2007 Volume 11 Issue 2 Pages 137-145
We report a patient with dysphagia after a brain-stem stroke who developed pleurisy caused by aspiration during swallowing rehabilitation. To prevent aspiration, safety conditions were experimentally determined by videofluoroscopic examination of swallowing（VF）before the start of swallowing rehabilitation, which was gradually performed. However, pleurisy occurred in the patient when food was changed from pureed food to that requiring mastication. So we developed a new rehabilitation method to refer VF after 24-day fasting. In this method, a bolus was put into the pharynx after laryngeal lifting was enhanced by positioning the back of the tongue as in the pronunciation of “ki” , and strongly swallowed when it was positioned at the epiglottic vallecula. Rehabilitation was restarted with it after inward rotation of the vocal cord was performed. As a result, food requiring mastication, which may have caused the aspiration, could be taken, and the eating efficiency became higher than before the occurrence of pleurisy. Even though aspiration was not observed by VF, it could have occurred in the patient when pureed food was taken. Furthermore, taking food requiring mastication may have enhanced the difference in the timing and aspiration.
