Izimpawu zobuchopho eziyinkimbinkimbi zidinga ukuhlafuna nokugwinya
Izingxenye zobuchopho obhekene nokukhiqiza inkulumo nokulawula imisipha yomlomo nomphimbo kungonakaliswa ngesikhathi sekhanda . Lo monakalo uphinde uthinte indlela imisipha kanye nezinzwa zabo ezihambisana ngayo ukuphendula emilayezo evela ebuchosheni noma ekucindezelweni nasezikhungweni ze-reflex emqaleni. Uma uhlelo lokuhlafuna nokugwinya lungasebenzi kahle, lungabangela izinkinga eziningi kubandakanya umkhuhlane.
Ukudla nokugwinya ubunzima kungase kube ukungabi nokusebenzisana phakathi kobuchopho kanye nemisipha enomthwalo wemfanelo, nakuba kungase kube nokulimala kwezicubu ezithinta inkinga.
I-Brain nokufaka
Kunemisipha ehlukene engama-26 emlonyeni, entanyeni, emphinjeni nasesiswini ukuthi ubuchopho bulawula uma ukudla noma uketshezi kudliwe. Izinzwa ezilawula lezi musipha zithola izibonakaliso ebuchosheni ukuze zisebenze ngendlela edidiyelwe. Lapho ubuchopho buye kwahlushwa ukulimala ngenxa yokuhlukunyezwa kwekhanda, izimpawu kulezi zinhlanzi ezingu-26 zingase zingabonakali.
Ukuhlola okusebenzayo kwe-MRI kanye ne-PET yobuchopho kubonisa ukuthi ukugwinya kuyinkimbinkimbi yenkambinkimbi nokuthi kukhona umehluko phakathi kokugwinya ngenjongo yokugwinya ngokucabangela lapho emuva komphimbo kubangelwa uketshezi noma ibhola lokudla. Ukugxila ngokufanele akukhawulelwanga endaweni eyodwa yobuchopho kodwa kuhilela izindawo eziningi zobuchopho.
Ukulimala ebuchosheni obuvela ekhanda eliyingozi kanye nokuphuma kwegazi, ukuvuvukala nesisindo sokufa kwesilingo kungavimbela izibonakaliso zokugwinya kusukela ekuhambeni ebuchosheni kuya emlonyeni nasemphinjeni, futhi emuva futhi.
I-Dysphagia kusuka ebuchosheni be-Brain
Amagama alandelayo asetshenziselwa ukuchaza izinkinga ezibangelwa ukulawulwa okunganele ngokwedlulele, ulimi, umlomo, umphimbo kanye nomlomo.
- I-Dysphagia: ubunzima bokugwinya
- I-Dysarthria : ubunzima bokumemezela inkulumo
Kunezinyathelo ezine, noma izigaba, okudingeka zilandelwe uma zigwinya. Zibizwa ngokuthi isigaba sokulungiselela ngomlomo, isigaba somlomo, isigaba se-pharyngeal kanye nesigaba sokuqapha. Ukungasebenzi kungenzeka kunoma iyiphi yalezi zisekelwe endaweni yokulimala kobuchopho
- Isigaba sokulungiselela ngomlomo : ukudla kufakwa emlonyeni, kodwa kunzima ukuyihlaziya kahle, ukuyixuba ngamathe bese kuyenza ibhola lokudla okulungele ukugwinya. Lokhu kuvame ukubonwa uma kunokulimala kwengqondo engaphansi kwe- subcortical .
- I-oral dysphagia : kunzima ukulawula ibhola lokudla uma selunguliwe, futhi kungakwazi ukufika endaweni efanele yokugwinya. Abacwaningi bakholelwa ukuthi i-nucleus ye-trigeminal ne- formtic reticular ingalawula lesi sigaba.
- Isigaba se-Pharyngeal dysphagia : ibhola lokudla liye layenza ngemuva komlomo kanye naphezulu kwe-pharynx. I-trigger efanelekile ayenzeki ngakho ukudla kuhamba kancane kancane emhlane. Lokhu kungaholela ekutheni kungene emaphashini. Ukulimala kwe- nucleus tractus solitaries kungabandakanyeka kule nkinga yokugwinya.
- Isiteji esiphezulu se-dysphagia : ukudla kuye kwadlula umphimbo futhi wangena emgodleni, kodwa uyanamathela. Ukudla nakho kungabuyela emuva bese kungena emaphashini. Izibonakaliso eziya emgodini oqala ukuxosha ukudla kuya esiswini ziyadingeka phakathi nalesi sigaba, futhi kuphinda kubonakale ukuthi i- nucleus tractus solitaries inomthwalo wemfanelo, ngaphezu kwe- nucleus ambiguus ne- dorsal motor nucleus.
Abacwaningi basacwaninga izindlela eziyinkimbinkimbi ezibhekene nokulawula ukugwinya.
