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Volume 62 (2011)
- Issue 6 Pages 511-
- Issue 5 Pages 433-
- Issue 4 Pages 377-
- Issue 3 Pages 315-
- Issue 2 Pages 63-
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Volume 62, Issue 5
Displaying 1-11 of 11 articles from this issue
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Special Issue on Rehabilitation in the Broncho-esophagological Field
Voice Rehabilitation
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Seiji Niimi2011 Volume 62 Issue 5 Pages 433-439
Published: October 10, 2011
Released on J-STAGE: October 25, 2011
JOURNAL RESTRICTED ACCESSIn order to improve vocal function, we have two choices to be applied : phonosurgery and voice therapy. For organic voice disorders the first choice should be phonosurgery. On the other hand, if the voice disorders are mainly caused by functional problems such as vocal abuse, hyper-function, hypo-function and so forth, voice therapy must be chosen. In this article, some basic items concerning voice therapy are discussed.
The concept of voice therapy consists of voice training and vocal hygiene. Since there have been many different maneuvers developed for voice therapy, we must be very conscious about selecting the most effective maneuver based on the scientific evidence. In order to choose the most appropriate way, we must consider the status of the function of the vocal organs, such as hyper- or hypo-function, etc.
Vocal hygiene concerns reformation of mal-habits in phonation and improvement of the environment of phonation. When vocal hygiene is introduced to patients, it reduces the recurrence rate of voice quality deterioration and inhibits the occurrence of vocal pathology. Physicians who engage in voice therapy must instruct the patient to observe vocal hygiene.
Voice therapy and vocal hygiene are two essential elements to improve voice problems.View full abstractDownload PDF (1197K) -
Aki Taguchi2011 Volume 62 Issue 5 Pages 440-444
Published: October 10, 2011
Released on J-STAGE: October 25, 2011
JOURNAL RESTRICTED ACCESSIn association with voice therapy and rehabilitation for dysphonia, here we primarily describe indications, treatment methods, and voice therapy methods. Voice therapy is generally carried out in a prescribed order, beginning with a medical interview followed by larynx observation, then medical examination, and finally treatment via therapy. The medical interview is extremely important for understanding the patient's issues and needs regarding his or her voice, and physicians should also inquire about the patient's occupation and occasions of experiencing voice overuse. Larynx observation should be conducted via larynx stroboscopy to observe vocal cord vibration precisely. In addition to aerodynamic inspection and acoustical analyses, subjective evaluations such as Voice Handicap Index may also aid in diagnosis. Prior to vocal therapy, patients should receive instruction on proper vocal hygiene, and any actions which the patient does not undertake should be stressed in particular. Methods of voice therapy fall into one of two categories : treatment dealing with symptoms, and comprehensive treatment. Symptom treatment methods include direction on changing vocal cord tension, pitch, and voice strength. Comprehensive vocal treatment methods include vocal function exercises, resonant voice therapy, and accent methods. These methods are intended to be implemented in patients'daily lives, and rehabilitation typically combines several of these treatment options. In performing vocal treatment, the doctor and speech therapist should share information and work together to promote treatment.View full abstractDownload PDF (277K) -
Yasushi Suzuki2011 Volume 62 Issue 5 Pages 445-452
Published: October 10, 2011
Released on J-STAGE: October 25, 2011
JOURNAL RESTRICTED ACCESSThere are many neuromuscular diseases presenting the possibility of voice or articulation disorders. When patients consult directly or have been referred to an otorhinolaryngologist for trouble relating to the voice or speech, we, otorhinolaryngologists occasionally suspect the existence of neuromuscular diseases from the features of the patient's voice and speech. We are also frequently requested to evaluate or the treat patients diagnosed with neuromuscular disease.
Recently, otorhinolaryngologists have been cooperating more closely with neurologists and rehabilitation doctors. Therefore, there is a growing call for otorhinolaryngologists who can provide proper advice relating to voice and articulation disorders, swallowing disorders and hearing impairments.
