Objective:　The forehead exercise for suprahyoid muscles (FESM, “Enge-Odeko-Taiso” in Japanese) is a popular method for training the suprahyoid muscles. This is a simple head-and-neck flexion technique in which resistance is applied by placing the hand on the forehead. However, because the angle of neck bending and application of resistance are left to the practitioner, the suprahyoid muscles may not be fully activated. These challenges may be mitigated by incorporating participant feedback (FB) information regarding the muscle contractions associated with neck movements. This study investigated the usefulness of visual feedback by using surface electromyography (sEMG) during the FESM.

　Methods:　Thirty-two healthy young adults with an average age of 24.0±3.6 years participated in this study. The participants were divided into two groups, with and without visual feedback, and were assigned to perform the FESM. The experiment was conducted in the following order: (1) practice; (2) first trial; (3) second trial; (4) third trial (after 15 min); (5) fourth trial (after one week). The group with feedback used sEMG as visual feedback in the second trial step (3) of this process. The measurement time per FESM was 5 s, and a total of three measurements were recorded during each trial. We assessed the electromyographic activity of the suprahyoid muscles in the study participants while they were performing the FESM. The analysis interval of the electromyographic waveform was 3 s, ranging from 1 s to 4 s after the start of the exercise. The representative value for each trial was determined as the average of the three calculated amplitude values.

　Results:　The analysis comprised 15 participants in each experimental group. A simple main effect test with the trial time as a factor showed a significant difference in the group with feedback. Furthermore, multiple comparison tests per trial showed a significant increase in the mean amplitude of the second, third, and fourth trials compared to that in the first trial. However, the simple main effect of the without-feedback group was not significantly different.

　Conclusion:　Our results show that the combined use of real-time FB with sEMG during the FESM helps increase the electromyographic amplitude in the suprahyoid muscles. The results also suggest that the effect was retained after one week.

　As the number of child development support centers (CDSC) is on the increase, dietary support, improvement of oral functions and guidance on oral hygiene management are also considered to belong to child development support services. In the Japanese city where this study was conducted, there is only one CDSC, and it was considered that there is a high regional need for the CDSC to take over the provision of developmental support from university hospitals, etc., which provided this function immediately after childbirth, and to provide continuous support in cooperation with local hospitals. Therefore, the purpose of this study was to identify the challenges related to dietary and oral function/hygiene of the children using the CDSC, as well as the needs of their parents.

　A questionnaire survey was conducted for the parents of 60 children who use the CDSC in that city. The questionnaire included basic information, eating behaviors, oral functions/hygiene, parents’ difficulties regarding their children’s diet and oral health, and desire to receive dietary guidance for the child. For statistical analysis of the questionnaire results, a chi-square test was conducted using “desire to receive dietary guidance for the child” as the dependent variable and the other questionnaire items as independent variables.

　The questionnaire results showed a collection rate of 61.7%, a mean age of 4.9±1.2 years, and a gender breakdown of 79.4% male and 20.6% female. In the eating behaviors section, 29.4% of parents had received dietary guidance/advice for their children. The survey also showed that 70.6% used a child’s chair at mealtimes. In the oral function/hygiene section, 58.8% said their children’s mouths are always open, and 41.2% of the children had abnormal findings during dental checkups. Moreover, 67.6% of parents had concerns about diets and oral functions/hygiene of their children, and 64.7% of parents wanted to receive dietary guidance for their children. Regarding the desire to receive dietary guidance, the rates of using a child chair (p＜0.05) and having concerns about diets and oral functions/hygiene (p＜0.05) were significantly higher among those with such desire.

　The results showed that there was a high local need for the CDSC, and that CDSC users faced many dietary and oral function/hygiene-related problems, which were of concern for their parents. Therefore, it is important that specialized personnel are involved from an early stage to assess the child’s condition appropriately and give support on how to provide food and improve perioral muscle function.

