【Purpose】This study was aimed to electromyographically examine whether the palatoglossus (PG) muscle might be involved in regulation system of transporting Newtonian liquid around the transition from the oral to the pharyngeal phases．That is，it was examined whether there might be change in PG muscle activity in relation to liquid volume during swallowing．

【Methods】Seven normal adults participated in this study．Each subject was instructed to swallow liquid of five different volumes； 12.5％，25％，50％，100％ and 150％ (or 125％) of optimum volume for swallowing，which was determined individually for each subject prior to this study．Smoothed EMG signals of PG muscle activity and levator veli palatini (LVP) muscle activity were studied in terms of swallowing volume．

【Results】PG muscle waveform for one single swallow showed two patterns of the activity；One was a pattern of a single peak and the other was of two peaks．The peak of the single peak pattern and the second peak of the two peak pattern were considered as the same．There was marked aspect of change in PG muscle activity at the timing of those peaks in relation to change in swallowing volume．That is，for three subjects，PG muscle activity was significantly correlated with swallowing volume while PG muscle activity was ranged in relatively higher region for remaining four subjects．The PG muscle could be involved in the regulation of swallowing at the transition of bolus from the oral to the pharyngeal phases．

This study aims to examine Nursing practices and the problems provided by home visiting nurses to caregivers of persons with dysphagia．Consequently， we classified Nursing practice into the following six areas： “Preventive assessment of the problem,” “Determination of the caregiving situation,” “Offer of appropriate information and the technology，depending on the nature of the problem,” “Communication in the case of emergencies,” “Understanding of food preferences,” and “Adjustment of the home care service.”

The difficulties and the problems encountered in nursing existed in the following areas：

“Understanding food preferences and supporting continued caregiving,” “Nursing diagnosis and nursing practice at home,” and “Adaptation to another occupational category,” etc．

【Purpose】This study aimed to modify an assessment scale of dysphagia risk for elderly persons to use as a first screening test，and to establish a screening system of dysphagia risk by means of the modified assessment scale and the second screening test．

【Methods】The study was approved by the Ethics Committee of the Aichi Prefectural College of Nursing ＆ Health．As the first screening test，a questionnaire survey was conducted using the modified assessment scale．The voluntary participants were 759 elderly people．As the second screening test，the repetitive saliva swallowing test，modified water swallowing test and food test were performed on 71 elderly people living at home who understood the purpose of this study and expressed their informed consent in writing．Then videofluorography was conducted as the gold standard．

【Results】1．For an improved assessment scale，twenty-three items were selected from considering the results of reproducibility and item analysis．Construct validity was analyzed by factor analysis．Four factors were obtained from the analysis, “pharyngeal dysphagia,” “aspiration,” “preparatory-oral dysphagia,” and “esophageal dysphagia.” Reliability was analyzed by internal consistency and test-retest．Cronbach's α was 0.92 and the test-retest correlation was 0.85 for overall scores．The validity and reliability were better than before the revision．

2．When the cut-off point in the modified assessment scale was put at 6 points，the sensitivity was 0.571 and the specificitJy was 0.560．

3．Logistic regression analysis was used with the first and second screening test， age， sex and clinical history and medications affecting swallowing function as the dependent variables and videofluorography as an independent variable．There was a statistically significant correlation with sex，and the odds ratio was 12.2．Predictive values obtained by sex，and the clinical history and medications affecting swallowing function，modified assessment scale and food test with a high odds ratio were 76.1％ with or without dysphagia risk by videofluorography．

【Conclusion】These results suggested the availability of screening by sex，clinical history and medications affecting swallowing function，modified assessment scale and food test for detecting elderly people with dysphagia risk．

We report trial of IOG between 5 years from April，2000 to March，2005 in 56 beds of our long term care ward and compare IOG with PEG (Percutaneous Endoscopic Gastrostomy)．We do not perform continuous nasogastric tube feeding (CNG) at our hospital in principle．In our hospital among these 5 years IOG was used to feed 43 dysphagic patients and PEG was used to 33 dysphagic patients as tube feeding．Seven (16.3％) of 43 patients who received IOG were able to eat orally three times a day and two patients were able to eat orally two times a day and three patients were able to eat once a day using IOG together．Only two patients (6.1％) who received PEG were able to eat orally three times a day and only one patient were able to eat two times a day and only one patient were able to eat once a day．The ratio to be able to eat orally is significantly higher in patients who received IOG than patients who received PEG．The ratio of MRSA positive in sputum is 39.5％ in IOG group and 51.5％ in the PEG group．It is slightly high in PEG，but there is not significant difference．Among these 5 years，17 patients (39.5％) died in the IOG group and 22 patients (66.7％) died in the PEG group．Mortality of the PEG group is significantly higher than that of IOG group．6 patients died by aspiration pneumonia in the IOG group，however，13 patients died by aspiration pneumonia in the PEG group．The mortality caused by pneumonia is significantly higher in the PEG group (39.4％) than in the IOG group (14.0％)．If we exclude pneumonia as the cause of death，mortality becomes approximately same in both group．IOG is a safe and useful method in comparison with PEG．PEG is placed easily now．IOG is the tube feeding that we should try once by all means before PEG．

