Freeze-thaw impregnation of macerating enzymes is used for softened foodstuffs while retaining their original shapes. Therefore, the technique has been used to produce new modified diets for persons with mastication and swallowing difficulties. However, there is little information on the use of these new diets in the medical field. In this study, the suitability of softened diets prepared with freeze-thaw impregnation of macerating enzymes as a modified diet was tested by a clinical evaluation. Regarding the softened diets, safety in eating, amount of intake and feeling were evaluated in the clinical evaluation. The subjects were 20 persons with mild dysphagia. They were usually served modified diets made of mashed and minced foodstuffs. Two kinds of diet―a conventional modified diet made of mashed and minced foodstuffs and the softened diet prepared with freeze-thaw impregnation of macerating enzymes― were served to the subjects for 7 days at lunchtime. The safety in eating was examined by videoendoscopic examination of swallowing on the first day and by observation of eating behavior every day. The amount of intake was calculated by subtracting the residual weight from the served weight on the previous and every day. The feeling was examined by questionnaire interview on the previous and final day. In examining the safety in eating, we did not observe a significant difference between the conventional modified diet and the softened diet. Comparing only main and side dishes, the amounts of intake (weight, energy, lipoid and carbohydrate) from the softened diets were significantly greater than these of the conventional modified diet. In the feeling interviews, the softened diet was highly evaluated for ‘pleasantness of the meal’ and ‘ease of swallowing’ compared with the conventional modified diet. The results suggested that the softened diet was safe and easy to swallow and could be served to patients with mild dysphagia as a new modified diet.
The mechanical properties of softened foodstuffs, which were prepared with freeze-thaw impregnation of macerating enzymes (hereinafter “softened foodstuffs”), were analyzed to assess the ease of eating and the mouthfeel. Measured samples were 18 softened foodstuffs, 3 kinds of conventional modified diet, and a silken tofu. The mechanical properties were evaluated by texture profiling analysis (TPA) using an instrument. Firmness, adhesiveness, cohesiveness and balance degree were determined by TPA. The weight ratio of residue that did not pass a 1-mm nylon mesh to original amount was calculated and the appearance of the residue was observed. The softened foodstuffs of vegetables and dumplings (chicken and shrimp) were more easily crushed than those of seafood. The shaped softened foodstuffs such as dumplings (chicken and shrimp) tended to be more cohesive than those which were only cut such as vegetables, seafood and meat. For evaluating the feeling of adhesion, balance degree was more suitable than adhesiveness in TPA. The weight ratios of residues of almost all softened foodstuffs were significantly lower than those of conventional modified diets. Since the softened foodstuffs of broccoli, cauliflower, taro and potato showed especially low residual rates, it was considered that these vegetables had almost no fibrous texture or feeling of remaining in the oral cavity. The results suggested that diets containing softened foodstuffs exhibited various textures and were easily crushed and cohered.
Objective: This study examined the effects of an 8-week tongue strengthening exercise for 3 months after the completion of training using a tongue pressure measuring instrument on tongue muscle power in young healthy adults. Subjects: Eleven young healthy adults (3 men and 8 women) participated in this study. The mean age of the participants was 20.6±1.2 years old. Methods: After a tongue pressure probe connected to a JMS tongue pressure monitor was inserted into the mouth and was fixed between the anterior portion of the tongue and the hard palate, participants performed tongue muscle strengthening exercises. The anterior part of the tongue was pressed repeatedly against the probe. Exercise intensity was set at 60% of maximum tongue pressure (MTP) in the first week, and was increased to 80% of MTP from the second week of the training. With 30 tongue pressing exercises as one set, the training was conducted 3 sets a day. Training frequency was 3 days a week, and participants were instructed not to rest for 3 consecutive days or more. Training was continued for 8 weeks. After the completion of the tongue muscle training, measurements of MTP were continued for another 3 months in order to evaluate whether the training effect was sustained. Results and discussion: MTP after 8 weeks of the training period (60.7±6.7 kPa) was significantly stronger than MTP before training (38.5±8.4 kPa) (p＜ 0.01). MTP 1 month after the completion of the training was 58.7±6.7 kPa; 2 months after the completion 58.7±7.0 kPa; 3 months after the completion 56.4±6.6 kPa. Although all of these values were significantly lower than MTP after 8 weeks of the training (1 or 2 months after completion: p＜ 0.05, 3 months after completion: p＜ 0.01), they were still higher than MTP before training (p＜ 0.01). It is suggested that the tongue strengthening exercise using the JMS tongue pressure measuring instrument might prevent frailty and sarcopenia in the elderly and contribute to swallowing rehabilitation for patients with dysphagia.
