ln Japan as an aging society，many people become aware that eating problem is large burden of care as disabled elderly lives in the community．lt is also true that to take care about eating problem in disabled is a basis of humanity．So rehabilitation approach that emphasizes on the solution or improvement of disablements on daily living is very important intervention for them．ln this paper，I gave a short historical overview of dysphagia rehabilitation in Japan．During the period from 1980 to 1985， a rehabilitation approach to dysphagic patients began in Japan．ln 1986，a videofluorographic evaluation was introduced to this field．Since then，many studies about dysphagia rehabilitation have been presented．By about 1990，a systematic rehabilitation approach began in some hospitals，and some new techniques including an intermittent catheterization were developed．Therapeutic exercise for eating was approved as a medical intervention by the National Health lnsurance System in 1994．The establistment of the Japanese Society of Dysphagia Rehabilitation in 1995 encouraged an interdisciplinary approach to disseminate．Eager participation from various professionals―especially physiatrists，dentists，nurses，dietitians，and speech therapists―is now advancing dysphagia rehabilitation research in Japan．

The traditional four-stage sequential model of swallowing is sufficient for describing the events that occur when subjects drink liquids． Recent studies of normal subjects eating solid foods reveal that the traditional model has limitations． Events in the process of eating solid food are described and classified using a Process Model that was developed during studies of other mamrnals．Several important new findings are noted： 1．jaw and tongue motions are linked during trituration and food transport； 2．triturated food is transported through the faucial pillars to the oropharynx while oral food processing continues；3．bolus formation for solid foods occurs in the pharynx，not in the oral covity；and 4．a bolus of food may accumulate in the oropharynx for five or more seconds before the pharyngeal swallow is intiated．A revised four-phase model of swallowing is proposed to incorporate the new findings． The new model has important implications for the physiology of normal and abnormal swallowing．

Swallowing movements and pharyngeal anatomy of a nine-month old female infant and a male adult were compared by using a hypersensitive X-ray TV system．Each subject had no oral or pharyngeal function disorders．According to anatomical measurement of both subjects，the diameters of the infant's oro- and esopharynx were nearly the same as those of the adult．The infant's hyoid bone was located anterior，and nearer to the mandibular than that of the adult．ln the infant，the tip of the soft palate， oropharyngeal border，and the apex of the epiglottis were located at a similar distance from the pharyngoesophageal segment， suggesting that the infant's oropharynx would be very short．By comparing swallowing movements between the infant and the adult after the swallowing reflexes were elicited，the following sequences appeared in the same order for each subject： closing of the nasopharynx，transport of bolus (milk or Barium solution) from the oral cavity to the pharynx by the tongue blade， and closing of the larynx with the epiglottis．Then bolus was transported to the esophagus by pharyngeal contraction．Each subject's nasopharynx closed right after swallowing reflexes were elicited．lt was reconfirmed that not only the adult but the infant as well stopped respiration during swallowing．However，the way the nasopharynx was closed differed between the subjects．The adult sealed the nasopharynx by lifting the soft palate，but the infant did so by retraction．Aspects of release at this site after swallowing were analogous in the infant and adult，with the soft palate and pharyngeal wall separating．A distinct difference between infant and adult swallowing would be the timing when reflexes were elicited．Although in the adult transport of bolus from the mouth to the oropharynx and the reflex took place at almost the same time，in the infant the bolus entered the pharynx almost 1 second before a reflex was induced，and passed over epiglottis and thorough the sinus piriform before finally reaching the pharyngoesophageal segment．There were only slight movements of the soft palate，pharynx，tongue blade，and epiglottis before the reflex．In this paper relevant functional and anatomical differences between the infant's and adult's swallowing were discussed．

