We examined the data of 37 patients with Parkinson's disease who were admitted to our hospital with aspiration pneumonia. All of them were perfectly able to eat food prior to the hospitalization, but were completely unable to eat at the start of the dysphagia rehabilitation. We investigated the factors associated with the restoration of the ability for oral intake in the 17 patients in whom the ability to eat food was completely restored by the time of discharge. The results revealed that the latter patients were significantly younger, had lower Hoehn-Yahr scores, and higher scores on the motor Functional Independence Measure (FIM) at discharge, higher scores on the cognitive FIM at admission, higher scores on cognitive FIM at discharge, and also a higher motor FIM efficiency, than the patients in whom the ability for oral intake was not restored by the time of discharge. In addition, there was a significant positive correlation between the degree of improvement in the swallowing function and the motor FIM efficiency. We concluded that among Parkinson's disease patients hospitalized for aspiration pneumonia, patients with better cognitive ability were more likely to show improvement of the motor functions and more likely to show a restored ability for oral intake.

　Objective:　Aspiration pneumonia is the most important complication of stroke related dysphagia．The aim of this study was to estimate the frequency of pneumonia in stroke patients fed by tube feeding in a rehabilitation hospital and to determine risk factors for this complication．

Method:　One hundred fifty-eight stroke patients with dysphagia fed by tube feeding admitted to the rehabilitation hospital 1 to 2 months from onset．They were studied retrospectively regarding the frequency and risk factors for the onset of aspiration pneumonia．We divided the subjects into two groups based on the presence or absence of pneumonia during the period of admission．Age，gender，location of disturbance，grading of dysphagia，nutritional status (albumin，total protein，body mass index)，complication and functional independence measure (FIM) on admission were evaluated between the two groups．

Results:　Twenty-two cases (13.9％) of the 158 stroke patients fed by tube feeding had aspiration pneumonia，which tended to develop among male and older patients compared with the patients without aspiration pneumonia．In the stroke patients with aspiration pneumonia，the location of the disturbance was found to be in the brain stem and cerebellum in 10 (28.6％) of 35 cases．In a logistic regression analysis，the location of disturbance (OR [odds ratio] 4.859，p＝0.01)，grade 1 of dysphagia severity scale (OR 8.747，p＝0.001)，male (OR 5.681，p＝0.006)，and age (OR 0.941，p＝0.043) were significant predictors for the occurrence of aspiration pneumonia in the stroke patients． Albumin values of 50％ of the stroke patients with aspiration pneumonia were moderately to markedly lower than 3.2 g/dL on admission，but nutritional status including albumin was not a significant predictor of it．The stroke patients fed by tube feeding indicated low FIM values on admission．FIM values on admission and complications among stroke patients were not different significantly between the two groups．

Conclusion:　 Of the stroke patients fed by tube feeding，13.9％ had aspiration pneumonia in the recovery stage in a rehabilitation hospital．Aspiration pneumonia was significantly more common among the stroke patients who were male，of older age，and with the location of disturbance in the brain stem and cerebellum，and who had severe dysphagia compared with those without aspiration pneumonia．

　Objective:　The Japanese Dysphagia Diet 2013 (JDD2013) for thickened liquids was designed as a three-level categorization system of thickness，which explained not only the drinking and visual properties，but also the viscosity ranges at a shear rate of 50 s^-1，and the ranges of line spread test (LST) values．However，LST is inadequate for thickened liquids containing different types of thickening agents and nutritional liquids containing proteins or fats． Recently，simple evaluation methods for thickened liquids using funnels or syringes have been reported．In this study，we investigated the most suitable method for evaluating thickened liquids．

Methods:　The samples were commercially available orange juices thickened by thickening agents containing xanthan gum (X)，guar gum (G) or starch (S)．The viscosities of the samples were controlled around 50，150，300，and 500 mPa・s at a shear rate of 50 s^-1．LST was performed in accordance with JDD2013，and the flow limits of the liquids were read．The funnel method measured the time at which pouring of thickened liquid (30 mL) into a funnel started till the end of outflow from the funnel by a stopwatch． On the other hand，in syringe method the nozzle of the syringe was covered with a finger，followed by filling of the syringe with thickened liquid up to the 10-mL mark．The finger was then removed from the nozzle and the scale of the remaining liquid volume left after 10 s was recorded．We then measured the viscosities of samples at shear rates of 1，5，10，50，100，500，and 1,000 s^-1 and performed sensory evaluation in the mouth cavity to verify the aptness of these methods．

Results:　The samples prepared with the same thickening agent showed smaller flow limits of LST for more viscous liquids． However，the flow limit of the sample G was longer than those of the samples X and S，whose viscosities were lower．For the funnel method，when the viscosity of the sample was high，the outflow time was long irrespective of the type of thickening agents．In syringe method，the higher the viscosity of the sample，more was the remaining volume．However，the remaining volume in high-viscosity sample G was less than that of the low-viscosity sample X．

Conclusions:　The funnel method was found to be suitable for simple evaluation of thickened liquids in this study．

Introduction:　This paper reports a case of decreased deglutition function due to the insertion of a cricothyrotomy kit．

Case:　An 83-year-old male，hospitalized for examination of arrhythmia．

Course:　Coronary aorta bypass grafting was performed on Day 8，and the patient started to take porridge on Day 10．However，ventricular tachycardia occurred frequently on Day 11 and disturbance of consciousness and dyspnea developed．Although the kit was inserted for use of an expectorant，his cough became frequent immediately after insertion and therefore saburra was sucked by a tracheal cannula．Functional decline was recognized in a deglutition evaluation by a speech-language-hearing therapist on Day 12．Furthermore，the patient was diagnosed with aspiration pneumonitis by chest X-ray and blood sampling and was forbidden to eat．Video-fluoroscopic (VF) examination performed on Day 18 revealed a decrease in larynx elevation in the pharynx period and test food remaining in the vallecula and piriform recess．The test food was not swallowed by one swallowing motion which was therefore repeated plural times，and part of the food entered the larynx．After VF，it was suspected that detention of the kit affected the swallowing function and therefore the kit was removed．VF on Day 23 showed that anterosuperior movement of the larynx was performed earlier and remaining food was reduced: it became possible to take the test food by one swallowing．Aspiration was not recognized after restarting porridge meal，his overall status improved and the patient was discharged on Day 31．

Discussion:　The distance of laryngeal elevation was shorter by 0.41 vertebral body and the delay time of laryngeal elevation was longer by 0.06 second while the cricothyrotomy kit was inserted than after removing the kit，in which state laryngeal insertion could be easily performed．When a tracheotomy that incises the second and third tracheal cartilage by small incision is performed，decrease of swallowing function due to limitation of hyoid and larynx elevation has been pointed out．This limitation of elevation presumably also occurred even with the kit inserted．Cricothyrotomy has been considered to be less invasive，allowing for rapid securing of the airway in comparison with tracheostomy，with a localized decline in ADL after insertion．However，insertion of the kit in cricothyrotomy may cause severe swallowing dysfunction even though it is a relatively simple procedure．The kit should be removed immediately when swallowing dysfunction is exacerbated．A strict judgment on its adaptation is needed when inserting the kit．