　Introduction:　Dysphagia is associated with a poor prognosis in patients with pneumonia, including increased mortality and prolonged hospitalization. Dysphagia due to sarcopenia is a problem in Japan with its aging population. Malnutrition is one of the major causes of sarcopenia. Although reports on the relationship between malnutrition and swallowing function for each disease are increasing, studies on patients with pneumonia remain scarce. This study used the Global Leadership Initiative on Malnutrition (GLIM), which is a useful diagnostic tool for malnutrition, to investigate the effect of malnutrition on admission on the food intake status at discharge in patients with pneumonia.

　Methods:　This retrospective cohort study included patients with pneumonia who underwent swallowing rehabilitation between April 2018 and March 2019. The patients’ age, sex, body mass index (BMI), Barthel index, skeletal mass index (SMI), Food Intake LEVEL Scale (FILS), and Charlson comorbidity index were assessed. The primary endpoint was food intake status at discharge, as assessed using the FILS. Malnutrition was assessed using the GLIM on admission, and two-group comparisons were made based on the presence or absence of malnutrition. Multiple regression analysis was performed using the discharge FILS as the dependent variable to analyze the factors associated with the recovery of swallowing function.

　Results:　Two hundred six participants (85 [51–103] years, 81 women) were included, of which 134 (64.6%) were diagnosed with malnutrition using the GLIM. The malnutrition group had significantly lower BMI, FILS at admission and FILS at discharge. Multiple regression analysis showed that malnutrition upon admission was independently associated with discharge FILS (β＝－0.419, p＝0.003). Patients with malnutrition had a lower rate of recovery of oral intake compared to patients without malnutrition.

　Conclusion:　Malnutrition on admission negatively affects the food intake status at discharge in patients with pneumonia. Patients with pneumonia and malnutrition on admission may require early nutritional intervention.

　The patient was a 22-year-old male with acute T-cell lymphoblastic leukemia. Owing to multiple relapses of the primary disease, the patient’s prognosis was poor. In addition, the patient developed severe dysphagia with salivary aspiration due to myelitis. Although the risk of aspiration pneumonia increases with oral intake, the patient and his family strongly desired oral feeding, leading to an ethical dilemma. After consulting with the attending physician and nurses, a decision was made to proceed with oral intake based on deliberation using the four quadrants. A unified approach was implemented to reduce the risk of aspiration pneumonia during oral intake. This included (1) oral care pre- and post-eating, (2) thorough suctioning, (3) compensatory approaches, and (4) risk management. The effect of oral intake on the patient’s mental state was assessed using the Profile of Mood States, which showed improvements in the categories “depression,” “anger,” “vigor,” “fatigue,” and “confusion.” Additionally, due to the unified approach during oral intake, there were no significant instances of aspiration pneumonia for the following 2 months until the patient was discharged. In this case, using the four quadrants for policy deliberation and unified approach during oral intake were considered beneficial interventions for this patient at the end of life.

　The decreased laryngopharyngeal sensation in Wallenberg’s syndrome is one of the factors that cause a delay in the initiation of oral intake, and training using ice chip swallowing or small amounts of water may not be indicated in severe cases or early onset cases. To the best of our knowledge, there are not many useful direct swallowing training methods.

　In the present study, a patient with Wallenberg’s syndrome, who presented with dysphagia and failure of opening of the upper esophageal sphincter (UES), received feeding training using frozen jelly slices (hereafter “frozen jelly training”) in the early stage of the disease, and the training was effective in improving the patient’s swallowing function.

　Frozen jelly training is a unique training method in our hospital for severely dysphagic patients with inadequate or delayed swallowing reflex induction and difficulty in code 0j or code 0t oral ingestion. Frozen jelly training has been reported to be useful for treating delayed swallowing reflex elicitation in patients with pseudobulbar palsy, but it was also useful in patients with Wallenberg’s syndrome in whom it was difficult to elicit the swallowing reflex. It is possible that the increased sensory input provided by the frozen jelly was useful in enhancing the swallowing reflex via the nucleus tractus solitarii (central pattern generator) and nucleus ambiguus. Direct training by unilateral swallowing, rotating the neck before swallowing in a sitting position, and balloon training were useful for defective opening of the UES.

　In patients with Wallenberg’s syndrome, swallowing function tests and appropriate training according to symptoms from early onset may contribute to the prevention of aspiration pneumonia and early recovery of swallowing functions, and may prevent a delay in the initiation of oral intake.