In Japan，rehabilitation for eating dysfunction，that is，dysphagia rehabilitation is just developing in recent ten years．The establishment of the Japanese Society of Dysphagia Rehabilitation (JSDR) in 1995 encouraged interdisciplinary and transdisciplinary approaches to disseminate．The Membership that was 1,970 in 1997 increased linearly and became more than double，4,265 in 2004．The composition of membership consists of speech therapists (32％)，dentists (18％)，nurses (11％)，physicians (11％)，dieticians (7％)，dental hygienists (6％)，occupational therapists (4％)，physical therapists (3％)，and others (8％)．Physiatrists account for one third of the physicians．Eager participation of many professions，especially，physiatrists，dentists，and speech therapists is making a new trend of dysphagia rehabilitation in Japan．The journal is published biannually and the scientific meeting is held annually．In last ten years (from January 1995 to August 2004)，2,946 scientific papers related dysphagia (including original articles，case reports，and reviews) were published in Japanese journals (searched by the Japana Centra Revuo Medicina) and 167 English written papers were published in the world from Japanese institutions (searched by the Ovid Medline)．As characteristic researches in recent Japan，following issues were noted； basic and clinical efforts for understanding of the Chew-swallow complex， development of several clinical examinations，confirmation of oral care effect on aspiration pneumonia，understanding of the Intermittent catheterization as both of alimentation and exercise method， and confirmation and refinement of the Balloon stretching for UES dysfunction．I hope further fruitful developments including making sure evidences in therapeutic effect of rehabilitation treatment in near future．

【Purpose】 Nasogastric tube feeding is a well-known cause of aspiration pneumonia．It has been reported that pneumonia associated with the tube is induced by aspiration of gastroesophageal reflux． However，not all patients who developed pneumonia exhibited reflux．These facts indicate that other factors also contribute to inducing pneumonia．The tube irritates the site of swallowing provocation，therefore it is hypothesized that tube placement might affect swallowing reflex and promote aspiration of saliva．In this study，we prospectively investigated the frequency of swallowing events during wearing of a nasogastric tube in order to clarify the effect of tube placement on the reflexive swallow．

【Method】 The study population consisted of five normal subjects．The subjects were instructed to rest and thereafter a feeding tube with an 8 French bore was inserted．Swallowing events were counted for 15 minutes before insertion of the tube and for 60 minutes after the insertion．Swallowing was identified by submental electromyographic activity and visual observation of laryngeal movement．

【Result】 The frequency of swallowing per five minutes immediately after insertion of the tube (19-29 times) was higher than that before the insertion (8-18 times) (Mann-Whitney test，p＜0.01)．Subsequently，the frequency of swallowing tended to decrease．Forty minutes after the insertion，the frequency was lower (1-15 times) than that before the insertion (p＜0.05)．

【Conclusion】 These results suggest that placement of a nasogastric feeding tube affects reflexive swallowing．

Objectives： Geriatric Soft Food (GSF) was developed for safe and quality ingestion for elderly people．The aim of the present study was to evaluate general/oral status and tongue pressure in a group of elderly people mainly taking GSF，and to examine the relationship within those evaluations and also their meal variation．

Subjects and Methods： Sixty-one residents (17 males and 44 females；over 65 years of age) in Himukaen Geriatric Health Services Facility took part in this study．The residents and their families were informed about the purpose and method of this study and gave their consent． Activities of daily living (ADL)，level of consciousness，Revised Hasegawa Dementia Scale (HDS-R)，number of remaining teeth，usage of removable prostheses，maximum voluntary tongue pressure (MVTP)，and type of daily meal (GSF only or GSF plus， regular food as a part of side dish)，were examined．

Results： For the type of daily meal，50 subjects ate GSF plus regular food (GSF＋R group)，while 11 ate only GSF (GSF group)．Between these groups，there were no statistical differences in age，gender distribution，level of consciousness，and oral status．The GSF＋R group tended to show better results in ADL，HDS-R and MVTP than the GSF group (p＜0.05)．There was a correlation between MVTP and HDS-R，which might be explained by low compliance with MVTP measurement in demented people．However，for subjects who showed an HDS-R value of 20 or over，MVTP was greater in the GSF＋R group (20.9 kPa) than the GSF group (6.1 kPa，p＜0.001)．

