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

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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  

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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  

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

DOI： 10.1111/joor.13373

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

Dysphagia is sometimes accompanied by pain. Because orofacial structures subserve mastication and swallowing, orofacial pain might impair both functions. Tongue biting can occur not only accidentally while eating but also in some pathological conditions. However, it remains unclear whether noxious mechanical stimulation of the tongue affects swallowing. To explore this question, we evaluated the effects of lingual pinch stimulation on the initiation of swallowing evoked by distilled water (DW) infusion with a flow rate of 5.0 µL/s for 20 s into the pharyngolaryngeal region in anesthetized rats. The swallowing reflex was identified by electromyographic (EMG) bursts in the suprahyoid muscles which include the anterior belly of the digastric muscle, mylohyoid and geniohyoid muscles, and laryngeal elevation by visual inspection. The number of DW-evoked swallows during pinch stimulation was significantly smaller than that in a control condition or during pressure stimulation. The onset latency of the first swallow during pinch stimulation was significantly longer than that in the control condition. DW-evoked swallowing was almost abolished following bilateral transection of the superior laryngeal nerve (SLN) compared with the control condition, suggesting that the SLN plays a crucial role in the initiation of DW-evoked swallowing. Finally, electrophysiological data indicated that some SLN-responsive neurons in the nucleus tractus solitarii (nTS) exhibited delayed latency from a single SLN stimulation during lingual pinch stimulation. These results suggest that noxious mechanical stimulation of the tongue inhibits the initiation of swallowing and modulates neuronal activity in the nTS.

DOI： 10.1007/s00455-022-10522-5

PubMed

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

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：(一社)日本老年歯科医学会  

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.physbeh.2022.113763

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

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

DOI： 10.1007/s00455-022-10421-9

PubMed

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1007/s00455-022-10421-9

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Other Link： https://link.springer.com/article/10.1007/s00455-022-10421-9/fulltext.html

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

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

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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  

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Language：Japanese   Publisher：日本口腔リハビリテーション学会  

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Language：Japanese   Publisher：日本口腔リハビリテーション学会  

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Language：Japanese   Publisher：新潟歯学会  

症例は75歳女性。初診より2日前に階段の昇降や嚥下の困難感を自覚、翌日に症状悪化しN病院脳神経内科へ緊急搬送、頭部MRIで右延髄背外側および右小脳半球に梗塞巣が認められた。摂食嚥下機能評価およびリハビリテーション目的に当科初診となった。2病日目に実施した摂食嚥下機能評価では、右側口唇の感覚運動不良、同側軟口蓋挙上不良および反射の消失、気息性嗄声を認め、改訂水飲みテストは3b点だった。3病日目に嚥下内視鏡検査を実施し、左側臥位・頸部右回旋にてゼリー(学会分類2013、0j)摂取が可能なことを確認して、直接訓練を開始した。4病日目より頸部回旋を併用したバルーン単純引き抜き法を開始、姿勢調整下での直接訓練を継続した。17病日目には咽頭残留量の改善を認め、また、嚥下造影検査では姿勢調整下での食塊通過、およびバルーン引き抜き時に頸部回旋側の対側への通過が確認できた。21病日目にリハビリテーション目的に転院となり、上記訓練の継続を紹介状に記載、介入終了となった。急性期の延髄外側症候群に伴う球麻痺症例において、誤嚥性肺炎の予防や早期機能回復を目標に、姿勢制御下で咽頭残留を軽減しながら安全に訓練を実施できた。またバルーン単純引き抜き法に頸部回旋を併用することで、有効な訓練効果が得られる可能性が考えられた。(著者抄録)

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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  

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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  

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

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：English   Publishing type：Research paper (scientific journal)  

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

DOI： 10.1111/jog.14963

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/jog.14963

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

BACKGROUND: Perimenopausal women experience a wide variety of systemic symptoms: hot flashes, sweating, mental health concerns and various oral sensory complaints (OSC). OSC in perimenopausal women include xerostomia, taste disturbance and burning mouth. However, the factors associated with these OSC have not been identified. The purpose of this investigation was to elucidate the factors associated with OSC in perimenopausal women. METHODS: The study cohort comprised 43 perimenopausal women aged 45-55 years. Data on medical history, medications, menstrual status, menopausal symptoms, quality of life, xerostomia, taste disturbance and burning mouth were collected. Volumes of unstimulated and stimulated saliva were measured. Tongue coating was evaluated according to a tongue coating index. Univariate analysis was performed to identify factors significantly associated with having xerostomia, taste disturbance, burning mouth and more than two OSC (2OSC). Next, the factors strongly associated with these symptoms were examined by logistic regression analysis. RESULTS: The number of menopausal symptoms was significantly higher, and volume of unstimulated saliva was significantly lower in participants with xerostomia, taste disturbance, burning mouth or 2OSC than in those without these characteristics. Agents targeting the central nervous system were more frequently taken by participants with burning mouth and 2OSC than by those without these characteristics. According to logistic regression analysis, the number of menopausal symptoms was an explanatory variable for xerostomia, taste disturbance, burning mouth and 2OSC. CONCLUSIONS: Our findings suggested that OSC associated with the number of menopausal symptoms. Management of menopausal symptoms may decrease OSC, leading to improved quality of life of perimenopausal women.

DOI： 10.1186/s12905-021-01401-6

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

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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Language：Japanese   Publisher：(株)診断と治療社  

更年期世代の女性には、のぼせや発汗などのいわゆる更年期症状のほか、口腔乾燥感、味覚異常、舌痛症、顎関節痛などの口腔に関する愁訴が多く認められ、QOLが著しく低下することが多い。口腔に愁訴がある場合、適切な診療科に紹介することにより、症状が改善する可能性がある。また、ホルモン補充療法が有効であるという報告もあるが、効果については見解の一致をみていないのが現状である。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J00525&link_issn=&doc_id=20210324150014&doc_link_id=%2Fae4sanke%2F2021%2F008804%2F015%2F0487b0491%26dl%3D3&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fae4sanke%2F2021%2F008804%2F015%2F0487b0491%26dl%3D3&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_4.gif

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

【目的】精神科病院の病棟内食堂で食事摂取可能な入院患者における誤嚥性肺炎リスクの影響要因を明らかにし、誤嚥性肺炎予防に向けた支援への示唆を得るために調査研究を行った。【方法】対象者は、A精神科病院入院患者約400名のうち、病棟内食堂で食事摂取可能な20歳以上85歳未満の者100名とした。対象者を誤嚥性肺炎リスク評価により高・中・低リスクに分け、その群のそれぞれの基本属性、日常生活の状況、食事摂取の状況、栄養状態(Body Mass Index:BMI、Geriatric Nutritional Risk Index:GNRI)、血液生化学所見(Total Protein:TP、Albumin:Alb、Hemoglobin:Hb、Hematocrit:Ht、White Blood Cell:WBC)を調査し、統計学的に検討した。【結果】対象者のうち、高リスク群0名、中等度リスク群24名、低リスク群76名であった。群間比較において、年齢は、中等度リスク群で有意に高値であった。BMI、GNRI、Ht、Hb、Peak Expiratory Flow:PEF、Repetitive Saliva Swallowing Test:RSSTは、中等度リスク群で有意に低値であった。Spearmanの順位相関係数では、年齢、BMI、GNRI、Alb、Ht、Hb、PEF、RSSTにおいて相関を認めた。二項ロジスティック回帰分析において、BMI、PEF、RSSTが独立変数として得られた。【結論】精神科病院の病棟内食堂で食事摂取可能な入院患者における誤嚥性肺炎リスクの影響要因は、BMI、PEF、RSSTの低下であることが示唆された。誤嚥性肺炎予防に向けた支援として、栄養状態や呼吸機能、嚥下機能の維持・改善を目指す取り組みが必要と考える。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J03152&link_issn=&doc_id=20210616040004&doc_link_id=%2Fcb5dvsph%2F2021%2F002501%2F004%2F0033-0043%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcb5dvsph%2F2021%2F002501%2F004%2F0033-0043%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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

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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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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Language：Japanese   Publisher：日本口腔リハビリテーション学会  

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Language：Japanese   Publisher：日本口腔リハビリテーション学会  

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Language：Japanese   Publisher：新潟歯学会  

三叉神経鞘腫とは、三叉神経根や末梢神経のシュワン細胞に発症する比較的稀な良性腫瘍の1つである。今回、三叉神経鞘腫摘出手術後に摂食嚥下障害を認めた症例を経験したのでここに報告する。症例は44歳女性。右巨大三叉神経鞘腫に対する腫瘍摘出術が施行され、術後2日目に摂食嚥下機能評価目的に当科初診となった。初診時、球麻痺症状としての顔面神経麻痺、舌の運動時の偏位や抵抗力の減弱、開鼻声を伴う左カーテン徴候、軟口蓋右側で感覚の低下や軟口蓋反射・咽頭絞扼反射の消失を認めた。反復唾液嚥下テストは1回、改訂水飲みテストは4点(嚥下後の呼吸良好、ムセなし)であり、嚥下内視鏡検査時には発声時の不完全な声門閉鎖が観察された。また、右側からの食塊口唇漏出、液体摂取時の嚥下反射惹起遅延、緩慢な咀嚼を認めた。食事再開は可能と判断し、半固形食、液体とろみ付与の食事形態で経口摂取再開とした。その後、嚥下訓練、咀嚼訓練を継続し、術後18日目の自宅退院時には食形態が軟飯・軟菜食までに回復した。退院後の術後34日目の再評価時、一部の球麻痺症状は残存したものの、反復唾液嚥下テスト5回、改訂水飲みテストは5点と改善を認めた。急性期病院においては在院日数の短縮が求められるため、本症例のように術後間もなくからの介入により退院まで円滑に摂食嚥下リハビリテーションを実施できたことが、自宅でも十分に生活できる程度の摂食嚥下機能の回復を促進し、生活の質の回復に寄与したものと考えられた。(著者抄録)

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Language：Japanese   Publisher：新潟歯学会  

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Language：Japanese   Publisher：日本口腔リハビリテーション学会  

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Language：Japanese   Publisher：新潟歯学会  

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

Capsaicin powerfully evokes the swallowing reflex and is a known therapeutic agent for improving dysphagia and preventing aspiration pneumonia. However, the role of capsaicin-sensitive nerves in the initiation of swallowing evoked by various natural stimuli remains unclear. To explore this question, we blocked laryngeal capsaicin-sensitive nerves following the coapplication of QX-314 and capsaicin (QX/Cap), and investigated the effects on swallowing evoked by mechanical and chemical stimulation in anesthetized rats. Swallows were evoked by capsaicin, carbonated water (CW), distilled water (DW), and punctate mechanical stimulation using von Frey filaments applied topically to the larynx. Swallows were documented by recording electromyographic activation of the suprahyoid and thyrohyoid muscles. The initiation of swallowing by capsaicin was strongly suppressed at 5 min following QX/Cap treatment and returned in a time-dependent manner. CW-evoked swallows at 5 min following QX/Cap treatment were significantly diminished compared with before and 30 min after treatment. In contrast, DW-evoked and mechanically evoked swallows were unchanged by QX/Cap treatment. Furthermore, CW-evoked swallows were virtually abolished by transection of the superior laryngeal nerves and significantly decreased by the topical application of acid-sensing ion channel-3 (ASIC3) inhibitor APETx2, but they were not affected by the nonselective transient receptor potential channel inhibitor ruthenium red or the ASIC1 inhibitor mambalgin-1. Taken together, we speculate that capsaicin-sensitive nerves play an important role in the initiation of CW-evoked swallows.NEW & NOTEWORTHY The initiation of swallowing evoked by laryngeal capsaicin and carbonated water application was diminished by the coapplication of QX-314 and capsaicin. Carbonated water-evoked swallows were also abolished by transection of the superior laryngeal nerves and were inhibited by the acid-sensing ion channel-3 inhibitor. Capsaicin-sensitive nerves are involved in the initiation of carbonated water-evoked swallows.

DOI： 10.1152/ajpgi.00233.2020

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

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

Overactive bladder (OAB) occurs idiopathic or secondary to a neurological cause. In addition, OAB may also occur due to xerostomia, because it causes excessive drinking of water. If xerostomia is one of the causes of OAB, treating xerostomia may be effective. This study aimed to investigate the prevalence of xerostomia with or without overactive bladder symptoms. A web-based questionnaire was administered to investigate the prevalence of xerostomia with or without overactive bladder symptoms. The survey included questions concerning age, gender, medical history, medications, OAB symptoms by the Overactive Bladder Symptom Score (OABSS), and xerostomia by the Dry Mouth Scale (DMS). From the analysis, a total of 21 (13.0%) participants were identified as having OAB. The prevalence of xerostomia was six (28.6%) in the OAB group and 14 (10.0%) in the non-OAB group. OABSS and DMS were significantly higher in the OAB group than in the non-OAB group. Urgency score and urgency incontinence score of OABSS were substantially higher in xerostomia participants than non-xerostomia participants. The adjusted odds ratio of OAB showed DMS total score, xerostomia symptoms, accompanying symptoms, and other symptoms that were all significantly associated with OAB. These results suggested that OAB subjects, even untreated subjects, had xerostomia. It may be beneficial for clinicians to perform dry mouth management in parallel with careful choice pharmacotherapy for the wellness of OAB patients.

