＜Purpose＞Development of a questionnaire to screen dysphagia practically，easily and efficiently．

＜Questionnaire＞The questionnaire is composed of 15 items，covering areas such as history of pneumonia，nutritional state，oral，pharyngeal and esophageal function and airway protective function．The response is selected from “A： severe symptom”，“ B： mild symptom” and “C： no symptom”．

＜Subject and Method＞

1）Examining reliability using repeated measure： Each subject（n ＝84，mean age 56 years）completed the questionnaire twice with one week interval．The first and second responses were compared to examine its reliability．

2）Examining specificity and sensitivity： 50 patients with stroke，and who have dysphagia but are able to take in food orally (dysphagia group，mean age 69 years)，145 patients with stroke but do not have dysphagia (non dysphagia group，mean age 69 years)，and 170 healthy individuals（healthy group，mean age 65）completed the questionnaire．The responses were aggregated for each item among the three groups in order to calculate the specificity and sensitivity．

＜Result＞ The first and second scores were consistent and showed high reliability with Cronbach alpha coefficient of 0.8473．Forty-six patients（92％）among the dysphagia group selected response A for at least one of the items． On the other hand， only 31 persons （9.8％）among the non dysphagia group and healthy group（n＝315）selected response A for at least one of the items．With the assumption that those who selected response A as having dysphagia， the specificity and sensitivity for detecting dysphagia when using the questionnaire were calculated； specificity ＝ 90.1％，sensitivity ＝ 92.0％．

＜Discussion＞ The current questionnaire showed high reliability，sensitivity，and specificity．The questionnaire is easy to administer and is anticipated to be effective in screening dysphagia in diverse population．

It is important for dysphagic patients to enjoy their meals safely．Therefore，it is essential to determine how their rneals should be presented in order to suit the patients’ swallowing functions．Each patient's swallowing functions and food textures must be synthesized and evaluated．We devised a new method for observing bolus transport using ultrasound Duplex-Doppler analysis．This study was aimed at examining the validity of the fixed quantity analysis of this new method．

The subjects were 11 healthy adult men．Three types of food with different food textures were used．We tested these foods’ textures beforehand （hardness stress，adhesiveness，cohesive levels， elastic modulus， coefficient of viscosity，and viscosity.) The depicted depiction conditions and analysis methods were all in accordance with our new observation method.

The following results were obtained: The coefficient of variation between individuals was small in the values obtained from the experimental subjects．(This was thought to be because these are values which can be subjected to fixed quantity analysis.) The clearest，most reliable data were best shown in the analysis between food texture and fastest velocity；the next reliable data were between food texture and，in descending order，mean acceleration，inflow time，and fastest velocity attainment time． From the results of the texture tests and our new method，it is thought that adhesiveness affects velocity and mean acceleration，and the coefficient of viscosity affects inflow time．

The results suggest that this inspection method can be used for fixed quantity analysis of bolus transport corresponding to differences in food texture．A standardized system of inspection related to texture could be developed with further study involving more precise characteristics of different foods and with a wider range of subjects．This new method could serve as a basic inspection method for food textures and their effects on patients’ swallowing functions．

The labium plays an important role in feeding and swallowing． Labial pressure during predation increases as a function of feeding and swallowing development．Accordingly，it is used as a standard assessment for the feeding and swallowing functions．However，there has been almost no research presented regarding labial pressure during the feeding and swallowing functions in the period of diminution．The purpose of this study is to clarify the differences in labial pressure between adults and elderly subjects．The subjects were 12 healthy adults（6 males： mean age ＝ 28.5 years，6 females： mean age ＝ 23 years） and 10 healthy elderly persons (5 males： mean age ＝ 74.8 years，5 females： mean age ＝ 75.2 years)．Two pressure sensors were secured in cavities prepared in an acrylic plate（2 millimeters thick）to measure labial pressure during swallowing and maximum closure．A comparison of adults and elderly subjects was undertaken in terms of the relationship between labial pressures at maximum closing and those during swallowing．Based upon the evaluation，the following results were obtained．

1） No significant difference in labial pressure was observed between adults and elderly subjects during swallowing．

2） The maximum labial pressure in adult subjects was significantly higher compared to elderly subjects．

3） A remarkable decline in the reserve pressure（the difference between the maximum labial pressure and labial pressure during swallowing）was recognized in elderly subjects as compared to the adult subjects．

4） The duration of labial pressure during swallowing was significantly greater in elderly persons as compared to adults．

5） No significant difference in the integral of labial pressure was observed between adults and elderly subjects during swallowing．

The healthy elderly subjects did maintain sufficient labial pressure during swallowing in the same manner as healthy adults．However，it was observed that there was a decrease in their reserve capacity and a lengthening of the duration of labial pressure，which suggests that the labial function is physiologically affected by the aging process．

During mastication there is not only jaw movement but also coordination of the movements of other organs such as the tongue，cheeks and lips．In this study we carried out an examination to analyze the coordination of jaw and tongue movements．

