The Japanese Journal of Dysphagia Rehabilitation
Online ISSN : 2434-2254
Print ISSN : 1343-8441
Volume 19 , Issue 1
The Japanese Journal of Dysphagia Rehabilitation
Showing 1-11 articles out of 11 articles from the selected issue
Original Paper
  • Masaru KONISHI
    2015 Volume 19 Issue 1 Pages 3-10
    Published: April 30, 2015
    Released: April 24, 2020
    JOURNALS FREE ACCESS

    Objective: We added non-ionic water-soluble iodine and water together into a rice cooker in order to make the test food including the contrast media. As a control, we made normal cooked rice. The aim of the study was to compare the differences in texture and taste between the test rice and control rice.

    Methods: As a contrast medium, non-ionic water-soluble iodine (Visipaque®) was used. The ingredients used for making the cooked rice including the contrast media were as follows:

    ① Rice (300 g) + Water (420 ml)

    ② Rice (300 g) + Visipaque® (150 ml) + Water (270 ml)

    We examined the presence of iodine in a grain of the rice by scanning electron microscopy (SEM). We also measured the textures and tastes of both types of rice. The results were compared by statistical analysis.

    Results: The presence of iodine element inside the test rice was identified by SEM. In the figures of the textures and tastes, the test rice scored significantly more highly than the test rice evaluated by the texture and taste meter.

    Conclusion: This method enabled most of the contrast medium to infiltrate into the rice. Furthermore, the textures and tastes of the test rice were as good as or better than those measured by the measuring equipment.

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  • Yoko WAKASUGI, Kanji NOHARA, Kentaro OKUNO, Hikari FUKATSU, Nami UEDA, ...
    2015 Volume 19 Issue 1 Pages 11-16
    Published: April 30, 2015
    Released: April 24, 2020
    JOURNALS FREE ACCESS

    The presence of aspiration on videoendoscopic evaluation of swallowing (VE) and videofluoroscopy does not necessarily correspond to the presence of fever or the onset of pneumonia during the patient's course, and these factors often do not match. We use C-reactive protein (CRP), an indicator of the inflammatory response within the body, as an indicator for assessing a patient’s course following testing. The relationships between the presence of aspiration and CRP, as well as fever during the course, were investigated using simplified CRP, which can be measured from a minute amount of blood.

    The subjects comprised 68 patients aged ≥65 years. The presence or absence of aspiration was assessed using VE. CRP was measured on the same day, and levels lower than 0.3 mg/dl were taken to be a negative result. In addition, the presence of fever within 3 months following the test was assessed, and the VE results, CRP status, and presence of fever during the course were compared.

    Comparison of the VE results and CRP status showed that a positive CRP result was obtained in 5 of 19 patients with no aspiration, 11 of 22 patients with overt aspiration, and 14 of 27 patients with silent aspiration, with no significant differences in CRP positivity among the three groups. Regarding the comparison of the VE results and the presence of fever, fever was observed in 8 of 19 patients with no aspiration, 9 of 22 patients with overt aspiration, and 13 of 27 patients with silent aspiration, with no significant differences in the presence of fever among the three groups. As for the comparison of CRP and the presence of fever, fever was observed in 10 of 38 CRP-negative patients and 20 of 30 CRP-positive patients, with a significant difference between the two groups.

    There was a mismatch between the presence of aspiration on the test and the presence of fever during the course and CRP status, suggesting that aspiration on the test may not be directly linked to the body's inflammatory response or fever during the course.

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  • ―Investigation of the Condition of Swallowing by Sensory Evaluation and Videofluorography―
    Tomoko TAKAHASHI, Takaharu NITOU, Niro TAYAMA, Hiro OGOSHI
    2015 Volume 19 Issue 1 Pages 17-23
    Published: April 30, 2015
    Released: April 24, 2020
    JOURNALS FREE ACCESS

    The present study examined the relationship between the physical properties of thickening liquid foods and the condition of swallowing by elderly persons without awareness of difficulty in swallowing as subjects. In order to study how the subjects swallowed the samples, the authors simultaneously employed two methods: sensory evaluation based on a ranking method, and videofluorographic examination of swallowing. Thickening liquid food samples of three different stages of hardness were employed for the study: sample with hardness of 2×102 N/m2 (simple contrast medium sample), as an example of a sample prepared without addition of commercial thickening agent; as well as a sample with hardness of 4×102 N/m2 (similar in hardness to stirred commercial plain yogurt) and a sample with hardness of 1.6×103 N/m2 (similar in hardness to mayonnaise), as samples prepared with the addition of commercial thickening agents. The outcome of the studies revealed some cases of aspiration (including inflow into the larynx) among subjects when given the sample with hardness of 2×102 N/m2. This sample demonstrated a low coefficient of viscosity and Newtonian flow, and was characterized by the shortness of timing of elicitability of swallowing reflex, which caused a relative delay in elicitability of swallowing reflex, thus resulting in aspiration in some subjects. Prolongation of transfer time in the oral cavity was observed for the sample with hardness of 1.6×103 N/m2, which was characterized by a high coefficient of viscosity, high adhesiveness, and more prominent in-mouth feeling of stickiness. These findings further suggest that, even among elderly persons without awareness of difficulty in swallowing, eating thickening liquid foods that have been adequately thickened is more likely to reduce the risk of aspiration, than eating smooth and free-flowing liquid foods.

