Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER PHYSIOLOGICAL SOC  

Dysphagia is caused not only by neurological and/or structural damage but also by medication. We hypothesized memantine, dextromethorphan, diazepam, and baclofen, all commonly used drugs with central sites of action, may regulate swallowing function. Swallows were evoked by upper airway (UA)/pharyngeal distension, punctate mechanical stimulation using a von Frey filament, capsaicin or distilled water (DW) applied topically to the vocal folds, and electrical stimulation of a superior laryngeal nerve (SLN) in anesthetized rats and were documented by recording electromyographic activation of the suprahyoid and thyrohyoid muscles and by visualizing laryngeal elevation. The effects of intraperitoneal or topical administration of each drug on swallowing function were studied. Systemic administration of diazepam and baclofen, but not memantine or dextromethorphan, inhibited swallowing evoked by mechanical, chemical, and electrical stimulation. Both benzodiazepines and GABA(A) receptor antagonists diminished the inhibitory effects of diazepam, whereas a GABA(B) receptor antagonist diminished the effects of baclofen. Topically applied diazepam or baclofen had no effect on swallowing. These data indicate that diazepam and baclofen act centrally to inhibit swallowing in anesthetized rats.
NEW & NOTEWORTHY Systemic administration of diazepam and baclofen, but not memantine or dextromethorphan, inhibited swallowing evoked by mechanical, chemical, and electrical stimulation. Both benzodiazepines and GABAA receptor antagonists diminished the inhibitory effects of diazepam, whereas a GABAB receptor antagonist diminished the effects of baclofen. Topical applied diazepam or baclofen was without effect on swallowing. Diazepam and baclofen act centrally to inhibit swallowing in anesthetized rats.

DOI： 10.1152/ajpgi.00299.2016

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY  

We describe swallowing reflexes evoked by laryngeal and tracheal vagal afferent nerve stimulation in anaesthetized guinea pigs. The swallowing reflexes evoked by laryngeal citric acid challenges were abolished by recurrent laryngeal nerve (RLN) transection and mimicked by electrical stimulation of the central cut ends of an RLN. By contrast, the number of swallows evoked by upper airway/pharyngeal distensions was not significantly reduced by RLN transection but they were virtually abolished by superior laryngeal nerve transection. Laryngeal citric acid-evoked swallowing was mimicked by laryngeal capsaicin challenges, implicating transient receptor potential vanilloid 1 (TRPV1)-expressing laryngeal afferent nerves arising from the jugular ganglia. The swallowing evoked by citric acid and capsaicin and evoked by electrical stimulation of either the tracheal or the laryngeal mucosa occurred at stimulation intensities that were typically subthreshold for evoking cough in these animals. Swallowing evoked by airway afferent nerve stimulation also desensitized at a much slower rate than cough. We speculate that swallowing is an essential component of airway protection from aspiration associated with laryngeal and tracheal afferent nerve activation.

DOI： 10.1113/jphysiol.2013.256024

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER IRELAND LTD  

To clarify the functional role of cortical descending inputs involved in the swallowing reflex, the effect of electrical stimulation of two cortical masticatory areas (CMAs: A- and P-area) on rhythmic jaw movements (RJMs) and superior laryngeal nerve (SLN)-evoked swallows were studied. RJMs and swallowing reflex were elicited by repetitive electrical stimulation of CMAs and the SLN, respectively. The electromyographic activities of jaw-closer (masseter), jaw-opener (digastric), and laryngeal-elevator (thyrohyoid) muscles were recorded to identify the RJMs and swallowing reflex. The number of evoked swallows was significantly lower, and swallowing interval was significantly longer during A-area stimulation compared with those without stimulation. Conversely, these parameters were not significantly altered during P-area stimulation. The inhibition of swallows by A-area stimulation was not affected by an increase in sensory input by wooden stick application between upper and lower teeth, or A-area stimulation preceding SLN stimulation. The present findings suggest that the swallowing reflex is inhibited by activation of the A-area, but not the P-area. Since no changes in swallows were seen after the increase in intraoral sensory input and prior activation of masticatory central pattern generator (CPG), swallowing inhibition may be mediated by direct inputs from the A-area or inputs via the masticatory CPG into the swallowing CPG. (c) 2012 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.neulet.2012.09.005

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

In order to evaluate the neuronal mechanisms underlying functional abnormalities of swallowing in orofacial pain patients, this study investigated the effects of noxious orofacial stimulation on the swallowing reflex, phosphorylated extracellular signal-regulated kinase (pERK) and gamma-aminobutyric acid (GABA) immunohistochemical features in brainstem neurons, and also analysed the effects of brainstem lesioning and of microinjection of GABA receptor agonist or antagonist into the nucleus tractus solitarii (NTS) on the swallowing reflex in anaesthetized rats. The swallowing reflex elicited by topical administration of distilled water to the pharyngolaryngeal region was inhibited after capsaicin injection into the facial (whisker pad) skin or lingual muscle. The capsaicin-induced inhibitory effect on the swallowing reflex was itself depressed after the intrathecal administration of MAPK kinase (MEK) inhibitor. No change in the capsaicin-induced inhibitory effect was observed after trigeminal spinal subnucleus caudalis lesioning, but the inhibitory effect was diminished by paratrigeminal nucleus (Pa5) lesioning. Many pERK-like immunoreactive neurons in the NTS showed GABA immunoreactivity. The local microinjection of the GABA(A) receptor agonist muscimol into the NTS produced a significant reduction in swallowing reflex, and the capsaicin-induced depression of the swallowing reflex was abolished by microinjection of the GABA(A) receptor antagonist bicuculline into the NTS. The present findings suggest that facial skin-NTS, lingual muscle-NTS and lingual muscle-Pa5-NTS pathways are involved in the modulation of swallowing reflex by facial and lingual pain, respectively, and that the activation of GABAergic NTS neurons is involved in the inhibition of the swallowing reflex following noxious stimulation of facial and intraoral structures.

DOI： 10.1113/jphysiol.2008.165324

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DOI： 10.1111/joor.13709

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DOI： 10.1007/s00455-024-10689-z

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Pharyngeal electrical stimulation (PES) applies electrical stimulation to pharyngeal mucosa (PhM) and represents a useful approach to improve swallowing function in patients with dysphagia. To determine the optimal PES modality to treat dysphagia, the mechanism underlying the effects of PES on swallowing function must be elucidated. In this study, we evaluated how PES and electrical stimulation of the superior laryngeal nerve (SLN) modulate the initiation of swallowing in anesthetized rats. A swallow was evoked by electrical stimulation of the PhM, SLN, and nucleus of the solitary tract (nTS) and pharyngeal mechanical stimulation using a von Frey filament. A swallow was identified by electromyographic bursts in mylohyoid and thyrohyoid muscles. Bilateral SLN transection abolished the swallows evoked by PhM electrical stimulation. PhM and SLN electrical stimulation decreased swallowing frequency in a similar time-dependent manner. Intravenous administration of the GABAA receptor antagonist bicuculine did not affect the time-dependent change in swallowing frequency during SLN electrical stimulation. Continuous SLN electrical stimulation significantly inhibited pharyngeal mechanically and nTS-electrically evoked swallows compared with before and 5 min after stimulation. The present findings suggest that the SLN plays a primary role in PES-evoked swallows. Additionally, continuous SLN electrical stimulation inhibits the initiation of swallowing, and the modulation of central network associated with swallowing might be partially involved in this inhibition.

DOI： 10.1016/j.neulet.2024.137672

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The external carotid artery (ECA) plays a major role in supplying blood to the head and neck. Although impeded blood flow in the ECA is expected to affect orofacial functions, few studies have shown how blood flow obstruction in the ECA contributes to impairment of these functions, including chewing and swallowing. This study was performed to investigate the effects of ECA ligation (ECAL) on immediate and long-term changes in masticatory and swallowing functions as well as the jaw-opening reflex evoked in the digastric muscle. The experiments were carried out using male Sprague-Dawley rats. In the acute experiment, the digastric reflex evoked by low-threshold electrical stimulation of the inferior alveolar nerve and the swallow reflex, identified by digastric and thyrohyoid electromyographic (EMG) bursts, were compared between before and 1 h after ECAL. The chronic experiment was conducted on freely moving rats. EMGs of the masseter, digastric, and thyrohyoid muscles were chronically recorded. The long-term effects of ECAL on behavior and muscle histology were compared between rats with an intact ECA and rats with ECAL. In the acute experiment, the peak amplitude of the digastric reflex on the ECAL side was significantly decreased 1 h after ECAL. In the chronic experiment, although most parameters of the masticatory and swallowing EMGs were not significantly different between the groups, the results suggest wide variation of the effect of ECAL on the muscles. Blood supply compensation from collaterals of the internal carotid artery may be permanent in some animals.NEW & NOTEWORTHY The inhibitory effect of unilateral external carotid artery ligation (ECAL) on the ipsilateral digastric reflex was small but evident. Most parameters of masticatory and swallowing muscle activity were not significantly different after ECAL. Wide variation was noted in the effect of ECAL on the ipsilateral muscle activity. Blood supply compensation from collaterals of the internal carotid artery may occur in response to the impaired blood flow.

DOI： 10.1152/ajpgi.00226.2023

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Language：English   Publisher：新潟歯学会  

目的:介護保険施設入所者において,肺炎の発症は口腔衛生状態と関連しているとの報告がある.本研究の目的は,新型コロナウイルス(COVID-19)緊急事態宣言下における歯科訪問診療の中断が,肺炎の発症に与えた影響について調査することである.方法:介護保険施設215件に対して郵送自記式質問紙調査を行い,COVID-19緊急事態宣言下における歯科訪問診療の実施状況について調査を行った.2019年1月から6月までの肺炎発症率,入院発生率,死亡率を,2020年1月から6月までのデータと比較した.結果:歯科訪問診療を行っていた介護保険施設のうち,37.7%が中断していた.全施設の肺炎発症率,入院発生率,死亡率は,2019年と比較して2020年の方が低くなっていた.歯科訪問診療の中断の有無で解析すると,中断していない施設では,2019年より2020年の方が肺炎発症率,入院発生率,死亡率が有意に低くなっていたが,中断した施設では,有意差が認められなかった.結論:COVID-19緊急事態宣言下における介護保険施設での歯科訪問診療継続は,肺炎発症率,入院発生率,死亡率低下に関連していることが明らかになった.(著者抄録)

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The effects of head and neck alignment and pharyngeal anatomy on epiglottic inversion remain unclear. This study investigated the factors involved in epiglottic inversion, including head and neck alignment and pharyngeal anatomy, in patients with dysphagia. Patients with a chief complaint of dysphagia and who underwent videofluoroscopic swallowing study at our hospital from January to July 2022 were enrolled. They were divided into three groups based on the degree of epiglottic inversion as the complete-inversion (CI), partial-inversion (PI), and non-inversion group (NI) groups. Data were compared among the three groups; a total of 113 patients were analyzed. The median age was 72.0 (IQR: 62.0-76.0) years; 41 (36.3%) and 72 (63.7%) were women and men, respectively. There were in 45 (39.8%) patients in the CI, 39 (34.5%) in the PI, and 29 (25.7%) in the NI groups, respectively. Single-variable analysis revealed significant relation to epiglottic inversion of Food Intake LEVEL Scale score, penetration-aspiration score with 3-mL thin liquid bolus, epiglottic vallecula and pyriform sinus residue, hyoid position and displacement during swallowing, pharyngeal inlet angle (PIA), epiglottis to posterior pharyngeal wall distance, and body mass index. Logistic regression analysis with complete epiglottic inversion as the dependent variable revealed the X coordinate at maximum hyoid elevation position during swallowing and PIA as significant explanatory variables. These results suggest that epiglottic inversion is constrained in patients with dysphagia who have poor head and neck alignment or posture and a narrow pharyngeal cavity just before swallowing.

DOI： 10.1007/s00455-023-10579-w

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BACKGROUND: Chewing and licking are primarily activated by central pattern generator (CPG) neuronal circuits in the brainstem and when activated trigger repetitive rhythmic orofacial movements such as chewing, licking and swallowing. These CPGs are reported to modulate orofacial reflex responses in functions such as chewing. OBJECTIVE: This study explored the modulation of reflex responses in the anterior and posterior bellies (ant-Dig and post-Dig, respectively) of the digastric muscle evoked by low-intensity trigeminal stimulation in conscious rats. METHODS: The ant-Dig and post-Dig reflexes were evoked by using low-intensity electrical stimulation applied to either the right or left inferior alveolar nerve. Peak-to-peak amplitudes and onset latencies were measured. RESULTS: No difference was observed between threshold and onset latency for evoking ant-Dig and post-Dig reflexes, suggesting that the latter was also evoked disynaptically. The peak-to-peak amplitude of both reflexes was significantly reduced during chewing, licking and swallowing as compared to resting period and was lowest during the jaw-closing phase of chewing and licking. Onset latency was significantly largest during the jaw-closing phase. Inhibitory level was similar between the ant-Dig and post-Dig reflex responses and between the ipsilateral and contralateral sides. CONCLUSION: These results suggest that both the ant-Dig and post-Dig reflex responses were significantly inhibited, probably due to CPG activation during feeding behaviours to maintain coordination of jaw and hyoid movements and hence ensure smooth feeding mechanics.