Background: Barium sulfate jelly (Ba gel) is commonly used on test foods for videofluoroscopic swallowing studies (VFSS). Since Ba has pulmonary toxicity, non-ionic contrast agents (NICAs) are used in VFSS for patients with suspicion of dysphagia. However, the food scientific properties of NICA-based gels have not yet been examined. Methods: Ba gels and NICA gels were prepared using three kinds of commercial gelling agents at different densities: carrageenan, pectin, and xanthan gum (XG) -locust bean gum (LBG) mixtures. We estimated the dysphagia diet classification of each gel based on analyses of their texture properties. Results: The NICA gels and Ba gels prepared with the carrageenan gelling agent were classified under the dysphagia diet codes 0j, 1j, and 3, and 0j, 2, and 3, respectively, in accordance with the density of the gelling agents. The NICA gels prepared with pectin gelling agents were classified as 0j, 1j, 2, whereas the pectin-based Ba gels were coded 0j or 1j because of minimal changes to the hardness. With the XG-LBG agents, the cohesiveness of both the NICA and Ba gels was reduced along with an increase of the hardness in proportion to the increasing density of the gelling agents, resulting in dysphagia diet codes 1j, 2, and 3. Conclusion: NICA gels could be prepared for VFSS test foods. The texture properties of Ba gels are difficult to control using pectin gelling agents, whereas the textures of NICA gels are adjustable using all three gelling agents. In the preparation of test foods for VFSS in accordance with the dysphagic diet code, the gelling agents and contrast agents should be chosen with regards to the purpose of the study.
Aim: The aim of this study was to clarify the factors related to life prognosis of elderly patients with aspiration pneumonia. Patients were classified by age (over 90, 75‒89, 65‒74), and factors related to their physical condition and hospitalized days were examined. Methods: Medical records of 80 patients (median age: 87.0 years) living in Japan and hospitalized for aspiration pneumonia between December 2010 and December 2016 were reviewed retrospectively. Swallowing function, nutritional status, activities of daily living, pre-hospital residence, bed rest period, fasting period, hospitalized days and prognosis were also evaluated. Statistical analysis was performed between the over 90 group, the 75‒89 group, and the 65‒74 group. In addition, the life prognosis at discharge (survived/death) was compared between the over 90 group and the 75‒89 group. Fisher’s exact probability test was conducted between pre-hospital residence (other hospital/nursing home/home) and age group (over 90 group/75‒89 group/65‒74 group). Furthermore, multiple logistic regression analysis with life prognosis at discharge as a dependent variable was conducted in all patients, the over 90 group and the 75‒89 group. Results: In comparison between the over 90 group, 75‒89 group, 65‒74 group, the hospitalized days was significantly shorter in the over 90 group. In Fisher’s exact probability test, in comparison to the over 90 group and the 75‒89 group, significant differences in nursing home and home were found. In the over 90 group, the Mini-Nutritional Assessment Short Form (MNA-SF) scores were significantly higher in patients who survived. In the 75‒89 group, the bed rest period was significantly shorter in patients who survived. In all patients, multiple logistic regression analysis with life prognosis at discharge as a dependent variable showed that MNA-SF score and BMI were significant independent variables. Conclusion: Nutritional status was the factor most relevant to the life prognosis of elderly patients with aspiration pneumonia. In the over 90 group, the hospital days was significantly shorter, suggesting the relationship of pre-hospital residence.
