This paper reports physical properties，the swallowing characteristics and tongue surface movements during swallowing of trial foods for swallowing disorders． We prepared two types of test samples adjusting hardness to a value similar to extremely thick mousse-like foods． One of them had modified starch and the other had guar gum added as the commercial thickening agents． Hardness，cohesiveness，energy of adhesiveness， of the modified starch sample were similar value to those of the guar gum sample． On the other hand， yield stress in measuring by spring relaxation of the modified f tarch sample was lower than that of the guar gum sample． The modified starch sample were thicker， difficult to swallow and more remained in the mouth than those of the guar gum sample． The mean value of grooving depth during swallowing of the modified starch sample significantly increased as compare to that of the guar gum sample． lt is estimated that spreadable foods in the mouth by the deformation invoked by the contacting the tongue with palate are increased grooving depth of the tongue surface during swallowing to cohere as a bolus． and those foods are not swallowable foods．

In dysphagia rehabilitation，we know it is best that various professional medical staff people，such as doctors，nurses，dietitians，physical therapists，occupational therapists，speech therapists and so on，take part in a dysphagia team and stay in contact with each other for patient care．However，this is not easy，and each staff member may not realize his or her own part．In our hospital the otolaryngologists and speech therapists began a rehabilitation approach to dysphagic patients from 1997．In our past experience of dysphagia treatment，we encountered some problems．Therefore，we felt the need for a team approach in dysphagia rehabilitation and considered how to organize it．

Looking back at six cases of swallowing disorder treated by otolaryngologists， we discussed who requested swallowing training， who was the examiner， who was the evaluator，and whether or not videofluoroscopic examination of swallowing（VF）or videoendoscopic examination of swallowing（VE）was carried out．From a different point of view，otolaryngologists and speech therapists discussed the problems．As a result，we came to the conclusion that doctors in attendance should have been the leaders in patients’ rehabilitation．

Even if we need a professional/dysphagia team，there is not always one at hand in every medical facility．For better dysphagia treatment， the attending surgeons or physicians must deepen their understanding and bear the burden as leaders．As the first step in organizing a team，we propose the circulation of dysphagia rehabilitation among the attending doctors and other medical staff people by making frequent contact with them during dysphagic patient care．

To investigate the growth pattern of the organs related to swallowing， standardized dental X-ray films were traced and measured． The measured points were the tip of the uvula， the apex of the epiglottis，the hyoid bone， and the pharyngoesophageal junction． The results are summarized as follows．

1．ln three-year-old children the average distance between the tip of the uvula and the apex of the epiglottis was 11.5±3.4mm， compared to 19.0±4.0mm in eight-year-old subjects． This distance is significantly increased as aging progresses (p＜0.01)． The most remarkable rate of growth is in children aged five to seven； during this period the occlusions of the first permanent molars are made．

2． Three types of base coordinates were set up to evaluate the growth direction of the swallowing organs． The first base coordinates had the abscissa connected to the center of the sella turcica and the nasion and the ordinate met the abscissa at the sella turcica perpendicularly． The second coordinates had the ordinate connected to the frontal ends of the second and fifth cervical vertebrae and the abscissa crossed the second ordinate at the frontal end of the second vertebra perpendicularly． The third coordinates had the same ordinate as the second， and the abscissa crossed the ordinate at right angles and passed through the sella turcica． As each measured point was clustered the most in the third coordinates，these third coordinates seemed to be the best for evaluating the growth direction of the swallowing organs．

3． ln the third coordinates， the ordinate values of each point decreased as aging progressed， respectively (p＜0.01)． The average absolute ordinate values of eight-year-olds increased compared to three-year-olds as follows： the tip of the uvula； 118.4％，118.0％，the apex of the epiglottis； 124.2％，121.2％， Hyoid bone；116.2％，114.6％， and the pharyngoesophageal junction； 123.4％ ，127.8％，in males and females， respectively．The only abscissa value that significantly increased as aging progressed was the hyoid bone in females (p＜0.05)．The oro-pharynx elongated with growth， and this seemed to be due to different changing rates of the measured points．

Hardness，adhesiveness，and cohesiveness of 27 kinds of diets for patients with dysphagia were examined as a preliminary study to determine the relationship between swallowing function and characteristics of diet texture． Those foods which were clinically considered to be suitable for patients with swallowing impairment were selected as materials．

In form， these foods were divided into 6 groups：consistent sol，thicker sol，inconsistent thicker sol，mixture of sol and gel，consistent gel，and inconsistent gel．Hardness was distributed from 1.87×10² N/m² to 3.51×10⁴N/m²， and adhesive energy ranged from 4.66×10 J/m³ to 1.14×10³ J/m³， with cohesiveness ranging from 0.08 to 0.99． Most of these foods were under 2×10⁴N/m² in hardness and below 2×10²J/m³ in adhesiveness． These results proved that soft and thinner foods were preferable for dysphagia patients． Diets for patients with dysphagia may be subdivided into small groups based on further analysis of their textures．

We used a swallowing exercise to treat an 18-year-old male who had severe dysphagia following dystonia． The patient had anoxic encephalopathy at 8 years of age when he received treatment for Guillain-Barre Syndrome．Until he had dystonia he was able to make a daily living by himself by riding in a wheel chair． The main programs of the swallowing exercise were relaxation and thermal stimulation．Before the exercise he was fed some pureed food． Afterwards， he was able to take a highly chopped meal． We discussed the process of the improvement of his dysphagia． We supposed that his dysphagia was caused by secondary bulbar degeneration after anoxic encephalopathy，and activation of the central pattern generator（swallowing center）was very important for this improvement．