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Inamoto, Saitoh E, Shibata S, Kagaya H, Nakayama E, Ota K, Onogi K, Kawamura Y. Effectiveness and applicability of a specialized evaluation exercise-chair in posture adjustment for swallowing. Jpn J Compr Rehabil Sci 2014; 5: 33-39. Aim: To evaluate the effectiveness of a newly-developed evaluation exercise-chair, Swallow Chair (SC), in terms of simplicity, applicability, and comfort for dysphagic patients, in comparison with a bed for adjusting posture. Methods: The subjects were three dysphagic patients who underwent videofluoroscopy (VFSS) and the effectiveness of the combined posture of reclining with rotation of the trunk and head for safe swallowing was evaluated. The recommended posture was adjusted and video-recorded under two conditions— using the SC or using a bed—during swallowing training, and the posture was then analyzed and compared. The evaluation criteria included the following: items necessary for posture adjustment and their number (simplicity), time required for posture adjustment (ease of use), and level of fatigue and pain experienced by the patient (comfort). Results: In all patients, SC required fewer items and less time for posture adjustment and caused lower subjective fatigue and pain compared with using the bed. The compensatory posture recommended in the evaluation was adjusted properly during swallowing training and meal consumption using the SC and all patients improved their posture along with food type and meal frequency. Conclusions: The SC is a simple, easy-to-use, and comfortable device for posture adjustment during evaluation, training, and meal consumption. more...

Itoh N, Kagaya H, Horio K, Hori K, Itoh N, Ota K, Kanada Y, Saitoh E. Relationship between movement asymmetry and sit-to-stand/stand-to-sit duration in patients with hemiplegia. Jpn J Compr Rehabil Sci 2012; 3: 66-71. Objective: To elucidate the relationship between sideto-side asymmetry and sit-to-stand and stand-to-sit duration in patients with right or left hemiplegia by three-dimensional motion analysis of the two movements. Methods: Forty-fi ve patients with hemiplegia (right hemiplegia in 21, left hemiplegia in 24) and 20 normal healthy adults were studied. Using three-dimensional motion analysis, an asymmetry index (AI) was calculated from the trajectory of the left-right component at the midpoint between two acromion markers as a function of time. Normal range of the sitto-stand and stand-to-sit duration was calculated as the mean ± SD obtained from normal subjects. Patients were divided into two groups according to duration: normal duration (within the mean ± 2SD of normal subjects) and abnormal duration (outside the mean ± 2SD of normal subjects). Motor function of the affected lower extremity and other parameters were compared between the normal and abnormal duration groups. Results: Sit-to-stand and stand-to-sit duration was signifi cantly prolonged in both right hemiplegic and left hemiplegic patients compared with normal subjects. In left hemiplegic patients, AI was signifi cantly higher in those with abnormal duration for both sit-to-stand and stand-to-sit movements. In left hemiplegic patients, the lower extremity motor function was signifi cantly poorer in those with abnormal duration for sit-to-stand movement. Conclusion: In patients with left hemiplegia, AI deviates toward the unaffected side, and impaired lower extremity motor function is associated with prolonged sit-to-stand duration. more...

Ota K, Saitoh E, Kagaya H, Sonoda S, Shibata S. Effect of postural combinations—the reclined seated position combined with head rotation—on the transport of boluses and aspiration. Jpn J Compr Rehabil Sci 2011; 2: 36-41 Purpose: The purpose of this study was to determine combinations of compensatory postural maneuvers used for dysphagic patients that could increase the risk of aspiration. Methods: Study 1: The pathway of the transported bolus was examined in various combinations of 30° head fl exion, head rotation to the right (0°, 30°, or 60°) and reclined seated position (90°, 60°, or 45°) by using synchronized imaging of videofl uoroscopic (VF; AP view) and videoendoscopic (VE) evaluation of swallowing in 5 healthy volunteers (24–45 years). Study 2: The occurrence of aspiration was evaluated in combinations of 30° head fl exion, head rotation (0° and 30° left and right), and a reclined seated position (90°, 60°, or 45°) by using VF lateral view in 10 dysphagic patients (74.7 ± 6.7 years). Results: Study 1: In a combined posture of 45° in a reclined seated position with a 30° head rotation to the right, the bolus reached the pyriform sinus on the side of rotation before the onset of the swallowing refl ex in 2 of the 5 healthy volunteers. Study 2: The aspiration rate was highest (40%) at a combined posture of 30° head rotation and 45° reclined seated position. Conclusion: These fi ndings suggest that certain postural combinations may increase the risk of aspiration. more...

Shibata S, Kagaya H, Inamoto Y, Saitoh E, Okada S, Ota K, Kanamori D. Swallowing maneuver analysis using 320-row area detector computed tomography (320-ADCT). Jpn J Compr Rehabil Sci 2011; 2: 54-62 Objective: Our objective was to examine whether swallowing maneuvers such as the Mendelsohn maneuver (MM) and the super-supraglottic swallow (SSGS) can be analyzed three-dimensionally and kinematically by using 320-row area detector computed tomography (320-ADCT). Methods: The subject was instructed to lean against a seat reclined at a 45° angle, hold 4 ml of 5% thickened liquid barium in the oral cavity, and then swallow normally or using the MM or the SSGS. Data were acquired for 3.15 s by using 320-ADCT, and images were reconstructed using a half-reconstruction method. The timing of each swallowing event was compared among the 3 swallowing methods. Results: We were able to determine the timing of vocal-cord closure and pharyngoesophageal segment (PES) opening during the normal swallowing method, the MM, and the SSGS. Conclusion: Swallowing maneuvers can be analyzed three-dimensionally and kinematically by using 320ADCT. more...