The Japanese Journal of Dysphagia Rehabilitation
Online ISSN : 2434-2254
Print ISSN : 1343-8441
Volume 8 , Issue 2
The Japanese Journal of Dysphagia Rehabilitation
Showing 1-8 articles out of 8 articles from the selected issue
Original Paper
  • Hiroshi SETA, Haruo INADA, Masahiro ABO, Atushi SUGIMOTO, Satoshi MIYA ...
    2004 Volume 8 Issue 2 Pages 127-134
    Published: December 30, 2004
    Released: August 21, 2020
    JOURNALS FREE ACCESS

    This study evaluated the reliability of the classification of upper esophageal imaging patterns.This classification is based on examination of healthy subjects using videofluoroscopy in the antero-posterior projection.By laterality of just under pyriform sinus flow,an overall classification of the imaging pattern is made as follows:only left (right) side pyriform sinus flow,dominant left (right) side pyriform sinus flow,or bilateral pyriform sinus flow.The pattern is segmented based on the existence of confluence in the upper esophagus,and 13 types of imaging patterns are defined.There were 52 healthy subjects who swallowed 5ml of 40% barium solution three times each.The pattern that appeared twice in three swallows was considered “the first pattern”.After a break of one whole day and night,swallowing three times was performed again,and these results were considered “the retest pattern”.The first pattern was compared with the retest pattern.In 49 subjects (94%),the first pattern was the same as the retest pattern.Even among healthy subjects,differences existed in the function of the pharyngoesophageal segment.However,imaging patterns appeared to be constant for a given individual.Decisions regarding the imaging pattern were made by adopting the pattern that appeared twice in three swallows.However,for a qualitative classification,errors are frequently made in the classification boundary.These findings indicated that the classification of upper esophageal imaging patterns was appropriate.

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  • Yoko INAMOTO, Kazuyo OGUCHI, Sachiyo HOTA, Eiichi SAITOH
    2004 Volume 8 Issue 2 Pages 135-142
    Published: December 30, 2004
    Released: August 21, 2020
    JOURNALS FREE ACCESS

    The purpose of this study is to investigate how the dietary status of dysphagic stroke patients in an acute care hospital predicted their dietary conditions after leaving hospital.

    Methods: 149 dysphagic stroke patients (average age 70.2),who received swallowing training from April 1,2001 to March 31,2003 were the subjects of this study. Data on their dietary status (nutrition type and food modification) on hospital discharge was collected from their medical records. A follow-up survey after they had left hospital was conducted by telephone inquiries on where they lived and their dietary status. The average number of days from the onset of illness to the survey was 429,and that from hospital discharge to the survey was 338.

    Results: On hospital discharge,33 patients were on full tube feeding,10 were on the combination of tube and oral feedings,and 94 were on full oral feeding.12 were dead.Of 137 patients who were alive on hospital discharge,133 patients responded to the survey (97%).76 respondents resided at home and 90% of them were on full oral feeding.70% of the patients who needed tube feeding were being hospitalized. The distribution of the dietary status in the follow-up survey was as follows; 19 (13%) were on full tube feeding,7 (5%) were on the combination of tube and oral feedings,89 (60%) were on full oral feeding.29 patients (19%) were dead and the whereabouts of 4 (3%) were unknown.42% of the respondents returned to normal diet. The coefficient of correlation between the nutrition type on hospital discharge and that at the time of the follow-up survey presented 0.768.

    Discussion:Swallowing abnormalities were observed in more than half of the patients one year or more post onset.Patients who presented symptomatic improvement by the time of discharge from an acute care hospital were likely to reside at their homes,not medical or other institutions.The dietary status on hospital discharge may predict dietary status afterwards.It should be noted,however,that some presented conspicuous improvement while some presented deterioration after hospital discharge. The results imply that a long-term care is required for dysphagic patients caused by stroke. A regular follow-up system should be in place taking into consideration the prevention of complications,continuous assessment of swallowing functions,QOL,and burden of nursing care on the patients' families.