DOI： 10.1111/luts.12354

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Language：Japanese   Publisher：(一社)歯科基礎医学会  

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Language：Japanese   Publisher：(一社)歯科基礎医学会  

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

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

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

PubMed

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

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

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

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

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

BACKGROUND: Movement of the hyoid and laryngeal complex is critical for preventing aspiration, as well as smooth bolus passage through the pharynx. We have developed a non-invasive system for measuring laryngeal movement during swallowing with a bend sensor and have already reported the time coordination between the signal waveform from the sensor and hyoid movement. OBJECTIVE: The aim of this study was to clarify the quantitative association between the output value of the sensor and hyoid movement during swallowing. METHODS: A small bend sensor was fixed on the skin surface along the midline of the neck of 13 healthy men (mean age, 30.8 ± 4.5 years). Laryngeal and hyoid movements during swallowing of 5 mL of water were recorded synchronously by the bend sensor and videofluorography. The relationship between the bend sensor output value (LM value) and hyoid position (x- and y-axis displacements) by videofluorography from the onset to the offset of the signal waveform was analysed for all tasks and for each task using Pearson's correlation coefficients. RESULTS: There was a positive correlation between the LM value and hyoid position for all tasks (x-axis displacement: r = .647, y-axis displacement: r = .233). In particular, there was a moderate to high correlation between the LM value and x-axis displacement for each task (.453 ≤ r ≤ .934). CONCLUSION: The LM value can be a quantitative parameter of anterior hyoid movement during swallowing that might be associated with bolus flow and upper oesophageal sphincter opening.

DOI： 10.1111/joor.12906

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

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

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Language：Japanese   Publisher：日本口腔リハビリテーション学会  

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Language：Japanese   Publisher：新潟歯学会  

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Language：Japanese   Publisher：新潟歯学会  

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Language：Japanese   Publisher：日本口腔リハビリテーション学会  

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Language：Japanese   Publisher：日本口腔リハビリテーション学会  

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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Language：Japanese   Publisher：(一社)日本言語聴覚士協会  

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

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

BACKGROUND: In Japan, day care services for elders include programmes aimed at improving nutrition and oral and motor functions. Few studies have qualitatively assessed these interventions. OBJECTIVE: To qualitatively search for the characteristic words used in the work logs of a preventive programme on oral function and nutrition for elders by intervention period and intervention type． METHODS: We included 83 participants (81.3 ± 8.2 years) from four day care services in Japan and divided them into the following groups randomly: those who received oral function intervention only, nutritional intervention only and those who received combined oral function plus nutritional intervention. The interventions were conducted twice per month for 24 months. Data from handwritten work logs were entered into a computer as text files. Monitoring of frequently appearing words, co-occurrence analysis and cross-tabulation by intervention period and intervention types was conducted using text mining analysis. RESULTS: Correspondence analysis revealed that the words used during 1-6 months and 7-12 months were similar in participants' subjective content, and those used in objective content in 13-18 months and 19-24 months were similar. These results indicate that subjective improvements increased after 13 months, and it was maintained within 24 months. The combined intervention type is ideal for oral and nutrition problems. CONCLUSION: Because this text mining approach revealed the changes in the words used and could be used to monitor any subjective improvement, this approach may help evaluate the effects of preventive care.

DOI： 10.1111/joor.12804

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Publishing type：Research paper (scientific journal)  

© 2019 The Authors. The Journal of Physiology © 2019 The Physiological Society Key points: Afferents carried by the superior laryngeal nerve play a primary role in the initiation of laryngeal mechanically evoked swallows in anaesthetized rats. Amiloride and its analogues inhibit swallowing evoked by mechanical stimulation, but not swallowing evoked by chemical and electrical stimulation. The epithelial sodium channel is probably involved in the initiation of laryngeal mechanically evoked swallows. Abstract: The swallowing reflex plays a critical role in airway protection. Because impaired laryngeal mechanosensation is associated with food bolus aspiration, it is important to know how the laryngeal sensory system regulates swallowing initiation. This study was performed to clarify the neuronal mechanism of mechanically evoked swallows. Urethane-anaesthetized Sprague–Dawley male rats were used. A swallow was identified by activation of the suprahyoid and thyrohyoid muscles on electromyography. The swallowing threshold was measured by von Frey filament and electrical stimulation of the larynx. The number of swallows induced by upper airway distension and capsaicin application (0.03 nmol, 3 μl) to the vocal folds was counted. The effects of topical application (0.3–30 nmol, 3 μl) of the epithelial sodium channel (ENaC) blocker amiloride and its analogues (benzamil and dimethylamiloride), acid-sensing ion channel (ASIC) inhibitors (mambalgine-1 and diminazene) and gadolinium to the laryngeal mucosa on swallowing initiation were evaluated. A nerve transection study indicated that afferents carried by the superior laryngeal nerve play a primary role in the initiation of laryngeal mechanically evoked swallows. The mechanical threshold of swallowing was increased in a dose-dependent manner by amiloride and its analogues and gadolinium, but not by ASIC inhibitors. The number of swallows by upper airway distension was significantly decreased by benzamil application. However, the initiation of swallows evoked by capsaicin and electrical stimulation was not affected by benzamil application. We speculate that the ENaC is involved in the initiation of laryngeal mechanically evoked swallows.

DOI： 10.1113/JP277895

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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

KEY POINTS: Despite evidence that the human cerebellum has an important role in swallowing neurophysiology, the effects of cerebellar stimulation on swallowing in the disrupted brain have not been explored. In this study, for the first time, the application of cerebellar neurostimulation is characterized in a human model of disrupted swallowing (using a cortical virtual lesion). It is demonstrated that cerebellar stimulation can reverse the suppressed activity in the cortical swallowing system and restore swallowing function in a challenging behavioural task, suggesting the findings may have important therapeutic implications. ABSTRACT: Repetitive transcranial magnetic stimulation (rTMS) can alter neuronal activity within the brain with therapeutic potential. Low frequency stimulation to the 'dominant' cortical swallowing projection induces a 'virtual-lesion' transiently suppressing cortical excitability and disrupting swallowing behaviour. Here, we compared the ability of ipsi-lesional, contra-lesional and sham cerebellar rTMS to reverse the effects of a 'virtual-lesion' in health. Two groups of healthy participants (n = 15/group) were intubated with pharyngeal catheters. Baseline pharyngeal motor evoked potentials (PMEPs) and swallowing performance (reaction task) were measured. Participants received 10 min of 1 Hz rTMS to the pharyngeal motor cortex which elicited the largest PMEPs to suppress cortical activity and disrupt swallowing behaviour. Over six visits, participants were randomized to receive 250 pulses of 10 Hz cerebellar rTMS to the ipsi-lesional side, contra-lesional side or sham while assessing PMEP amplitude or swallowing performance for an hour afterwards. Compared to sham, active cerebellar rTMS, whether administered ipsi-lesionally (P = 0.011) or contra-lesionally (P = 0.005), reversed the inhibitory effects of the cortical 'virtual-lesion' on PMEPs and swallowing accuracy (ipsi-lesional, P < 0.001, contra-lesional, P < 0.001). Cerebellar rTMS was able to reverse the disruptive effects of a 'virtual lesion'. These findings provide evidence for developing cerebellar rTMS into a treatment for post-stroke dysphagia.

DOI： 10.1113/JP277545

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Language：Japanese   Publisher：(公社)日本補綴歯科学会  

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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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Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publisher：日本口腔リハビリテーション学会  

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Language：Japanese   Publisher：新潟歯学会  

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Language：Japanese   Publisher：新潟歯学会  

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Language：Japanese   Publisher：(NPO)日本咀嚼学会  

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

DOI： 10.1111/nmo.13384

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Language：Japanese   Publisher：(一社)日本女性医学学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier {BV}  

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：(一社)歯科基礎医学会  

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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  

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：(公社)日本補綴歯科学会  

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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

Swallowing pressure generation is important to ensure safe transport of an ingested bolus without aspiration or leaving residue in the pharynx. To clarify the mechanism, we measured swallowing pressure at the oropharynx (OP), upper esophageal sphincter (UES), and cervical esophagus (CE) using a specially designed manometric catheter in anesthetized rats. A swallow, evoked by punctate mechanical stimulation to the larynx, was identified by recording activation of the suprahyoid and thyrohyoid muscles using electromyography (EMG). Areas under the curve of the swallowing pressure at the OP, UES, and CE from two trials indicated high intrasubject reproducibility. Effects of transecting the hypoglossal nerve (12N) and recurrent laryngeal nerve (RLN) on swallowing were investigated. Following bilateral hypoglossal nerve transection (Bi-12Nx), OP pressure was significantly decreased, and time intervals between peaks of thyrohyoid EMG bursts and OP pressure were significantly shorter. Decreased OP pressure and shortened times between peaks of thyrohyoid EMG bursts and OP pressure following Bi-12Nx were significantly increased and longer, respectively, after covering the hard and soft palates with acrylic material. UES pressure was significantly decreased after bilateral RLN transection compared with that before transection. These results suggest that the 12N and RLN play crucial roles in OP and UES pressure during swallowing, respectively. We speculate that covering the palates with a palatal augmentation prosthesis may reverse the reduced swallowing pressure in patients with 12N or tongue damage by the changes of the sensory information and of the contact between the tongue and a palates. NEW & NOTEWORTHY Hypoglossal nerve transection reduced swallowing pressure at the oropharynx. Covering the hard and soft palates with acrylic material may reverse the reduced swallowing function caused by hypoglossal nerve damage. Recurrent laryngeal nerve transection reduced upper esophageal sphincter negative pressure during swallowing.

DOI： 10.1152/japplphysiol.00944.2017

PubMed

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

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

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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：Japanese   Publisher：(公財)8020推進財団  

退院時に独歩をめざす「DOPPOプロジェクト」への参加意思があるN病院入院患者32名を対象とし、リハビリ開始時に口腔・嚥下機能の評価と身体機能評価を行い、相互の関連性について検討した。口腔機能の評価項目は[咬合力][グミ咀嚼能力][舌圧][口唇閉鎖力]、嚥下機能の評価項目は[3オンス水飲みテスト][反射唾液嚥下テスト(RSST)]とした。身体機能の評価項目は[握力][下肢伸展力][SPPB][10m歩行時の速度および歩数][6分間歩行距離]とした。検討の結果、口腔機能と身体機能との関連性については、多くの項目間で有意な相関が認められた。嚥下機能が低下している群(15名)と非低下群に分けて身体機能各項目の群間比較を行ったところ、低下群は[SPPB]が有意に低く、[10m歩行時の歩数]が有意に多かった。歩行速度が<0.8m/sの16名を"歩行速度低下群"、他の16名を"非低下群"として口腔・嚥下機能各項目の群間比較を行ったところ、低下群は[咬合力][グミ咀嚼能力][舌圧][RSST]が有意に低値であった。

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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

PubMed

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Language：Japanese   Publisher：新潟歯学会  

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Language：Japanese   Publisher：日本口腔リハビリテーション学会  

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Language：Japanese   Publisher：新潟歯学会  

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

Studies of mechanisms of feeding behavior are important in a society where aging- and disease-related feeding disorders are increasingly prevalent. It is important to evaluate the clinical relevance of animal models of the disease and the control. Our present study quantifies macaque hyolingual and jaw kinematics around swallowing cycles to determine the extent to which macaque swallowing resembles that of humans. One female and one male adult Macaca mulatta were trained to feed in a primate chair. Videofluoroscopy was used to record kinematics in a sagittal view during natural feeding on solid food, and the kinematics of the hyoid bone, thyroid cartilage, mandibular jaw, and anterior-, middle-, and posterior-tongue. Jaw gape cycles were defined by consecutive maximum gapes, and the kinematics of the swallow cycles were compared with those of the two consecutive non-swallow cycles preceding and succeeding the swallow cycles. Although there are size differences between macaques and humans, and macaques have shorter durations of jaw gape cycles and hyoid and thyroid upward movements, there are several important similarities between our macaque data and human data reported in the literature: (1) The durations of jaw gape cycles during swallow cycles are longer than those of non-swallow cycles as a result of an increased duration of the jaw-opening phase; (2) Hyoid and thyroid upward movement is linked with a posterior tongue movement and is faster during swallow than non-swallow cycles; (3) Tongue elevation propagates from anterior to posterior during swallow and non-swallow cycles. These findings suggest that macaques can be a useful experimental model for human swallowing studies.

