加賀谷 斉

This study investigated the effects of Mendelsohn maneuver with three-dimensional kinematic analysis. Nine female speech-language pathologists (nine females, mean ± SD 27.1 ± 3.5 years old) underwent 320-row area detector scan during swallows of 4-ml nectar-thick liquid using with no maneuvers (control) and with Mendelsohn maneuver (MM). Critical event timing (hyoid, soft palate, epiglottis, laryngeal vestibule, true vocal cords (TVC), UES), hyoid and laryngeal excursion, cross-sectional area of UES, and volume of pharyngeal cavity and bolus were measured and compared between two swallows. In MM, all the events were significantly prolonged with delayed termination time (p &lt 0.05) except UES opening. The onset, termination, and duration of UES opening were not significantly affected by MM nor was timing of bolus transport. The hyoid bone was positioned significantly higher at maximum displacement (p = 0.011). Pharyngeal constriction ratio was 95.1% in control and 100% of all subjects in MM. Duration of minimum pharyngeal volume was significantly longer in MM than in control (p = 0.007). The MM produces several distinct changes in the kinematics of swallowing in healthy subjects with no dysphagia. The changes in the timing and magnitude of hyoid displacements and prolonged closure of the pharynx during swallowing suggest the utility of MM for improving the safety and efficiency of swallowing in selected cases.

This study investigated the effects of three different volumes of honey-thick liquid on the temporal characteristics of swallowing. Twenty-six healthy subjects (15 males, 11 females) underwent 320-row area detector CT scan while swallowing 3, 10 and 20mL of honey-thick liquid barium. Three-dimensional images were created at 10images/s. Kinematic events involving six structures (velopharynx, hyoid bone, epiglottis, laryngeal vestibule (LV), true vocal cords (TVC), upper esophageal sphincter (UES)) and timing of bolus movement were timed using frame by frame analysis. The overall sequence of events did not differ across three volumes; however, increasing bolus volume significantly changed the onset and termination of events. The bolus head reached to pharynx and esophagus earlier and the duration of bolus passing through UES was significantly longer in 10 and 20mL compared to 3mL (P<.05). Consequently, the onset of UES opening was significantly earlier with increased volume (P<.05). LV and TVC closure occurred later in 20mL compared to 3mL (P<.05). These changes in motion of pharynx and larynx appeared to promote swallow safety by preventing aspiration, suggesting that anatomical structure movements adapt in response to bolus volume. Our findings also suggest that the pharyngeal swallow behaviours may be modified by afferents in the oral cavity. The three-dimensional visualization and quantitative measurements provided by 320-ADCT provide essential benchmarks for understanding swallowing, both normal and abnormal.

This study aimed to (1) evaluate changes in bolus and air volumes in the pharyngo-laryngeal cavity during swallowing and (2) determine how differences in these volumes during swallowing are influenced by bolus amount using 320-row area detector computed tomography (320-ADCT). Three-, 10-, and 20-ml honey-thick liquids (5% w/v) were presented to ten healthy subjects placed in a 45A degrees reclining position. 3D images were created in 29 phases at an interval of 0.1 s for 3.15 s. Changes in bolus and air volumes in the pharyngo-laryngeal cavity were calculated. The two one-sided tests were used to determine equivalency of the pharyngo-laryngeal volume of each event (i.e., onset of hyoid elevation, soft palate closure, true vocal cord closure, closure of laryngeal vestibule, epiglottis inversion, pharyngo-esophageal sphincter opening) for each bolus volume. The pharyngo-laryngeal volume during swallowing was about 20 ml before swallowing. The volume temporarily increased with tongue loading, but decreased to about 0 ml with pharyngeal contraction. Subsequently, the volume returned to the original volume after airway opening. Most of the air was released from the pharyngo-laryngeal space before the bolus flowed into the esophagus during swallowing. As the bolus volume to be swallowed increased, the maximal pharyngo-laryngeal volume increased, but changes in air volume remained constant. 320-ADCT allowed for analysis of dynamic volume changes in the pharyngo-laryngeal cavity, which will increase our knowledge of kinematic and volumetric mechanisms during swallowing.

