嚥下訓練の生理学的基盤と運動再学習の可能性

The physiological basis of swallowing therapy and application of the principles of motor (re) learning

　嚥下訓練が有効であることは臨床で示されてきたが，個々の訓練法が標準的方法として認知されるには至っておらず，詳細な実施方法，適応，評価・測定の確立により，エビデンスを提示する必要がある．本稿では，嚥下訓練の類型と代表的な手技について，その生理学的基盤を消化管(内)の生体機械工学と流体力学の原理をもとに示す．生理学的基盤を明示することで，治療の標的と効果測定の焦点を定めることができ，エビデンスを蓄積することが可能となる．訓練の組み立てにあたり，運動(再)学習の原則を活用することが欠かせない．嚥下改善を目標とした実用的な訓練プランを提示し，嚥下訓練の今後の展開を記す．

　Swallowing therapy has been considered effective in clinical cases but each intervention method is yet to be recognized as a standard method for dysphagia rehabilitation.　Specifications of the method and patient population to whom the method is appropriate, as well as assessment and/or measurement of the therapy outcome must be established in order to demonstrate clinical evidence.　This paper aims to present the physiological bases of selected methods and techniques of swallowing therapy, namely, biomechanics and fluid dynamics.　Therapy targets and outcome measures will become more focused and specific with the knowledge of physiological changes that result from swallowing therapy.　To implement any swallowing therapy, application of the principles of motor (re) learning is essential.　Several therapy plans are presented and future directions of swallowing therapy are described.