DOI： 10.1007/s00455-017-9812-4

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

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Language：Japanese   Publisher：(一社)日本言語聴覚士協会  

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Language：Japanese   Publisher：(一社)歯科基礎医学会  

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

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

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Language：Japanese   Publisher：日本嚥下医学会  

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

Aim: We hypothesized that feeling mucosal dryness in one body region and the skin may be associated with dryness in other regions and that there are common background factors for dryness. In an earlier web-based survey, we reported prevalence figures of dry eyes, nose, mouth, skin, and vagina. In the present study, additional analyses were made to investigate the factors associated with dryness in each region, and simultaneous dryness in multiple regions.
Methods: A web-based questionnaire was completed by 310 Japanese women. The questions included dryness of the eyes, nose, mouth, vagina, and skin. Menopausal and other symptoms were also addressed. Multiple logistic regression modeling was performed to identify factors associated with dryness in each region and in multiple dry regions.
Results: Dry eyes were associated with dryness in the nose and with headache; dry nose was associated with dryness in the vagina and eyes; dry mouth was associated with sticky mouth symptom and dryness of the nose; dry skin was associated with use of xerogenic medications and vaginal discharge; and dryness of the vagina was associated with vaginal itchiness and dry nose. Vaginal discharge (odds ratio, 9.64; 95% confidence interval, 3.15-29.51) and sticky mouth (odds ratio, 6.35; 95% confidence interval, 1.29-31.29) were further associated with dryness in multiple regions.
Conclusion: The present results confirmed our study hypothesis by showing that dryness in one region was clearly associated with that in another or in multiple regions. The result implies the need for holistic diagnosis and counseling for patients with dryness complaints.

DOI： 10.1111/jog.13290

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

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

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

ObjectiveThe aim of the present study was to quantify the relation between physical fitness and oral function, including tongue and lip movements.
BackgroundPhysical fitness and oral function influence quality of life and activities of daily living in older individuals. Occlusal contact and mastication performance are associated with physical fitness, but the association between tongue and lip movements and physical fitness is unclear.
Material and methodsSixty-six independent community-dwelling older individuals (24 men, 42 women; mean age, 70.35.9years) participated in this study. Measures of physical fitness were the one-leg standing time with eyes open, the functional reach test, anteflexion, the timed up and go test, and grip strength. Measures of oral function were tongue pressure, lip pressure, tongue movement from side to side, the repetitive saliva-swallowing test (RSST), oral diadochokinesis and masticatory efficiency. Multiple regression analysis was used to quantify the relation between physical fitness and oral function.
ResultsAfter adjustment for age, sex, BMI, exercise habits and number of remaining teeth, the tongue movement from side to side and/or oral diadochokinesis were chosen as significant factors in each physical fitness measurement. Furthermore, the lip pressure and masticatory efficiency were associated with handgrip strength.
ConclusionOral function, including tongue and lip movements, was associated with physical fitness in older people in this study. Tongue dexterity as characterised by tongue movement from side to side and oral diadochokinesis particularly associated with physical fitness.

DOI： 10.1111/ger.12186

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

OBJECTIVE: The aim of the present study was to quantify the relation between physical fitness and oral function, including tongue and lip movements. BACKGROUND: Physical fitness and oral function influence quality of life and activities of daily living in older individuals. Occlusal contact and mastication performance are associated with physical fitness, but the association between tongue and lip movements and physical fitness is unclear. MATERIAL AND METHODS: Sixty-six independent community-dwelling older individuals (24 men, 42 women; mean age, 70.3 ± 5.9 years) participated in this study. Measures of physical fitness were the one-leg standing time with eyes open, the functional reach test, anteflexion, the timed up and go test, and grip strength. Measures of oral function were tongue pressure, lip pressure, tongue movement from side to side, the repetitive saliva-swallowing test (RSST), oral diadochokinesis and masticatory efficiency. Multiple regression analysis was used to quantify the relation between physical fitness and oral function. RESULTS: After adjustment for age, sex, BMI, exercise habits and number of remaining teeth, the tongue movement from side to side and/or oral diadochokinesis were chosen as significant factors in each physical fitness measurement. Furthermore, the lip pressure and masticatory efficiency were associated with handgrip strength. CONCLUSION: Oral function, including tongue and lip movements, was associated with physical fitness in older people in this study. Tongue dexterity as characterised by tongue movement from side to side and oral diadochokinesis particularly associated with physical fitness.

DOI： 10.1111/ger.12186

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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  

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Language：Japanese   Publisher：(一社)日本女性医学学会  

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

Background: Sudden death in multiple system atrophy (MSA) usually occurs during sleep and was therefore attributed to suffocation resulting from vocal cord abductor paralysis, a characteristic laryngeal finding of MSA. This led to the use of tracheostomy and noninvasive positive pressure ventilation (NPPV) for the prevention of sudden death. However, neither method has been able to prevent sudden death, and both have occasionally precipitated treatment-related complications, including central sleep apneas and exacerbation of floppy epiglottis. Therefore, it is important to determine the mechanisms and prevention of sudden death in MSA.
Methods: We reviewed the literature on the mechanisms and prevention of sudden death in patients with MSA.
Results: Sudden death in MSA is hypothesized to be a consequence of disordered central respiration, suffocation caused by sputum and food, upper airway obstruction from NPPV acting on a floppy epiglottis, cardiac autonomic disturbance, or a combination of these factors.
Conclusion: Various factors may be involved in the mechanism of sudden death in MSA. A multidisciplinary approach 'is needed to prevent sudden death, and this requires an organized system of several medical specialties. Neurologists require a cooperative network that includes experts in otorhinolaryngology, sleep medicine, dysphagia rehabilitation, and cardiology. (C ) 2016 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.parkreldis.2016.04.011

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DOI： 10.1111/nmo.12839

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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Language：Japanese   Publisher：(一社)歯科基礎医学会  

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Language：Japanese   Publisher：日本嚥下医学会  

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Language：Japanese   Publisher：日本嚥下医学会  

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1007/s00455-015-9641-2

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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：Bentham Science Publishers B.V.  

Background and Objective: Tube feeding has been significantly associated with a higher rate of aspiration pneumonia that is mainly related to oral microorganisms and a reduced salivary flow. Thus, the difference in the mode of nutritional intake is expected to affect the oral environment, but this has not yet been fully clarified. The purpose of this study was to investigate, in tube-fed patients, changes in the oral moisture and the counts of microorganisms in saliva and tongue coating, which occur after oral ingestion resumption. Methods: Study participants were 7 tube-fed inpatients of the Niigata University Medical and Dental Hospital (72.7±8.5 years old) who received dysphagia rehabilitation at the Unit of Dysphagia Rehabilitation until oral ingestion resumption. Their oral health, swallowing, and nutrition status, oral mucosal moisture, amount of unstimulated saliva and the counts of microorganisms (total microorganisms, streptococci, Candida) in saliva and tongue coating were investigated and compared before and after the recommencement of oral intake. Results: Tongue coating, choking, oral mucosal moisture and amount of unstimulated saliva were improved significantly after resumption of oral ingestion. The other investigated parameters did not significantly change, except for the streptococci in tongue coating, which significantly increased 1 week after oral ingestion recommencement, but decreased thereafter. Conclusion: After oral intake resumption, oral mucosal moisture and amount of unstimulated saliva were improved. However, because of a transitory increase in the counts of streptococci with oral ingestion recommencement, it is important to appropriately manage oral hygiene in these patients, according to the changes in their intraoral microbiota.

DOI： 10.2174/1874210601610010079

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DOI： 10.5466/ijoms.15.85

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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：Japanese   Publisher：日本顎口腔機能学会  

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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

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

The prevalence of esophageal involvement and its impact on clinical manifestations in patients with multiple system atrophy (MSA) remains unknown. We recruited 16 consecutive patients with dysphagia associated with MSA (MSA group) and 16 consecutive patients with dysphagia associated with amyotrophic lateral sclerosis (ALS group). We assessed the presence or absence of food stagnation within the esophagus using videofluorography. Food stagnation within the esophagus was observed in 16 patients (100 %; 7 severe, 9 mild) in the MSA group and in 4 patients (25 %; 4 mild) in the ALS group (P &lt; 0.001). Follow-up videofluorography revealed that food stagnation in patients with MSA could exacerbate during the disease course. Patients with MSA and severe food stagnation showed a wide range of intraesophageal stasis by videofluorography. Among the 16 patients in the MSA group, 4 developed aspiration pneumonia and 1 died of suffocation associated with food regurgitation during continuous positive airway pressure therapy. In conclusion, food stagnation within the esophagus occurs more frequently in MSA patients with dysphagia than in ALS patients with dysphagia. Because food stagnation can cause serious complications such as aspiration pneumonia and suffocation, patients with MSA should be evaluated by videofluorography, especially those with stagnation in the esophageal phase.

DOI： 10.1007/s00455-015-9641-2

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Language：Japanese   Publisher：新潟歯学会  

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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：SPRINGER  

This study aimed to elucidate the relationship between the piezoelectric waveform latency, hyoid bone movement, surface electromyogram (sEMG), and the pharyngeal transit time (PTT) during swallowing. Forty-one healthy subjects were divided into three age groups: younger (20-39 years, n = 8), middle-aged (40-59 years, n = 9), and older (60-79 years, n = 24). Motion analysis of the hyoid bone using videofluorography (VF), waveform analysis of the front neck using piezoelectric films, and sEMG of the suprahyoid muscle group were performed simultaneously. Latencies of the three movement phases were defined as upward (VFS1), forward (VFS2), and returning to starting position (VFS3). The three phases of the piezoelectric waveform-from wave initiation of the negative wave to the start of the second deep negative wave; from the start of the second deep negative wave to the start of the last positive wave (SLPW); and from the SLPW to the end of the last positive wave-were defined as PS1, PS2, and PS3, respectively. VFS1-3 and PS1-3 were significantly correlated. VFS1 and PS1 latencies were significantly longer with thick liquid than with thin liquid. VFS2, PS1, and PS2 latencies were longer in the older group than in the other two groups. The start of PS1 was nearly equal to those of sEMG and VFS1. Bolus arrival time in the valleculae was statistically equal to the end of the PS1 with both thin and thick liquids. To establish the swallowing screening using Piezoelectric film, further investigation is necessary in the dysphagia patients.

DOI： 10.1007/s00455-015-9654-x

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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：Japanese   Publisher：(一社)歯科基礎医学会  

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Language：Japanese   Publisher：日本嚥下医学会  

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

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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=20160222240012&doc_link_id=%2Fex2gakuk%2F2015%2F002201%2F012%2F0040-0041%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fex2gakuk%2F2015%2F002201%2F012%2F0040-0041%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：PERGAMON-ELSEVIER SCIENCE LTD  

In swallowing, the tongue contacts against the hard palate to generate pressure for propelling a bolus from the oral cavity into the pharynx. Meanwhile, the hyoid and larynx move upward and forward to facilitate the bolus from the pharynx into the esophagus. It has been well known that sequential coordination between those actions is critical for safety accomplishment of swallowing. However, the absence of noninvasive assessment for it limits the detection to the physiological symptom of dysphagia. We applied a sensor sheet on the hard palate to measure tongue contact pressure and a bend sensor on the frontal neck to monitor the laryngeal movement, which was synchronized with hyoid motion for assessing the coordination between both actions in 14 healthy male subjects when swallowing 5 ml of water. The sequential order of tongue pressure and hyoid movement was successfully displayed. Tongue pressure was produced after slight movement of the hyoid and closely to the hyoid elevation, then reached a maximum when the hyoid stabilized in the most anterior superior position, and ceased concurrently with the onset of hyoid descent. Additionally, the synchronized data from both sensors showed positive correlations between identified time points on the laryngeal signal waveform and onset, peak and offset of tongue pressure. Our sensing system successfully showed the coordination between tongue pressure production and hyoid motion, and could be a simple and noninvasive method for clinicians to evaluate the oral and pharyngeal stages of swallowing. (C) 2015 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.physbeh.2015.05.004

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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：CENTER ACADEMIC PUBL JAPAN  

In Japan, one of the most common causes of death in elderly people is aspiration pneumonia. Maintenance of oral hygiene and feeding functions are important elements, especially in patients with dysphagia caused by stroke, neurological diseases, and after operations on the head and neck cancer, as well as in the elderly to prevent aspiration pneumonia. It should also be noted that not only oral health care and physical therapy related to feeding functions but also dental treatment is included in the clinical management during interventions whenever needed. On the other hand, for the patients and/or elderly in need of assistance in maintaining a safe diet, it is recommended that a specialized team comprising physicians, dentists, and speech therapists in functional rehabilitation observes meal conditions of the subjects and evaluates such factors as meal contents, posture during meals, usage of dishes and cutlery, meal times, status of consciousness, perception, and motivation. First, I will present the clinical interventions to those patients, which include oral health care, dental treatment, physical therapy and meal assistance, as well as team approaches in those circumstances. In addition, clinical and basic research results will be introduced, which are expected to foster the understanding of physiology in chewing and swallowing. These results are also expected to develop the clinical technology to maintain or recover the feeding functions.

DOI： 10.3177/jnsv.61.S72

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

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Igaku-Shoin Ltd  

Swallowing is regarded as the first step in nutrition
it transports food boluses and liquid from the mouth to the stomach and is a defensive response to prevent aspiration. Swallowing movements are produced by a central pattern generator (CPG) located in the lower brainstem. The swallowing CPG includes two main groups of neurons: one is located within the nucleus tractus solitarii and contains the generator neurons involved in triggering, shaping, and timing the sequential or rhythmic swallowing pattern and the other is located in the ventrolateral medulla and contains switching neurons that distribute the swallowing drive to various pools of related motoneurons. Swallowing movements can be triggered by either central inputs or peripheral inputs from pharyngeal and laryngeal regions, but the precise neural mechanisms of the swallowing CPG remain to be fully elucidated. This review discusses the fundamental knowledge of ingestion behaviors, with a focus on swallowing.

