Abstract
We present a case of a woman in her 30s with panhypopituitarism that had persisted for 3 years. She fell unconscious and was diagnosed with central pontine myelinolysis. After acute stage therapy, she regained alertness; however, spastic tetraparesis, dysphagia, and dysarthria persisted. She was transferred to our hospital to undergo rehabilitation. To reduce spasticity of shoulder joints, orthopedic selective spasticity control surgery (OSSCS) of the bilateral latissimus dorsi, teres major, long and short heads of the humeral biceps, and long head of the humeral triceps muscles was performed. Before OSSCS, her tongue movement was compensated using her jaw motion while talking. Her speech intelligibility rating scale score was 4. She underwent grade 3 swallowing training of food with partial aid in a 50° upright position. She could not move the bolus of food using her tongue; instead, she extended her neck in order to swallow. After OSSCS, the voluntary movement of her tongue improved, and her speech intelligibility rating scale score was 3-4. She could remain in a sitting position in a wheelchair. She started eating normal food by herself using chopsticks 47 days postoperatively. The time required for meal intake remarkably reduced.
OSSCS of the bilateral shoulder joints was performed to reduce spasticity of the upper extremities. In addition, dysphagia and dysarthria also improved following OSSCS. Recently, dysphagia due to malposition of the scapula or trunk has been reported. OSSCS has been found to facilitate the sitting position and improve the range of shoulder joint and scapula movements as well as the range of tongue and larynx movements.
Thus, an approach to correcting truncal position and improving shoulder joint and scapula movements may be necessary to treat spastic dysphagia and dysarthria.
