【Purpose】 Swallowing maneuvers using foods are often started with jelly, for which sliced jelly is recommended. We investigated the differences of bolus transition from the oral cavity to pharynx between solid and liquid foods, using gelatin jelly and thickened water.

【Subjects and methods】 The subjects were 141 patients who underwent video-fluorography（VF）from January 2005 through December 2005. There were 77 males and 64 females, with average age of 74 years. The transit time of bolus from the oral cavity to the pharynx was measured by VF images. The posture for taking foods was set at 30-45 degrees and at 60-90 degrees from the horizontal. Gelatin jelly and thickened water with viscosity of 750 mPa・s were used. In six patients with oral swallowing phase disorder, the transit time of sliced jelly and crushed jelly from the oral cavity to the pharynx were measured. Which type of jelly was better for these patients to perform swallowing maneuvers was also investigated.

【Results】 The transit time of jelly was 7.7±15.2 seconds and that of water was 3.8±8.8 seconds. Water was transferred more quickly than jelly (n ＝ 141, p＜0.01). In the investigation of the relationship between the posture for taking foods and the transit time of jelly and thickened water, the transit time of jelly was 8.6±17.4 seconds and that of thickened water was 3.6±6.8 seconds at 30-45 degrees, while the transit time of jelly was 7.0 ± 13.5 seconds and that of thickened water was 3.9 ± 10.0 seconds at 60-90 degrees. The transit time of thickened water was shorter than that of jelly at any posture for taking foods (p＜0.05). In the analysis of transit time of sliced jelly and crushed jelly, the transit time of sliced jelly was 22.5±8.0 seconds and that of crushed jelly was 15.5±8.5 seconds. The crushed jelly was transferred from the oral cavity to the pharynx more quickly than the sliced jelly (n ＝ 6, p＜0.05).

【Conclusion】 The thickened water was transferred from the oral cavity to the pharynx more quickly than jelly. In the patients with oral swallowing phase disorder, crushed jelly was transferred more quickly than sliced jelly. Liquid foods might be more suitable than solid foods for swallowing maneuvers in patients with oral swallowing phase disorders.

【Objective】We investigated the establishment of an acceptance and an effective dysphagia rehabilitation method for people with severe learning disabilities by evaluating their cognitive function and feeding function with the application of feeding training.

【Subjects and Methods】The subjects of this study were 12 adults with severe learning disabilities (8 males and 4 females, mean age 38.2 ± 11.0 years old). The subjects included those who were asked to be instructed in terms of the appropriate eating style by the facility staff for the following reasons：“they finish eating too fast” or “they swallow without chewing”. We obtained informed consent from the subjects and their guardians prior to the investigation. Afrer examinations to ascertain general condition, a dentist and a speech therapist evaluated their feeding function, a speech therapist their ADL/growth, and a national registered dietitian their nutritional status. Then, the dysphagia rehabilitation, with particular emphasis on pacing, was performed once a month. Subjects were grouped depending on the frequency of receiving this instruction, and their feeding function and nutritional status were evaluated one year later. This study was performed with approval from the Ethics Committee of The Nippon Dental University.

【Results】Out of 12 subjects, seven received serving assistance for pacing as one of the dysphagia rehabilitation, and five of these seven showed improved eating function one year later. This result suggested that their individual-social development and fine motor action-adaptation development may have impacted the effects of the dysphagia rehabilitation.

【Conclusion】It is important to develop a specialized dysphagia rehabilitation method including evaluation of cognitive function for people with severe learning disabilities.

【Objective】We investigated the location of bolus at the beginning of the swallowing reflex and found that the swallowing movement and bolus coordination depended on three patterns of chewing. The purpose of this study was to know whether different chewing methods influence the swallowing movement.

【Method】Six healthy adults (average age 28.5 ± 2.6) participated in this study. Subjects were instructed to eat 8-g cookies containing barium by three kinds of chewing methods： a） free mastication, b） mastication with a fixed number of times, or c） mastication by anterior teeth. Bolus transportation was imaged with videofluorography from a side view and recorded by digital video. The position of the leading edge of the bolus was classified into oral cavity (OC), upper-oropharynx (UOP), valleculae (VAL), or hypopharynx (HYP). The swallowing movement was divided into three stages： stage 1 ＋ transport, postfausial aggregation time (PFAT), valleculae aggregation time (VAT), and hypopharyngeal transit time (HTT). Swallow onset was defined as the time when movement of the hyoid began its rapid elevation.

【Result】The position of the bolus at the beginning of the swallowing reflex was frequently at the VAT in the free mastication method and mastication with a fixed number of times method. In the mastication by anterior teeth method, the position was frequently at the HYP. Mastication by the anterior teeth method reached HYP earlier. Food transportation time was shorter in the mastication with a fixed number of times method, and longer in the mastication by anterior teeth method at VAT. Longer VAT can be the risk of aspiration.

