In the present study, the effects of lip closure training were examined in terms of brain activity and oral functions. Nineteen healthy women (22.1±2.9 years old) were randomly assigned to two groups: the training group in which lip closure training was performed for 4 weeks using a mouth rehabilitation apparatus, and the control group in which the training was not performed. Maximum lip closure pressure was measured before and after the training. Furthermore, brain hemodynamic responses (Oxy-Hb concentration) in the whole brain were measured during a lip closure task using this mouth rehabilitation apparatus and during a task in which the subjects were required to keep 50% of the maximum lip closure pressure (50%-pressure task). The results indicated that the maximum lip closure pressure and performance in the 50%-pressure task were improved after the training in the training group. Before the training, mean cortical hemodynamic responses (Oxy-Hb concentration) increased in the prefrontal pole, right and left dorsolateral prefrontal cortex, supplementary motor area, and presupplementary motor area during the lip closure task in both the control and training groups. Furthermore, 4 weeks after the training intervention, the mean cortical Oxy-Hb concentrations in the various prefrontal regions including the prefrontal pole similarly increased during the lip closure task in the training group. However, in the control group, the mean cortical Oxy-Hb concentrations in the prefrontal pole did not increase during the lip closure task 4 weeks after the first measurement. These results suggest that continuous lip closure training improves not only lip closure functions but also higher brain functions by persistent activation of the prefrontal pole.

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We examined the effects of lip closure training in terms of brain activity, lip functions, and activities of daily living, as a preliminary research. Lip closure training for 3 min using a mouth rehabilitation apparatus was performed three times a day for 4 weeks for 5 elderly subjects (82.6±2.7 years old) who were admitted to a health service facility for the elderly. Various physiological functions of these subjects were evaluated before and 2 and 4 weeks after intervention of the training: maximum lip closure pressure, oral functions assessed by a repetitive saliva swallowing test and amount of saliva, sleep-awake patterns (circadian rhythm) assessed by actigraphy, arousal level assessed by a bispectral index (BIS) based on prefrontal EEGs, and feeding behaviors.

The lip closure training elevated the arousal level during the training period. After 4 weeks of daily training, maximum lip closure pressure and swallowing scores in the repetitive saliva swallowing test were improved, and the mean spectral power for the 24-h circadian rhythm was increased in all but one subject. These results, along with those of previous studies, suggest that lip closure training improves lip functions, arousal level and formation of circadian rhythm in the 24-h cycle.

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Purpose:　In acute stroke, the oral environment influences aspiration pneumonia. We investigated salivary secretory immunoglobulin A (sIgA) which is related to oral immunity and the quantity of bacterial DNA, and examined the relationship with aspiration pneumonia.

Method (s):　Thirteen patients (Median age ± quartile deviation; 81.0±7.0) who were hospitalized for the onset of stroke were enrolled in the study. Saliva samples were collected at about 10:00 a.m. on days 5, 7, 9, 11 and 13 in the hospital, and the quantity of salivary sIgA (per 1 ml) and the quantity of epidermal growth factor (EGF) which has proliferation with mucous membrane (per 1 ml) were measured by enzyme-linked immunosorbent assay (ELISA).The quantity of three bacterial DNA (Streptococcus pneumoniae: S. pneumoniae, Pseudomonas aeruginosa: P. aeruginosa, Streptococcus mitis: S. mitis) was measured by real-time polymerase chain reaction (real-time PCR). The subjects were divided into a non-pneumonia group (5 subjects) and a pneumonia group (8 subjects). The characteristics, saliva volume, the quantity of salivary sIgA and the quantity of EGF were compared in both groups and the amount of each bacterial DNA was examined by the change on each of hospital days 5, 7, 9, 11, and 13.

Result (s):　In the pneumonia group, the level of consciousness on the 5th day of hospitalization was significantly lower than in the non-pneumonia group (p＜0.05), and the non-oral feeding subjects significantly outnumbered those in the non-pneumonia group. Saliva volume on day 7 and 9 of hospitalization significantly decreased in the pneumonia group (p＜0.01, p＜0.05), the quantity of sIgA on days 5, 7 and 9 of hospitalization significantly increased in the pneumonia group (p＜0.05). S. pneumoniae was detected in 3 subjects in the non-pneumonia group, and 4 subjects in the pneumonia group. An antibiotic was used for all subjects in the pneumonia group, and P. aeruginosa was detected in 4 subjects. At the same time, S. mitis and S. pneumoniae were not detected or in only a small quantity.

Conclusion:　Acute stroke patients with complicated pneumonia showed decreased saliva volume, and increased sIgA. The quantity of EGF correlated with that of sIgA. S. pneumoniae was detected in the nonpneumonia subjects. In pneumonia subjects administered antibiotics, P. aeruginosa was detected instead of S. pneumoniae.

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Background:　Disuse atrophy of swallowing-related organs due to an excessive decrease in swallowing frequency is suspected to occur in patients with poor oral intake, especially elderly people. However, swallowing frequency during daily life has not previously been examined in elderly or dysphagic patients.

