In the Japanese Dysphagia Diet 2013 produced by the JSDR Dysphagia Diet Committee (JDD2013), it is clear that the classification of Universal Design Foods (UDF) also corresponds to other classifications. However, the accuracy of this has not been researched. In this study, we evaluated the classification of UDF that corresponded to the code of JDD2013 by sensory evaluation. Twenty-five registered dietitians were selected for sensory evaluation and 50 samples of commercial nursing-care foods were used. We found that 56% of the samples matched the UDF product marking and sensory evaluation. It is indicated that there is a need for greater masticatory performance than product marking. Furthermore, we found that the classification of UDF in JDD2013 will increase the matching ratio by “Code 4” to include “Crushed with Tongue.”

　This study focused on the decline of swallowing function, which is considered to be the main cause of aspiration pneumonia. The aim of the present study was to design a clinical pathway based on swallowing functional assessment and to consider its effect in patients admitted with aspiration pneumonia.

　The swallowing functional assessment for patients with aspiration pneumonia was undertaken using the basic information of the patient as well as the following four aspects and sub-items: general condition, food intake condition, swallowing function and oral condition. This functional evaluation was conducted at three points: (1) at the beginning of the intervention by a speech therapist, (2) at the end of pneumonia treatment, and (3) at the end of the intervention with stable swallowing function. 102 aspiration pneumonia patients (51 males, median age 90 years) were included and compared between the oral-intake group and the dead or non-oral-intake group. Moreover, the clinical pathway was developed in accordance with pneumonia treatment and then applied to the other 51 patients (24 males, median age 91 years) and its effect was examined.

　At the end of pneumonia treatment, there were significant differences between the two groups in age, BMI, Barthel Index, consciousness level, response to verbal command, expectoration of sputum, pharyngeal suction, amount of oral intake, gargle function and oral care independence. Furthermore, multiple logistic regression analysis including these items as the independent variables and setting the oral intake discharge as the objective variable showed that both response to verbal command and amount of oral intake were significant factors. A comparison of the total length of hospital stay from admission to discharge did not show a significant difference between before and after introducing the clinical pathway of swallowing functional assessment. The term from the end of pneumonia treatment to the end of the intervention was significantly shorter after introducing the clinical pathway, especially in the oral intake group, suggesting that swallowing functional assessment and support for patients in the clinical pathway were effective.

　The clinical intervention based on swallowing functional assessment for aspiration pneumonia patients was shown to be possibly effective in terms of support for oral intake after discharge.

　In this study, first, we conducted tests using different syringes and verified the errors depending on the type of syringe. Second, we verified the effect of the solvent in the syringe test using five types of solvent. Finally, we compared the syringe test and line-spread test (LST).

　Test 1:　The samples were water and liquid nutrition products thickened by xanthan gum-based and starch-based thickeners. The viscosity of the sample was approximately 50, 150, 300, and 500 mPa・s at a shear rate of 50 s^-1. A syringe test was conducted using three types of syringe (BD, TERUMO, and JMS). We then made a calibration curve from the BD results, estimated the viscosity from the residual amount in each syringe test, and verified the error. The remaining volume changed depending on the type of syringe. However, we created a calibration curve from the BD results and substituted the remaining volume of TERUMO and JMS to estimate the viscosity. As a result, approximately 80% of all samples had a difference of less than±10% from the measured viscosity value, and it was considered that there were few practical problems in measurement error depending on the type of syringe.

　Test 2:　The samples were water, saline solution, tea, orange juice, and liquid nutrition products, thickened by xanthan gum-based thickener, and a syringe test was conducted. Tea and orange juice had the same remaining volume as water. Liquid nutrition products tended to have less remaining volume than other solvents, and saline was observed to be inconsistent. It should be noted that liquid nutrition products are easy to underestimate, while saline solutions have unstable test values.

　Test 3:　A syringe test and LST were performed using water and liquid nutrition products thickened by xanthan gum-based thickener. LST was higher or equivalent to that of low-viscosity water in all liquid nutrition products. In the syringe test, the reversal of order as seen in LST was seen only in the highviscosity region. The syringe test seemed to be superior to LST as a simple evaluation method for thickened liquids in that there was no contradiction in the classification of viscosity with respect to thin thickening.