DOI： 10.1111/joor.13537

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BACKGROUND: Lingual pressure (LP) generation is cooperatively controlled not only by the intrinsic tongue (I-ton) muscles but also by hyoid muscle activation. However, the measurement of endurance and fatigue properties of I-ton muscles is difficult due to the instability of electrodes. OBJECTIVE: The purpose of this study was to apply suction electrodes to measure electromyograms (EMGs) of I-ton muscle and to evaluate integrated EMG amplitude (iEMG) and mean power frequency (MPF) of EMG in the I-ton and hyoid muscles performing continuous LP. METHODS: Twenty healthy adult volunteers (10 males, 10 females, mean age 28.8 years) were instructed to perform 10-s LP generation tasks at 25%, 50%, 75% and 100% of maximum LP in randomised order with visual feedback. During each task, EMGs of the I-ton, suprahyoid (S-hyo), infrahyoid (I-hyo) and masseter (Mass) muscles were simultaneously recorded. The iEMG and MPF of EMG burst during 10-s LP tasks were compared. The recording period was divided into three substages to analyse temporal changes with the Friedman test. RESULTS: During the 10-s task, the iEMG significantly increased as the LP strength increased (p < .001). There was no time-dependent change in the I-ton iEMG; however, the MPF of the I-ton EMG burst decreased in all tasks (p < .05). The S-hyo and I-hyo iEMGs gradually increased, especially with strong LP (p < .01). CONCLUSION: While I-ton muscles may easily fatigue during 10-s LP generation, S-hyo and I-hyo muscles may help compensate for the weakened I-ton muscle activity by increasing their activity to maintain LP.

DOI： 10.1111/joor.13612

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INTRODUCTION: Declining oral function may affect subsequent physical frailty in the older population. The aim of this longitudinal study was to summarise data on patients who underwent functional oral examination and evaluate the impact of management on patients with oral hypofunction (OHF). METHODS: Dental outpatients aged over 65 years at their initial visit to the Niigata University Hospital received detailed assessment of seven oral function items to diagnose oral hypofunction using diagnostic criteria defined by the Japanese Society of Gerodontology. Patients with OHF at the first assessment received management including oral health guidance for low function and dental treatment. They were re-evaluated approximately 6 months later and the two assessments were compared. According to the results of the second assessment, the patients were divided into two groups: OHF improved and OHF re-diagnosed. RESULTS: Of the 273 patients who underwent the first assessment, 86 (31.5%) were diagnosed with OHF and received management. Of those, 42 (48.8%) completed the second assessment. Comparing the first and second assessment, significant improvement was observed in oral hygiene, occlusal force, tongue-lip motor function of /pa/, mastication and swallowing. The change in values from the first assessment demonstrated a significant difference between the OHF improved and re-diagnosed groups only in occlusal force. CONCLUSION: Management for patients with OHF can contribute to the improvement of poor oral function, and an increase in occlusal force was notable in the recovery from OHF.

DOI： 10.1111/ger.12655

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Language：Japanese   Publisher：日本顎口腔機能学会  

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Language：Japanese   Publisher：新潟歯学会  

小脳橋角部腫瘍摘出術後に残存した咀嚼障害に対して筋電位から得られた音声バイオフィードバック(以下,BF)を用いた咀嚼訓練を実施した一例を報告する。症例は36歳女性。目のかすみを自覚し,近医を受診したことを契機に小脳橋角部腫瘍を指摘され,20XX年Y月Z-7日術前嚥下機能評価目的に当科初診となった。同月Z日に広範囲にわたる左迷走神経鞘腫摘出術を施行され,その際左側の迷走神経は数本の神経線維を残し切断された。術後は,左側の三叉・顔面・舌咽・迷走・舌下神経麻痺ならびに摂食嚥下障害を認めた。当院と回復期リハビリテーション病院において直接および間接訓練を実施し,嚥下障害は段階的に改善して調整食にて自宅退院となったが,咀嚼障害が残存した。咀嚼障害に対して,グミゼリーを用いた咀嚼能率評価,咀嚼時の顎運動軌跡と筋電位記録,さらにBF訓練を実施した。BF訓練では,グミゼリーやガムなどを一定のリズムで意識的に咀嚼するよう指示した。その結果,咀嚼運動経路パターンの改善,咬筋・舌骨上筋の筋活動量の向上,ならびに咀嚼能率の改善を認めた。BF訓練を通して随意的に咀嚼運動が調節されたことにより,リズミカルな咀嚼や筋出力の増大がもたらされたと推察される。咀嚼能率の改善は十分とは言いがたかったが,軟菜～常食が摂取可能となった。(著者抄録)

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DOI： 10.1007/s00455-022-10421-9

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1111/joor.13373

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When eating, mastication is always followed by swallowing. The present study assessed the effect of mastication on swallowing-related neural pathways in humans. Twenty healthy volunteers participated and underwent baseline transcranial magnetic stimulation to evaluate cortico-pharyngeal and cortico-hand motor-evoked potentials (MEPs). Next, they performed a chewing task and a swallowing task. Repeated-measures ANOVA revealed that pharyngeal MEPs were significantly higher after the swallowing task than after the chewing task, even though the number of swallows across tasks was matched. This implies that chewing movements suppress swallowing-related activity in the pharyngeal motor circuit.

DOI： 10.1016/j.physbeh.2022.113763

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BACKGROUND: Outcome prediction for dysphagia recovery is essential for rehabilitation treatment planning. Several studies have reported various predictors for resuming oral feeding after post-stroke dysphagia. However, evidence on oral health and function, a crucial part of feeding, has rarely been reported. Therefore, the goal of this study was to identify the oral status-related factors that could predict oral intake resumption in acute stroke patients. METHODS: 80 acute stroke patients with dysphagia were included. Clinical data, including the changes of general condition, oral and swallowing functions, were collected once a week until discharge. Patients were divided into two groups based on the outcome of the food intake level scale at discharge, and data were compared between the groups. RESULTS: 60 patients had regained complete oral intake before discharge. Multiple logistic regression showed that posterior tongue pressure could significantly predict complete oral intake recovery. Tongue pressure and modified water swallowing test score also significantly influenced diet forms. In addition, Spearman correlation analysis showed that improvement of other oral status-related factors, such as oral moisture and dentition status, also indicated the improvement of diet forms and swallowing function during the hospital stay. CONCLUSION: Tongue pressure measurement could be a useful oral status-related indicator for predicting complete oral intake and adjusting diet forms for acute stroke patients during hospitalization. Acute stroke patients should receive proper oral status evaluation and implementation to enhance functional recovery.

DOI： 10.1016/j.jstrokecerebrovasdis.2022.106401

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It still remains unclear how the suprahyoid muscles function in bolus formation during mastication. This study aimed to investigate the contributory role of the suprahyoid muscles during mastication. A total of 20 healthy young volunteers were asked to perform tongue pressure generation tasks and unilateral mastication tasks using peanuts and two different types of rice crackers. Surface electromyographic (EMG) activity of the masseter and suprahyoid muscles and mandibular kinematics were recorded. Suprahyoid activity increased with increasing tongue pressure. Masticatory duration until the first deglutition differed significantly among the different foods; the harder the food, the longer the duration. This was also the case in masseter activity per masticatory cycle. Masticatory rate and suprahyoid activity per masticatory cycle were significantly higher during soft rice cracker mastication. Masseter activity was higher on the masticatory side than on the non-masticatory side, however, there was no difference in suprahyoid activity between the sides. Suprahyoid activity and jaw gape showed significant positive correlation in the early stage on both the masticatory and non-masticatory sides. The suprahyoid muscles functioned dominantly for jaw-opening during peanut mastication, and for bolus formation, especially in the late stage during soft rice cracker mastication. Bolus formation was performed dominantly on the masticatory side during rice cracker mastication. These findings clearly demonstrate a functional role of the suprahyoid muscles during mastication of solid foods from assessments using both EMG activity and mandibular kinematic recordings.

DOI： 10.3389/fphys.2022.881891

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Our previous studies implicated the voltage-gated sodium channel subtype NaV 1.7 in the transmission of action potentials by the vagal afferent nerves regulating cough and thus identified this channel as a rational therapeutic target for antitussive therapy. But it is presently unclear whether a systemically administered small molecule inhibitor of NaV 1.7 conductance can achieve therapeutic benefit in the absence of side effects on cardiovascular function, gastrointestinal motility or respiration. To this end, we have evaluated the antitussive effects of the NaV 1.7 selective blocker Compound 801 administered systemically in awake guinea pigs or administered topically in anesthetized guinea pigs. We also evaluated the antitussive effects of ambroxol, a low affinity NaV blocker modestly selective for tetrodotoxin resistant NaV subtypes. Both Compound 801 and ambroxol dose-dependently inhibited action potential conduction in guinea pig vagus nerves (assessed by compound potential), with ambroxol nearly 100-fold less potent than the NaV 1.7 selective Compound 801 in this and other NaV 1.7-dependent guinea pig and human tissue-based assays. Both drugs also inhibited citric acid evoked coughing in awake or anesthetized guinea pigs, with potencies supportive of an NaV 1.7-dependent mechanism. Notably, however, the antitussive effects of systemically administered Compound 801 were accompanied by hypotension and respiratory depression. Given the antitussive effects of topically administered Compound 801, we speculate that the likely insurmountable side effects on blood pressure and respiratory drive associated with systemic dosing make topical formulations a viable and perhaps unavoidable therapeutic strategy for targeting NaV 1.7 in cough.

DOI： 10.1016/j.ejphar.2021.174192

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BACKGROUND: Oral hypofunction is defined as the reversible stage preceding oral dysfunction. However, its assessment and management need further examination and consideration. OBJECTIVE: The present study aimed to examine the current state of oral hypofunction among outpatients at the university hospital. METHODS: New outpatients underwent medical interviews and detailed assessment of oral hypofunction at their initial visit to our dental department. Oral hypofunction was diagnosed if the results of three of the following seven assessment items were below cut-off values: poor oral hygiene, oral dryness, reduced occlusal force, decreased tongue-lip motor function, decreased tongue pressure, decreased masticatory function and deterioration of swallowing function. The relationships between factors used to diagnose oral hypofunction as well as the distributions of assessment values were clarified. RESULTS: Seventy-five of 209 patients (35.9%) were finally diagnosed with oral hypofunction. Diagnosis of oral hypofunction was significantly related to patient age, Eichner index, a chief complaint of dental or periodontal disease or ill-fitting dentures and a history of neurodegenerative disease. The lowest quintile values for poor oral hygiene, oral dryness and decreased masticatory performance were all above current cut-off values. Reduced occlusal force contributed strongly to the diagnosis of oral hypofunction. CONCLUSION: Oral hypofunction in dental outpatients at a university hospital was associated with patient age, medical history and chief complaint at presentation. Diagnosis of oral hypofunction can be closely related to reduced occlusal force. The validity of cut-off values for assessments of oral hypofunction needs further consideration.

DOI： 10.1111/joor.13237

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Language：Japanese   Publisher：(一社)日本摂食嚥下リハビリテーション学会  

本研究は誤嚥性肺炎入院患者の治療体系において、主たる原因である嚥下機能低下に注目し、摂食嚥下機能評価フロー立案と、その実施効果の検証を目的とした。誤嚥性肺炎入院患者に対し、患者の基本情報の他、全身状態、食事摂取状況、嚥下機能、口腔状態の4つの側面と細項目から構成された摂食嚥下機能評価項目を設定し評価を実施した。言語聴覚士による(1)介入開始時、(2)肺炎治療終了時、嚥下機能が安定した(3)介入終了時の3点による機能評価を102名(男性50名、年齢中央値90歳)について経口退院群と死亡・非経口退院群で2群比較検討した。さらに、肺炎治療とあわせた摂食嚥下機能評価フローを立案し、51名(男性24名、年齢中央値91歳)を対象に実施効果を検討した。肺炎治療終了時には、年齢、BMI、Barthel Index、意識レベル、従命可否、排痰の可否、咽頭吸引の要不要、経口摂取量、含嗽力、口腔ケア自立度において2群間で有意な差が認められた。これらを独立変数、経口摂取退院を目的変数とした多重ロジスティック回帰分析の結果、食事の経口摂取量と従命可否が有意な項目となった。摂食嚥下機能評価フローの導入前後における、入院から退院までの全体の在院日数の比較では、有意な差は認められなかった。肺炎治療終了後から介入終了時までの在院日数の比較では、経口退院群においてフロー導入後に有意な短縮が認められ、摂食嚥下機能評価とそれに対応する患者支援が有効に進んでいたと考えられた。誤嚥性肺炎入院患者に対して、摂食嚥下機能評価フローを導入することで、経口摂取可能な患者では、入院期間短縮の点で有効である可能性が考えられた。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J03152&link_issn=&doc_id=20211020030002&doc_link_id=%2Fcb5dvsph%2F2021%2F002502%2F002%2F0090-0101%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcb5dvsph%2F2021%2F002502%2F002%2F0090-0101%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：新潟歯学会  

