「口腔期の嚥下失行」が疑われた左半球損傷の3例

Three Cases Suspected "Swallowing Apraxia during Oral Stage"

　咽頭期嚥下に異常はないが，口腔期嚥下の過程において失行要因による異常が疑われた左半球損傷の3例を報告した．3例とも右利きで，顔面を含む右片麻痺があり，口部顔面失行および発語失行を伴っていたが，運動障害性構音障害はなかった．また，パン，ヨーグルト，水を用いた嚥下造影では，咀嚼-食塊形成-移送過程において，動作の停滞，躊躇，拙劣さ，および所要時間の延長を認めた．筆者らはこの現象を「口腔期の嚥下失行」に該当すると結論した．言語治療として，口腔顔面動作や構音の練習，口腔期嚥下を想定した間接訓練を行い，食事場面では環境整備などに注意を払った．その結果，嚥下失行は，症例1では改善したが，症例2では残存し，症例3では拒否のため経口摂取を断念した．責任病巣については，Broca領域および左中心前回の関与が考えられた．

　We report on 3 patients who, although lacking pharyngeal dysphagia, presented apraxic movements during the oral stage of swallowing.　All cases were right-handed and had left hemispheric lesions due to a cerebrovascular disease.　They had a right facial paresis, buccofacial apraxia, and apraxia of speech, but had no paretic dysarthria.　During a videofluoroscopic examination of swallowing bread, yogurt, and water, all 3 cases showed reduced and delayed movements, hesitation, clumsiness, and prolongation of the time required for swallowing.　We concluded that this condition corresponds to "swallowing apraxia during the oral stage".　As for intervention, we had the patients practice buccofacial movements, articulation, and the swallowing process in the oral stage, and also modified their environments during eating.　As a result, problems in the oral stage improved in case 1, but remained in case 2, and case 3 eventually refused to eat and gave up oral intake all together.　MRI or CT findings demonstrated left hemispheric lesions involving Broca's area and/or left anterior central gyrus to be common among the patients.