Conclusion： The clinical utility of maximum tongue pressure measurement for food selection was suggested．

In this study，we investigated the swallowing properties of soft tea jelly made with different gelling agents．Sensory analysis with a ranking test was carried out among young panelists and elderly panelists who used day-care services．We suggested the way of taking foods which imitated the elderly panelists and instructed young panelists to do the same in the sensory analysis．

The following results were obtained：

1． From the comparison of physical properties of three tea jellies made with different gelling agents which were adjusted to equal hardness，it was suggested that carrageenan jelly (made with mixed carrageenan) had low adhesiveness like agar jelly and high cohesiveness like gelatin jelly．

2． Carrageenan jelly was evaluated as more cohesive than agar jelly and easier to swallow than gelatin jelly．This suggests that carrageenan jelly has suitable properties for elderly people who have swallowing problems．

3． When young panelists imitated the elderly panelists' way of taking food such as holding the jelly in the mouth for ten seconds，the result was similar to that of the elderly panelists．

Purpose：The purpose of this study was to examine the compatibility of palatal augmentation prosthesis (PAP) by investigating the prognosis of PAP which was prepared in our hospital in an attempt to promote the recovery of swallowing function in patients with dysphagia after surgical intervention for mandibular/tongue cancers．

Subjects and methods： Five patients (Case Nos.① to ⑤；all males；age at operation：25-63；average age： 50.6 yrs) who had submitted to PAP settlement after subtotal or total lingual resection due to mandibular/tongue cancers during the period from June 2003 to April 2004 (11 months) in the Department of Oral surgery，Okayama University were enrolled in this study．The evaluation of swallowing function before and after PAP settlement was performed by means of lingual mobility test，modified water drinking test and food ingestion test in addition to the swallowing videofluorography and ultrasonic diagnosis．The assessment of PAP compatibility was mainly based on the superior mobility of the tongue and disabilities during oral and pharyngeal stages．The clinical course after settlement of PAP prepared by using the palatographs thus obtained was examined by referring to the patient's medical record．

Results： In Case Nos.①，② and ⑤，their tongues showed almost no superior or anterior movement with the resultant low scoring points．Case No.④ had a relatively high scoring point，the result of which could be explained in relation to the size of skin flap in part．The examination performed before PAP settlement revealed some disabilities during preparatory/lingual stages in all cases as well as those during pharyngeal stage in all except for Case No.③．The time elapsed after operation to PAP settlement was 8642 days in Case No.① and 2107 days in Case No.②．In Case Nos.③ to ⑤，the corresponding time ranged from 38 to 56 days． After PAP settlement，the improved ingestive and swallowing functions were evident during preparatory/lingual stage for food mass transportation in Case Nos.③ to ⑤． Especially in Case Nos.④ and ⑤，disability during pharyngeal stage was also improved． In Case Nos.① and ②， however，a sense of incongruity still remained at the time of swallowing which finally resulted in PAP incompatibility，though some improvement was observed during preparatory/lingual stage． In Case Nos.③ to ⑤ with an established PAP compatibility， PAP subsequently became unnecessary and thus removed owing to the completely improved swallowing function in Case No.③．On the other hand，PAP is now used under a continued adjustment in Case No.④ and no adjustment in Case No.⑤．

Discussion：

1) In 3 cases in which PAP was applicable in a relatively early stage after operation，PAP compatibility could be obtained though the extent of lingual resection varied case by case．In the remaining cases in which PAP was applied at a more prolonged time after operation，however，a trend of PAP incompatibility was observed especially in those with more extended range of resection，suggesting that the outcome would be better when PAP is applied as early as possible after operation．

2) Although the examination of lingual mobility employed as a clinical criterion for PAP application was useful in part，it seemed necessary to establish more detailed criteria for its validation．