Yini Okufanele Uyihlole
Ezinye zezibonakaliso zokuqala zokuxwayisa inkinga yokugwinya zihlanganisa:
- Ukudla noma ukuphuza kubangela ukukhwehlela ngokushesha
- Ukubola ngemva nje kokugwinya
- Ukukhetha uma uzama ukugwinya
- Ukuhlafuna noma ukugwinya
- Ukuphoqa ukudla phakathi kwehlathi noma igamu
- Ukuvuza kokudla noma uketshezi ngekhaleni
- Ukugcoba / ukuvuza oketshezi noma ukudla okuvela emlonyeni ngenkathi bedla noma bephuza
- Ukudla kancane kancane
- Ukuguqulwa okubonakalayo noma ubunzima bokugwinya
- Ungadli noma uphuze ngokwanele
- Ukukhwehlela okumanzi okumanzi
- Izikhalazo zokuthi uma uzizwa sengathi ukudla kunamathela emphinjeni
- Ubuhlungu ngemuva kwe-sternum ngemva kokudla
Njengoba kubalulekile ukuba sikwazi ukukhuluma, ukukhwehlela nokugwinya, noma ubani onenkinga kulezi zindawo udinga ukubona ochwepheshe wezinkulumo zokukhuluma. Ukuhlolwa okuqondile kungasiza ekunqumeni inkinga engaphansi kokulahlekelwa ukulawulwa komuntu kulo msebenzi obalulekile.
Indima Yolwazi Lokukhuluma Ngezilimi Ngemva Kokuhlukunyezwa Kwekhanda
Ungase ungacabangi ukuthi umelaphi wolimi okhuluma ulimi angasiza umuntu obunzima ukugwinya. Kodwa-ke, lolu hlobo lwezokwelapha ludlulisa izinkinga eziningi ezivame ukuhamba ndawonye njengokulawula izindebe, ulimi kanye nomhlathi, okubalulekile kokubili ukukhuluma nokugwinya.
Uchwepheshe we-swallow swallowing angase aqale nge-interview, bese uhlola umlomo bese uhlinzeka ukudla kanye namanzi okushisa ngamazinga ahlukene obukhulu ukuze anqume ukuthi umuntu uphendula kanjani.
Kukhona izivivinyo eziningi, ezingavamile ezingase zisetshenziswe uma kudingekile ukuthi ziqonde kahle ukuthi yisiphi isigaba sokugwinya esisebenzi kahle.
Ukuvivinywa Okuvamile Kwezingqinamba
- I-Barium Swallow: I- Barium uhlobo lokungafani olubonisa ama-x-ray. Isigulane sinikezwa uketshezi noma iphilisi eboshwe nge-barium bese i-ray isetshenziselwa ukubona indlela uhlelo lusebenza ngayo, futhi uma iphilisi ingadlula emlonyeni kuya esiswini.
- Isifundo se-Dynamic Swallow : Ukudla kuhlanganiswe ngokulinganisa kwe-barium futhi kudliwe. Inqubo yokuhlafuna ibonwa nge-x-ray, kufaka phakathi ikhono lokwenza ukudla ibhola, ukuyisusa emuva emqaleni bese uligwinya. Kungenzeka ukubona ukuthi ukudla kungena emaphashini.
- Ukuhlola okuyi- Endoscopy / Fiber-Optic Ukuhlolwa Okubhekayo : I-tube ithunyiwe phansi emphinjeni futhi izithombe zezintuthwane ezithintekayo nezixubile zithathwa ngenkathi zigwinya.
- I-Manometry : I-tube encane ifakwa emphinjeni ukukala ukucindezela ngenkathi igwinya. Lokhu kungaba yinye indlela yokunquma ukuthi amandla amathanga abuthakathaka abangela ukunyakaza okuncane kokudla.
Ukubuyiswa Kwezinto Ezibucayi Emva Kokuhlukunyezwa Kwekhanda
Izenzakalo ezibalulekile ezimbalwa zidinga ukuhlangabezana nombono wokulimala komqondo lapho kunquma ukuthi umuntu uzokwazi kanjani ukugwinya nokuthi kungenzeka ukuthi ukuvuselelwa kuyobuyisela kanjani lo msebenzi.
- Kumele kube nokuthuthuka okuqhubekayo ezingeni lokuqaphela. Izimpendulo ezifanele ezinhlobonhlobo zomzimba, ezenzakalweni nezokubukwayo ziyadingeka. Njengoba ukuzimela kukhula futhi izimpendulo ziba ngcono, kungenzeka ukuthi ubuchopho buzophendula ngokufanele ukwethulwa kokudla kanye namanzi.
- Ikhono lokuhlala ligxile emisebenzini futhi unciphise ukudideka kubalulekile. Ukubamba iqhaza ekwelapheni ukwelashwa, nokuthola isidlo sonke ngaphandle kwezinkinga, kudinga ukuhlushwa.
Kunezinhlobo ezithile zokuzivocavoca okukhethekile abahlinzeki abazenzayo neziguli ezikhwabanisa ikhanda, nokuthi imindeni ingasisiza futhi ukuthi isisulu sezinhlekelele sisinde.
