Objective: In this study, we aimed to examine the appropriateness of viscosity ranges of thickened liquid at 3 levels that were described in the draft of the Japanese Dysphagia Diet 2012 by the dysphagia diet committee of the Japanese Society of Dysphagia Rehabilitation.
Methods: We selected 151 Certified Nurses in Dysphagia Nursing. Twelve thickened liquids were used for the sensory evaluation. Samples were evaluated to determine which among the levels “less than mildly thick,” “mildly thick,” “moderately thick,” “extremely thick,” or “more than extremely thick” is the most suitable. The results obtained in the sensory evaluation were compared with viscosity.
Results and Discussion: Our results suggested that the lower limit of “mildly thick”(50 mPa・s)was suitable. The borderline of “mildly thick” and “moderately thick”(100 mPa・s)was approximately better but needed more consideration. The borderline between “moderately thick” and “extremely thick”(400 mPa・s), and upper limit of “extremely thick”(600 mPa・s) were too high, requiring more consideration for lowering the level. Based on a previous research and this study, the viscosity ranges were changed from 3 levels of thickened liquid in the draft of the Japanese Dysphagia Diet 2012 to the Japanese Dysphagia Diet 2013 (Thickened Liquid).
The purpose of this study was to examine the change of multidirectional lip-closing force in continuing and discontinuing button-pull exercise training. The subjects were 15 healthy males (mean age: 30.1±1.8 years). One set of button-pull exercises consisted of performing button-pull exercises 7 times for 1 min. The subjects carried out 3 sets of button-pull exercises every day for 4 weeks. After 4 weeks of training, the button-pull exercises were discontinued. The multidirectional lip-closing force was measured every week for 8 weeks by the multidirectional lip-closing force measurement system.
The multidirectional lip-closing force of the center part of the upper and lower lips, and that of the right oblique upper part were significantly increased by the exercises after 3 weeks. The multidirectional lipclosing force was not significantly different between 3 weeks and 4 weeks. It is suggested that the buttonpull exercises require a certain training period, and that the lip-closing force achieved by training reaches a plateau after a certain period of time.
After discontinuing the training, there was a significant decrease of lip-closing force in 2 weeks. Therefore, it is important to continue button-pull exercises. The lip-closing force is large in the center part of the upper and lower lip, and is weak at the corner of the mouth. Thus, it was found that there is directional specificity in multidirectional lip-closing force.
Purpose: The Oral Health Assessment Tool (OHAT) is a simple oral health screening tool to assess oral health in dependent elderly individuals. In this study, we examined whether the oral health condition of hospitalized patients would be changed by an oral care protocol using OHAT. We also investigated the attitude of ward nurses to OHAT and the oral care protocol using a questionnaire to understand their feeling toward OHAT and the oral care protocol.
Methods: A total of 35 patients were enrolled in this study from the neurology inpatient unit of a university hospital (mean age 73.7±13.1 years old). At admission, ward nurses performed oral assessment using OHAT, and, based on the OHAT score, the oral care plan was set and oral care was performed. Oral re-assessment was performed weekly, and the care plan was modified based on the OHAT score. At the timings of the first and final OHAT assessments, the amounts of oral bacteria on the tongue, palate and buccal vestibule were counted. The changes in the bacteria amount and OHAT scores from the first to the final assessment were compared with the Wilcoxon test.
Results: Oral bacteria amounts tended to decrease on all three locations, and the difference was statistically significant on the buccal vestibule. For the OHAT score, the total score, and the scores of the lips, tongue, saliva, and cleanness were significantly decreased. Twelve patients (34%) were referred to a dental office as a result of the first OHAT assessment. From the questionnaire to ward nurses, all participants replied that OHAT and the oral care protocol were useful.
Conclusions: Our results showed that oral health condition was improved by the oral care protocol from the improvement of OHAT scores. This suggests that OHAT is a useful indicator for oral health condition. Our findings also suggest that ward nurses had some understanding of oral assessment and protocols.
The aim of the present study was to clarify the risks for dysphagia and its influencing factors in patients with chronic obstructive pulmonary disease (COPD). Moreover, we aim to use these findings as a basic reference material in nursing care to prevent aspiration pneumonia. Data were collected from 62 outpatients diagnosed with COPD using self-administered questionnaires, physical function tests, and medical records. Factors influencing risks for dysphagia were then analyzed. Those judged to be at risk included 46.8% of the total subjects or nearly half of the entire subject sample. In addition, the extent of dysphagia risk in COPD patients was estimated. The results suggested that the appropriateness of teeth and dentures and duration of COPD morbidity were factors that could serve as indicators of dysphagia risk in COPD patients. Therefore, these patients require nursing care (e.g., identifying dysphagia risk factors) that utilizes these potential indicators of dysphagia risk.
