A Case of Immediately Effective Physical Therapy for Swallowing Difficulty Observed in a Long-Term Patient Following Thoracic Esophageal Carcinoma Surgery

<p>　Preface:　We report a case of ingestion dysphagia in a patient due to poor posture after undergoing surgery for thoracic esophageal carcinoma exhibited immediate improvement following physical therapy (hereafter, “swallowing physical therapy”).</p><p>　Case:　The patient was a male in his late 70s who had undergone surgery for thoracic esophageal carcinoma 5 years prior. Decrease in food intake (resulting in undernutrition), poor physical activity due to extended periods of bedrest, and difficulty swallowing made living at home difficult, so he was hospitalized. His respiratory rate was 24 breaths per minute. Cervical muscle strength (GS scale) was Grade 2. Regarding muscle tone, there was hypertonia in suboccipital muscles, suprahyoid muscles, infrahyoid muscles, sternocleidomastoid, pectoralis major, etc. Regarding range of motion, chin-to-sternum distance with the neck bent was 9 cm. In the forward head posture, the head-to-bed distance when supine was 19 cm, and in the supine position with scapulae protracted and spine bent forward, the acromia-tobed distance was 9 cm. The subjective assessment of ease of swallowing was 2. Food intake was at 70%. Coughing during eating was observed.</p><p>　Progress:　As part of physical therapy for swallowing, stretching and mobilization to alleviate poor posture were performed. To maintain the effects of improvement, muscle re-education and breathing practice were performed. With a single intervention, respiratory rate was 22 breaths per minute, muscle strength was Grade 2 on the GS scale, and, for muscle tone, hypertonia had decreased in the muscle groups listed above. Regarding range of motion, the chin-to-sternum distance with the neck bent improved from 9 cm to 6 cm. Posture improved from 19 cm to 9 cm for head-to-bed distance and from 9 cm to 6 cm for acromia-to-bed distance. The subjective assessment of ease of swallowing was 5. Food intake was complete and there was no coughing during eating.</p><p>　Discussion:　It is speculated that increased range of motion along with postural changes and improved breathing resulting from relaxed muscle tone improved swallowing ability and contributed to the disappearance of coughing during eating. GS grade was still Grade 2 following the intervention but swallowing had improved. This is evidence that, by evaluating various factors that inhibit swallowing ability (such as limited range of motion, muscle extension, hypertonia, etc.) and performing proper intervention, even a single intervention can result in improvement in swallowing ability.</p>