神経筋疾患の気管食道領域のリハビリテーション 特にえん下障害と気道管理について

Abstract

This report deals with the rehabilitation of the tracheoesophageal disorders in neuromuscular diseases. Neuromuscular diseases can divide into two groups. The one is the group of diseases which are expected to cure such as myasthenia gravis and Guillain Barre syndrome. The other in those which are difficult to cure such as Parkinson disease and spino cerebellar degeneration.In the first group the rehabilitation of the tracheo-esophageal disorders is effective. When the patients are in the acute period and have dysphagia, the treatment and management should be concentrated on preventing aspiration pneumonia. If the dysphagia is not improved by the treatment, the rehabilitation for dysphagia will be performed. When he was tracheostomized, the phonation must be recovered for the first time. In the second group which mainly includes progressive seuro-muscular disease, much in not expected the surgical and non surgical treatment on the dysphagia. The main purpose of the rehabilitation are to delay their progress, to keep their slight disorders, and to prevent respiratory infection. The family and patients teaching on the care of the patients is stressed in the rehabilitation. Because of the progressiveness the effect of the training does not continue long. If the patients were tracheostomized, the phonation must be maintained to make contact with surrounding people in order to get higher quality of assistance. But in the terminal stage, laryngectomy or laryngeal closure in not avoidable to prevent aspiration pneumonia.