【Purpose】The study aimed to develop a family-assessment scale for dysphagia risk of elderly people to use as a first screening test, and to establish a screening system for dysphagia risk by means of the family-assessment scale and food test.
【Methods】The study was approved by the Ethics Committee of the Aichi Prefectural College of Nursing＆Health. The family-assessment scale made contained 14 items. As the first screening test, a questionnaire survey was conducted among the elderly people and their families using the elderly self-assessment scale and the family-assessment scale, respectively. Valid responses were obtained from 366 families, among 293 paired with elderly people. As the second screening test, the food test was conducted on 50 elderly people living at home who understood the purpose of this study and expressed their informed consent, and whose family was assessed by the family-assessment scale, Then videofluorography was conducted as the gold standard.
【Results】1. For the family assessment scale, twelve items were selected from considering the results of reproducibility and item analysis. Construct validity was analyzed by factor analysis. Two factors were obtained from the analysis, “preparatory-oral-pharyngeal dysphagia,” and “aspiration.”
2. Reliability was analyzed by internal consistency and test-retest. Cronbach's α was 0.89 as for overall scores. The correlation coefficient for the elderly self-assessment and the family-assessment to dysphagia risk for elderly people was 0.60～0.79.
3. When the cut-off point in the family-assessment scale was put at 3 points, the sensitvity was 0.583 and the specificity was 0.500.
4. Logistic regression analysis was used with the family-assessment scale and food test, with sex and clinical history and medications affecting swallowing function as the dependent variables and videofluorography as an independent variable. Predictive values obtained by the family-assessment scale, food test, sex and medications affecting swallowing function with a high odds ratio were 78.0％ with or without dysphagia risk by videofluorography.
【Concbsion】These results indicated the family-assessment scale had good concordance with the elderly self-assessment scale, and suggested the availability of screening by the family-assessment scales for detecting elderly people with a dysphagia risk.
This study examined the appropriate characteristics of test foods and the influence of the swallowing threshold on the assessment, in order to establish a simple method for assessing masticatory function based on the number of masticatory cycles.
The subjects were 28 young people (in their 20s) and 26 elderly people（70 years or older）living in a community. Their occlusal condition parameters (contact area, maximum pressure, total force, and force of the first molar) were measured. The pre-swallowing boluses ef each test food (dried apricots, sliced bread cooked burdock roots, cooked chicken, kamaboko, boiled mushrooms, arares, boiled spinach, and teriyaki yellowtail) were collected to analyze the characteristics of the boluses：particle size distribution, texture (hardness, cohesiveness, adhesiveness, resnience) and water content. The number of masticatory cycles till swallowing was counted. To find the regression equations of the number of masticatory cycles, the parameters of occlusal condition and the characteristics of the boluses were analyzed as explanatory variables using multiple regression analysis.
The regression equations of the number of masticatory cycles were found for cooked burdock roots and boiled spinach. From the equations, it was clarified that the contact area and maximum pressure influenced the chewing number of cooked burdock roots, and the force of the first molar influenced the chewing number of boiled spinach. The number of masticatory cycles increased as the values of their parameters decreased. However, the particle size distribution and texture had a stronger influence. Correlations between the parameters and number of masticatory cycles were observed. It was considered that these foods were masticated until their own swallowing thresholds.
The method for assessing masticatory function based on the number of masticatory cycles using cooked burdock roots and boiled spinach was found to be valid. However, it was clarified that the particle size distribution and texture had a stronger influence than the occlusal conditions. To assess the masticatory function based on the number of masticatory cycles using these foods, it is necessary to consider their swallowing thresholds carefully.