Here we describe the pathosis of typical neuromuscular diseases encountered in our general practice, the features of the voice in these diseases, and the vocal training provided as rehabilitation.View full abstractDownload PDF (2180K)
Respiratory Rehabilitation
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Takeshi Ishizaki2011 Volume 62 Issue 5 Pages 453-462
Published: October 10, 2011
Released on J-STAGE: October 25, 2011
JOURNAL RESTRICTED ACCESSRecently, there have many clinical guidelines or statements on evidence-based pulmonary rehabilitation in which recommendation items were validated. Comprehensive pulmonary rehabilitation is provided together with related professional health care providers (“team medical treatment”). In liaison with a local medical team, long-life pulmonary rehabilitation should be continued with acceptance of patients themselves and their families.
The final goals of pulmonary rehabilitation are alleviation of dyspnea and improvements in exercise ability, health-related quality of life, and activity in daily life. For widespread clinical applications, pulmonary rehabilitation, which has gradually begun to spread in Japan, needs to become more standardized and individualized for each patient. It is also necessary to expand enlightenment of medical staff and of local communities in order to acieve public recognition. Favorable impact of pulmonary rehabilitation on pulmonary diseases other than COPD has begun to appear, suggesting wide applications of pulmonary rehabilitation.View full abstractDownload PDF (1492K) -
Hiroyuki Nakamura2011 Volume 62 Issue 5 Pages 463-469
Published: October 10, 2011
Released on J-STAGE: October 25, 2011
JOURNAL RESTRICTED ACCESSThe purpose of preoperative respiratory care is to achieve early ambulation after surgery by improving the patient's general condition and preventing serious postoperative lung complications. Therefore, it is important to perform preoperative evaluation and predict postoperative complications and the effect on respiratory function by surgical approach. Smoking cessation for at least 1 month before surgery is recommended for smokers because they are at a significantly higher risk of developing postoperative pneumonia than non-smokers. Systematic reviews on various techniques of airway clearance have not provided convincing evidence of their effectiveness. The use of an airway clearance technique should therefore be based on the patient's condition in consideration of its advantages and disadvantages. Incentive spirometry is routinely used after surgery, but there is no sufficient evidence supporting its effectiveness. Lung cancer, esophageal cancer, and head and neck cancer are strongly related to smoking, and therefore patients with such cancers often have chronic obstructive pulmonary disease (COPD).Because there is an association between airflow limitation in COPD and the incidence of postoperative lung complications, it is of great significance to preoperatively provide comprehensive respiratory care, including improvement of respiratory function, in patients with COPD. There have been a number of reports that preoperative respiratory care, such as inspiratory muscle training, reduces postoperative lung complications. Further studies are necessary to provide high-quality evidence.View full abstractDownload PDF (290K) -
Tetsuri Kondo, Tsuyoshi Ichikawa2011 Volume 62 Issue 5 Pages 470-476
Published: October 10, 2011
Released on J-STAGE: October 25, 2011
JOURNAL RESTRICTED ACCESSThe larynx and pharynx play important roles in food swallowing. Food aspiration into the lower airways is prevented here, and vocal cord closure is necessary in coughing. Integration of these actions is also performed here. After resection of oro-glossal carcinoma, swallowing rehabilitation concerning oral and pharyngeal phase impairments is necessary. Tracheostomy eliminates the compressive phase of a cough, and thus attenuates cough strength. Patients should be encouraged to walk near their bed as early as possible after an esophagectomy. In such patients, selective bronchial aspiration using bronchoscopy may be useful for protection of the suture. Some devices analogous to non-invasive mechanical ventilation are also widely used for cough assistance. Since esophagectomized patients may have aspiration at the laryngeal elevation as well as in the laryngeal descent phase, food should have appropriate viscosity and elasticity when oral ingestion is started. Since obstructive sleep apnea syndrome is a common disease now, these patients may undergo head and neck surgery. After general surgery, a lateral or semirecumbent position may be beneficial to prevent sleep apnea. Nasal CPAP should be started as fast as possible after extubation of the endotracheal tube.View full abstractDownload PDF (537K)
