Ubunzima bobuchopho bubunyanzelekile ukuhlafuna nokugwinya
Ingxenye yengqondo ejongene nokuvelisa intetho nokulawula imisipha yomlomo kunye nomhombo ingonakaliswe ngexesha loxinzelelo lwentloko . Lo monakalo uchaphazela indlela iimisipha kunye neentsholongwane ezinxulumene nazo ziphendule kwimilayezo evela kwingqondo okanye kwixinzelelo kunye neengqondo ezibangelwa emqaleni. Xa inkqubo yokuhlafuna nokugwinya ingasebenzi kakuhle, inokukhokelela kwiinkathazo ezininzi ezibandakanya i-pneumonia.
Ukutya nokugwinya iingxaki kungabikho ukungalingani phakathi kwengqondo kunye neengxaki ezixanduva, nangona kunokunokuba nomonakalo wezinto ezincinci ezifaka ingxaki kwingxaki.
Ubungqina kunye nokuLungisa
Kukho izidumbu ezingama-26 emlonyeni, entanyeni, emqaleni nasemgodini apho ubuchopho bulawula xa ukutya okanye umbane kudla. Iimbilini ezilawula ezi zihlunu zithola iimpawu ezisuka kwingqondo ukuze zisebenze ngendlela edibeneyo. Xa ubuchopho buye bangela ukulimala kwintlungu yesifo, imiqondiso kulezi zihlunu ezingama-26 ingabonakali.
I-MRI esebenzayo kunye ne-PET uvavanyo lwengqondo lubonisa ukuba ukugwinya kuyinkqubo eyinkimbinkimbi kwaye kukho ukungafani phakathi kokugwinya ngenjongo yokuxhamla ngokumangalisa xa umqolo womqala uphuhliswa ngumbane okanye ibhola lokutya. Ukulungiswa ngokuchanekileyo akuphelelanga kwenye indawo ethile yengqondo kodwa kubandakanya indawo ezininzi zobuchopho.
Ukulimala kwengqondo ebuchosheni obukhulu kunye nokuphuma kwegazi, ukuvuvukala kunye nokufa kweeselfowuni ukufa kunokuthintela izibonakaliso zokugwinxa ukusuka ekuchotsheni ebuchosheni ukuya emlonyeni nasemqaleni, kwaye ubuyele kwakhona.
Dysphagia kwiBrain Injury
Amagama alandelayo asetyenziselwa ukuchaza iingxaki ezibangelwa ukulawulwa okungonelanga kolwimi, umlomo, umphimbo kunye nesifo.
- UDysphagia: ubunzima bokugwinya
- I-Dysarthria : ubunzima bokuthetha intetho
Kukho amanyathelo amane, okanye amanyathelo, okufuneka alandelwe xa egwinya. Zibizwa ngokuba yisigaba sokulungiselela ngomlomo, isigaba somlomo, isigaba se-pharyngeal kunye nesigaba sokuqhafaza. Ukungasebenzi kungenzeka nakweyiphi enye yezi zinto ngokusekelwe kwindawo yokulimala kwengqondo
- Isigaba sokulungiselela ngomlomo : ukutya kuqaliswa emlonyeni, kodwa kunzima ukuyihlafuna ngokuchanekileyo, ukuyixuba ngamathe kunye nokwenza ibhola yokutya ekulungele ukuginywa. Oku kubonakala ukuba kukho ukulimala kwengqondo .
- I-oral dysphagia : ubunzima bokulawula ibhola yokutya xa sele yenziwe, kwaye ayikwazi ukufika kwindawo efanelekileyo yokugwinya. Abaphandi bakholelwa ukuba i -nucleus ye - trigeminal kunye nesakhiwo esicacileyo sinokulawula lesi sigaba.
- Isigaba se-Pharyngeal dysphagia : ibhola yokutya iyenze emlonyeni nasemlonyeni we-pharynx. I-trigger efanelekileyo ayenzeki ngoko ukutya kuhamba ngokukhawuleza kumqolo womqala. Oku kunokubangela ukuba ukutya kungene kwimiphunga. Ukulimala kwi- nucleus tractus solitaries kunokubandakanyeka kule ngxaki ephazamisayo.
- Isigaba se-esophageal dysphagia : ukutya kuye kwadlula emqaleni waza wangena kwi-oophagus, kodwa iyanamathela. Ukutya kunokubuyela kwakhona uze ungene emiphakeni. Izibonakaliso kwi-esophagus eyenza ukunyusa ukutya kwisisu kuyafuneka ngexesha lesi sigaba, kwaye kwakhona kukho i- nucleus tractus solitaries kukholelwa ukuba yinyanzelo, ngaphezu kwe- nucleus ambiguus kunye ne -motorcycle nucleus.
Abaphandi baqhubeka befunda iindlela ezinzima zokulawula ukugwinya.
