ABSTRACT
<b>Objective:</b> With the recent aging trend in the Japanese population, dysphagia appears to be increasing. However, few epidemiologic surveys have been conducted to determine the prevalence of dysphagia in local inhabitants. Ohkuma et al. prepared a highly reliable questionnaire using a simple test and safe examination method. We investigated the presence/absence of symptoms of dysphagia in local inhabitants, evaluated their association with subjective symptoms, and examined whether the inhabitants were following a particular diet, which is the most important factor in management of dysphagia.<br><b>Methods:</b> A cross-sectional study involving 743 inhabitants (age: over 20) of an isolated island was performed. Each subject was asked basic questions (awareness about the presence/absence of dysphagia and dietary habits), and the data was analyzed by chi-square test. Based on their responses, dysphagia incidence was determined and rated on a 3-category scale (severe, mild, and no dysphagia).<br><b>Results:</b> Responses were recollected from 368 subjects (response rate, 49.5%). The percentage of subjects aware of dysphagia in the severe, mild, and no dysphagia groups was 13.8%, 3.2%, and 0%, respectively and the percentage of subjects who changed their dietary habits was 17.2%, 2.6%, and 0%. These percentages were significantly higher in the severe group than in the mild and no dysphagia groups, though the value was less than 20% in the 3 groups.<br><b>Conclusion:</b> Most subjects in the present study were unaware of dysphagia, suggesting that patients with dysphagia tend to be unaware of the key symptoms of dysphagia.
ABSTRACT
We experienced a case of delayed-onset Wallenberg's syndrome following cervical spine fracture coexisting with suspected conversion disorder. A 69-year-old man was involved in a traffic accident, and was admitted to our rehabilitation unit for the purpose of posttraumatic rehabilitation. At first, he complained of right occipital and nuchal pain. But his complaints changed to ataxia, dysphagia and a suspected brainstem lesion four months after the accident. His brainstem MRI showed a small ischemic lesion in the right dorsolateral area of the medulla oblongata. The long time lag between the original traumatic event and his changing complaints made the diagnosis difficult. Accordingly, rehabilitation assessment and conventional rehabilitation approaches were prepared for all of his symptoms. The dysphagia and ataxia were gradually reduced and the hemiparesis lessened and disappeared. A couple of points were suggested by this case. The first is “We must never overlook a change of neurological symptom masked as conversion disorder, and never deny what the patient says without careful listening.” The second is “We should offer the patient a conventional rehabilitation program without the option for malingering and falsification. This case might suggest that our attitude toward so-called gray-zone cases has an influence on the functional/social prognosis.
ABSTRACT
As a result of introducing swallowing rehabilitation at a special nursing home for the elderly, a resident became able to take food orally for the first time in about 4 years since having a PEG tube inserted. Further, the resident's FIM, FG, and DSS values improved to some extent. While nutritional care using the PEG tube is recognized as a long-term enteral nutritional therapy, the tube is mostly used as a “PEG tube for survival” and scarcely used as a “PEG tube for eating”, which indicates a PEG tube for supporting oral ingestion. The result indicates that it is preferable to use the PEG tube “for eating” in addition to its use as an option for long-term enteral nutritional therapy. The result also indicates the need to conduct, with the cooperation of nurses and nursing care workers, the nutritional care and regular follow-ups of all nursing home residents, as well as to maintain and improve the residents' swallowing function and their activities of daily living (ADL) by continuing swallowing rehabilitation, oral care, and measures against gastroesophageal reflux disease.