title: Proposal for a New Exercise Method for Dysphagia with Velopharyngeal Inadequacy: A Case of Bickerstaff's Brainstem Encephalitis.
abstract: Bickerstaff's brainstem encephalitis is an autoimmune disease with the primary lesion situated in the brainstem and three cardinal signs: ophthalmoplegia; ataxia; and impaired consciousness. A 68-year-old man was started on rehabilitation exercise 3 months after onset of Bickerstaff's brainstem encephalitis, due to remnant dysarthria and dysphagia (Functional Oral Intake Scale, level 5) after the cardinal signs of Bickerstaff's brainstem encephalitis resolved. Exercise involved using a straw in the anterior midline between the dorsal tongue and hard palate. While the patient was inhaling through the straw, the straw was blocked. After strengthening suction as much as possible, the patient was asked to immediately dry swallow at the same time that suction was stopped. Effects of exercise were examined using videofluorographic swallowing studies before and after 6 weeks of training to compare posterior and superior velar displacements and the presence of nasopharyngeal reflux. No adverse effects of exercise were encountered, and Functional Oral Intake Scale improved to level 7, with significant increases in posterior and superior velar displacement during swallowing compared with before training. In addition, nasopharyngeal reflux that had consistently been seen on swallowing before training was absent after 6 weeks of exercise. This exercise method may prove useful.
authors.affiliation: Department of Rehabilitation Medicine, Tokai University Oiso Hospital, 21-2 Gakkyo, Oiso-machi, Naka-gun, Kanagawa 259-0198, Japan. y-koyama@tokai.ac.jp.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Koyama
authors.forename: Kayako
authors.initials: K
authors.lastname: Nitta
authors.forename: Michi
authors.initials: M
authors.lastname: Tochikura
authors.forename: Takashi
authors.initials: T
authors.lastname: Kasahara
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kametsu
authors.forename: Minoru
authors.initials: M
authors.lastname: Toyokura
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Masakado
mesh_terms: D000368:Aged; D001259:Ataxia / Q000150:complications; D001933:Brain Stem; D003244:Consciousness Disorders / Q000150:complications; D003680:Deglutition Disorders / Q000209:etiology* / Q000503:physiopathology / Q000534:rehabilitation*; D004660:Encephalitis / Q000150:complications*; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D009886:Ophthalmoplegia / Q000150:complications; D014681:Velopharyngeal Insufficiency / Q000209:etiology*