Dysphagia Rehabilitation Dentist

Odontology に「 Diagnosis and evaluation of 100 dysphagia patients using videoendoscopy at a core hospital of a local city in Japan 」(Yonenaga K, Majima H, Oyama S, Ishibashi K, Tanno H.)が掲載されている。 Abstract  Japan has entered an era of a super-aging population, and given the importance of oral nutrition, the need to evaluate swallowing function has increased.  Herein, we contribute to continued developments in evaluating eating and swallowing functions by describing current videoendoscopy (VE) usage and trends to evaluate and diagnose causes of dysphagia. In all, 100 patients (58 men and 42 women; mean age: 79 years) with suspected dysphagia were enrolled; 15 of these were re-examinations.  Examinations were conducted according to the Japanese Society of Dysphagia Rehabilitation VE examination guidelines for swallowing.  In this study, several patients (77.8 %) with poor vocalization and a saliva reservoir were unable to eat. While evaluating the relationship betw...

Archives of Physical Medicine and Rehabilitation に「 The Rapid Aspiration Screening in Suspected Stroke Part 1: Development and Validation 」（Stephanie K. Daniels, Shweta Pathak, John C. Rosenbek, Robert O. Morgan, Jane A. Anderson）が掲載されている。 Abstract Objectives To develop and validate a nurse-administered screening tool to identify aspiration risk in patients with suspected stroke. Design Validity study comparing evidence-based swallowing screening items with videofluoroscopic swallowing study (VFSS). Settings The study was completed in a certified primary stroke center in a major metropolitan medical facility. Participants Consecutive patients (N=250) admitted with suspected stroke. Interventions Patients were administered evidence-based swallowing screening items by nurses. A VFSS was completed within 2 hours of swallowing screening. Main Outcome Measure Validity relative to identifying VFSS determined aspiration for each screening item and for various combinations o...

Archives of Physical Medicine and Rehabilitationに「 Rehabilitation of swallowing and cough functions following stroke: an expiratory muscle strength training trial 」 （Karen Wheeler Hegland, Paul W. Davenport, Alexandra E. Brandimore, Floris F. Singletary, Michelle S. Troche）が掲載されている。 Abstract Objective To determine the effect of expiratory muscle strength training on both cough and swallow function in stroke patients. Design Prospective pre-post intervention trial with one participant group. Setting Two outpatient rehabilitation clinics Participants Fourteen adults with a history of ischemic stroke in the preceding 3 – 24 months participated in this study. Intervention Expiratory muscle strength training (EMST) . The training program was completed at home and consisted of 25 repetitions per day, 5 days per week, for 5 weeks. Main outcome measures Baseline and post-training measures were: maximum expiratory pressure, voluntary cough airflows, reflex cough challenge to...

Dysphagiaに「 Pathophysiology of Radiation-Induced Dysphagia in Head and Neck Cancer 」（Suzanne N. King, Neal E. Dunlap, Paul A. Tennant, Teresa Pitts, 2016）が掲載されている。 Abstract Oncologic treatments, such as curative radiotherapy and chemoradiation, for head and neck cancer can cause long-term swallowing impairments (dysphagia) that negatively impact quality of life. Radiation-induced dysphagia comprised a broad spectrum of structural, mechanical, and neurologic deficits. An understanding of the biomolecular effects of radiation on the time course of wound healing and underlying morphological tissue responses that precede radiation damage will improve options available for dysphagia treatment. The goal of this review is to discuss the pathophysiology of radiation-induced injury and elucidate areas that need further exploration. 「Radiation-Induced Dysphagia」は放射線誘発性嚥下障害とでも訳するのであろうか。 放射線による嚥下障害としては、口腔乾燥による口腔内食塊形成不全や、嚥下困難が挙げられる。 日本気管食道科学会会報Vol. 46 (1995) No. 5 P 437-442に「放射線照射による嚥下障害の1症...

