2010 Volume 14 Issue 2 Pages 155-161
A 41-year-old woman with dysphagia due to Foix-Chavany-Marie syndrome (FCMS). She showed voluntary movement disorder of facial, lingual, pharyngeal, masticatory, and developed anarthria and dysphagia. The voluntary movement of affected muscle was impossible except for only mouth opening but automatic and emotional movement such as laughter or a yawn was preserved (automatic-voluntary-dissociation). Videofluoroscopic examination of swallowing showed impaired oral cavity stage severely and transfer food bolus to the pharynx even in the reclined position of 30-degree and the food inserted in the back of the tongue. We performed passive exercise for affected muscles but voluntary movement did not improve at all. It was impossible that she masticated, but we observed mastication by a jaw and a tongue movement and swallowing saliva in a non-intentional scene. Therefore, we thought that it could use this automatic masticatory movement as process to transfer food bolus to pharynx. We performed sensory input for mastication and rehabilitation to elicit masticatory movement. Stimulation with the spoon which picked up food to push a lower jaw molar tooth part as methods to elicit masticatory movement was effective. Just after this stimulation, a jaw and a tongue rhythmical vertical motion similar to mastication occurred and transferred food bolus to pharynx. As a result of having continued feeding training using this stimulation, use of masticatory movement, placed at 45-degree reclined position, made it possible for the patient to ingest paste food. Continuation of training to induce masticatory movement leads to depression of input threshold of masticatory movement and activation of masticatory CPG and we speculate it contributed to improvement to transfer food bolus to pharynx by masticatory movement.
