Objective: When examining cooked rice by videofluoroscopic examination of swallowing (VF), we usually use cooked rice pasted with the powder or liquid of barium sulfate as a test food for VF. However, the appearance, texture and taste of the test food rice are quite different from those of real cooked rice, so it is difficult to know the patient’s real swallowing function of cooked rice. In the present study, we tried to make cooked rice containing the contrast medium with as similar characteristics to real rice as possible.
Materials and Methods: As a contrast medium, non-ionic water soluble iodine (Iodine) was used. The method of preparing the cooked rice including the contrast media was as follows:
We examined the penetration of Iodine in a grain of rice by fluorescence X-ray analysis. The radiographic image of the test rice was taken with a phantom and then the visibility was evaluated. The texture of the grain of rice was also measured. The texture of the Iodine rice was evaluated and compared with that of the control.
Results: The image of rice ① showed sufficient enhancement to evaluate the swallowing function, but that of ② was not enough to visualize the rice. The textures of rice ① and ② showed a wide range, and their adhesiveness was higher than that of the control rice.
Conclusion: We developed a test food in which the contrast medium was infused in rice grains. This test food rice has good contrast and similar texture to real rice.
Purpose: The duration of activity in the swallowing muscles during swallowing increases with age. However, it is uncertain whether this increase is due to a decline of swallowing function in normal elderly people. In the present study, subjects were grouped into three or two by responses to the questions of the Seirei Questionnaire on Swallowing related to pharyngeal and/or oral functions. Then, the relation between the duration of suprahyoid muscle activity during swallowing and these groups was examined.
Methods: The subjects were 83 people ranging from 23 to 86 years old (36 men, 47 women). Water boluses of 3 ml and 10 ml were used for single water swallowing (SWS), and the duration of sEMG activity during SWS was measured.
Results: The duration of the half maximum (half width, HW) during the 3 and 10 ml SWS was 0.62± 0.22 s (mean±SD, n＝78) and 0.57±0.24 s (n＝80). There was a weak correlation between HW and age (3 ml SWS: r＝0.330, p＝0.003, n＝78; 10 ml SWS: r＝0.238, p＝0.034, n＝80). In three groups, ‘responding A to any item’, ‘responding not A but B’, and ‘responding only C’ to nine items related to oral and pharyngeal functions, HW during the 3 ml SWS was 0.83±0.30 s (n＝6), 0.61±0.19 s (n＝23), 0.60±0.21 s (n＝49), respectively. As for 10 ml SWS, HW was 0.75±0.34 s (n＝7), 0.57±0.20 s (n＝24) and 0.55± 0.23 s (n＝49). The UNIANOVA test with age as a covariate did not show a significant difference between the groups. Similarly, between the groups ‘responding A or B to any item’ and ‘responding only C’ to 5 items related to pharyngeal functions, there was no significant difference.
Conclusion: Although HW of the suprahyoid muscle activity during swallowing increases with age, this does not represent a decline of swallowing function.
Purpose: The aim of this study was to investigate how thickeners alter gustatory thresholds as well as gustatory intensities by adding them to three solutions differing in taste (sweet, salty, or sour).
Subjects and Methods: The subjects were 16 healthy adults. The solutions were flavored with sucrose for sweetness, sodium chloride for saltiness, or tartrate for sourness. We used “Toromi Pawah Sumairu®” as the thickener. Three differently flavored solutions were not thickened or thickened with either a 1% thickener or 2% thickener solution. Taste thresholds were measured using test solutions with one of six different concentrations of a flavoring substance. Taste intensities were measured using 1% thickener or 2% thickener test solutions with reference to the taste intensity of the thickener-free test solutions.
Subjects were requested to assess taste intensities on a scale of －3 to ＋3 (7 grades).
Results: 1. Taste thresholds: Taste thresholds for sweetness were significantly higher in the 2% thickener solution than in the thickener-free one (p＜0.05). There was no significant difference in the thresholds for saltiness among the test solutions. Concerning sourness, taste thresholds were significantly higher in increasing order of the 2% thickener, 1% thickener, and thickener-free solutions.