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  • ―A Chart to Estimate the Possibility of Aspiration in patients with severe motor and intellectual disabilities
    Keiko MURAYAMA, Toyoko KANDA, Izumi KONDO, Eiji KITAZUMI, Kazuo KODAMA
    2004 Volume 8 Issue 2 Pages 143-155
    Published: December 30, 2004
    Released: August 21, 2020
    JOURNALS FREE ACCESS

    Aspiration related respiratory diseases are always the leading cause of death in patients with cerebral palsy (CP).However,evaluation of dysphagia with videofluoroscopy (VF) or videoendoscopy (VE) in such patients has been difficult due to incorporation,physical deformity,and motor disabiilty.Also,the many small rehabilitation centers in Japan where most of these patients are cared for have limited access to these diagnostic apparatuses.Since 1999 we have attempted to estimate the risk of aspiration with a simple questionnaire survey,in cooperation with a comprehensive project to study disability,social health,and welfare,supported by the Ministry of Health,Labor and Welfare of Japan.In this project we constructed a 2001 version (Ver.2.0) of a dysphagiae valuation system for patients with CP.The purose of this study was to develop a new tool for easily evaluating dysphagia via statistical analysis of the multi center trial data of the Ver.2.0 system.Eighty-one physically disabled patients in eight rehabilitation units (including one university hospital) aged 1-47 years old (61 with cerebral palsy,20 with other diseases) were enrolled in this study.The only patient selection criterion was the risk of aspiration estimated by the attending physician.All the patients were evaluated by the Ver.2.0 system.A family member or a nursing staff taking care of the patient answered “the family questionnaire”. Professionals (pediatrician,dentist,occupational therapist,speech and language pathologist) checked the chart.Two or more experienced pediatric neurologists or rehabilitation specialists evaluated VF results independently.Data of 75 patients were used for the analysis.Based on the results of VF,the patients were divided into three groups:Ⅰ,no aspiration; Ⅱ,pure liquid aspiration (no aspiration of soild food);Ⅲ,solid food (and/or thick liquid) aspiration.The number of patients in each group was 18,20,and 37,respectively.From the results of multivariate logistic regression analysis,eight variables were identified for distinguishing group Ⅰ (no aspiration) from group Ⅱ and Ⅲ,and 14 variables for group Ⅲ (presence of solid food aspiration) from group Ⅰ and Ⅱ with 100% probability.Content validity was also studied.Identified variables included a wide variety of categories from medical history or physical status to feeding time or cognitive function.These results show the importance of evaluating dysphagia in CP with a broad view.Based on those results we developed a 33-item screening test (2002 edition),which includes a “Family questionnaire”and “Chart for estimating the possibility of aspiration”. Each item in the estimation chart was weighted and scored by statistical calculation.In a clinical setting,this system may be a powerful tool to identify CP patients who need further diagnostic study such as VF.

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  • ―Comparison of cases among resection of tongue,mouth floor and mandible―
    Akiko NAMBA, Yukari YAMASHITA, Kohji TAKAHASHI, Yukihiro MICHIWAKI, Ka ...
    2004 Volume 8 Issue 2 Pages 156-166
    Published: December 30, 2004
    Released: August 21, 2020
    JOURNALS FREE ACCESS

    <Purpose> There have been very few reports in which systematic swallowing functional therapies were applied to postoperative oral cancer patients and their recovery process was precisely discussed.Therefore,we developed “Manual of Swallowing Functional Therapy” and used it in therapies to postoperative oral cancer patients.The purpose of this study is to clarify their recovery processes on contrast to resection areas.