AimTo examine the efficacy of postural strategy training using a balance exercise assist robot (BEAR) as compared with conventional balance training for frail older adults. MethodsThe present study was designed as a cross-over trial without a washout term. A total of 27 community-dwelling frail or prefrail elderly residents (7 men, 20 women; age range 65-85 years) were selected from a volunteer sample. Two exercises were prepared for interventions: robotic exercise moving the center of gravity by the balance exercise assist robot system; and conventional balance training combining muscle-strengthening exercise, postural strategy training and applied motion exercise. Each exercise was carried out twice a week for 6 weeks. Participants were allocated randomly to either the robotic exercise first group or the conventional balance exercise first group. Main outcome measures: preferred and maximal gait speeds, tandem gait speeds, timed up-and-go test, functional reach test, functional base of support, center of pressure, and muscle strength of the lower extremities were assessed before and after completion of each exercise program. ResultsRobotic exercise achieved significant improvements for tandem gait speed (P = 0.012), functional reach test (P = 0.002), timed up-and-go test (P = 0.023) and muscle strength of the lower extremities (P = 0.001-0.030) compared with conventional exercise. ConclusionsIn frail or prefrail older adults, robotic exercise was more effective for improving dynamic balance and lower extremity muscle strength than conventional exercise. These findings suggest that postural strategy training with the balance exercise assist robot is effective to improve the gait instability and muscle weakness often seen in frail older adults. Geriatr Gerontol Int 2017; 17: 1982-1990.

<p>Shibata S, Kagaya H, Tanaka S, Fujii W, Nakagawa K, Matsuo K, Abe K, Ishibashi N, Inamoto Y, Saitoh E. Efficacy of a novel training food based on the process model of feeding for mastication and swallowing: A study among dysphagia patients. Jpn J Compr Rehabil Sci 2017; 8: 82-87.</p><p>Objective: Our goal was to verify the validity and safety of chew-swallow managing food (CSM) for dysphagia patients.</p><p>Methods: We conducted a study on 14 inpatients diagnosed with dysphagia and judged to be capable of ingesting pureed foods. We instructed each participant to ingest and freely swallow 4-g samples of CSM and pureed food. For each sample, we measured the number of chewing cycles, number of swallows, position of the leading edge of the bolus at the time of swallowing initiation, amount of residue in the oral cavity and pharynx, and occurrence of laryngeal penetration or aspiration.</p><p>Results: The number of chewing cycles was significantly higher for the CSM. The position of the leading edge of the bolus at the time of swallowing initiation was primarily in the valleculae for both the CSM and pureed food, and the rate of laryngeal penetration did not significantly differ between the two test foods. There was a high rate of residue on the dorsum of tongue with the CSM and in the valleculae with the pureed food.</p><p>Conclusion: The CSM induced chewing in dysphagia patients, and the prevalence of penetration did not differ from the pureed food. Therefore, we concluded that the CSM could be used in chewing exercises with the same level of safety as the pureed food.</p>

Background: The toe clearance of a paretic limb in the swing phase of gait is related to tripping, which is considered a major cause of falls. The biomechanical factors for obtaining toe clearance are more complicated in hemiparetic gait than that in normal gait because of the compensatory movements during swing phase. Understanding the biomechanical factors should help in targeting the point for rehabilitative interventions. Objective: To clarify the biomechanical factors behind toe clearance during swing phase in hemiparetic gait. Methods: Fifty patients with hemiparesis after a stroke participated in this study. Three-dimensional motion analysis was used for the kinematic analysis of the hemiparetic gait. The correlation coefficients between limb shortening and angle changes and between limb shortening and hip elevation and foot lateral shift were calculated. Limb shortening was defined as the shortening of the hip-toe distance. The significant factors that determine toe clearance were examined by multiple regression analysis. Independent variables were limb shortening, hip elevation, and foot lateral shift. Results: Limb shortening was negatively correlated with hip elevation (r = -0.75) and foot lateral shift (r = -0.41). Multiple regression analysis showed a significant contribution of limb shortening and hip elevation to toe clearance. The coefficient of determination was 0.95. Conclusions: Toe clearance was mainly determined by limb shortening and hip elevation, which were found to be in a trade-off relationship. These results warrant further investigation into the use of three-dimensional motion analysis in the rehabilitation clinic to facilitate targeted rehabilitative training to restore gait ability.

