【Objectives】The purpose of this study was to develop an objective and general standard for evaluating tongue motor function by measuring maximum tongue pressure，duration of tongue contact，pressure integral，time taken to reach maximum pressure，etc．in bolus formation and transfer during swallowing．

【Subjects and Methods】The subjects were 14 healthy volunteers （8 men and 6 women， mean age 29.1）， who individually had normal occlusion．Two palatal plates were produced for each person；one plate was used every day before measuring，and the other plate used for measuring contained a pressure sensor at three points： the mid-point between the left and right mesial sides of the first molar， the palatal side of the mesial side of the left first molar，and the point equidistant between the first two points．The pressure when the tongue was pressed with maximum pressure against the palate (isometric pressure) was measured．Next，saliva，food A (5 cc of water)， food B (2.5 g of food to which was added 2 g of thickening agent in 100 cc of water)，and food C (2.5 g of food to which was added 3 g of thickening agent in 100 cc of water) were swallowed and the tongue pressure was measured． The maximum tongue pressure，duration of tongue contact，pressure integral，and time taken to reach maximum pressure were analyzed．

【Result】A difference was found between men and women in tongue pressure formation．The isometric tongue pressure was formed better，compared to the maximum tongue pressure．Regarding the maximum tongtie pressure，the difference among parts was not remarkable，and even when the food viscosity increased，no tendency toward increase in pressure was found．The duration of tongue contact on the side edge of the tongue was significantly longer than that of the central part of the tongue．As the food viscosity increased，the pressure integral for males was significantly larger，and the duration of tongue contact and the time taken to reach maximum pressure were significantly increased for both males and females．Regarding the time taken to reach maximum pressure，a significant difference was found for all parts．

【Conclusion】For bolus formation and transfer，it is necessary to force the side edge of the tongue against the palate．Tongue motor function assessment in bolus formation and transfer is not based only on the maximum tongue pressure；rather，the duration of tongue contact，pressure integral，and time taken to reach maximum pressure must also be evaluated．The time taken to reach maximum pressure is an important parameter which refiects food viscosity．

【Purpose】Videofluorography（VF）is known to be the best way of evaluating dysphagia so far，but the interpretation of such assessment depends on subjective judgment．This study measured inter-rater and intra-rater reliability of VF for swallowing function．

【Subjects and Methods】Participants included 5 dentists，1 speech language pathologist，and 1 nurse．They evaluated VF images of 6 dysphagic patients repeatedly 4 times using an evaluation sheet and criteria of our own．The kappa coefficient was calculated to estimate inter-and intra-rater reliability．

【Results】The average kappa coefficient of all evaluation items between raters was low，0.24-0.34．Items that have some relation to aspiration such as amount of aspiration or Penetration-Aspiration Scale showed relatively high reliability，however，each of the other items generally yielded low reliability．In addition，repeating the appraisal did not improve inter-rater reliability．On the other hand，the average kappa coefficient of intra-rater reliability showed high reliability，0.53-0.67．In addition，each item generally showed high reliability．

【Discussion】Evaluation of aspiration did not differ from raters who were expected to have passable knowledge and clinical experience of dysphagia．However，the protocol of VF was altered in order to tailor the examination to each patient's needs．In brief，the incidence of aspiration differs according to the protocol．Therefore，to improve the reliability of VF，VF by well-experienced raters as well as practice evaluation of VF must be performed． Evaluation of oral and pharyngeal motor function differed among raters， in other words， selection of swallowing therapy depends on the rater．Therefore，we have to decide swallowing therapy by mutual consent to avoid misapplication of the therapy．

The “Chin down” maneuver is a postural technique used widely for treatment of individuals with dysphagia．However，its precise anatomical meaning has not been defined．Flexion can occur at the various points in the cervical spine (and atlanto-occipital joints)，and the resulting postures may have differing effects on swallow physiology．We studied the current practice of speech therapists in Japan with a questionnaire survey regarding the chin down posture．The questionnaire addressed anatomical postures and terminology， and was circulated to 34 speech therapists，each with five or more years of experience in dysphagia rehabilitation；the response rate was 88％．There were five main findings，as follows： 1）There were five Japanese terms for the chin down posture，including “Ago-hiki” in 57％ and “Keibu-zenkutsu-i” in 20％ of respondents．There were no significant differences in terminology based on duration of clinical experience or number of the patients they treated per month． 2） We included five photographs showing a variety of head and neck positions．Three out of five of these pictures were selected by respondents as showing the “Chin down” posture： Head flexion on the neck position (53％)，Neck flexion position (30％)，and combined Head and neck flexion position (17％)．3）There was no clear relationship between the five pictured positions and the various terms used by respondents to describe them：each position was named by multiple terms，and multiple positions were named by the same term．4）The name of “Chin down” was more popular than “Chin tuck.” 5）Some respondents did not recognize differences in either terminology or in the pictured neck and head positions．In summary，there is poor agreement about the meaning of the chin down posture in this sample of Japanese speech therapists．There are several possible explanations for this： the posture has never been precisely defined in the literature，and clinicians and investigators have overlooked the fact that flexion may occur at various points in the cervical spine and atlanto-occipital joints．We suggest that a clear definition of the chin down is critical because the various postures may have differing effects on swallow physiology．

