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研究生:林雅玲
研究生(外文):LIN, YA-LING
論文名稱:口腔運動對吞嚥障礙長者舌肌力之成效
論文名稱(外文):The Effect of Oral Exercise on Tongue Strength for Elderly with Swallowing Impairment
指導教授:胡月娟胡月娟引用關係
指導教授(外文):HWU, YUEH-JUEN
口試委員:楊孟寅鐘淑英
口試委員(外文):YANG,MENG-YINZHONG,SHU-YING
口試日期:2020-06-19
學位類別:碩士
校院名稱:中臺科技大學
系所名稱:長期照顧碩士學位學程
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2020
畢業學年度:108
語文別:中文
論文頁數:109
中文關鍵詞:吞嚥障礙口腔運動舌肌力老化
外文關鍵詞:Dysphagiaoral exercisetongue strength
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根據世界衛生組織定義,65歲以上老年人口占總人口比率達到7%時稱為「高齡化社會」,達到14%是「高齡社會」,若達20%則稱為「超高齡社會」(內政部,2018)。據內政部統計爾後人口將呈現負成長,預計 2026 年老年人口將超過 20%,進入超高齡社會。
專家指出老年人經常衍生高齡咀嚼、吞嚥功能退化問題(張世傑,2013)發生吞嚥障礙原因有很多,往往通常是因為疾病或漸漸老化造成肌無力而造成,肌肉力量變差,吞嚥速度會變慢,味覺、嗅覺也會變遲鈍。老化在吞嚥功能上依症狀與原因為:口水不足、口腔感覺功能衰退、口咽部肌肉無力、疾病相關因子、舌骨移位不足及舌骨會厭韌帶肌肉纖維減少,上述症狀皆是造成吞嚥障礙原因,吞嚥跟肌肉力量有相當大的關係,簡單的說:任何有傷害到吞嚥有關的神經或肌肉,都會造成老年人吞嚥困難的原因。
本研究旨在探討口腔運動對吞嚥障礙長者舌肌力之成效,採類實驗研究設計(Quasi-experimental research design),以中部某護理之家及長期照顧機構長者為研究對象,選取(1)意識清楚聽得懂指令之個案。(2)願意加入本研究並簽署同意書者。(3)年齡≧65歲。(4)喉嚨發聲吞嚥篩選≦4分,符合條件之長者,分為實驗組與對照組長者共36人。對照組採一般常規護理,實驗組介入口腔運動,包括發音體操、舌肌運動、唾液腺體操,每天二次,一次30分鐘,一週五天,持續12週,並以廣義估計模式 (Generalized Estimating Equations, GEE),檢定各個時間點,成效觀測值的改變情形以檢視介入措施的成效。
研究結果顯示,有吞嚥障礙長者(前測 vs 3個月後測)舌肌力之成效,實驗組10.56 kpa vs 12.61 kpa,對照組10.28 kpa vs 8.78 kpa。經廣義估計方程模式顯示,接受口腔運動介入吞嚥障礙長者舌肌力之成效皆優於對照組(p =.009)。

According to the definition of the World Health Organization, when the proportion of the elderly population over 65 years old reaches 7%, it is called "aged society", and 14% is "old age society". If it is 20%, it is called "super senior society" (Ministry of Interior, R.O.C. 2018). According to the statistics of the Ministry of the Interior, the population will show negative growth. It is expected that the elderly population will exceed 20% in 2026 and enter the ultra-age society.
Experts point out that older people often develop advanced chewing and degenerative swallowing problems (Zhang, 2013). There are many causes of dysphagia, often caused by muscle weakness caused by disease or aging. When it is worse, the swallowing speed will be slower, and the taste and smell will become dull. The symptoms and causes of aging in swallowing function are insufficient saliva, deteriorating oral sensory function, muscle weakness of oropharynx, disease-related factors, insufficient transposition of the hyoid bone, and reduction of muscle fibers in the ligament of the hyoid bone. These symptoms are caused by dysphagia. The reason is that swallowing has a considerable relationship with muscle strength. Simply put: Any nerve or muscle that is damaged by swallowing will cause difficulty in swallowing in the elderly.
The purpose of this study was to explore the effect of oral exercise on tongue muscle strength of elderly people with dysphagia. A quasi-experimental pretest-posttest research design was adopted, eligible residents were recruited from a long-term care institution as the research object and selecting (1) awareness cases that clearly understand the instructions. (2) Those who are willing to join this study and sign the consent form. (3) Age ≧65 years old. (4) The throat vocalization and swallowing screening ≦ 4 points.
The elders who meet the conditions are divided into experimental group and control group of 36 persons. The comparison group received usual care only, and the experimental group received an oral exercise program, including pronunciation gymnastics, tongue muscle exercise, salivary gland gymnastics, for 30 minutes, twice per day, 5 days weekly for 12 weeks. Generalized Estimating Equations (GEE) was used for examining the changes in effectiveness observations at various points in time to examine the effectiveness of interventions.
The results of the study showed that the effect of tongue strength in the elderly with dysphagia (pretest vs. 3 months later) was 10.56 kpa vs 12.61 kpa in the experimental group and 10.28 kpa vs 8.78 kpa in the control group. The GEE model shows that the effect of oral muscle intervention on the tongue strength of elderly patients with dysphagia is superior to the control group (p = .009).