BACKGROUND: In a patient with severe hemiplegia, the risk of the knee giving way is high during the early stage of gait exercise with an ankle-foot orthosis. However, use of a knee-ankle-foot orthosis has many problems such as large amount of assistance and compensatory motions. To resolve these problems, we have engaged in the development of the Gait Exercise Assist Robot (GEAR). OBJECTIVE: To evaluate the improvement efficiency of walk with GEAR in a stroke patient. METHODS: The subject was a 70-year-old man presented with left thalamus hemorrhage and right hemiplegia. The patient underwent exercise with the GEAR 5 days a week, for 40 minutes per day. We evaluated the Functional Independence Measure score for walk (FIM-walk score) every week. The control group consisted of 15 patients aged 20-75 years with hemiplegia after primary stroke, who had equivalent walking ability with the subject at start. As the primary outcome, we defined improvement efficiency of FIM-walk, which was gain of FIM-walk divided the number of required weeks. RESULTS: Improvement efficiency of FIM-walk of the subject was 1.5, while that of control group was 0.48 +/- 3.2 (mean +/- SD). CONCLUSIONS: GEAR is potentially useful for gait exercise in hemiplegic patients.

【目的】急性期病院では高齢障害者が増加し、リハビリテーションの重要性が高まっている。当院急性期病棟に理学療法士を病棟配置した効果を検討した。【方法】疾患別リハビリテーション実施者を対象とし、病棟配置前の44例を対照群、病棟に専任配置後の79例を専任群、専従配置(ADL維持向上等体制加算算定)後の83例を専従群とし、当院患者データベースより後方視的に調査した。【結果】専従群は他2群よりリハビリテーション実施割合が有意に増加、リハビリテーション開始までの日数、在院日数は有意に短縮した。アンケート調査より、病棟医師・看護師は情報共有がしやすい、リハビリテーション専門職は病棟とのパイプ役として期待との回答が多かった。【結論】理学療法士の専従配置は病棟医師・看護師と情報共有を密に行え、治療の効率化が図れると示唆された。(著者抄録)

The aim of this study is to evaluate the effect of visual biofeedback therapy in acquiring supraglottic swallow (SGS) in a randomized-controlled trial with healthy individuals. Eighteen individuals (mean age, 26 years) who could not close or keep closed the vocal folds before and during the swallow in SGS were allocated randomly to either a visual biofeedback group (eight individuals) or a nonbiofeedback group (10 individuals). A videoendoscope was inserted intranasally and an SGS exercise, using 4ml of green-colored water, was performed 30 times per day up to 5 days. When the participant failed to perform SGS, the result was provided only to the participants in the visual biofeedback group. The median length of time until acquiring SGS was 1.5 days in the visual biofeedback group and 3.5 days in the nonbiofeedback group (P=0.040). We concluded that visual biofeedback effectively enabled participants to acquire SGS earlier. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

【目的】Hand-held dynamometerによる股関節外転筋力測定において,非測定下肢機能が測定値に与える影響を明らかにすること.【方法】健常者30名と片麻痺患者59名を対象とし,背臥位で両側股関節外転筋力を,非測定下肢を固定する方法(固定法)としない方法(非固定法)で測定した.同一法における左右および麻痺側・非麻痺側,固定法と非固定法での測定値を比較し,片麻痺患者では麻痺側筋力を従属変数,非麻痺側筋力と麻痺の程度を独立変数として重回帰分析を行った.【結果】非固定法の計測値が固定法よりも有意に小さかった.健常者では非測定下肢の固定によらず左右の相関が高かったが,片麻痺患者では非固定法において相関が低かった.重回帰分析の結果,固定法における麻痺側筋力は非麻痺側下肢機能の影響を強く受けていた.【考察】固定法では非測定下肢機能の影響を受け,測定下肢の筋力を正確に反映していないと考えられた.(著者抄録)

【目的】習熟した看護師が臨床所見やスクリーニングテストから摂食嚥下障害臨床的重症度分類(DSS)を判定し,嚥下内視鏡検査を用いたDSS評価と比較すること.【方法】2011年7月から2012年3月までに摂食・嚥下障害看護認定看護師(CNDN)1名がDSSを臨床的に評価し,その後に,多職種が嚥下内視鏡検査を行ってDSSを最終的に評価した摂食嚥下障害患者45例(平均年齢75歳)を対象とした.自作プロトコールから自動的に行ったDSS判定,CNDNによるDSS判定,嚥下回診で嚥下内視鏡検査を用いたDSS判定の三つを比較した.【結果】プロトコールと嚥下回診の判定一致は64%,CNDNと嚥下回診の判定一致は91%,プロトコールとCNDNの判定一致は69%であった.【結論】習熟したCNDNは,臨床所見とスクリーニングテストを用いて十分正確にDSSを判定できる可能性が示された.(著者抄録)