DOI： 10.11477/mf.1416200108

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DOI： 10.1016/j.foodhyd.2014.09.029

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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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UNLABELLED: We evaluated the ultra-wide-field retinal images for a 53-year-old man who developed peripheral retinal tears in an eye implanted with a Kamra corneal inlay after laser in situ keratomileusis. The peripheral fundus was photographed using the ultra-wide-field Optos imaging system. The images had a dark ring in the center of the retinal images that moved with eye movement. Photographs of the peripheral retinal tears were taken by directing the eye laterally to move the dark ring away from the retinal tears. The retinal tears were photocoagulated while viewing the retina through a wide-angle contact lens and with the eye directed laterally. We recommend using a wide-angle viewing lens to examine and treat an eye implanted with a corneal inlay. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

DOI： 10.1016/j.jcrs.2014.10.024

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Language：Japanese   Publisher：新潟歯学会  

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Language：Japanese   Publisher：新潟歯学会  

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Language：Japanese   Publisher：新潟歯学会  

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Language：Japanese   Publisher：新潟歯学会  

症例は79歳男性、当院呼吸器内科に左小細胞肺癌/右非小細胞肺癌切除術後で通院中であったが、2014年3月19日から発熱を伴う全身状態悪化により3月22日に当院呼吸器内科に緊急入院となった。右下葉の斑状影を伴う肺炎、肝嚢胞の腫大と内部出血を認め、さらに脳梗塞を併発した。抗生剤、解熱剤投与にて徐々に全身状態改善みられ、内服を試みたところ、むせが頻回に認められたため、4月1日に摂食嚥下機能回復部に紹介された。初診時、全身状態として低栄養、炎症傾向が継続しており、摂食機能評価では、口腔衛生状態は不良、改定水飲みテスト3b点であった。介入3日目の嚥下内視鏡検査実施では、咽頭残留はあるもの摂取方法や食形態の制限を行うことで誤嚥・喉頭侵入なく食事摂取可能と判断し、4日目よりペースト食にて食事を開始した。口腔機能の改善、食形態の改善を図るため、15日目に義歯の製作を開始、17日目には嚥下造影検査を施行し、液体のとろみ付け継続の必要性を確認した。28日目には上下全部床義歯を装着、数回の調整を行い、32日目に行った摂食機能評価では口腔衛生状態、口腔内乾燥は顕著な改善を認め、改定水飲みテスト5点に改善、食形態の食上げは可能と判断し、粥食を米飯に食上げした。42日目に実施した嚥下造影検査では、前回と比べ喉頭侵入量の改善は認めたものの、液体の多量摂取時には不顕性誤嚥を認めたため、液体に1%程度のゆるめのとろみを付けることを継続とした。当科介入中に、口腔機能の改善に伴い摂食嚥下機能が回復し、43日目に経過良好にて転院となった。(著者抄録)

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Language：Japanese   Publisher：(一社)歯科基礎医学会  

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

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

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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Language：English   Publisher：(一社)歯科基礎医学会  

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PUBLIC LIBRARY SCIENCE  

Background: In the recent hyper-aged societies of developed countries, the market for soft diets for patients with dysphagia has been growing and numerous jelly-type foods have become available. However, interrelationships between the biomechanics of oral strategies and jelly texture remain unclear. The present study investigated the influence of the initial consistency of jelly on tongue motor kinetics in different oral strategies by measuring tongue pressure against the hard palate.
Methods: Jellies created as a mixture of deacylated gellan gum and psyllium seed gum with different initial consistencies (hard, medium or soft) were prepared as test foods. Tongue pressure production while ingesting 5 ml of jelly using different oral strategies (Squeezing or Mastication) was recorded in eight healthy volunteers using an ultra-thin sensor sheet system. Maximal magnitude, duration and total integrated values (tongue work) of tongue pressure for size reduction and swallowing in each strategy were compared among initial consistencies of jelly, and between Squeezing and Mastication.
Results: In Squeezing, the tongue performed more work for size reduction with increasing initial consistency of jelly by modulating both the magnitude and duration of tongue pressure over a wide area of hard palate, but tongue work for swallowing increased at the posterior-median and circumferential parts by modulating only the magnitude of tongue pressure. Conversely, in Mastication, the tongue performed more work for size reduction with increasing initial consistency of jelly by modulating both magnitude and duration of tongue pressure mainly at the posterior part of the hard palate, but tongue work as well as other tongue pressure parameters for swallowing showed no differences by type of jelly.
Conclusions: These results reveal fine modulations in tongue-palate contact according to the initial consistency of jelly and oral strategies.

DOI： 10.1371/journal.pone.0091920

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

摂食に関連した咽頭と食道機能の加齢変化とその関係について検討した。健常若年男性10例、健常高齢男性12例を対象とした。全ての被験食で若年者と比較して高齢者で食道内残留スコアが高値を示した。とろみ液体、粥で若年者と比較して高齢者で咽頭内残留スコアが高値を示した。嚥下反射惹起ポイントは全ての被験食で若年者と比較して高齢者で高値を示した。若年者群では食道、咽頭、口腔の各パラメータ間で有意な相関を認めなかったが、高齢者群では食道内残留と咽頭、口腔のいくつのパラメータ間で相関を認めた。とろみ液体と粥では咽頭内残留スコアが高い被験者は食道内残留スコアも有意に高値を示した。とろみ液体と粥では、嚥下反射惹起ポイントが高い被験者は食道内残留スコアが有意に高値を示した。とろみ液体と粥では、Eichner's分類B群およびC群がA群と比較して食道内残留スコアが有意に高かった。

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Language：Japanese   Publisher：日本嚥下医学会  

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

ObjectivesBehavioural performance of tablet swallowing was evaluated with different tablet conditions in terms of size, number and surface coating.
MethodsFour 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 15ml 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 findingsAll 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.
ConclusionsThis 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.

DOI： 10.1111/jphp.12155

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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

DOI： 10.1111/jphp.12155

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：Japanese   Publisher：新潟大学教育・学生支援機構  

新潟大学歯学部では,初年次教育として大学学習法を実施している.この授業は講義・演習での知識や技能をもとに,レポート作成とプレゼンテーションを行うもので,その学習活動を通して,間題解決能力,論理的思考力,表現力の開発をねらいとしている.今回,学習成果の直接評価に向けて,パフォーマンス評価を導入すべく,レポートからこれら能力を読み解くルーブリックづくりに取り組んだ.また,この経験からみえてきたパフォーマンス評価の難点とその対処について検討した.その結果,パフォーマンス評価により能力を把握できる可能性が示されたが,導入には教員の理解と協力,能力と関連した適切な評価観点の設定,評価の信頼性を高める工夫,評価と指導の一体化を考慮した授業デザインなど,いくつかの課題があることも明らかになった.The curriculum of Niigata University Faculty of Dentistry provides the &quot;Study Skills&quot; course as first year education. The ultimate goal of this course is to develop student abilities of problem solving, logical thinking and expression. For that purpose, each student is guided through the process of writing a report and presenting its content. To access the degree to which these abilities were achieved, we created a rubric and used it to evaluate the student reports. Based on the experience of this trial, we discussed problems for the introduction of performance assessment into the course. Although performance assessment has a high potential to grasp these abilities, there are some practical problems that may interfere with its introduction, such as &quot;how to involve the faculty in assessment&quot;, &quot;how to establish dimensions of the rubric that appropriately relate with the student abilities&quot;, &quot;how to increase the reliability of assessment&quot;, &quot;how to design the course to allow for a connection between assessment and instruction&quot;.

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Language：Japanese   Publisher：(一社)日本顎顔面補綴学会  

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Language：Japanese   Publisher：新潟歯学会  

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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  

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The tongue is important for orofacial movements, including swallowing. Although numerous studies have focused on tongue pressure against the palate, its physiological role has not been fully evaluated. The tongue pressure generation may have the temporal coordination with the swallowing relational organs. The aim of this study was to clarify the physiological mechanisms of tongue pressure and to investigate the temporal relationship among tongue pressure, supra-hyoid muscle activity, and videofluorographic (VF) images during swallowing. Fifteen healthy young subjects participated. Tongue pressure measured using a sensor sheet with five channels, electromyographic EMG, and VF was recorded synchronously during 4-ml barium swallowing. Swallowing behavior in VF images with and without the sensor sheet was compared. Furthermore, the temporal relationship between events measured from tongue pressure, EMG, and VF was evaluated. Swallowing behavior on VF images was not affected by placement of the sensor sheet. Tongue pressure at the posterio-lateral point of the hard palate tended to have biphasic peaks. Tongue pressure production with a monophasic pattern appeared during the same period as the second peak in the biphasic pattern. The onset of tongue pressure was later than the start of hyoid movement and onset of EMG, and offset was observed between the hyoid at the up-forward position and reposition. Onset of tongue pressure at the anterior area was correlated with the start of slight hyoid elevation. Offset of tongue pressure at the posterio-lateral points was strongly time locked with the hyoid at the up-forward position. The present results suggested the temporal coordination of tongue pressure generation with the swallowing-related organs. That is, the tongue pressure was produced for bolus propulsion, and was closely related to hyoid movement temporally during swallowing. These results may contribute to clarify the clinical state with the disorder of tongue kinetics.

DOI： 10.1002/phy2.167

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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：ELSEVIER IRELAND LTD  

Purpose: Although a closed hollow obturator is often applied to post maxillectomy patients, it has a few problems such as complexity of fabrication and water leakage to inside. A one step curing technique to fabricate a closed hollow obturator by constructing a small hollow bulb made by two thermoplastic resin sheets is described in the present report.
Methods: In the one step curing technique, after dewaxing the wax denture fabricated conventionally, one size smaller hollow body was fabricated with two thermoplastic resin sheets and set into the investment mold as a core. Then the circumferential part of obturator was cured by the pour type resin.
This technique was used to fabricate an obturator prosthesis in a 60-year-old post-maxillectomy patient. The weight of this obturator was well controlled and the definitive prosthesis weighed 22 g. At a one year follow-up, the obturator fared well without any water leakage or breakage.
Conclusions: This technique allows the fabricator to control the thickness and weight of the obturator by the amount of relief provided by the hollow bulb. It also rectifies the disadvantages of the closed hollow obturator such as water leakage and complexity of fabrication. Crown Copyright (C) 2013 Published by Elsevier Ireland on behalf of Japan Prosthodontic Society. All rights reserved.

DOI： 10.1016/j.jpor.2013.08.003

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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)   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. (J Oral Sci 55, 191-198, 2013)

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)   Publisher：WILEY  

center dot Activation of vagal afferent nerves innervating the tracheal and laryngeal mucosa evokes swallowing in anaesthetized guinea pigs.
center dot The swallowing evoked by airway stimulation was probably initiated by the activation of the same afferent nerves that regulate coughing but occurred at lower stimulus intensities and was less susceptible to desensitization than the cough reflex.
center dot We speculate that the swallowing associated with airway sensory nerve activation is a key component of airways protection from aspiration.
Abstract 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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When chewing solid food, part of the bolus is propelled into the oropharynx before swallowing; this is named stage II transport (St2Tr). However, the tongue movement patterns that comprise St2Tr remain unclear. We investigated coronal jaw and tongue movements using videofluorography. Fourteen healthy young adults ate 6 g each of banana, cookie, and meat (four trials per foodstuff). Small lead markers were glued to the teeth and tongue surface to track movements by videofluorography in the anteroposterior projection. Recordings were divided into jaw motion cycles of four types: stage I transport (St1Tr), chewing, St2Tr, and swallowing. The range of horizontal tongue motion was significantly larger during St1Tr and chewing than during St2Tr and swallowing, whereas vertical tongue movements were significantly larger during chewing and St2Tr than during swallowing. Tongue movements varied significantly with food consistency. We conclude that the small horizontal tongue marker movements during St2Tr and swallowing were consistent with a "squeeze-back" mechanism of bolus propulsion. The vertical dimension was large in chewing and St2Tr, perhaps because of food particle reduction and transport in chewing and St2Tr.

DOI： 10.1007/s00455-013-9453-1

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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Language：Japanese   Publisher：(一社)歯科基礎医学会  

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Language：Japanese   Publisher：(一社)日本言語聴覚士協会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PUBLIC LIBRARY SCIENCE  

Background: Swallowing dysfunction (also known as dysphagia), which results in a deterioration of nutritional intake, slows rehabilitation and causes aspiration pneumonia, is very common following neurological impairments. Although videofluorographic (VF) examination is widely used for detecting aspiration, an objective and non-invasive method for assessing swallowing function has yet to be established because of a lack of adequate devices and protocols. In this paper, a bend sensor whose resistance is altered by bending was introduced to monitor swallowing-related laryngeal movement.
Methods: Six healthy male volunteers were recruited in the present study. Specific time points on the signal waveform produced by the bend sensor were defined to describe laryngeal movement by differential analysis. Additionally, the physiological significance of the obtained waveform was confirmed by analyzing the sequential correlations between the signal waveform from the bend sensor and hyoid bone kinetics simultaneously recorded by VF.
Results: Seven time points were successfully defined on the signal waveform to reference laryngeal movement. Each time point was well correlated with certain VF events, with evidence of no significant time lags, and there were positive correlations between waveform time points and matched VF events. Furthermore, obvious similarities were noticed between the duration of each phase on the signal waveform and the duration of the matched hyoid bone activity.
Conclusions: The present monitoring system using a bend sensor might be useful for observing the temporal aspects of laryngeal movement during swallowing, and it was well coordinated with hyoid bone movement.