Yintoni Yokujonga
Ezinye zezibonakaliso zokuqala zengxaki yokugwinya ziquka:
- Ukutya okanye ukusela kubangela ukukhwehlela ngokukhawuleza
- Ukugquma emva kokugwinya
- Ukukhethwa xa uzama ukugwinya
- Ukuhlafuna okanye ukugwinya
- Ukukhahlela ukutya phakathi kwesitye okanye i-gum
- Ukuvuza kokutya okanye utywala ngempumlo
- Ukugcoba / ukuvuza kwamanzi okanye ukutya okuvela emlonyeni xa udla okanye usela
- Ukutya ngokukhawuleza
- Ubunzima bokubonakala okanye ubunzima bokugwinya
- Ukungadli okanye ukusela ngokwaneleyo
- Ukukhwehlela okumanzi
- Izikhalazo ukuba xa uziva ngathi ukutya kuyanamathela emqaleni
- Ubuhlungu emva kwe-sternum emva kokutya
Ekubeni kubalulekile ukuba sikwazi ukuthetha, ukukhwehlela nokugwinya, nabani na ubunzima kule mimandla kufuneka babone intetho yolwimi. Ukuvavanywa okuthe ngqo kunokunceda ukucacisa ingxaki ephantsi kokulahlekelwa ngumntu kulo msebenzi obalulekileyo.
Indima yoLwimi lweNtetho emva kweNtsingiselo yeNtloko
Usenokungacingi ukuba ulolu lweelwimi luza kunceda umntu onzima ukugwinya. Nangona kunjalo, olu hlobo lonyango lujongana nemibandela eninzi ehamba ngokufana nokulawula umlomo, ulwimi kunye nomhlathi, okubalulekileyo kwiintetho zombini kunye nokugwinya.
Ingcali yomgulane ingaqala ngendlebe nodliwano-ndlebe, uze uhlolisise umlomo uze unikeze ukutya kunye namanzi ahlukeneyo kumanqanaba athathaka ukuze ubone ukuba umntu uphendula njani.
Kukho iimvavanyo ezininzi, ezininzi ezingasetyenziswayo ezinokusetyenziswa xa kuyimfuneko ukuqonda ukuba yeyiphi isigaba sokugwinya kungasebenzi kakuhle.
Uvavanyo oluqhelekileyo
- I-Barium Swallow: I-Barium luhlobo oluthile olubonakalisa kwi-x-ray. Isigulane sinikwa umthamo okanye ipiliti eboshwe nge-barium kwaye i-ray-ray isetyenziselwa ukubona indlela inkqubo isebenza ngayo, kwaye ukuba i pilisi ingadlula emlonyeni ukuya kwisisu.
- Isifundo sokuSondeza iDynamic : Ukutya kubambisene nokuhluka kwe-barium kwaye kudliwe. Inkqubo yokuhlafuna iboniswe kwi-x-ray, kuquka ukukwazi ukudala ukutya kwibhola, ukuyihambisa emva emqaleni kwaye uyiginye. Kuyakwazi ukubona ukuba ukutya kungena emiphakeni.
- Uvavanyo lwe-Endoscopy / i-Fiber-Optic Swallow Assessment : Ityhubhu ifakwe phantsi emqaleni kunye nemizobo ye-osophageal ne-tracheal muscle ithathwa xa iginya.
- I-Manometry : Intshubhu encinci ifakwe emqaleni ukuba ulinganise uxinzelelo xa uginya. Le nto ingaba yindlela enye yokufumanisa ukuba amandla obuthakathaka obuthathaka abangela ukuba kuqhutywe ukunyuka kokutya.
Ukubuyiswa kwezinto eziphambili emva kwexinzelelo lweNtloko
Iimbali ezincinci ezibalulekileyo kufuneka zidityaniswe ukusuka kwimeko yokulimala kwengqondo xa uqikelela indlela umntu oza kukwazi ngayo ukugwinya kunye nokuba kwenzeka ukuba ukubuyiswa kwakhona kuya kubuyisela lo msebenzi.
- Kufuneka kubekho ukuphucula okuqhubekayo kwinqanaba lokuqonda. Iimpendulo ezifanelekileyo kwiimpawu eziphathekayo zomzimba, izibhengezo nezibonwayo ziyimfuneko. Njengoko ukuzimela kukunyuka kwaye iimpendulo ziba zifanelekileyo, kunokwenzeka ukuba ingqondo iya kuphendula ngokufanelekileyo ukuqaliswa kokutya kunye namanzi.
- Ukukwazi ukuhlala kugxile kwimisebenzi nokunciphisa ukudideka kubalulekile. Ukuthatha inxaxheba kwiyeza lokugwinya, kunye nokufumana isidlo sonke ngaphandle kweengxaki, kudinga uxinzelelo.
Kukho inani elithile lokunciphisa izithintelo ezenziwa ngabagqirha kunye nezigulane zentlungu, nokuba iintsapho zinokukunceda ukuncedwa kwintlungu yomntu.