皮膚筋炎は自己免疫疾患のひとつであり、合併症としてしばしば嚥下障害を呈する。多くの場合は、原疾患の治癒とともに嚥下障害も改善することが報告されているが、治療が長期化し嚥下障害が遷延する報告も見受けられる。我々は、皮膚筋炎の活動性が安定後も関連する合併症等の影響により治療が難渋した症例を経験したため報告する。患者は73歳、男性。X-10年に皮膚筋炎の診断を受け、外来通院にてフォローを行っていたが再燃し、当院入院となった。四肢筋力低下、嚥下困難感を主訴に当科紹介となった。入院当初の嚥下造影検査では液体誤嚥や固形物の咽頭残留を伴う咽頭期障害が顕著であった。原疾患に対してステロイドパルス療法、低栄養改善のために経鼻経管栄養を開始した後に、少量のゼリーを用いた直接訓練を進めた。皮膚筋炎の活動性が安定した後も嚥下障害は残存し、さらに原疾患の合併症として蠕動運動障害や腸管気腫を発症したことで経管栄養の調整及び嚥下訓練は難渋した。その後、代償的嚥下法を獲得し、自宅退院後もごく少量の楽しみ程度の経口摂取が継続可能となった。皮膚筋炎では、関連する消化器や呼吸器等の合併症、低栄養が嚥下障害の予後に関連すると思われる。リハビリテーションの実施にあたっては、全身状態の変化に留意し、難治例には残存機能を生かした訓練を行う必要があることが考えられた。(著者抄録)

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Physical inactivity is one of the causes of most metabolic syndromes. The incidence of metabolic syndrome is expected to increase in the near future because of the reduced opportunities for exercise caused by COVID-19. Non-alcoholic fatty liver disease (NAFLD) is currently the most common cause of chronic liver disease. Changes in diet and lifestyle have led to a dramatic increase in the prevalence of NAFLD in the world. NAFLD is characterized by excessive triglyceride (TG) accumulation in the hepatocytes due to both increased inflow of free fatty acids and de novo hepatic lipogenesis. Thus far, no study quantitatively assessed the liver fat deposition after a rapid decline in physical activity. Herein, we describe a case of a 17-year-old Japanese boy with severe fat infiltration of the liver, due to a rapid decline in physical activity, treated at our facility. Our rehabilitation and nutritional support teams administered appropriate exercise and nutrition support to reduce weight and improve liver dysfunction. Our findings support dietary changes and exercise therapy to manage such cases.

DOI： 10.7759/cureus.16530

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We investigated how swallowing behaviors are affected by the temperature and carbonation of water in healthy humans. Twenty-nine healthy volunteers were instructed to drink as much natural water, carbonated water, or cider as they wanted, and we recorded the volume of solution swallowed and electromyographic (EMG) activity of the masseter and suprahyoid muscles. Sensory tests regarding the ease of holding the solution in the mouth and ease of swallowing were also performed. The volume of carbonated water swallowed was significantly lower than that of natural water and cider. The ease of holding and swallowing the solution significantly differed between solution types such that natural water was the easiest solution to hold and swallow, followed by cider and then carbonated water in both tests. EMG activity was also affected by the solution type. Masseter EMG activity was significantly lower when swallowing natural water compared with carbonated water. Suprahyoid EMG activity was significantly lower when swallowing natural water compared with carbonated water and cider. The volume of solution swallowed was significantly correlated with the ease of holding and swallowing the solution, but not with masseter or suprahyoid EMG activities. The ease of holding and swallowing the solution significantly affected masseter and suprahyoid EMG activities. The results suggested that when participants experienced difficulty holding and swallowing the solution, masseter and suprahyoid EMG activity increased. Considering our findings that mechanical stimulation with bubbles decreased the volume of solution swallowed and increased EMG activities, carbonated water swallowing may be useful in treating deglutition disorders.

DOI： 10.1007/s00455-020-10147-6

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There is wide variation in chewing behaviours, even among healthy humans. Further, the way in which humans determine swallowing initiation when chewing solid foods remains unclear. The current study sought to investigate how the bolus properties change over time during chewing, and to clarify which factors affect chewing and swallowing behaviours, including swallowing initiation, in healthy humans. Twenty-four healthy volunteers were instructed to chew 8 g of steamed rice and spit it out at 50%, 100% and 150% of their own chewing duration, defined as the time of chewing from onset of the first chewing cycle to onset of the first swallow. Chewing and swallowing behaviours were monitored and determined by visual inspection of video recordings. The physical properties such as hardness, cohesiveness and adhesiveness as well as water content of the bolus were measured. In each subject, maximum bite force, tongue pressure and stimulated salivary flow rate were also measured. Hardness gradually decreased, and the cohesiveness and water content of the bolus did not change up to 50% of chewing duration, followed by a slight but significant increase. The adhesiveness of the bolus rapidly decreased at the beginning of chewing. Chewing duration was significantly related to stimulated salivary flow rate; greater salivary flow rate was associated with shorter chewing duration. Variation of chewing duration and swallowing initiation was not dependent on bolus properties during the chewing of steamed rice, but mainly depended on the surface lubrication of the bolus.

DOI： 10.1111/joor.13151

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The factors affecting the survival of patients with aspiration pneumonia (AP) remain unclear. This study aimed to determine whether factors, including oral status, swallowing function, and oral intake level, were related to survival outcomes in older patients hospitalized for AP. The study enrolled patients with AP who were admitted to our hospital between February 2017 and November 2019. Patients were divided into two groups based on the 90-day mortality after the first swallowing function evaluation: survivors and deceased. The data were compared between the two groups. A total of 29 patients were diagnosed with AP. Of these patients, 13 died within 90 days. The numbers of patients who could not use removable dentures and required sputum suctioning and had cough reflex at rest were significantly higher in the deceased than in the survivors. The salivary pooling and pharyngeal clearance scores evaluated by videoendoscopy, International Dysphagia Diet Standardisation Initiative Functional Diet Scale score determined after swallowing function evaluation, and consciousness level were significantly worse in the deceased than in the survivors. There were significant differences in patients' oral status, swallowing function, oral intake level, and consciousness level between the survivors and deceased.

DOI： 10.1007/s00455-021-10306-3

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BACKGROUND: Thermal tactile oropharyngeal stimulation has been clinically used to facilitate swallowing initiation in dysphagic patients. We previously demonstrated that thermal stimulation applied to the oral cavity provokes an immediate excitability in pharyngeal motor cortex. The aim of the current study was to investigate whether thermal stimulation can produce longer lasting effects on the corticopharyngeal neural pathway. METHODS: Healthy volunteers (n = 8/12) underwent baseline pharyngeal motor evoked potential (PMEP) measurements evoked by transcranial magnetic stimulation. In the first experiment, subjects received thermal stimulation alternating 30 seconds of 15 and 36°C applied to the tongue surface for either 10 minutes, 5 minutes, or sham. In the second experiment, one of three intermittent thermal stimulus patterns was delivered: cold (alternating 30 seconds of 15 and 36°C), warm (continuous 36°C), or hot (alternating 30 seconds of 45 and 36°C) for 10 minutes. In both experiments, PMEP were remeasured every 15 minutes up to 60 minutes following thermal stimulation. KEY RESULTS: Repeated measures ANOVA for each stimulus time in the first experiment showed a significant increased change in PMEP amplitude at 30 minutes following only 10-minute stimulation compared with sham (P < .05). In the second experiment, we found that cold stimulation was more effective than the other stimulation (P < .05) at increasing PMEP amplitudes. CONCLUSIONS AND INFERENCES: Ten-minute cold stimulation on the tongue can induce a delayed (30 minutes) increase in pharyngeal cortical excitability, providing a clinically useful therapeutic window for its application in dysphagic patients.

DOI： 10.1111/nmo.13938

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Examining the coordination of respiration and swallowing is important for elucidating the mechanisms underlying these functions and assessing how respiration is linked to swallowing impairment in dysphagic patients. In this study, we assessed the coordination of respiration and swallowing to clarify how voluntary swallowing is coordinated with respiration and how mastication modulates the coordination of respiration and swallowing in healthy humans. Twenty-one healthy volunteers participated in three experiments. The participants were asked to swallow 3 ml of water with or without a cue, to drink 100 ml of water using a cup without breathing between swallows, and to eat a 4-g portion of corned beef. The major coordination pattern of respiration and swallowing was expiration-swallow-expiration (EE type) while swallowing 3 ml of water either with or without a cue, swallowing 100 ml of water, and chewing. Although cueing did not affect swallowing movements, the expiratory time was lengthened with the cue. During 100-ml water swallowing, the respiratory cycle time and expiratory time immediately before swallowing were significantly shorter compared with during and after swallowing, whereas the inspiratory time did not differ throughout the recording period. During chewing, the respiratory cycle time was decreased in a time-dependent manner, probably because of metabolic demand. The coordination of the two functions is maintained not only in voluntary swallowing but also in involuntary swallowing during chewing. Understanding the mechanisms underlying respiration and swallowing is important for evaluating how coordination affects physiological swallowing in dysphagic patients.

DOI： 10.3389/fphys.2021.696071

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BACKGROUND: To date, there have been few guidelines proposed for adjustment of the food consistency, particularly to match the oral function of older adults, which will guide clinicians and caregivers in appropriately modifying food. OBJECTIVE: We investigated how oral, swallowing, and cognitive conditions of older adults who required daily nursing care in a nursing home were associated with different dietary food consistencies. METHODS: Clinical examinations to record dentition status, swallowing, and cognitive functions were performed, and the feeding status, including the food consistencies and need for assistance at lunchtime, was evaluated in 37 older residents in nursing homes. The swallowing function was assessed by performing a modified water-swallowing test, and food swallowing was tested using pudding and rice crackers. The χ2 test was used to determine the relationships among the parameters. RESULTS: No participants were able to take cooked rice, nor regular and soft side dishes. There was no significant relationship between dentition status and feeding status. Of the participants, 95% ate pudding without any problems and 49% ate rice crackers without any signs of swallowing difficulty such as coughing or stopping chewing. There was a significant relationship between the food test score using a rice cracker and the level of food consistencies, and between the same test score and the level of mealtime assistance, whereby the better the score of the food test using a rice cracker, the better was the level of food consistencies including use of a thickening agent and the better was the level of mealtime assistance. CONCLUSION: The results strongly suggest that the food test using a rice cracker was associated with the level of food consistency and mealtime assistance for older adults in nursing homes.

DOI： 10.1159/000511912

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We investigated how the physical properties of food affect chewing kinematics, and examined the effects of aging on behavior. Twenty young and 21 older volunteers were asked to freely chew rice crackers and spit the food out at their average chewing duration. We compared chewing characteristics among the conditions (age × rice cracker), and examined the area of rectified masseter and suprahyoid electromyographic bursts per chewing cycle. We also evaluated temporal changes in those values. In addition, the bolus properties at the end of chewing were compared. The harder/larger the rice cracker, the longer the chewing duration and the greater the number of chewing cycles. These values also increased with age. Chewing cycle time was not affected by age and rice cracker properties, except in one condition: for the rice cracker with the lowest hardness and density, the chewing cycle time was longer than for the other rice crackers. Chewing cycle time decreased at the middle stage of chewing, followed by an increase, with increasing suprahyoid electromyographic activity at the late stage. The physical properties of the bolus at the end of chewing did not differ between age groups, and depended on the initial properties. The water absorption rate of the bolus was significantly greater for the rice cracker with the lowest hardness and density compared with other rice crackers. The results demonstrated that not only hardness, but also other factors, such as density, significantly affected chewing behaviors.

DOI： 10.1016/j.physbeh.2020.113102

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A major component of gastric acid is hydrochloric acid (HCl), which can activate transient receptor potential vanilloid 1 (TRPV1). In the present study, we investigated how sustained laryngeal TRPV1 activation affects the frequency of the swallowing reflex. Experiments were carried out on 85 male Sprague-Dawley rats. The effects of short and sustained application of chemicals (3 µl of 0.1 N HCl or capsaicin) on the frequency of swallowing and of time-dependent changes in the occurrence of swallowing evoked by supralaryngeal nerve stimulation were determined. To evaluate vascular permeability of the larynx, Evans blue dye was intravenously injected after 5 or 60 min of sustained TRPV1 activation. SB366791 (a TRPV1 inhibitor) and Cap/QX-314 (a TRPV1-expressed neuronal inhibitor) significantly inhibited HCl/capsaicin-induced swallowing, but air flow-induced swallowing was not affected. Although the number of air flow-induced swallows induced by capsaicin stimulation was not affected within 5 min, but significantly reduced by 60-min capsaicin or HCl application. The swallowing threshold associated with supralaryngeal nerve stimulation did not significantly change throughout the recording period. Evans blue dye concentrations in the larynx were significantly higher at 60 min in the 10-5 M capsaicin group than in the other groups. Our results suggest that sustained TPRV1 activation not only desensitizes TRPV1, but also inactivates mechanoreceptors, which may be attributed to increases in vascular permeability and edema, as part of an inflammatory process.

