老年吞咽障碍患者的吞咽功能康复研究

目的探讨在养老院开展老年吞咽障碍者吞咽功能康复训练的可行性。方法对宁波市8家养老院的86例老年吞咽障碍患者进行吞咽功能康复训练,主要包括基础吞咽训练、冰刺激疗法、摄食训练及针对性训练。训练2个月后采用洼田氏饮水试验进行评价。结果治疗前后的洼田氏饮水试验、吞咽能力评价分级改善均有统计学显著意义(P<0.05)。结论在养老院实施吞咽功能康复训练有助于改善老年人吞咽功能,延缓吞咽障碍的进展。     

吞咽康复护理对脑卒中病人吞咽功能的影响

目的 探讨吞咽康复护理对脑卒中病人吞咽功能的影响.方法 选取2018年1月-2018年12月我院收治的脑卒中患者中出现吞咽障碍者80例为对象,分为对照组和观察组,每组40例.对照组给予常规护理,观察组在对照组基础上给予吞咽康复护理,1个月后对两组患者的临床效果进行比较.结果 观察组患者在康复护理1个月后基本痊愈的例数明...     

老年妇女冠心病的研究现状

冠心病是严重威胁人们健康的常见病和多发病。随年龄增长其发病率成倍增长。近年来,随着男性冠心病的深入研究,发病率和死亡率逐渐下降。但是,老年妇女冠心病就成为人们关注的突出问题。本文将对各种易患因素及临床特征进行较详细阐述。     

吞咽康复训练对老年脑卒中吞咽功能障碍患者生活质量的影响

目的探讨吞咽康复训练对老年脑卒中吞咽功能障碍患者生活质量的影响。方法选择温州市中医院康复科2015年1月至2016年12月老年脑卒中吞咽功能障碍患者200例,根据随机数字法分为康复训练组和对照组,每组100例。对照组在常规药物治疗脑卒中吞咽功能障碍的基础上给予吞咽电刺激治疗;康复训练组在对照组治疗的基础上进行吞咽康复训练治疗,共4 w。观察并对比两组治疗疗效,采用洼田饮水试验和标准吞咽功能评价量表(SSA)评价吞咽功能,采用生活质量评价量表评价生活质量。结果康复训练组疗效明显优于对照组(P0.05),总有效率明显高于对照组(P0.05)。训练前,康复训练组和对照组洼田饮水试验分级、SSA评分、社会功能、情感智能、精神健康、活动、躯体疼痛、生理功能、生理智能和总体健康评分比较差异无统计学意义(P0.05)。训练后,两组洼田饮水试验分级均明显低于训练前(P0.05),SSA评分均明显低于训练前(P0.05),社会功能、情感智能、精神健康、活动、躯体疼痛、生理功能、生理智能和总体健康评分均明显高于训练前(P0.05);康复训练组洼田饮水试验分级明显低于对照组(P0.05),SSA评分明显低于对照组(P0.05),社会功能、情感智能、精神健康、活动、躯体疼痛、生理功能、生理智能和总体健康评分明显高于对照组(P0.05)。结论吞咽康复训练可改善老年脑卒中吞咽功能障碍患者吞咽功能,提高生活质量。     

健康老年人的运动功能评测

一、对象和方法受检对象１２８人，男性８３人，女性４５人，年龄４５～７５岁。均来自北京地区，从事办公室工作或已退休，无长期运动锻炼基础。近１年内全面体检无高血压及心脏、呼吸、血液、代谢等疾病。试验前测量身高、体重，使用运动心肺功能测试系统（包括便携式运...     

老年妇女癌的诊断和预防

在雌激素替换疗法中加用孕激素,既能预防妇女子宫癌又能减少乳腺癌。戒烟能减少肺癌和心脏病的危险。高纤维及低脂饮食可减少结肠癌及乳腺癌的发病。对绝经后出血者应仔细检查及早发现子宫内膜癌。发现子宫内膜增生时,应该用孕激素治疗以预防子宫腺癌发生。建议所有妇女进行孕激素试验,如出血,应每月持续使用孕激素13天。乳房X线像及其它一些诊断方法可早期发现乳腺癌。     