2. Taste intensities: Taste intensities for sweetness were significantly lower in the 2% thickener solution than in the 1% thickener solution and in the thickener-free one (p＜0.01). There was no significant difference in the intensities for saltiness among the test solutions. Concerning sourness, taste intensities were significantly lower in increasing order of the 2% thickener, 1% thickener, and thickener-free solutions (p＜0.001).
Conclusion: It was found that generally an increase in liquid viscosity caused by adding a thickener raised taste thresholds and lowered taste intensities. It is considered that there may have been components in the thickener that caused different changes in taste.
The present study investigated whether patients’ swallowing ability was associated with recovery from dysphagia after stroke.
This study included 39 acute stroke patients (21 males and 18 females) who were referred for dysphagia rehabilitation, could communicate, and agreed to participate in the study. Swallowing ability was assessed using the Functional Oral Intake Scale (FOIS) at the start of the speech-language-hearing therapist (ST) intervention and the 30th day. The patients were divided into the following two groups: the swallowing recovered group and the unchanged or fallen group. Patients’ motivation was evaluated using the apathy scale.
Thirty-one patients’ swallowing improved and 8 patients’ swallowing deteriorated or remained unchanged. No significant difference were observed between the two groups in age, primary diseases, medical history of stroke, Activity of Daily Living (ADL), quadriplegia, Japan Coma Scale (JCS), results of blood tests, number of days before ST began, the number of days of fasting, aspiration pneumonitis, or depression score. In the unchanged or fallen group, the Body Mass Index (BMI) was significantly higher on admission. In the recovered group, the motivation was significantly higher at the time when ST intervention began.
On multivariate analysis, BMI and patients’ motivation were significant predictors of recovery from dysphagia. It was suggested that patients’ motivation affects recovery from dysphagia.
Purpose: We performed this study to investigate the effects of neck brace wearing and head angle changes on the easiness of water swallowing.
Subjects and Methods: The subjects were 27 healthy persons (age, 22.5±3.5 yr).
They took one of the following 4 head positions: intermediate angle without a neck brace (I－), extended angle without a neck brace (E－), intermediate angle with a neck brace (I＋), and extended angle with a neck brace (E＋). The easiness of water swallowing was evaluated by following methods: the amount of unrestricted mouthful water (AUMW), maximum water volume at one swallow (MAXV), and subjective easiness of water swallowing represented by the easiness of sipping water (ESI), the easiness of swallowing (ESW), and the easiness of water sliding down the throat (ESL).
For statistical analysis, two-way ANOVA with repeated measurement and multiple comparison test were used with the level of significance set at p＜0.05.
1. For AUMW, only I＋ was significantly less compared to the three other head positions (p＜0.01).
2. For MAXV, I－ and I＋ was significantly less than E－ and E＋ (p＜0.01).
3. For ESI, the VAS value of I－ was significantly smaller than that of E－ (p＜0.01). The VAS value of I＋ was significantly smaller than that of E＋ (p＜0.01).
4. For ESW, the VAS value of I＋ and E＋ was significantly smaller than that of I－ and E－ (p＜0.01).
5. For ESL, the VAS value of I－ and I＋ was significantly smaller than that of E－ and E＋ (p＜0.01).
The VAS value of I＋ and E＋ was significantly smaller than that of I－ and E－ (p＜0.01).
Conclusions: Both head angle changes and neck brace wearing exerted influences on each index of the easiness of water swallowing. It was suggested that adjustment of head angle is effective in order to facilitate water swallowing while wearing a neck brace.
We performed a comparative study on saliva wetness and oral mucosa moisture in eight patients with Parkinson’s disease (PD), ten patients with cerebrovascular disease (CVD) and ten patients with fractures. Saliva wetness showed no apparent tendency in PD patients, but increased in CVD patients and decreased in fracture patients. Oral mucosa moisture of the tongue decreased in PD patients and stayed in the standard range in CVD and fracture patients. Oral mucosa moisture of the cheek stayed in the standard range in all three groups. There was no correlation between saliva wetness and oral mucosa moisture of the tongue in the three groups. We should consider the variations of saliva wetness and oral mucosa moisture according to pathogenesis in oral care and swallowing rehabilitation.