"Direct" Indirect Training Approach to Rehabilitation of Dysphagia Patients. A New Method for Rehabilitation with a Feeding-tube.

The rehabilitation approaches for training patients with dysphagia consist of both direct approaches (eating training) and indirect approaches (basic training for dysphagia patients without food). On the other side, some recent reports revealed that some patients who had had severe dysphagia were improved while the feeding approach was with a naso-gastic tube and an oral-esophago feeding tube. So we thought that stimulation of these feeding tubes for the pharynx and the larynx would produce some useful reactions for dysphagia patients. We developed a new method for the rehabilitation of such patients. The technique is the repeated insertion of the naso-gastric tube at the time of the swallowing motion, which we called the "direct" indirect training approach. Sometimes, other basic training procedures for dysphagia patients are admissible. We treated 26 patients by this method. The patients included those with disorders of the corticobulbar tract (n = 11), a disorder of the medulla (n = 5), a disorder of the peripheral nerve (n = 7), and a long-lasting disused state (n = 3). Twenty-four patients were improved and could eat orally without major problems. Laryngeal elevation curves of this approach in the pre- and post-therapeutic states revealed that the threshold of the swallowing reflux was lower, and the swallowing actions were changed dynamically, and became more useful.