Swallowing disorder refers to difficulty swallowing when eating or drinking. It is one of the common geriatric syndromes. With the acceleration of the aging of the population in our country, it is caused by aging, stroke, pharynx and laryngeal tumors postoperative surgery, etc. There are more and more patients with swallowing dysfunction.
Swallowing disorder mainly refers to the obstruction in the process of food entering from the mouth to the stomach, resulting in a feeling of obstruction and stagnation in the pharynx, retrosternal or xiphoid process posterior area. Especially dysphagia caused by organic diseases and physiological dysphagia. The latter has no underlying disease. The patient just feels that there is a mass blocking the pharynx and behind the sternum and cannot swallow.
| Symptoms of dysphagia
Dysphagia occurs in different diseases and will have different symptoms. Common ones include the following aspects:
1. Cerebral infarction Patients with dysphagia may manifest themselves as choking on drinking water or coughing when eating liquid food. Severe coughing, insensitivity to food, water, and mucous membranes, some of which may be accidentally swallowed into the trachea, causing aspiration pneumonia and repeated fever.
2. If dysphagia occurs due to neuromuscular disease, it may also be accompanied by difficulty in chewing. Therefore, eating hard and dry food will make swallowing more difficult, prolonged eating time, effortful eating, reduced food intake, malnutrition, and dehydration. Common clinical manifestations.
3. If it is neuromuscular junction disease , such as myasthenia gravis causing dysphagia, typical fatigue symptoms will appear. For example, you can eat steamed buns at the beginning and chew them with strength, but then you can only drink porridge. This happens a volatile situation.
4. If you have difficulty swallowing, bite your cheek at the same time, or your speech is unclear, the corners of your mouth are skewed, , and you have salivation symptoms when you lower your head, it indicates that the facial nerve is involved.
| Training methods for dysphagia
1. Organ training
1. Cheek practice: close your mouth, puff up your cheeks, hold for 5 seconds, relax, and then quickly transfer air to the left and right cheeks, repeat 5-10 times.
2. Tongue exercises such as extension, contraction, up and down, left and right swings, circular movements in the mouth, etc., each lasting 5 seconds, repeated 5-10 times. If conditions do not permit, passive tongue stretching activities can be used instead.
3. Lip exercises allow patients to pronounce sounds such as "wu", "yi" and "a" after inhaling, and they can shrink their lips to blow balloons, bubbles, etc. Training the lip muscles through pronunciation can enhance the glottis atresia function and respiratory control .
4. Mandibular, facial and cheek movements: Open the mouth to the maximum, hold for 5 seconds, then relax; move the mandible to the left/right, hold for 5 seconds, then relax, repeat 10 times or make exaggerated chewing movements, repeat 10 times; open the mouth Say "Yeah" with exaggerated movements, then close it quickly and repeat 10 times; close your mouth, puff out your cheeks, hold for 5 seconds, relax; open your mouth, lift the tip of your tongue to the back of your front teeth, stick to the hard palate and roll it back, that is, do Tongue curling exercise, last 5-10 times.
2. Laryngeal lifting exercise
For patients whose larynx can be lifted, let them swallow empty and maintain the lifted position. When swallowing, ask the patient to press the tongue against the hard palate, hold the breath, and maintain this position for a few seconds. At the same time, let the patient place his index finger on thyroid cartilage and his middle finger on cricoid cartilage to feel the larynx rising. For patients who are unable to lift their larynx, you can massage their neck and push up their larynx to promote swallowing.
3. Cold stimulation
Use tongue depressor to stimulate the back of the tongue. Use cold cotton swabs to stimulate the posterior pharyngeal wall, palatal arch, posterior root of tongue, soft palate in the morning, noon and evening every day to induce the swallowing reflex. , if choking or nausea occurs, stop stimulation. During cold stimulation, make swallowing movements. If there is excessive salivation, cold stimulation can be performed on the salivary glands on the affected side of the neck, 3 times a day for 10 minutes each time, until the skin becomes slightly red.
4. Feeding training Feeding training
is suitable for patients who are conscious, stable, and can produce a swallowing reflex. A small amount of accidental swallowing can also be coughed out at will. The specific method is as follows:
1. The eating position can be sitting, not lying down, and can be in a Dining table should not be eaten by the bed; patients who cannot sit up should raise the head of the bed at least 30 degrees, bend their head forward, and the feeder should be on the healthy side.
2. Feeding method
(1) Feed while standing on the healthy side of the patient, starting from 1-4 ml, and place the food bolus on the back of the tongue on the healthy side or on the cheek of the healthy side. Adults should not eat more than 300 ml each time. 30 ml after eating It is not advisable to turn over, buckle your back, suction, etc. within 1 minute.
(2) Empty swallowing: After each swallowing of food, do a few more empty swallowing movements to allow all the food to be swallowed before proceeding to the next step of feeding.
(3) Interactive swallowing: Let the patient swallow solid food and liquid food alternately, or feed a little water (1-2 ml) after each swallow. This will help stimulate the swallowing reflex and achieve the purpose of removing food retained in the pharynx, but be careful to avoid Accidents such as choking and aspiration of and may occur.
(4) Nodding swallowing: When the neck is tilted back, the epiglottis vallecula narrows, which can squeeze out the retained food. Then the head is lowered and the swallowing action is repeated several times to clear and swallow the retained food.
(5) Lateral swallowing: The piriform recess is another area where food is easily retained after swallowing. By using the chin to nod to the left and right, you can remove and swallow the piriform recess on both sides. Nest food.
3. Food selection should be based on the patient’s eating habits and severity of dysphagia, and select foods that are easily accepted by the patient. Patients with poor chewing ability should eat less meat or other solid foods and choose more foods that are easy to swallow, such as pureed vegetables, egg custard, thick soups, etc. Clean your mouth and pharynx before and after eating to reduce lung infection.
Dysphagia is very annoying, but the disease takes a long time to recover. You must persist in rehabilitation training. Only by persisting in training can you have hope of recovery. If the patient is in a bad mood, he or she must learn to relax in time, listen to more music, watch movies, and chat with good friends, which will be more conducive to the treatment of dysphagia.