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  • Masaki KAMIYA, Kikuo OTA, Keisuke MORISHIMA, Syunji SAWA, Izumi KONDO
    2015 Volume 19 Issue 1 Pages 24-32
    Published: April 30, 2015
    Released: April 24, 2020
    JOURNALS FREE ACCESS

    Purpose: Elderly patients who suffer from dysphagia and dementia tend to eat only small portions of dysphagia diet, including blenderized food, while they eat larger portions if the visual appearance of such food is closer to that of normal food. In this study, we examined the effect of the visual perception of food on swallowing function and cerebral blood flow.

    Methods: Thirty-one healthy adults (19 males and 12 females) took part in the study. The subjects were shown images of both normal food and blenderized normal food on an i-Pad. First, we used nearinfrared topography (NIRS) to examine changes in oxygenated hemoglobin concentrations (Oxy-Hb) in the prefrontal cortex. Next, we conducted the repetitive saliva swallowing test (RSST) and measured salivary amylase activity. We also examined the reliability of our study with 22 subjects, 12 males and 10 females, of the 31 participants.

    Results: Oxy-Hb levels were significantly higher with normal food than with blenderized food (p<0.05), though the reliability was low. RSST values were significantly higher with normal food than with blenderized food (p<0.01), with high reliability (ICC=0.62). There were no significant differences in salivary amylase activity values, with low reproducibility.

    Discussion: In cases where higher Oxy-Hb values were shown with normal food than with blenderized food, their appetite might be stimulated and the projection pathway from the amygdala to the prefrontal cortex might be activated. The low reliability in this test may have been due to habituation through learning as well as the effect of processing of information, other than visual information, in the frontal lobe. The RSST showed higher values with normal diet than with blenderized food, suggesting that the appearance of normal food increased saliva secretion and enhanced swallowing reflex.

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  • Hiroshi FURUUCHI, Keita TAHATA, Mai NAKAJIMA, Toshio SHOJI, Hitoshi KA ...
    2015 Volume 19 Issue 1 Pages 33-40
    Published: April 30, 2015
    Released: April 24, 2020
    JOURNALS FREE ACCESS

    Aim: Meals for patients with dysphagia often consist of soft foods and paste foods. However, these meals rarely match patients’ preference because they are altered not only in shape but also in taste. Meals that stimulate appetite while reducing the risk of mis-swallowing are essential for patients to continue enjoying tasty and safe meals. Therefore, we examined the effect of taste preference on the swallowing function using a non-contact, non-invasive throat organ movement analysis equipment (NESSiE), which permits the quantitative evaluation of laryngeal elevation.

    Subjects: Fifty-five healthy adult volunteers (age distribution: 30s, 11; 40s, 11; 50s, 12; 60s, 8; and 70s, 13).

    Methods: Each subject tried all 28 flavors of the eating recovery assisting food “i Eat®” and one flavor that each subject liked most was used as the preferred food. The patients underwent the test in a chair in a sitting position with a 70° body angle. The neck was relaxed, and the subjects wore an eye mask to prevent visual information from affecting the sense of taste or mastication. To exclusively evaluate the taste, each subject received a spoonful each of the preferred food and the preferred food supplemented with bitterness to decrease the palatability in the oral cavity, and the subjects were allowed to chew or swallow freely. Swallowing time was measured while the subject ate the preferred food and the bittered food three times each in a random order and six times in total, and the mean for each food was used for the evaluation.

    Results: The swallowing time for the bittered food increased significantly in subjects in their 50s and above. No extension was observed in subjects in their 30s or 40s.

    Conclusion: The results suggested that the bitterness exerted some effect on the program to encourage smooth swallowing movement through the sensory network for taste and inhibited the movement of masseter muscles during the swallowing movement. In addition, it was suggested that the difference in laryngeal movement caused by preferences such as taste was partially due to the decreased swallowing function, as a result of aging.