【Objective】Ingestion and swallowing abilities were investigated in patients who had been admitted because of choke and acute respiratory failure due to aspiration pneumonia，and those with signs of dysphagia．

【Subjects and Methods】The subjects consisted of 55 patients who had been referred to our department to receive an evaluation of their swallowing ability． Patients with acute organic diseases in central nervous system were excluded from the present study．The 55 patients were divided into three groups： a choke group consisting of 13 patients with acute respiratory failure following a distinct episode of choke or aspiration； a pneumonia group consisting of 27 patients with respiratory failure due to aspiration pneumonia； and a dysphagia group consisting of other 15 patients with signs of dyaphagia who were referred to our department for an evaluation of their abilitiy to swallow．Ingestion and swallowing abilities were retrospectively compared among these three groups．

【Results】In 46 patients investigated by video-fluorography，the proportion of patients who showed any finding of aspiration tended to be higher in the pneumonia group than in the other two groups； 44％ in the choke group， 84％ in the pneumonia group，and 67％ in the dysphagia group．The incidence of a cough reflex at the time of aspiration or penetration into the larynx was significantly higher in the dysphagia group than in the other two groups； 17％ in the choke group，18％ in the peumonia group，and 89％ in the dysphagia group．The proportion of patients who got to orally ingest three meals was 46％ in the choke group，26％ in the pneumonia group，and 60％ in the dysphagia group．The proportion of patients who showed signs of dysphagia prior to be acute respiratory failure was 68％ in the choke and pneumonia groups．

【Discussion】Airway defense mechanisms including cough reflex are thought to be maintained in patients within the extent of signs of dysphagia rather than those admitted with acute respiratory failure caused by choke or aspiration peumonia． Appropriate evaluations and tactics for patients within the extent of signs of dysphagia are important for maintenance or safe and long-term oral ingestion．

【Purpose】The purpose of this study is to investigate factors related to oral conditions after oral health care．

【Subjects and Methods】We performed oral health care on 68 persons staying at a special nursing home for the elderly．They were examined with respect to oral conditions and age，sex，activities of daily living，and oral care situations．The data were statistically analyzed using multiple regression analysis．

【Results】The factors related to the value of oral cleaning were cleaning frequency (p ＝ 0.001，standardized panial regression coefficient β ＝.363) and the denture use situation (p ＝ 0.040，β ＝ －0.277)．The factors related to the value of furred tongue were salivary wetness (p ＝ 0.004，β ＝ 0.331) and sex (p ＝ 0.007，β ＝ －0.306)．The factor related to the value of oral malodor was cleaning frequency (p ＝ 0.003，β ＝ 0.352)．

【Conclusion】 Assistance and support procedures， such as increase in the oral cleaning frequency or limitation of unnecessary denture wearing，and wetness of the mouth，may contribute to the success of oral health care．

To clarify the characteristics of desirable nursing-home food for elderly people，a sensory evaluation of preferences and measurement of the physical properties using apple mash were done．

The panel consisted of 139 elderly persons aged 65 years or older (25 men， 114 women， average age 83 years old) and 34 staff (14 men，20 women，average age 42 years old) in Gunma Prefecture nursing-home facilities． Three kinds of sample made of mashed apple with different viscosity were prepared，sample A (commercial apple mash)，sample B (thickening agent was added to sample A) and sample C (apple juice and thickening agent was added to sample A)．The sensory evaluation with ranking test was done for the elderly people．Also，a phonation test，articulation test，RSST and MWST were done as swallowing function tests． The level of judgment for severe care，ADL and state of tooth disease were investigated．Physical properties of the sample were measured with a B-type rotation viscosity meter and the texture analyzer．

As for the viscosity of the appearance， sample B was the highest， followed by sample A， then sample C． Sample B had the largest stress and adhesion energy，and sample C had the smallest．When the compression speed was changed，a high，positive correlation was found between the stress and the adhesion energy．

Sensory evaluation showed that sample C was the softest and had the lowest viscosity among the three samples， and was easy to swallow．“Overall preference” and ease of swallowing did not necessarily correspond to the choices of healthy people．

People with swallowing difficulties were selected from the panel members as a parameter for the articulation test，MWST and feeding level．People with swallowing difficulties evaluated sample C as the most palatable sample． It was thus clarified that the popularity of food depends on the degree of swallowing function．

A number of children who had been treated in the neonatal intensive care unit cannot eat solid or viscous materials although they have no major anatomical and functional problems concerning oral movements．It has been attributed to the prolonged and complete prohibition of oral intake beyond the critical period for acquiring tolerance to tactile and pressure stimulation by food．