　Purpose:　Head-raising (Shaker) exercises are one of the methods for improving the activity of the suprahyoid muscles. Head-and-neck elevation movements are of three kinematic types: head, neck, and combined head-and-neck flexion. However, it is unclear which of the three types is most effective. Therefore, we examined and compared the effects of the three types of flexion on the suprahyoid muscles.

　Method:　A total of 25 healthy elderly individuals aged 65 years were recruited. We determined the electromyographic activities of the suprahyoid and sternocleidomastoid muscles during head, neck, and combined head-and-neck flexion by the participants. Each task was measured twice, and there was a 30- second break between tasks. The analysis interval was set to 3 s after stabilization of the elevation. The average amplitude over 3 s was determined. The larger of the two mean values was used as the representative value. Muscle activity during head flexion was normalized to 100%, and the rate of change for neck, and combined head-and-neck flexion were calculated. Muscle activity during each task was compared using Friedman’s test and multiple comparisons. The significance level was set at 5%.

　Results:　The suprahyoid muscle activities were as follows (median [interquartile range]): head flexion, 100%; neck flexion, 68.8% [51.7-97.8%]; and head-and-neck flexion, 64.4% [46.8-95.6%]. Muscle activity during head flexion was significantly higher than during neck flexion and head-and-neck flexion. The sternocleidomastoid muscle activities were as follows (median [interquartile range]): head flexion, 100%; neck flexion, 173.3% [105.9-255.0%], and head-and-neck flexion, 144.3% [118.0-255.0%]. The muscle activity during head flexion was significantly lower than during neck and head-and-neck flexion.

　Conclusion:　Head flexion is the most effective type of head-raising movement. We plan to investigate its effects on swallowing in future interventional studies.

　Purpose:　Oral care is essential to prevent aspiration pneumonia. However, oral care is difficult in many facilities for the elderly because many elderly people cannot gargle or refuse oral care. Furthermore, it is difficult to secure time for oral care, and so an efficient care method is desired. Therefore, we verified whether aroma candy, which is effective in removing tongue coating, would be an efficient and effective oral care at our facility.

　Method:　The subjects were 92 residents of special elderly nursing homes who were randomly divided into two groups: an intervention group (n＝46) and a non-intervention group (n＝46). The intervention group ingested aroma candy three times a day for 7 days, usually after meals. After the intervention, Ueda's tongue coating index (TCI) and the number of Candida were compared with those before ingestion. Candida were classified into five levels according to the number of colonies using a Candida detector. The non-intervention group continued normal care and was reassessed after 1 week. As followup, the same two items were examined 1 month after the start of aroma candy ingestion and compared with those immediately after intervention.

　Results:　The intervention group indicated a tendency of decreased TCI compared to the non-intervention group, but no significant change was observed in the number of Candida. In the pre-post comparison of the intervention group, TCI decreased significantly after the intervention. However, TCI increased significantly after 1 month. Comparing by resident conditions in the intervention group, Candida decreased significantly in the dentureless group, the side dish food form code 3 (Japanese Dysphagia Diet 2013) or less group, and the low body mass index group (＜20 kg/m²). All groups tended to maintain low values until 1 month later.

　Conclusion:　Aroma candy was considered to have a certain effect under conditions such as not using dentures or eating a diet that does not leave food residue. Aroma candy is expected to improve the oral health of the elderly as an efficient means of oral care without causing pain to the user, and to maintain and improve the QOL.

　A 74-year-old woman was diagnosed with dysphagia due to dermatomyositis. Symptoms of dermatomyositis onset were gait disturbance and a dusky red rash on her neck and back. She was transferred to our hospital because of general malaise and dysphagia. After the diagnosis of dermatomyositis, corticosteroid therapy and immunosuppressive therapy relieved the symptoms of dermatomyositis, including elevated creatine kinase, myalgia, and skin rash; however, severe dysphagia persisted. Swallowing-related muscle strength training was initiated with careful attention to overuse from the subacute phase. Tongue strength and swallowing ability improved without any adverse events such as flare-ups of dermatomyositis. Muscle strength training with careful attention to overuse and state of illness may be effective for subacute dysphagia due to dermatomyositis.