DOI： 10.1152/ajpgi.00082.2020

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BACKGROUND: Tongue lift movement (TLM) is used as a therapy to improve tongue pressure against the hard palate for dysphagic patients. OBJECTIVE: The present study aimed to characterize the time-dependent endurance changes in hyoid muscle activity and hyoid-laryngeal displacement during TLM in different ways. METHODS: Sixteen young healthy volunteers were instructed to perform TLM at maximum effort (100%) against the anterior and posterior parts of the hard palate using a balloon-type tongue pressure instrument, followed by a 10-second recording during anterior 80% TLM, anterior 100% TLM, posterior 80% TLM and posterior 100% TLM with visual feedback. Electromyography (EMG) of suprahyoid (S-Hyo) and infrahyoid (I-Hyo) muscles and videofluorography were simultaneously recorded. To evaluate temporal changes, the recording period was divided into three substages: early, middle and late. Tongue pressure, integrated EMG (iEMG), power frequency of EMG burst and hyoid-laryngeal position were compared among the conditions (80% vs 100%, anterior vs posterior and early vs middle vs late). RESULTS: Tongue pressure was stably maintained for 10 seconds in all conditions. S-Hyo iEMG and I-Hyo iEMG were significantly greater at 100% than at 80%, while no significant difference was observed between positions. S-Hyo iEMG and I-Hyo iEMG significantly increased at the late stage, while power frequency of EMG burst gradually decreased. Significant temporal changes in laryngeal elevation were observed only in posterior 100% TLM. CONCLUSION: The current results suggested that isometric posterior TLM may be more useful compared with anterior TLM in clinical situations for dysphagic patients to elevate the hyolaryngeal complex.

DOI： 10.1111/joor.12988

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BACKGROUND: There is a wide variation of chewing behaviors even in healthy humans. The present study was aimed to clarify how the rheological properties of the bolus during chewing is different among individuals. We also investigated if the swallowing threshold was consistent among the individuals and if the difference in the bolus properties at the swallowing affected swallowing movement. METHODS: Twenty-nine healthy volunteers were asked to ingest 8 g of steamed rice. Based on the chewing duration defined by the time until first swallow, participants were asked to chew the food, then either spit it out, or swallow it, at 50%, 100% and 150% of chewing duration. In seven volunteers, the maximum bite force was measured. RESULTS: The hardness of the bolus gradually decreased throughout recording. Although the chewing duration varied widely, there was a significant negative correlation between time and hardness, regardless of the difference in individual chewing duration. The cohesiveness of the bolus was unchanged at the 100% time point, followed by a slight but significant increase. There was no significant correlation between the chewing duration and adhesiveness of the bolus. Swallowing-related bursts of Supra and Infra EMGs were not related to the chewing duration or bolus properties, and chewing duration did not affect swallowing function. CONCLUSION: The current results suggest that the bolus properties such as the hardness and cohesiveness during chewing is just dependent on the chewing duration and the difference in the bolus properties does not affect the swallowing initiation and movement.

DOI： 10.1111/joor.13044

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BACKGROUND: Tongue lift movement (TLM) task is considered a treatment strategy in dysphagic patients. However, there is no evidence of effect of sustained tongue movements on the related muscle contraction. OBJECTIVES: The present study aimed to characterise the properties and time-dependent changes of the electromyographic (EMG) features of suprahyoid muscles during TLM. METHODS: Twenty young healthy volunteers were instructed to perform TLM at maximum effort in either the anterior or the posterior position, during measurement of tongue pressure for 7 s. Supra- (S-hyo) and infra-hyoid (I-hyo) EMGs were recorded. The area and power frequency of EMG burst and the area under the curve of tongue pressure were compared among the conditions: trials (1st, 2nd vs 3rd trials); anterior vs posterior TLM; and early vs late 3 s of each trial. RESULTS: There was no difference in the tongue pressure among trials or between the early and late 3 s. Anterior tongue pressure was significantly higher than posterior tongue pressure (P < .001). The area of I-hyo EMG burst was significantly larger (P = .044), and the power frequency of I-hyo EMG burst was significantly smaller (P = .042) during posterior TLM than anterior TLM. A significant difference in the power frequency of both EMG bursts was observed between early and late stages during both anterior (P < .05) and posterior (P < .01) TLM. CONCLUSION: Hyoid muscles may compensate for rapid fatigue of the tongue muscle to maintain tongue pressure by changing their activity pattern during tongue pressure generation.

DOI： 10.1111/joor.12894

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Swallowing has a vital function in airway protection and is the next step after mastication. Swallowing impairment, which is known as dysphagia, is frequently accompanied by pain. Previous clinical studies have shown that orofacial pain affects swallowing function. Thus, it was hypothesized that orofacial noxious inputs may modulate swallowing function. Previous studies using anesthetized animals has proposed that the facial skin-nucleus tractus solitarii (NTS), masseter muscle-NTS, lingual muscle-NTS, and lingual muscle-paratrigeminal nucleus-NTS pathways may be involved in the inhibition of swallowing caused by facial, masseter, and lingual pain. Moreover, the activation of gamma-aminobutyric acidergic NTS neurons is involved in the inhibition of the swallowing reflex following trigeminal noxious inputs. This review focused on the recent management of dysphagia, neural mechanisms of swallowing, and relationship between orofacial pain and swallowing function. This and other future studies in this field can provide a better understanding of both normal and impaired swallowing and can help develop a new approach to treat patients with dysphagia and orofacial pain.

DOI： 10.2334/josnusd.19-0408

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Coughing, huffing and swallowing protect the airway from aspiration. This study was conducted to compare the physical properties of voluntary coughing, huffing and swallowing in healthy subjects. Ten healthy men were asked to huff, cough and swallow repeatedly. Electromyograms (EMGs) were recorded from the left side of the external oblique (EO), sternocleidomastoid, suprahyoid (SH) and thyrohyoid muscles. Airflow was recorded using a face mask with two-way non-rebreathing valves. The expiratory velocity of huffing and coughing and the SH EMG of all actions presented high intraclass correlation coefficients (> 0.8). The inspiratory and expiratory velocities did not differ significantly between coughing and huffing. The expiratory acceleration of coughing was significantly higher than that of huffing, whereas the expiratory volume of coughing was significantly smaller than that of huffing. The EO EMG of coughing and huffing were significantly larger than that of swallowing. The EO EMG activity during the expiratory phase was significantly higher than that of the other phases of both coughing and huffing. The SH EMG of coughing and huffing were significantly smaller than that of swallowing. Correlation analysis revealed that the expiratory velocity of coughing was strongly positively correlated with that of huffing. The expiratory volume of huffing was significantly positively correlated with hand grip strength. These results suggest that EO and SH muscle activities during huffing or coughing differ those during swallowing, and huffing and coughing may work similarly in expiratory function.

DOI： 10.1371/journal.pone.0242810

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Language：Japanese   Publisher：新潟歯学会  

クロウ・深瀬(POEMS)症候群の治療中に誤嚥性肺炎を発症し、摂食嚥下リハビリテーションを行った一例を報告する。症例は83歳男性。2012年にPOEMS症候群と診断され、サリドマイド治験に参加し、加療されていた。2017年11月に誤嚥性肺炎の診断で入院となり、摂食嚥下機能評価目的に当科初診となった。初診時、随意咳嗽力が低下し、粗そう性および湿性嗄声を認め、最長発声持続時間は9.9秒であった。反復唾液嚥下テスト3回、とろみ付き液体1ml摂取では3%以上のSpO2低下と頸部聴診にて湿性音を認めた。嚥下内視鏡検査では、喉頭浮腫および唾液誤嚥を認め、少量の食物摂取も困難であった。重度咽頭期障害の診断にて、口腔ケアおよび間接訓練にて介入を開始した。介入23日目に嚥下造影検査を経て、直接訓練を開始したものの、介入44日目に熱発とCRPの上昇があり、痰喀出も困難な状況のため直接訓練は中止となった。介入63日目に摂食嚥下リハビリテーション目的で地域医療支援病院に転院となり、2ヵ月間のリハビリテーションを実施したものの嚥下機能に明らかな改善はみられなく、胃瘻造設のため当院へ再入院となった。唾液誤嚥レベルの重度咽頭期障害は変わらなかったものの、転院前は困難であった痰喀出は可能であった。その後も直接訓練と間接訓練を継続し、最終的に少量のゼリー摂取が可能となり、リハビリテーション病院への転院を迎えた。(著者抄録)

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We examined how attention alters chewing and swallowing behaviors. Twenty-one healthy volunteers were asked to freely eat 8 g of steamed rice in three separate trials, and we obtained the average number of chewing cycles (N) and chewing duration (T) prior to the first swallow in each trial. We also conducted an N-limited test, in which participants chewed the food while independently counting the number of chewing cycles and swallowed the food when they reached N, and a T-limited test, in which they chewed the food for T sec and then swallowed. We recorded electromyograms (EMGs) from masseter and suprahyoid muscles and collected videoendoscopic images. In the N-limited test, chewing speed decreased, masseter muscle activity (area under the curve of the rectified EMG burst) per cycle increased, and suprahyoid muscle activity per cycle decreased. In the T-limited test, the chewing speed increased, muscle activities per cycle decreased, and the number of cycles increased. The occurrence frequency of bolus propulsion into the pharynx before swallowing was smaller in the N- and T-limited tests than in the free chewing test. Further, the whiteout time was longer in the T-limited test than in the free chewing test. Attentional chewing changes not only chewing but also swallowing behavior.

DOI： 10.1038/s41598-019-42422-4

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DOI： 10.1111/nmo.13384

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This study aimed to investigate whether the jaw-opening (JOR) and jaw-closing reflexes (JCR) are modulated during not only peripherally, but also centrally, evoked swallowing. Experiments were carried out on 24 adult male Japanese white rabbits. JORs were evoked by trigeminal stimulation at 1 Hz for 30 s. In the middle 10 s, either the superior laryngeal nerve (SLN) or cortical swallowing area (Cx) was simultaneously stimulated to evoke swallowing. The peak-to-peak JOR amplitude was reduced during the middle and late 10-s periods (i.e., during and after SLN or Cx stimulation), and the reduction was dependent on the current intensity of SLN/Cx stimulation: greater SLN/Cx stimulus current resulted in greater JOR inhibition. The reduction rate was significantly greater during Cx stimulation than during SLN stimulation. The amplitude returned to baseline 2 min after 10-s SLN/Cx stimulation. The effect of co-stimulation of SLN and Cx was significantly greater than that of SLN stimulation alone. There were no significant differences in any parameters of the JCR between conditions. These results clearly showed that JOR responses were significantly suppressed, not only during peripherally evoked swallowing but also during centrally evoked swallowing, and that the inhibitory effect is likely to be larger during centrally compared with peripherally evoked swallowing. The functional implications of these results are discussed.

DOI： 10.1016/j.brainres.2018.05.002

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Language：Japanese   Publisher：新潟歯学会  

聴神経腫瘍術後に嚥下障害を認めた一例を報告する。症例は56歳女性。2017年2月に小脳・脳幹を圧迫する聴神経鞘腫に対する摘出術施行、術後左小脳出血及び延髄から橋にかけて低吸収域を認めたため、脳内血腫除去および減圧開頭術が施行された。術後11日目に嚥下機能評価目的に当科初診となった。小脳前庭症状としての姿勢保持困難と失調性構音障害、球麻痺症状としての顔面神経麻痺、舌運動減弱、開鼻声を伴う右カーテン徴候を認めた。反復唾液嚥下テストは2回、改訂水飲みテストおよびとろみ付液体3ccでのテストでは3a点(嚥下後湿性音あり)であった。嚥下内視鏡検査時、安静時より咽頭内分泌物貯留、左側披裂・声帯は傍正中位固定で声門閉鎖不良、ホワイトアウトは減弱しており、とろみ付液体摂取時の食道流入不良、鼻咽腔逆流を認めた。さらに、残留物は不顕性誤嚥をしていた。重度摂食嚥下障害の診断にて、口腔ケア・間接訓練から介入を開始した。耐久性が改善した術後19日目以降は間接訓練の負荷を増やし、少量のとろみ付液体を用いた直接訓練も開始した。術後35日目に実施した嚥下造影検査では、依然として嚥下後の咽頭残留量が多く食事開始にはいたらなかった。転院を前に術後55日目に実施した最終評価では、幻暈などの前庭症状は改善していたものの球麻痺症状に大きな変化は認められなかった。最終的に食事開始までは至らなかったものの、訓練の効果による咽頭残留の軽減と姿勢調整を行うことで安全な経口摂取方法の提案ができた。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer New York LLC  

The aim of this study was to determine if bolus and dry swallow showed similar pressure changes in the oropharynx using our newly developed device. A unique character of it includes that baropressure can be measured with the sensor being placed in the balloon and can assess the swallowing mechanics in terms of pressure changes in the oropharynx with less influences of direct contacts of boluses and oropharyngeal structures during swallow indirectly. Fifteen healthy subjects swallowed saliva (dry), 15 ml of water, 45 ml of water, and 15 ml of two different types of food in terms of viscosity (potage soup-type and mayonnaise-type foods). Suprahyoid muscle activity was recorded simultaneously. Three parameters, area under the curve (AUC), peak amplitude, and duration of pressure, were analyzed from each swallow. Almost all of the bolus swallowing events had biphasic baropressure responses consisting of an early phase and late phase (99%), whereas 90% of the saliva swallowing events had a single phase. AUC, peak, and duration displayed greater effects during the late phase than during the early phase. Baropressure of the early phase, but not of the late phase, significantly increased with increasing volume
however, small but significant viscosity effects on pressure were seen during both phases. Peak pressure of the late phase was preceded by maximum muscle activity, whereas that of the early phase was seen when muscle activity displayed a peak response. These findings indicated that our device with the ability to measure baropressure has the potential to provide additional parameter to assess the swallow physiology, and biphasic baropressure responses in the early and late phases could reflect functional aspects of the swallowing reflexes.