阿尔茨海默病病人吞咽功能、营养状态与认知功能的相关性研究

目的 探讨AD病人吞咽功能、营养状况与认知功能的关系。方法 选择2019年10月至2021年11月在南京医科大学第一附属医院(江苏省人民医院)老年神经科住院的60～79岁的AD病人56例为AD组,另选取同期性别、年龄相匹配的体检病人60例作为对照组。收集2组TC、TG、HDL-C、LDL-C、FPG、UA、白蛋白及Hb等实验室检查指标,并完成微型营养评定简表(MNA-SF)及洼田饮水试验的评估,比较2组间的差异。分别通过吞咽障碍程度分级量表及MMSE评估AD病人吞咽功能障碍分级及认知功能,探讨AD病人认知功能、吞咽功能及营养状态之间的关系。结果 AD组Hb、白蛋白水平以及MNA-SF评分均显著低于对照组(P<0.05);AD组营养状况随着吞咽障碍程度分级的增加而下降(P<0.05);Spearman相关性分析表明,AD病人的MNA-SF评分与MMSE评分呈正相关(r=0.554,P<0.05)。结论 AD病人的吞咽功能及营养状况明显下降,并且随着吞咽功能下降,营养不良逐渐加重,同时AD病人认知功能与营养状况存在显著相关性。在临床工作中应加强对AD病人吞咽功能的筛查,增强营养支持,积极改善AD病人的认知功能和生活状况。     

居家康复护理早期改善老年人吞咽功能的效果评价

目的探讨居家康复护理在改善老年人吞咽功能中的应用价值。方法选取132位居家老人进行吞咽功能筛查与评估,对存在吞咽障碍者进行吞咽护理管理和康复功能训练,6个月后评估口腔卫生、误吸风险、吞咽疗效、日常生活能力。结果 37例老人存在吞咽障碍,6个月后死亡6例,共纳入31例。干预后吞咽障碍显著改善(P0.05);干预前后口腔卫生状况、误吸风险等级、日常生活能力比较,差异具有统计学意义(P0.05)。结论筛查和评估居家老人的吞咽功能,采取有效居家康复护理,从口腔卫生到摄食训练指导,将预防与康复训练相结合,有助于降低误吸的发生率,促进吞咽功能,提高老人日常生活能力。     

浅析老年妇女生活状况—北京市老年人多维纵向研究基线调查结果概述

以北京市老年多维纵向研究基线调查资料为依据，从老年人的一般生活状况，基本特征，社会状况，对养老的态度及健康状况等几个方面分析老年妇女的生活状况，发现女性文盲老人的特征为：低教育水平，低就业率、高经济依赖，提示提高文素质特别是妇女的文化程度是改善生活状况和社会地位的根本措施。     

The modified barium swallow database

Every center that carries out the modified barium swallow (MBS) has a potential storehouse of useful clinical and radiological information filed away in the patient's files and in the center's video library. The modified barium swallow database automates the recording, storage, and analysis of this information. This project utilizes a standardized clinical and radiological data form which provides a consistent approach to the reporting of the MBS results. The information on the data form is entered into the MBS database software program for decoding and permanent storage. This database program, designed for the computer novice, is menu driven to simplify operation. Once the patient information is verified on the computer screen, the program can generate different types of reports for clinical and research purposes. The program has routines to search for patients with any clinical or radiological findings of interest. The ability to group and recall patients with specific findings has been an aid in teaching, peer review, and research. The program has been modified based upon feedback and experience at three centers in Toronto that have used it for 9 months.     

Interobserver variability in cineradiographic assessment of pharyngeal function during swallow

Cineradiographic examinations of 72 patients with dysphagia and normal or abnormal studies demonstrating a range of pharyngeal dysfunctions during swallowing were retrospectively reviewed independently by six radiologists. The interobserver variability was then assessed. There was high concordance for the assessment of contrast medium reaching into the trachea, absent pharyngeal constriction, and the presence of Zenker diverticula. The concordance was less for normal pharyngeal function as well as decreased pharyngeal constriction and cricopharyngeal muscle impression less than 50%. The number of disagreements varied according to the observer's experience. Cineradiographic examinations of pharyngeal function during swallow had an acceptable degree of interobserver variability and can be a useful tool for the evaluation of pharyngeal function in patients with dysphagia.     