【目的】対麻痺者の歩行再建において歩行補助ロボットWearable Power-Assist Locomotor(WPAL)の有用性を検討する.【対象と方法】軽介助以下の介助量で股継手付き両長下肢装具およびWPALを用いた歩行が可能な対麻痺者12名を対象とした.対象に装具およびWPALを装着し,快適歩行速度で連続歩行時間,連続歩行距離を計測すると同時に,歩行に必要な介助量をFunctional Ambulation Categories(FAC)を用いて評価した.【結果】連続歩行時間は8名,連続歩行距離は11名でWPALを用いた歩行が装具歩行を上回り,有意差を認めた.装具歩行でFACが2(軽く触れる程度の介助)または3(監視)の症例においても,WPALを用いた歩行では全例で4(平地歩行自立)であった.【結論】WPALを用いると装具より長時間・長距離の歩行が可能で,歩行に必要な介助量も少なかった.(著者抄録)

<p>Mizokoshi E, Kagaya H, Oguchi K, Aoyagi Y, Shibata S, Inamoto Y, Hattori A, Yamamoto A, Ota N, Hota S, Kondo T, Saitoh E. Usefulness of swallowing rounds in acute general hospital. Jpn J Compr Rehabil Sci 2016; 7 : 73-79.</p><p>Objective: To investigate the usefulness of swallowing rounds using videoendoscopic evaluation of swallowing in patients with suspected dysphagia admitted to an acute general hospital.</p><p>Methods: 473 patients (mean age 79 years) in whom swallowing rounds were conducted in 2013 were analyzed retrospectively. The parameters analyzed were disease at admission, eating status scale (ESS) score, dysphagia severity scale (DSS) score, food texture, onset of pneumonia during hospitalization, discharge destination, and nutrition method at discharge.</p><p>Results: The most common diseases at admission were pneumonia (48%) and stroke (20%). Compared to the first swallowing round, significant (p < 0.001) improvements in ESS score, DSS score, and food texture were achieved at discharge or end of intervention in all patients, pneumonia patients, and stroke patients. The incidence of pneumonia onset during hospitalization was 4.9%. The incidence of pneumonia was significantly (p=0.045) higher in patients with respiratory diseases than in stroke patients.</p><p>Conclusion: In this study, significant improvements of ESS score, DSS score and food texture were achieved by conducting swallowing rounds, indicating their usefulness in acute general hospital.</p>

<p>Objective: The aim of this study was to measure the initiation of pharyngealswallowing during discrete swallowing and during chew-swallowing in younger and olderhealthy subjects and to determine the normal range of the stage transition duration (STD)for different food boluses. The correlations between STDs were investigated.Methods: Twenty-eight younger subjects (< 60 years old) and 25 oldersubjects (≥ 60 years old) were enrolled. While in the sitting position, the subjectsswallowed 10 ml of thin liquid barium (LQ), 8 g of corned beef hash with barium (CB), 8 gof cookie with barium (CK), and a two-phase mixture of 4 g of corned beef hash with bariumand 5 ml of thin liquid barium (MX). A videofluoroscopic examination of swallowing wasperformed at 30 frames/s in the lateral projection. The delay in pharyngeal swallowing(i.e., STD) was measured. The normal range (mean ± 2SD) of STDs for each bolus type wasdetermined, and correlations were calculated to examine the relationship among STDs.Results: The median STDs for LQ, CB, CK, and MX in all subjects were 0.0,1.2, 2.4, and 1.9 s, respectively. The STDs were prolonged for CB, CK, and MX comparedwith LQ. Additionally, the median STD was longer for LQ, CB, and CK in older than inyounger subjects. No significant correlations were found between STDs except for thosebetween CB and CK. Conclusions: A delayed pharyngeal response is commonlyobserved during chew-swallowing. Liquids, solids, and two-phase mixtures exhibitindependent timings of pharyngeal swallow initiation.</p>