Izimpawu Ezizitholayo Zizobuyela Ngemva Kokuhlukunyezwa Kwekhanda
Ezinye izimpawu ukuthi ithimba le-rehab lihlose ukukhombisa ukuthi ukulawula ngokugwinya kubuya kuhlanganisa:
- Hlala ugxile futhi uqonde ukuthi kwenzekani emvelweni
- Ukulungisa amaphutha uma uzama ukwenza noma yiluphi uhlobo lomsebenzi
- Izinkinga ngokugwinya ikakhulukazi ekuhloleni nasekudalweni kwebhola lokudla, hhayi ekulawuleni imisipha yomphimbo
- Uma ukudla kwehla ngendlela engafanele, kukhona ukukhwehlela okunamandla ukuvikela indlela yokuhamba emoyeni
- Ikhono lokuphefumula nokuphefumula ngempumelelo likhona
- Ikhono lokudla amakholori anele nokudla ngokudla
Yini Ongayidla?
Ekuqaleni kungase kudingeke ukuba kutholakale ukudla kanye nezikhukhula ukuze kube nokuthungwa okuqhubekayo. Umgulisi wokugwinya unquma ukuthi yiluphi uhlobo lokuthungwa olusebenza kangcono ukuze kunzima ukugwinya kwesiguli. Ama-textures afaka:
- Kuhlanjululwe: Kukhethwe uma kunobuthakathaka bomlomo nolimi, kunzima ukuhlafuna nokuhlanza umlomo uma ugwinya. Ukudla okuhlanzekile kunciphisa ithuba lokuthi ucezu olukhulu lokudla luzobanjwa futhi luvimbe umoya
- I-soft mechanical: lokhu kudla kunomhlabathi noma ukusika zibe yizicucu ezincane. Bangabantu abathile abaye baphumelela ekudleni okuhlanzekile, kodwa basengozini yokungena ezinqabeni ezinkulu.
- I-soft : lokhu kudla kungenxa yabantu abanomlomo obuthakathaka obunzima obunzima ekuhlaleni ngokwanele ukudla ngokugqoka njalo. Ukudla okunjengama-bagels noma i-steak okudinga ukuhlafuna okuqinile nokulungiselela ukugwinya kugwenywe.
- Ukunqunywa okunamandla: kuvame ukusetshenziselwa abasindile abathintekayo bekhanda abanobunzima obengeziwe njengokunquma uhlangothi olufanele lokudla okumele lubekwe emlonyeni, noma obunobuthakathaka obuphezulu obangela ukuba kube nzima ngabo ukusika ukudla kwabo.
- Ngokuvamile: Ukudla okuvamile akunamingcele.
Ukuphakelayo Okufakelwayo
Ngezinye izikhathi ikhono lomzimba lokugwinya alibuyanga. Kulezi zimo, kubalulekile ukuqala ukuphakelayo okufakelwayo.
- Ukunceliswa kwe-IV : Isixazululo sesikhathi esifushane singase sinikeze ukudla okunomsoco nge-IV. Lokhu kungasetshenziswa uma kunomonakalo ohlelweni lokugaya okuvimbela ukusetshenziswa komsoco ngendlela ejwayelekile.
- I-Nasogastric Tube : Lena uhlobo lwesikhashana lokudla okufakelwayo. I-tube iyangena ngekhala bese phansi kuya esiswini. Ingasetshenziswa ngemuva nje kokulimala kwekhanda ngenkathi umuntu esesesithombeni, noma eneminye imikhawulo ebavimbela ekugwileni ukudla okuvamile.
- I-PEG Tube: I- PEG imelela i-Percutaneous Endoscopic Gastrostomy. I-tube yokudla ihlinzekwa ngodonga lwesisu ngaphakathi esiswini. Lena indlela yesikhathi eside yokudla okufakelwayo.
Ukubuyiswa kwe-Head Trauma nokulayishwa
Ukuphuluka kusukela ekutheni uhlaselwe ikhanda kungaba yinkqubo encane. Kungase kube nezinselelo eziningi zokunqoba, ngokugwinya nje ngokuba omunye wabo. Njengoba ukudla okunomsoco kuyingxenye ebalulekile emisipha, izinzwa kanye nezicubu zokuphulukisa, ukugwinya kuyoba yinkinga yokuqala ebhekiswe yiqembu elihlukumezekile.
> Imithombo
> Inkulumo Yama-American Speech, Language and Hearing Association (2016) Ukulimala Okubuhlungu KwamaBrain. http://www.asha.org/public/speech/disorders/TBI/
> Hamdy, S. (2006) Indima ye-cortex ye-cerebral ekulawuleni ukugwinya, i- GI Motility online ini: 10.1038 / gimo8
> Lang, I. (2009) Ukulawula ubuchopho bezinsizi zezigaba zokugwinya. Dysphagia. 24 (3): 333-48. i-doi: 10.1007 / s00455-009-9211-6