Swallowing Rehabilitation
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Ichiro Fujishima, Hideaki Kanazawa2011 Volume 62 Issue 5 Pages 477-484
Published: October 10, 2011
Released on J-STAGE: October 25, 2011
JOURNAL RESTRICTED ACCESSTo treat swallowing disorders arising from broncho-esophagological disease it is indispensable to control the causative disease. Adequate rehabilitation improves not only swallowing function but also quality of life in disabled people. In many cases, diet modification, positioning strategies and various rehabilitation trainings are effective for a various swallowing disorders. Broncho-esophagological surgeons should be fully aware of the nature of the disease and of the effectiveness and limitations of its treatment by surgery.View full abstractDownload PDF (1157K) -
Yukio Ohmae2011 Volume 62 Issue 5 Pages 485-493
Published: October 10, 2011
Released on J-STAGE: October 25, 2011
JOURNAL RESTRICTED ACCESSPosture changes are used as therapy techniques for several types of patients with dysphagia. Postural strategies for dysphagia are designed to eliminate the risk of aspiration by altering the bolus flow and pharyngeal dimensions during swallowing. When postures are selected to match the anatomic and physiologic aspects of swallowing disorders, the postural techniques have been demonstrated to eliminate aspiration effectively. It is important to diagnose the anatomic and physiological features of swallowing disorders, and then select the appropriate posture according to the swallowing problem. Recently videofluorographic and/or videoendoscopic examinations are used as precise diagnostic and management tools.
The head down (chin down) posture is widely used as a safe position with swallowing disorders. Chin down produces space in the vallecula, so that bolus entering the vallecula remains until the pharyngeal swallowing is triggered. Head rotation to the damaged side allows bolus passage down the intact contralateral side. Head back provides gravity assistance to the bolus flow through the oral cavity and pharynx. Combinations of these strategies can be used with added effect.
Postural techniques are helpful to prevent aspiration through redirected bolus flow or changed pharyngeal dimensions. However, as definitions of posture positions have never been clear, we should define postural positions and their physical effects on swallowing functions.View full abstractDownload PDF (3309K) -
Yasushi Fujimoto, Tsutomu Nakashima2011 Volume 62 Issue 5 Pages 494-500
Published: October 10, 2011
Released on J-STAGE: October 25, 2011
JOURNAL RESTRICTED ACCESSTo establish a precise rehabilitation program for dysphagia after surgical procedure for head and neck cancer, it is very important to address not only body functions but also restrictions in participation and activity. A team approach (with nurses, speech language pathologists, nutritionists, psychiatrists and dentists) is necessary for intensive dysphagia intervention. Surgical plans (organs resected and reconstruction methods) can be a predictor of swallowing disturbance. We can devise a rehabilitative approach before surgery. Swallow exercise before surgery enables patients to understand how to prepare for the operation and provides a sense of ease. Swallow exercise is started just after wound healing, with basic (indirect) exercise followed by phased direct exercise. Based on accurate evaluation of videofluorography and fiberendoscopic evaluation of swallowing, we can select suitable rehabilitative approaches. In severe cases, surgery such as laryngeal suspension, cricopharyngeal myotomy and arytenoid adduction, needs to be considered in conjunction with continuous therapy.View full abstractDownload PDF (1106K)
Glossary
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]2011 Volume 62 Issue 5 Pages 501-503
Published: October 10, 2011
Released on J-STAGE: October 25, 2011
JOURNAL RESTRICTED ACCESSDownload PDF (1717K) -
[in Japanese]2011 Volume 62 Issue 5 Pages 504-505
Published: October 10, 2011
Released on J-STAGE: October 25, 2011
JOURNAL RESTRICTED ACCESSDownload PDF (1377K)
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