Background: Gait assessment is important to determine the most effective strategy to regain gait function during stroke rehabilitation. To understand the mechanisms that cause abnormal gait patterns, it is useful to objectively identify and quantify the abnormal gait patterns. Objective assessment also helps evaluate the efficacy of treatments and can be used to provide suggestions for treatment. Objective: To evaluate the validity of quantitative indices for retropulsion of the hip, excessive hip external rotation, and excessive lateral shift of the trunk over the unaffected side in hemiplegic patients. Methods: Forty-six healthy control subjects and 112 hemiplegic patients participated. From the 112 patients, 50 patients were selected into each abnormal gait pattern with some overlap. Participants were instructed to walk on a treadmill and were recorded using a three-dimensional motion analysis system. An index to quantify each of the three abnormal gait patterns was calculated from the three-dimensional coordinate data. The index values of patients were compared with those of healthy subjects and with the results of observational gait assessment by three physical therapists with expertise in gait analysis. Results: Strong correlation was observed between the index value and the median observational rating for all three abnormal gait patterns (-0.56 to -0.74). Most of the patients with an abnormal gait pattern had a higher index value than the healthy subjects. Conclusions: The proposed indices are useful for clinical gait analysis. Our results encourage a more detailed analysis of hemiplegic gait using a motion analysis system.

Background: The efficacy of botulinum toxin A (BoNTA) injection on spasticity is usually measured using Modified Ashworth Scale (MAS), but this only evaluates muscle tone at rest and has poor reliability. There are no reports that quantitatively evaluate pes varus during walking after botulinum treatment. The purpose of this study was to evaluate the efficacy of BoNTA injection on pes varus during gait using 3-dimensional motion analysis. Methods: Twenty-four hemiplegic patients with spastic pes varus deformity during gait received BoNTA injection into lower limb muscles. MAS score, comfortable overground gait velocity, and pes varus angle during treadmill walking were evaluated before, 2, 6, and 12 weeks after the injection. Five healthy subjects were also recruited to develop the pes varus/valgus angle as a normal reference. Results: The median MAS scores were significantly lower at 2 and 6 weeks after the injection. The maximum pes varus angle during the swing phase was significantly lower at 2, 6, and 12 weeks after the injection. It was significantly lower at 6 weeks after the injection during stance phase. The comfortable overground gait velocity was also improved after the injection. However, 2 patients experienced pain during gait and their pes varus angle increased during the follow-up period. Conclusions: BoNTA injection improved pes varus angle during gait. Evaluating motion in addition to spasticity at rest is recommended because improvements in limb function do not always parallel improvements in spasticity at rest.

Although oropharyngeal and laryngeal structures are essential for swallowing, the three-dimensional (3D) anatomy is not well understood, due in part to limitations of available measuring techniques. This study uses 3D images acquired by 320-row area detector computed tomography ('320-ADCT'), to measure the pharynx and larynx and to investigate the effects of age, gender and height. Fifty-four healthy volunteers (30 male, 24 female, 23-77 years) underwent one single-phase volume scan (0.35 s) with 320-ADCT during resting tidal breathing. Six measurements of the pharynx and two of larynx were performed. Bivariate statistical methods were used to analyse the effects of gender, age and height on these measurements. Length and volume were significantly larger for men than for women for every measurement (P &lt; 0.05) and increased with height (P &lt; 0.05). Multiple regression analysis was performed to understand the interactions of gender, height and age. Gender, height and age each had significant effects on certain values. The volume of the larynx and hypopharynx was significantly affected by height and age. The length of pharynx was associated with gender and age. Length of the vocal folds and distance from the valleculae to the vocal folds were significantly affected by gender (P &lt; 0.05). These results suggest that age, gender and height have independent and interacting effects on the morphology of the pharynx and larynx. Three-dimensional imaging and morphometrics using 320-ADCT are powerful tools for efficiently and reliably observing and measuring the pharynx and larynx.