DOI： 10.1371/journal.pone.0070850

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Language：English   Publisher：Research Institute of Oral Science, Nihon University School of Dentistry at Matsudo  

Aim: For the treatment of polydipsia, medication and occupational therapy are implemented. Since polysipsia canʼt be completely intercepted, patients are isolated or restrained in severe case. Determining the predictive factors of polysipsia may lead to decreasing abnormal water consumption. This study aimed to reveal the influence of subjective oral dryness, salivary volume and other factors including medication on polydipsia in patients with schizophrenia. Methods: Fifty-two patients were divided into two groups: a polydipsia patient (PD) group and a non-polydipsia patient (NPD) group. Their age, medical history, age of onset of schizophrenia, duration of suffering, tobacco, frequency of mouth opening, subjective oral dryness, number of medications, number of xerogenic medications, chlorpromazine (CPZ) equivalent dose, salivary volume and salivary spinability were investigated. Results: The number of total medications was significantly higher than that of the NPD group. Subjective oral dryness of the PD group was rated as ʻsevereʼ compared with the NPD group, and the frequency of mouth opening in the PD group was higher than the NPD group, though there were no significant differences. There was no significant difference in salivary volume and spinability between the two groups. Logisticregression analysis that demonstrated the predictors of polydipsia were tobacco and number of medications. Conclusion: It was shown that the predictors of polydipsia were tobacco and number of medications. The polydipsia may reduce by decreasing medications and quitting tobacco.

DOI： 10.5466/ijoms.12.29

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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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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DOI： 10.1111/j.1745-4603.2012.00364.x

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Language：Japanese   Publisher：(一社)日本口腔診断学会  

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

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

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Language：Japanese   Publisher：(一社)日本口腔診断学会  

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

唾液分泌量が減少すると、口腔粘膜が乾燥する。そのため、歯科治療時にデンタルミラー、ロールワッテなどが粘膜に張り付き、疼痛や不快感を起こすことがある。したがって、唾液分泌量が減少している患者の歯科診療にあたっては、苦痛を軽減する配慮が必要である。しかし、歯科衛生士教育課程に口腔乾燥症に関する実習を導入した報告はない。新潟大学歯学部口腔生命福祉学科では、歯科衛生士教育課程において、口腔乾燥症に関する講義・実習を行っている。本稿の目的は、口腔乾燥症に関する講義および実習の紹介と、アンケート調査の結果を検討することである。2009年から3年間、本学歯学部口腔生命福祉学科3年次学生に口腔乾燥症に対する講義および実習を行った。講義および実習後に、理解度、必要性に関するアンケートを行った。その結果、受講した全員が講義および実習を理解できたと答えていた。また、実習の必要性については、全員が必要であると答えていた。実習が「将来役に立つと思う」と回答したのは、98.5%であった。唾液分泌量と理解度および必要性、有用性の間には、関連性は認められなかった。本アンケート調査は、実習直後に行ったため、理解度も必要性も高いという回答が多かったと思われる。今後、講義や実習に対する関心度の調査、卒後の再調査による評価を加えることによって、口腔乾燥症に関する学習効果の向上を図る必要がある。(著者抄録)

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Language：Japanese   Publisher：(一社)日本口腔内科学会  

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Language：Japanese   Publisher：(一社)日本口腔内科学会  

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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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Language：English   Publisher：Research Institute of Oral Science, Nihon University School of Dentistry at Matsudo  

<b>Aim</b>: In dental treatment, to remove an instrument, such as dental mirror or to remove a dental cotton roll inserted in the gingivobuccal fold, often brings the patient discomfort or pain. To prevent these uncomfortable conditions, dental instruments or dental cotton rolls are moistened based on an empirical basis. However, there has been no research done evaluating whether discomfort is reduced by these techniques. The purpose of this study was to evaluate the effects of moistened techniques on the patientsʼ discomfort and the operatorsʼ ease. <b>Materials and Methods</b>: Thirty eight subjects without hyposalivation were studied. Two procedures were implemented. One was that a dry or moistened dental mirror was removed after exclusion of the buccal mucosa. The other was removal of a dental cotton roll from the gingivobuccal fold after either moistening it or leaving it dry. The subjectsʼcomfort and the operatorsʼ treatment ease were evaluated on five point scales. <b>Results</b>: During these procedures, the subjectsʼ comfort was significantly increased by moistening of both the dental mirror and the cotton roll. The ease of performing both procedures was also significantly increased for operators in the moistened condition. In addition, there was a significant positive correlation between the subjectsʼ comfort and the operatorsʼ ease. <b>Conclusion</b>: When using dental instruments and removing cotton rolls, moistening increases both the subjectsʼ comfort and operatorsʼ treatment ease.

DOI： 10.5466/ijoms.11.85

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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：Japanese   Publisher：新潟歯学会  

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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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 voluntary swallows are identical to those of involuntary swallows, which suggests that the swallowing central pattern generator is a common component of both neuronal networks and therefore is responsible for inter-individual variations. © 2012 Elsevier Inc.

DOI： 10.1016/j.physbeh.2012.02.007

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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：Japanese   Publisher：(一社)日本女性医学学会  

口腔疾患に対するホルモン補充療法(HRT)の効果を明らかにするため、文献検索を行った。PubMedから391件、医学中央雑誌から142件の該当文献が得られ、そのうち57件について検討した。ヒトを対象とした文献は41件で、多くがアメリカ、フィンランドの文献であった。筆頭著者の73.2%は歯科所属であった。57件の文献をアウトカムによって、口腔乾燥感および唾液、口腔の不快感、残存歯数、歯周疾患、顎骨骨密度、インプラント、顎関節症の七つに分けて検討した。HRTは口腔の不快感と顎骨骨密度に対しては効果があるといえる可能性が高い。一方、その他のアウトカムについてはコンセンサスが得られていないことが分かった。

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Language：Japanese   Publishing type：Research paper (international conference proceedings)  

The present study tested whether electrical stimulation increases the number of voluntary repetitive swallows in humans and if summation of peripheral inputs increases the number of swallows. In addition, the potential of initiating both voluntary and involuntary swallowing was compared and the effect of chewing behaviors on the initiation of swallowing evoked by the electrical stimulation was evaluated. Facilitatory effect of both the mid- and hypo-pharyngeal stimulation was much larger than that of mid-pharyngeal stimulation. The longer the pulse duration was, the larger the number of swallows was, suggesting temporal and spatial summation of peripheral inputs into the swallowing center. There was a wide variation in the number of swallows among subjects. The number of reflexively evoked swallowing (i.e., involuntary swallow) by pharyngeal stimulation also varied greatly, and there was a significant linear correlation in the number of swallows between voluntary and involuntary swallowing, which suggests that the swallowing central pattern generator is a common component of both neuronal networks and therefore is responsible for inter-individual variations. The chewing strongly inhibited the initiation of swallows. Although it should be clarified how the chewing behaviors modulate swallowing function, these data suggest the functional interaction between chewing and swallowing centers.

DOI： 10.5692/clinicalneurol.52.1192

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Language：Japanese   Publisher：日本味と匂学会  

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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：Japanese   Publisher：(一社)歯科基礎医学会  

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Language：Japanese   Publisher：医学図書出版(株)  

過活動膀胱に対するイミダフェナシンおよびソリフェナシンの有効性を比較した。さらに、口腔乾燥および便秘の発現について評価した。蓄尿症状の評価は過活動膀胱症状質問票を用いた。口腔乾燥については口腔乾燥質問票を用い、便秘については便秘評価尺度により評価した。過活動膀胱症状スコアの変化量において両群間に差は認められなかった。その結果、イミダフェナシンとソリフェナシンは同等の有効性を有することが示された。(著者抄録)

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Language：Japanese   Publisher：(株)ライフ・サイエンス  

インターネットによる質問調査で、40歳以上の男性100名、女性199名の合計299名(平均年齢66.9歳)を対象とした過活動膀胱(overactive bladder:OAB)を中心とする健康調査を実施した。過活動膀胱症状質問票(overactive bladder symptom score:OABSS)を用いて調査した結果、OABと判定された患者は全体の約16.7%であった。しかしながら、OABと判定された患者の中で下部尿路機能障害の治療を受けている患者はわずかに14.0%であった。口腔乾燥質問票(dry mouth score:DMS)および便秘評価尺度(constipation assessment scale:CAS)を用いて口腔乾燥および便秘症状を評価した結果、OABと判定された回答者ではそれらのスコアが有意に高かった。以上の結果、高齢者におけるOAB治療は不十分であり、また治療薬である抗コリン薬を処方する場合は、その副作用(口腔乾燥、便秘)に注意が必要と考えられた。(著者抄録)

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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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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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Language：Japanese   Publisher：新潟歯学会  

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

2006年から介護予防事業の一つとして口腔機能の向上が取り入れられた。その評価項目の1つであるオーラルディアドコキネシスの測定法には、ICレコーダーで録音し回数をカウントする方法(IC法)、電卓のメモリー機能を用いる方法(電卓法)、ペンで点を打つ方法(ペン打ち法)などがある。今回われわれは、オーラルディアドコキネシス回数を自動的に測定することができる新しい口腔機能測定器「健口くん」を開発した。本研究の目的は、従来のIC法、電卓法および「健口くん」を用いる方法でオーラルディアドコキネシス回数を測定し、その結果を比較検討することである。79歳の高齢者49名(男性26名、女性23名)、および80歳の高齢者355名(男性175名、女性180名)を対象とした。対象者に、/pa//ta//ka/の順番でそれぞれ5秒間できるだけ早く繰り返し発音するように指示し、IC法、電卓法、健口くん法で測定した。健口くん法による平均値は/pa/で6.0±0.9回/秒、/ta/で6.0±0.9回/秒、/ka/で5.7±0.8回/秒であった。健口くん法とIC法には有意な高い相関が認められた。電卓法では相関が低く、1秒間に7.0回を過ぎると電卓でのミスカウント数が大きくなっていた。電卓のキーを叩くタッピング運動の速度には限界があるため、正確に測定できない可能性があると思われた。したがって、新しい口腔機能測定器を用いる健口くん法は、オーラルディアドコキネシス回数の測定に有用であることが示唆された。(著者抄録)

DOI： 10.11259/jsg.24.48

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER PHYSIOLOGICAL SOC  

Tsukada T, Taniguchi H, Ootaki S, Yamada Y, Inoue M. Effects of food texture and head posture on oropharyngeal swallowing. J Appl Physiol 106: 1848-1857, 2009. First published March 26, 2009; doi:10.1152/japplphysiol.91295.2008.-This study aimed to describe the electromyographic (EMG) activity patterns of the genioglossus (GG) and suprahyoid (SHy) muscles during swallowing. The effects of changes in food texture/consistency and head posture on transport of the swallowed bolus were also investigated. Participants were 10 normal adults. Test foods consisted of a liquid, a syrup, or 4 ml of paste made from 0.5% or 1.0% agar. Each food was swallowed with the head in one of three positions, and EMGs and videofluorographic (VF) images were recorded. Mean values of onset, peak, and offset times, peak amplitude, area, and duration of the EMG burst were measured. The total swallowing time, oral ejection time, pharyngeal transit time, clearance time, fauces transit time, and upper esophageal sphincter (UES) transit time were measured. The GG muscle burst patterns showed two peaks (GG1 and GG2) during each swallowing. The offset time and duration of the GG1 burst and the onset, peak, and offset times and duration of both the GG2 and SHy bursts were significantly affected by food texture. There were no significant differences in bolus transit time among the different experimental conditions. Regression analyses demonstrated significant linear relationships between the tongue tip touching the palate and the peak of the GG1 burst, between passage of the bolus tail at the fauces and offset of the GG1 burst, between passage of the bolus tail at the UES and peak of the GG2 burst, and between passage of the bolus tail at the UES and offset of the SHy burst. These results demonstrate that the duration, but not the amplitude, of tongue and suprahyoid muscle activity were increased with increasing hardness of food during swallowing and that the bolus transit time can be fixed within a certain range of physical food properties.

DOI： 10.1152/japplphysiol.91295.2008

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Epithelial sodium channels (ENaCs) are a subfamily of ion channels within the degenerin/ENaC (DEG/ENaC) superfamily. Previous studies have shown the immunolocalization of ENaC in the neural elements of the cutaneous mechanoreceptors as well as dorsal root and trigeminal ganglion neurons, indicating the involvement of this molecule in mechanotransduction. The present study examined the expression of ENaCβ, a major component of ENaC protein, in the mechanoreceptive Ruffini endings in the periodontal ligament of the rat incisors by immunohistochemistry. The expression of ENaCβ in the trigeminal ganglion - which innervates the periodontal Ruffini endings - was also investigated at the mRNA and protein levels. Furthermore, double staining and a nerve injury experiment were applied to clarify its detailed localization in the periodontal Ruffini endings. ENaCβ immunoreaction in the trigeminal ganglion was recognizable in the comparatively large neurons which have been considered to mediate mechanotransduction. Immunohistochemistry for ENaCβ demonstrated dendritic ramifications of the Ruffini endings as well as the rounded cells in the periodontal ligament. Double staining with ENaCβ and either PGP9.5 or S-100 protein showed immunoreaction for ENaCβ in both the axonal and glial elements in the periodontal ligament. Some ENaCβ positive cells with rounded profiles were reactive to non-specific cholinesterase activity. Furthermore, a transection of the inferior alveolar nerve failed to eliminate the rounded cells with ENaCβ reaction, indicating that they were the terminal Schwann cells associated with the periodontal Ruffini endings. These findings suggest that ENaCβ is a key mechanotransducing channel in the periodontal Ruffini endings. Probably, the terminal Schwann cells together with the axon terminals regulate mechanotransduction in the periodontal endings.