DOI： 10.1007/s00455-017-9836-9

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Language：English   Publishing type：Research paper (scientific journal)  

Surface electrical stimulation of the laryngeal region is used to improve swallowing in dysphagic patients. However, little is known about how electrical stimulation affects tongue movements and related functions. We investigated the effect of electrical stimulation on tongue pressure and hyoid movement, as well as suprahyoid and infrahyoid muscle activity, in 18 healthy young participants. Electrical stimulation (0.2-ms duration, 80 Hz, 80% of each participant's maximal tolerance) of the laryngeal region was applied. Each subject swallowed 5 ml of barium sulfate liquid 36 times at 10-s intervals. During the middle 2 min, electrical stimulation was delivered. Tongue pressure, electromyographic activity of the suprahyoid and infrahyoid muscles, and videofluorographic images were simultaneously recorded. Tongue pressure during stimulation was significantly lower than before or after stimulation and was significantly greater after stimulation than at baseline. Suprahyoid activity after stimulation was larger than at baseline, while infrahyoid muscle activity did not change. During stimulation, the position of the hyoid at rest was descended, the highest hyoid position was significantly inferior, and the vertical movement was greater than before or after stimulation. After stimulation, the positions of the hyoid at rest and at the maximum elevation were more superior than before stimulation. The deviation of the highest positions of the hyoid before and after stimulation corresponded to the differences in tongue pressures at those times. These results suggest that surface electrical stimulation applied to the laryngeal region during swallowing may facilitate subsequent hyoid movement and tongue pressure generation after stimulation. NEW & NOTEWORTHY Surface electrical stimulation applied to the laryngeal region during swallowing may facilitate subsequent hyoid movement and tongue pressure generation after stimulation. Tongue muscles may contribute to overshot recovery more than hyoid muscles.

DOI： 10.1152/japplphysiol.00512.2017

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Language：English   Publishing type：Research paper (scientific journal)  

Pharyngeal electrical stimulation (PEStim) has been found to facilitate voluntary swallowing. This study investigated how PEStim contributed to modulation of swallowing function in 15 healthy humans. In the involuntary swallowing test, water was injected onto the pharynx at 0.05 ml/s and the onset latency of the first swallow was measured. In the voluntary swallowing test, subjects swallowed their own saliva as quickly as possible for 30 s and the number of swallows was counted. Voluntary and involuntary swallowing was evaluated before (baseline), immediately after, and every 10 min after 10-min PEStim for 60 min. A voluntary swallowing test with simultaneous 30-s PEStim was also conducted before and 60 min after 10-min PEStim. The number of voluntary swallows with simultaneous PEStim significantly increased over 60 min after 10-min PEStim compared with the baseline. The onset latency of the first swallow in the involuntary swallowing test was not affected by 10-min PEStim. The results suggest that PEStim may have a long-term facilitatory effect on the initiation of voluntary swallowing in healthy humans, but not on peripherally-evoked swallowing. The physiological implications of this modulation are discussed.

DOI： 10.1371/journal.pone.0190608

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY  

Mastication is essential to the eating process and forms an important part of feeding behaviour. Many factors related to the food bolus, such as bolus texture and size, are known to influence mastication. The aim of this study was to determine the effects of body posture on (i) chewing duration prior to the first swallow and (ii) patterns of mastication-related EMG activity. We asked 10 healthy adults to chew 8g of steamed rice with barium sulphate while we recorded masseter, suprahyoid and infrahyoid muscle activity and simultaneously collected videofluorographic images. Participants chewed in either an upright or reclining position. Chewing duration, which was defined as the time from the start of mastication to the first swallow, was not different between the positions. However, the variability of chewing duration was larger in the upright versus reclining position, and the chewing duration in the reclining position was distributed around 15s. Masseter activity gradually decreased in a time-dependent manner and was significantly larger at the early versus late stage of mastication. Suprahyoid activity was significantly larger at the early versus middle stage of mastication in the upright position only. Finally, masseter activity per second was negatively correlated with changes in chewing duration, that is, the larger the increase in chewing duration in the reclining position, the more the decrease in masseter activity per second. These results suggest that position-dependent changes in chewing behaviours, as described by chewing duration and EMG activity, may vary among participants.

DOI： 10.1111/joor.12555

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Language：Japanese   Publisher：(一社)日本摂食嚥下リハビリテーション学会  

介護保険施設において、口腔ケアおよび摂食指導を必要としている要介護高齢者は少なくない。今後、研修歯科医が食事の場面に立ち会い、摂食指導をすることが重要であるが、その機会はまだ少ないと考えられる。新潟大学では、特別養護老人ホームを週に1回訪問し、口腔ケアや摂食指導を行っているが、その際に研修歯科医が2〜3名ずつ同行して、実際の口腔ケアや摂食指導を研修している。今後、よりよい研修プログラムを提供するため、研修歯科医の介護保険施設における口腔ケアおよび摂食指導の経験の有無や、本プログラムを研修した感想等に関するアンケート調査を実施した。対象は、2009〜2013年度に、口腔ケアおよび摂食指導の研修を行った本学研修歯科医144名とし、口腔ケアおよび摂食指導に対する知識・経験の有無について調査した。その結果、80.4%が口腔ケアの知識があると回答していたが、実際に口腔ケアあるいは摂食指導を経験したことがある者は少なかった(口腔ケア56.6%、摂食指導18.2%)。また、大半が、口腔ケアおよび摂食指導が勉強になったと回答していた。口腔ケアあるいは摂食指導に対する歯科専門スタッフの介入価値があると思うと回答した者は、口腔ケアでは82.5%、摂食指導では78.3%と高い割合を示した。要介護高齢者の数は増加の一途をたどっており、今後、口腔ケアおよび摂食指導において歯科医師が果たす役割は、ますます大きくなっていくと思われる。患者家族やコメディカルに摂食指導をする立場にある歯科医師の臨床研修に、介護保険施設等における口腔ケアおよび摂食指導を導入することは重要であるといえる。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J03152&link_issn=&doc_id=20170524040003&doc_link_id=%2Fcb5dvsph%2F2016%2F002002%2F003%2F0080-0085%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcb5dvsph%2F2016%2F002002%2F003%2F0080-0085%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：PERGAMON-ELSEVIER SCIENCE LTD  

We compared onset latency, motor-response patterns, and the effect of electrical stimulation of the cortical masticatory area between peripherally and cortically evoked swallows by electrical stimulation in anesthetized rats. The number of swallows and the motor patterns were determined using electromyographic recordings from the thyrohyoid, digastric, and masseter muscles. The onset latency of the first swallow evoked by electrical stimulation of the cortical swallowing area (Cx) was significantly longer than that evoked by stimulation of the superior laryngeal nerve (SLN). The duration of thyrohyoid burst activity associated with SLN-evoked swallows was significantly longer than that associated with either Cx-evoked or spontaneous swallows. Combining Cx with SLN stimulation increased the number of swallows at low levels of SLN stimulation. Finally, A-area (the orofacial motor cortex) stimulation inhibited Cx-evoked swallows significantly more than it inhibited SLN-evoked swallows. These findings suggest that peripherally and cortically evoked swallows have different response properties and are affected differently by the mastication network. (C) 2016 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.brainresbull.2016.02.015

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PERGAMON-ELSEVIER SCIENCE LTD  

Clinically, reclining posture has been reported to reduce risk of aspiration. However, during involuntary swallow in reclining posture, changes in orofacial and pharyngeal movement before and during pharyngeal swallow should be considered. Further, the mechanisms underlying the effect of body posture on involuntary swallow remain unclear. The aim of the present study was to determine the effect of body posture on activity patterns of the suprahyoid muscles and on patterns of bolus transport during a natural involuntary swallow. Thirteen healthy male adults participated in a water infusion test and a chewing test. In the water infusion test, thickened water was delivered into the pharynx at a very slow rate until the first involuntary swallow was evoked. In the chewing test, subjects were asked to eat 10 g of gruel rice. In both tests, the recording was performed at four body postures between upright and supine positions. Results showed that reclining changed the location of the bolus head at the start of swallow and prolonged onset latency of the swallowing initiation. Muscle burst duration and white-out time measured by videoendoscopy significantly increased with body reclining and prolongation of the falling time. In the chewing test, reclining changed the location of the bolus head at the start of swallow, and the frequency of bolus residue after the first swallow increased. Duration and area of EMG burst and whiteout time significantly increased with body reclining. These data suggest that body reclining may result in prolongation of pharyngeal swallow during involuntary swallow. (C) 2015 Elsevier Inc All rights reserved.

DOI： 10.1016/j.physbeh.2015.12.024

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PERGAMON-ELSEVIER SCIENCE LTD  

This study aimed to investigate how the activity of the masseter (Mas) and suprahyoid (Hyoid) muscles is influenced by the physical properties of food, how changes in the rheological properties of food differ between different foods during the process of food reduction, and how different salivary flow rates affect bolus-making capability during masticatory behavior in healthy humans. Ten healthy adults participated in this study. Electro-myographic (EMG) recordings were obtained from the Mas and Hyoid muscles, and 15 g of steamed rice and rice cake was prepared as test foods. In the ingestion test, the subjects were asked to eat each food in their usual manner. The chewing duration, number of chewing cycles before the first swallow, Mas and Hyoid EMG activity, and chewing cycle time were compared between the foods. Total chewing duration was divided into three substages: early, middle, and late; chewing cycle time and EMG activity per chewing cycle of each substage were compared between the foods and among the substages. In the spitting test, the rheological properties of the bolus at the end of each substage were compared between the foods and among the substages. Finally, stimulated salivary flow rates were measured and the relationships between salivary flow rate and chewing duration, EMG activity, and changes in physical food characteristics were investigated. There were significant differences in total chewing duration and the number of chewing cycles, but not in chewing cycle time, between the foods, which had similar hardness values. The EMG activity levels of the Mas and Hyoid per chewing cycle for the rice cake were significantly greater than for the steamed rice throughout the recording periods. While Mas activity did not change among the substages during chewing, Hyoid EMG activity decreased as chewing progressed. Chewing cycle time also gradually decreased as chewing progressed. The hardness of both foods initially increased, then gradually decreased back to baseline. The adhesiveness of the rice cake initially increased, and did not fall throughout the recording period; the adhesiveness of the steamed rice did not significantly change. Cohesiveness barely changed in either of the two foods during chewing, but was significantly greater for the rice cake than for the steamed rice. Finally, a correlation between the stimulated salivary flow rate and chewing performance was evident only in a change in Mas EMG activity. The current results demonstrate that the activities of the Mas and Hyoid muscles changed as chewing progressed, and were affected by hardness, adhesiveness, and cohesiveness. Salivary flow rate may affect the changes in Mas activity during the process of bolus formation. (C) 2015 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.physbeh.2015.10.004

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PERGAMON-ELSEVIER SCIENCE LTD  

We investigated (1) how peripheral inputs might assist central inputs in the control of voluntary evoked swallowing, (2) inter-individual variation in involuntary and voluntary swallowing initiation, and (3) whether natural chewing behavior affects the initiation of involuntary swallowing in healthy humans. Eleven participants completed a repetitive saliva swallowing test (RSST), chewing test (CHEW), and rest period,(REST). In RSST, participants repetitively swallowed as quickly as possible. In CHEW, subjects chewed gum freely. We delivered pharyngeal electrical stimulation (PEStim) to the laryngopharynx and compared the number of swallows that occurred with and without PEStim. PEStim significantly increased the number of voluntary evoked swallows in RSST, as well as the number of swallows in CHEW and REST trials, although this facilitatory effect was larger in REST trials. We found a positive correlation between the number of swallows at RSST without PEStim and that at REST with PEStim within individuals. Additionally, we found a significant positive correlation between the number of swallows at RSST with PEStim and the sum of that at RSST without PEStim and at REST with PES. Based on the current results, we suggest that (1) peripheral inputs within a certain range appear to facilitate the central inputs that control voluntary swallowing, (2) inter-individual variations in swallowing initiation may arise from differences in the excitability of the common neural network in the lower brainstem, and (3) during chewing, food reduction in the oral cavity is prioritized, such that the neural network associated with chewing may regulate swallowing initiation. (C) 2015 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.physbeh.2015.08.003

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PERGAMON-ELSEVIER SCIENCE LTD  

We study whether the red nucleus is involved in control of swallowing. The swallowing reflex was induced in anesthetized rats by repetitive electrical stimulation of the superior laryngeal nerve. The electromyographic activities of the mylohyoid and thyrohyoid muscles were recorded in order to identify the swallowing reflex. Repetitive electrical stimulation applied to the red nucleus reduced the number of swallows. The onset latency of the first swallow was increased during repetitive electrical stimulation applied to the magnocellular part of the red nucleus. Microinjection of monosodium glutamate into the red nucleus also reduced the number of swallows. The onset latency of the first swallow was increased after microinjection of monosodium glutamate into the magnocellular part of the red nucleus. These results imply that the red nucleus is involved in the control of swallowing. (C) 2015 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.brainresbull.2015.05.007