【Objective】In 2002，we reported that a bolus which mixed liquid and solid food promptly moved to the hypopharynx prior to swallowing when it was chewed and swallowed．The purpose of this study was to identify influence of chewing and to endoscopically identify factors related to the swallowing reflex．

【Subjects and Methods】Subjects were nine healthy volunteers (mean age of 28.8 years)．An elastic 4-Fr tube was inserted through the left nostril and fixed so that the tube was at the level of the palatopharyngeal muscle． Greencolored water was injected using a syringe pump at the rate of 6.5 ml/min (slow)，or 11.5 ml/min (fast)．We recorded suprahyoid muscle EMG and endoscopically observed fluid transport and recorded the images on a digital videotape．We measured the time from the start of injection to initiation of swallow reflex under six different conditions；food was either chewed or not chewed ，food was either swallowed spontaneously or volitionally delayed and liquid injection speed was slow or fast．

【Results】Latencies were significantly different only between spontaneous and volitionally delayed swallowing (p＜0.01) or between slow and fast infusions (p＜0.05)．There was no significant difference between chewing and no chewing．When subjects volitionally delayed swallowing，adduction of the arytenoids and expansion of the pharynx were seen in all subjects．In spontaneous swallows，swallow initiation was elicited when liquid reached pharyngoepiglottic band or filled the half of pyriform sinus．In volitionally delayed swallows，swallow initiation was elicited when liquid overflowed the pyriform sinus into the aryepiglottic fold or interarytenoid notch．

【Discussion】Chewing had no effect on the duration between the onset of liquid infusion and initiation of the swallow reflex．Volitional delay of swallowing altered the anatomy of the pharynx to accommodate the increased bolus volume and avoid aspiration but not alter threthold of swallow reflex．This interesting finding will be useful Dysphagia rehabilitation．

【Objective】We divided the feeding process depending on the location of bolus．We analyzed the chewing cycle of each swallowing stage，to investigate the cooperation between mastication and swallowing movement．

【Method】Twelve healthy adults (average age，28.8 ± 3.7y) having normal occlusion participated in this study．Subjects were instructed to eat 8g of cookies containing barium，and then jaw and bolus movements during mastication and swallowing were recorded simultaneously．Bolus transportation was recorded by videofluorography from a lateral view，and the jaw cycle was recorded by digital video from the antero-posterior view．The swallowing stage was divided into four stages，as follows： In Stage 1 transport，food is moved to the molar region； in Processing，food is manipulated to bolus in the mouth； in Stage 2 transport，bolus is propelled into the oropharynx during chewing，and hypopharyngeal transit time is the pharyngeal stage of swallowing．All of the subjects were classified into two groups according to the types of chewing cycle： ln Type 1 (n＝3)，lateral jaw displacement during mastication is larger than vertical displacement； in Type 2 (n＝9)，lateral jaw displacement is smaller than vertical．Maximum gape，cycle breadth： maximum breadth of the chewing loop； duration of the chewing cycle； duration of each swallowing stage，and the rate of duration of each swallowing stage，were compared by each type of chewing cycle．

【Results】The duration of Processing of Type 1 was shorter than that of Type 2．In Type 1，neither the duration nor the chewing cycle changed between Processing and Stage 2 transport．In Type 2，the maximum gape and the duration of Stage 2 transport were shorter than those of Processing．

【Discussion】There are two patterns of coordination of jaw movement and food transport．That is Stage 2 transport with or without reduction of jaw movement according to the progress of mastication．Therefore，it was suggested that the food transportation and bolus formation was different when the chewing cycle pattern was different．

We report a 76-year-old woman with dysphagia caused by left lateral medullary infarction．She developed venigo，left limb ataxia，dysarthria and dysphagia．Vertigo and ataxia improved soon，but dysphagia remained severely．Videofluoroscopic examination of swallowing (VF) showed an impairment of the upper esophageal sphincter opening．and the balloon dilatation method for cricopharyngeal dysfunction was applied．Dysphagia did not improve at all though the balloon treatment was continued for five months．Because the larynx elevated enough in VF，a cricopharyngeal myotomy was performed．However dysphagia did not change and vomiting appeared．Because she accepted a tracheotomy，a laryngeal suspension was added．After the laryngeal suspension，the entrance of the esophagus was opened with forward motion of the neck and the food bolus passed into the esophagus with gravity．She became to eat three times a day and the tube nutrition became unnecessary． lf a cricopharyngeal myotomy is not effective for dysphagia of Wallenberg syndrome，we should consider the addition of a laryngeal suspension．