-
[show abstract]
[hide abstract]
ABSTRACT: We investigated factors for aspiration by videofluoroscopy (VF) and swallowing exercises in stroke patients. Subjects were 102 stroke patients aged 34-101 years (mean 72.8+/-13.8 years) including 72 males and 30 females and for whom VF was performed because of suspected swallowing difficulty. They consisted of 64 patients with cerebral infarction, 33 patients with cerebral hemorrhage, and 5 patients with subarachnoid hemorrhage. Aspiration was classified into aspiration with choking and silent aspiration (SA) by the presence of a cough reflex. Eating instructions such as foodstuffs and intake methods and outcome were investigated. On VF, aspiration with foodstuffs was found in 59 of 102 (57.8%) patients and SA was found in 44 of them (44.1%). Some patients ate food on the ward in spite of SA in VF. Such patients were given eating instructions by the judgment of the attending physician, but foodstuffs and intake methods based on the results of VF could be changed in most cases. As for swallowing training, direct training was conducted only in a few patients in the group that presented overt aspiration in this study. On the other hand direct training was possible in the majority of patients if foodstuffs and intake methods were handled appropriately in SA. If these strok patients were approached with attention paid to the forms of foodstuffs and intake method on the basis of detailed evaluation on VF using mimic foodstuffs, eating was possible without aspiration in many cases.
Brain and nerve = Shinkei kenkyū no shinpo 10/2007; 59(9):977-81.
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the influence of maximal bite force, maximal tongue pressure, number of mastications and swallowing on the oro-pharyngeal residue in the elderly.
Oro-pharyngeal residue in the elderly is an indication of dysphagia. Pharyngeal residue is especially critical as it may cause aspiration pneumonia, which is one of the major causes of death in elderly.
Videofluorographic recordings were performed on 14 elderly volunteers (six males, eight females, age range 65-93 years) without any history or symptoms of dysphagia. The subjects were instructed to consume 9 g of barium containing bread in two manners; free mastication and swallow (FMS: masticate and swallow freely), and limited mastication and swallow (LMS: swallow once after 30 chewing actions). The amount of oral and pharyngeal residue was evaluated using a 4-point rating scale. Maximal occlusal force was measured by a pressure sensitive sheet, and maximal tongue pressure using a handy probe. Multiple regression analysis was performed to examine the influence of these items on the amount of oral and pharyngeal residue in FMS and LMS.
In FMS, age was found to be a factor which increased oral residue (p = 0.053), and the number of swallowing (p = 0.017) and the state of the prosthesis (p = 0.030) reduced the pharyngeal residue. In LMS, tongue pressure was a factor which reduced oral residue (p = 0.015) and increased pharyngeal residue (p = 0.008).
It is suggested that in the elderly tongue pressure contributed to propulsion of the food bolus from oral cavity into the pharynx, and multiple swallowing contributed to the reduction in the amount of pharyngeal residue.
Gerodontology 10/2007; 24(3):143-50. · 1.03 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study was investigated clinical factors for aspiration in stroke patients by videofluoroscopy (VF). Subjects were 102 patients with strokes aged between 34 and 101 years including 72 males and 30 females and for whom VF was performed for swallowing difficulty or suspected swallowing difficulty. They consisted of 64 patients with cerebral infarction, 33 patients with cerebral hemorrhage, and 5 patients with subarachnoid hemorrhage. Before VF, pharyngeal reflex, physical status, and cognitive function were evaluated as bedside clinical assessment. As for swallowing evaluation at bedside, the repetitive saliva swallowing test (RSST) and water swallowing test were performed. Aspiration was classified into aspiration with choking and silent aspiration (SA) by presence of a cough reflex. As results, aspiration with foodstuffs on VF was found in 59 of 102 (57.8%) patients and SA was found in 44 of them (43.1%). In patients with not only pharyngeal reflex but also cervical and maintaining a position stability, and those who were decreased in cognitive function, aspiration should always be supposed and the observation for eating behavior against aspiration should be needed. We divided patients into three groups; no aspiration, SA and aspiration with choking. Significant difference was observed between the groups in Mini-Mental State Examination, Barthel Index, and RSST. Although in the water-swallowing test, swallowing was possible without choking, SA was observed on VF in most cases. Therefore, in cases with serious disability and cognitive dysfunction with advanced age, RSST and water swallowing test should not be overestimated, it is worth conducting VF when aspiration is suspected from neurological assessment.