Swallowing is one of the basic activities in humans. The pharynx functions as an airway and a food channel, and a pharyngeal swallow usually occurs after bolus transport from the oral cavity. However, direct fluid infusion through a catheter into the hypopharynx produces a pharyngeal swallow without the oral stage in experimental situations. The purpose of this study was to examine whether a pharyngeal swallow, which is not accompanied by bolus transport, can occur during normal human feeding. Fifty-three healthy volunteers (25-89 years) were recorded, via videofluoroscopic examination of swallowing, during 3 different swallowing trials: command swallow of 10 ml liquid barium, chew-swallow of corned beef, and chew-swallow of a mixture of corned beef and liquid barium. Subsequently each swallow was classified as being either a consecutive pharyngeal swallow (CPS), following transport, or an isolated pharyngeal swallow (IFS), without immediately prior transport. The location of the bolus at swallow initiation was also noted. Of 307 trials, 681 swallows were identified, which included 43 IFS and 638 CPS. IFS only occurred as the first swallow of a trial, but the frequency of IPS did not differ between 28 younger (&lt; 60 years) and 25 older 60 years) people. Of the three food types, IFS occurred more frequently with the mixed food than with liquid. These results suggest that IFS may represent an airway protective mechanism. In conclusion, IFS occurs in normal swallowing during a daily eating situation. Swallowing is more complex than a simple reflex. (C) 2015 Tohoku University Medical Press

Objective: This study aimed to classify sequential swallowing types using videoendoscopy (VE) avoiding radiation exposure and compare the results using videofluoroscopy (VF). Design: Twenty-one healthy adults simultaneously underwent VF and VE during sequential straw drinking. Each discrete swallow was classified into an L-segmental type (laryngeal vestibule opens after swallow) or L-continuous type (laryngeal vestibule closure continues after swallow) using VF and a V-segmental type (velopharynx opens after swallow) or V-continuous type (velopharynx closure continues after swallow) using VE. Test-retest reproducibility and interrater and intrarater reliability were evaluated in ten healthy adults. Results: Of 128 swallows, 94 were L-segmental and 34 were L-continuous types as per VF, whereas 95 were V-segmental and 33 were V-continuous types as per VE. The leading edge of the bolus at swallow onset was significantly deeper in L-continuous types (P = 0.001). Laryngeal vestibule closure on VF images corresponded to velopharyngeal closure on VE images for 127 of 128 swallows (kappa = 0.98, P &lt; 0.001). All subjects showed the same types of swallows in the first and the second studies. Both interrater and intrarater reliability were high. Conclusion: VE showed high reproducibility and reliability in the classification of sequential swallowing types.

Laterality of bolus passage in the pharynx is often seen in patients with medullary infarction. We evaluated the dominant side of bolus passage in the pharynx and investigated the factors that cause the passage to dominantly occur on the affected side. Forty-one patients (35 men and 6 women, 64 +/- 9 years) with unilateral medullary infarction participated in this study. Bolus passage of 4 mL of thick liquid was evaluated in 3 regions (oropharyngeal, thyropharyngeal, and cricopharyngeal) and classified into 4 patterns (dominantly on the unaffected side [UAS], on both sides without clear laterality [BS], dominantly on the affected side [AS], and nonpassage of the bolus [NP]) by videofluoroscopic examination of swallowing. The bolus passages were as follows: UAS, BS, and AS occurred in 2, 32, and 7 patients in the oropharyngeal region; UAS, BS, and AS occurred in 5, 20, and 16 patients in the thyropharyngeal region; and UAS, BS, AS, and NP occurred in 11, 9, 10, and 11 patients in the cricopharyngeal region, respectively. In the thyropharyngeal region, the proportion of patients in whom the swallowing reflex occurred when the bolus was in the oropharynx and the proportion of patients with unilateral pharyngeal constrictor paralysis were greater in patients whose bolus passage was AS than in patients whose passage was BS. This suggests that the bolus predominantly passed through the affected side of the thyropharyngeal portion because of the asymmetry of pharyngeal contraction during swallowing in the early period after onset.

