摂食嚥下リハビリテーションにおけるリクライニング位の再考

Restudy of the reclining position in swallowing rehabilitation

　姿勢調整法は，摂食嚥下関連器官の構造を変化させ，食塊を送り込みしやすくして，安全に嚥下する代償法として，摂食嚥下障害のリハビリテーションで用いられている．いくつかの方法があり，仰臥位に近い体位をとるものはリクライニング位と呼ばれる．少量の液体などの摂取における誤嚥防止の即時効果が認められ，食物形態や一口量の調整と合わせて，摂食訓練で用いられている．その一方，咀嚼を要する食物を食べるメカニズムに対するリクライニング位の影響については，これまであまり論じられていない．しかし，この姿勢は，摂食訓練以外でも食事などで広く取り入れられている．リクライニング位が咀嚼嚥下に及ぼす影響を明らかにし，多様な食品を，より安全に食べるための研究が期待される．ここでは，リクライニング位による摂食嚥下機能の変調に関する，近年の知見に言及し，摂食嚥下リハビリテーションにおけるリクライニング位について改めて考えてみたい．

　Posture techniques, which potentially change dimensions of anatomic structures and direction of food flow, have been utilized to promote safe swallowing in patients with dysphagia. The reclining position, which is one of the posture adjustment methods, is the posture in which the body trunk is inclined backward close to the supine position. The effects of this posture technique have been verified in studies that used small amount of liquids, and it has been clinically used extensively for recovering patients' swallow. However, the influence of the reclining position on eating solid food, which requires chewing, has not been actively studied so far, although this technique has been used for daily meals with various food as well as for swallowing therapies. Clarifying the influence of the reclining position on eating with mastication will elucidate therapeutic effects on intake of a variety of foods. In this paper, the author aims to restudy the reclining position in eating and swallowing rehabilitation by referring to recent findings on alteration of eating and swallowing functions caused by the reclining position.