Aim: The aim of this study was to determine whether the number of days to weaning from tube feeding affects motor FIM gains in stroke patients admitted to our convalescent rehabilitation ward with a condition requiring tube feeding.

　Methods: This was a retrospective cohort study of 213 stroke patients (age 76 [69-82], 85 females) admitted to our convalescent rehabilitation ward between April 2014 and December 2018 with a condition requiring tube feeding. The primary outcome was motor FIM gain. The effect of the number of days to weaning from tube feeding on motor FIM gain was investigated in a multivariate analysis.

　Results: The number of days from admission to weaning was 23 [12-47] days and motor FIM gain was 21 [7-37] points. In multiple regression analysis, the number of days from admission to weaning from tube feeding independently influenced motor FIM gain (β ＝－0.320, p＜0.001).

　Conclusions: In convalescent stroke patients requiring tube feeding on admission, motor FIM gains may be higher the earlier the patient is weaned from tube feeding after admission.

　Expansion of the pharyngeal lumen causing a decline of pharyngeal constriction is reportedly associated with aging. Other than aging, however, it is not clear what factors are associated with expansion of the pharyngeal lumen. As the larynx is adjacent to the pharynx, we hypothesized that the age-related change of larynx position could be a potential factor affecting expansion of the pharyngeal lumen in the elderly. The aim of this study was to elucidate the association between the area of the pharynx and the larynx position in the elderly.

　This cross-sectional study included 75 dental clinic outpatients who had symptoms of swallowing difficulty and had no medical history of disease-causing dysphagia such as stroke, Parkinson's disease or neuromuscular disease. Age, sex, body mass index (BMI), number of remaining teeth, and tongue pressure were recorded. A lateral image captured by a videofluoroscopic swallowing study was used for measuring the pharyngeal area as an index of the pharyngeal lumen. The hyoid and larynx positions were also measured. Multiple regression analysis was performed with pharyngeal area as the dependent variable. Pharyngeal area was independently associated with aging (β ＝0.4489, p＜0.001), BMI (β ＝－0.1841, p＝0.041) and larynx position (β ＝－0.4318, p＝0.002). The results suggest that decreased weight or laryngeal descent may be a useful index of the area of pharynx expansion.

　Background:　Functional deterioration of the tongue and lips causes hypoplasia of the bolus, limits the diet that can be ingested, and leads to malnutrition, but there have been few reports on the relationship. In this study, we considered that the oral diadochokinesis of patients admitted to general hospitals could be used as an index to grasp nutritional status and diet modification, and investigated the relationship.

　Methods:　The subjects were patients referred to the Department of Oral and Maxillofacial Surgery of a general hospital for swallowing function evaluation, and 259 inpatients aged 65 years or older (135 males, average age 84.4±8.0) who ingested orally and were able to perform an oral diadochokinesis test. Using the Geriatric Nutritional Risk Index, we classified them into two groups: a high nutritional risk group and a moderate / mild / none group. The diet modification was determined based on the results of a swallowing function evaluation and swallowing endoscopy, and was divided into two groups: a soft diet / paste diet group and a regular diet / chopped diet group. Differences in oral diadochokinesis between groups were compared, and the ROC curve was used to calculate the cutoff values for malnutrition and diet modification.

　Results:　158 out of 259 were classified into the severe nutritional risk group, and their oral diadochokinesis (/pa/ 3.6 times/s, /ta/ 3.6 times/s, /ka/ 3.3 times/s) was moderate/mild/no nutritional risk. It was significantly lower than the moderate/mild/no group (/pa/ 4.4 times/s, /ta/ 4.2 times/s, /ka/ 3.9 times/s). If the cutoff values are /pa/ 4.7 times/s, /ta/ 4.7 times/s, and /ka/ 4.3 times/s according to the ROC curve, the sensitivity / specificity (severe nutritional risk group) is 75.3% / 44.6%, 77.8% / 42.6%, 74.7% / 43.6%. On the other hand, in terms of diet modification, 142 people ate normal diet or chopped diet. Oral diadochokinesis was significantly lower in the soft / paste diet (JSDR2021 code: 3,2) group (/pa/ 3.5, /ta/ 3.4, /ka/ 3.1) than in the normal diet / chopped diet (JSDR2021 code: 4,3) group (/pa/ 4.3, /ta/ 4.1, /ka / 3.9). If the cutoff values are /pa/ 4.5, /ta/ 4.7, /ka/ 4.3 according to the ROC curve, the sensitivity /specificity (soft food / paste food group) is 76.9% / 46.5%, 81.2% / 39.4%, 79.5% / 42.3%.

　Conclusion:　Oral diadochokinesis values of 4 times/s or less of older inpatients admitted to a general hospital may be a predictive indicator of malnutrition and low diet modification.

　Background:　Functional deterioration of the tongue and lips causes hypoplasia of the bolus, limits the diet that can be ingested, and leads to malnutrition, but there have been few reports on the relationship. In this study, we considered that the oral diadochokinesis of patients admitted to general hospitals could be used as an index to grasp nutritional status and diet modification, and investigated the relationship.