We investigated detailed history of oral intake，related diseases，and response to treatment，in addition to present neurological and oropharyngeal problems in nine patients with eating rejection，in order to elucidate underlying etiology for rejection．We especially focused on the influence of the critical period．All patients had experienced complete prohibition of oral intake for a long period； six had been completely prohibited oral intake since their birth，whereas the other three had taken a certain amount of milk orally before prohibited period after surgerical intervention for digestive organs．Mean corrected age for initiation of oral intake and participation in oral-stimulation program during the prohibited period of the former six patients were not significantly higher than those of 19 control children who could eat properly after a long prohibition of oral intake since birth．Disorders of digestive or respiratory organs and oropharyngeal hypersensitivity (including taste) were significantly more frequent in these patients than in controls．In the treatment procedure，desensitization was more difficult when prohibited periods were beyond the critical period．

The results suggest that prohibition of oral intake beyond the critical period is at least partially related to the rejection to eat．Accumulation of the noxious stimulation in the course of treatment for digestive or respiratory disorders and underlying hypersensitivity associated with developmental disorders might also play an important role for the pathogenesis．Treatment procedures comprising desensitization of hypersensitivity，slower induction of food and taste，counseling for family，and cooperation with day nursery were effective．

Patients with tongue cancer who have undergone surgical resection often develop swallowing disorder due to lack of tongue mobility and sensibility．The palatal augmentative prosthesis，or PAP， is a tool for prosthodontic management of glossectomy patients，seeking to improve tongue/palate contact during speech and swallowing．Recent study suggested that the presence of an intraoral prosthesis not only increases tongue contact to the palate or pseudoplate but also provides a better oral anchor point against which the base of the tongue can function．The purpose of this study is to examine pharyngeal manofluorography to evaluate the effect of the PAP for glossectomy patients．

A subject，who had undergone resection of the hemi lateral tongue，used a PAP， seeking to improve swallowing function．Under conditions of both with and without the PAP，the pressures of the areas of the tongue base and the low hypopharynx，the duration of the base of tongue/pharyngeal posterior wall contacts and pharyngeal transit time were obtained using manofluorography．

With insertion of the PAP， the pressure in the low hypopharynx was significantly lower， the duration of tongue base/pharyngeal posterior wall contacts was slightly longer，and pharyngeal transit time was significantly shorter．

The wave of the pressure observed in the area of the low hypopharynx is termed the C-wave，which the pharyngeal constrictors are responsible for．The higher C-wave without the PAP suggested that pharyngeal posterior wall contraction compensated for the lack of tongue base force projected to the bolus for propulsion．With the PAP，a better oral anchor point，against which the base of the tongue can function，might provide driving force and relieve the activity of the pharyngeal posterior wall．

【Objectives】The “Jaw Opening” procedure described in Daniels and Worthingham's Muscle Testing (DMT) is a simple technique for the clinical evaluation of mouth opening movement．However，the evaluation is subjective，and it is difficult to distinguish between functional (F) and weakly functional (WF) mouth opening．We have previously confirmed the usefulness in healthy adults of the manual resistance movement described in DMT and an indirect cervical traction device that simply and objectively evaluates mouth opening movement in the quantitative evaluation of the force (maximum mouth opening force) required to maintain maximum mouth open position against resistance in the mouth closing direction．

It is not uncommon for the mouth opening muscles to be resected in surgical oral cancer patients；however，to date，there is no mention of the quantitative evaluation of pre/postoperative changes in maximum mouth opening force in the literature．In the present study，we clinically applied a method for measuring mouth opening force using an indirect cervical traction device before and after surgery in tongue cancer patients．

【Subjects and Methods】The subjects were 6 patients (mean age，62 years) admitted for radical treatment of tongue cancer．The surgical procedure involved hemigrossectomy and unilateral resection of the suprahyoid muscles in 4 patients and subtotal glossectomy and extensive resection of the suprahyoid muscles in 2 patients． Evaluation were performed twice，once each before and after surgery．Measurement of maximum mouth opening force：Subjects were seated with the head and neck in the neutral position．The researcher placed one hand on top of the subject's head to restrain head movement，while instructing the subject to maintain maximum mouth opening．A belt was placed under the mandible，and traction was applied in an approximately perpendicular direction relative to the axis of the trunk，and the maximum value (kg) was confirmed． Measurement of maximum mouth opening (distance)：Subjects were asked to open their mouths as wide as possible，and bimaxillary central incisor distance was measured in mm using calipers．

【Results and discussion】The maximum mouth opening force (mean ± standard error) was 18.7 ± 2.0kg before surgery and 16.7 ± 1.3kg after surgery，representing a non-significant decrease postoperatively．The maximum mouth opening (mean ± standard error) was 49.5 ± 2.4mm before surgery and 34.8 ± 2.8mm after surgery， representing a significant decrease postoperatively．These findings indicate that，with respect to mouth opening movement after tongtie cancer surgery in which the suprahyoid muscles were resected and the infrahyoid muscles were compensated，maximum mouth opening force was preserved，notwithstanding a reduction in maximum mouth opening．It is therefore possible that the infrahyoid muscles play a more important role than the suprahyoid muscles in maximum mouth opening force．