Objective:　This study examined swallowing frequency in elderly people using a portable device capable of long-term operation and compared the findings with those in a younger population and differences in daily life activities.

Methods:　Two groups participated in this study. The elderly people group consisted of 47 elderly people (average age 83.4±8.2 years) living in a nursing home and the control group consisted of 15 healthy young people (average age 26.5±3.5 years). For 1 h each, we examined swallowing frequency during daily life in individuals from these groups and then compared data on swallowing frequency as follows. 1) We compared swallowing frequency in the elderly group and the control group. 2) 39 elderly people were divided into two groups according to the degree of daily life activities: a semi-bedridden group and a bedridden group, and the swallowing frequency was compared. All participants were instructed not to eat or drink anything during measurement.

Results:　1) The swallowing frequency in the elderly group was 2–23 times/h and the average was 9.0±5.4 times/h, and that in the control group was 16–76 times/h and the average was 40.7±19.5 times/h. Thus, the swallowing frequency in elderly people was significantly lower than that in young healthy people (p＜0.0001). 2) The swallowing frequency in the bedridden group was 2–21 times/h and the average was 7.7±4.6 times/h, and that in the semi-bedridden group was 3–23 times/h and the average was 11.6±6.2 times/h. Thus, the swallowing frequency in the bedridden group was significantly lower than that in the semi-bedridden group (p＜0.05). Conclusion: These results indicated that during daily life, elderly people tend to swallow less frequently than young people. In addition, the swallowing frequency is lower in elderly subjects showing low activity in daily life.

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In 2009, Niigata University Hospital opened Dysphagia Support Station where the specialists support dysphagic patients or their families. The aim of this study was to conduct questionnaire survey to the visitors and to have a grip of problems in these patients at home.

Between October in 2009 and November in 2012, the number of visitors who answered our questionnaire was 370 of total 2,433 visitors. Major ages of them were between 50 and 80 (68.4%). More than a half of visitors were not patients but patients’ family or carers (59.4%). The ratio of the patients who had any problems with diet was 87.3% and what they need were supporting chewing or swallowing problems or care foods.

Daily and clinical intervention to dysphagic patients, especially the elderly at home is needed by the specialists. The results of the present study suggest that Dysphagia Support Station should spread to support not only the patients but also their families.

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Case:　A 54-year-old man presented with left Horner syndrome, left facial paralysis, lateropulsion toward the left side, bulbar palsy, and sensory disturbance in the right face and left limb/body. He was diagnosed with left lateral medullary infarction by brain MR imaging. Dysphagia was so severe that oral intake was prohibited at the time of admission. Upon laryngoscopic examination, there was a large amount of saliva pooling in the pyriform sinus, but the vocal cords were not paralyzed. There was a large amount of residue in the left pyriform sinus after deglutition.

In videofluoroscopy, the dominant side for bolus transport to the hypopharynx was the left and that for bolus passage at the cricopharyngeal portion was the right. Swallowing with head rotation toward the nonresidual side was attempted to clear the left residue, but it was not effective. On the other hand, swallowing with head rotation toward the food residual side was effective for clearance of the left pyriform sinus.

Conclusion:　We usually attempt swallowing with head rotation toward the non-residual side to clear residue in the pyriform sinus. In this case, swallowing with head rotation toward the food residual side was effective. If there is no vocal cord palsy, this technique should be attempted.

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Bottle feeding activity involves a series of motions that are done with coordination of suckling, swallowing, and respiration. Therefore, among infant bottle feeding disorders there are cases in which there are disorders in swallowing or respiration in addition to suckling, or problems in the coordination of these movements.

We conducted Videofluoroscopy (VFSS) and fiberscopic laryngoscope tests in a male infant with bottle feeding disorder, and determined that the bottle feeding disorder condition was due to laryngomalacia and laryngeal paralysis. In order to help him acquire eating function, we started in food intake training and instruction. He was able to acquire eating ability. Therefore I report this case.

In this case, there was no abnormality during pregnancy and childbirth. He caught pneumonia by bottle feeding disorder and so he needed tube feeding. Subsequently, he caught aspiration pneumonia on trying bottle feeding. He consulted my clinic in order to assess his swallowing function at 11 months old.

On his feeding liquid contrast medium by feeding bottle, aspiration was observed on VFSS. But aspiration was not observed on his feeding potage like contrast medium by spoon. On fiberscopic laryngoscope tests, we identified that laryngomalacia improved but there was laryngeal paralysis. On his first medial examination, we didn't identify development disorder except bottle feeding.

It was his condition that breathing in strongly caused aspiration because of laryngeal paralysis if protection for airway by swallowing was late. And so we thought that we needed to stop bottle feeding and start weaning food. With regard to feeding liquid, we started from thicker liquid, such as potage like water, and from by spoon to by cup and straw. He was able to drink thicker liquid by cup without choking on 1 year 10 months old. Next, we changed viscosity and so we made thinner to half of viscosity. He was able to drink normal water without choking on 2 years 9 months old. With regard to straw, we start from thicker liquid in some way. He was able to drink normal water by straw without choking on 3 years 9 months old. But he had still laryngeal paralysis slightly on that time.

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