The Japanese Journal of Dysphagia Rehabilitation
Online ISSN : 2434-2254
Print ISSN : 1343-8441
Volume 10 , Issue 2
The Japanese Journal of Dysphagia Rehabilitation
Showing 1-6 articles out of 6 articles from the selected issue
Original Paper
  • Kaoru KOHYAMA, Hiroko SAWADA, Miho NONAKA, Misao NAKAJOH
    2006 Volume 10 Issue 2 Pages 115-124
    Published: August 31, 2006
    Released: December 26, 2020
    JOURNALS FREE ACCESS

    Rice cake (mochi) is a difficult food to chew and swallow.Recently the food industry has produced some mochi-like products by modifying the texture for the elderly or people with chewing and swallowing difficulties.We compared the texture of standard rice cake and a modified product.An instrumental two-bite test was adopted to characterize sample texture including firmness,cohesiveness,adhesiveness,and compression energy.The modified product was softer and had less cohesiveness and bite energy than standard rice cake.However,the adhesiveness value of the modified product was similar to that of the standard.The modified product exhibited more stable texture when cooking time and storage time after cooking were varied. We also recorded mastication and swallowing behaviors of 11 normal women eating the two rice cake samples.Electromyography from both sides of the masseter muscles and suprahyoid musculatures;larynx movement by an array of three small pressure sensors placed on the thyroid cartilage,and swallowing sound beside the cricoid cartilage,were measured.Electromyography during chewing revealed that the modified product required shorter mastication time (60% of the standard) and smaller amplitude of jaw-closing muscles (78%) than the standard rice cake.Those resulted in much less mastication effort until swallowing (57% for the masseter muscles,and 50% for the suprahyoid musculatures,of the standard).The modified product also showed less activity (69% of the standard) of the suprahyoid musculatures at the beginning of the swallowing corresponding to less adhesiveness.However,similar larynx movement and sound for swallowing were observed for both samples.Human measurement provided more direct evidence for difficulties in mastication than instrumental texture analysis,but it showed less difference between the two samples in swallowing.As healthy subjects could change the manner of mastication according to sample texture,there may not be significant differences between boli of different rice cake samples after swallowing began.

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  • Ryo OHNO, Ichiro FUJISHIMA, Tomohisa OHNO, Hirotatsu TAKAHASHI, Yuri K ...
    2006 Volume 10 Issue 2 Pages 125-134
    Published: August 31, 2006
    Released: December 26, 2020
    JOURNALS FREE ACCESS

    【Purpose】Nasogastric tubes are commonly used for the management of nutrition.The bleeding or ulcer formation are sometimes experienced in the nose,the pharynx,the esophagus and the stomach.Incorrect tube insertion into the trachea,and gastroesophageal reflux are also generally known as complication in association with the nasogastric tube,but there is no rational evidence that the nasogastric tube might affect swallowing behavior.We evaluated effects of a nasogastric tube on swallowing attitude in patients with swallowing disorders by records of videofluoroscopy.

    【Subjects and methods】The subjects were 63 patients with swallowing disorders who were underwent videofluoroscopy both with a nasogastric tube inplace and after its removal at our hospital after 1993.We evaluated the change in findings after a tube was removed and the association between the improvement after tube removal and the size or the way in pharynx of inserted tubes.

    【Results and discussion】After removal of the nasogastric tube,the improvement in inversion of the epiglottis was observed in 28 patients,the decrease in residue in the pharynx in 14,the improvement in passage through the pharynx in 5,the improvement in aspiration and penetration in 9,and the acquisition of swallowing in 5.Statistically significant changes after removal of the nasogastric tube tended to be observed when the tube size was large and the tube was inserted into the esophageal entrance on the opposite side of the nasal cavity after crossing in the pharynx.

    【Conclusion】This study confirmed the influences of the nasogastric tube on swallowing in patients with swallowing disorder.

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  • Yasuhiro SASAO, Takashi TACHIMURA, Kanji NOHARA, Takeshi WADA
    2006 Volume 10 Issue 2 Pages 135-141
    Published: August 31, 2006
    Released: December 26, 2020
    JOURNALS FREE ACCESS

    【Objectives】The aim of this study was to examine whether orbicularis oris muscle (OOM) activity during lip closure might be changed in relation to the thickness of a plate inserted into the labial vestibule (lip-plate).

    【Methods】Five normal adults participated in this study.Lip-plates were fabricated for each subject with a tailor-made basis in their width and height while the thickness of the lip-plate was adjusted as follows:5.0mm,7.5mm,10.0mm,12.5mm, 15.0mm and 17.5mm.Each subject was directed to keep the lips closed tightly with the lip-plate in place.Smoothed EMG signals of the upper and lower OOM were collected during lip closure.

    【Results】OOM activity was correlated with changes in thickness of the lip-plate in place.The characteristics of changes in the activity were not different between the lower and upper lips.

    【Conclusion】The OOM could be changed in accordance with the thickness of the lip-plate.It is suggested that lip function might be improved by means of a tailor-made lip-plate for person with dysphagia due to lip closing dysfunction.