Journal of Oral and Maxillofacial Surgery（Zhuo-shan Huang, Wei-liang Chen, et　al.)に 「 Dysphagia in tongue cancer patients before and after surgery 」が掲載されている。 Abstract Purpose To define factors influencing postoperative aspiration in tongue cancer patients and to analyze the characteristics of dysphagia before and after surgery. Methods A total of 112 tongue cancer patients participated in the present work. Videofluoroscopic swallowing studies (VFSSs) were performed on all patients before and after surgery. A Penetration–Aspiration Scale (PAS) score ≥3 was defined as an aspiration risk. Qualitative data were collected on a frame-by-frame basis from each VFSS and analyzed. Results Smoking (58.14%, p<0.01), tongue resection >50% (38.71%, p<0.05), and advanced tumor stage (49.18%, p<0.01) were strong risk factors for aspiration. High incidences of inadequate tongue movement, delayed oral transit time, reduced hyoid bone elevation, poor aspiration or penetration,...

Journal of Surgical Research （IF2.121）に「The effect of methylene blue treatment on aspiration pneumonia」 （Mehmet Kanter , Sevtap Hekimoglu Sahin, Umit Nusret Basaran, Suleyman Ayvaz, Burhan Aksu, Mustafa Erboga, Alkin Colak Volume 193, Issue 2, February 2015, Pages 909–919）が掲載されている。   Background The study aimed to examine whether methylene blue (MB) prevents different pulmonary aspiration materials-induced lung injury in rats. Methods The experiments were designed in 60 Sprague–Dawley rats, ranging in weight from 250–300 g, randomly allotted into one of six groups ( n = 10): saline control, Biosorb Energy Plus (BIO), hydrochloric acid (HCl), saline + MB treated, BIO + MB treated, and HCl + MB treated. Saline, BIO, and HCl were injected into the lungs in a volume of 2 mL/kg. After surgical procedure, MB was administered intraperitoneally for 7 days at a daily dose of 2 mg/kg per day. Seven days later, rats were killed, and both lungs in all groups were examined bioch...

講義のグループで抄読した、 PAS（ Paired associative stimulation） を使用した脳血管患者に対する効果を検討した論文です。 Targeting unlesioned pharyngeal motor cortex improves swallowing in healthy individuals and after dysphagic stroke. Michou E, Mistry S, Jefferson S, Singh S, Rothwell J, Hamdy S.   Abstract BACKGROUND & AIMS: Patients with stroke experience swallowing problems (dysphagia); increased risk of aspiration pneumonia, malnutrition, and dehydration; and have increased mortality. We investigated the behavioral and neurophysiological effects of a new neurostimulation technique (paired associative stimulation [PAS]), applied to the pharyngeal motor cortex, on swallowing function in healthy individuals and patients with dysphagia from stroke. METHODS: We examined the optimal parameters of PAS to promote plasticity by combining peripheral pharyngeal (electrical) with cortical stimulation. A virtual lesion was used as an experimental model of stroke, created with 1-Hz repetitive transcranial magne...

  Ann Rehabil Medに 「 Use of Videofluoroscopic Swallowing Study in Patients with Aspiration Pneumonia 」（Park S, Lee JY, Jung H, Koh SE, Lee IS, Yoo KH, Lee SA, Lee J. 36:785-90, 2012）が掲載されている。 Abstruct Objective To investigate the clinical characteristics of dysphagic elderly Korean patients diagnosed with aspiration pneumonia as well as to examine the necessity of performing a videofluoroscopic swallowing study (VFSS) in order to confirm the presence of dysphagia in such patients. Method The medical records of dysphagic elderly Korean subjects diagnosed with aspiration pneumonia were retrospectively reviewed for demographic and clinical characteristics as well as for VFSS findings. Results In total, medical records of 105 elderly patients (81 men and 24 women) were reviewed in this study. Of the 105 patients, 82.9% (n=87) were admitted via the emergency department, and 41.0% (n=43) were confined to a bed. Eighty percent (n=84) of the 105 patients were diagnosed with brain d...