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PERGAMON-ELSEVIER SCIENCE LTD  

The aim of the present study was to investigate the adaptation of the swallowing reflex in terms of reduced swallowing reflex initiation following continuous superior laryngeal nerve stimulation. Forty-four male Sprague Dawley rats were anesthetized with urethane. To identify swallowing, electromyographic activity of the left mylohyoid and thyrohyoid muscles was recorded. To evoke the swallowing response, the superior laryngeal nerve (SLN), recurrent laryngeal nerve, or cortical swallowing area was electrically stimulated. Repetitive swallowing evoked by continuous SLN stimulation was gradually reduced, and this reduction was dependent on the resting time duration between stimulations. Prior SLN stimulation also suppressed subsequent swallowing initiation. The reduction in evoked swallows induced by recurrent laryngeal nerve or cortical swallowing area stimulation was less than that following superior laryngeal nerve stimulation. Decerebration had no effect on the reduction in evoked swallows. Prior subthreshold stimulation reduced subsequent initiation of swallowing, suggesting that there was no relationship between swallowing movement evoked by prior stimulation and the subsequent reduction in swallowing initiation. Overall, these data suggest that reduced sensory afferent nerve firing and/or trans-synaptic responses, as well as part of the brainstem central pattern generator, are involved in adaptation of the swallowing reflex following continuous stimulation of swallow-inducing peripheral nerves and cortical areas. (C) 2014 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.brainresbull.2014.12.008

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Language：Japanese   Publisher：日本歯科医学教育学会  

超高齢社会の到来に伴い、訪問歯科診療の需要も増加しているが、供給は十分になされていないのが現状である。その理由として、在宅の訪問歯科診療実施が不安だという報告もある。今後、増加する訪問歯科診療の需要に応えるには、歯学部学生に対して、訪問歯科診療見学実習を実施し、実習後に評価を行って実習内容の改善に努めることが必要であると考える。新潟大学歯学部歯学科では、1998年から6年次生に対して訪問歯科診療見学実習を行っている。今回、訪問歯科診療に対する意識および現在行われている訪問歯科診療見学実習の評価に関する情報収集を目的として、質問紙法による調査を実施した。2013年に、6年次生を対象とした訪問歯科診療見学実習前後に無記名の質問紙調査を行い、比較検討した。解析対象となった33名全員が、実習を有意義であると回答していた。有意差は認められなかったものの、訪問歯科診療を「大変」と思う者および訪問歯科診療に対する不安は実習後に減少しており、訪問歯科診療を実際に見学することによって訪問歯科診療の実状を知ることができたためだと考えられる。その一方、見学後の総括で、訪問歯科診療で行うことが可能な診療や診療姿勢についての指導が必要であることも明らかになった。今後、見学内容をさらに改善し、継続していきたいと考えている。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)  

Objectives Behavioural performance of tablet swallowing was evaluated with different tablet conditions in terms of size, number and surface coating. Methods Four different types of tablets were prepared: small or large, and with or without a surface coating. Fourteen normal male adults were instructed to swallow the prepared tablets with 15 ml of water. The number of tablets in one trial was changed from one to three. To evaluate swallowing and tablet transport, electromyographic activity was recorded in the left suprahyoid muscles, and videofluorographic images were examined. Key findings All tablet conditions (size, number and surface coating) affected the swallowing performance in terms of total number of swallows, electromyographic burst patterns and location of remaining tablets. Increases in the size and number of tablets increased the number of swallows and electromyographic burst area and duration. In addition, all of these parameters increased while swallowing tablets without a coating compared with tablets with a coating. Location of the remaining tablets was mainly within the mouth. Conclusions This study only clarified the normal pattern of tablet swallowing under several conditions in healthy subjects, but the results may facilitate comprehensive evaluation and treatment planning in terms of administering medication to dysphagic patients. © 2013 Royal Pharmaceutical Society.

DOI： 10.1111/jphp.12155

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

The aims of the present study were to determine whether the interval between swallows and the electromyographic (EMG) burst patterns of the suprahyoid muscles is affected by peripheral inputs during swallowing. Eighteen normal adults were asked to perform repetitive voluntary swallowing as quickly as possible, and three variables of swallowing were measured and evaluated, i.e., the swallowing intervals and the time interval between the onset and peak (rising time) and between the peak and offset (falling time) of the suprahyoid EMG burst. During recording, pharyngeal fluid infusion was applied with distilled water or 0.3 M NaCl solution at a very slow infusion rate (0.2 mL/min). The former and latter were used to activate and inhibit the excitation of water-sensitive receptors in the pharynx, respectively. The swallowing interval was significantly shorter during infusion of water than during infusion of NaCl solution. The rising time was also significantly shorter during infusion of water than during infusion of NaCl solution. There was a linear positive correlation between these values and facilitatory effects: the longer either the swallowing interval or rising time with infusion of 0.3 M NaCl solution, the stronger the facilitation of swallowing by the activation of water receptors. Facilitatory effects on the swallowing interval and rising time showed a linear correlation. It is suggested that weak liquid stimulation changed sensory inputs into the swallowing center and synchronously modulated the swallowing interval and time interval between the onset and peak of the EMG burst.

DOI： 10.1007/s00221-013-3641-y

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Nihon University School of Dentistry  

We evaluated the effects of gel consistency and bolus volume on ingestion in humans. Eight healthy men were asked to ingest liquids, and sample foods of different gel consistencies and volumes, as usual. Tongue pressure against the hard palate was recorded at five points, and bolus flow was recorded using videoendoscopic images. The number of squeezes increased as gel consistency and volume increased. The integrated magnitude of tongue pressure during squeezing increased with increasing gel consistency. Bolus propulsion into the pharynx was affected by bolus characteristics, and location of the bolus head at the onset of pharyngeal swallowing was not related to squeezing behavior. The trigger point at which pharyngeal swallowing began was subject-dependent. During swallowing, the magnitude of tongue pressure moderately increased with increasing gel consistency, as compared with squeezing. Tongue pressure was not related to bolus volume. The current results suggest that patterns of tongue pressure during squeezing and swallowing are differentially affected by bolus conditions. However, healthy subjects differed in the techniques used for squeezing and swallowing.

DOI： 10.2334/josnusd.55.191

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Other Link： http://search.jamas.or.jp/link/ui/2015016896

Language：English   Publishing type：Research paper (scientific journal)  

The present study was designed to evaluate how typical Japanese staple foods - rice and rice cake - with different physical properties influence the patterns of muscle activity during chewing. Six normal adults were asked to eat rice and rice cake freely in a natural manner. Surface electromyographic recordings of the masseter and suprahyoid muscles were performed. There were large differences between the foods in terms of masticatory duration. The masseter activity per cycle was significantly greater for rice cake than for rice. The masseter activity gradually decreased as chewing progressed, although the suprahyoid activity did not change throughout the sequence of rice cake chewing. The results suggest that the process of bolus formation with rice cake is very different from that with rice in terms of jaw-closing and jaw-opening muscle activities. Practical Applications: This study aimed to examine how the masticatory sequence adapts to variations in the initial properties of foods. This research may enhance our understanding of the oral physiology of bolus formation and changes in the physical properties of foods during chewing. © 2012 Wiley Periodicals, Inc.

DOI： 10.1111/j.1745-4603.2012.00364.x

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER IRELAND LTD  

It has been reported that the jaw opening reflex (JOR) evoked by intra-oral innocuous stimulation was suppressed during a reflex swallow in anesthetized animals only. However, the mechanism of JOR inhibition during swallowing has not yet been elucidated. The aim of the present study was to investigate the effects of peripheral nerve stimulation on masticatory behaviors, as well as the modulation of low threshold afferent evoked JOR responses during chewing and swallowing in freely feeding animals. The JOR in the digastric muscle was evoked by low threshold electrical stimulation of the inferior alveolar nerve (IAN). Changes in the peak-to-peak amplitude of digastric electromyographic responses were compared among the phases of chewing and swallowing. IAN stimulation did not produce any differences in cycle duration, gape of the jaw in one cycle, or swallowing interval, suggesting a minimal effect on feeding behaviors. The JOR amplitude during the fast-closing, slow-closing, and slow-opening phases of chewing was significantly smaller than that of the control (recorded when the animal was at rest) and fast-opening phase. During swallowing, the JOR amplitude was significantly less than the control. Inhibition of the JOR during swallowing is assumed to prevent unnecessary opposing jaw opening motion. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.neulet.2012.12.047

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Language：Japanese   Publisher：新潟歯学会  

【目的】居宅療養管理指導では、口腔内の衛生管理と口腔機能の評価が義務付けられている。今回、居宅療養管理指導の実施が対象者にもたらした効果について検討した。【対象と方法】S市在住で訪問診療の希望があった20名(82.2±8.0歳)を対象とした。訪問歯科診療および居宅療養管理指導を継続し、初診時と3ヵ月後の要介護度、摂食機能評価(栄養摂取状況、経口摂取状態、洗口能力、舌運動、頬運動、口輪筋運動、咀嚼運動、嚥下運動、義歯使用状況)、口腔清掃状況の各項目を比較し、それぞれ4段階で評価した。また、改善度について3段階で評価した。【結果】往診依頼内容は歯科治療8例、義歯治療7例、口腔ケア・摂食機能療法5例で、義歯治療依頼における要介護度が有意に低かった。摂食機能に関わる各項目を介入前後で比較したところ、いずれの項目についても統計学的に有意な変化は認められなかった。一方、改善度に関する解析では、いずれの項目も「変化なし」が有意に多かった。【考察】居宅療養管理指導を行うことで口腔衛生面、摂食に関わる機能の維持は可能だった。しかし、食事形態や経口摂取状況が低下したケースが認められたのは、予防的措置あるいは摂食機能以外の要因によると考えられる。本研究の結果、要介護高齢者であっても適切な歯科治療および療養管理指導を行うことで、要介護度の悪化防止と摂食機能の維持が可能なことが示唆された。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2012&ichushi_jid=J00999&link_issn=&doc_id=20130111530002&doc_link_id=%2Fdj2ngtdt%2F2012%2F004202%2F002%2F0089-0096%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdj2ngtdt%2F2012%2F004202%2F002%2F0089-0096%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

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 urethane. To identify DIG and MH neurons, the peripheral nerve (either DIG or MH) was stimulated to evoke action potentials of single motoneurons. Motoneurons were identified as such if they either (1) responded to antidromic nerve stimulation of DIG or MH in an all-or-none manner at threshold intensities and (2) followed stimulation frequencies of up to 0.5 kHz. As a result, all 11 MH neurons recorded were synchronously activated during the swallowing reflex, while there was no activity in any of the 7 DIG neurons recorded during the swallowing reflex. All neurons were anatomically localized ventromedially at the level of the caudal portion of the trigeminal motor nucleus, and there were no differences between the MH and DIG neuron sites. The present results strongly suggest that at least in the rabbit, DIG motoneurons are not tightly controlled by the swallowing CPG and, hence, the DIG muscle is less involved in the swallowing reflex.

DOI： 10.1007/s00455-011-9363-z

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Language：English   Publishing type：Research paper (scientific journal)  

The present study tested whether electrical stimulation increases the number of voluntary repetitive swallows in humans. In addition, the potential of initiating both voluntary and involuntary swallows was compared using electrical stimulation. Fourteen normal male adults were instructed to perform repetitive voluntary swallowing as quickly as possible over 30 s, and the number of swallows was counted with and without repetitive electrical stimulation (80% of maximal tolerated intensity; 0.1 ms in pulse duration; 30 Hz) of the nasal cavity, nasopharynx, oropharynx, or laryngopharynx. Although the number of swallows was significantly increased during electrical stimulation of the laryngopharynx, oropharynx, and nasopharynx, there was a wide variation in the number among subjects. The number of reflexively evoked swallows (i.e., involuntary swallows) by pharyngeal stimulation also varied greatly, and there was a significant linear correlation in the number of swallows between voluntary and involuntary swallows. The present study demonstrated the facilitatory effects of pharyngeal electrical stimulation on voluntary swallowing in humans. Furthermore, the potentials of initiation of

DOI： 10.1016/j.physbeh.2012.02.007

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE BV  

Many phosphorylated extracellular signal-regulated kinase (pERK)-immunoreactive (IR) cells are expressed in the trigeminal spinal subnucleus caudalis (Vc), upper cervical spinal cord (C1-C2), nucleus tractus solitarii (NTS) and paratrigeminal nucleus (Pa5) after capsaicin injection into the whisker pad (WP), masseter muscle (MM), digastric muscle (DM) or stemohyoideus muscle (SM). The pERK-IR cells also showed NeuN immunoreactivity, indicating that ERK phosphorylation occurs in neurons. The pERK-IR cells were significantly reduced after intrathecal injection of MEK 1/2 inhibitor PD98059. The pERK-IR cells expressed bilaterally in the Vc and C1-C2 after capsaicin injection into the unilateral DM or SM, whereas unilaterally in the Vc and C1-C2 after unilateral WP or MM injection. After capsaicin injection into the WP or MM, the pERK-IR cell expression in the Vc was restricted rostrocaudally within a narrow area. However, the distribution of pERK-IR cells was more wide spread without a clear peak in the Vc and C1-C2 after capsaicin injection into the DM or SM. In the NTS, the unimodal pERK-IR cell expression peaked at 0-720 mu m rostral from the obex following capsaicin injection into WP, MM, DM or SM. In the ipsilateral Pa5, many pERK-IR cells were observed following capsaicin injection into the SM. The number of swallows elicited by distilled water administration was significantly smaller after capsaicin injection into the we, MM or DM but not SM compared to that of vehicle-injected rats. Various noxious inputs due to the masticatory or swallowing-related muscle inflammation may be differentially involved in muscle pain and swallowing reflex activity. (C) 2011 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.brainres.2011.08.032