Swallowing/ventilation interactions during oral swallow in normal children and children with cerebral palsy

Many children with cerebral palsy (CP) suffer from feeding disorders. Twenty children with spastic CP and 20 neurologically normal children (age range 6.2–12.9 years) were monitored with ultrasound imaging of the oral cavity synchronized with surface electromyographic (EMG) recordings of masseter and infrahyoid museles and respiratory inductance plethysmograph (RIP) recordings during feeding tasks. A lip-cup contact detector signaled contact of the drinking cup on the lip during liquid tasks. Children with CP required more time than normals for collection and organization of 5 ml and 75 ml liquid boluses for swallowing. The ventilatory preparation phase, recovery to baseline resting ventilatory pattern after swallowing, and total time for task completion were longer in children with CP for 5-ml and 75-ml tasks. The interval from lip-cup contact until alteration of ventilation from baseline resting ventilatory pattern was longer for children with CP during 75-ml tasks but not for 5-ml tasks. The interval from completion of the task-related cookie swallow until initiation of the next swallow was longer in children with CP than in normal children. These data provide evidence than children with CP manage solid boluses more easily than liquid boluses and small liquid boluses more easily than large liquid boluses. This investigation statistically confirms empirically based recommendations that children with CP be allowed more time to complete feeding tasks and consume small volume drinks rather than large volume drinks.     

Oral-motor skills following sensorimotor intervention in the moderately eating-impaired child with cerebral palsy

The purpose of this study was to determine the efficacy of oral sensorimotor treatment in moderately eating-impaired children with cerebral palsy and to examine the effects of treatment on measures of growth. Six domains of feeding were examined in 35 children 4.3–13.3 years of age. Weight and skinfold measures were taken. Children were observed at lunch time, and spoon-feeding, biting, chewing, cup drinking, straw drinking, swallowing, and drooling were examined. Children underwent 20 weeks of sensorimotor treatment, 5–7 min/day, 5 days/week. Limited improvement was observed in the following eating domains: spoon-feeding, biting, and chewing, but not in drinking. Children as a group maintained the pretreatment weight-age percentile. To meet the increasing growth demands of the teenage years, oralmotor therapy may need to be combined with oral caloric supplementation.     

Durational aspects of oral swallow in neurologically normal children and children with cerebral palsy: An ultrasound investigation

Little data exist on the oral management of food boluses in neurologically normal children or children with cerebral palsy (CP). Twenty children with spastic CP and 20 neurologically normal children (age range: 6.2–12.9 years) were monitored with ultrasound imaging of the oral cavity during liquid and solid bolus tasks. A lip-cup contact detector synchronized to ultrasound image output was used during liquid tasks. Data collected from recorded ultrasound images were used to assess durational aspects of the oral phase of swallowing in neurologically normal children and children with CP. Coordinated analysis of ultrasound images with lip-cup contact data allowed timing of intervals in the pre-oral and oral phases of swallowing during liquid feeding tasks. Children with CP required more time than neurologically normal children for collection, preparation, oral transit, and total oral swallow time for 5-ml liquid boluses. Total oral swallow time was longer for solid bolus tasks in children with CP. Oral transit time for solid boluses was significantly longer than for liquid boluses in neurologically normal children and children with CP.     

Effect of oral sensorimotor treatment on measures of growth and efficiency of eating in the moderately eating-impaired child with cerebral palsy

Thirty-five children with cerebral palsy and moderate eating impairment were studied to determine the effect of oral sensorimotor treatment (OST) on eating efficiency and measures of growth (weight gain). After taking effects of maturation into account, 11 children who received OST (group A) exceeded their expected centile line by 1.7 percentile points after 10 weeks of treatment. Chewing exercises alone (group B) had no effect on weight gain. Although small decreases occurred in the time needed to eat three standard textures of food (solid, viscous, puree) in groups A and B, these were not significant. Children maintained their weight-for-age percentile line although at the lower end of expected norms. These children will be at risk of growth failure because of the increased energy demands once they enter their teenage growth spurt. The clinical implications of these findings are that prolonged mealtime and oralmotor therapies may be adequate through the childhood years. Thereafter, children's growth must be monitored carefully, and oral caloric supplementation is suggested to provide the necessary energy for growth.     

