In the past. People suffer from cerebral infarction, cerebral hemorrhage, have hemiplegia and other sequelae, and do not know where to find a doctor, do not know who can cure the disease. They were in a hurry. Now, most people know that there is a rehabilitation program, and they don’t care how good the doctor is, but it is better to have rehabilitation than not to have rehabilitation. It doesn’t matter whether they walk in circles or not, they can walk anyway. However, after this contradiction was solved, a new problem emerged. The patient couldn’t eat, couldn’t swallow, and choked and coughed when he ate and drank. What should we do?
For the patient, no one is more anxious than the family. The patient could not eat, so he was fed through a nasal feeding tube. After a long time, they feel that it is not a good thing, so they remove the nasal feeding tube, but after it is removed, they still can not feed into the meal, and as a result, they put the nasal feeding tube on again. In fact, not all patients have severe symptoms of swallowing disorder, and some patients can resume swallowing through the mouth after induction and scientific training. However, due to the lack of knowledge of many people in this area, patients are unable to eat through the mouth for a long time, resulting in disuse swallowing disorder.
Some family members try to feed the patient through the mouth because there is no nasal feeding tube at home, but the patient really has a swallowing disorder, and once the meal is imported, it will be spit out, either choking or coughing, which will lead to aspiration over time and serious complications such as aspiration pneumonia, which will eventually endanger life. Due to frequent choking and coughing, a long time “no filial son at the bedside”, some family members will give up feeding the patient. Patients can not eat, serious lack of nutrition, electrolyte disorders, life is affected, not long after the death.
In fact, most of the stroke patients have swallowing disorder, after correct and scientific rehabilitation, it is possible to restore some feeding function. According to the report, the prevalence of swallowing disorder in acute stroke patients is 41%, and 51% in brainstem stroke. The efficiency of rehabilitation treatment for swallowing disorder can reach 70%.
To treat swallowing disorders, it is necessary to first understand the physiology of swallowing. Without understanding the process and mechanism of swallowing, we do not know how to cure swallowing disorder, and if we do not understand the process and mechanism of swallowing, we will end up with an empty basket.
The normal swallowing process is divided into 4 processes, that is, 4 phases.
First is the preparation phase. It is the process of food being chewed and made into food mass. It is done by the lips, teeth, jaw, tongue, buccal muscles, hard palate and soft palate.
The second is the oral phase. It is the process of food being pressed into the pharynx. The tongue actively carries the food on the tongue to the back of the mouth and then presses it into the pharynx.
The third is the pharyngeal phase. It is the process by which food is sent to the esophagus through a reflex activity.
Finally, there is the esophageal phase. This phase is where food is sent to the stomach by gravity and peristalsis of the esophagus.
Thus, it appears that the process of swallowing is a very complex problem, which is carried out by the central nervous system and the participation of the cerebral nerves of the V, VII, IX, D, Ⅺ and the cervical plexus. Therefore, a problem with any part of the swallowing process can lead to the appearance of swallowing disorder. In other words, it is not a matter of taking it for granted to solve the swallowing disorder.
To understand where a patient’s swallowing disorder appears, a swallowing disorder assessment must be done.
The most commonly used assessment methods are the Eiichi Saedo method and the Toshio Kubota method. A specialist rehabilitation physician is required to perform the assessment.
Another more complex assessment is the ingestion-swallowing process. A variety of foods are prepared. Start with paste-like food, gradually use liquid and semi-liquid, and then gradually transition to semi-solid and solid. Start with a quantity of 1/4 tablespoon and gradually increase to 1.5 tablespoons. Start with a spoon, then a cup, to using a straw.
The purpose of the assessment is to find out: whether the patient has any cognitive impairment with food. Whether there is an entrance impairment. The time required to eat and swallow. Whether there is an obstacle to delivery to the pharynx. Whether there is an obstacle to the passage of food through the pharynx to the esophagus. If there is a wet sound or hoarseness, the possibility of aspiration should be considered.
Treatment of swallowing disorders includes: behavioral therapy, basic training, ingestion training, and electrical stimulation.
Behavioral therapy: includes changing swallowing posture, sensory facilitation integrated training, and changing the texture and consistency of food.
Due to swallowing disorders, some food residues are often left in the patient’s pharynx. The areas where food is most likely to remain are the epiglottic valley and the pyriform sinus. Changing the patient’s head or body in a certain position while the patient is swallowing can remove the residual food in the pharynx. This includes swallowing sideways and turning the head, swallowing empty versus cross swallowing, swallowing with the head down, and swallowing from a tilted head to a nodding head. The decision on which position to use needs to be made only after the rehabilitation physician has clarified the area of food retention. These methods can only be used temporarily and then gradually discontinued when physiological function is restored.
Basic training: Includes.
1. Training of peripheral muscles. Such as: lip movement, jaw movement, tongue movement.
2, breath-holding-vocal training.
3.Cough training.
4.Sound composition training.
5.Breathing training.
It is necessary to decide how to train after the rehabilitation physician analyzes the condition, or to teach the family to complete the training by themselves.
Feeding training: Before feeding training, sensory facilitation training should be done. For example, use a frozen cotton swab to scratch the soft palate of the affected side to stimulate the appearance of the gag reflex, wrap the cut fruit with gauze and tie it with a string so that the fruit is in the mouth and the string is outside the mouth, and let the patient chew with the back teeth.
During ingestion, the patient should take the trunk flexed at 30°, supine position with the head flexed forward and the shoulder on the affected side padded with a pillow. The head is tilted to the healthy side. This position facilitates the transport of the food mass to the root of the tongue and reduces the risk of accidental aspiration. The feeder should stand on the healthy side of the patient and deliver the food to the healthy side of the mouth. When feeding, choose food that is easy to swallow, has a relatively uniform density, is appropriately viscous, easily deformed, and not easily adhered to the mucosa.
Ingestion training is a highly specialized task and must be guided by a rehabilitation physician to do so.
Electrical stimulation: It is an adjunctive treatment for swallowing disorders. There are three main aspects;
1, imported swallowing therapy instrument, each treatment takes a long time, requires skin preparation, and requires the patient’s cooperation, while doing electrotherapy and swallowing action.
2, low frequency electrical stimulation: including: neuromuscular electrical stimulation, functional electrical stimulation, transcutaneous electrical stimulation, etc.
3.Biofeedback therapy instrument.
Psychotherapy: Patients with swallowing disorders often have psychological disorders. Perhaps the patient is just a swallowing disorder, or food sensory disorder, reduced oral sensation, or the swallowing disorder itself is not very serious, thus refusing to carry out rehabilitation training, and eventually cannot eat through the mouth, affecting the rehabilitation of the whole body and limbs.