Since 1993, we have done the videofluorographic swallowing study for the objective method for dysphagia evaluation and the study is very effective in evaluation and making a decision of treatment．Also, it is relatively safe method．

For the quantitative evaluation of clinical state of dysphagia and the videofluorographic swallowing study, we developed the clinical functional scale and videofluorographic swallowing scale．Those scales are pretty well correlated with aspiration grades, however, we will try developing new version of those scales for better correlation with long term outcomes．

For treatment of dysphagia, diet modification is very important part as well as exercise and compensatory technique．So, based on food material's viscosity, we developed three class dysphagia diet system for diet modification matched to the test steps of videofluorographic swallowing study and line spread test is very convenient method to classify each food materials at home．

We did a long term prospective study of dysphagia after stroke with videofluorographic swallowing study and result was better than other reports．We think that this improvement was a result of our treatment including our own diet modification method mentioned before．

Finally, we think that doctor’s role is very important in evaluation and making decision of treatment of dysphagia so, doctor have to be the leader of dysphagia treatment team

Providing adequate assistance during eating is one of the most important aspects of caring patients with dysphagia at home． ln order to provide the care service more effectively， we surveyed the actual conditions of the patients with dysphagia at home by conducting questionnairing on home visiting nurses． Nurses at several home nursing teams in Mie prefecture including lse-Hisai-Tsu city areas submitted their replies to the questionnaire on their patients under care． Of 169 patients surveyed， 28 suffered from dysphagia and five were placed on tube feeding． Prevalence of dysphagia was higher in the patients in their seventies（18.8％）and eighties（18.7％）than those in sixties (53％)．Fourteen dysphagic patients had history of pneumonia (50％)． Prevalence of pneumonia was significantly higher in the patients who often choked during feeding（64.7％，11/17）than those who had no history of choking (27.％，3/11)．Regarding the relationship between the feeding position and the incidence of choking， those who needed aid to sit up at 90 degrees choked more frequently（81.8％，9/11）than those who sat up at 60 degrees (47.1％，8/17)．Furthermore，the patients who were placed in lower position than the usual sitting position during feeding had fewer choking episodes （41.7％，5/12） than those who were placed in a constant position (75％，12/16)．Of 28 patients who often choked， ten were fed in relatively short period． This fact suggested the importance of taking sufficient feeding time for the patients who had the history of choking． We should consider not only patients’ levels of disability but also their ages when we take care of those with dysphagia at home． Aspiration pneumonia is one of the life-threatening events in home care patients． Appropriate care should be provided for the patients with dysphagia by maintaining lower sitting position during feeding and keeping pace with them．

This is a study to investigate the effects of bolus volume and temperature on the respiration pattern and the duration of deglutition apnea during swallowing． The subjects included 4 men and 11 women who understood the purpose of the present study and expressed their consent (mean age 20.4 years，SD 3.1)． The subjects swallowed water bolus 60 times in total： 10ml water at 5℃， 20ml water at 5℃， 10ml water at 25℃，20ml water at 25℃，10ml water at 50℃，and 20ml water at 50℃，respectively，ten times．The respirograms and surface electromyograms（EMGs）of the suprahyoid muscles were simultaneously recorded during swallowing．

The respiration patterns during swallowing were classified．The frequency of the single type（respiration pattern indicating complete deglutition with one swallowing movement）and EAE subtype（respiration pattern consisting of expiration，apnea and expiration） and the duration of deglutition apnea observed in EAE subtype under various bolus conditions were evaluated． Two-way analyses of variance（ANOVA）were employed to assess the data obtained，and the effects of bolus volume and temperature were evaluated． A test was conducted to clarify the difference in population ratio， and the results obtained were used to determine the effects of bolus volume on the frequency of resptration patterns．

In terms of the frequency of the single type，tests performed to evaluate the interactions between bolus volume and temperature showed no significant difference．Regarding the frequency of the single type，a significant difference was recognized only in the bolus volume and a significant decrease was observed in the experiment conducted with a bolus volume of 20ml when compared with 10ml (P＜0.01)．With the frequency of EAE subtype，similar results were obtained (P＜0.05)．The frequency of IAI subtype （respiration pattern consisting of inspiration，apnea and inspiration）increased significantly in the experiment conducted under the condition of bolus volume of 20ml， against 10ml (P＜0.05)．As for the duration of deglutition apnea in EAE subtype，there were no significant interactions between bolus volume and temperature，and there was a significant difference only in bolus volume．The duration of deglutition apnea in EAE subtype increased significantly in the experiment conducted with a bolus volume of 20ml when compared with 10ml (P＜0.05)．

The respiration pattern and the duration of deglutition apnea during swallowing were thus influenced by bolus volume， but not temperature． lt was suggested that， by increasing the bolus volume of swallowing，the respiration-type recognition rate was changed and there was coordination of the prolonged deglutition apnea with respiration．

We report the results of the retrospective study conducted during the period between April，1999 and December，1999．Forty subjects studied consisted of 21 males and 19 females including those treated at the rehabilitation clinic for dysphagia established in the Faculty of Dentistry，Niigata University，in October，1999．Their ages ranged from 2.5 to 94 years．According to primary diagnoses，they suffered from oral cancer (n＝14)，stroke (n＝8)， dementia (n＝8)，Parkinson's disease (n＝3)，congenital myopathy (n＝3) and other diseases (n＝4)．Of 40 patients suffering from swallowing disorder，26 patients were placed on tube feeding and underwent the first medical examination (65％)．After the introduction of rehabilitation，they showed the improvement of symptoms to the level of oral feeding．The results obtained in the present study suggested the effectiveness of the therapeutic approach using rehabilitation in the patients with sub-acute disease who showed the symptoms of dysphagia．ln the clinical practice，it was difficult for dentists to take sufficient care of inpatients， outpatients and home care patients with dysphagia．Since the establishment of the rehabilitation clinic for dysphagia，more effective therapeutic approach has been taken to improve swallowing disorder．