【Discussion】The mastication with a fixed number of times method was effective to prevent aspiration. On the other hand, mastication by the anterior teeth method made it raise a risk of aspiration. This was because the swallowing reflex started earlier in the mastication with a fixed number of times method, and later in the mastication by anterior teeth method. Thus, the chewing method affected the swallowing movement.

【Purpose】Patients with swallowing disorder often need respiratory physiotherapy due to retention of secretion. However, drainage of secretion can not be effectively obtained when the condition is complicated by marked dryness in the oral cavity or upper respiratory tract. We noticed that oral care immediately before respiratory physiotherapy is good to drain the secretion. So the aim of this study is to evaluate the effectiveness of oral care to the respiratory physiotherapy on airway clearance.

【Subjects and Methods】The subjects were 25 inpatients (23 males, and 2 females aged 81.4 years) with aspiration pneumonia who were receiving oral care and respiratory physiotherapy in our hospital between January 2004 and February 2005. Respiratory physiotherapy alone or that combined with oral care immediately before was randomly performed to the subjects on 2 consecutive days. Oral care was performed by the same dental hygienists and respiratory physiotherapy by the same physical therapists, and secretion was finally removed by suctioning. Under the above two conditions, the amount and properties of sputum, easiness of the suctioning procedure using the 100 mm visual analog scale（VAS）were evaluated. ln the oral cavity, the degree of oral dryness was evaluated.

【Results and Discussion】The amount of sputum with oral care group showed significantly larger（p＜0.01）than that without oral care group. And the suctioning in the group with oral care is significantly（p＜0.01）easier than in without oral care group assessed by the VAS. When there were severe oral dryness and purulent sputum, the amount of sputum significantly increased, and the easiness of the suctioning procedure significantly improved in the group with oral care. The improvement in the group with oral care may be because of moistening of the oral cavity, pharynx, and upper respiratory tract after oral care, facilitating secretion flow. When there are severe oral dryness and purulent sputum, oral care just before the respiratory physiotherapy may be useful in clinical setting.

【Purpose】We designed and constructed a standardized swallowing evaluation form to be used among professionals working with swallowing impaired patients. The purpose of the form was to enable accurate recording and dissemination of information between all people involved in the care process by recording and scoring swallowing function factors. Factors affecting swallowing ability were graded on a point scale for each patient, with a cumulative total providing a quantitative value reflecting the current swallowing status or level of improvement.

【Subjects and methods】We evaluated 31 subjects diagnosed as having dysphagia resulting from CNS disorder. Multiple appraisals lead to a total of 92 forms being used, and fourteen factors associated with swallowing ability were identified and graded over the course of each assessment. These included cognition of food, motivation, palsy, ataxia, tracheotomy, tongue exercises, nasopharyngeal closure, elevation of the lingual root, glottis closure, elevation of the larynx, RSST (Repetitive Saliva Swallowing Test), swallowing reflex, voice disorder and understanding.

【Results and Discussion】1. It was found that the cumulative point total of swallowing function factors from each evaluation correlated significantly with Fujishima's grading in dysphagic patients.

2. Ten factors were additionally found to correlate significantly with Fujishima's grading. These included cognition of food, motivation, tongue exercises, nasopharyngeal closure, elevation of the lingual root, glottis closure, RSST, swallowing reflex, voice disorder and understanding. These factors, individually or in conjunction, thus appear to have importance in predicting swallowing ability. Multiple regression analysis revealed that the regression formula including motivation, ataxia, elevation of the lingual root, swallowing reflex, voice disorder can be predict Fujishima’s grading.

3. In 26 cases which had undergone at least 2 swallowing evaluations, elevation of the lingual root correlated strongly with swallowing ability at the time of the last swallowing evaluation. Among fourteen factors, only elevation of the lingual root can be predict Fujishima's grading by multiple regression.

Thus our case conference form is thought to be useful to evaluate swallowing function of dysphagic patients.

We report a patient with dysphagia after a brain-stem stroke who developed pleurisy caused by aspiration during swallowing rehabilitation. To prevent aspiration, safety conditions were experimentally determined by videofluoroscopic examination of swallowing（VF）before the start of swallowing rehabilitation, which was gradually performed. However, pleurisy occurred in the patient when food was changed from pureed food to that requiring mastication. So we developed a new rehabilitation method to refer VF after 24-day fasting. In this method, a bolus was put into the pharynx after laryngeal lifting was enhanced by positioning the back of the tongue as in the pronunciation of “ki” , and strongly swallowed when it was positioned at the epiglottic vallecula. Rehabilitation was restarted with it after inward rotation of the vocal cord was performed. As a result, food requiring mastication, which may have caused the aspiration, could be taken, and the eating efficiency became higher than before the occurrence of pleurisy. Even though aspiration was not observed by VF, it could have occurred in the patient when pureed food was taken. Furthermore, taking food requiring mastication may have enhanced the difference in the timing and aspiration.