冷凍ゼリーによる摂食訓練が有用であった重度偽性球麻痺患者の1例

A case with severe pseudobulbar palsy for whom eating training with frozen jelly was helpful

　脳梗塞後遺症により，長期にわたり経口摂取と発声が困難であった重度偽性球麻痺患者に対し，スライス状の冷凍ゼリーによる直接訓練（以下，冷凍ゼリー訓練）と側臥位による発声訓練を実施した結果，嚥下機能と発声機能の改善を経験した．冷凍ゼリー訓練とは，嚥下反射の惹起不全や遅延がある患者に実施する当院特有の訓練方法である．本症例においては，完全側臥位法と冷凍ゼリー訓練の併用が，唾液誤嚥の減少や咽頭粘膜の清浄化などの咽頭クリアランス改善・咽頭知覚向上に寄与し，側臥位での発声訓練は，唾液誤嚥の予防と喉頭の過緊張の軽減に繋がった可能性があった．重度の嚥下障害とディサースリア合併例では，慢性期であっても両障害の関連性に留意し，優先課題の適切な抽出と能力に合ったアプローチを行うことにより機能改善の可能性があると考える．

　We experienced a case with severe pseudo spastic paralysis, who had had difficulty with oral intake and phonation for a long time, and improved his swallowing function and speech through a combination of “eating training,” which consisted of eating slices of frozen jelly (“frozen jelly training”), and phonation training, which a patient does while lying on his or her side. Frozen jelly training is an eating training method unique to our hospital. It is performed for patients with severe swallowing disorders who have difficulty with oral intake of thickened liquid and jelly. In the present case, the implementation of frozen jelly training may have contributed to the improvement of pharyngeal clearance and pharyngeal perception, including the reduction of saliva aspiration and cleaning of pharyngeal mucosa. Phonation training in the side-lying position may have prevented aspiration of saliva and reduced laryngeal hypertonia. In patients with severe dysphagia and severe dysarthria, there is a possibility of functional improvement even in the chronic stage, by paying attention to the relevance of both disorders, appropriately deciding on the priority issues, and using an approach which matches the ability of the patient.