Abstract
We treated a brainstem stroke dysphagia patient with poor tongue movement, and found that a palatal augmentation prosthesis (PAP) was helpful for dysphagia rehabilitation. The patient was a 76-year-oldmale who had been receiving PEG feeding following a brainstem stroke. He was referred to us for dysphagia rehabilitation after his general condition had stabilized. At the first examination, the patient was clearly conscious, had tetraplesia, severe hoarseness, and dysarthria. Videoendoscopy was performed to evaluate his swallowing function. Poor tongue propulsion, mild delay of swallowing, moderate pharyngeal residue after swallowing and silent aspiration when taking thin liquid were observed, but pharyngeal contraction itself was not damaged. We remodeled the upper denture to PAP using soft relining, and started direct exercise by jelly or thick liquid. As a result, after three monthsof rehabilitation he could eat soft meals orally.
Using videofluoroscopy and manofluorography, we compared the swallowing functionwith PAP and without PAP to examine the effects of PAP in terms of: 1) the oral transit time, 2) the pharyngeal transit time, 3) the tongue basepharyngeal wall contact time, 4) the pharyngeal airway closure time, 5) manofluorographic analysis at the upper esophageal sphincter, and 6) the pharyngeal residue.
Swallowing improved in all the items with PAP than compared withno PAP. We conclude that PAP can be considered effective for brainstem stroke patients with pharyngeal dysphagia.