Dysphagiaに「 Human Hyolaryngeal Movements Show Adaptive Motor Learning During Swallowing 」（Humbert IA, Christopherson H, Lokhande A, German R, Gonzalez-Fernandez M, Celnik P. 2012）が掲載されている。 Abstruct The hyoid bone and larynx elevate to protect the airway during swallowing. However, it is unknown whether hyolaryngeal movements during swallowing can adjust and adapt to predict the presence of a persistent perturbation in a feed-forward manner (adaptive motor learning). We investigated adaptive motor learning in nine healthy adults. Electrical stimulation was administered to the anterior neck to reduce hyolaryngeal elevation, requiring more strength to swallow during the perturbation period of this study. We assessed peak hyoid bone and laryngeal movements using videofluoroscopy across thirty-five 5-ml water swallows. Evidence of adaptive motor learning of hyolaryngeal movements was found when (1) participants showed systematic gradual increases in elevation against the force of electri...

Dysphagiaに「 Radiological Image-Guided Placement of Covered Niti-S Stent for Palliation of Dysphagia in Patients with Cervical Esophageal Cancer 」（ Takeshi Fujita, Masahiro Tanabe, Kensaku Shimizu, Etsushi Iida, 2013）が掲載されている。   Abstract The aim of this study was to evaluate the clinical effectiveness of covered Niti-S stent placement under multidetector CT and fluoroscopy guidance for the palliation of dysphagia in patients with cervical esophageal cancer. Under radiological imaging guidance using axial and sagittal CT scans, and fluoroscopy, Niti-S esophageal stents were placed in ten consecutive patients with complete obstruction caused by cervical esophageal cancer (9 men and 1 woman; age range = 54–79 years; mean age = 68.1 years) between February 2010 and December 2011. The procedure time and technical success rate were evaluated. Swallowing improvement was assessed by the following items: ability to eat and/or swallow (graded as follows: 3 = ability to eat nor...

Noninvasive Detection of Thin-Liquid Aspiration Using Dual-Axis Swallowing Accelerometry 以前、ニューロリハ医のメモリーノートで紹介されていた文献です。  ずっと、文献読む機会もなかったのですが、ようやく春休みになり読んでみました。 加速度計は10kHzでサンプリングし、バンドパスフィルタは0.1Hzから3kHzとあります。 読んでいて興味深かったのは、頸部聴診法はexperienced speech-language pathologists (62 % sensitivity, 66 % specificity)とあり、プロのSTでも感度、特異度は60%台と述べられていることでした。現在、加速度計を使用した嚥下評価があることを知って勉強になりました。これから国内での発表も検索していきます。 Abstract Aspiration (the entry of foreign contents into the upper airway) is a serious concern for individuals with dysphagia and can lead to pneumonia. However, overt signs of aspiration, such as cough, are not always present, making noninstrumental diagnosis challenging. Valid, reliable tools for detecting aspiration during clinical screening and assessment are needed. In this study we investigated the validity of a noninvasive accelerometry signal-processing classifier for detecting aspiration. Dual-axis cervical accelerometry signals were collected from 40 adults on thin-liquid...

以前、OAGアセスメントについて述べたが、その改良版であるROAGの紹介である。 Andersson P, Hallberg IR, Renvert S.Spec Care Dentist.;22:181-6. 2002に　 「 Inter-rater reliability of an oral assessment guide for elderly patients residing in a rehabilitation ward .」が掲載されている。 http://onlinelibrary.wiley.com/doi/10.1111/j.1754-4505.2002.tb00268.x/pdf  要旨は The aim of this study was to test the inter-rater reliability of a revised oral assessment guide (ROAG) for patients residing in a geriatric rehabilitation ward. A consecutive sample of 140 patients was recruited for the study. Oral assessments were performed for 133 newly admitted patients by one registered nurse (RN) during a period of six months. A dental hygienist (DH) carried out 103 oral assessments during the same half-year. For 66 patients, the RN and the DH performed independent assessments. There was an agreement between the RN and the DH in the majority of the independent assessments, except for tongue and teeth/dentures. The percentage agreement exceeded ...

