2021 Volume 25 Issue 3 Pages 252-258
Introduction: We report a case of multiple system atrophy in which oral ingestion was successfully introduced in the complete lateral decubitus position (CLDP).
Case: The patient was an 87-year-old male with multiple system atrophy diagnosed 4 years prior. The patient had undergone gastrostomy.
Course: The patient was independent in oral ingestion on admission. Due to gradually progressive dysphagia, enteral feeding was initiated through gastrostoma on Day 79 after admission. Swallowing rehabilitation in the conventional position (supine position angled at 30° with neck flexion) was initiated on Day 90. However, swallowing rehabilitation was suspended because an increased body temperature was observed 3 days later; only enteral feeding was continued. After the increased body temperature was resolved, videoendoscopic evaluation of swallowing (VE) was performed to fulfill the wish for oral ingestion by the patient and his family on Day 213. The Hyodo score was 7 in both the conventional position and CLDP. As the neck was elevated due to rigidity, we considered that swallowing rehabilitation in the CLDP would be preferable. On Day 217, swallowing rehabilitation therapy was initiated. The post-clinical course was uneventful without a fever. VE was performed again on Day 254. No apparent finding of aspiration pneumonia was observed. On Day 278, the patient could ingest orally with assistance from a nurse.
Discussion: Prior to swallowing rehabilitation in the CLDP, a fever related to aspiration pneumonia was observed in this case. This possibly occurred because dysphagia and the rigidity of the neck both resulted from multiple system atrophy. According to the findings of preceding VE, the conventional position could also have been an option. However, due to the rigidity of the neck, swallowing rehabilitation in the CLDP was indicated. After 2 months of swallowing rehabilitation in the CLDP, the patient could ingest orally. An advantage of the CLDP is that the method seems sufficiently simple for medical staff who are not swallowing therapists to assist patients with dysphagia. As observed in this case, the CLDP may be applicable for other diseases in which swallowing rehabilitation in the CLDP has not been described to date. Standardized criteria are also warranted for further application of the CLDP.
