Purpose:　Tongue pressure is measured in order to estimate swallowing function, and it decreases after esophagectomy. Its decrease is associated with the period of fasting and duration in intensive care unit (ICU). However, the decrease in tongue pressure is unknown in gastrectomy, which requires less surgical invasion for tissues related to swallowing function than esophagectomy. Screening tests for swallowing are the focus in gastric cancer patients. The aim of this study was to compare postoperative tongue pressure between patients with gastric cancer and those with esophageal cancer.

　Methods:　We analyzed the data of 40 inpatients (26 males and 14 females; 40–88 years old) who underwent gastrectomy/esophagectomy and an evaluation of swallowing function at Okayama University Hospital and Hokkaido Cancer Center. The gastric and esophageal cancer patients were matched for age, sex, tongue pressure before operation (baseline), repetitive saliva swallowing test (RSST) and cancer stage. For evaluation of swallowing function, tongue pressure and RSST were measured at baseline, and at 1 and 2 weeks postoperatively. Data related to tongue pressure were collected from patients’ medical records, including sex, age, cancer stage, operative approach, surgical duration, amount of bleeding during surgery, duration of intubation, fasting, ICU stay, and lifestyle. The rate and change in tongue pressure were analyzed using the two-way ANOVA test and Wilcoxon signed-rank test between gastric and esophageal cancer patients. The related factors of tongue pressure were analyzed using the Mann-Whitney U test and χ² test.

　Results:　The rate of tongue pressure decrease after gastrectomy was significantly smaller than that after esophagectomy (p＝.026). In gastric cancer patients, surgical duration (p＜.001), length of ICU stay (p＜.001) and fasting after gastrectomy (p＜.001) were significantly shorter than those in esophageal cancer patients.

　Discussion:　These results may be related to the distance between the surgical field and tissues related to swallowing function such as the oral cavity, pharynx and larynx, and shorter periods of surgery, ICU stay and fasting after gastrectomy than esophagectomy.

　Conclusions:　The rate of decrease in tongue pressure in gastric cancer patients was smaller than that in esophageal cancer patients.

　Aim:　We developed a four-parameter scoring system for videofluoroscopic examination of swallowing (VF). The aims of the parameters were to decide whether patients with dysphagia should be provided solid food.

　Patients and Methods:　The subjects were 151 patients who underwent VF at our hospital between February 2018 and April 2021. VF examinations were performed using jelly as the solid food, and swallowing function was assessed using the following four parameters: 1) oral food processing (processing movement) and tongue motion, 2) propulsion from the oral cavity to the pharynx, 3) timing of swallowing reflex initiation, and 4) pharyngeal clearance after swallowing. Each of the four parameters was scored on a scale from 0 points (normal) to 3 points (severe). Scores for each parameter obtained during VF were compared with the rate of solid food supply within 1 month after VF.

　Results:　In patients who scored better than Grade 5 on Fujishima’s Food Intake Level Scale (FILS) for dysphagia within 1 month after VF, the rate of intake of solid food decreased with increasing score for each of the four parameters. The rate was significantly lower in patients with a score of 2 or 3 than in those with a score of 0 in every parameter.

　Conclusions:　For each of the four parameters used in the present study, the rate of solid food intake decreased with increasing score. We would like to verify the validity of the parameters.

　Objective:　To disseminate the Japanese Dysphagia Diet (JDD) to home care workers by creating promotional material using infographic techniques.

　Methods:　The creation of the infographic began in April 2019 in Nishi-Tokyo City as part of the “Multi-Professional Collaborative Project for Meal Support” launched by the Institute of Gerontology, the University of Tokyo (IOG). The project team consisted of medical professionals, municipalities, and a researcher from the IOG. The infographic’s content was determined based on the needs and challenges mentioned by home care workers for the dissemination of the JDD. The infographic was printed on plastic file folders so that mobile home care workers can look at it at any time. An instructional video that shows how to use the plastic file folder was made and uploaded to the YouTube channel of Nishi-Tokyo City. Thereafter, we conducted a questionnaire survey on the usefulness of the folder.

　Result:　The infographic comprises three major sections: background, why the JDD is recommended, and an explanation of the JDD. In the survey, of the 86 home care workers involved in meal support, 85.5% reported that they have current situations that will benefit from using the plastic file folder, and 92.8% answered that there was likely to be an opportunity to use it in the near future.

　Conclusions:　This survey suggested that the infographic material may help disseminate the JDD to home care workers.

　Objective:　This study aimed to clarify the status of support provided by multidisciplinary medical personnel for frail elderly with dysphagia and their caregivers.

　Methods:　Semi-structured interviews were conducted with 8 multidisciplinary medical professionals working in a dysphagia clinic at 4 hospitals that cooperated with this research from 21 hospitals located in prefecture A in Japan. Data were analyzed using the modified grounded theory approach.

　Results:　The results generated 30 concepts and 7 categories. Multidisciplinary medical personnel working in dysphagia clinics provided the initial support by “listening to frail elderly and their caregivers talk about their hopes regarding eating” and “swallowing evaluation based on the overall background of the frail elderly and their caregivers.” These personnel supported the frail elderly at risk of aspiration by “educating frail elderly and their caregivers to consider the balance between overall life and the state of care.”

