慢性期脳卒中患者の嚥下機能に関連する要因分析

Abstract

The purpose of this study was to investigate the related to swallowing function among chronic stroke patients with dysphagia in nursing home. Using a cross-sectional survey design, the subjects were 60 chronic stroke patients (22 men and 38 women, mean age of 82.6+/-8.3SD) who had given approval for participation in the study. Expert nurses and physical therapists examined swallowing function by Modified Water Swallow Test (MWST) and Repetitive Salvia Swallowing Test (RSST), oral function (oral sense, dry mouth, mouth opening), pulmonary function (respiration, blowing, ability to blow), motor and cognitive function (positioning, range of neck, dementia). There was significant relationship between MWST and RSST (0.64; p<0.01). Multiple linear regression analysis revealed that the independent factors related to MWST were oral sense, dry mouth, and position of chin. These three factors could explain 49% of MWST variance (adjusted R(2)=0.49). The independent factors related to RSST were revealed to be dementia and oral sense. These two factors could explain 44% of RSST variance (adjusted R(2)=0.44). These findings indicate that the independent factors related to reflexive swallowing are different from these related to volitional swallowing. The result of the present study suggested that improvement of oral function is important for promoting reflexive swallowing, and that improvement of cognitive activity is important for promoting volitional swallowing from viewpoint of swallowing rehabilitation for chronic stroke patients.