Objective: To examine whether quantitative analysis of videofluoroscopic swallowing study (VFSS) images can quantitatively demonstrate the pathophysiology of swallowing disorders in patients.

Methods: In total, 71 patients with Parkinson's disease (PD) (mean age 73.4±7.2 years) and 45 patients with sarcopenia (mean age 81.7±4.8 years) were included in the pathological group in this study. The control group comprised 151 individuals without swallowing disorders (mean age 76.0±7.6 years). To examine the distinctive features of swallowing dynamics in the pathological and control groups, a quantitative analysis of VFSS images was conducted. VFSS analysis parameters included measures of bolus movement, such as oral transit time (OTD), pharyngeal transit time (PTD), total transit time (TTD), and stage transition duration (STD). Furthermore, the onset and duration of movements in swallowing organs, including the soft palate, hyoid bone, epiglottis, and upper esophageal sphincter, were measured. VFSS was conducted using a 3-mL liquid bolus.

Results: In the PD group, the swallowing disorder features included extended OTD, PTD, TTD, delayed STD, delayed onset times of the soft palate and epiglottis, and shortened movement duration. The sarcopenia group revealed a shortened movement duration in the hyoid bone and epiglottis.

Conclusion: The quantitative analysis of VFSS permitted the assessment of swallowing dynamics. The abnormalities observed during swallowing movements in the PD and sarcopenia groups indicated specific pathophysiologies of these conditions, underscoring the utility of VFSS image analysis in understanding swallowing disorders.

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease causing dyspnea on exertion, exercise intolerance, decline in quality of life, and physical inactivity. The patient is a 78-year-old male. He complained of quadriplegia and was diagnosed with a C7/Th1 cervical epidural abscess. After treatment with antibiotics, he was transferred to our hospital. He had tetraplegia, which corresponded to the ASIA impairment scale D, and his Functional Independence Measure (FIM) motor score was 35 points. In addition, he had severe COPD; the Medical Research Council (MRC) dyspnea scale was grade 5, and the COPD assessment test (CAT) score was 26 points. He complained of dyspnea on exertion with low intensity movements. Despite rehabilitation, improvement in ADL and physical function was poor, his FIM motor score was 43 points and the Berg balance scale (BBS) score was 21 points at the 30th day. Therefore, we started assist use of a short-acting β2 agonist (SABA) before rehabilitation on the 33rd day, and his dyspnea on exertion, physical activity, and respiratory dysfunction improved. On the 83rd day, the improvement was as follows: the MRC dyspnea scale was grade 4, the CAT score was 18 points, his 6-minute walk distance was 110 m, and his BBS score was 40 points. He was weaned from continuous oxygen therapy and discharged on day 112, at which time his FIM motor score was 69 points. We considered that the assist use of SABA before rehabilitation improved his respiratory status and physical activity without worsening his respiratory function or limb muscle weakness due to dyspnea and quadriplegia.