[Relationships of swallowing function to changes in motor functions in stroke patients with motor dysphagia]

To clarify the clinical features of physical therapy for motor dysphagia by identifying changes in indices when swallowing function changes.

Subjects comprised 59 stroke patients with motor dysphagia. They were subdivided into 3 groups according to changes in swallowing function (Group A: improved, Group B: deteriorated. Group C: unchanged). Measured indices for swallowing movement consisted of 4 items; distance from the genion to the thyroid cartilage (GT), distance from the thyroid cartilage to the sternum (TS), relative thyroid position (GT/(GT + TS)), and strength of the suprahyoid muscles (GS grade). Measured indices for neck-trunk function consisted of the passive neck range of motion in 4 directions (flexion, extension, lateral flexion, and rotation), and neck-trunk-pelvis stage (NTP stage) as described by Yoshio. Measured indices for swallowing function were the repetitive saliva swallowing test, the modified water swallowing test, the food test, and Saitoh's classification of dysphagia.

Group A consisted of 30 patients (mean age, 68.1 years), Group B consisted of 6 patients (mean age, 78.7 years), Group C consisted of 23 patients (mean age, 73.0 years). Group A exhibited significant improvements in GS grade, NTP stage, neck extension and rotation. In Group B, only relative thyroid position was affected. In Group C, no changes were evident.

To obtain improved swallowing function, approaches aimed at both local function of swallowing muscles and neck-trunk function should be used. Preventing deterioration of swallowing function requires attention to thyroid position affected by inappropriate posture.