Research on muscle activation patterns during swallowing has been limited. Newly developed 320-row area detector computed tomography (320-ADCT) has excellent spatial and temporal resolution, which facilitates identification of laryngopharyngeal structures and quantitative kinematic analysis of pharyngeal swallowing. We investigated muscle activity patterns by observing the changes in length of hyoid muscles. 320-ADCT was performed in 26 healthy males while swallowing. The following parameters were analyzed three-dimensionally: 1) origins and insertions of the stylohyoid, anterior and posterior digastric, mylohyoid, geniohyoid, and thyrohyoid muscles; and 2) movement of the hyoid bone. The stylohyoid, posterior digastric, and mylohyoid muscles began to shorten simultaneously during the initial stage of swallowing. The shortening of these muscles occurred during the upward movement of the hyoid bone. Subsequently, the geniohyoid, thyrohyoid, and anterior digastric muscles began to shorten, synchronizing with the forward movement of the hyoid bone. A significant correlation was observed between the shortened muscle lengths of the stylohyoid, posterior digastric, and mylohyoid muscles and the upward movement of the hyoid bone (r = 0.45-0.65). A correlation was also observed between the shortened muscle length of the geniohyoid muscle and the forward movement of the hyoid bone (r = 0.61). In this study, the sequence of muscle activity during pharyngeal swallowing remained constant. Serial shortening of the hyoid muscles influenced the trajectory of the hyoid bone. The stylohyoid, posterior digastric, and mylohyoid muscles initiated the swallowing reflex and contributed to upward movement of the hyoid bone. The geniohyoid is a key muscle in the forward movement of the hyoid bone.

In patients with unilateral pharyngeal paresis and dysphagia, the head is rotated to the paretic side to prevent food flow to the rotated side during swallowing. Only a few studies to date have reported on pyriform sinus morphology upon head rotation. The purpose of this study was to measure the volume, depth, and cross-sectional area of the pyriform sinus during head rotation using 320-row area detector computed tomography. We imaged the neck during head rotation at 0A degrees and at 30A degrees, 45A degrees, and 60A degrees to the left or right in nine healthy young adults and determined the volume, depth, and cross-sectional area of the pyriform sinus in each position. On the rotated side, volume and cross-sectional area were significantly decreased at 60A degrees. In contrast, volume, cross-sectional area, and depth were all significantly increased on the opposite side at 60A degrees. These results suggest that head rotation at 60A degrees significantly increases the volume, cross-sectional area, and depth of the opposite side, and significantly decreases the volume and depth of the rotated side of the pyriform sinus.

The present study examined the effect of bolus viscosity on the onset of laryngeal closure (relative to hyoid elevation), the duration of laryngeal closure, and other key events of swallowing in ten healthy volunteers. All volunteers underwent 320-row area detector computed tomography swallow studies while swallowing 10 ml of honey-thick barium (5 % v/w) and thin barium (5 % v/w) in a 45A degrees reclining position. Three-dimensional images of both consistencies were created in 29 phases at an interval of 0.10 s (100 ms) over a 2.90-s duration. The timing of the motions of the hyoid bone, soft palate, and epiglottis; the opening and closing of the laryngeal vestibule, true vocal cords (TVC), and pharyngoesophageal segment; and the bolus movement were measured and compared between the two consistencies. The result showed differing patterns of bolus movement for thin and thick liquids. With thin liquids, the bolus reached the hypopharynx earlier and stayed in the hypopharynx longer than with thick liquids. Among events of laryngeal closure, only the timing of TVC closure differed significantly between the two consistencies. With thin liquids, TVC closure started earlier and lasted longer than with thick liquids. This TVC movement could reflect a response to the faster flow of thin liquids. The results suggest that bolus viscosity alters the temporal characteristics of swallowing, especially closure of the TVC.

Objective: To examine the efficacy of postural strategy training using a personal transport assistance robot (PTAR) for patients with central nervous system disorders. Design: Single-group intervention trial. Setting: Rehabilitation center at a university hospital. Participants: Outpatients (N=8; 5 men, 3 women; mean age, 50 +/- 13y) with a gait disturbance (mean time after onset, 34 +/- 29mo) as a result of central nervous system disorders were selected from a volunteer sample. Interventions: Two methods of balance exercise using a PTAR were devised: exercise against perturbation and exercise moving the center of gravity. The exercises were performed twice a week for 4 weeks. Main Outcome Measures: Preferred and tandem gait speeds, Functional Reach Test, functional base of support, center of pressure (COP), muscle strength of lower extremities, and grip strength were assessed before and after the completion of the exercise program. After the exercise program, enjoyment of exercise was investigated via a visual analog scale questionnaire. Results: After the program, statistically significant improvements were noted for tandem gait speeds (P=.009), Functional Reach Test (P=.003), functional base of support (P=.014), and lower extremity muscle strength (P&lt;.001-.042). On the other hand, preferred gait speeds (P=.151), COP (P=.446-.714), and grip power (P=.584) did not change. Finally, subjects rated that this exercise was more enjoyable than traditional balance exercises. Conclusions: Dynamic balance and lower extremity muscle strength were significantly improved in response to postural strategy training with the PTAR. These results suggest that postural strategy training with the PTAR may contribute to fall prevention of patients with a balance disorder. Archives of Physical Medicine and Rehabilitation 2013;94:59-66 (C) 2013 by the American Congress of Rehabilitation Medicine