The Tohoku Journal of Experimental Medicineに「 Preventive strategies for aspiration pneumonia in elderly disabled persons .」（Takashi Ohrui2005 Sep;207(1):3-12.）が掲載されている。 論文は以下のサイトより閲覧可能である。 http://www.jstage.jst.go.jp/article/tjem/207/1/3/_pdf abstract Pneumonia is the fourth leading cause of death despite the availability of potent new antimicrobials in Japan. Aspiration of oropharyngeal bacterial pathogens to the lower respiratory tract is one of the most important risk factors for pneumonia. Impairments in swallowing and cough reflexes among disabled older persons, e.g., related to cerebrovascular disease, increase the risk of pneumonia. Thus, strategies to reduce the volumes and pathogenicity of aspirated material should be pursued. Since both swallowing and cough reflexes are mediated by endogenous substance P contained in the vagal and glossopharyngeal nerves, pharmacologic therapy using angiotensin-converting enzyme inhibitors, which decrease substance P catabolism, can impr...

Clinical Infectious Diseases に「 Geriatric oral health and pneumonia risk .」（Terpenning M、2005 Jun 15;40(12):1807-10）が掲載されている。以下のサイトより。 http://cid.oxfordjournals.org/content/40/12/1807.long 高齢者の口腔状態と肺炎リスクについて述べている。特に 不十分な口腔ケア と 嚥下障害 は肺炎リスクが高くそれぞれ hazard ratio, 1.55; P = .03]とhazard ratio, 1.61; P = .043 になっている。 誤嚥性肺炎治療、リハビリテーションに携わる人であれば、知られている内容であるがなぜ口腔ケアが誤嚥性肺炎予防によいか根拠を説明することは大切である。本邦の口腔ケア研究成果も大変有名であるが、多くの根拠論文に触れておくことは院内研究等で他者に説明する際重要と考えられた。 　　　　　　　　　　　　　　　　　　　　　　　　　　　　　 　　　　　　　　　　　　　　　　　　Figure 1 Cases of fever and pneumonia among dentate patients and edentate patients who did or did not receive oral care. 口腔ケアをすると特に発熱発症数が減っています。                        

急性呼吸不全による人工呼吸患者の栄養管理ガイドラインに掲載されている論文です。 Nutritionに「 Dose enteral nutrition　compared　to　parenteral　nutrition　result　in better　outcomes　in　critically　ill　adult　patients？　A systematic　review　of　the　literature 」（Gramlich　L，Kichian　K，Pinilla　J，et　al．2004．843－848．）が掲載されている。論文は下記サイトより。 http://www.criticalcarenutrition.com/docs/pubs/gramlich.pdf すでに読まれた方も多いと思われるが、enteral nutrition（EN）とparenteral nutrition (PN)を比較したSystematic Reviewである。 文中では、PNで高血糖発生率が向上することが述べられている。また、結論として感染性合併症の 点からも早期からENの方がよいとしている。 しかし、嚥下性肺炎患者に対するENにはGERDによる肺炎再発リスクがあり、一概にENだけと言えない状況がある。そのため、EN、PNの選択は患者の状態やマンパワーといった環境により選択されると思われる。 他には、文中にある「 Nutritional support is part of the standard of care for the critically ill adult patient .」は栄養の重要性を述べており、嚥下性肺炎リハビリテーションに携わるセラピストは留意する必要があると思われた。

The International Journal of Language & Communication Disordersに「 Drooling in Parkinson's disease: a novel speech and language therapy intervention .」 （Marks L, Turner K, O'Sullivan J, Deighton B, Lees A. 2001;36 Suppl:282-7.）が掲載されている。 　 Abstract Drooling and difficulty swallowing saliva are commonly reported in people with Parkinson's disease (PD). Drooling in PD is the result of swallowing difficulties rather than excessive saliva production. Currently, there is little research into the effectiveness of treatments to reduce drooling. The aims of the study were to develop objective measures of saliva volume and drooling for PD and to assess the efficacy of two therapeutic strategies to control drooling, i.e. specific speech and language therapy (SLT) including a portable metronome brooch to cue swallowing and injections of botulinum toxin into both parotid glands to reduce the amount of saliva produced. This paper will describe the assessments used, including the mea...

