Position of Bolus Head at the Onset of Swallowing of Paste Food in Patients with Severe Motor Intellectual Disabilities

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  • 重症心身障害児者におけるペースト食品嚥下開始時の食塊先端部の位置
  • ジュウショウ シンシン ショウガイジシャ ニ オケル ペースト ショクヒンエンカ カイシジ ノ ショクカイ センタンブ ノ イチ

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<p>Aims:　The hyoid bone of patients with severe motor and intellectual disabilities (SMID) does not often appear clearly in videofluoroscopic examination of swallowing (VF). In this study, the bolus position at the time of contact between the tongue base and the posterior pharyngeal wall during the pharyngeal stage of swallowing between patients with SMID and healthy adults was compared.　Subjects and Method:　The subjects of this study were 19 healthy adults (healthy group) and 41 patients with SMID (disability group). We used the VF to video-record the subjects at 30 frames/s as they swallowed 3 to 5 mL of paste food. We identified the onset of elevation of the hyoid bone and the time of contact between the tongue base and the posterior pharyngeal wall, measured the time interval between these two movements during swallowing by a person in whom the onset of elevation of the hyoid bone could be identified, and evaluated aspiration. In addition, we evaluated the bolus position at the onset of elevation of the hyoid bone, and at the time of contact between the tongue base and the posterior pharyngeal wall in three stages: before, reaching or after the bolus reached the vallecula of the epiglottis. The results were compared by one-way analysis of variance or Fisher’s exact test.　Results and Discussion:　There was no difference between the time intervals from the onset of elevation of the hyoid bone to the time of contact between the tongue base and the posterior pharyngeal wall. The average value of each group was 0.105 to 0.231 s, and the position of the bolus head at both time points was consistent in 92.8% of the subjects.　The bolus position at the time of contact between the tongue base and the posterior pharyngeal wall based on the position of the vallecula in the healthy group was: before: 7 (36.8%), reaching: 12 (58.3%), after: 0; and in the disability group was: before: 2 (4.9%), reaching: 18 (43.9%), after: 21 (51.2%). There was a difference in the proportion of the number of people regarding the bolus position at the time of contact between the tongue base and the posterior pharyngeal wall between the healthy group and the disorder group.　Conclusion:　When swallowing the paste foods, the bolus position at the onset of the swallowing movement of patients with SMID tended to pass through the vallecula compared with healthy adults.</p>

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