Tongue-to-palate pressure generation has been reported to be suitable for strengthening the suprahyoid muscles. To strengthen the muscles, it is necessary to plan the exercise load appropriately; however, the intensity of tongue-to-palate pressure generation required to strengthen the suprahyoid muscles is unclear. This study aimed to determine the correlation between tongue-to-palate pressure generation and the electromyographic (EMG) activity of the suprahyoid muscles and the intensity of tongue-to-palate pressure generation to strengthen the suprahyoid muscles in healthy older adults.

A total of 15 healthy younger adults (27.1±2.6 years) and 12 healthy older adults (76.0±3.0 years) participated in this study. Values are shown as mean ± SD. We determined the EMG activity of the suprahyoid muscles when the participants performed the head-raising exercise and tongue-to-palate pressure generation. To standardize the percentages of maximum pressure, the participants were asked to produce a pressure equal to various percentages of their maximum tongue-to-palate pressure. This was done in 20% increments ranging from 20% of maximum pressure to maximum tongue pressure. Pearson’s productmoment correlation coefficient was used to analyze the relationship between tongue-to-palate pressure and EMG activity of the suprahyoid muscles. A simple linear regression analysis was performed to estimate the exercise intensity of the tongue required for functional improvement of the suprahyoid muscles.

Statistical analysis was performed using Pearson’s product-moment correlation coefficient for evaluating the relationship between tongue-to-palate pressure and activity of the suprahyoid muscles in healthy younger and older adults. The EMG activity of the suprahyoid muscles during the head-raising exercise was equivalent to the suprahyoid EMG activity induced by 65% of maximum tongue pressure in healthy younger adults and 50% of maximum tongue pressure in healthy older adults.

Tongue-to-palate pressure generation at 50% of maximum tongue pressure showed effective EMG activity in the suprahyoid muscles and can be used to strengthen the suprahyoid muscles in healthy older adults. Future studies are needed to determine the exercise load such as duration and frequency of exercise and the anterior or posterior position required to strengthen the suprahyoid muscles.

Introduction: In swallowing, oral sensation plays an important role in shape recognition, smooth mastication, and transportation of the bolus. Oral stereognosis, which is the ability to recognize the shape of objects inside the oral cavity without visual information, is also one of the oral sensations. However, objects (pieces) used in previous studies were not uniform in terms of material, type, and method. Therefore, the DF8 kit was developed in Japan for oral sensation research; it includes 10 test pieces (TPs) with different shapes. However, no reports have examined oral stereognosis using this kit. In this study, we used the DF8 kit to measure oral stereognosis and examine the differences in the number of correct responses and age for each TP, oral stereognosis and static tongue haptic threshold, and the relationship between oral stereognosis and oral motor function.

Method: Eighty-four healthy subjects (18 to 79 years old) were included in this study. Oral stereognosis, static tongue haptic threshold, and oral motor function were measured using the DF8 kit.

Results and Discussion: No evident relationship was observed in terms of age. The correct response rate for the DF8 kit was not lower in the older adult group than in the adolescent group. The results showed that oral stereognosis was retained in the older adult group (69.6±16.5 years old). Furthermore, the number of correct responses varied with TP shape. Several correct responses were reported for the asymmetric TP. When TP shape could not be determined, subjects tended to provide incorrect responses for TPs with a similar shape. However, no significant correlation was found between oral stereognosis and oral motor function/articulatory function. The static tongue haptic threshold increased with age but had no evident relationship with the correct response rate for the DF8 kit. Static perception was good, but there were still some cases with a low number of correct responses for the DF8 kit. This result suggests that the static tongue haptic threshold alone may not be enough to estimate the state of oral stereognosis. Our results highlight the need for further studies on the relationship between oral stereognosis and the static tongue haptic threshold and oral motor function/articulatory function.

Purpose: The aim of this study was to examine whether the improvement in the Food Intake LEVEL Scale (FILS) among inpatients using artificial nutrition is related to rehabilitation, nutritional management, hospital variety, etc. A secondary analysis of the stroke (convalescence phase) database of the Japan Rehabilitation Nutrition Database (2015), was used for factor analysis.

Methods: The subjects were 232 cases using artificial nutrition (average age 82.2±9.5 years) among the cases in the Japan Rehabilitation Nutrition Database (N＝1105). As a total of 19 independent variables, seven factors related to “disease” such as gender, age, and disease; six factors related to “nutrition/rehabilitation evaluation” such as FIM score, nutritional evaluation, and dysphagia rehabilitation; and six factors related to “hospital diversity” and “outcome” were set.

The relationship between the variable and the dependent variable “FILS difference at admission and discharge” (excluding patients with FILS Lv.7 or higher at admission) was analyzed by Spearman's rank correlation coefficient (ρ). In addition, the Mann-Whitney U test and Kruskal-Wallis test were used to analyze the “FILS difference at admission and discharge” of each independent variable by a nonparametric test (p＜0.01).

Results: The median age of this database was 83.0 (76.0‐89.0). A correlation analysis between the dependent variable “FILS difference at admission and discharge” and the variables of inpatients using artificial nutrition showed that “FILS at discharge” (ρ＝0.73) and “FIM at discharge” (ρ＝0.66) were correlated (p＜0.01).

The results of testing the difference between “FILS difference at admission and discharge” and each variable showed that the “disease” variable was significantly different in malnutrition (p＜0.01). In the “nutrition / rehabilitation evaluation” variable, there was a significant difference in MNA-SFC (p＜0.01). The “outcome” variable was significantly different only at the discharge destination (p＜0.01).

