Nutritional care and management were established as a service at care facilities that can be charged to insurance. Oral maintenance has also been introduced as a treatment subject to the addition, given that swallowing disorders contribute significantly to malnutrition. Videoendoscopy (VE) was introduced in 2007, and the present study empirically verified the reduction in aspiration pneumonia and the economic effects of incorporating the oral maintenance plan in nutritional care and management. The phase before introduction of VE was considered Period I, and the three years after introduction were divided into Periods II–IV. For each phase, we surveyed the number of hospitalization days overall, the number of hospitalization days for aspiration pneumonia, the fall in revenue at the facility, and the addition for oral maintenance. While the length of hospitalization for aspiration pneumonia was 933 days during Period I, it fell to roughly half this during Periods II–III, and fell to roughly 190 days in Period IV. As a result, there was an overall increase in revenue of approximately ten million yen in Period IV compared to Period I. The introduction of VE and development of the oral maintenance plan led to a decrease in aspiration pneumonia, and may make it possible to ensure the QOL of users, control rising medical costs, and secure steady income for care facilities.
[Purpose] The aim of this study was to investigate the possible effects of spoken prior notice on drink swallowing.
[Subjects] The subjects were two groups: 11 younger participants ranging in age between 20 and 30 years old (mean age of 21.7, 1 male ＆ 10 females), and 8 older participants ranging in age between 65 and 75 years old (mean age of 68.4, 3 males ＆ 5 females).
[Method] Swallowing of apple juice, Aojiru (grass) juice, or water with or without spoken prior notice, was measured using surface electromyography and cervical auscultation.
[Results] Regardless of age, the maximum suprahyoid muscle activity significantly decreased when the drink was ingested without spoken prior notice. The interval between the onset of swallowing sound and the onset of infrahyoid muscle activity significantly shortened when the anticipation given by the prior notice was contradicted in the older participants.
[Conclusion] The results suggest that swallowing is affected by spoken prior notice. This phenomenon can be used for dysphagia rehabilitation.
Purpose: The tongue plays an important role in bolus formation and transportation to the oropharynx and in retaining pharyngeal pressure during mastication and swallowing. Recently, the palatal augmentation prosthesis (PAP) has been used for compensating deteriorated tongue-palate contact during swallowing and articulation in dysphagic patients. However, the detailed mechanisms by which PAP improves tonguepalate contact during swallowing are not well understood. The purpose of this study was to examine the effects of a palatal plate on the tongue-palate contact during swallowing in normal adults with an experimentally enlarged oral cavity.
Methods: An experimental occlusal splint (＋5 mm bite height) for increasing oral cavity volume and a palatal plate (5 mm thick) to compensate for the enlarged oral cavity were made for 10 healthy young volunteers with perfect dentition. Tongue pressure against the hard palate during swallowing of 10 ml of water and 10 g of pudding was recorded by the sensor sheet with five measuring points in each subject under three conditions: control (no splint or palatal plate), with splint, and with both splint and palatal plate. The order of onset, duration, maximum magnitude and integrated value of tongue pressure were compared among the three experimental conditions.
Results: Compared to the controls, the order of tongue pressure onset was significantly disorganized with splint, but tended to be increased with splint and palatal plate. The duration, maximum magnitude, and integrated value of tongue pressure decreased with splint, but tended to be increased to the control levels with splint and palatal plate during swallowing of water and pudding. This tendency was remarkable at the anterior-median and posterior-median parts of the palate.
Conclusion: The results of this study that the experimental palatal plate restored tongue-palate contact during swallowing by compensating for enlargement of the oral cavity by the occlusal splint suggested a part of the mechanism of the effect of PAP on dysphagic patients.
Of the children with autistic spectrum (ASD) diagnosed by a pediatrician and who had received care at Regional Rehabilitation Centers for Children with Disabilities, 338 (including their parents) from whom informed consent was obtained were administered questionnaires that contained questions assessing whether they had problematic mealtime behaviors, problems of eating manners, bias of sensation (referred to as “deviated sensation” below), or dislike of activities.