目錄
摘要 IV
Abstract VI
誌 謝 III
目錄 VIII
圖目錄 XI
表目錄 XII
附錄 XIV
第一章 緒論 1
第一節 研究動機與重要性 1
第二節 研究目的 2
第三節 研究問題 2
第四節 研究假設 2
第五節 名詞界定 2
第二章 文獻查證 5
第一節 舌於吞嚥功能上的重要性 5
第二節 吞嚥障礙的成因 6
第三節 吞嚥訓練與口腔運動 10
第四節 口腔運動及影響成效相關因素 22
第五節 吞嚥障礙訓練成效 23
第三章 研究方法 31
第一節 研究倫理 31
第二節 研究設計 31
第三節 研究架構 33
第四節 研究對象及場所 34
第五節 介入方案 34
第六節 研究工具與信效度檢定 37
第七節 資料收集 42
第八節 統計資料分析 45
第四章 研究結果 47
第一節 研究對象基本資料之描述性統計 47
第二節 口腔運動對吞嚥障礙長者舌肌力的影響 49
第三節 口腔運動對吞嚥障礙長者飲食改變的影響 53
第四節 口腔運動對吞嚥障礙長者自覺吞嚥困難量表的影響 62
第伍章 討論 65
第一節 口腔運動對吞嚥障礙長者舌肌力之影響 65
第二節 口腔運動對吞嚥障礙長者飲食改變的影響 66
第三節 口腔運動對吞嚥障礙長者自覺吞嚥困難量表的影響 69
第陸章 結論與建議 71
第一節 結論 71
第二節 研究限制與困難 73
第三節 建議 75
中文參考文獻 76
英文參考文獻 78

圖目錄
圖2-3-1代償性吞嚥技巧 14
圖3-3-1研究架構圖 33
圖3-6-1 IOPI儀器圖 40
圖3-7-1 研究流程圖 44
圖4-2-1二組舌肌力平均分數折線圖 52
圖4-3-1 二組食物攝取量平均折線圖 57
圖4-3-2口腔運動介入後比較兩組流質有效百分率 58
圖4-3-3口腔運動介入後比較兩組糊食有效百分率 58
圖4-3-4口腔運動介入後比較兩組糊食人數 59
圖4-3-5口腔運動介入後比較兩組剁食有效百分率 59
圖4-3-6 口腔運動介入後比較兩組剁食人數 60
圖4-3-7口腔運動介入後比較兩組一般有效百分率 60
圖4-3-8口腔運動介入後比較兩組一般飲食人數 61
圖4-3-9口腔運動介入後比較兩組鼻胃管留置人數 61
圖4-4-1 二組自覺吞嚥量表平均分數折線圖 63

表目錄
表2-3-1吞嚥障礙常見原因與口腔運動對照表 ………………….15
表2-3-2 口腔運動的相關文獻 ……………………………………19
表2-3-3 吞嚥訓練方案的相關文獻 ………………………………19
表2-5-1 舌肌運動的相關文獻 ……………………………………25
表3-2-1 研究設計模式 ……………………………………………32
表3-5-1 口腔運動訓練方案 ………………………………………35
表3-6-1使用愛荷華口腔功能测量儀(IOPI)測量舌肌力步驟 …...40
表4-1-1 比較兩組研究對象基本屬性 ……………………………49
表4-2-1 實驗組與對照組在舌肌力之前測比較 …………………51
表4-2-2 實驗組與對照組不同後測時間舌肌力分數平均得分 …51
表4-2-3 GEE分析口腔運動介入對長者舌肌力影響之成效 ……52
表4-2-4 GEE分析口腔運動介入實驗組舌肌力不同時間之成效 …………………………………………………………………...53
表4-3-1 實驗組(n = 18)與對照組(n = 18)在食物攝取量之前測比較…………………………………………………………………… 56
表4-3-2 不同後測時間食物攝取量平均數 ………………………57
表4-4-1 實驗組(n = 18)與對照組(n = 18)在自覺吞嚥量表之前測比較 …………………………………………………………………...63
表4-4-2 實驗組與對照組不同後測時間自覺吞嚥量表平均得分 64
表4-4-3 GEE分析口腔運動介入後對長者自覺吞嚥困難量表之成效 …………………………………………………………………...64


附錄
附錄一 人體研究計劃雙向同意書 86
附錄二 人體研究計劃雙向同意書 87
附錄三 專家效度名單 88
附錄四 問卷專家效度審定邀請函 89
附錄五 專家效度檢測建議表 90
附錄六 IRB通過之問卷 93
附錄七 喉嚨發聲吞嚥篩選量表(GUSS) 94




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