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE BV  

The present study aimed to examine whether the jaw-opening reflex (JOR) is modulated during swallowing, and if so, to compare the modulation between the low- and high-threshold afferent-evoked reflex responses. Experiments were carried out on 11 anesthetized rabbits. The inferior alveolar nerve was stimulated to evoke the JOR in the digastric muscle. The stimulus intensity was either 1.5 (low threshold) or 4.0 (high threshold) times the threshold for eliciting the JOR. As a conditioning stimulation, the superior laryngeal nerve (SLN) was repetitively stimulated to evoke the swallowing reflex. The stimulus intensity ranged from 0.6 to 8.0 times the threshold to evoke the swallowing reflex during SLN stimulation over 20 s. Electromyographic (EMG) activities of the digastric and mylohyoid muscles were recorded, and the peak-to-peak EMG amplitude of the digastric muscle was measured and compared with and without SLN stimulation, as well as with and without swallowing. Comparisons were also made between low- and high-threshold afferent-evoked JORs. The JOR was strongly suppressed during SLN stimulation. The degree of suppression increased and the latency for the JOR was delayed when the stimulus current applied to the SLN was increased. Such modulation was apparent when the low-threshold afferent-evoked JOR was recorded. Effects of motor outputs of swallowing events and those of single-pulse stimulation of SLN on the inhibition of the JOR were not noted. These results suggest that the JOR evoked by both the low- and high-threshold afferents was inhibited during laryngeal sensory input and following swallowing, probably to prevent opposing jaw movements evoked by oral sensory input during swallowing. (C) 2011 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.brainres.2011.03.065

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Authorship：Corresponding author   Language：English   Publisher：Japanese Association for Oral Biology  

The number of water-induced swallows was decreased following capsaicin injection into the facial (whisker pad) skin, masseter or lingual muscle. The capsaicin-induced inhibitory effect on the swallowing reflex was depressed after intrathecal administration of mitogen-activated protein kinase (MAPK) kinase (MEK) inhibitor. The inhibitory effect on swallowing following capsaicin injection into the lingual muscle was diminished by paratrigeminal nucleus (Pa5) lesioning. Many phosphorylated extracellular signal-regulated kinase-like immunoreactive neurons in the nucleus tractus solitarii (NTS) showed gamma-aminobutyric acid (GABA) immunoreactivity and capsaicin-induced inhibition of the swallowing reflex was diminished by local microinjection of the GABAA receptor antagonist into the NTS. The present findings suggest that facial skin-NTS, masseter muscle-NTS, lingual muscle-NTS and lingual muscle-Pa5-NTS pathways are involved in the swallowing inhibition by facial, masseter and lingual pain, and that the activation of GABAergic NTS neurons may be involved in inhibition of the swallowing reflex.

DOI： 10.2330/joralbiosci.53.137

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER IRELAND LTD  

Pain is associated with swallowing abnormalities in dysphagic patients. Understanding neuronal mechanisms underlying the swallowing abnormalities associated with orofacial abnormal pain is crucial for developing new methods to treat dysphagic patients. However, how the orofacial abnormal pain is involved in the swallowing abnormalities is not known. In order to evaluate neuronal mechanisms of modulation of the swallows by masticatory muscle pain, here we first induced swallows by topical administration of distilled water to the pharyngolaryngeal region. The swallowing reflex was significantly inhibited after capsaicin (10, 30 mM) injection into the masseter muscle compared to vehicle injection. Moreover the number of phosphorylated extracellular signal-regulated kinase-like immunoreactive (pERK-LI) neurons in the nucleus tractus solitarii (NITS) was significantly increased in the rats with capsaicin injection into the masseter Muscle compared to that with vehicle injection. Rostro-caudal distribution of pERK-LI neurons in the NTS was peaked at the obex level. The capsaicin-induced inhibitory effect on swallowing reflex was reversed after intrathecal administration of mitogen-activated protein kinase (MAPK kinase (MEK) inhibitor, PD98059. The present findings Suggest that phosphorylation of ERK in NTS neurons may be involved in capsaicin-induced inhibition of swallowing reflex. (C) 2008 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.neulet.2008.12.008

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Language：Japanese   Publisher：日本消化器病学会-甲信越支部  

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Language：Japanese   Publisher：新潟歯学会  

クロウ・深瀬(POEMS)症候群の治療中に誤嚥性肺炎を発症し、摂食嚥下リハビリテーションを行った一例を報告する。症例は83歳男性。2012年にPOEMS症候群と診断され、サリドマイド治験に参加し、加療されていた。2017年11月に誤嚥性肺炎の診断で入院となり、摂食嚥下機能評価目的に当科初診となった。初診時、随意咳嗽力が低下し、粗そう性および湿性嗄声を認め、最長発声持続時間は9.9秒であった。反復唾液嚥下テスト3回、とろみ付き液体1ml摂取では3%以上のSpO2低下と頸部聴診にて湿性音を認めた。嚥下内視鏡検査では、喉頭浮腫および唾液誤嚥を認め、少量の食物摂取も困難であった。重度咽頭期障害の診断にて、口腔ケアおよび間接訓練にて介入を開始した。介入23日目に嚥下造影検査を経て、直接訓練を開始したものの、介入44日目に熱発とCRPの上昇があり、痰喀出も困難な状況のため直接訓練は中止となった。介入63日目に摂食嚥下リハビリテーション目的で地域医療支援病院に転院となり、2ヵ月間のリハビリテーションを実施したものの嚥下機能に明らかな改善はみられなく、胃瘻造設のため当院へ再入院となった。唾液誤嚥レベルの重度咽頭期障害は変わらなかったものの、転院前は困難であった痰喀出は可能であった。その後も直接訓練と間接訓練を継続し、最終的に少量のゼリー摂取が可能となり、リハビリテーション病院への転院を迎えた。(著者抄録)

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Language：Japanese   Publisher：新潟歯学会  

頭頸部癌術後は、高頻度に摂食嚥下障害を生じる。今回、舌癌術後に摂食嚥下障害を生じ、リハビリテーションによる食形態や姿勢の調整によって経口摂取が可能となった症例を経験したので報告する。症例は68歳の男性。舌亜全摘術、両側頸部郭清術、腹直筋皮弁再建術、気管切開術、胃瘻造設術後、放射線治療開始と同時にN大学医歯学総合病院摂食嚥下機能回復部に紹介受診となった。初診時、頸部拘縮、舌切除による創部瘢痕化を伴う口腔移送不良・鼻咽腔閉鎖不全・咽頭収縮不全を認めた。嚥下内視鏡検査と嚥下造影検査により、リクライニング60度、左側臥位・右側頸部回旋位にてとろみ付液体2ccの食道流入が可能なことを確認して、毎日の間接訓練および代償法を用いた直接訓練を開始した。術後放射線治療の影響による口腔粘膜炎は自制内であり、訓練手技を獲得して耐久性が向上した介入29日目より食事開始、介入35日目には口腔移送改善を目的として舌接触補助床を用いた訓練を開始したものの、違和感や嘔気が強く常時使用にはいたらなかった。今後は、経口摂取のみでの栄養確保、歯科補綴学的アプローチによる口腔準備期の改善も可能であると考えている。(著者抄録)

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Language：Japanese   Publisher：新潟歯学会  

聴神経腫瘍術後に嚥下障害を認めた一例を報告する。症例は56歳女性。2017年2月に小脳・脳幹を圧迫する聴神経鞘腫に対する摘出術施行、術後左小脳出血及び延髄から橋にかけて低吸収域を認めたため、脳内血腫除去および減圧開頭術が施行された。術後11日目に嚥下機能評価目的に当科初診となった。小脳前庭症状としての姿勢保持困難と失調性構音障害、球麻痺症状としての顔面神経麻痺、舌運動減弱、開鼻声を伴う右カーテン徴候を認めた。反復唾液嚥下テストは2回、改訂水飲みテストおよびとろみ付液体3ccでのテストでは3a点(嚥下後湿性音あり)であった。嚥下内視鏡検査時、安静時より咽頭内分泌物貯留、左側披裂・声帯は傍正中位固定で声門閉鎖不良、ホワイトアウトは減弱しており、とろみ付液体摂取時の食道流入不良、鼻咽腔逆流を認めた。さらに、残留物は不顕性誤嚥をしていた。重度摂食嚥下障害の診断にて、口腔ケア・間接訓練から介入を開始した。耐久性が改善した術後19日目以降は間接訓練の負荷を増やし、少量のとろみ付液体を用いた直接訓練も開始した。術後35日目に実施した嚥下造影検査では、依然として嚥下後の咽頭残留量が多く食事開始にはいたらなかった。転院を前に術後55日目に実施した最終評価では、幻暈などの前庭症状は改善していたものの球麻痺症状に大きな変化は認められなかった。最終的に食事開始までは至らなかったものの、訓練の効果による咽頭残留の軽減と姿勢調整を行うことで安全な経口摂取方法の提案ができた。(著者抄録)

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Language：Japanese   Publisher：新潟歯学会  

頭頸部癌術後は、高頻度に摂食嚥下障害を生じる。今回、舌癌術後に摂食嚥下障害を生じ、リハビリテーションによる食形態や姿勢の調整によって経口摂取が可能となった症例を経験したので報告する。症例は68歳の男性。舌亜全摘術、両側頸部郭清術、腹直筋皮弁再建術、気管切開術、胃瘻造設術後、放射線治療開始と同時にN大学医歯学総合病院摂食嚥下機能回復部に紹介受診となった。初診時、頸部拘縮、舌切除による創部瘢痕化を伴う口腔移送不良・鼻咽腔閉鎖不全・咽頭収縮不全を認めた。嚥下内視鏡検査と嚥下造影検査により、リクライニング60度、左側臥位・右側頸部回旋位にてとろみ付液体2ccの食道流入が可能なことを確認して、毎日の間接訓練および代償法を用いた直接訓練を開始した。術後放射線治療の影響による口腔粘膜炎は自制内であり、訓練手技を獲得して耐久性が向上した介入29日目より食事開始、介入35日目には口腔移送改善を目的として舌接触補助床を用いた訓練を開始したものの、違和感や嘔気が強く常時使用にはいたらなかった。今後は、経口摂取のみでの栄養確保、歯科補綴学的アプローチによる口腔準備期の改善も可能であると考えている。(著者抄録)

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Language：Japanese   Publisher：新潟歯学会  

低酸素脳症発症後に嚥下障害を認めた一例を報告する。症例は69歳女性。2015年11月より右気胸にて当院呼吸器感染症内科に入院した。入院6日目に院内で緊張性気胸を再発し、心肺停止に伴う低酸素脳症を発症した。発症58日目に意識レベルの改善を認め、嚥下機能評価のため当科初診となった。指示理解不良で意識レベルはJCS I-3であり、口腔衛生状態は不良で、残存歯は少ないが義歯使用により咬合支持が得られる状態であった。発声・腹式呼吸は不可だった。顎舌顔面の感覚あるものの、舌運動は不良で、呼吸状態不良につき頬ふくらまし・吸引は不可だった。頸部運動は不良で、反復唾液嚥下テストは0回だった。介入3日目(発症60日目)、嚥下内視鏡検査を実施した。安静時より咽頭に分泌物の貯留あり。とろみ摂取時には、喉頭侵入および咽頭残留があったものの誤嚥は認められなかった。先行期から嚥下咽頭期にわたる機能的嚥下障害と診断し、口腔ケア・間接訓練から介入を開始した。呼吸状態安定時のみ少量の直接訓練を実施した。介入57日目(発症114日目)には、義歯調整を行った後に、嚥下造影検査を実施した。液体・ゆるめのとろみにて声門上まで喉頭侵入し、固形物は喉頭蓋谷及び舌背に残留を認めた。ティースプーン一杯量を摂取した際に、患者は咽頭残留を自覚できた。食事による訓練が可能と判断し、全粥・半固形食とろみ付きの食事を開始した。並行して舌運動訓練を実施し、最終的に全粥・半固形食を3食摂取可能となった。(著者抄録)

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Language：Japanese   Publisher：新潟歯学会  