Iimpawu ezizenzekelayo ziya kubuya emva koxinzelelo lweNtloko
Ezinye iimpawu ukuba iqela le-rehab likhangele ukubonisa ukulawulwa kokugwinya ukubuyela kwakhona kubandakanya:
- Ukuhlala ugxininise nokuqonda oko kwenzekayo kwimeko
- Ukulungisa iimpazamo xa uzama ukwenza nayiphi na uhlobo lomsebenzi
- Iingxaki zokugwinya zingundoqo ekuhlaleni nasekudaleni ibhola lokutya, kungekhona ekulawuleni izihlunu zomqala
- Ukuba ukutya kuhla ngendlela engafanelekanga, kukho ukukhwehlela okuqinileyo ukukhusela indlela yokuhamba
- Ukukwazi ukuphefumula kwaye ukuphefumula ngempumelelo kukhoyo
- Ukukwazi ukutya iikhalori ezaneleyo kunye nesondlo ngokutya
Yintoni ongayidla?
Ekuqaleni kunokuba kuyimfuneko yokutya kunye nezixhobo zokunwa kwamanzi ukuze ube nokuthutha okuqhubekayo. Umgudu weengcambu ubeka ukuba luhlobo luni lokubumba lusebenza ngokusemandleni kwisigulane esithile sokugula. Textures ziquka:
- Ukuhlanjululwa: Kukhethwe xa kukho umlomo nobuthakathaka beelwimi, kunye nobunzima obufuna ukuhlafuna nokucoca umlomo xa ugwinya. Ukutya okucocekileyo kunciphisa ithuba lokuba inxalenye enkulu yokutya iya kubanjwa kwaye ibingele indlela yokuhamba
- I-soft mechanical: ezi zinto zidla phantsi okanye zinqunywe zibe ziincinane. Ziyabantu abantu abaye baphumelela kwisidlo esicocekileyo, kodwa basengozini yokukhahla kwiindawo ezinkulu.
- I-soft : oku kutya kukuba ngabantu abanobuthakathaka bemisipha yomlomo abanenkathazo yokufuna ukutya ngokufanelekileyo ngokuchithwa rhoqo. Ukutya okufana neengxowa okanye i-steak ezifuna ukuhlafuna ngamandla kunye nokulungiselela ukugwinya kugwenywa.
- Ukutyunjwa okulula : kudla ukusetyenziswa kubaxhoba abathintekayo beentloko ezinobunzima obongezelelekileyo ezifana nokumisela uhlangothi olufanelekileyo lokutya ukuba lubekwe emlonyeni, okanye obunobuthakathaka obuphezulu obangela ukuba kube nzima ukuba banqume ukutya kwabo.
- Ngokuqhelekileyo: Ukutya okuqhelekileyo akukho mingcele.
Ukuxhaswa kokuSebenza
Ngamanye amaxesha amandla okugwinya angagodli. Kule meko, kuyafuneka ukuba uqalise ukuxhaswa kokufakelwa.
- I-IV Yokutya : Isisombululo esifutshane sinokubonelela ngesondlo nge-IV. Oku kungasetyenziswa ukuba kukho umonakalo kwinkqubo yokugaya ukutya okuthintela ukusetyenziswa kwesondlo ngendlela eqhelekileyo.
- I-Tube ye-Nasogastric : Olu hlobo lwakutshanje lokutya okufakelwayo. I-tube iyangena ngeempumlo ize iphinde isisu. Ingasetyenziselwa nje emva kokuxhwaleka kwentloko ngelixa umntu esesiphini, okanye eneminye imingcele ekuthintela ukugwinya ukutya okuqhelekileyo.
- I-PEG Tube: I- PEG imele i-Percutaneous Endoscopic Gastrostomy. I-tube yokutya isetyenziswe ngodonga lwesisu esiswini. Le ndlela yexesha elide lokutya okufakwayo.
Ukubuyiswa kweNtshutshiso yeNtloko kunye nokuThengisa
Ukufumana ukusukela kwintlungu yesifo kunokuba yinkqubo ephantsi. Kukho imingeni emininzi yokunciphisa, ngokugwinya nje ngokuba enye yazo. Ekubeni isondlo siyinto ebalulekileyo kwimisipha, iimbilini kunye nezicubu zokuphulukisa, ukugwinya kuyakuba yinkomfa yakudala ejongene neqela elixinzelelekileyo.
> Imithombo
> I-American Speech, uLwimi kunye nokuLawula uMbutho (2016) Ukulimala kweBrain Injury. http://www.asha.org/public/speech/disorders/TBI/
> Hamdy, S. (2006) Indima ye-cortex ye-cerebral ekulawuleni ukugwinya, i- GI Motility kwi-intanethi ye-intanethi : 10.1038 / gimo8
> Lang, I. (2009) Ukulawulwa kwesibindi sobunzima bezigaba zokugwinya. Dysphagia. 24 (3): 333-48. i-doi: 10.1007 / s00455-009-9211-6