There were many problematic behaviors at mealtimes including “walking away from the table” and “making a clattering noise (hitting or kicking furniture),” and many poor eating manners including “eating just one food item,” “overfilling the mouth” and “swallowing food whole.” There was a relationship between the problematic behavior at mealtimes and the level of development. It seems to be difficult for these problematic behaviors to lessen naturally or disappear with age.
“Having a least favorite tactile sense,” “having a favorite tactile sense,” and “having a least favorite sound” accounted for over 30% on sensory bias, but no clear trend was found with age or level of development. Fewer reluctant acts were observed in the 8-9 age group and normal group, of which a high proportion was found “to have had it in the past,” implying that the acts can be improved with age.
A significant relationship was observed between problems at mealtime and sensory bias. It is important to reduce the sensory bias, yet control is difficult. Reluctant acts appeared to be improved in the group with sensory bias, which suggested that there is a possibility of improvements in problems in daily life including mealtimes despite sensory bias being a characteristic of ASD. In order to achieve this, a support program to promote overall development is required.
[Objective] The aim of this study was to investigate whether there were any differences in the types (e.g. regular, blender-processed, gelled) of foods and the assessment methods used to determine the types of foods served to residents with dysphagia, depending on the involvement of registered dietitians (RDs), at long-term care facilitiesL (LTCFs) in Japan.
[Participants] A total of 2,767 facilities consisting of all publicly aided LTCFs in Hokkaido, Tokyo, Kanagawa, Aichi, Kyoto, and Kumamoto prefectures, which were registered in the Welfare and Medical Service Network System (WAMNET) as of November 2007, were selected for this survey.
[Methods] From November 2007, a questionnaire was mailed to RDs (or dietetic technicians) at the 2,767 LTCFs in six prefectures in Japan, and responses were obtained by mail by February 2008.
[Results] Responses to the questionnaire were obtained from 1,639 facilities (59.2%), of which those that did not provide answers regarding the qualifications of the respondents (RD or dietetic technician) or the number of residents with dysphagia were excluded from the analyses. As a result, responses of 1,251 facilities, or 45.2% of all facilities, were evaluated.
1. With the assumption that boiled carrots were served to residents with dysphagia, “blenderprocessed” was selected for the type of foods by a majority of the respondents (74.0‐75.1%), followed by “thickened” (54.9‐53.9%) (multiple responses).
2. The facilities were categorized into paired groups with or without involvement of RDs in determination of food types. Then, the number of different kinds of food types that were estimated to be provided to dysphagic residents at each facility were compared between the paired groups. The results showed that, at least the number of food types to be served in the group with the largest number of RDs involved was significantly higher than the counterpart without RD involvement.
3. The assessment methods used to determine food types showed that certain types of facilities with involvement of RDs relied more on multiple resources such as clinical evaluation, meal rounds and preferences of residents or their family members, and less on a single resource.
[Discussion and Conclusions] At long-term care facilities in Japan, whether RDs are involved in the determination of food types depends on the circumstances of each facility. The findings of this study implied that, though various other factors are involved, the involvement of RDs leads to more food types in diets for residents including those with dysphagia, evaluated by assessing the physical or mental conditions of the residents.
Purpose: The aim of our study is (1) to explain the dietitian’s concept of “puree” and “paste,” which are constituents of a modified diet for dysphagic persons and (2) to investigate the differences in the physical properties of purees and pastes.
Methods: We conducted a questionnaire among 244 dietitians and they categorized 31 commercial foods as follows: liquid, puree, paste, mousse, and solid. These foods are measured physical properties.
Results and Discussion: Of the 31 foods, 7 had categorized purees; 6, pastes; and 5, both pastes and purees. A comparison of the hardness and viscosity (60 rpm) shows that purees have hardness values of ＜ 700 N/m2 and viscosity values of ＜5,000 mPa・s, while pastes have hardness values of ＞700 N/m2 and viscosity values of ＞5,000 mPa・s.