The balloon dilatation method for cricopharyngeal dysfunction became known to rehabilitation area in 1992，but the precise procedure，indication and outcome was not reported．As for balloon catheter treatment，four methods（a to d）were applied according to the cricopharyngeal condition．We chose two types of balloon，a ball balloon（bardia Biocath foly catheter^®，14～18Fr，Bard）and a cylinder balloon （Lunderquist Oumanesophageal Dilation Polyvinylchloride Baloon^®，14～19Fr，Cook）a．lntermittent dilation method by ball balloon．b．Pull through method synchronized with swallowing or simple pull through method by ball balloon． c．Ball balloon swallowing method． d．Continuous dilatation method by cylinder balloon．We treated seventeen cricopharyngeal dysphagia patients using the above balloon catheter treatment methods．Of the seventeen patients，the cause of cricopharyngeal dysphagia was due to eleven brain stem infarction，three post operative subarachnoid hemorahge，one cervical injury and two from other causes．Nine patients showed successful rehabilitation using balloon methods and were able to eat oraly．Seven patients had a poor response to the ballon methods and required operation．We used also balloon methods on the post operative stricture of cricopharyngeal segment and the results were good．Balloon methods were useful for acute stage cricopharyngeal dysphagia，but were also good for the chronic stage．We also proposed the classification of cricopharyngeal dysphagia according to the findings from the videofluoroscopic examination of swallowing．

Mealtimes provide one of the great pleasures in the lives of elderly people． There are，however，only a few study reports available today on the relationship between the decline in feeding functions and meal content．The purpose of this study was to clarify the actual feeding conditions at meals and to evaluate how our test food（a gelatin dessert）affects feeding functions．The subjects were 97 housebound elderly persons（including those with acquired physical-mental impairment）．We conducted an experiment using a test food to evaluate individual subjects feeding functions，as well as interviewing each of the subjects，assisted by a caregiver if necessary，to get detailed information on his/her feeding conditions．We obtained the following results：

1． ln the interview，32 out of 97 subjects（33.3％）reported experiencing choking during their regular meals while，in the experiment（using the test food），only 7 out of 93 subjects（7.5％）reported it．

2． ln the interview， out of those who had acquired cerebro-vascular disorders or dementia，it was indicated that many were subject to frequent choking during their regular meal．On the other hand，in the experiment，out of those subjects who had acquired Parkinson’s disease，many were subject to frequent choking during the meal．

3． Regarding the causes of the choking， the interview revealed that 10 out of 30 subjects （33.3％） attributed it to unstable posture， 15 out of 27 subjects （56.6％） to an inappropriate upper-body position， and 13 out of 28 subjects （46.5％） to a head position with an inappropriate neck angle．

4． Regarding the causes of choking during the test food meal，the experiment revealed that 5 out of 7 subjects （71.4％） attributed it to an unstable posture，4 out of 6 subjects （66.6％） to an inappropriate upper-body position， and 4 out of 6 subjects （66.6％） to a head position with an inappropriate neck angle．

A survey of dysphagia rehabilitation in a clinical setting was conducted by sending questionnaires to members of the Japanese Society of Dysphagia Rehabilitation（JSDR）．Based on the replies to the questionnaire，the subjects were classified into four groups： whether they offered exercise therapy for eating and swallowing problems and whether they used videofluorography．ln about half of the facilities where exercise therapy was offered，videofluorography was used．On the other hand，few of the facilities where exercise therapy was not offered used it．Among facilities surveyed，many hospitals used videofluorography，while few dental clinics used it even though most of the dental clinics offered exercise therapy for dysphagia．Concerning the kinds of professions engaged in dysphagia rehabilitation in the facilities，many nurses and speech therapists were in a rehabilitation team．ln most of the facilities， various kinds of professionals worked as team on the examination and rehabilitation of dysphagic patients．The importance of a team approach is gradually being recognized in the field of dysphagia rehabilitation．However，about half of the facilities pointed out difiiculties in maintaining good teamwork among various professionals in a team．Among problems in dysphagia rehabilitation，insufficient examination and risk management ranked high on the list．The results of the survey suggested the difficulties in coordination between facilities（especially between a hospital and a dental clinic），education needed for dysphagic examination and exercise therapy，and teamwork among various kinds of professionals．The JSDR is expected to play an important role in resolving these problems．