Some patients with Down syndrome who request treatment for feeding and swallowing disorders seem to present not only with these symptoms but also with sensory response problems. Here, we examined the relationship between feeding and swallowing disorders with sensory response problems (i.e., response problems to sensory stimuli) as measured by the Japanese version of the Short Sensory Profile. The subjects were patients who visited the swallowing rehabilitation departments of two hospitals and consulted the School for Special Needs Education. Parental consent was obtained for all subjects. In total, 20 subjects aged 3–11 years (mean age, 7.1±2.7 years) were selected. Sensory response problems were measured in seven sections including tactile sensitivity and taste/smell sensitivity. Answers were summed in each section and a total score was calculated. “Probable differences” lie between the first and second SD below the mean and a “Definite difference” lies below the 2SD mark. Feeding and swallowing disorders were evaluated using two items: swallowing ability and mastication ability. Using these measures, patients were diagnosed with or without sensory response problems and with or without feeding and swallowing disorders. We combined the two measures and categorized the subjects into four groups: patients with a feeding problem only (Group F), those with a sensory response disorder only (Group S), those with both (Group FS), and those with neither (Group N) for each feeding and swallowing disorder. A significant difference was observed in terms of tactile sensitivity in the definite difference range, and swallowing disorders (p＝ 0.014). Moreover, a significant difference was observed in terms of movement sensitivity, auditory filtering in the probable difference range, and mastication disorders (p＝ 0.018) (p＝ 0.002). Patients with Down syndrome who request treatment for feeding and swallowing disorders are affected by several related problems, including sensory response problems that vary among individuals. Therefore, we suggest that sensory response problems need to be considered when treating feeding and swallowing disorders.
The causes of xerostomia are diverse and include Sjӧgren’s syndrome, psychological stress, and side effects of medications. In some patients, the cause may be multifactorial (e.g., psychological stress and side effects of medications, or irradiation and mouth breathing). No unified diagnostic criteria for xerostomia have been established; therefore, the criteria used in clinical practice differ among dentists. Furthermore, it is difficult to diagnose multiple causes using a flow chart-type diagnostic sheet. Therefore, we created a new diagnostic sheet that is useful for multiple causes of xerostomia. In the present study, we used this sheet to diagnose new patients in our xerostomia clinic. The cause of xerostomia was an autonomic nerve disturbance (61.4%); other causes included the side effects of medications (57.3%), mouth breathing (36.8%), Sjӧgren’s syndrome (15.9%), dental psychosomatic disorder (14.5%). The degree of coincidence of diagnosis was very high (κ: 0.99, p＜ 0.001). A total of 164 patients (74.5%) had plural diagnosis. The results of this study indicate that multiple factors are likely related to xerostomia. Therefore, the use of a diagnostic sheet that can facilitate multiple diagnoses in patients with xerostomia seems necessary.
Cranial nerve palsy is a rare complication in patients with nasopharyngeal carcinoma (NPC) who have received radiation therapy. In this study, we report a case of dysphagia due to lower cranial nerve palsies as a late complication after 14 years of radiation therapy for NPC. A 38-year-old man with aspiration pneumonia was admitted to the department of respiratory medicine; he had received radiation therapy and chemotherapy for NPC at 21 years of age. He had episodes of difficulty in swallowing at 35 years of age and dysarthria at 36 years of age. Since then, he had experienced frequent paroxysm of fever. On admission, physical examination revealed right hemiatrophy of the tongue (right hypoglossal nerve palsy) and mild hypesthesia of the right pharyngeal wall (right glossopharyngeal nerve palsy). Furthermore, disturbance of salivary secretion was found, and total molar teeth loss due to dental caries and periodontitis was recognized. Antibiotic therapy for pneumonia and oral exercises were initiated. Videofluoroscopic examination of swallowing showed pharyngeal residue, and most foods were passed through the left side of the pharynx. After remission of pneumonia, the patient was transferred to the department of otolaryngology for further evaluation and treatment. In addition, videoendoscopic examination of swallowing revealed laryngeal penetration and right vocal cord paresis (right glossopharyngeal and vagus nerve palsies). Direct swallowing training was initiated, and postural adjustment with rotation of the head was conducted. In addition, a nutrition support team intervention was initiated, and easily chewable and swallowable foods (Code 3 of Japanese Dysphagia Diet 2013 by the JSDR dysphagia diet committee) were provided. After receiving swallowing therapy, the patient eventually achieved full oral intake. Lower cranial nerve palsies (right hypoglossal, glossopharyngeal and vagus nerve palsies), as a late complication of radiation therapy, is considered as the main cause of dysphagia. Disturbance of salivary secretion and the related total molar teeth loss may be also involved in dysphagia. The understanding of the dysphagia mechanisms with videofluoroscopic and videoendoscopic examination, swallowing therapy including postural adjustment, and nutrition support team intervention may contribute to the achievement of oral intake. Although the patient could fortunately achieve oral intake, long-term follow-up of the patient is required, because the course of late complications of radiation therapy is usually slowly progressive and refractory. Recently, the combination of chemotherapy and radiation therapy is persistently performed to improve prognosis of NPC. Note that the incidence of dysphagia due to late development of cranial nerve palsies may increase in the near future in exchange for improvement of prognosis.