尾関 恩

BACKGROUND: The chin-down posture is often used as a compensatory manoeuvre for patients with dysphagia. This posture presumably involves flexion of the head and/or neck, but this is not clearly defined. OBJECTIVE: This study aimed to assess the effects of head flexion posture in a retrospective study of videofluoroscopic examination of swallowing (VF). METHODS: A total of 73 patients who underwent VF both with and without head flexion posture in the lateral projection were included in the analysis. The head and neck angles at the initiation of the swallowing reflex, penetration-aspiration scale (PAS), nasopharyngeal closure time, stage transition duration, duration of laryngeal closure, time from swallowing reflex to laryngeal closure and to the opening of upper oesophageal sphincter (UES), duration of UES opening, location of the bolus leading edge at swallowing reflex, and bolus transition time were evaluated. RESULTS: The head flexion angle increased (p < 0.001), but the neck flexion angle did not change in the head flexion posture. Moreover, PAS improved (p < 0.001), aspiration was reduced (p < 0.001), the time between the swallowing reflex and the onset of laryngeal closure was shortened (p = 0.006), and the leading edge of the bolus at swallowing reflex became shallower (p = 0.004) in the head flexion posture. Other parameters did not significantly change. CONCLUSION: The head flexion posture resulted in earlier laryngeal closure and a shallower position of the leading bolus edge at swallowing reflex, resulting in PAS improvement and decreased aspiration.

OBJECTIVE: The "chin-down" posture involves tucking the chin to the neck. However, clinicians and researchers have their own forms of the chin-down posture: some consider it to be head and neck flexion, whereas others consider it to be head flexion alone. The purpose of this study was to evaluate the effects of head, neck and combined head-and-neck flexion postures separately. METHODS: Ten healthy volunteers participated in the study. The head and neck were set in neutral (N), head flexion (HF), neck flexion (NF) or combined head-and-neck flexion (HFNF) positions. Participants were instructed to swallow 4 ml of thick barium liquid in an upright sitting position. Head and neck angles at rest, distances in the pharynx and larynx at rest, and duration of swallowing were measured. Statistical analysis was performed with a paired t-test with Bonferroni correction. RESULTS: Head angles in HF, NF and HFNF positions were significantly greater than in the N position. Neck angles were significantly greater in the NF position than in the N position. The distance between the tongue base and the posterior pharyngeal wall, the vallecular space and the airway entrance were smaller in the HF position than in the N position. The tongue base was in contact with the posterior pharyngeal wall longer in the HF position than in the N position. CONCLUSION: Because HF, NF and HFNF positions have different effects, we recommend the use of these terms instead of "chin-down position."

腋窩リンパ節郭清の有無が肩関節可動域に与える影響について検討した。乳腺外科で乳がん手術を施行し、術後1ヵ月以上経過観察可能であった女性57例とした。腋窩リンパ節の郭清が行われた郭清あり群は34例、郭清が行われなかった郭清なし群は23例であった。術後在院日数は郭清あり群で有意に長かった。退院後も外来でリハを継続した症例は郭清あり群が5例、郭清なし群が3例であった。肩関節可動域には、郭清あり群と郭清なし群では術前の有意差はみられなかったが、退院時には、郭清あり群で屈曲が平均35度、外転が平均42度減少し、有意差がみられた。しかし、術後1ヵ月と術後3ヵ月では両群に関節可動域の有意差はみられなかった。肩関節内旋と外旋は経過中、郭清の有無による可動域の差はみられなかった。

排便コントロール不良の慢性期脊髄損傷患者8例に対して洗腸法を行い,その使用状況と洗腸導入前後の排便状況を後方視的にアンケート調査した.患者は男性7名,女性1名,平均年齢43.9±16.0歳であった.全症例が退院後も排便コントロールとして洗腸法を継続しており,洗腸操作は頸髄損傷患者で介助を要したが,それ以外では自立した.総使用液量は0.8L〜10L,洗腸法時間は10〜120分と個人差があった.洗腸法以外の排便手段も含めた排便所要時間は,洗腸法導入前36.9分,導入後58.8分であった.排便間隔は導入前3.25日,導入後3.31日とわずかに延長していた.洗腸法導入にて便秘8例中2例,失便5例中2例で自覚症状が改善し,全症例で腸管機能の自覚的満足度が上昇した.半数が浣腸・座薬・摘便から離脱でき,洗腸法の効果は高位脊髄損傷患者で著しかった.洗腸法は脊髄損傷患者の排便機能障害に対し,有用な一手段であると考えられた