Brain and nerve = Shinkei kenkyū no shinpo 06/2007; 59(5):521-6.
-
[show abstract]
[hide abstract]
ABSTRACT: The tongue plays an important role in swallowing by contacting the palate. The aim of the present study was to investigate the characteristics of tongue pressure production during swallowing in post-stroke patients using a newly developed sensor sheet.
Ten post-stroke inpatients with hemiplegia and five healthy volunteers participated in this study. Magnitude of tongue pressure during a dry swallow was measured using a newly developed sensor sheet comprising five sensors applied directly to the palate or to the palatal surface of a maxillary denture using denture adhesive. Swallowing ability was evaluated by measuring the time taken to swallow 30 ml of water. The magnitude of tongue pressure was compared between the post-stroke patients and healthy subjects as well as between each measuring point in both groups. The relationship between tongue pressure and swallowing ability and that between tongue pressure and state of occlusal support were also examined.
The magnitude of tongue pressure in the post-stroke patients was smaller than that of the healthy subjects at the measuring points along the median line (Welch test, p < 0.05), larger in the non-paralysed side than in the paralysed side (two-way ANOVA, p < 0.05), and was influenced by swallowing ability and occlusal support (Welch test, p < 0.05).
Measurement of the magnitude of tongue pressure shows promise as a simple, non-invasive and quantitative method by which tongue activity in post-stroke patients, in whom swallowing ability is a concern, could be evaluated.
Gerodontology 01/2006; 22(4):227-33. · 1.03 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study was designed to determine the factors influencing eating ability of old in-patients in a rehabilitation hospital.
Cross-sectional investigation.
Forty-six in-patients in the rehabilitation ward of Hashimoto Hospital in Kagawa Prefecture in Japan were investigated using a multidisciplinary approach.
Age, gender, state of dentition, muscle activity of lip, cheek and tongue, biting force, salivary flow rate per a minute (SFR), masticatory ability for gummy jelly, swallowing ability, texture of meal, independency of walking (Functional Independence Measure = FIM) and ability to communicate.
Bivariate analysis for the relationship between surveyed items and masticatory ability (chi-square test) identified that better masticatory ability for gummy jelly was associated with age (< 85years), gender (male),state of dentition (dentate), SFR (high), activity of lip (good), biting force (high), swallowing ability (good) and activity of communication (high). Among these items, SFR (p = 0.001), gender (p = 0.004), ability to communicate (p = 0.005) and age (p = 0.012) were found having an influence on the masticatory ability (logistic regression analysis). On the other hand, age (< 85years), gender (male), SFR (high), activity of lip (good), activity of cheek (good), biting force (high), masticatory ability (good) and swallowing ability (good) had a relationship with normal texture of meal. In regression analysis, only two items, activity of lip (p = 0.003) and swallowing ability (p = 0.024) emerged as factors on texture of meal.
Masticatory ability for gummy jelly was influenced by cognitive function and was excluded from the factors on the state of meal. These results suggested the limitation of evaluation using test food, so dentists should observe eating behaviour of in-patients. In addition, dentists should pay attention to the activity of the lip and swallowing ability as well as dentition and prostheses in the rehabilitation of eating ability. As SFR was the most significant factor on masticatory ability, this emphasizes the necessity of care for dry mouth caused by side effects of multi-medication.
Gerodontology 07/2003; 20(1):24-31. · 1.03 Impact Factor