DOI： 10.2220/biomedres.30.113

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Language：Japanese   Publisher：新潟歯学会  

口腔乾燥症の診断には、安静時唾液分泌量の測定が重要である。一般的に吐唾法が用いられているが、唾液を吐出する能力を必要とするため唾液の吐出が難しい患者への応用は困難である。ワッテ法は、術者がロールワッテを舌下部へ挿入し、唾液を吸収させる方法であるため吐出が不要である。また、測定時間はわずか30秒間もしくは60秒間と比較的短く簡便である。しかし、その有用性およびカットオフ値に関する検討はまだなされていないのが現状である。そこで、ワッテ法のドライマウスの臨床における有用性を検討する目的で、ワッテ法と吐唾法との比較検討を行った。被験者は、口腔乾燥を自覚していない健常者26名と新潟大学医歯学総合病院くちのかわき外来受診者10名の計36名とした。吐唾法による15分間の安静時唾液、30秒間および60秒間のワッテ法による唾液分泌量を測定し分析した。その結果、吐唾法による安静時唾液分泌量とワッテ法30秒値、60秒値との間にいずれも有意な正の相関が認められた。従って、ワッテ法は唾液分泌測定法のひとつとして利用できることが示唆された。さらに、ワッテ法における唾液分泌機能低下の目安としてカットオフ値を算出した結果、30秒値は0.14g、60秒値は0.25gとなった。本研究の被験者のうち、唾液分泌が実際に減少しているものは9名のみであった。今後、被験者を増やし、ワッテ法におけるカットオフ値を明確にする必要があると考えている。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER PHYSIOLOGICAL SOC  

This study aimed to evaluate the effects of food texture and viscosity on the swallowing function by measuring tongue pressure and performing a videofluorographic (VF) examination. Eleven normal adults were recruited for this study. Test foods with different consistencies and liquid contents, i.e., a half-solid nutrient made of 0.8 and 1.5% agar powder, syrup, and a liquid containing 40 wt/vol% barium sulfate, were swallowed, and the anterior (AT) and posterior tongue pressures (PT) and electromyographic (EMG) activity of the suprahyoid muscles were recorded, together with VF images. The timing of each event obtained from EMG, tongue pressure, and VF recordings was measured and then compared. We found that the AT and PT activity patterns were similar and showed a single peak. The peak, area, and time duration of all of the variables for AT and PT and EMG burst increased with increasing hardness of the bolus. The onset of the EMG burst always preceded those of the AT and PT activities, while there were no significant differences in peak and offset times among EMG burst, AT, and PT. Total swallowing time and oral ejection time were significantly longer during the swallowing of 1.5% agar than any other boluses, while pharyngeal transit time and clearance time were significantly longer during the swallowing of syrup, which was as hard as the liquid, but showed a higher viscosity than the liquid. The results suggested that the major effects of food hardness were to delay oral ejection time, which strongly delays total swallowing time. In addition, pharyngeal bolus transit is not dependent on the hardness of food but on its viscosity.

DOI： 10.1152/japplphysiol.90485.2008

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Hyoid action was studied regarding bolus movement during normal ingestion in five subjects using videofluorography in the sagittal plane. The subjects were asked to take one mouthful of steamed rice and chew it normally until the mouth was empty. Food intake, transport to the postcanines, chewing, and swallowing were identified using frame-by-frame analysis of the images. Two types of swallowing were identified during the sequence: interposed and terminal swallowing. The former was observed during chewing, while the latter was observed at the end of the sequence. Differences were observed in the size of the food bolus passing through the pharyngo-esophageal junction: a larger volume was observed for the interposed swallow, which was reflected in the dilation of the junction and a longer time taken for the passage of food. There was no difference in hyoid movement between the two swallows, either in the vertical or horizontal direction, i.e., the hyoid moved maximally during its function in swallowing, regardless of the bolus size passing through the pharyngo-esophageal junction. This suggests that the swallowing-related motor action involved in hyoid movement is unaffected by sensory input. © 2007, Japanese Association for Oral Biology. All rights reserved.

DOI： 10.2330/joralbiosci.49.180

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Tongue pressure against the anterior and posterior portions of the hard palate as well as the electromyographic activity of suprahyoid muscle during swallowing test foods with three different consistencies (thinned, medium, and thickened paste) and liquid were recorded. Significant differences and wide variations were noted in the peak amplitude and area of posterior tongue pressure, which was larger for thickened paste compared to liquid, thinned, and medium pastes. Regarding the anterior tongue pressure, the duration was significantly longer during swallowing thickened paste compared to liquid and thinned paste, while there were no differences in the peak amplitude and area. The results suggest that a basic pattern of tongue pressure is maintained during swallowing but is modulated by sensory feedback in a different manner between the anterior and posterior portions of the tongue to complete propulsion of the bolus in the oral cavity. © 2006, Japanese Association for Oral Biology. All rights reserved.

DOI： 10.2330/joralbiosci.48.278

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

Changes in reflex responses in the genioglossus (GG) muscle evoked by electrical stimulation of the inferior alveolar nerve and GG muscle tone (background activity, BGA) were investigated during sleep-wakefulness stages in rabbits. The GG muscle showed two types of electromyographic activity patterns: a respiration-related phasic activity and non-respiration-related activity. GG reflex responses and BGA exhibited a stage-dependent decrease as they were constantly suppressed from quiet wakefulness to non-rapid eye movement sleep (NREMS) to rapid eye movement sleep (REMS). Degree of suppression of reflexes was much larger than that of BGA regardless of GG activity patterns. When amplitude of reflex responses was compared between with and without rapid eye movements during REMS, no difference between the conditions was noted. These results suggest that excitability of the GG muscle is affected by sleep stages by not only a modulation of excitability in motoneurons but also in interneurons involved in the reflex arc. (C) 2005 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.brainres.2005.10.013

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

The aim of this study was to determine the effect of unilateral acute inflammation of cramofacial deep tissues on the ipsilateral and contralateral jaw-opening reflex (JOR). The effects of mustard oil (MO), injected into the temporomandibular joint region, were tested on the JOR recorded in the digastric muscle and evoked by low-intensity electrical stimulation of the ipsilateral and contralateral inferior alveolar nerve in anesthetized rats. The MO injection induced a long-lasting suppression of the amplitude of both ipsilaterally and contralaterally evoked JOR, although the latency and duration of the JOR were unaffected. The suppressive effect was more prominent for the contralaterally evoked JOR, and observed even when background activity in the digastric muscle was increased by the MO injection. The results indicate that changes in the, JOR amplitude following MO injection do not simply reflect alterations in motoneuronal excitability, and suggest that inflammation of deep craniofacial tissues modulates low-threshold sensory transmission to the motoneurons. (c) 2005 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.brainresbull.2005.06.013

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

Mastication is the first stage of digestion and involves several motor processes such as food intake, intra-oral food transport, bolus formation and chewing in its broad sense. These complicated motor functions can be accomplished by the well-coordinated activities in various cranial motoneurons innervating the jaw, hyoid, tongue and facial muscles. The brainstem masticatory central pattern generator (CPG) plays a crucial role in generating basic activity patterns of these cranial motoneuron groups. However, descending inputs from higher brain (e.g., cerebral cortex) and mastication-generated peripheral sensory inputs also play important roles in modulating the activity pattern of each motoneuron so that the final motor outputs fit the environmental demand. In this review, we focus on the coordination of the trigeminal, facial and hypoglossal motoneurons during mastication. We first summarize findings showing the activity patterns of muscles innervated by these motoneurons during natural mastication, and then discuss the possible neural mechanisms underlying their coordinated activities during mastication. (C) 2005 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.resp.2005.02.017

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

Previous studies have shown that jaw reflexes and activity patterns of the jaw muscles were modulated in the presence of jaw muscle pain. However, there is no study comparing the modulatory effects on the jaw reflexes induced by noxious stimulation to the jaw muscle. To clarify this, effects of the application of mustard oil (MO), an inflammatory irritant, into the temporalis (jaw-closing) muscle on (1) jaw-opening reflex evoked by tooth pulp stimulation (TP-evoked JOR) as a nociceptive reflex, (2) jaw-opening reflex evoked by interior alveolar nerve stimulation as a non-nociceptive reflex and (3) jaw-closing reflex evoked by trigeminal mesencephalic nucleus stimulation as a proprioceptive reflex were investigated in anesthetized rats. The MO application induced suppression of all reflexes. and the effect on the TP-evoked JOR was more prominent than on the other reflexes. To elucidate the involvement of endogenous opioid system for the suppressive effect, a systemic administration of naloxone following the MO application was conducted. The MO-induced suppressive effect on the TP-evoked JOR was reversed by the naloxone administration. The results suggest that noxious stimulation to the jaw muscle modulate jaw reflexes particularly for the nociceptive jaw-opening reflex, and the modulatory effect includes both facilitatory and inhibitory aspects. The results also suggest that pain modulatory systems such as the endogenous opioid system play a crucial role in the suppression of the nociceptive transmissions related to nociceptive reflexes, and in some pathological states, defense reflexes may not be evoked properly. (c) 2005 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.brainres.2005.02.003

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

The effects of physical characteristics of foods on the coordination of extrinsic tongue muscle activities during natural mastication were evaluated. Electromyograms of tongue-retractor (styloglossus, SG) and tongue-protractor (genioglossus, GG) muscles as well as the jaw-movement trajectories were recorded during raw rice and chow pellet chewing in the freely moving rabbit. Each masticatory cycle included a jaw closing (Cl) phase consisting of a fast-closing (FC) and a slow-closing (SC) phase, and a jaw opening (Op) phase. The duration of the Cl and SC phases was found to be much larger while the duration of the FC phase was much smaller during rice chewing than pellet chewing. The jaw movements during rice chewing had smaller amplitudes of the gape and lateral excursion of the jaw as compared with those during pellet chewing. The SG muscle had a double-peaked burst activity in each masticatory cycle with one peak during the Op phase (the SG1 burst) and the other during the Cl phase (the SG2 burst). They were significantly larger during pellet chewing as compared with rice chewing, but the duration of the SG2 burst was significantly longer during rice chewing than pellet chewing. The offset of the SG2 burst was delayed during rice chewing as compared with that during pellet chewing. There was little difference in the activity pattern of the GG burst between the foods. Our present results suggest that the SG muscle activity could be modified by the sensory feedback possibly to adapt to environmental demands during chewing. (C) 2004 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.neulet.2004.07.043

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

To evaluate the coordination of tongue and suprahyoid muscle activities during natural mastication, electromyogratus (EMGs) of jaw-closer, jaw-opener, suprahyoid (mylohyoid, MH), tongue-retractor (styloglossus, SG) and tongue-protractor (genioglossus, GG) muscles were recorded as well as the jaw-movement trajectories in vertical and horizontal axes in awake rabbits. Each masticatory cycle had three components including the fast-closing (FC), slow-closing (SC) and opening (Op) phases. The duration of the SC phase was much longer during pellet chewing while the durations of the FC and Op phases were much shorter during pellet chewing than bread or banana chewing. The jaw movements during banana chewing had a small amplitude of lateral excursion and a large amplitude of gape as compared with those during pellet and bread chewing. The MH muscle exhibited double-peaked EMG bursts during the Op phase. The MH bursts in the late part of the Op phase were dominant on the non-chewing side during pellet and bread chewing. The SG muscle also exhibited double-peaked EMG bursts. During pellet and bread chewing, the SG bursts during the SC phase were significantly larger on the chewing side than the non-chewing side. These bursts were also dominant during pellet chewing as compared with banana chewing. There was little difference in the GG bursts between the chewing and non-chewing sides or among the foods. Our results suggest that patterns of the MH and SG muscle activity are affected by the peripheral inputs and/or chewing patterns while those of the GG muscle activity was less modulated regardless of the consistency of foods. (C) 2004 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.brainres.2004.06.047

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

To clarify the jaw-closer and tongue-retractor muscle activity patterns during mastication, electromyographic activity of the styloglossus (SG) as a tongue-retractor and masseter (Mass) as a jaw-closer muscles as well as jaw-movement trajectories were recorded during cortically evoked rhythmic jaw movements (CRJMs) in anesthetized rabbits. The SG and Mass muscles were mainly active during the jaw-closing (C1) phase. The SG activity was composed of two bursts in one masticatory cycle; one had its peak during the jaw-opening (Op) phase (SG1 burst) and the other during the C1 phase (SG2 burst). The Mass activity during the C1 phase was dominant on the working side (opposite to the stimulating side) while the SG1 and SG2 bursts were not different between the sides. When the wooden stick was inserted between the molar teeth on the working side during CRJMs, the facilitatory effects on the SG1 and SG2 bursts on both sides were noted as well as those on the Mass bursts, but the effects on the SG1 burst seemed to be weak as compared with those on the Mass and SG2 bursts. The difference in the burst timing between the sides was noted only in the SG1 burst. When the trigeminal nerves were blocked, the peak and area of the SG and Mass burst decreased during CRJMs, and the facilitatory effects of the wooden stick application on the muscles were not noted. The results suggest that the jaw and tongue muscle activities may be adjusted to chew the food and make the food bolus. (C) 2004 Elsevier B.V. All rights, reserved.