Conclusion: The results of this study show that “improvement of oral intake” in elderly inpatients using artificial nutrition is associated with ADL at discharge, nutritional assessment, rehabilitation, and discharge location. On the other hand, “improvement of oral intake” was not related to aging, severity of pneumonia, complications, and hospital variety.

Goal:　This research aimed to shed light on factors influencing aspiration pneumonia risk among psychiatric hospital in-patients capable of taking their meals in the ward canteen and to obtain suggestions for support to prevent aspiration pneumonia.

Method:　The subjects of the research were 100 patients, aged 20 and 85, capable of taking their meals in the ward canteen, out of approximately 400 psychiatric in-patients in a psychiatric hospital. The subjects were divided into high, medium and low risk by aspiration pneumonia risk assessment and the following parameters were investigated and studied statistically for each patient in the group: base attributes, daily life situation, meal-taking situation, nutritional situation (body mass index (BMI), geriatric nutritional risk index (GNRI) ), and blood biochemistry findings (total protein (TP), albumin (Alb), hemoglobin (Hb), hematocrit (Ht), and white blood cells (WBC)).

Results:　There were 0 patients in the high-risk group, 24 in the medium-risk group and 76 in the lowrisk group. A comparison between groups showed that age was significantly higher in the medium-risk group. BMI, GNRI, Ht, Hb, peak expiratory flow (PEF), and repetitive saliva swallowing test (RSST) were significantly lower in the medium-risk group. In the Spearman rank correlation coefficient, a correlation was found for age, BMI, GNRI, Alb, Ht, Hb, PEF and RSST. In binary logistic regression analysis, BMI, PEF and RSST were obtained as independent variables.

Conclusion:　It is suggested that BMI, PEF and RSST are factors that influence aspiration pneumonia risk among psychiatric hospital in-patients capable of taking their meals in the ward canteen. It seems that efforts to provide support to improve nutritional situation, respiratory function and swallowing function are essential for the prevention of aspiration pneumonia.

Objective:　Thickened liquid is a worldwide intervention approach for dysphagia. The widespread use of thickened liquid has created a need to establish clear terminology to describe the proper consistency that is recommended for patients with dysphagia. The Japanese Dysphagia Diet 2013 (JDD2013) classified thickened liquid into three levels of thickness, and explained not only the subjective assessment but also the viscosity ranges measured by a cone and plate type viscometer. However, the high price, complex operation and time taken to operate the viscometer discouraged its use in the clinical setting.

Therefore, the viscosity of thickened liquid should be quantified with an objective device. We developed a new device, TOROMADORA^®, for evaluating the viscosity of thickened liquid. In this study, we investigated the applicability of TOROMADORA^®.

Methods:　Verification test no. 1: We prepared six samples which were commercially available seasonings. Each sample was adjusted to 20, 30, 40℃, making 18 samples in total. The 18 samples were measured by TOROMADORA^®, and the measurements were compared with the viscosity measured by a cone and plate type viscometer. Verification test no. 2: We prepared commercially available orange juice and water thickened by three thickening agents containing xanthan gum. The thickness levels of the samples were controlled according to JDD2013 for thickened liquid. The samples were measured by TOROMADORA^® and the cone and plate type viscometer.

Results:　Verification result no. 1: At 20℃ and 40℃, there was a correlation between the measurements by the cone and plate type viscometer and the measurements by TOROMADORA^®. Verification result no. 2: The thickness of the samples with various thickening agents in the different solvents measured by TOROMADORA^® was closely correlated with those measured by the viscometer.

Conclusion:　This study suggested that TOROMADORA^® can measure the viscosity of thickened liquid.

Objective:　The poor appearance of some food styles, such as blended foods, can adversely affect food preference and cause loss of appetite. Eye tracking can be effective for objectively determining food preference in patients with difficulty in communicating. The objective of this study was to use an eye tracking system to investigate the relationship between food preference and unconscious eye gazing in a patient with dementia.

Subject and Methods:　The subject was a 75-year-old-man in Long-Term Care Level 2 with a score of nine points on the Hasegawa Dementia Scale-Revised (HDS-R) used by the Japanese insurance system. His primary illness was cerebellar hemorrhage complicated by dementia. The food forms were unprocessed and blended test food, and the test foods were grilled fish weighing about 78 g (iEat, EN Otsuka Pharmaceutical Co., Ltd.). We attached an eye tracker (Tobii pro/glasses 2, Tobii Technology Japan Ltd.), and had the patient freely look for 10 s at each dish that had been served. One set was 10 s, and we carried out three sets. After the observation period, the patient ate test foods freely within 10 min. The gazing point was measured for 10 s from the time the food was served to the time the subject started eating. Gaze data stored in the recording unit were analyzed using analytical software (Tobii Studio, version 4.9; Tobii Technology Japan, Ltd.). The amount of food intake was measured after the meal. Higher food intake was interpreted as “high” preference level, while lower food intake was interpreted as “low” preference level.

Results:　The number of gaze point fixations and the total gaze point fixation time were significantly correlated with the amount of food intake. The intake of unprocessed food was higher than that of processed food. These findings are consistent with those observed in healthy adults.

Conclusion:　The results suggested that subjects with dementia tend to gaze most often and longest at foods they highly prefer.