In this study, changes in swallowing activity due to different cervical rotations and trunk inclination angles were examined. The basic posture was set at 60° semi-Fowler's position and the following three posture conditions were established in consideration of the mutual relationship between cervical rotation and trunk inclination angle: (1) Posture A: cervical median position, median trunk position, (2) Posture B: 30°cervical rotation, trunk median position, and (3) Posture C: cervical median position, 30° trunk inclination angle. The subjects enrolled in this study included 11 normal elderly volunteers with no disturbed swallowing in daily activities (normal group) and 13 patients with cerebrovascular disorder (disease group). In the two groups, the water swallowing test (WST) and repetitive saliva swallowing test (RSST) were performed. The result of WST was assessed to be negative or positive according to the profile, while that of RSST was assessed by comparing the determined frequencies between various postures. As a result, no significant difference was observed in the results of WST and of RSST between various postures in the normal group. Comparing the results of WST in the disease group, on the other hand, a negative result was observed significantly often for Postures A and C as compared with Posture B. Concerning RSST as well, significantly higher values were obtained for Postures A and C as compared with Posture B. In the comparison of WST between the normal and disease groups, the result in the normal group was significantly better than that in the disease group. In the comparison of RSST between the two groups, significantly higher values were observed in the normal group than in the disease group for all Postures A, B and C. These results suggest it is effective to establish the cervical median position at the basic posture of 60°semi-Fowler’s position. Furthermore, it is also suggested that not only to rotate the neck alone but also to establish the trunk at a inclination position while maintaining the neck at the median position is useful in patients with dysphagia due to disturbed pharyngeal passing on the paralyzed side.
The aim of this study was to investigate the usefulness of texture profile analysis (TPA) as a method for measuring the mechanical properties of dysphagia thickening agents. Commercial dysphagia products were dispersed or dissolved in de-ionized water as a solvent and subjected to some physical measurements, including TPA for hardness, adhesiveness, and cohesiveness, shear viscosity using a B-type viscometer, shape retention by the so-called ring method, and strain and frequency dependence of dynamic viscoelasticities to examine the correlation among measurements. Data cross-checking was also carried out among institutions using the same test samples.
Xanthan-gum based products behaved rheologically as weak gels, showing a low degree of frequency dependence of dynamic storage modulus with mechanical loss tangent ranging from 0.1 to 1 throughout the frequencies assessed. Also, hardness and cohesiveness from TPA were hardly altered by table speed or deformation speed. At a table speed of 10 mm/s and reasonable addition levels from an application point of view (i.e., ＜5%), TPA hardness increased from 170 to 1,200 N/m2 with addition level, while cohesiveness was rather constant within 0.7–0.9 regardless of hardness. A positive correlation was evident between hardness and shear viscosity, while a negative correlation was found between hardness and the ring method indication. Essentially the same data were obtained by different institutions for TPA but not for the viscosity.
The results indicate the usefulness of TPA as a mechanical measurement for dysphagia thickening agents, and their mechanical properties can be well described by a hardness-cohesiveness two-dimensional plot. TPA is advantageous over other physical methods in that it is performed using instruments widely used in the food industry and that it shows a good correlation with other conventional methods along with high data reproducibility, contributing to quality control and texture design of dysphagia products.
[Purpose] Intermittent-oro-esophageal tube feeding is an advantageous method, and has been applied in many patients with dysphagia. In this paper, we report a specific intraoral appliance which facilitates intermittent-oro-esophageal tube feeding on a patient with dysphagia in whom several problems made this method difficult.
[Subjects and Methods] A 72-year-old male with a history of subarachnoid hemorrhage developed cerebral hemorrhage in the subcortex of the left occipital lobe, leading to dysphagia and higher brain dysfunction. The swallowing function was evaluated, and a jelly diet was initiated for training. Finally, 3-times-a-day oral ingestion of a easy swallowing diet was achieved. But, the patient could not take a sufficient volume of water, and so water intake was assisted via intermittent-oro-esophageal tube feeding. However, poor attention due to the higher brain dysfunction resulted in troubles such as tube-biting or extubation during feeding, making it difficult to perform this procedure safely. Therefore, a new intraoral appliance was invented and employed. Intraoral appliance: This appliance is applied in the maxilla, and has the following 2 characteristics: bite at the molar is elevated; and a tunnel-like hole through which the tube is inserted is present on the palate side of the maxillary left molar region. Bite elevation prevents tube-biting at the anterior teeth portion, and facilitates tube insertion into the oral cavity. Tube insertion through the tunnel-like hole is useful for avoiding tube-biting and tube elimination by the tongue and ensuring tube enters to the pharynx.
[Results and Discussion] Using this intraoral appliance, intermittent-oro-esophageal tube feeding was done safely, in a patient with dysphagia with the risk of tube-biting. This appliance might promote the indication of intermittent-oro-esophageal tube feeding, and improve the quality of life of dysphagia patients.
Background: Some studies have demonstrated that ACE inhibitors, amantadine and cilostazol, prevent aspiration pneumonia. However, it has not been evident whether these drugs also prevent pneumonia among tube-fed patients. The aim of this study was to clarify the effect of these drugs on preventing fever among tube-fed patients.
Subjects: The inpatients of our hospital who were fed by a tube for at least 1 day from October 1, 2005 to September 30, 2007.
Methods: A retrospective cohort study. The parameters were age, drugs, number of days of tube feeding, fever (38℃ or higher) and administration of antibiotics by intravenous drip infusion. The outcomes were the percentage of days of fever and administration of antibiotics to the days of tube feeding.
Analysis: Patients taking ACE inhibitors or/and amantadine were compared with those not taking these agents. In the analysis of antithrombotic agents, we compared the patients taking cilostazol with those taking aspirin (too few patients took ticlopidine or clopidogrel).
Results: The study included 285 patients, mean age was 76.7 years old. Two hundred and twenty-two patients were admitted with cerebrovasculardisease, 28 patients with neuromuscular disease, and 31 patients with other central neurologic diseases or injury. Two hundred and fifty-eight patients were fed through nasogastric tube, 64 patients through gastrostomy tube, and 1 patient jejunostomytube. The proportion of the days of fever and administration of antibiotics was 17.5 days/year and 31.3 days/year, respectively.
(1) ACE inhibitors and amantadine: 26 patients took at least one of these drugs a month, 273 patients took none (some patients began or quit within the study period). The mean age of patients taking and not taking these drugs was 74.9 and 75.9, respectively (p＝0.0237). The proportion of the days of fever was 8.3 vs. 18.3 days/year (p＝0.0002), respectively. The proportion of the days of administration of antibiotics was 18.5 vs. 32.3 days/year (p＜0.0001), respectively.
(2) Antithromboticagents: 30 patients took cilostazol and 30 patients took aspirin. The mean age of patients taking cilostazol and aspirin was 78.1 and 75.4, respectively (p＝0.0022). The proportion of the days of fever was 10.0 vs. 14.4 days/year, respectively (p＜0.0001). The proportion of the days of administration of antibiotics was 20.0 vs. 28.1 days/year, respectively (p＜0.0001).
Conclusions: Our data reveals that the drugs which can improve swallowing reflex may prevent fever among tube-fed patients. We suggest that improving swallowing reflex can be a new strategy for preventing pneumonia associated with tube feeding.