Masahiro Ikeno, Speech Therapist, Doctor (Sensory Science), Hiromichi Metani, Medical Doctor,
Doctor (Medical Science), Shinya Fukunaga, Speech Therapist, Doctor (Medical Science), Akio
Tsubahara, Medical Doctor, Doctor (Medical Science)
Jpn J Compr Rehabil Sci 7: 39-44, 2016
Many patients are reported to experience dysphagia following thoracotomy, and there is a high rate of persistence of dysphagia as a result of prolonged endotracheal intubation. The importance of appropriate postoperative evaluation and rehabilitation has also been reported. A patient who had dysphagia following thoracotomy but recovered the ability for oral intake by undergoing long-term dysphagia rehabilitation in the active community-living phase (home care phase) is reported. The patient was a 90-year-old man diagnosed with severe dysphagia on the basis of recurrent laryngeal nerve paralysis following thoracotomy. The patient received a gastrostomy and was placed on home care. The patient visited our hospital 6 months after surgery, during which time his function had worsened due to his lack of oral intake ability. A videofluoroscopic swallowing study was performed after the patient presented at our hospital on the basis of information received from the patientfs care manager. This was followed by tongue movement exercises and the chin push-pull maneuver. Directly thereafter, swallowing exercises were initiated with simultaneous introduction of compensatory techniques (postural adjustments, conscious swallowing). Eight months after surgery, the patient was capable of full oral intake. The mechanisms by which dysphagia improved in the present case were likely the spontaneous healing of postoperative recurrent laryngeal nerve paralysis and the efficacy of exercises for recovering from swallowing function disuse that occurred during the period when he was incapable of oral intake. The rehabilitation of the present patient suggested that specialized and continuous evaluation and rehabilitative intervention are needed even at the stage of transition to the active community-living phase.
Key words: community-living phase rehabilitation, medical cooperation, dysphagia