Introduction：In the treatment of dysphagia，a subjective assessment of certain factors，such as the patient's quality of life，is important．However，their studies in Japan are insufficient at present．In this article，to examine the usability of generic and disease-specific measures on people with dysphagia，we tested the MOS 36-Item Short-Form Health Survey (the SF-36) Japanese version 1.2 (Fukuhara et al., 2001)，and the SWAL-QOL and SWAL-CARE outcomes tool (McHorney et al., 2000，2002) in Japanese．

Method： We tested both questionnaires on people with dysphagia，in a mail survey protocol．The number of subjects analyzed was 23，18 male and 5 female，aged 58.7 on average．Seventeen of them had cerebro-vascular disease，three brain tumor，two traumatic brain injury，one hypoxic encephalopathy．

Result：We tested the SF-36．Cronbach's α ranged from 0.59 to 0.72 for all eight scales and it exhibited internalconsistency reliability．All scales except one (Body Pain) were significantly lower than the standard scores for Japanese．The profile obtained was similar to that of people with cerebro-vascular disease．We pretested the SWAL-QOL/CARE．All the scores showed extensive distributions．The Cronbach's α ranged from 0.86 to 0.90 for all scales and it exhibited the internal-consistency reliability．In the results obtained from the same question and the rate of missed data，significant differences were not obtained between the SWAL-QOL/CARE and the SF-36．Hence，we obtained reliability on external criterion．The discriminant validity was assured by the low correlations of the total scores toward the SF-36 (the SWAL-QOL 0.26，the SWAL-CARE 0.25，on average)．The convergent validity was also assured by the certain correlation of the scores between similar scales of them (the Mental Health 0.50， p＞0.5)．

Conclusion： We found that the SF-36 is useful for people with dysphagia，and confirmed the operational validity of the SWAL-QOL/CARE in Japanese．Revising our questionnaire and continuing investigation and psychometric tests to increase the clinical usability remain as future work．

Purpose： This study examined the severity of dysphagic inpatients following stroke， before and a fter swallowing training．

Methods： Out of 122 inpatients that received swallowing training for one year from April 1，2001，66 with etiologies of stroke or cerebral hemorrhage were investigated， focusing on the Dysphasia Severity Scale (“DSS”) and their diet status．To measure the DSS improvement，the variance between the start and end of training was calculated as follows：⊿DSS (“⊿DSS”) ＝ DSS at the end of training―DSS at the start of training．

Results： When the training started，those classified as “chance aspirator” on the DSS accounted for 73％．Concerning their diet status， 45％ were NPO (nothing per OS)．Comparison of 46 subjects between the start and end of the training presented a ⊿DSS average of 1.5 (minimum 0，maximum 5)．29(63％)，17(37％)，and 0(0％) patients respectively presented improvement，invariance and deterioration in DSS scores．The 29 presented improvement with a⊿DSS average of 2.4．Saliva，food，and water aspirators at the start of training presented ⊿DSS average scores of 1.3，2.0 and 2.3 respectively，with water aspirators presenting the greatest improvement．Concerning variance in ⊿DSS of different groups in terms of age，sex，and the first recurrence，no significant variance in ⊿DSS was found．

Discussion： When training started，risky cases held a majority； approximately 70％ of patients had aspiration，and about 50％ were in NPO condition．This requires effective risk management and the optimum timing of rehabilitation Saliva aspirators leveled in DSS scores while water aspirators improved，suggesting that saliva aspirators at the start of rehabilitation require a long-term follow-up．Rehabilitation programs undertaken by a team should be implemented on a continuing basis in a future．

The purpose of the study was to ascertain whether educating the main caregivers of patients with dysphagia about specific rehabilitation techniques improves a patient's condition．The subjects of the investigation were 27 main caregivers who take care of dysphagic patients． The main caregivers were randomized into two groups after giving their informed consent (experimental group：14；control group：13)． The experimental group received 4 months education from researchers on care of dysphagic patients， while the control group was just observed without education．Outcome was assessed according to patients’ symptoms of dysphagia，answers to questions about performing activities of daily living (ADL：Barthel Index)，pulse rate and blood oxygen saturation (SpO₂)．For the main caregivers，knowledge of dysphagia was assessed．All questionnaires were completed by nursing staff．These factors were assessed before and after the intervention．The SpO₂ of dysphagic patients in the experimental group improved significantly after education compared with before education (p＜0.05)．In conclusion，home nurses should instruct main caregivers of dysphagic patients in rehabilitation techniques in order to improve a patient's condition．

PURPOSE： The purpose of this study was to clarify the effects of the vertical dimension of occlusion (VDO) on the swallowing function of edentulous individuals．