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by impaired social communication, and has increased in recent years. Several studies have compared dietary variety among children with ASD, with normal cognitive development, and with other developmental disabilities, and have concluded that dietary variety is lower in children with ASD and that these children are more likely to refuse food. As one of the causes of selective eating, we thought that children with ASD have some difficulties with eating due to their underdeveloped oral function.
The observational assessment pointed out that children with ASD had some problems with oral function in eating, chewing, biting with front teeth and swallowing. However, there have been no studies which used quantitative indicators for a comparative assessment with typically developed children. Additionally, the oral function of children with ASD has not been fully investigated. Therefore, the purpose of this study was to clarify the oral function of children with ASD. The participants were 27 ASD children (ASD group) and 25 typically developed children (TD group). We used quantitative indicators to assess eating and chewing functions. As a quantitative indicator of eating function, we measured the amount of yogurt remaining on a spoon after eating yogurt from the same size of spoon. Furthermore, we assessed chewing function by counting the number of times of chewing and measuring lip closure while eating a standardized rice cracker.
The statistical results showed that the eating function of the children with ASD was underdeveloped, especially when eating food from the spoon using their lips. Moreover, the number of times of chewing when eating the standardized food by the ASD group was significantly greater and the lip closure when chewing was less developed.
It is considered that the problem of eating such as selective eating is caused by sensory unbalance or behavioral characteristics in children with ASD, but we suggest that they need additional comprehensive support in view of the development delay in oral function.
Objectives: To find evidence related to dysphagia intervention, this study aimed to clarify the time and heritability of which participants to perform exercises for dysphagia prevention.
Methods: Participants were adult twins. They exercised for dysphagia intervention three times a day for two weeks. We computed the means and standard deviations (SD) of the number of times that an exercise was performed in a day. By univariate genetic analyses, we calculated the heritability.
Results: In total, 28 twin pairs (n＝56) participated; 86% were monozygotic, and 77% were females. The mean of age was 58.6 (SD＝11.7) years. The heritability of execution times of exercises at first five days was 0.65. The heritability to exercise execution on weekend (0.00) is lower than that of weekday (0.38-0.50).
Conclusions: There is not significant difference through all periods. In the early part of the initiation, health professionals should have knowledge on the genetic characteristics of patients. On the other hand, environmental changes would be effective to prevent forgetting the exercise on the weekend.
In the present study, we prepared rice gruel samples including model solid pieces of food with different physical properties, and studied the correlations between the physical properties and the oral sensation which is indicative of the ease of eating. For the model solid pieces of food, we used heated carrots (diced into 5 mm cubes), the physical properties of which had been varied by changing the conditions of heating. The heated carrots were mixed into the rice gruel samples (called “mixed rice gruel”) so that the carrots accounted for 20% of the weight of the rice gruel. In terms of the physical properties, we studied the rupture properties of a single grain of the basic rice gruel and the rupture properties of a single grain of the heated carrot, and also measured the texture properties of the mixed rice gruel. Sensory evaluation was employed for examining the oral sensation which is indicative of the ease of eating. All measurements were made using samples heated to 45℃ and 20℃. There was no correlation between the hardness of the texture properties of the mixed rice gruel and the firmness obtained from the sensory evaluation. The firmness showed high correlations in the rupture properties of a single grain of the rice gruel and a single grain of the heated carrot. At a sample temperature of 45℃, no significant differences were found between the basic rice gruel and the mixed rice gruel in the sensory evaluation of the ease of eating. On the other hand, at a sample temperature of 20℃, the mixed rice gruel was more firm than the basic rice gruel, and showed a residual feeling in the mouth after swallowing. Thus, the inclusion of heated carrots in the rice gruel appeared to have an effect on the ease of eating at a sample temperature of 20℃. The outcome of the present study indicated the necessity of studying the correlations between the physical properties of a single grain of the rice gruel and a single grain of the heated carrot as solid pieces of food, in addition to measuring the texture properties of the mixed rice gruel.
We analyzed an oral health report from dietitians dispatched to the areas affected by the Great East Japan Earthquake in order to clarify specific oral health problems after the disaster.