A potential reduction in the serum albumin in patients with dysphagia may be attributed in part to the difficulty in deciding as to which physical properties are suitable for these patients. According to the dietary criteria performed in Seirei Mikatahara General Hospital, therefore, foods classified into 3 grades of severity were selected among 5 graded foods to determine their physical properties. As a result, the hardness of 2–7×103N/m2 was considered suitable for patients with dysphagia of Grade 1, 1–10×103N/m2 for those of Grade 2, and 1.2×104N/m2 or less for those of Grade 3. The cohesiveness was revealed to be suitable at 0.2–0.5 for patients with dysphagia of Grade 1, 0.2–0.7 for those of Grade 2, and 0.2–0.7 for those of Grade 3. As for the adhesiveness, the value below 2×102J/m2 was considered suitable for patients with dysphagia of Grade l and below 2×102J/m3 for those of Grade 2. It was however suggested that the cohesiveness should be around 0.4 when the adhesiveness ranged from 2–5×102J/m3. Although the adhesiveness below 3×102J/m3 was revealed to be suitable for patients with dysphagia of Grade 3, It was suggested that the cohesiveness should be around 0.4 when the adhesiveness ranged form 3–8×102J/m3.
【Objective】The purpose of this study is to investigate the dominant bolus transport side to the hypopharynx and passage side at the cricopharyngeal portion in patients with Wallenberg syndrome.
【Subjects and methods】The subjects consisted of 47 trials of videofluoroscopy in 24 cases of Wallenberg syndrome presenting with dysphagia.We evaluated the dominant bolus transport side to the hypopharynx and passage side at the cricopharyngeal portion with the head in the neutral position by using videofluoroscopy in the antero-postenor projection. When the transport side was the affected side, head rotation or swallowing in the decubitus position was performed to lead the bolus to the non-affected side.
【Results】The dominant bolus transport side to the hypopharynx was as follows：15 (32％) were both sides with no laterality, 24 (51％) were the affected side and 8 (17％) were the non-affected side. The dominant bolus passage side at the cricopharyngeal portion was as follows：6 (13％) were both sides with no laterality, 9 (19％) were the affected side,16 (34％) were the non-affected side and 16 (34％) were no passage. The efficacy of adjusting the swallowing position to control the bolus was 80％ when the transport side was the affected side.
【Conclusion】The dominant bolus transport side to the hypopharynx is often the affected side although the dominant bolus passage side at the cricopharyngeal portion is the non-affected side. It is considered important to control bolus transport by adjusting the swallowing position.
【Purpose】The feeding function in mammals changes from suckling behavior to more complex feeding and swallowing functions including mastication. It is noted that the development of and maturation in the central nervous system is essential during this period, therefore, it is necessary to form neuronal circuits involved with feeding and swallowing functions within a specified period of postnatal time. The purpose of this study was to reveal the changes in activation of central neuronal nucleus involved with feeding caused by the weaning condition when the pups begin to shift from suckling to mastication with the observation using the Fos protein（Fos）as a marker of immunohistochemistry.
【Methods】Twenty-seven Sprague-Dawley rats were separated into the following 3 groups (9 pups in each group) at 15 postnatal days：①Early weaning group (feeding on solid food exclusively), ②Unweaned group (sucking milk artificially without feeding on solid food), ③Control group (nursed with dam). Then, at 19 and 21 postnatal days (P19 and P21, respectively) they were perfused for fixation and the brainstem tissues were extracted and prepared by coronal section (50 μm in thickness). The authors counted the number of Fos-immunoreactive (FI) neuronal cells in the nucleus nervi hypoglossi (XII), nucleus tractus solitarius (NTS), and trigeminal nucleus interpolaris (Sp5i) in thebrainstem.
【Resuts】FI cells were obselved in the early weaning group, especially in P19 rats, there were significant differences between these rats and other groups in the number of FI cells in XII and NTS. Otherwise, in P21 rats, a comparison showed no significant differences in the NTS region. In the Sp5i area, observation indicated the greatest number of FI cells in the early weaning pups, and the control group showed the smallest number of FI cens. Consequently, it was thought that differences in feeding or sucking behavior during the weaning stage influence the nervous activity in the central neuronal nucleus associated with feeding and swallowing functions.
【Conclusion】This study suggested that alterations in the neuroactivity in the central neuronal nucleus were related to changes in the food that rat pups feed on during the weaming period.
