The Japanese Journal of Dysphagia Rehabilitation
Online ISSN : 2434-2254
Print ISSN : 1343-8441
Volume 21 , Issue 2
The Japanese Journal of Dysphagia Rehabilitation
Showing 1-6 articles out of 6 articles from the selected issue
Original Paper
  • Kumiko SAKAGUCHI, Shuichi HARA
    2017 Volume 21 Issue 2 Pages 61-70
    Published: August 31, 2017
    Released: April 19, 2020

    Aim: The aim of this study was to clarify the relationship between neck muscle strength and swallowing function in the elderly.

    Methods: The subjects were a healthy group of eight people and a hospitalization group of 26 people (70–89 yrs). Neck muscle strength measurement, repetitive saliva deglutition test (RSST), modified water swallow test (MWST), grip strength measurement, articulation and ADL were evaluated. The statistical analysis included an intraclass correlation coefficient analysis, a Spearman’s rank correlation coefficient analysis, a partial correlation analysis, and a multiple regression analysis. Both the healthy group and the hospitalization group were classified by presence or absence of dysphagia, and a Mann-Whitney U-test was performed.

    Results: ICC in the healthy group was 0.921. In the hospitalized group, age, MWST and grip strength correlated with neck muscle strength. All variables of the dysphagia group were significantly lower than those of the non-dysphagia group. In the multiple regression analysis, OD (/ta/) was an independent variable for neck muscle strength.

    Conclusions: It was suggested that neck muscle strength is correlated with swallowing function in the elderly.

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  • Katumi AZENISHI, Natumi HORI, Atuko UENOYAMA, Miki YOSHIMURA, Noritosh ...
    2017 Volume 21 Issue 2 Pages 71-82
    Published: August 31, 2017
    Released: April 19, 2020

    Purpose: A method for softening meat without deformation through heating and immersion in foodquality-improvement agents is investigated from the perspectives of physical properties, palatability, and chewability.

    Method: Rectangular semi-frozen pork fillets with dimensions of 2 cm width×1 cm thickness were immersed for 15 h in a solution of distilled water and 3% food-quality-improvement agent (Suberakaze Meat; Food Care, Inc.), then heated for 10 min in standard cookers and pressure cookers for 8 min. Rates of weight increase and weight reduction were calculated from the weight before and after immersion of the sample and the weight after cooking.

    A rheometer was used to measure penetration stress, penetration energy and hardness, cohesion, and adhesion. Young and elderly participants provided sensory evaluations of eight items on a five-point scale. The suprahyoid (opening) and masseter (closing) muscles of the young participants were measured by electromyography (EMG) to analyze swallowing from the start of mastication up to the oral phase and then to subsequent phases.

    Results: In comparison with untreated specimens, treated specimens had lower weight loss, lower penetration stress, and lower penetration energy. Furthermore, treated specimens were softer and had more stable adhesion values. In sensory evaluations, both young and elderly participants reported improved softness, unity, ease of chewing and swallowing, and flavor. EMG measurements from the start of mastication up to the oral phase indicated reductions in mastication count, activity, and duration. EMG measurements from the start of mastication to beyond the oral phase indicated reduced mastication times, with improved mean unity. In the comparison of heating methods, specimens heated in a pressure cooker showed higher weight-reduction rates and lower penetration stress and energy than did those heated in standard cookers. Furthermore, meat texture was softer and adhesion lower when heated in a pressure cooker. Unprepared specimens heated in a pressure cooker showed markedly lower cohesion.

    Conclusions: The use of commercially available food-quality-improvement agents softens meat through improved enzymes and water retention. This should lead to improved ease of eating for elderly persons with poor dentition. In addition, the pressure cooker heating showed the tendency of reducing penetration stress, penetration energy and hardness compared with normal pan heating.

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  • Hiroyuki MORISAWA, Kojiro KAGAWA
    2017 Volume 21 Issue 2 Pages 83-91
    Published: August 31, 2017
    Released: April 19, 2020

    Objectives: With the increase of the frail elderly, the quality of life (QOL) of the frail elderly with dysphagia is attracting attention. In past studies, it has been pointed out that dysphagia reduces the QOL of the elderly needing nursing care, but the current QOL scale is limited to the standard for general people. However, in order to measure QOL specialized in dysphagia, it is necessary to use a diseasespecific QOL scale. The present conditions are uncertain about what kind of symptoms are involved in QOL. Also, the guidelines of the intervention are not shown. Therefore, we performed the study for the purpose of clarifying an association between dysphagia and disease-specific QOL of the frail elderly in this study.

    Methods: The subject of this study is 64 elderly people (average age 79.3±7.3 years) from support required help 1 to long-term care insurance level 2 who used outpatient rehabilitation over the long-term. The investigation used an interview survey about a basic attribute, a matter of the meal, ADL, DRACE, SWAL-QOL, SWAL-CARE and life satisfaction. We distributed two groups in the presence or absence of aspiration risk and examined the results of SWAL-QOL.

    Results: It was confirmed that the aspiration risk was present in 45.3% of subjects. Through the presence or absence of aspiration risk, the difference was barely found in the order of the lower item of SWALQOL. However, it was confirmed that the group with the aspiration risk had significantly decreased QOL in burden, eating desire, fear, mental health, communication, SWAL-QOL fatigue. Furthermore, it was confirmed that QOL decreased as much as symptoms (saliva, oral cavity, and pharynx) increased.