This study extracted the issues regarding oral health from the free description of responses of 602 dispatched dietitians by using key words. The key words for the first textual search were chosen from a standard oral health assessment sheet and other materials. Secondary key words for the second textual search were selected from the results of the first textual search. The free descriptions extracted from the first and second textual searches were categorized into similar groups and labeled by the KJ method.
Oral health issues were classified into four categories: “difficulty of swallowing,” “difficulty of chewing,” “environmental degradation,” and “degradation of oral condition.” Difficulty of swallowing included “needs for soft meals by dysphagia,” “needs for thickening agent by choking,” and “aspiration.” Difficulty of chewing included “needs for chopped meals due to reduced mastication” and “degradation of dietary intake by loss of denture.” Environmental degradation included “overeating of snacks/increase of dental caries and obesity” and “impossibility of brushing teeth.” Degradation of oral condition included “stomatitis” and “sputum production and dry mouth.”
These results suggest that an oral health support system is necessary for eating assistance during disasters. Health professionals should focus on oral health and enhance the cooperation between other fields for future disasters.
Aims: The association between tongue thrusting during swallowing and gross motor, cognitive, and linguistic development in children with Down syndrome (DS) is unknown. In the present study, we aimed to clarify this relationship.
Subjects and Method: We enrolled 38 children with DS between the ages of 1 and 9 years. The feeding scenes of early weaning food (food mashed to potage or paste) and medium-term weaning food (food soft enough to mash between the tongue and the palate) were video recorded, and the frequency of tongue thrusting during swallowing and whether the tongue moved up and down was evaluated. In addition, gross motor development was evaluated by Gross Motor Function Measure (GMFM)-66, while cognitive and linguistic development were evaluated by the Kyoto Scale of Psychological Development 2001, and their association with the frequency of tongue thrusting during swallowing and up-and-down tongue movement was investigated.
Results and Discussion: The correlation between the frequency of tongue thrusting during swallowing early and medium-term weaning food and age, total points on GMFM-66, and the developmental age of the Kyoto Scale of Psychological Development 2001 was assessed. Children who rarely thrust their tongue during swallowing acquired higher scores on GMFM-66 than those who often thrust their tongue, and most these children could crawl on all fours and sit on a bench. In addition, most of these children had acquired skills of up-and-down tongue movement. However, the developmental age of the Kyoto Scale of Psychological Development 2001 was observed to be similar between the children who rarely thrust their tongue during swallowing and those who often thrust their tongue.
Conclusion: Tongue thrusting during swallowing in children with DS was considered to be associated with gross motor skills.
Regarding a girl who was diagnosed with Beckwith-Wiedemann syndrome and in whom suckling disorder due to macroglossia was observed, we herein report on the handling of pediatric ingesting/swallowing outpatient services in our department and the patient’ s course until she achieved sufficient ingesting/swallowing functions.
The patient was a 3-month-old girl with macroglossia observed from birth, on whom tongue reduction surgery was conducted for macroglossia approximately 3 months after birth in the Plastic Surgery Department of this hospital. However, because suckling disorder was observed with no improvement in her protruding tongue due to macroglossia, she was referred to our department for the purpose of dysphagia training. At the initial diagnosis, an imperfect oral lip seal due to macroglossia was observed without any sucking reflex. A nasogastric tube was placed and strongly attached around the upper and lower lips with medical tape.
Clinical diagnosis: Dysfunction at the preparatory stage. Desensitization was initiated to remove irritation, after which swallowing-facilitation training was conducted via gustatory stimuli using yogurt, encouraging her to swallow saliva. At this time, we explained the purpose of the training to her mother and attending nurse as well and asked her family to actively participate in the training. Specifically, we encouraged them to actively assist her lips. Once she became capable of moving her tongue backwards and closing her mouth with the assistance of her lips, she shifted from swallowing-facilitation training to direct training, wherein she started taking stage 2 baby food from a spoon using her lips.
Second tongue reduction surgery for modification purposes was conducted, after which rejection of oral intake was temporarily observed; however, adjustment of the form of food enabled the intake of infant foods.
In this case, tongue reduction surgery and oropharyngeal intubation for airway maintenance were conducted after birth and the patient was forced to endure various uncomfortable situations around the oral cavity including frequent intraoral suction and long-term nasogastric tube feeding, making oral intake difficult. However, early ingesting/swallowing instructions and intervention by the family were believed to lead to the successful acquisition of ingesting/swallowing functions.