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This study investigated the effects of Mendelsohn maneuver with three-dimensional kinematic analysis. Nine female speech-language pathologists (nine females, mean ± SD 27.1 ± 3.5 years old) underwent 320-row area detector scan during swallows of 4-ml nectar-thick liquid using with no maneuvers (control) and with Mendelsohn maneuver (MM). Critical event timing (hyoid, soft palate, epiglottis, laryngeal vestibule, true vocal cords (TVC), UES), hyoid and laryngeal excursion, cross-sectional area of UES, and volume of pharyngeal cavity and bolus were measured and compared between two swallows. In MM, all the events were significantly prolonged with delayed termination time (p more...

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

This retrospective clinical investigation was conducted to evaluate the usefulness of the Secretion Severity Rating Scale (Secretion Scale) in predicting the risk of pneumonia in acute-phase fasting stroke patients. Videoendoscopic (VE) evaluation of swallowing was performed in 72 consecutive stroke patients with a nonoral status. The patients were classified into 2 groups based on the Secretion Scale: the pharyngeal residual group (n=38; Secretion Scale level 0, 8 [11.1%]; level 1, 30 [41.7%]) and the laryngeal residual group (n=34: Secretion Scale level 2, 13 [18.1%]; level 3, 21 [29.2%]). The higher the Secretion Scale score, the more severe the swallowing dysfunction. The results of the evaluation were compared with the frequency of aspiration as well as with the incidence of pneumonia in the period from VE examination to discharge. In addition, the incidence of pneumonia was compared in the aspiration-positive and aspiration-negative groups. After VE evaluation, 4 patients (10.5%) in the pharyngeal residual group developed pneumonia versus 12 (35.3%) in the laryngeal residual group; the incidence of pneumonia was significantly higher in the laryngeal residual group (P < .05; Fisher's exact test). Our data indicate that the Secretion Scale can be a useful risk-management tool for predicting pneumonia in acute-phase fasting stroke patients. more...