摂食嚥下障害の臨床

The role of speech-language-hearing therapists in dysphagia rehabilitation

　肺炎が死因の第3位を占めるわが国では，肺炎の原因にもなる摂食嚥下障害の訓練治療に言語聴覚士（以下，ST）の存在が不可欠となっている．しかし，摂食嚥下領域におけるSTの役割が重要視されればされるほど，合併するコミュニケーション障害が軽視されかねない．チーム医療の概念が，多職種との垣根を越えたtransdisciplinary team（相互乗り入れ型）に移行しつつある現在，ST以外の職種も摂食嚥下訓練を施すようになっている．これは，呼吸・発声・発語・言語・認知・聴覚を知る専門家ならではの言語聴覚療法，摂食機能療法が提供できないと，STはチームの中で淘汰されることを意味している．他職種との協調をはかりながらも，他職種との差別化を維持できる知識と技能を備え，摂食嚥下障害の評価・訓練・支援をコミュニケーション障害と切り離さずに考えられる専門家であり続けることが，摂食嚥下領域にかかわるSTに求められる姿である．

　In Japan, pneumonia is ranked as the nation's third most common cause of death, with the incidence of pneumonia-related death being particularly high among the elderly population. Since aspiration, a symptom of swallowing disorders (dysphagia), can often lead to a person developing pneumonia, dysphagia intervention by speech-language-hearing therapists (SLHTs) is considered important. However, there is a tendency in clinical settings for priority to be placed on the treatment of dysphagia, while less attention is given to communicative disorders. In addition, the relatively new concept of a transdisciplinary team approach encourages participation of non-SLHT professionals in swallowing therapy. Under such circumstances, SLHTs are challenged to reflect upon who they are and what their role is in dysphagia rehabilitation. While working together with other professionals in the dysphagia team, SLHTs should be able to offer better service to society and patients with dysphagia by making full use of the knowledge and skills that are unique to their profession. Without recognition of the contribution of SLHTs as specialists in communication and communication disorders, the presence of an SLHT in dysphagia rehabilitation may be jeopardized in the future.