    <Methods> 15 oral cancer patients who underwent operation in First Department of Oral and Maxillofacial Surgery Department,School of Dentistry,Showa University were used as subjects of this study (Partial glossectomy: 4,Hemiglossectomy:2,Subtotal glossectomy: 1,Mouth floor resection:1,Mouth floor and mandible marginal resection:1,Partial mandible resection:4,Partial mandible and buccal mucosa resection:1,Partial pharyngeal and mandible resection:1).Two or three weeks after operations,“Swallowing Function Test” was applied to the patients for selecting training items in “Swallowing Functional Therapy”.The selected items were done once a week,and recovery processes were checked once a month by “Swallowing Function Test”.In addition,“30ml water swallow test”,an interview about swallowing,and Videofluorography were also done.

    <Results> In patients' recovery process,we found features on contrast to resection areas.Partial glossectomy:Though their functional disorder was NOT severe,tongue functional training was useful.Hemiglossectomy: The item of “tongue lateral movement” was NOT achieved for a long period.Subtotal glossectomy: A variety of functional disorders were recovered after six months postoperative.Also,the item of “root of tongue elevation” was useful. Mouth floor resection: Recovered in one month.Mouth floor and mandible resection: Functional disorders remained for a long period.Partial mandible resection:Restriction of mandible and neck movement were remarkable.Partial mandible and buccal mucosa resection:Immediately after the operation,functional disorders of lips and cheeks were remarkable.But at last,the item of “tongue protrusion” was NOT achieved.Partial pharyngeal and mandible resection:The item of “Puffing out Cheeks” was NOT achieved remarkably.

    <Conclusion> Recovery processes (of postoperative oral cancer patients') of swallowing function were different on contrast to their resection areas.Therefore,“Swallowing Functional Therapy”,in which we can select training items systematically for each patients,might be useful.

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Clinical Report
Research Report
  • Akemi OGATA, Kenji WAKABAYASHI, Yasunori MIYAMOTO, Yoshiaki OHTSUKA, Y ...
    2004 Volume 8 Issue 2 Pages 173-181
    Published: December 30, 2004
    Released: August 21, 2020
    JOURNALS FREE ACCESS

    Objective: Administering drugs to children can be difficult even in the absence of dysphagia.In children with severe multiple disorders including dysphagia,the issue becomes very serious,and agents that can assist drug administration are needed.However,few studies have investigated the state of drug administration to children with severe multiple disorders including dysphagia,or appropriate dosage forms for such children.Thus,to identify factors necessary to assist drug administration,a survey was conducted on administration of drugs to children with severe multiple disorders including dysphagia,including the use of jelly for facilitating drug administration.

    Subjects and Methods: Subjects were 34 children with severe multiple disorders including dysphagia who were receiving oral medications and guidance for oral ingestion at an outpatient nursing facility,university hospital or national hospital.A survey was conducted on caretakers of these children to ascertain current state of drug administration (dosage form,drug type,and administration),difficulties in drug administration,and the utility of two types of jelly (A and B) for assisting drug administration.

    Results: Granulated or powdered drugs were dispensed to more than 90% of subjects.Syrups and tablets were also common,and capsules were also dispensed to some children.Most children were taking 2-3 different drugs,with some taking up to nine.Almost 80% of granulated or powdered drugs were administered by mixing with food or liquid other than water.In many subjects,dosage form did not match regular eating habits,and severity of dysphagia did not match administration methods.More than 90% of caretakers reported difficulty in administrating drugs,and many were frustrated with their inability to consistently administer specified amounts of medication. More than 60% of caretakers found drug administration easier with jelly,particularly with Jelly B,and stated that they would like to use jelly.

    Discussion:These findings suggest that appropriate dosage forms and administration methods based on severity of dysphagia are necessary when assisting administration of drugs to children with dysphagia.

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  • Takaaki KUBO, Kazutomo YUNOKUCHI, Masayoshi NAITO, Gang WANG, Yoriko S ...
    2004 Volume 8 Issue 2 Pages 182-185
    Published: December 30, 2004
    Released: August 21, 2020
    JOURNALS FREE ACCESS
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