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  • Hitomi KAMISAKU, Yoshiharu MUKAI, Shouji HIRONAKA
    2015 Volume 19 Issue 1 Pages 41-51
    Published: April 30, 2015
    Released: April 24, 2020
    JOURNALS FREE ACCESS

    Objective: The lip pressure and the lip-upper extremity coordinate motion-induced strain on three different types of spoon were measured upon ingestion to clarify the effects of spoon shape on the injection action.

    Subjects and Methods: The subjects were 47 normal young adults (10 men, 37 women, 20.5±0.82 years old). A small lip pressure sensor and a strain sensor were placed at the bowl and the junction between the bowl and handle of the spoon, respectively. The three types of spoon had a different long axis and thickness from the bottom to the lid of the bowl as follows: a, 43/4; b, 34/6; c, 34/4 (mm). All types of spoon had the same width of 28 mm. The lip pressure sensor was placed at 1 mm deep from the lid of the bowl of the tested spoons. Four milliliters of pudding placed on each spoon was ingested by the subjects on their own. Measurement parameters were the lip pressure (integrated pressure, pressure sustained period and maximum pressure), the strain at lower lip contact (integrated contact strain, contact sustained period and maximum strain) and the bending strain upon withdrawal of the spoon (integrated bending strain, bending strain sustained period and maximum bending strain). Time zone analyses were performed in developed waves of lip pressure and strains of lower lip contact and withdrawal bending.

    Results and Discussion: Upon ingestion the lip pressures did not significantly differ among the three types of spoon used. Wave analyses showed a common pattern in spoon usage as the initial contact of the bowl to lower lip, then the development of lip pressure, and the final withdrawal of the spoon with contact to the upper lip. In contrast, when the thick bowl spoon was used, the integrated contact strain and the maximum strain during lower lip contact were significantly bigger than those of the thinner spoons, suggesting that the contact to the lower lip stabilizes the spoon-aided ingestion. Also, when using the thick bowl spoon, the maximum bending strain was significantly bigger than when using the others, suggesting that the spoon is withdrawn by slipping the upper lip along the curvature of the bowl in cooperation between the upper extremity and upper lip.

    Conclusion: The results indicate that the thickness of the spoon bowl plays a role in self-ingestion.

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  • Yoko TANAKA, Yuko NAKANO, Madoka YOKOO, Yoshie TAKEDA, Kaori YAMADA, J ...
    2015 Volume 19 Issue 1 Pages 52-62
    Published: April 30, 2015
    Released: April 24, 2020
    JOURNALS FREE ACCESS

    Objectives: From a viewpoint of quality of life for patients with dysphagia, it is important to pay attention to the forms and physical properties of foods and choose foods and cooking methods suited to the ability of each patients. In hospital, medical staffs determine which food form to serve patients. However, a suitable judgment may be unable to be made at home or in institutions without a specialist. In this study, the association between tongue pressure and food form and the associations among food form, grip and walking state were determined to examine whether they may serve as criteria for the food form selected for patients.

    Methods: Of the inpatients in the Saiseikai Hiroshima Hospital and the residents in the Long-Term Care Health Facility Hamanasou, 201 elderly (36 men and 165 women) were included, following informed consent. The survey consisted of tongue pressure, grip, walking state, and food form.

    Results: Tongue pressure and grip of the patients who were eating nomal diet showed the value lower than those of the patients who were eating adjusted foods. There was a significant positive correlation between tongue pressure and grip. For tongue pressure, there was no difference between men and women in the patients who ate the same food form. However, grip values were significantly higher in the male patients than the female patients, even when they took the same food form. Although there was no correlation between age and tongue pressure, there was a negative correlation between age and grip. According to walking ability, both the tongue pressure and grip values were significantly higher in the subjects who could walk, as compared with the subjects who used a wheelchair or the subjects who were confined to the bed; the same values were significantly higher in the subjects who used a wheelchair compared with the subjects who were confined to the bed.

    Thus, associations between grip and tongue pressure and food form were found, which suggests that these values may be effective indicators for the determination of food form. However, grip was observed the sex difference and the age difference. Therefore, tongue pressure which does not require consideration of age or sex, could be used as a simple and easy indicator. Furthermore, walking ability was associated with food form. Consequently, we suggest that tongue pressure and walking ability might be useful indicators to determine the appropriate food form to serve.

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Short Communication
  • Satoko SHIN, Hanae FUJITA, Tomoko ITO
    2015 Volume 19 Issue 1 Pages 63-68
    Published: April 30, 2015
    Released: April 24, 2020
    JOURNALS FREE ACCESS

    Purpose: The purpose of this study was to elucidate the actual swallowing during nighttime sleep in the elderly by comparing the number of swallows in the elderly with those in young adults, and to articulate the relationship between nighttime swallowing and either latency time of swallowing reflex (LTSR) while awake or resting saliva volume.

    Subjects: The subjects were 10 adults in their twenties (young group) and 9 elderly subjects aged 65 and older (elderly group) with no history of dysphagia.