Journal of Neurology に「 Non-invasive assessment of swallowing and respiration in Parkinson’s disease 」（Lorraine L. Pinnington Khulood A. Muhiddin Richard E. EllisE. Diane Playford(2000) 247 : 773–777）が掲載されている。 Abstract Oro-pharyngeal dysphagia is well recognised but often underestimated in people with Parkinson's disease. Asymptomatic patients may fail to receive timely advice or therapy, thus placing them at risk. The aim of this study was to determine whether subclinical abnormalities in swallowing and discrete changes in function such as those produced by prompting can be detected by non-invasive methods. We examined 12 people with idiopathic Parkinson's disease and 14 elderly comparison subjects. Five components of respiratory synchronisation and swallowing efficiency were monitored using the Exeter Dysphagia Assessment Technique. Ten feeding trials were administered under standard quiet conditions. The patients were then restudied using verbal prompts when the spoon was...

Stroke に「 Neurological Signs in Relation to Type of Cerebrovascular Disease in Vascular Dementia 」（Salka S. Staekenborg ; Wiesje M. van der Flier ; Elisabeth C.W. van Straaten, ;Roger Lane; Frederik Barkhof; Philip Scheltens, 2008; 39: 317-322）が掲載されている。 （論文free） 要旨は 「 Background and Purpose— The aim of this study was to describe the prevalence of a number of neurological signs in a large population of patients with vascular dementia (VaD) and to compare the relative frequency of specific neurological signs dependent on type of cerebrovascular disease. Methods— Seven hundred six patients with VaD (NINDS-AIREN) were included from a large multicenter clinical trial (registration number NCT00099216 ). At baseline neurological examination, the presence of 16 neurological signs was assessed. Based on MRI, patients were classified as having large vessel VaD (18%; large territorial or strategical infarcts on MRI), small vessel VaD (74%; white matter hyperintensities [WMH], multiple l...

Gastroenterol Hepatol に「 Management of Dysphagia in Stroke Patients 」（Reza Shaker, and Joseph E. Geenen. 7 (5) : 308–332. 2011）が掲載されている。 　Shaker法で有名なShaker先生が脳卒中嚥下障害の質問に答える形で掲載されている。全文無料で読むことができる。 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127036/?tool=pubmed 質問は、嚥下障害の定義から、頻度、脳卒中嚥下障害についての説明、診断方法等が説明されており、分かりやすい内容で記載されている。 　特に栄養障害、脱水症と感染症は嚥下障害の合併症状と述べており、嚥下障害にアプローチする者としては特に注意を要するところである。 　 　

dysphagiaに「 The Digastric Muscle is Less Involved in Pharyngeal Swallowing in Rabbits 」（2011 Aug 24．Takanori Tsujimura, Aki Yamada, Yuki Nakamura, Takako Fukuhara, Kensuke Yamamura and Makoto Inoue）が掲載されている。 　新潟大学で研究された内容であり、要旨は「The swallowing reflex is centrally programmed by the lower brain stem, the so-called swallowing central pattern generator (CPG), and once the reflex is initiated, many muscles in the oral, pharyngeal, laryngeal, and esophageal regions are systematically activated. The mylohyoid (MH) muscle has been considered to be a “leading muscle” according to previous studies, but the functional role of the digastric (DIG) muscle in the swallowing reflex remains unclear. In the present study, therefore, the activities of single units of MH and DIG neurons were recorded extracellularly, and the functional involvement of these neurons in the swallowing reflex was investigated. The experiments were carried out on eight adult male Japanese white rabbits anesthetized with ureth...