SUBJECTS and METHODS： Nine healthy edentulous individuals (6 males and 3 females，mean age 57.4) who wear complete dentures were tested．A 5cc bolus of liquid was repetitively given to the subjects to swallow with three different occlusal dimensions using experimental apparatus．The apparatus contacts the maxillary and mandibular ridges， but the vertical relationship can be varied．The setting dimensions include normal VDO (Normal)，a reduced VDO (Reduced)，and a condition without the apparatus (None)．Movements of the tongue surface were quantified by measuring grooving depth on coronal sections during swallowing by ultrasonography (SSA-320A，Toshiba Medical)．Differences among the respective dimensions were analyzed by ANOVA and Fisher's PLSD test (p＜0.05)．

RESULTS and DISCUSSIONS： Results of the present study showed a significant increase in the grooving depth during swallowing with no apparatus compared to that of the Normal VDO (p＜0.05)，and there was no significant difference between the Normal and Reduced groups．In the group without the apparatus，the tongue seemed to require greater movement for swallowing，suggesting that restoring some VDO，perhaps even with an upper single denture，can improve the swallowing function．

CONCLUSION： lt was suggested that providing prosthetic apparatus with at least some VDO significantly improved the tongue movements during swallowing．

Purpose： We have developed four clinical indexes for assessing the secondary factors that impede laryngeal movement in swallowing．This study examined the reliability of the measurement，and its application in the clinical field， especially characteristics with aging and sexuality，and the relationship between these indexes and dysphagia．

Method： One hundred and nine persons participated in this study．We subdivided the subjects into five groups (A：younger healthy group，30；B：elderly group，17；C：chronic CVD without dysphagia，20； D：chronic CVD with dysphagia，32；E：dysphagic inpatient with CVD，10)．The four clinical indexes are as follows： distance from genio to thyroid with neck extension (GT)，distance of thyroid-sternum with neck extension (TS)，calculated ratio of the thyroid cartilage level (T-position ＝ GT/(GT+TS))，and classification of neck flexion holding ability in the supine position (GS grade)．

Results：The reliability of these indexes was 0.84-0.94 with ICC (1，1) and ICC (2，1) in group E．The standard values of these indexes were measured (GT＝6.4 ± 0.9cm， TS ＝ 12.2 ± 1.0cm， T-position： 0.34 ± 0.04 in group A， GT＝6.6 ±1.0cm，TS＝9.5 ± 1.1cm，T-position ＝ 0.41 ± 0.05 in group B)．In comparison among group B，C and D，there was no significant difference between B and C，but there was a significant difference between C and D with TS， T-position，and GS grade．

Conclusion： The results of this study clarified that these indexes are useful for evaluating the secondary factors that impede laryngeal movement in swallowing．

[Purpose] We examined the effects of manual therapeutic techniques and their duration on two Dysphagia patients with brain damage．[Case 1] The 79-year old male patient had undergone a cerebral infarction and suffered from right Hemiplegia．The patient had been kept under continuous catheterization with a naso-gastric tube and tracheal cannula for 6 months．For the first evaluation we used Blue Dye Marker (BDM)，which went down the trachea．We used manual therapeutic techniques on the neck and truncus (especially the suprahyoid muscle group) of this patient (hospitalized during this time)．After 5 weeks，there were no traces of intracheal BDM．The tracheal cannula was removed and he was able to eat．[Case 2] The 64-year old female patient suffered from normal pressure hydrocephalus for 20 months after having undergone a shunt operation．Her dietary intake was almost 60％．We thought her limited ingestion was a result of high-tone of her neck and face during meals．We immediately tried a treatment to reduce the hypertonia of her neck and face，and to ultimately stretch contractile muscles．After the treatment， she was able to ingest more，and occurrences of high-tone in her face and neck decreased．As of the next day，though，these results were no longer stable．We implemented a program that informed the care staff about various body positioning techniques，as well as welfare equipment．Alongside the staff we worked with the assistive devices and body positioning techniques．After receiving treatment from the care staff，her dietary intake was 90％． [Consideration about clinical] The rigidity of the muscles which block swallowing can be attributed to both physiological contraction and pathophysiological reduction． In selecting manual therapeutic techniques one should understand the characteristics of the target area’s anatomy． We believe that the suprahyoid muscle group should focus only on swallowing instead of body posture． For this treatment to continue to be effective， assistive devices （adaptable to patients） and effective body postures （for individual patients） need to be chosen． [Conclusion] With our knowledge of anatomy and physiology， we made use of manual therapeutic techniques， in order to reduce hypertonia occurring in the areas surrounding the face and neck． These techniques took effect immediately． However， in maintaining these results it is necessary for the team to take into account the swallowing mechanisms and the environmental adaptation involved in helping the patient．