2003 Volume 7 Issue 2 Pages 151-158
[Purpose] We examined the effects of manual therapeutic techniques and their duration on two Dysphagia patients with brain damage．[Case 1] The 79-year old male patient had undergone a cerebral infarction and suffered from right Hemiplegia．The patient had been kept under continuous catheterization with a naso-gastric tube and tracheal cannula for 6 months．For the first evaluation we used Blue Dye Marker (BDM)，which went down the trachea．We used manual therapeutic techniques on the neck and truncus (especially the suprahyoid muscle group) of this patient (hospitalized during this time)．After 5 weeks，there were no traces of intracheal BDM．The tracheal cannula was removed and he was able to eat．[Case 2] The 64-year old female patient suffered from normal pressure hydrocephalus for 20 months after having undergone a shunt operation．Her dietary intake was almost 60％．We thought her limited ingestion was a result of high-tone of her neck and face during meals．We immediately tried a treatment to reduce the hypertonia of her neck and face，and to ultimately stretch contractile muscles．After the treatment， she was able to ingest more，and occurrences of high-tone in her face and neck decreased．As of the next day，though，these results were no longer stable．We implemented a program that informed the care staff about various body positioning techniques，as well as welfare equipment．Alongside the staff we worked with the assistive devices and body positioning techniques．After receiving treatment from the care staff，her dietary intake was 90％． [Consideration about clinical] The rigidity of the muscles which block swallowing can be attributed to both physiological contraction and pathophysiological reduction． In selecting manual therapeutic techniques one should understand the characteristics of the target area’s anatomy． We believe that the suprahyoid muscle group should focus only on swallowing instead of body posture． For this treatment to continue to be effective， assistive devices （adaptable to patients） and effective body postures （for individual patients） need to be chosen． [Conclusion] With our knowledge of anatomy and physiology， we made use of manual therapeutic techniques， in order to reduce hypertonia occurring in the areas surrounding the face and neck． These techniques took effect immediately． However， in maintaining these results it is necessary for the team to take into account the swallowing mechanisms and the environmental adaptation involved in helping the patient．
