A case of dysphagia in the chronic period of cerebral infarction - Efficacy of indirect therapy for dysphagia

Abstract

This report describes a patient aged sixty-one with dysphagia who had suffered putaminal infarction five years previously. His swallowing function had gradually deteriorated over the five years. He was admitted to our hospital with aspiration pneumonia on 1 August 2002. His ADL consisted of independent walking with t-cane and driving a wheelchair, and he had no other disability except for right hemiplegia and dysphonia. His MPT was three seconds at 30 August. A brain MRI did not show any new lesions. The abdominal muscles were hypertonic. At sitting and riding in a wheelchair, posteriorly-tilted pelvis, fixed-positional neck and hyper-flexed neck were observed. An esophago-pharyngogram corroborated the aspiration on 30 August. We thought the change of posture during the five years had been brought about by the dysphagia. A physical therapist performed indirect therapy from 30 August, focused on improvement of posture. A month later, the patient could sit and ride in his wheelchair with naturally-tilted pelvis. An esophago-pharyngogram showed no aspiration on 11 October. He could swallow without aspiration. Our conclusion is that gradual change of posture can cause deterioration of swallowing in a dysphagia patient in the chronic period of cerebral infarction. Indirect therapy by a physical therapist on such patients with dysphagia is effective.