Changes in swallowing activity with differences in neck rotation and trunk tilt angle were considered. The basic posture was set to the semi-Fowler's position of 60°, and four conditions were set up in consideration of the correlation of neck rotation and trunk tilt angle. ①Posture A：right middle neck, right middle trunk, ②Posture B：30° neck rotation, right middle trunk, ③Posture C：right middle neck, 30° trunk tilt, ④Posture D：right middle neck position,15° trunk tilt, The study subjects were ten healthy adults who do not have a problem in dysphagia function as a healthy group, and 13 cerebrovascular-disease patients as a disease group. For the healthy group, subjects were made to voluntarily swallow water of 30 ml at normal temperature, and the amount of muscular activities of each peak hour was measured (MEB-5504, Nihon Kohden Corp.) and suprahyoids were extracted by the bipolar lead, In the disease group, the Water Swallowing Test and the Repetitive Saliva Swallowing Test (RSST) were performed after 5 minutes of quietness for each of four postures. Between each posture, the Water Swallowing Test carried out the profile and RSST carried out comparison examination of the number of times of a judgment, respectively. To examine the amount of muscular activities in the healthy group, the value of posture B was compared with that of posture A, and a significantly high value was shown, and at least the figure was compared with the value of posture B and, as for the value of C, showed a significantly low value. To examine the profile of the Water Swallowing Test in the disease group, at posture B, there were few normal groups intentionally compared with posture A, and C and D, In comparing the number of times of judgment of RSST, posture B showed a low value compared with posture A, and it was almost the same as posture A in posture C and posture D. From the above result, the importance of carrying out a setup in consideration of the correlation of neck and trunk was suggested in posture of the semi-Fowler's position of 60°. That is, only the neck was not rotated to dysphagia, but after holding to right middle, the neck was considered to be more effective to make it trunk tilt.
The purpose of this study is to investigate the dyspahgia of patients with a tracheotomy tube in long-tem care facility.
【Methods】Forty-nine (49) dysphagic patients received swallowing therapy for six months while they were in our long-term care facility, Eleven (11) of them had tracheotomies, who were investigated in this study, Data collected from swallowing conference reports and medical charts of the patients included the consciousness level, MMSE, incidence of aspiration evaluated by the videofluoroscopic swallow studies (VFSS), swallowing training methods, Dysphagia Severity Scale (DSS), dietary status, type of tracheotomy tube and incidence of complication.
【Results】Aspiration was detected in eight patients (73％), all of whom presented silent aspiration (100％). By the evaluation of VFSS and clinical swallowing examination, three patients continuously received direct training, two patients started direct training, two patients stopped direct training and continued only indirect training, and four patients continuously received indirect training, For all these patients, swallowing therapy was given two to five times per week. In regard to their DSS, one patient could improve the grade without aspiration, while the remaining ten patients stayed in the grade with aspiration. Regarding their dietary status, one patient could resume oral feeding after tube feeding, while the remaining ten patients continued to be fed through tubes. During the investigation, decannulation was performed on one patient. Aspiration pneumonia was observed as a complication in three patients (27％).
【Discussion】Among patients who needed tracheotomies even after they were transferred to the long-term care facility, decannulation was rarely performed. Given the high incidence of silet aspiration among patients whose aspiration VFSS detected and the high incidence of aspiration pneumonia, it is essential to evaluate and treat dysphagic patients with a tracheotomy tube in a comprehensive manner including VFSS, clinical swallowing examination, and daily examination of systemic conditions. In the future we need to further develop the collaboration with professionals in other fields.
To replace a naso-gastric tube we used a guid wire. A thin gide wire is inserted and it is left in position after the old tube has been removed, then a new tube is inserted along the guide wire. We have named this method as “the naso-gastric guide wire tube replacement technique”. Sixty three times in thirteen cases we had complete success using this replacement method, only one time the guide wire was pulled out due to a jerking movement from the patient. It took about ten minutes to perform this method. No complication was seen. In one case this method was used 25 times over a 3 year period. There was no ulcer or inflammation on the mucosal surface of the nasal and pharyngeal cavity when using 8 Fr polyurethane naso-gastric tube. This method is extremely usefull when we need to exchange a naso-gastric tube, especially in difficult cases of tube insertion.