重症心身障害児者の嚥下時舌骨運動の特徴:健常成人との比較  [in Japanese] Characteristics of Hyoid Bone Movement during Swallowing in Patients with Severe Motor and Intellectual Disabilities: A Comparison with Healthy Adults  [in Japanese]

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Author(s)

    • 中村 達也 NAKAMURA Tatsuya
    • 島田療育センターはちおうじリハビリテーション科 Department of Rehabilitation, Shimada Ryoiku Center Hachioji
    • 北 洋輔 KITA Yosuke
    • 国立精神・神経医療研究センター精神保健研究所知的障害研究部 Department of Developmental Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry
    • 甲斐 智子 KAI Tomoko
    • 島田療育センターはちおうじリハビリテーション科 Department of Rehabilitation, Shimada Ryoiku Center Hachioji
    • 鮎澤 浩一 AYUZAWA Koichi
    • 島田療育センターはちおうじリハビリテーション科 Department of Rehabilitation, Shimada Ryoiku Center Hachioji
    • 小沢 浩 OZAWA Hiroshi
    • 島田療育センターはちおうじ神経小児科 Department of Pediatrics, Shimada Ryoiku Center Hachioji

Abstract

<p>【目的】本研究では,重症心身障害児者の咽頭期嚥下の特徴を,嚥下時舌骨運動を健常成人と比較することで明らかにすることを目的とした.【対象と方法】健常成人24名(健常群)と重症心身障害児者24名(障害群)について,嚥下造影検査(VF)を用いてペースト食品3~5 mLの嚥下を撮影し,30フレーム /秒で動画記録した.第二および第四頸椎を基準線とした座標面を設定し,VF動画をフレームごとに解析することで,舌骨の挙上開始時から最大挙上時までの前方・上方・総移動距離,移動軌跡,下顎 ―舌骨間距離を測定した.さらに,舌骨移動時間を各対象者について共通の時間単位に線形変換後,舌骨運動を挙上相と前進相の段階に分けた.そして,健常群の平均値95%信頼区間下限値を基準値とし,挙上相で基準値を下回った者を挙上相後退群,前進相で下回った者を前進相停滞群と群分けし,評価結果を一元配置分散分析で群間比較した.【結果および考察】挙上相後退群は12名,前進相停滞群は7名であった.分散分析および多重比較の結果,舌骨の前方移動距離は,健常群が挙上相後退群(<i>p</i><0.01)および前進相停滞群(<i>p</i><0.01)に比較して有意に大きかった.舌骨の上方移動距離は,挙上相後退群が健常群に比較して有意に大きかった(<i>p</i><0.01).下顎 ―舌骨間距離は,挙上相後退群が健常群(<i>p</i><0.01),前進相停滞群(<i>p</i><0.05)に比較して有意に大きかった.この要因として,挙上相後退群は腹側舌骨上筋群の筋の延長による筋出力低下,前進相停滞群は舌骨下筋群の伸張性低下または低緊張による筋出力低下が考えられた.【結論】重症心身障害児者には,舌骨が主に上方に移動すべき時期に後方に牽引される群と,主に前方に移動すべき時期に移動距離が不足する群が存在した.</p>

<p>Aims: This study aimed to clarify the characteristics of pharyngeal swallowing in patients with severe motor and intellectual disabilities (SMID) by comparing hyoid bone movements during swallowing in patients with SMID and healthy adults. Subjects and Method: This study included 24 healthy adults and 24 patients with SMID. We recorded videofluoroscopic images of swallowing (VF) at 30 frames/s as subjects swallowed 3 to 5 mL of food paste. A coordinate plane with the second and fourth cervical vertebrae as the reference line was set and VF animation was analyzed for each frame. For the period from the start of hyoid bone elevation to the maximum elevation, we measured the anterior/superior/total moving distance, movement trajectory, and distance between mandible and hyoid bone. The hyoid bone movement time was linearly transformed for each subject to common time units. Hyoid bone movement was divided into a superior phase and an anterior phase, using the mean lower limit of the 95% confidence interval for healthy adults as the reference value. Those who were below the reference value in the superior phase were classified as the superior phase recession group (SR), and those below the reference value in the anterior phase were classified as the anterior phase stagnation group (AS). The results were compared using one-way analysis of variance (ANOVA). Results and Discussion: The SR group included 12 subjects, with 7 in the AS group. ANOVA with multiple comparisons showed that the anterior movement distance of the hyoid bone was significantly greater in healthy adults than in the SR (<i>p</i><0.01) and AS (<i>p</i><0.01) groups. The superior movement distance of the hyoid bone was significantly greater in the SR group than in healthy adults (<i>p</i><0.01). The distance between the mandible and the hyoid bone was significantly greater in the SR group than in healthy adults (<i>p</i><0.01) and the AS group (<i>p</i><0.05). It was thought that muscle contraction power decreased due to extension of the ventral suprahyoid muscles in the SR group, and that muscle contraction power decreased due to a decrease in extensibility or to hypotonicity of the infrahyoid muscles in the AS group. Conclusion: Among patients with SMID, the hyoid bone pulled backward in one group when it should have moved upward, and moved an insufficient distance in the other group when it should have moved forward.</p>

Journal

  • The Japanese Journal of Dysphagia Rehabilitation

    The Japanese Journal of Dysphagia Rehabilitation 22(3), 205-213, 2018

    The Japanese Society of Dysphagia Rehabilitation

Codes

  • NII Article ID (NAID)
    130007639909
  • NII NACSIS-CAT ID (NCID)
    AA11193069
  • Text Lang
    JPN
  • ISSN
    1343-8441
  • NDL Article ID
    029667766
  • NDL Call No.
    Z74-B252
  • Data Source
    NDL  J-STAGE 
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