巴金森病吞嚥困難的新近發展與吞嚥復健治療建議

Swallowing Rehabilitation of Dysphagia in Parkinson Disease: Recent Advances and Recommendations

10.6315/TJPMR.202106_49(1).0001

王錦滿(Chin-Man Wang)；吳逸如(Yih-Ru Wu)；王亭貴(Tyng-Guey Wang)

巴金森病（Parkinson disease） ； 吞嚥困難（dysphagia） ； 早期治療（early intervention） ； 吞嚥復健治療（swallowing rehabilitation） ； Parkinson disease (PD) ； dysphagia ； early intervention ； swallowing rehabilitation

台灣復健醫學雜誌

49卷1期（2021 / 06 / 01）

1 - 10

繁體中文

吞嚥困難是巴金森病常見的問題，輕者影響生活品質，嚴重者導致營養不良、水分攝取不足，甚至肺炎造成死亡。吞嚥困難的介入是巴金森病的復健照顧中重要的一環，需要臨床工作者與研究者正視這個問題，積極針對這個課題，發展評估工具與治療處理策略。早期症狀輕微時以吞嚥障礙問卷、慕尼黑吞嚥困難測試問卷或非侵入式的表面肌電圖、感測器檢查評估病狀，需要確定誤吸狀況時，建議以螢光吞嚥攝影或纖維內視鏡來檢查。巴金森病是退化性疾病，吞嚥困難的症狀大多數隨著病程越來越嚴重，因此希望早期發現問題與診斷，及早給予治療與建議，以減緩變嚴重之速度。先前巴金森病吞嚥困難的治療建議大多依據腦中風吞嚥的治療來訂定，但巴金森病吞嚥困難之個別性與複雜性較腦中風高，有更多系統受影響，需跨專科的治療團隊合作。積極吞嚥復健治療，包含口腔運動、喉部運動、發聲練習、呼肌訓練、唱歌、居家吞嚥訓練或居家口腔運動等。口腔清潔衛生在無法由口進食的病人仍需每日執行，可減少肺炎發生。經由教育來提升病人、照顧者與醫療團隊對巴金森病吞嚥困難的相關知識，才有機會早期發現、早期診斷與治療，減緩吞嚥功能的退化。早期治療強調預防與減緩退化，並建議每隔三個月追蹤其狀況，晚期症狀嚴重時，追蹤評估與治療頻率需增加。

Dysphagia is common in Parkinson disease (PD). Dysphagia may affect quality of life in the early stage of PD and can cause dehydration, malnutrition, or even result in pneumonia and mortality in the late stage. Accordingly, management of dysphagia is a crucial issue in PD. Clinicians and researchers should spend more effort developing sensitive evaluation tools and effective intervention strategies for dysphagia in PD. In the early stage of disease, the Swallowing Disturbance Questionnaire, Münich Dysphagia Test for Parkinson’s Disease questionnaire, or noninvasive tools involving surface electromyography or sensors should be used to detect subtle or mild dysphagia. In the late stage, a video fluoroscopic swallowing study or fiberoptic endoscopic examination are recommended for detecting penetration, aspiration, and bolus residuals. PD is a degenerative disease. The symptoms of dysphagia may get worse and be related to disease severity. Therefore, early detection with early diagnosis to enable an early intervention may slow the progress of dysphagia in PD. Traditional swallowing rehabilitation programs for patients with stroke were previously applied directly to patients with PD. The causes of PD-related dysphagia are heterogeneous, and more systems are affected than in stroke. Accordingly, more experts should form the transdisciplinary care team for PD swallowing rehabilitation than in stroke. Active therapeutic programs exist that have been proven to benefit PD dysphagia; they include oral motor exercises, laryngeal exercises, Lee Silverman voice treatment, expiratory muscle strength training, signing, home programs of swallowing training, and home programs of oro-motor exercises. In patients with PD and severe dysphagia who receive tube feeding, oral hygiene remains a critical part of daily care and may decrease the development of aspiration pneumonia. Through education of patients with PD, their caregivers, and medical teams, early intervention for PD-related dysphagia can be accomplished with early detection. Such efforts may help slow the progress of swallowing dysfunction and prevent complications in PD. However, regular follow-ups at 3-month intervals are suggested for the evaluation of swallowing function in PD. When comorbidity with acute swallowing function declines, intense active swallowing rehabilitation programs should be employed.

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