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  • Eiko ARAI, Chie YAMAMURA, Hiroko EGAWA, Toshio JYOH, Hisanori SHIMADA, ...
    2006 Volume 10 Issue 2 Pages 142-151
    Published: August 31, 2006
    Released: December 26, 2020
    JOURNALS FREE ACCESS

    Using five types of reconstituted flour having different compositions of the gluten-constituent proteins glutenin and gliadin,we prepared cookies with physical properties that were suitable as food for the elderly or as nursing food for patients with slight dysphagia.The breaking properties of cookies whose glutenin and gliadin component ratios were altered were evaluated by instrument measurements,and the eases of cookie swallowing was evaluated by a sensory test and measurements of water absorption of cookies and model bolus physicality.When the component ratio of gliadin-to-glutenin was changed from a ratio resembling that of marketed flour of 1:1 to 1:2, the cookies began to crumble easily,and when they were mixed with saliva their texture improved.This made it easier to form a bolus.A sensory test on young volunteers also demonstrated that cookies with a gliadin-to-glutenin ratio of 1:2 were more suitable food for the elderly and as nursing food than cookies with a gliadin-to-glutenin ratio of 1:1.These results prove that to manufacture cookies that are suitable as such food,it is beneficial to increase the glutenin portion of gluten-constituent protein The main reason why an increase in glutenin alters the physicality of cookies might be because an increase in glutenin decreases the water content absorbed by gluten during dough preparation,which in turn causes the water content absorbed by the starch to increase,thereby promoting starch gelatinization.

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Research Report
  • Yuri KURODA, Ichiro FUJISHIMA, Hirotatsu TAKAHASHI, Norimasa KATAGIRI, ...
    2006 Volume 10 Issue 2 Pages 152-160
    Published: August 31, 2006
    Released: December 26, 2020
    JOURNALS FREE ACCESS

    No standardized method for evaluation of esophageal findings on videofluoroscopic examination of swallowing (VF) has yet been suggested.Esophageal residue is recognized on videofluoroscopic examination of swallowing (VF) in many cases.We attempted to classify and evaluate esophageal residue.Methods of removing esophageal residue,if present,were also investigated.【Subjects】The subjects were 234 patients (160 men and 74 women,with a mean age of 73.1 years) with dysphagia,who received VF during the 1.5-year period between October 2003 and April 2005 and could be observed until the esophageal stage.The underlying diseases were cerebrovascular accident in 98 and pneumonia in 62 of these subjects.【Methods】The subjects were instructed to swallow 3ml of 40% barium sulfate (viscosity:about 5300 cp),which was thickened with a thickener,at various angles (30,45,60,and 90 degrees) of the body trunk,at which the best pharyngeal swallowing was recognized,and esophageal residue was evaluated in terms of the following 4 items on en face views:1) Extent of residue (Residue 1: None-slight,Residue 2: Moderate,Residue 3: Extensive); 2)site of residue [upper esophagus (1/3),middle esophagus (1/3),lower esophagus (1/3),upper to middle esophagus (2/3),middle to lower esophagus (2/3),and whole esophagus]; 3) presence/absence of intraesophageal reflux;and 4)methods for residue removal [ (a) Dry swallowing,(b) elevation of the angle of the body trunk + dry swallowing,(c) swallowing gelatinized slices (food bolus) without chewing,and (d) intake of 40% barium liquid].

    【Result】We could classify each esophageal residue with this method.Esophageal residue was recognized in 73.5% (172) of the subjects.With regard to the residue sites,the highest proportion,39% (68) of the subjects,had residue throughout the esophagus,followed by 24% (41) with residue in the middle to lower esophagus (2/3).Intra-esophageal reflux was recognized in more than half of the subjects with residue.Although methods for removing esophageal residue,(a) to (d) described above,were effective,the selected method needs to be tailored for individual patients.We consider esophageal residue to correlate with esophagolaryngeal reflux and pharyngolaryngeal reflux.Methods of standardization for evaluating esophageal findings on VF are considered to promote simplification of evaluation of the esophageal stage and thereby to contribute to clinical studies of the stage.

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Short Communication
  • ― Efficiency of adopting food forms that take into account the differences in swallowing functions ―
    Tomoko TAKAHASHI, Kuniko MASUDA, Aki KAWANO, Keiko FUJII, Hiro OGOSHI
    2006 Volume 10 Issue 2 Pages 161-168
    Published: August 31, 2006
    Released: December 26, 2020
    JOURNALS FREE ACCESS

    The present study examined how,in a newly opened special nursing-care home for the aged,the residents underwent changes in their nutritional condition as a result of eating meals having a texture selected to match their individual eating and swallowing functions.Disparity was recognized in the textural property values between those eating Food Form Ⅰ (soft food) and Food Form Ⅱ (soft,one-bite food) which was designed for subjects with good swallowing functions.In contrast,the textural properties were evaluated as soft,highly cohesive,and uniform for Food Form Ⅲ (soft,mashed food) and Food Form IV (soft jelly and food thickened with commercial agents),which were for subjects with poor swallowing functions.Transition in the BMI values of the subjects rose slightly with time,for all four Food Forms (as far as the mean BMI values were concerned).In particular,the standard deviation of BMI for subjects eating Food Form Ⅳ,who had the poorest swallowing functions among all subjects,decreased compared with that measured at the time the nursing-care home was opened.These results demonstrate that, in step with the moderate increase in the BMI values,the nutritional condition of the subjects eating Food Form Ⅳ improved in general during the same period.Nine months after the opening of the nursing home,the subjects underwent measurement of triceps skinfold thickness,mid-upper arm circumference,mid-upper arm muscle circumference,and mid-upper arm muscle area.The mean values of those measurements indicated no unfavorable nutritional condition in any of the four Food Form subjects.These findings imply that,by assessing the individual swallowing functions of the elderly,detemining what food form is most appropriate for each,and managing the textural properties of each food form,each elderly person will be able to intake more food orally.This will enable them to secure their required energy level and ultimately improve their nutritional condition.

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