the lower thoracic-lumbar cord between T12 and L1 (group TL). Mean age was 34.0 years (range 16 - 68 years). Of these patients, 13 used the Walkabout, four used the gear joint, and 28 used the Primewalk as the medial hip joint. Recursive partitioning, which predicted the final status of gait from the level, degree of paresis, age, and inhibitory factors, was performed, and a decision tree for gait was constructed. Inhibitory factors were spasticity, involuntary spasms or muscle contractions, pain, contracture, weakness of the upper extremities, and decreased motivation to perform gait exercise. The degree of gait independence was rated on the following. five-point scale: outdoor independent gait (5 points), indoor independent gait (4 points), indoor supervised gait (3 points), indoor assisted gait (2 points), and gait within parallel bars (1 point). New branches were added to the decision tree for gait based on the clinical experience, thereby constructing a new decision tree. Results: The coincident ratio between the value predicted on the basis of the decision tree of gait and the value actually observed was 53.3%. The coincident ratio between the value predicted on the basis of the modified decision tree of gait and the actually observed value was 68.9%. Conclusion: The results provide valuable information to medical teams that may assist prescription of gait orthoses.