Itoh N, Kagaya H, Saitoh E, Ohtsuka K, Yamada J, Tanikawa H, Tanabe S, Itoh N, Aoki T, Kanada Y. Quantitative assessment of circumduction, hip hiking, and forefoot contact gait using Lissajous figures. Jpn J Compr Rehabil Sci 2012; 3: 78-84.<BR>Objective: To quantitatively assess gait abnormalities using Lissajous figures obtained from three-dimensional motion analysis of treadmill gait, with the goal of applying the findings to the treatment of gait disorders.<BR>Methods: Thirty-nine healthy subjects and 30 hemiplegic patients were studied. Treadmill gait analysis was conducted using a three-dimensional motion analysis system. Using the Lissajous figures obtained from the gait analysis, quantitative indexes were developed for three gait abnormalities: circumduction, hip hiking, and forefoot contact. The indexes were validated through comparison with observational assessment by physiotherapists with expertise in gait analysis. <BR>Results: The values obtained for all the indexes were significantly higher in hemiplegic patients compared to healthy subjects (p < 0.001). Correlation analysis was conducted between the index values and observational scores for each gait abnormality, yielding Spearman's rank correlation coefficients of -0.82 for circumduction, -0.64 for hip hiking, and -0.84 for forefoot contact (p < 0.001).<BR>Conclusion: We successfully developed objective quantitative indexes for gait abnormalities, which were not influenced by rater bias.

Kagaya H, Okada S, Shigeta R, Ogata N, Ota K, Shibata S, Saitoh E: Dysphagia associated with unilateral vocal cord immobility after cardiovascular surgery. Am J Phys Med Rehabil 2011; 90: 901-907. Objective: Dysphagia associated with unilateral vocal cord immobility (UVCI) has received much less attention than did voice and phonation. The aim of this descriptive study was to evaluate the outcome of dysphagia associated with UVCI. Design: Between June 2006 and September 2009, 69 hospitalized patients who underwent cardiovascular surgery were referred for dysphagia. Video endoscopic evaluation of swallowing was used for the detection of swallowing difficulties. Severity of dysphagia was assessed using the Dysphagia Severity Scale. Results: Among the 69 patients, 31 UVCI patients who underwent video endoscopic evaluation of swallowing at least twice were used for analysis. All patients had severe to mild dysphagia at the first evaluation. Nineteen patients recovered from the UVCI at a mean follow-up of 125 days, whereas 12 had persistent UVCI at a mean follow-up of 216 days. Dysphagia Severity Scale at the first evaluation was not significantly different in both groups. At the last follow-up, the Dysphagia Severity Scale improved considerably without a significant difference in the magnitude of improvement in both groups. In the recovered and persistent UVCI groups, 16 and 7 patients, respectively, resumed their regular diets. Conclusions: Dysphagia associated with UVCI after surgery recovers, irrespective of the functional results of the UVCI.

Objectives: This study aimed to determine the laryngeal elevation muscle motor points, evaluate the movement of hyoid bone and larynx during stimulation of the motor points, and examine the potential for treating severe dysphagia by functional electrical stimulation. Methods: The motor points of the laryngeal elevation muscles were anatomically determined from four cadavers. Those motor points in two healthy subjects and one lateral medullary syndrome patient were electrically stimulated by surface or implanted electrodes. Results: The movements elicited by electrical stimulation of the motor points were greater in implanted than in surface electrodes. Elevation of the hyoid bone and the larynx in a lateral medullary syndrome patient were achieved with the implanted electrodes, but the upper esophageal sphincter opening was not obtained unless an additional cricopharyngeus muscle block was provided. Conclusion: The hyoid bone and larynx were elevated by electrically stimulating the motor points of the laryngeal elevation muscles.