RESUMO
Sarcopenic dysphagia is defined as dysphagia caused by sarcopenia of the whole body and swallowing-related muscles. We present a case of sarcopenic dysphagia with improved swallowing function after strength training of swallowing-related muscles using neuromuscular electrical stimulation (NMES). A 78-year-old man was admitted to our hospital with an intraductal papillary mucinous tumor of the pancreatic duct. After admission, the patient developed aspiration pneumonia and was placed on strict bed rest without oral intake, which resulted in progressive malnutrition. At the start of swallowing rehabilitation, he had whole-body sarcopenia, nutritional impairment, and weakness in swallowing-related muscles, with a maximum tongue pressure of 21.4 kPa and an opening force of 5.1 kg. In the videofluoroscopic swallowing study, he aspirated 3 cc of a moderately thick liquid. Consequently, as part of swallowing rehabilitation, strengthening training of swallowing-related muscles with NMES was undertaken for about three weeks. As a result, the maximum tongue pressure and opening force improved to 28.4 kPa and 6.8 kg, respectively. A subsequent videofluoroscopic swallowing study showed no obvious aspiration during any procedure. The patient was discharged on the 86th day on a regular diet. As a component of swallowing rehabilitation, NMES may offer therapeutic benefits for patients with sarcopenic dysphagia.
RESUMO
Background: Constraint-induced aphasia therapy (CIAT) has been reported as a short-term, intensive language training program for improving language function in patients with chronic aphasia. We report the recovery of language function in a patient with chronic aphasia who was evaluated in the baseline assessment as having reached a plateau. Case: The patient with subcortical aphasia was a 62-year-old, right-handed man. At 192 days after left putamen hemorrhage, he visited our hospital to begin CIAT. The patient's language and speech abilities were evaluated 1 month before and immediately before the start of CIAT. To evaluate the training effect, language function was assessed immediately after, 1 month after, 3 months after, and 6 months after the end of CIAT. The Western Aphasia Battery (WAB), the single-word-naming task in the Test of Lexical Processing in Aphasia (TLPA), and the Verbal Activity Log (VAL) were used to assess his language function and the amount of spoken language. From 1 month before CIAT to 6 months after CIAT, the WAB Aphasia Quotient increased by 6.1 points. Compared with before therapy, the errors of apraxia of speech in the TLPA disappeared from immediately after to 6 months after CIAT. Although the VAL score at 3 months after CIAT was higher than that before the start of CIAT, the score decreased after 6 months because of reduced opportunities for communication with friends. Discussion: CIAT improved the word-naming ability and amount of spontaneous, real-world spoken language in a patient with chronic aphasia.
