[[alternative]]Prevalence of Impaired Swallowing in Home-based Rehabilitation People in Miaoli

[[abstract]] 長期照護居家復健個案易有吞嚥問題風險。國內尚無相關之研究，因此本研究目的為調查苗栗縣長期照護居家復健個案之吞嚥問題盛行率，並探討影響居家復健個案吞嚥問題之相關變項。 本研究針對20歲以上之苗栗縣長期照護居家復健個案，使用Logemann等人( 1999 ) 所設計之「西北大學吞嚥問題個案檢核表」進行吞嚥問題篩檢，有128位個案完成吞嚥篩檢。依據篩檢結果，分成有吞嚥問題與無吞嚥問題；以Fisher’s exact probability test統計分析，比較兩組在個人基本資料、醫療史、行為變項、粗動作變項、口腔運動測試及吞嚥測試變項之差異。 結果發現，吞嚥問題盛行率為37.5%；其中，50%的吞嚥問題風險組合併兩項以上吞嚥問題風險，且其吞嚥問題風險之期別以口腔期及咽部期吞嚥問題為主。有吞嚥問題風險組在配合度、互動能力、對吞嚥問題察覺、察覺口中分泌物及處理口中分泌物等行為不安全之比例，顯著高於無吞嚥問題風險組。有吞嚥問題風險組在構造生理、遵從指令、吶語症、顏面無力、口腔感覺、吞口水及自發咳嗽等口腔動作變項不安全之比例，顯著高於無吞嚥問題風險組。有吞嚥問題風險組在咳嗽、清喉嚨、咽部吞嚥延遲、喉部上抬減少及每口多次吞嚥等不安全之比例，顯著高於無吞嚥問題風險組。 居家復健個案有吞嚥問題者比例高。此實證數據提供苗栗縣長期照護居家復健個案之吞嚥問題之依據，以利衛生保健單位及醫療院所擬定長期照護居家復健個案之吞嚥問題照護計畫。[[abstract]]Home-based rehabilitation people have high risk of impaired swallowing. However, there is no study concerning this issue yet in Taiwan. Thus, the aim of this study is to investigate the prevalence of impaired swallowing in home-based rehabilitation people in Miaoli, and to explore the relevant variables which affect them. One hundred and twenty-eight participants who were above 20 years old and received home-based rehabilitation in Miaoli were collected in this study. The Northwestern Dysphagia Patient Check Sheet was adopted to investigate the prevalence of swallowing problems. The participants were divided to the group with and without swallowing problems. Fisher’s exact probability test was used to examined the following variables: patient’s profile, medical history variables, behavioral variables, gross motor variables, observations from oromotor testing, and trial swallows The results show that the rate of the prevalence of swallowing problems was 37.5%. Half of the participants with swallowing problems have two or more problems, and the mainly problems are the oral stage and/or the pharyngeal stage of impaired swallowing. In behavioral variables, they have significantly higher unsafe percentage in cooperativeness, awareness of problems swallowing, awareness of secretions, and ability to manage secretions than those without swallowing problems. In oral motor tests, they have significantly higher unsafe percentage in oral, pharyngeal, laryngeal anatomy and physiology, ability to follow directions, dysarthria, facial weakness, oral sensation, saliva swallowing, and voluntary cough/throat clearing than those without swallowing problems. In swallow tests, they have significantly higher unsafe percentage in coughing/throat clearing, delayed pharyngeal swallow, reduced laryngeal elevation, and multiple swallows per bolus during trial swallows than those without swallowing problems. The study provides empirical evidence on swallowing management needs to the home-based rehabilitation people in Miaoli. These data can be used for speech pathologists and related professionals to make swallowing plans for the people in Miaoli