    Methods: The number of swallows during nighttime sleep was determined based on waveform data from swallowing sounds recorded during sleep using an IC recorder and laryngopharynx microphone, then the young group and the elderly group were compared. In all subjects, LTSR was measured by the simple swallowing provocation test (S-SPT) while awake during the day, and resting saliva was collected before bedtime using the cotton method. And the number of swallows, resting saliva, LTSR and age were analyzed.

    Results and Discussion: The mean number of swallows during nighttime sleep was 4.22±1.06/h in the elderly group and 4.39±1.26/h in the young group. This difference between the groups was not statistically significant according to an unpaired t-test. This finding is seen as the number of swallows during nighttime sleep was not affected by the aging. The LTSR was significantly longer in the elderly group than in the young group, and the resting saliva volume was significantly less in the elderly group than in the young group. However, the number of swallows, resting saliva, age and LTSR, there was no significant relationship at all. These results suggest that it is difficult to be estimated the number of swallows during nighttime sleep from LTSR, resting saliva in healthy elderly.

    Conclusion: The present findings suggest that the number of swallows during nighttime sleep in the elderly may not be affected by advancing age. The state of swallowing during sleep at night was suggested that cannot assess from age, resting saliva, LTSR while awake.

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Case Report
  • Ichiro KOIKE, Kazuyo OGUCHI, Sachiyo HOTA
    2015 Volume 19 Issue 1 Pages 69-74
    Published: April 30, 2015
    Released: April 24, 2020
    JOURNALS FREE ACCESS

    The patient was a 23-year-old male who had sustained injuries to his head, trunk and left arm at work. He was diagnosed with left scapula fracture, multiple rib fracture, left hemopneumothorax and bilateral pulmonary contusion. On the day of injury, the patient underwent conservative treatment with orotracheal intubation. The patient was found to have bilateral vocal cord paralysis, possibly due to intubation, on post-injury day 13. A tracheostomy was performed and the patient started to wear a cuffed unfenestrated tracheostomy cannula. The patient was found to have accumulated oropharyngeal secretions or aspiration of secretions on post-injury day 17, hence phonatory and swallowing rehabilitation (air blowing method) was begun, by blowing oxygen gas into a supra-cuff suctioning line. We blew secretions in the trachea or larynx up toward the mouth with oxygen gas at a rate of 1-3 l/min, and told the patient to repeatedly swallow secretions. Since we found that stimulation from endoscopy or blown oxygen gas induced excess secretions and made it difficult to continue rehabilitation by continuously blowing air on post-injury day 34, we changed from a continuous to intermittent method of blowing air. We found that bilateral vocal cord adduction movement was improved, and the secretions from hypopharyngeal to vocal cord were reduced. We changed the cannula to a speech cannula on post-injury day 42, and removed the speech cannula on post-injury day 50.

    During the rehabilitation, we measured voluntary swallowing of secretions on post-injury days 17 and 50 when the rehabilitation started and the cannula was removed, respectively. The patient was told to repeatedly swallow secretions as frequently as possible, and the measurement was performed after moistening the patient's oral cavity with cotton swabs. The time taken for 10 consecutive times of voluntary swallowing with air blowing was shorter than that without air blowing on both post-injury day 17 and 50.

    The air blowing temporarily increased the times of repetitive swallowing of secretions following instructions, and repetitive swallowing of secretions strengthened swallowing-related muscles in this case. We also speculate that phonation prevented the vocal cords from damage due to disuse and improved secretion management skills.

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  • Rie SATO
    2015 Volume 19 Issue 1 Pages 75-81
    Published: April 30, 2015
    Released: April 24, 2020
    JOURNALS FREE ACCESS

    Mouth care is provided in diverse places ranging from the home to the hospital, in diverse stages from acute to terminal, and the indications and methods also vary in each case. We have conventionally evaluated oral care by sanitary conditions, function of swallowing, oligotrophy, preventive effect of aspiration pneumonia, improvement of life prognosis, etc. On the other hand, the oral cavity is an organ with functions that are directly related to the dignity of the person, such as conversation and eating. In this sense, oral care is holistic. Thus, there is a concern that conventional evaluation cannot evaluate the versatility of oral care.

    In this study, for two terminal carcinoma patients, I referred to the nursing record or household diary, performed a qualitative investigation, and tried to evaluate the caring objective. As a result, I found that the relationship of caring between patient and care provider deepened. In terminal cancer patients, holistic care is occasionally needed. Therefore, the relationship between the provider and recipient through mouth care is suggested to have worked positively. In future, it is necessary to evaluate mouth care from the viewpoint of the relationship between care provider and recipient. A simple score which can be used in clinical practice is needed.

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