shibata seiko

OBJECTIVES: Surgical procedure is considered in patients with severe dysphagia when conservative treatment fails. This study aimed to evaluate laryngeal suspension (LS) and upper esophageal sphincter (UES) myotomy for treating severe dysphagia due to brain disease. METHODS: Fourteen patients underwent LS and UES myotomy, with a median follow-up of 5 years and 6 months when conservative treatment failed. The penetration-aspiration scale (PAS), the Dysphagia Severity Scale (DSS), the Eating Status Scale (ESS), and diet contents were evaluated just before surgery, at discharge, and at the last follow-up. RESULTS: Preoperative intake was tube feeding in all patients. The patients learned the extended head and flexed neck posture to open the esophageal inlet. PAS, DSS and ESS scores, and diet contents were significantly improved at discharge compared with before surgery, and were maintained until the last follow-up. Eight patients had pneumonia during their hospital stay, and five had pneumonia between discharge and at the last follow-up. Age was significantly, negatively correlated with DSS and ESS at the last follow-up. CONCLUSION: Although LS and UES myotomy require a long inpatient rehabilitation and the risk of pneumonia after surgery is high, the outcome is favorable and the effects last for a long time.

<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><b>Objective</b>: Our goal was to verify the validity and safety of chew-swallow managing food (CSM) for dysphagia patients.</p><p><b>Methods</b>: 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><b>Results</b>: 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><b>Conclusion</b>: 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>

健常成人10名を対象として嚥下反射開始前に起こる下咽頭への食塊輸送に対する咀嚼と重力の影響を検討した.バリウム水溶液(液体)10ml,バリウム含有コンビーフ(コンビーフ)8g,液体5ml・コンビーフ4gの混合物(混合)を,座位,よつばい位の2体位で咀嚼させ,ビデオ嚥下造影(VF)を各2回ずつ試行した.その結果,座位において嚥下反射開始直前の食塊の深達度は喉頭蓋谷部Valleculae(VAL)+下咽頭Hypopharynx(HYP)で,混合と他の2食物間で有意差を認めた.更にHYPでは全食物間で有意差を認めた.よつばい位において食物の違いによる深達度の有意差を認めなかった.座位とよつばい位を比較した結果,コンビーフでは体位を変化させても食塊先端位置の分布は殆ど変わらなかった.液体では有意差は認めなかったもののよつばい位においてHYPまで達する頻度が減少傾向にあった.混合では座位に較べてよつばい位でVAL+HYP,HYPに達する率が有意に減少した

When normal subjects eat solid food, the bolus is formed in the oropharynx prior to swallowing. Bolus formation for liquids, however, is usually in the mouth. The purpose of this study was to determine whether the act of chewing alters the relationship between bolus position and swallow initiation. Ten healthy volunteers aged 29.2±4.1 years were imaged with videofluorography while consuming barium-mixed foods included 10ml-liquid (LQD), 8g-corned beef hash (CBH), 8g-cookie (COK), and a mixture of 5ml-liquid with 4g-CBH (MIX). They were instructed to chew and then swallow. For liquid, an additional recording was made with command swallow. Swallow onset was defined as the moment hyoid began its rapid elevation. The position of the leading edge of bolus at swallow onset and the duration of bolus transition were measured. The position of the leading edge of bolus was classified in Oral cavity (OC), Upper-oropharynx (UOP), Valleculae (VAL), or Hypopharynx (HYP). With LQD, the leading edge of bolus was in OC or UOP at time of swallow onset in 89.5% of swallows without chewing. In contrast, bolus entered VAL and HYP before swallow onset in 45% of swallows of LQD with chewing. For CBH and COK, the leading edge of the bolus entered VAL before swallow onset in 55.0% and 50.0% of swallows, respectively. For MIX swallows, the leading edge reached VAL or lower before swallow onset in 100% of swallows. From these findings the act of chewing seemed to be a prime determinant of a manner of chew-swallow complex characterized by the existence of the stage II transport. And for observation of this phenomenon clinically, MIX chew-swallowing is the most suitable because of its high reliability. In chew-swallow of food including liquid properties (LQD and MIX), high frequency of bolus entering in HYP before swallow onset was observed. The food transport to hypopharynx seemed to be influenced by gravity. This finding was very important in consideration of aspiration mechanism of dysphagic patients especially with falsenegative results of videofluorographic study. High correlation was recognized in the chewing time and the oropharyngeal transport time, and hypopharyngeal transit time was long in LQD with chewing and MIX. Steadiness of hyoid bone movement time indicated that this parameter should be suitable for standardize of time measurement. The manner of chew-swallow complex was obviously different from that of command swallow. It seemed to be important clinically to assess chew-swallow complex additionally to the conventional videofluorography.