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小脳橋角部髄膜腫摘出術後に嚥下障害を認めた一例を報告する。症例は57歳女性。2015年1月9日、疼痛の制御困難につき、当院脳神経外科入院下にて摘出術施行された。同月13日(術後4日目)、嚥下機能評価目的に当科初診。口腔衛生状態は不良で、残根歯多数認め、臼歯部の咬合支持はほぼ無い状態。安静時より湿性嗄声を認め、自己喀痰は困難。左側三叉・顔面・舌咽・迷走・舌下神経領域の運動・感覚不全麻痺あり。反復唾液嚥下テストは0回、唾液誤嚥の疑いを認めたために0.5mlの水飲みテストを行ったところむせを認めた。以上より、準備期から嚥下咽頭期にわたる機能的嚥下障害と診断して、まずは口腔ケア、間接訓練より介入開始。術後18日目、嚥下内視鏡検査を実施。検査食の咽頭部残留を認めるも明らかな誤嚥を認めなかったことから、翌日より直接訓練を開始。術後27日目、嚥下造影検査実施。右側臥位・左側頸部回旋位では、中間位に比して嚥下後の咽頭部残留が減少したことから、姿勢調整により経口摂取可能と判断して同日より食事開始。経過に応じ食上げを行い、並行して新義歯作製および咀嚼訓練実施。最終的に中間位にて米飯・軟々菜食まで摂取可能となり、術後86日目に自宅退院に至った。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2015&ichushi_jid=J00999&link_issn=&doc_id=20151228460006&doc_link_id=%2Fdj2ngtdt%2F2015%2F004502%2F006%2F0081-0085%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdj2ngtdt%2F2015%2F004502%2F006%2F0081-0085%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本顎口腔機能学会  

味覚刺激が嚥下運動にどのような変化を与えるかについて調べることを目的として、異なる濃度の塩味またはうま味溶液を口腔内に微量注入した時の随意性嚥下運動を記録した。健常成人29名を対象として、出来るだけ早く繰り返し嚥下するよう指示し、その際に咽頭または口腔への溶液刺激(0.2mL/min)を与えた。咽頭への溶液刺激は蒸留水または0.3 M NaCl溶液とし、口腔への溶液刺激は蒸留水または3種類のNaイオン濃度(6mM、40mM、240mM)のうま味溶液(モル濃度比2対1のグルタミン酸ナトリウムとイノシン酸ナトリウム混合溶液)、うま味溶液と同濃度のNaイオンを含むNaCl溶液とした。測定開始後4から9回目までの各嚥下間の平均時間を嚥下間隔時間として各条件間で比較した。NaCl溶液、蒸留水いずれの咽頭刺激においても嚥下間隔時間の顕著な個人差が認められた。NaCl溶液刺激時の嚥下間隔時間は蒸留水よりも有意に長く、咽頭の水受容器による嚥下反射誘発促進効果、NaCl溶液による水受容器応答の抑制が確認された。さらにNaCl溶液刺激時の嚥下間隔時間が長い被験者ほど蒸留水刺激による随意性嚥下の促進効果が高かった。一方、口腔への溶液刺激では、うま味溶液刺激時のみ蒸留水に対して有意な短縮を認めた。随意性嚥下能力の高い順から上位群、中位群、下位群ごとに嚥下間隔時間の変化を調べたところ、上位群、下位群では各溶液の濃度の違いによる有意な差は認められなかったのに対して、中位群のみ溶液濃度が高くなるに従って嚥下間隔時間の短縮を認めた。以上の結果は、中位群におけるうま味成分がもつ随意性嚥下への促進効果を示唆するものである。随意性嚥下誘発能力の個人差をもとに、末梢入力に対する嚥下運動誘発の時間間隔を比較したところ、咽頭刺激時とは異なっていたことから、口腔への味覚刺激がもつ嚥下中枢への効果は単なる加重効果として捉えられず、その効果の作用機序の理解に向けてはさらなる議論が必要である。(著者抄録)

DOI： 10.7144/sgf.20.106

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Language：Japanese   Publisher：日本歯科衛生学会  

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Language：Japanese   Publisher：医歯薬出版(株)  

2006〜2010年に当院を摂食・嚥下評価目的で受診した神経難病患者のうち、嚥下造影検査時に液体3mlの誤嚥を認めなかった筋萎縮性側索硬化症(ALS)患者35例と多系統萎縮症(MSA)患者43例および進行性核上性麻痺(PSP)患者5例の3疾患群と、健常者11例を加えた4群間で嚥下時の食塊移送状態を比較し、各疾患の特徴について検討した。結果、ALS患者の特徴として、嚥下反射惹起前に食塊が中咽頭から下咽頭にかけて流入し、嚥下後の咽頭内食塊残留が顕著であった。MSA患者では咽頭内食塊残留が他疾患に比べて少なかったものの、食塊の咽頭内早期流入が顕著であった。PSP患者は3疾患うち最も重度な嚥下機能障害を示した。すなわち、食塊が早期に下咽頭まで流入し、また咽頭内残留率が高かった。

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Language：Japanese   Publisher：クインテッセンス出版(株)  

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Language：Japanese   Publishing type：Meeting report   Publisher：(一社)歯科基礎医学会  

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Language：Japanese   Publishing type：Meeting report   Publisher：(一社)歯科基礎医学会  

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Language：Japanese   Publishing type：Meeting report   Publisher：日本歯科衛生学会  

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CiNii Article

CiNii Books

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CiNii Article

CiNii Books

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J-GLOBAL

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Event date： 2021.8

Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

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Language：English   Presentation type：Oral presentation (general)  

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Event date： 2021

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Event date： 2020.12

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Event date： 2020.12

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Event date： 2020.9

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Event date： 2020.9

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Event date： 2020

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Event date： 2019.12

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Event date： 2019.12

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Event date： 2019.9

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Event date： 2019

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Event date： 2018.11

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Event date： 2018.9

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J02994&link_issn=&doc_id=20200514280010&doc_link_id=10.7144%2Fsgf.25.32&url=https%3A%2F%2Fdoi.org%2F10.7144%2Fsgf.25.32&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Event date： 2018.9

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Event date： 2018.6

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頭頸部癌術後は、高頻度に摂食嚥下障害を生じる。今回、舌癌術後に摂食嚥下障害を生じ、リハビリテーションによる食形態や姿勢の調整によって経口摂取が可能となった症例を経験したので報告する。症例は68歳の男性。舌亜全摘術、両側頸部郭清術、腹直筋皮弁再建術、気管切開術、胃瘻造設術後、放射線治療開始と同時にN大学医歯学総合病院摂食嚥下機能回復部に紹介受診となった。初診時、頸部拘縮、舌切除による創部瘢痕化を伴う口腔移送不良・鼻咽腔閉鎖不全・咽頭収縮不全を認めた。嚥下内視鏡検査と嚥下造影検査により、リクライニング60度、左側臥位・右側頸部回旋位にてとろみ付液体2ccの食道流入が可能なことを確認して、毎日の間接訓練および代償法を用いた直接訓練を開始した。術後放射線治療の影響による口腔粘膜炎は自制内であり、訓練手技を獲得して耐久性が向上した介入29日目より食事開始、介入35日目には口腔移送改善を目的として舌接触補助床を用いた訓練を開始したものの、違和感や嘔気が強く常時使用にはいたらなかった。今後は、経口摂取のみでの栄養確保、歯科補綴学的アプローチによる口腔準備期の改善も可能であると考えている。(著者抄録)

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Event date： 2018.3

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Event date： 2018.3

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Event date： 2018.2

Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

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Event date： 2017.12

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Event date： 2017.12

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Event date： 2017.9

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J02994&link_issn=&doc_id=20180411290011&doc_link_id=%2Fex2gakuk%2F2017%2F002401%2F011%2F0040-0041%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fex2gakuk%2F2017%2F002401%2F011%2F0040-0041%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Event date： 2017.9

Language：Japanese  

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Event date： 2017.9

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Event date： 2017.9

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J04306&link_issn=&doc_id=20171005130271&doc_link_id=10.11477%2Fmf.6001200137&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.6001200137&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Event date： 2017.9

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Event date： 2017.6

Language：Japanese  

低酸素脳症発症後に嚥下障害を認めた一例を報告する。症例は69歳女性。2015年11月より右気胸にて当院呼吸器感染症内科に入院した。入院6日目に院内で緊張性気胸を再発し、心肺停止に伴う低酸素脳症を発症した。発症58日目に意識レベルの改善を認め、嚥下機能評価のため当科初診となった。指示理解不良で意識レベルはJCS I-3であり、口腔衛生状態は不良で、残存歯は少ないが義歯使用により咬合支持が得られる状態であった。発声・腹式呼吸は不可だった。顎舌顔面の感覚あるものの、舌運動は不良で、呼吸状態不良につき頬ふくらまし・吸引は不可だった。頸部運動は不良で、反復唾液嚥下テストは0回だった。介入3日目(発症60日目)、嚥下内視鏡検査を実施した。安静時より咽頭に分泌物の貯留あり。とろみ摂取時には、喉頭侵入および咽頭残留があったものの誤嚥は認められなかった。先行期から嚥下咽頭期にわたる機能的嚥下障害と診断し、口腔ケア・間接訓練から介入を開始した。呼吸状態安定時のみ少量の直接訓練を実施した。介入57日目(発症114日目)には、義歯調整を行った後に、嚥下造影検査を実施した。液体・ゆるめのとろみにて声門上まで喉頭侵入し、固形物は喉頭蓋谷及び舌背に残留を認めた。ティースプーン一杯量を摂取した際に、患者は咽頭残留を自覚できた。食事による訓練が可能と判断し、全粥・半固形食とろみ付きの食事を開始した。並行して舌運動訓練を実施し、最終的に全粥・半固形食を3食摂取可能となった。(著者抄録)

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Event date： 2017.3

Language：Japanese  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J02994&link_issn=&doc_id=20170814470009&doc_link_id=%2Fex2gakuk%2F2017%2F002302%2F009%2F0128-0129%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fex2gakuk%2F2017%2F002302%2F009%2F0128-0129%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Event date： 2017

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Event date： 2016.11

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Event date： 2016.11

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Event date： 2016.9

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Event date： 2016.9

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Event date： 2016.9

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Event date： 2016.8

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Event date： 2016.6

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Event date： 2016.3

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J02994&link_issn=&doc_id=20160908470016&doc_link_id=%2Fex2gakuk%2F2016%2F002202%2F016%2F0146-0147%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fex2gakuk%2F2016%2F002202%2F016%2F0146-0147%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Event date： 2015.9

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Event date： 2015.9

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Event date： 2015.9

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Event date： 2015.3

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J02994&link_issn=&doc_id=20150812230014&doc_link_id=%2Fex2gakuk%2F2015%2F002102%2F014%2F0142-0143%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fex2gakuk%2F2015%2F002102%2F014%2F0142-0143%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Event date： 2014.12

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Event date： 2014.12

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Event date： 2014.9

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J02994&link_issn=&doc_id=20150213300011&doc_link_id=%2Fex2gakuk%2F2014%2F002101%2F011%2F0048-0049%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fex2gakuk%2F2014%2F002101%2F011%2F0048-0049%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Event date： 2014.9

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J02994&link_issn=&doc_id=20150213300013&doc_link_id=%2Fex2gakuk%2F2014%2F002101%2F013%2F0052-0053%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fex2gakuk%2F2014%2F002101%2F013%2F0052-0053%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Event date： 2014.9

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Event date： 2014.3

Language：Japanese  

味覚刺激が嚥下運動にどのような変化を与えるかについて調べることを目的として、異なる濃度の塩味またはうま味溶液を口腔内に微量注入した時の随意性嚥下運動を記録した。健常成人29名を対象として、出来るだけ早く繰り返し嚥下するよう指示し、その際に咽頭または口腔への溶液刺激(0.2mL/min)を与えた。咽頭への溶液刺激は蒸留水または0.3 M NaCl溶液とし、口腔への溶液刺激は蒸留水または3種類のNaイオン濃度(6mM、40mM、240mM)のうま味溶液(モル濃度比2対1のグルタミン酸ナトリウムとイノシン酸ナトリウム混合溶液)、うま味溶液と同濃度のNaイオンを含むNaCl溶液とした。測定開始後4から9回目までの各嚥下間の平均時間を嚥下間隔時間として各条件間で比較した。NaCl溶液、蒸留水いずれの咽頭刺激においても嚥下間隔時間の顕著な個人差が認められた。NaCl溶液刺激時の嚥下間隔時間は蒸留水よりも有意に長く、咽頭の水受容器による嚥下反射誘発促進効果、NaCl溶液による水受容器応答の抑制が確認された。さらにNaCl溶液刺激時の嚥下間隔時間が長い被験者ほど蒸留水刺激による随意性嚥下の促進効果が高かった。一方、口腔への溶液刺激では、うま味溶液刺激時のみ蒸留水に対して有意な短縮を認めた。随意性嚥下能力の高い順から上位群、中位群、下位群ごとに嚥下間隔時間の変化を調べたところ、上位群、下位群では各溶液の濃度の違いによる有意な差は認められなかったのに対して、中位群のみ溶液濃度が高くなるに従って嚥下間隔時間の短縮を認めた。以上の結果は、中位群におけるうま味成分がもつ随意性嚥下への促進効果を示唆するものである。随意性嚥下誘発能力の個人差をもとに、末梢入力に対する嚥下運動誘発の時間間隔を比較したところ、咽頭刺激時とは異なっていたことから、口腔への味覚刺激がもつ嚥下中枢への効果は単なる加重効果として捉えられず、その効果の作用機序の理解に向けてはさらなる議論が必要である。(著者抄録)

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Language：Japanese  

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Language：English   Presentation type：Symposium, workshop panel (nominated)  

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