    Conclusion: 1. Aspiration risk is present in 45.31% of this study’ s subjects. 2. About the order of the lower ten items of SWAL-QOL, they do not have a major gap in order through the presence or absence of risk. 3. In the group with aspiration risk, disease-specific quality of life decreases. 4. It was found that the symptoms such as saliva and oral cavities, the pharynx reduced quality of life. It is thought that the approach to the swallowing function is indispensable to plan QOL maintenance and improvement.

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Short Communication
  • Fumie TEZUKA, Isamu NAKAMURA, Teiko HOSIDE, Saori HATTORI, Nobuko TAKA ...
    2017 Volume 21 Issue 2 Pages 92-98
    Published: August 31, 2017
    Released: April 19, 2020

    In 2013, a mentally handicapped child suffocated during lunch time at a special school for handicapped children in A-prefecture, Japan. The Ministry of Education sent to all schools in Japan a special message concerning this problem, recommending consultations with doctors or experts in this field, or experienced teachers, in the case of children having feeding disorders.

    However, most school teachers have no criterion to distinguish children having these difficulties. In our survey on previous studies, we could not find any detailed survey on the cases of suffocation among mentally handicapped children. Therefore, we carried out a questionnaire regarding those children’s food feeding behavior in order to find some methods that enable school personnel to distinguish children having the risk of suffocation.

    According to our survey, 14 children out of 489 respondents have nearly suffocated and there are significant differences in the 7 eating habit items between those who might have suffocated and the others.

    Moreover, we found the following three items, (i) to (iii), especially show very significant differences: (i) to barely chew food before swallowing, (ii) to fill one’s mouth full of food while eating, and (iii) to put one’s tongue out with one’s mouth open when swallowing food. This result indicates that these criteria could help detect the risk of mentally handicapped children suffocating during the time of eating. Therefore, these eating habits would be useful for school personnel to screen children having the risk of suffocation and, if it is necessary to consult doctors or experts, to inform them about these habits.

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  • Toshiaki TSUKATANI, Saori KOBAYASHI, Keiko HIRAOKA, Taeko TANAKA, Hiro ...
    2017 Volume 21 Issue 2 Pages 99-105
    Published: August 31, 2017
    Released: April 19, 2020

    Purpose: Suffocation due to food is a major complication of dysphagia but reports on such accidents at hospitals are rare. The purpose of this study was first, to analyze cases of suffocation in hospitalized patients, and second, to determine the factors related to suffocation for future risk management.

    Materials and Methods: Cases of suffocation due to food reported to the Division of Medical Safety at our hospital were retrospectively studied for 3 years from 20xx. In this study, the cases were limited to the incident-accident level of more than 3b. One hundred and thirty patients matched by age and hospitalized department to the suffocation group were randomly selected as controls in this period.

    Results: Five suffocation cases were reported; two were hospitalized in orthopedics and three in internal medicine. The mean age of these cases was 83.4 years old, ranging from 64 to 94. Four out of the five suffocation cases had a past history suggesting the possibility of declining swallowing function and all five cases could eat on their own. Activity of daily living of the suffocation cases was mostly at the boundary between independence and requiring assistance. Accidents of suffocation happened in the early phase of hospitalization period (average days from admission was 9.2). All cases ate a regular or slightly soft diet, not a swallowing-regulated diet. In the suffocation group, four out of five cases (80%) who were taking diuretics had a significantly higher rate than in the control group, 31 out of 130 patients (23.8%). 11,381 patients over the age of 65 were hospitalized during this period and thus the probability of suffering a suffocation accident was 0.04%, almost one out of 2,500 patients.

    Conclusion: Suffocation accidents among inpatients are likely to occur in cases who eat meals independently, have a past history suggesting the possibility of dysphagia, eat a regular or almost regular diet, and are in the early phase of hospitalization.

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Case Report
  • Kiyomi KISHI, Shuhei SUGISHITA, Misako HASHIMOTO, Toshihiro MATSUI
    2017 Volume 21 Issue 2 Pages 106-111
    Published: August 31, 2017
    Released: April 19, 2020

    Introduction: Assistance with eating is recognized to be important for terminal phase patients who have difficulty in eating and efforts have been made in accordance with the patient’ s condition. We provided eating assistance for a terminal phase patient with lung cancer who was about to give up eating meals with relatives. We report this case who regained motivation and could eat meals with the assistance of a registered dietitian.

    Case report: An 83-year-old woman suffered from right lung cancer. She wished to eat meals with relatives, but was admitted to our hospital due to difficulty in eating caused by increasing pain and dyspnea. The pain and dyspnea decreased by day 10, but then increased on day 12 due to pleural effusion. She could not eat enough, lost motivation for eating, and almost gave up eating meals with relatives. On day 15, a registered dietitian checked the eating status and found that the problem was not swallowing dysfunction but dyspnea during eating. She re-evaluated the food texture and changed to a dysphagia diet for easy mastication. The patient regained motivation for eating due to decreased dyspnea, so the medical staff and family coordinated staying overnight at home. On day 18, the patient could remain out of hospital and eat meals with relatives.

    Discussion: In this case, we considered that dyspnea during eating caused the difficulty in eating and the patient accepted the dysphagia diet for easy mastication. In addition, we were able to prepare for the patient to be discharged early from hospital by sharing information among team members. We recognized anew the importance of providing eating assistance for terminal phase patients. We plan early intervention via cooperation among team members and wish to help not only in terms of food texture, but also patients’desire to eat.

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