　Aim:　To verify the reliability of a four-parameter scoring system for videofluoroscopic (VF) examination of swallowing performed to determine whether patients with dysphagia should be given solid food.

　Patients and Methods:　The participants were 10 patients who underwent VF at our hospital between March and May 2022. VF examinations were performed using jelly as the solid food, and swallowing function was assessed based on 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 parameter was scored on a scale from 0 points (normal) to 3 points (severe). Five assessors were assigned to each participant’s examination: two speech-language therapists, one nurse, one registered dietitian, and one radiological technologist. A doctor was additionally assigned as a benchmark assessor. We verified the intraclass correlation of the five assessors and the benchmark and the correlation coefficient between the assessors and the benchmark.

　Results:　The intraclass correlations of the five assessors to the benchmark were 1) r＝0.54, 2) r＝0.35, 3) r＝0.50, and 4) r＝0.73. The correlation coefficients between the five assessors and the benchmark were 1) r＝0.6, 2) r＝0.43, 3) r＝0.62, and 4) r＝0.77.

　Conclusions:　In the four-parameter VF scoring system for swallowing function, reliability was highest for parameter 4), moderate for parameters 1) and 3), and weakest for parameter 2). We had to add some supplementary information to increase the reliability of the scoring system. We recognized once again that various events can occur in a series of swallowing movements such as in this study.

　Introduction:　In patients with dysphagia, oral hygiene management is important because the oral environment tends to deteriorate by oral hypofunction and less self-cleaning. Oral hygiene management, including scaling (dental tartar removal) in patients with dysphagia, should be performed by a safe method while preventing the risk of aspiration. In this case report, we describe a patient with dysphagia and orthostatic hypotension who underwent tartar removal using an ultrasonic scaler with oral moisturizing gel as an alternative to water injection to prevent aspiration and hypotension.

　Case:　A 55-year-old male. He had cerebellar hemorrhage after brain tumor resection and postoperative bulbar palsy, which caused dysphagia and orthostatic hypotension. He was admitted to our hospital for surgery to improve swallowing function. Evaluation of the oral cavity revealed significant accumulation of dental tartar.

　Course:　Although ultrasonic scalers can efficiently remove tartar, there is concern about the risk of aspiration due to the influx of water into the pharynx. Therefore, we attempted to remove tartar in a sitting position, but a marked decrease in blood pressure was observed for a short period of time, which was thought to be due to orthostatic hypotension. The sitting position is desirable for dysphagia, while the supine position is desirable for orthostatic hypotension: the two positions are contradictory. We attempted to remove tartar using an ultrasonic scaler while the patient was in bed, without water injection, using an oral moisturizing gel. Vital signs were monitored and pain was assessed during the procedure. No abnormalities in vital signs were observed during all procedures, and there were no complaints of pain during or after the procedures. The removal of tartar was as effective as when the ultrasonic scaler was used under water injection, and it was possible to prepare the oral environment before surgery.

　Discussion:　Tartar removal using oral moisturizing gel instead of water made it possible to remove tartar while the patient was in bed, while preventing aspiration and hypotension. Oral care gel may be useful for tartar removal to avoid aspiration and hypotension.

　Introduction:　The oral condition of dependent persons can deteriorate, leading to oral candidiasis due to insufficient oral care. Herein, we report a patient with amyotrophic lateral sclerosis (ALS) and poor oral hygiene in whom oral candidiasis may have been suppressed by oral care using Neonisin-e^®-containing oral gel (Ne gel).

　Case:　A 64-year-old man had developed ALS 16 years ago and was using an electric wheelchair. He was referred to hospital dentistry for manufacturing a prosthesis for dysphagia. At his first visit, his oral hygiene was found to be poor and white pseudomembrane formation was observed on the buccal mucosa and tongue. Oral candidiasis was suspected, which could have been caused by poor oral hygiene, as well as a history of diabetes and long-term antibiotic usage. Antifungal medication was started for 6 days and oral hygiene instructions were given by a dental hygienist.

　Course:　The patient managed his oral hygiene himself as he lived alone. He was able to hold a toothbrush; however, he was not able to move it correctly because of ALS and so used an electric toothbrush. The plaque control record (PCR) at his first dental visit was 58.3%, indicating poor oral hygiene. In order to maintain a good oral condition without oral candidiasis, oral hygiene instructions were given to him by a dental hygienist, who also recommended using Ne gel. The white pseudomembrane disappeared after using the antifungal agent.

　Oral candidiasis did not recur during the period of oral care with the Ne gel. Recurrence of oral candidiasis was observed on days 42 and 106, a period of oral care without the Ne gel because the patient chose not to use it then. However, from day 7 to the final visit, the PCR was 20% or less and the oral hygiene was maintained well.

　Discussion:　In this case, oral candidiasis was probably suppressed by oral care using Ne gel. After oral hygiene instructions were given by the dental hygienist, oral hygiene was maintained well, but oral candidiasis recurred during the period when Ne gel was not used. Therefore, oral care using Ne gel may prevent the recurrence of oral candidiasis and reduce the need for frequent administration of antifungal agents.