Ultrasound sonography was used to study the tongue，and a three-dimensional mandibular movement analyzing system was used to study jaw movement．In addition，we synchronized these two movements into a single image．Moreover，we classified the coordination of jaw and tongue patterns and carried out quantitative evaluation using dynamic analysis．The results were summarized as follows：

1． From the tongue coronal section and the images produced by ultrasound sonography，the M-cursor shows the angle of inclination of the lower jaw．It is possible to analyze the side of tongue movement and carry out simultaneous analysis of tongue and lower jaw movements．

2． Regarding the coordination of the jaw and tongue，we classified approximately four patterns．The reverse type shows jaw and tongue movements in opposition to each other．The synchronism type shows synchronized movement． The mixed type shows alternately reverse type and synchronism type movements．Those with no correlation between jaw and tongue movements are classified as other．

3． When the frequency of each pattern was examined，the highest rate was the reverse type．In addition，there was a significant difference in pattern distribution between the working side and the balancing side during the early stages of chewing．

4． There was a significant difference between use of the habitual side and the non-habitual side as the working side before swallowing．It was found that the same distribution tended to be shown between the habitual working side and the non-habitual balancing side， and between the non-habitual working side and the habitual balancing side before swallowing．There was also a difference in the pattern distribution between males and females in the early stages of working side chewing action．

5． The subjects were divided into groups according to the length of their tongue movements．Significant differences were found between the large movement group and the small movement group，which also applied to the length of jaw movements；the jaw movement distances were also significantly longer than the tongue movement distances．This shows that there is a correlation between the jaw and tongue movement distances．

These results indicate that this method can be used to analyze the coordination of jaw and tongue movements during mastication， and brought out evaluation characteristics of the coordination of jaw and tongue patterns．

This study investigates the subjective symptoms and factors related to swallowing function among elderly persons living at home．Some 2508 elderly person aged 60 and over belonging to a Senior Club were investigated using a seif-administered questionnaire with respect to Dysphagia Risk Assessment Scale which measures the swallowing function of elderly persons living at home， and the factors related there to；sex，age，health conditions and lifestyle．The study of 658 subjects consisted of 276 males and 382 females（mean age 74.9 years，SD 6.7）who responded to all questions related to sex，age，and Dysphagia Risk Assessment Scale．The data were tested by Mann-Whitney test，Pearson correlation coefficient and multiple regression analysis．The results were as follows．

1． The elderly persons living at home were frequently aware of symptoms of “aspiration” and “esophageal dysphagia,” but rarely “pharyngeal clearance problems” as subjective symptoms indicating decreased swallowing function．

2． From the results of the Mann-Whitney test and Pearson correlation coefficient，the following 10 factors showed statistically significant differences in relation to total scores of Dysphagia Risk Assessment Scale： sex，age，clinical history，medications affecting swallowing function，the number of teeth，mastication ability，physical exercise，going outside，going outside and talking，and drinking (p＜0.05)．Multiple regression analysis was used with the 10 factors as dependent variables and total scores of Dysphagia Risk Assessment Scale as independent variables．The factors indicating a statistically significant correlation were clinical history influencing swallowing function， physical exercise，mastication ability，medications affecting swallowing function and age to (p＜0.05)．Thus，the disease factors that influenced swallowing in the past， physical exercise less than 1-2 times a week，poor mastication ability，taking medications affecting swallowing and age in turn were closely related to decreased swallowing function．

3． Accordingly， a habit physical exercise and mastication ability strongly impacted the swallowing function of elderly persons living at home in addition to their clinical history and medications．It was suggested that continuous light physical exercise and maintaining mastication ability will prevent against a declining swallowing function by aging．

Objectives： The button-pull exercise is one of the strategies employed to stimulate the lip closing function for patients suffering from dysphagia caused by failure of the lip function． The purpose of this study was to examine the relationship between orbicularis oris muscle activity and the peak force of pulling a plate out of the lips in relation to the size of the plate．

Methods： Five normal persons were employed as subjects．Eight plates of different size (two vertical dimensions × four horizontal dimensions) with the same thickness (3 mm) were manufactured on a custom-made basis for each subject with plaster casts secured individually so that each plate could be inserted within the mucolabial folds．Each subject was instructed to hold each plate with the lips closed．The electromyographic activity of the orbicularis oris muscles of the lower and the upper lips was recorded starting with the onset of plate traction until each plate was pulled out． Peak force was also recorded in association with EMG using a tension gauge when the plate was pulled out of the lips． Smoothed peak EMG activity was measured at 0.1 second intervals for 2 seconds until the plate was pulled out．

Results： Peak force was increased in accordance with the increase in plate size irrespective of its vertical or horizontal size．However， the change in muscle activity was variable across subjects．

Conclusion： It was suggested that the button-pull exercise for lip closure training should be intended not to increase the peak traction force by increasing the plate size but to improve proprioception of lip closure． In other words， use of the button-pull exercise to stimulate the lip closure function should be based on electromyography and the direction of muscle contraction．