以密集式呼吸肌阻抗訓練對於急性後期合併吞嚥障礙患者的呼吸、吞嚥功能與舌骨位移量之效果

吞嚥障礙病患可以藉由呼吸肌阻抗訓練（Respiratory Muscle Strength Training, RMST）提升其呼吸、吞嚥功能與舌骨位移量，呼吸肌與舌骨上肌群的肌力提升為間接治療中重要的訓練項目之一，國內高雄長庚醫院曾以壓力閾值型阻抗設備進行針對以口進食功能、呼吸及嗓音音質的相關研究，但卻未深入探討RMST對於吞嚥功能的成效及相關影響。本研究目的為探究使用自製流速限制型阻抗訓練器執行RMST對於呼吸、吞嚥、以口進食功能及舌骨位移量的效果。研究採單一受試多重處理實驗設計（ABBA），招募三位急性後期照護病房中吞嚥障礙病患為研究對象，研究對象皆會接受除了臨床常規訓練外的RMST，研究期間每週量測最大吐氣壓力與功能性以口進食量表，且研究對象在訓練前和訓練後皆會完成電視螢光吞嚥攝影檢查，分析其吞嚥影像，包含嗆入-吸入量表、改良式鋇劑吞嚥障礙量表與舌骨位移量。研究結果顯示三位研究對象經八週的RMST後，皆可增加其最大吐氣壓力、改良式鋇劑吞嚥障礙量表、功能性以口進食量表、嗆入-吸入量表與舌骨垂直位移量之表現。本研究存有三項研究限制，分別為因納入條件嚴謹及較長的介入週期以致於樣本數較少、量性分析上無進行信度比較與自主訓練時訓練次數計算有可能出現誤差，該訓練尤可提供呼吸肌無力與吞嚥障礙患者介入之參考。

Dysphagia can improve their respiratory function, swallowing ability, and hyoid bone movement through respiratory muscle strength training (RMST). Strengthening respiratory muscles and suprahyoid muscles is one of the important indirect training approaches. Kaohsiung Chang Gung Memorial Hospital in Taiwan previously conducted research using pressure threshold resistance devices on oral intake function, respiratory function, and voice quality, but did not investigate the effects and relevant impacts of RMST on swallowing function.The purpose of this study is to investigate the effects of RMST using a self-made flow-restricted resistance training device on respiratory function, swallowing function, oral intake ability, and hyoid bone movement.The study adopted a single-subject multiple treatment design (ABBA) and recruited three patients with dysphagia from a post acute care. In addition to usual care, the participants received RMST. During the study period, maximum expiratory pressure (MEP) and function oral intake scales (FOIS) were measured weekly.Swallowing videofluoroscopy was performed before and after training to analyze swallowing, including penetration-aspiration scale (PAS), modified barium swallow impairment profile (MBSImP), and hyoid bone movement. The results indicated that after 8 weeks of RMST, all three participants increased their MEP, MBSImP, FOIS, PAS, and hyoid vertical movement. The study had three limitations: the strict inclusion criteria and longer intervention period led to a smaller sample size, no reliability comparison was performed for quantitative analysis, and there might be errors in calculating the number of self-training sessions. Based on the results, These findings suggest that this training protocol may provide a valuable reference for intervention in patients with respiratory muscle weakness and dysphagia.