DOI： 10.1016/j.brainres.2004.05.005

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

To study peri-oral facial muscle activity patterns and coordination with jaw muscles during ingestive behavior, electromyographic (EMG) activities in the peri-oral facial (buccinator: BUC, orbicularis oris: ORB) and jaw (masseter, digastric) muscles along with jaw movement trajectories were recorded in awake rabbits. A standardized amount of apple in a cylindrical shape was used as the test food. The period from food intake to just before swallowing (the masticatory sequence) was divided into three masticatory periods (preparatory period, rhythmic chewing period and preswallow period) based on the activity pattern of jaw muscles and jaw movement trajectories, and jaw movements and EMG activities in both the jaw and facial muscles during each masticatory period were assessed. Both the jaw and facial muscles were active throughout the masticatory sequence, and the activity patterns of facial muscles and the pattern of coordination between the facial and jaw muscles varied for each masticatory period. No consistent pattern was noted for the BUC activity during the preparatory period, whereas the OR-B showed tonic activity throughout this period. During the rhythmic chewing and preswallow periods, both the ORB and BUC showed jaw-movement-related rhythmic bursts. However, significant differences were noted in the burst properties in both facial muscles and their temporal correlations with the jaw muscle activities between these two periods. Results Suggest that the neural mechanisms regulating facial muscle activities may differ between the masticatory periods, and such mechanisms may contribute to the well-coordinated orofacial movements required for smooth masticatory sequence. (C) 2003 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.brainres.2003.11.037

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

Peripheral input convergence on trigeminal premotor neurons in the vicinity of trigeminal motor nucleus has been investigated. Thirty neurons were identified by their antidromic responses to microstimulation of the masseteric subnucleus of trigeminal motor nucleus (NVmot-mass). Peripheral receptive fields were found in the buccal mucosae, periodontal ligaments, palate, tongue and vibrissae for 16 neurons located in the intertrigeminal area (NVint), supratrigeminal area (NVs), main sensory trigeminal nucleus (NVsnpr) and subnucleus gamma of the oral nucleus of the spinal trigeminal tract (NVspo-gamma). Eleven neurons in the NVint, NVs and NVspo-gamma responded to passive jaw opening: nine neurons were activated and two were inhibited. None of the neurons responded to both the orofacial mechanical stimulation and passive jaw opening. Forty-six percent of neurons (13 out of 28 tested) received inputs from the inferior alveolar nerve (IAN) and 53% of neurons (8 out of 15 tested) received inputs from the infraorbital nerve (ION). Out of 15 neurons tested for inputs from the IAN and ION, 7 neurons in the NVsnpr and NVspo-gamma received input from both. Sixteen percent of neurons (4 out of 25) received inputs from the masseteric nerve (MassN). None of the neurons with inputs from IAN and/or ION also received inputs from the MassN. We suggest that trigeminal premotor interneurons with projections to the NVmot-mass fall into two broad categories, those with inputs from the IAN and/or ION and those with inputs from the MassN, possibly muscle spindle afferents, and no neuron receiving inputs from both. (C) 2002 Elsevier Science B.V. All rights reserved.

DOI： 10.1016/S0006-8993(02)03662-4

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

Genioglossus (Gg) reflexes elicited by electrical stimulation of the inferior alveolar nerve were examined in naturally chewing rabbits. To eliminate possible contaminations of the digastric (Dig) activity in the Gg responses, the Dig nerve was denervated bilaterally. Masticatory and tongue muscles were well coordinated during chewing after the denervation; i.e., there were no significant differences in the phase durations between before and after denervation. The Gg reflex measured was divided into three categories depending on the chewing phase (i.e., jaw-opening, OP; fast-closing, FC; and slow-closing, SC) in which the stimulus was delivered. The reflex amplitude was phasically modulated for the phases, in that the amplitude in the OP phase was larger than that in any other phase (P&lt;0.05). On the other hand, the amplitude in the FC and SC phases was not significantly different to each other and from the control value obtained when the animal was awake and resting. The pattern of the modulation in the reflex amplitude was different from the previous report as to the Dig reflex in that OP&lt;FCsimilar toSC&lt;control was obtained. The results suggest that the modulatory mode in the Gg and Dig reflexes may be different in the pattern of the modulation under the natural chewing behavior and the Gg reflex is independent of the masticatory muscles in the nature. The reflex could be more sensitive to control the tongue movements collecting food bolus in the OP phase during chewing than in the jaw-closing phase. (C) 2002 Elsevier Science B.V. All rights reserved.

DOI： 10.1016/S0006-8993(02)03512-6

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

To study the function of the tongue and the coordination among jaw, tongue, and hyoid muscles during chewing and swallowing, we recorded the electromyographic activities from the masseter (Mas), digastric (Dig), mylohyoid (Myl), thyrohyoid (Thy), genioglossus (Gg) and styloglossus (Sg) muscles as well as jaw movement trajectories in the freely behaving rabbit. Three phases were identified in the chewing cycle (fast- and slow-closing and opening phases). The Gg (main tongue protruder) was active synchronously with the Dig during opening. The Sg (tongue retractor) showed two peaks in each cycle, one in the opening phase and the other in the closing phase. The latter may have a role in retracting the tongue during jaw closing. The co-contraction of the antagonists (i.e. Gg and S-) during opening may contribute to shape the tongue to be appropriate to gather the foodstuff. In the swallowing cycle, five phases were identified, two in the closing phase and three in the opening phase. Regression analysis revealed that swallowing cycles had a longer cycle duration than that of the chewing cycles due to an extra phase (a pause) inserted in the opening phase, where there was a small co-activation in the jaw opening and closing muscles. The findings suggest that the swallowing center affects masticatory center in the central nervous system, and may also support the view that the masticatory burst timing begins with the Dig activities in the middle of the opening phase. (C) 2001 Elsevier Science BY All rights reserved.

DOI： 10.1016/S0006-8993(01)02848-7

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

Changes in the masseteric monosynaptic reflex (MMR) and jaw-opening reflex (JOR) responses resulting from conditioning stimulation in the hypothalamus were studied in anesthetized rabbits. Stimulation of the lateral hypothalamus evoked a facilitation of the MMR and an inhibitory or facilitatory effect on the JOR. The facilitatory effect on JOR was stronger than that on the MMR. The facilitatory effective site for the JOR was in the dorsal and lateral directions as compared to the inhibitory field. The results suggest two functionally distinct regions in the lateral hypothalamus that separately project to the jaw-opening muscles. (C) 2001 Elsevier Science Ireland Ltd and the Japan Neuroscience Society. All rights reserved.

DOI： 10.1016/S0168-0102(01)00260-7

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

The aim of this study was to clarify the modulation of motoneuron excitability in masticatory muscles during sleep. For this purpose, changes in the reflex responses of the masseter and digastric muscles between sleep and wakefulness were studied in freely behaving rabbits. Stimulation of the jaw closing muscle spindle afferents induced the masseteric monosynaptic reflex (MMR). During quiet sleep (QS), which gradually replaced quiet wakefulness, the mean MMR amplitude showed no change. During active sleep (AS), MMR amplitudes were markedly reduced, but they were confounded by the occasional occurrence of facilitation in the amplitude. The facilitatory reflexes were often related to rapid eye movements (REMs). However, the excitatory input probably did not originate from the same region as the REM generator, since the REM and the large MMR did not always occur simultaneously. On the other hand, jaw opening reflexes remained inhibited. The results indicated that there is mainly a difference in the excitability between the two groups of motoneurons during AS; masseter motoneuron activity was inhibited but occasionally facilitated by excitatory inputs occurring in association with REMs, however, the digastric motoneuron activity was remained inhibited. The excitatory inputs may induce dysfunctional muscle contraction of the jaw closing muscles as seen in bruxism. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.

DOI： 10.1016/S0168-0102(99)00031-0

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Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：ELSEVIER SCIENCE BV  

We studied effects of electrical stimulation in the hypothalamus on the masseteric monosynaptic reflex (MMR) and the jaw-opening reflex (JOR) in rabbits. MMRs were obtained in the masseter EMG (electromyogram) after the electrical stimulation of the trigeminal mesencephalic nucleus. JORs were obtained in the digastric EMG after electrical stimulation of the inferior alveolar nerve. As for conditioning stimulus, the electrode was located in the hypothalamus. Short and small facilitation (260%) was obtained in the MMR when the conditioning was delivered in the lateral hypothalamic area. The C-T interval of this facilitation was less than 10 ms. On the other hand, the typical effect on JOR was a large facilitation (900%) followed by a late inhibition (30%). The C-T interval of the facilitation was less than 10 ms and approximately 40 ms for the inhibition. The area in the hypothalamus where the stimuli were effective, was larger for JOR than MMR. We concluded that the lateral hypothalamic area acted differently on the masseter and digastric motoneurons. We discussed the relationship between the craniomandibular disorders such as bruxism and the limbic system.

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

Effects of food consistency on the mode of the phase-linked modulation in the digastric reflex amplitude were examined in naturally chewing rabbits. Two test foods with different textures (bread as a soft food, pellet as a hard food) were used. The digastric reflex was elicited by electrical stimulation (10 train pulses at 2 kHz) of the inferior alveolar nerve. The amplitude of the digastric reflex measured was divided into three categories depending on the chewing phases in which the stimulus was delivered and each value was compared with the control response obtained when the animal was resting. The reflex was strongly inhibited in the jaw-opening phase and no difference was observed in the inhibitory effect between the foods. In the jaw-closing phase, larger digastric reflexes than those in the opening phase were elicited with both foods. This was the case in both the fast-closing and slow-closing phases. Reflex amplitude was significantly larger during chewing of the hard food than the soft food and, thereafter, inhibition of the reflex was observed only during chewing of the soft food in the closing phase. The results suggest the following: (1) food consistency may affect the central mechanism which regulates the digastric reflex and (2) the reflex may contribute to the regulation of masticatory force during chewing particularly hard food. (C) 1998 Elsevier Science B.V. All rights reserved.

DOI： 10.1016/S0006-8993(97)01470-4

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

DOI： 10.1007/PL00009566

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Responsible for pages：1月8日   Language：Japanese Book type：Scholarly book

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Responsible for pages：66   Language：Japanese Book type：Dictionary, encyclopedia

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Responsible for pages：124-129   Language：Japanese Book type：General book, introductory book for general audience

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Responsible for pages：383-386   Language：English Book type：Scholarly book

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：(株)全日本病院出版会  

筋電図検査とは、表面電極や針電極を用いて対象とする筋の活動電位(筋電位)を記録することで、筋収縮の定量的評価を行うものである。表面筋電図では電極を皮膚や粘膜上に貼付するため、ターゲットとする筋活動を非侵襲的に広く記録することができる反面、筋を限定して記録するのが難しいという欠点をもつ。針電極では、限定した部位の単一運動単位を記録でき、波形解析や伝導速度の計測により、脳神経内科疾患などの診断に用いることができるが、電極刺入時に痛みを伴うことや、筋の限局部位のみの評価であることから深部の筋活動の記録以外には適さず、摂食嚥下運動という統合機能の評価には向かない。目的に応じて嚥下内視鏡検査や嚥下造影検査などを併用し、多面的なアプローチを行うことによって機能評価が可能となる。(著者抄録)

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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：クインテッセンス出版(株)  

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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Language：Japanese   Publisher：(株)ライフ・サイエンス  

口腔乾燥症や味覚障害は、「乾いた食べ物を食べづらい」、「飲み込みづらい」、「何を食べてもおいしくない」、「常に嫌な味がする」などの症状を呈し、食思不振から低栄養を招くこともある。しかし高齢者の中には、口腔乾燥症や味覚障害であることに気づかず、水を飲むことで対処していたり、知らない間に塩分過剰摂取になっていることもある。医療従事者や周囲の者がこれらの症状に気づき、医療機関受診を勧奨し、適切な治療を行うことで、QOLの向上を図ることが可能である。(著者抄録)

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Language：Japanese   Publisher：(株)ライフ・サイエンス  

口腔乾燥症や味覚障害は、「乾いた食べ物を食べづらい」、「飲み込みづらい」、「何を食べてもおいしくない」、「常に嫌な味がする」などの症状を呈し、食思不振から低栄養を招くこともある。しかし高齢者の中には、口腔乾燥症や味覚障害であることに気づかず、水を飲むことで対処していたり、知らない間に塩分過剰摂取になっていることもある。医療従事者や周囲の者がこれらの症状に気づき、医療機関受診を勧奨し、適切な治療を行うことで、QOLの向上を図ることが可能である。(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：(一社)日本老年歯科医学会  

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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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  

