Serious problems in dysphagic patients from the viewpoint of rehabilitation medicine
It is imperative that both specialists and general physicians recognize and understand the contribution of dysphagia to patients with various conditions and develop the ability to prioritize proper evaluation and treatment plans. There is a definite need to increase the importance of dedicated patient care and research in the emerging field of dysphagia.
Treatment of dysphagia has been a new task in rehabilitation medicine during the past few decades. Japanese insurance began coverage of dysphagia treatment in 1994. One year later, the The Japanese Society of Dysphagia Rehabilitation (JSDR) was established. The JSDR had 1,600 members in 1996 and has rapidly expanded its membership since. The objective of this unique society is to perform activities related to research, education, dissemination, and structuralization in the field of dysphagia rehabilitation to resolve problems in individuals with eating and swallowing difficulties.
Annual publication of the Japanese Journal of Dysphagia Rehabilitation began in 1997. The field of dysphagia rehabilitation began growing thereafter and has progressed more rapidly since 2000. The JSDR also holds annual meetings to promote the progress and spread of knowledge regarding the diagnosis of, evaluation of, and transdisciplinary approaches to dysphagia through presentation of papers and their practical applications, exchange of knowledge and welfare activities, encouragement of continuing medical education for members, and enhancement of mutual coordination and cooperation among members and related domestic and foreign societies.
As shown in Fig. 4.2, dysphagia rehabilitation in Japan started with the clinical application of videofluorography (VF ) in the mid-1980s. The first original paper to mention the usefulness of VF for rehabilitative approach was published in 1986. This paper described analysis of the postural effect on dysphagia management.
Bar chart showing the number of articles related to dysphagia in four major rehabilitation journals in Japan (Jpn J Rehab Med since 1965, Sogo Rehab since 1973, J Clin Rehab since 1992, and Jpn J Dysphagia Rehab since 1997)
4.1 Dysphagia Team Development in Japan
The concept of a team approach to swallowing disorders has developed over time [13–15]. The team approach is generally divided into the following three categories according to the relationships among disciplines: the multidisciplinary approach, interdisciplinary approach, and transdisciplinary approach (Table 4.1).
Team healthcare approach to providing dysphagia treatment
A team of professionals from different disciplines who independently treat patients from their own perspective and formally interact with little or no awareness of the work of professionals from other disciplines.
A team of professionals from diverse fields who work in a coordinated manner toward a common goal for the patient. Information is exchanged and communicated, and a consensus regarding the treatment plan is established among team members, typically during team meetings.
A team composed of professionals from various fields cooperating across disciplines and has flexibility for the diversity of team composition. Disciplinary boundaries are blurred; team members share roles to achieve broader and deeper analysis, leading to a more efficiently integrated team approach.
The transdisciplinary teamwork model is suitable for dysphagia rehabilitation and is common in Japan, especially for the small facilities that may face shortages in the number and kinds of healthcare workers [16, 17]. In this model, participating disciplines complement the scope of one another without rigid borders between them. Practitioners from various disciplines freely share fundamental knowledge, perspectives, and skills. This model thus leads to more efficient integration, permits better understanding, and achieves more effective evaluation. The JSDR was founded under the concept of a transdisciplinary team approach for dysphagia rehabilitation .
The swallowing team at the FHUR provides one of the best examples of the attitude that a transdisciplinary team should exhibit. This team comprises professionals in several fields: physiatrists , dentists , certified dysphagia nurses , speech-language-hearing therapists (SLHTs ) , otolaryngologists , dental hygienists , dieticians , and ward nurses .
Physiatrists play an important role in the treatment-oriented evaluation and management of dysphagia using videoendoscopy (VE ) and VF to perform swallowing examinations.