We report a patient admitted for the deep cervical abscess and diagnosed with piriform sinus fistula during rehabilitation for swallowing disorder. The patient was a 65-year-old man, in whom painful swelling occurred in the left neck, and a cervical abscess was diagnosed. After admission, mediastinitis concomitantly developed, and drainage was emergently performed. Swallowing disorder was recognized after surgery, and so the patient underwent rehabilitation. On videofluoroscopic examination of swallowing, failure of the laryngeal elevation, pharyngeal constriction, and opening of the esophageal orifice were observed, and these were assumed to be due to inflammation and postoperative scarring. Balloon bousie was effective for the impaired opening of the esophageal orifice. The patient underwent balloon training in parallel with eating training, and mostly recovered the capability of ingesting conventional food within about 1 month. The piriform sinus fistula was observed on videofluoroscopy after recovery, and identified as the cause of the cervical abscess. Piriform sinus fistula should be suspected especially in cases of cervical abscess with no underlying disease. Balloon bousie was effective for swallowing disorder following surgery for a cervical abscess.
We report the case of a 42-year-old man with severe dysphagia and quadriplegia subsequent to bilateral medial medullary infarction. On the 16th day after the stroke onset, a tracheostomy was performed due to pneumonia and tube feeding was implemented. An endoscopic swallowing examination showed a poor reflexive swallow followed by silent aspiration of saliva pooled in the pyriform sinuses.
After 3 months of rehabilitation, the tracheostomy tube was removed and oral feeding of a modified diet was initiated. The videofluoroscopic examination revealed incomplete pharyngeal contraction but normal opening of cricopharyngeal sphincter. The Mendelson maneuver and supraglottic swallow were applied to improve the laryngeal elevation and avoid laryngeal penetration, respectively. Six months after the onset, the patient eventually could eat normal meals.
Severe dysphagia due to bilateral medial medullary infarction is known to demonstrate poor prognosis. Our case, however, suggests the possibility of recovering from dysphagia in young patients who are free of respiratory disorders and who make rehabilitation efforts for tracheostomy weaning and oral feeding.
Parkinson's disease is associated with swallowing dysfunction which causes the risk of aspiration and pneumonia. Subthalamic nucleus deep brain stimulation (STN-DBS) is a widely accepted surgical treatment for advanced Parkinson's disease (PD): quadripolar electrodes are placed in the subthalamic nucleus and deliver high-frequency stimulation. Swallowing dysfunction was reported to be therapeutically resistant to STN-DBS, while it was reported that STN-DBS improved not the oral stage but the oropharyngeal stage. However, these inconsistent results were based on small studies. We report the changes of swallowing function in three cases by comparing the DBS ON and OFF conditions. All cases underwent videofluoroscopy at 6 months after the DBS surgery and two cases also underwent videofluoroscopy three times before the surgery, at 1 week and at 6 months after the surgery.
Case 1: A 69-year-old man who had had PD for 18 years. The motor examination score of Unified Parkinson's Disease Rating Scale (UPDRS, Part III) dropped to 24 after STN-DBS from 66 before STNDBS. In videofluorography (VF) findings, the oral and oropharyngeal transit times in the condition of DBS ON at 6 months after surgery were the shortest. Thus, the videofluoroscopic dysphagia scale was improved in the DBS ON condition.
Case 2: A 72-year-old woman who had had PD for 10 years. The UPDRS Part III score dropped to 17 after STN-DBS from 19 before STN-DBS. In VF findings at 1 week after the surgery, the oral and oropharyngeal transit times were longer in the DBS ON condition. The videofluoroscopic dysphagia scale worsened in the DBS ON condition. At 6 months after surgery, the oral and oropharyngeal transit times and the videofluoroscopic dysphagia scale were improved.
Case 3: A 56-year-old woman who had had PD for 13 years. The UPDRS Part III score dropped to 5 after STN-DBS from 56 before STN-DBS. The oral and oropharyngeal transit times and the videofluoroscopic dysphagia scale did not show a remarkable change under each condition.