【目的】新潟県内の病院における摂食嚥下障害の評価とリハビリテーション(以下、リハ)の実施状況、診療受け入れが可能な病院の分布を把握し、地域の摂食嚥下障害診療システムを構築するうえでの課題について検討する。【方法】調査期間は2014年7月1日から8月30日。新潟県内の全病院に調査用紙を郵送した。内容は、摂食嚥下障害の評価とリハ実施の有無、関わる職種、検査内容、摂食嚥下障害のための特別食の有無・種類、摂食嚥下障害の評価・リハ(評価かリハの一方あるいは両方)の他医療機関からの受け入れ、受け入れ不可能な理由などである。調査結果から、摂食嚥下障害患者の受け入れが可能な病院の分布図を作成した。【結果】130病院中120病院(92.3%)から回答を得た。評価は93病院(回答した120病院の77.5%)、リハは83病院(69.2%)で実施されていた。評価・リハに関わる職種は、言語聴覚士が71病院(評価・リハが実施されていた94病院の75.5%)、医師70病院(74.5%)、看護師65病院(69.1%)などであった。嚥下造影検査は41病院(評価が実施されていた93病院の44.1%)、嚥下内視鏡検査は29病院(31.2%)で実施されていた。特別食は120病院中94病院(78.3%)で提供されていた。評価・リハの外来での受け入れ意向があったのは120病院中47病院(39.2%)、入院での受け入れ意向があったのは60病院(50.0%)であった。受け入れ不可能な理由は、人員の不足、経験・知識の不足、機器の準備がない、などであった。精査(嚥下造影検査か嚥下内視鏡検査の一方あるいは両方)を実施、かつ外来受け入れ意向があったのは120病院中33病院(27.5%)、入院受け入れ意向があったのは37病院(30.8%)で、成人の受け入れ可能な病院はすべての二次医療圏に存在したが、2つの二次医療圏で小児の受け入れ可能な病院がなかった。【結論】新潟県では約70%の病院で摂食嚥下障害の評価・リハが実施されていたが、他医療機関からの受け入れ可能な病院は3割程度であった。小児の受け入れ可能な病院がない2つの二次医療圏の解消が課題である。(著者抄録)

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Language：Japanese   Publisher：(公財)8020推進財団  

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J-GLOBAL

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

超高齢社会およびストレス社会到来に伴い、今後、口腔乾燥症患者は増加する可能性がある。口腔乾燥症の診療にあたっては、1)傾聴・受容・共感の姿勢を大切にすること、2)口腔乾燥症の原因は複数あることが多いため見落とさないように留意すること、3)情報収集に努め、治療の選択肢を増やすこと、4)一般市民に向け、広く情報発信に努めること、が重要である。口腔乾燥症の診査、診断、治療について概説した。

DOI： 10.11259/jsg.32.305

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Language：Japanese   Publisher：(株)診断と治療社  

更年期世代の女性には、のぼせ、ほてりなどのいわゆる更年期症状のほか、口腔乾燥感、味覚異常、顎関節痛、舌痛などの口腔に関する疾患が多く認められる。このうち、舌痛症は口腔灼熱感(BMS)の一症状としてとらえられている。BMSの治療法には、薬物療法や原因除去療法があげられる。薬物療法のうちホルモン補充療法(HRT)については、BMSが改善したという報告や症状の改善が認められないという報告があり、見解の一致をみていないのが現状である。(著者抄録)

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Language：Japanese   Publisher：(株)ライフ・サイエンス  

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Language：Japanese   Publisher：(一社)歯科基礎医学会  

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Language：Japanese   Publisher：(一社)歯科基礎医学会  

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Language：Japanese   Publisher：(公社)日本リハビリテーション医学会  

リハビリテーションの分野において、電気刺激療法は鎮痛や筋力強化などの目的で古くから使用されてきた。筋力強化をめざした電気刺激療法は、脳血管疾患患者の摂食嚥下障害に対する理学療法として浸透してきたが、その効果に関するエビデンスはいまだ十分に得られていない。一方、筋力強化とは別に、感覚神経への刺激を通して、中枢神経系に働きかけることによって嚥下運動にかかわる中枢神経系の改善をめざした治療法もある。本稿では、電気刺激療法の種類や原理を紹介したうえで、中枢強化を目的とする電気刺激療法にも触れ、摂食嚥下障害への応用について、今後の展望と課題を解説する。(著者抄録)

DOI： 10.2490/jjrmc.54.672

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

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Language：Japanese   Publisher：(株)全日本病院出版会  

咀嚼は、摂食運動の初期に食塊形成を行う過程であり、咀嚼を開始・維持するとともに運動パターンを決定する大脳皮質、パターン形成の場である延髄のパターン発生器と呼ばれる神経細胞集団、食物粉砕と食塊形成に直接かかわる顎、舌、顔面の筋などがかかわる。加えて、口腔内で食塊の情報をとらえてこれを脳に伝えることは円滑な咀嚼運動遂行にとって必須である。そのための受容器として、歯に加えられた触圧覚や位置感覚を伝える歯根膜機械受容器と閉口筋の筋紡錘がある。これらの刺激は、安静時には開口反射や閉口反射を引き起こすが、咀嚼中には抑制を受けることで、不必要な反射が咀嚼を障害しないための制御機構が働く。咀嚼によって分泌される唾液や味覚は、食べることを楽しむためのアイテムである。食物の粉砕をゴールとするのではなく、食べるための咀嚼を考えるうえで、咀嚼と嚥下の機能連関を考えることが重要である。(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：English   Publishing type：Research paper, summary (international conference)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

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

DOI： 10.7144/sgf.23.138

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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=20170814470014&doc_link_id=10.7144%2Fsgf.23.138&url=https%3A%2F%2Fdoi.org%2F10.7144%2Fsgf.23.138&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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

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

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：新潟歯学会  

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Language：Japanese   Publisher：日本口腔リハビリテーション学会  

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Language：Japanese   Publisher：新潟歯学会  

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Language：Japanese   Publisher：(一財)竹田健康財団竹田綜合病院  

神経難病では、疾患の進行とともに嚥下機能も低下していく。しかし、これらの疾患の嚥下機能を経時的に評価した報告は少なく、さらに嚥下機能を簡易的、客観的に評価する検査がほとんどないのが現状である。今回の研究では、嚥下口腔期の評価として重要とされる舌筋力を測定し数値化できる舌圧に着目し、当院入院中の神経難病患者の舌圧と口腔期嚥下機能との関連を調べた。最大舌圧と嚥下造影検査(Videofluoroscopic examination:VF)を利用し、疾患別、経口摂取可否、食形態別で比較した。現在までに、全ての比較において有意な差は認められていないが、症例数を増やし調査を進めていくことで、神経難病における最大舌圧と口腔期嚥下機能への影響を明らかにできるものと期待している。(著者抄録)

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：OXFORD UNIV PRESS  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：OXFORD UNIV PRESS  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：OXFORD UNIV PRESS  

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Language：Japanese   Publisher：バイオメカニズム学会  

人口の高齢化や疾患の多様化が進んだことにより、「食べる・飲む」ことの機能障害である摂食嚥下障害に注目が集まっている。これまでの医療は、摂食嚥下機能障害に対して、主として経管栄養などの代替栄養を用いることを選択してきた。近年、高齢者の増加に伴い、人間らしく生きることを追求すれば食物の経口摂取は当然の権利であると見直されてきたこと、また国民医療費の負担増などの社会的問題の顕在化、などをきっかけとして摂食嚥下リハビリテーションが広まりつつあるが、摂食嚥下機能の評価、エビデンスを伴う治療的アプローチに関しては、未だ多くの課題が残されている。本稿では、摂食嚥下障害の背景にある日本の超高齢社会の実態を踏まえて、今後の医療発展のためにどのような臨床技術・研究が望まれているかについて解説する。(著者抄録)

DOI： 10.3951/sobim.40.4_229

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Language：Japanese   Publisher：(株)日本医事新報社  

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Language：Japanese   Publisher：日本嚥下医学会  

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

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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

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

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：BMJ PUBLISHING GROUP  

DOI： 10.1136/gutjnl-2016-312388.226

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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

DOI： 10.7144/sgf.22.148

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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=20160908470017&doc_link_id=%2Fex2gakuk%2F2016%2F002202%2F017%2F0148-0149%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fex2gakuk%2F2016%2F002202%2F017%2F0148-0149%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：全国保険医団体連合会  

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Language：Japanese   Publisher：新潟歯学会  

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

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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

DOI： 10.7144/sgf.22.38

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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=20160222240011&doc_link_id=%2Fex2gakuk%2F2015%2F002201%2F011%2F0038-0039%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fex2gakuk%2F2015%2F002201%2F011%2F0038-0039%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本嚥下医学会  

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

これまで嚥下誘発のメカニズムや嚥下運動関連筋活動のパターンを解明するために、さまざまな生理学的研究が行われてきた。そこでは、舌骨上筋・下筋群などの嚥下関連筋の筋電図、喉頭や舌などの運動などが評価対象となっているが、これらを同時に記録した例は少なく、さらに嚥下誘発条件の違いがもたらす効果についてはいまだに明らかにされていない。そこで本研究では、喉頭運動と舌骨上筋群筋電図の同時測定により、咽頭への溶液刺激が嚥下動態に与える影響について解析することを目的とした。健常成人10名を対象に、蒸留水もしくは0.3 M NaCl溶液による咽頭刺激時の随意性嚥下運動および反射性嚥下運動を記録し、各溶液間における随意性嚥下の比較および随意性嚥下と反射性嚥下の比較を行った。随意性嚥下時の溶液間の比較では、喉頭運動の挙上第1相のみに有意な変化がみられた。一方、随意性嚥下と反射性嚥下の比較では、反射性嚥下に比べて随意性嚥下で挙上第1相が延長し、第2相が短縮していた。第1相の延長は、嚥下反射の準備として舌骨を引き上げることを示し、第2相の短縮は、その準備により随意性運動から反射性運動への移行が円滑になっていること示すと考えられる。(著者抄録)

DOI： 10.7144/sgf.22.6

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Other Link： http://search.jamas.or.jp/link/ui/2016221956

Language：Japanese   Publisher：(株)ヒョーロン・パブリッシャーズ  

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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Language：Japanese   Publisher：神戸常盤大学・神戸常盤大学短期大学部  

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Language：Japanese   Publisher：神戸常盤大学・神戸常盤大学短期大学部  

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

DOI： 10.7144/sgf.21.144

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Other Link： http://search.jamas.or.jp/link/ui/2015356211

Language：Japanese   Publisher：日本歯科医学会  

口腔ケアは嚥下障害を有する患者において、誤嚥性肺炎予防のために重要とされている。本研究では、嚥下障害患者の経口摂取開始や食事形態のアップが、口腔環境の改善にどのような効果をもたらすかについて調べた。対象は、経管栄養中の入院患者のうち、口腔ケアを必要とする17名とした。初診後に通常の摂食嚥下リハビリテーションに加えて、以下の項目について毎週計測もしくは記録した;経口摂取状況、食事形態、摂食機能、口腔衛生状態、舌苔付着、舌背と頬粘膜の水分量、唾液分泌量、口腔内の細菌数である。その結果、口腔環境、ことに口腔衛生状態、舌苔付着、舌背水分量は経口摂取や食事形態のアップに従って改善していった。また、これらの項目の値は互いに高い相関を示した。唾液分泌量、口腔内の細菌数は食事摂取や食事形態によって影響を受けなかった。摂食機能のうち、顎口腔顔面舌運動、構音、最大発声時間などが、口腔環境との間に高い相関を示した。本研究の結果、口腔衛生状態を口腔ケアによって改善するだけでなく、日々の経口摂取そのものが口腔環境の改善に大きく影響することが示唆された。(著者抄録)

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Language：Japanese   Publisher：(株)医学書院  

嚥下は,反射性にも随意性にも誘発可能な運動である。また,嚥下は必要な栄養や水分を口腔から咽頭,食道を経て胃へと送り込む消化管活動であるだけでなく,誤嚥や窒息を防ぐための防御反応でもある。嚥下運動の誘発とパターン形成に関わるのは延髄のパターン発生器と呼ばれる細胞集団であり,咽喉頭からの入力や大脳皮質などからの入力が閾値を超えることにより,一連の活動が引き起こされる。(著者抄録)

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Language：Japanese   Publisher：The Institute of Electronics, Information and Communication Engineers  

The initiation of swallowing reflex are known to have two different types such as voluntary swallowing and reflex swallowing. To clarify such initiation mechanism, many studies have been done to analyze swallowing behaviors under the condition of pharyngeal water stimulation. However, most studies evaluated merely electromyography of related muscles, but have yet to directory evaluate the movement of swallowing organs such as the larynx. Then we applied swallowing function evaluation system SFN/3A that we have developed into this analysis. Experiments using 5 healthy volunteers revealed that 0.3M NaCl solution extended the first phase of the laryngeal elevation in voluntary swallowing by its inhibitory effect, while distiller water shortened the first phase of the elevation by its promoting effect. In addition, reflex swallowing was verified to shorten the first phase of the elevation as well as to extend the second phase, suggesting that reflex motion components of the elevation is accelerated in reflex swallowing.

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Other Link： http://search.jamas.or.jp/link/ui/2015325644