　They supported frail elderly who had difficulty in ingesting and a high risk of aspiration as follows: “They explained to their families the current situation wherein it is difficult for them to swallow,” “They strived to help frail elderly to enjoy the taste of food,” and “They discussed a stable life with the frail elderly and caregivers.”

　Caregivers decide on end-of-life care without wishing for artificial hydration and nutrition; conversely, some frail elderly ate what they wanted despite having dysphagia. Multidisciplinary medical personnel supported these people “to determine the direction of support through a multidisciplinary approach.”

　The personnel provided the ultimate goal of these support processes: “Frail elderly, their caregivers, and multidisciplinary medical personnel coordinate to achieve feasible goals.”

　Conclusions:　Multidisciplinary medical personnel working in dysphagia clinics aim to gain an understanding of the eating preferences of the elderly patients with dysphagia and their caregivers. Caregivers decide on end-of-life care and help treat the elderly patients so that they can eat their desired food despite the presence of dysphagia. For this reason, elderly patients with dysphagia, their caregivers, and multidisciplinary medical personnel coordinate to achieve feasible goals.

　Treatment of head and neck cancer may often cause dysphagia. Dysphagia has been reported to affect a patient’s quality of life and nutritional status. Herein, we report three cases of postoperative dysphagia patients who received head and neck cancer treatment. These patients underwent hospitalized intensive dysphagia rehabilitation shortly after leaving the acute care hospital and had improved swallowing function.

　Case 1:　A 65-year-old man was diagnosed with dysphagia secondary to treatment of a left-sided oral floor cancer. He had difficulties in transferring bolus into the pharynx. He was instructed to perform direct training along with changes in body posture that included leaning on his right side and rotating his head to the left side three times a day, with indirect training and coughing in the forward inclined posture. His Fujishima’s Grade improved from 3 to 8 and his Fujishima’s Level improved from 3 to 8 within 9 days of hospitalization.

　Case 2:　A 59-year-old man was diagnosed with dysphagia after undergoing treatment of a cancer on the left side of his oropharynx. He presented with difficulties in transferring bolus into the pharynx and upper esophageal sphincter dysfunction. He was instructed to perform direct training with changes in body posture that included leaning on the right side and rotating his head to the left side three times a day along with indirect training using the balloon dilatation method and coughing in a forward inclined posture. His Fujishima’s Grade improved from 2 to 5 and his Fujishima’s Level improved from 1 to 5 within 4 days of hospitalization.

　Case 3:　A 32-year-old man was diagnosed with dysphagia after undergoing treatment of a cancer on the left side of his tongue; subsequently, he had difficulties in transferring bolus into the pharynx. He was instructed to perform direct training while in a lying-down posture three times a day along with indirect training and coughing in a forward inclined posture. He also performed cervical and shoulder stretching, and tongue strengthening exercises. His Fujishima’s Grade improved from 5 to 8 and His Fujishima's Level improved from 4 to 7 within 8 days of hospitalization.

　Discussion:　Swallowing function improved in these three cases after they underwent hospitalized intensive dysphagia rehabilitation. These patients were instructed to perform both direct training (postural control techniques) and indirect training (coughing in the forward inclined posture). This suggests that swallowing function might be improved more effectively by suitable intensive training shortly after being discharged from the acute care hospital.

　Preface:　We report a case of ingestion dysphagia in a patient due to poor posture after undergoing surgery for thoracic esophageal carcinoma exhibited immediate improvement following physical therapy (hereafter, “swallowing physical therapy”).

　Case:　The patient was a male in his late 70s who had undergone surgery for thoracic esophageal carcinoma 5 years prior. Decrease in food intake (resulting in undernutrition), poor physical activity due to extended periods of bedrest, and difficulty swallowing made living at home difficult, so he was hospitalized. His respiratory rate was 24 breaths per minute. Cervical muscle strength (GS scale) was Grade 2. Regarding muscle tone, there was hypertonia in suboccipital muscles, suprahyoid muscles, infrahyoid muscles, sternocleidomastoid, pectoralis major, etc. Regarding range of motion, chin-to-sternum distance with the neck bent was 9 cm. In the forward head posture, the head-to-bed distance when supine was 19 cm, and in the supine position with scapulae protracted and spine bent forward, the acromia-tobed distance was 9 cm. The subjective assessment of ease of swallowing was 2. Food intake was at 70%. Coughing during eating was observed.

　Progress:　As part of physical therapy for swallowing, stretching and mobilization to alleviate poor posture were performed. To maintain the effects of improvement, muscle re-education and breathing practice were performed. With a single intervention, respiratory rate was 22 breaths per minute, muscle strength was Grade 2 on the GS scale, and, for muscle tone, hypertonia had decreased in the muscle groups listed above. Regarding range of motion, the chin-to-sternum distance with the neck bent improved from 9 cm to 6 cm. Posture improved from 19 cm to 9 cm for head-to-bed distance and from 9 cm to 6 cm for acromia-to-bed distance. The subjective assessment of ease of swallowing was 5. Food intake was complete and there was no coughing during eating.

　Discussion:　It is speculated that increased range of motion along with postural changes and improved breathing resulting from relaxed muscle tone improved swallowing ability and contributed to the disappearance of coughing during eating. GS grade was still Grade 2 following the intervention but swallowing had improved. This is evidence that, by evaluating various factors that inhibit swallowing ability (such as limited range of motion, muscle extension, hypertonia, etc.) and performing proper intervention, even a single intervention can result in improvement in swallowing ability.