Modified barium swallow: clinical and radiographic correlation and relation to feeding recommendations

Clinical and videofluoroscopic evaluation of swallowing were correlated to determine their agreement and relationship to feeding recommendations. We reviewed a total of 148 patients with swallowing difficulties, of which 93 (45 women, 48 men; mean age 62 years) were evaluated by both clinical and radiographic examinations. A variety of materials were used for clinical bedside evaluation of oral and pharyngeal function. Radiographic examination was done with variable viscosity materials and videotape recording of the oral cavity and pharynx. The severity of oral and pharyngeal abnormalities was graded and findings of the examinations were compared. The combined results of both evaluations generated an index of swallowing difficulty which was correlated to the type of diet used if oral feeding was recommended or to a nonoral route of nutrition. In the assessment of oral and pharyngeal dysfunction, clinical evaluation and radiographic examination correlated closely in 94% of patients; however, the status of pharyngeal function was not determined in 61 (66%) of the 93 patients by clinical examination alone. The combined swallowing index was calculated in 89 patients and its severity correlated significantly with the type of feeding recommended; 64 patients were placed on one of three types of diets and 25 had enteral feedings. In conclusion, combined clinical and radiographic examinations correlated well, but clinical evaluation alone was limited by failure to evaluate the pharynx in many patients. The swallowing severity correlated well with final feeding recommendations.     

Influence of cold stimulation on the normal pharyngeal swallow response

We examined the potential influence of cold stimulation of the anterior tonsillar pillars, before and after topical anesthesia, on the temporal linkage between the oral and pharyngeal components of the swallow. We hypothesized that if elicitation of the pharyngeal swallow were dependent upon stimulation of faucial mucosal receptors this response would be facilitated by cold tactile stimulation and inhibited by topical anesthesia. In 14 healthy volunteers undergoing simultaneous videoradiography and manometry we measured and compared regional transit and clearance times, and the timing of hyoid motion, upper esophageal sphincter relaxation, and opening within the swallow sequence. There was a significant, volume-dependent forward shift in timings of hyoid motion, upper esophageal sphincter (UES) relaxation profile, and opening which were influenced neither by cold stimulation nor topical anesthesia. Regional transit and clearance times and UES coordination were not influenced by cold stimulation. Pharyngeal clearance time was prolonged by tonsillar pillar anesthesia due to earlier arrival of the bolus head at this region (p=0.002). We conclude that the normal pharyngeal swallow response is neither facilitated nor inhibited by prior cold tactile stimulation or topical anesthesia to the tonsillar pillars, respectively. These observations do not support the hypothesis that elicitation of the pharyngeal swallow response is dependent upon stimulation of mucosal receptors in the tonsillar arches.     

Use of the electroglottograph for measurement of temporal aspects of the swallow: Preliminary observations

The electroglottograph (EGG) is a noninvasive, electrical impedance device that was developed for observing vocal fold contact during phonation. After a thorough study of the frequency response characteristics of the EGG, we found that the EGG output can be used to identify maximum laryngeal displacement and the duration of laryngeal movement during swallowing. With a small intranasal pressure transducer placed beneath the velum and the EGG electrodes placed externally on the thyroid cartilage, additional information on the temporal aspects of the swallow can be measured. The EGG has direct clinical application when teaching such techniques as the safe swallow and Mendelsohn maneuver and it is useful as a research technique when using repeated measures designed to study the swallow reflex.     

Oral-motor skills following sensorimotor therapy in two groups of moderately dysphagic children with cerebral palsy: Aspiration vs nonaspiration

The purpose of this study was to determine the effect of oral sensorimotor treatment on oral-motor skills and measures of growth in moderately eating impaired children with cerebral palsy who were stratified by state of aspiration/nonaspiration. Twenty-seven children aged 2.5–10.0 years participated in this study (aspiration: n=7, nonaspiration: n=20). Weight and skinfold measures were taken. Children were observed at lunch time and six domains of feeding were examined: spoon feeding, biting, chewing, cup drinking, straw drinking, swallowing, and drooling. Children underwent 10 weeks of control and 10 weeks of sensorimotor treatment, 5–7 minutes/day, 5 days/week. Treatment compliance for the entire group was 67%. Children who aspirated had significantly poorer oral-motor skills in spoon feeding, biting, chewing, and swallowing than children who did not aspirate. There was significant improvement in eating: spoon feeding (fewer abnormal behaviors, p<0.03), chewing (more normal behaviors, p<0.003), and swallowing (more normal behaviors, p<0.008). There were no significant changes in drinking skills. Children as a group maintained their pretreatment weight-age percentile but did not show any catch-up growth. Children showed adequate energy reserves as measured by skinfold thicknesses. Improvement in oral-motor skills may help these children to ingest food more competently (i.e., less spillage). However, their weight remains at the lowest level of age norms.