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This study investigated the effects of three different volumes of honey-thick liquid on the temporal characteristics of swallowing. Twenty-six healthy subjects (15 males, 11 females) underwent 320-row area detector CT scan while swallowing 3, 10 and 20 mL of honey-thick liquid barium. Three-dimensional images were created at 10 images/s. Kinematic events involving six structures (velopharynx, hyoid bone, epiglottis, laryngeal vestibule (LV), true vocal cords (TVC), upper esophageal sphincter (UES)) and timing of bolus movement were timed using frame by frame analysis. The overall sequence of events did not differ across three volumes; however, increasing bolus volume significantly changed the onset and termination of events. The bolus head reached to pharynx and esophagus earlier and the duration of bolus passing through UES was significantly longer in 10 and 20 mL compared to 3 mL (P < .05). Consequently, the onset of UES opening was significantly earlier with increased volume (P < .05). LV and TVC closure occurred later in 20 mL compared to 3 mL (P < .05). These changes in motion of pharynx and larynx appeared to promote swallow safety by preventing aspiration, suggesting that anatomical structure movements adapt in response to bolus volume. Our findings also suggest that the pharyngeal swallow behaviours may be modified by afferents in the oral cavity. The three-dimensional visualization and quantitative measurements provided by 320-ADCT provide essential benchmarks for understanding swallowing, both normal and abnormal.

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

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.

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.

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.

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.

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.

Research on muscle activation patterns during swallowing has been limited. Newly developed 320-row area detector computed tomography (320-ADCT) has excellent spatial and temporal resolution, which facilitates identification of laryngopharyngeal structures and quantitative kinematic analysis of pharyngeal swallowing. We investigated muscle activity patterns by observing the changes in length of hyoid muscles. 320-ADCT was performed in 26 healthy males while swallowing. The following parameters were analyzed three-dimensionally: 1) origins and insertions of the stylohyoid, anterior and posterior digastric, mylohyoid, geniohyoid, and thyrohyoid muscles; and 2) movement of the hyoid bone. The stylohyoid, posterior digastric, and mylohyoid muscles began to shorten simultaneously during the initial stage of swallowing. The shortening of these muscles occurred during the upward movement of the hyoid bone. Subsequently, the geniohyoid, thyrohyoid, and anterior digastric muscles began to shorten, synchronizing with the forward movement of the hyoid bone. A significant correlation was observed between the shortened muscle lengths of the stylohyoid, posterior digastric, and mylohyoid muscles and the upward movement of the hyoid bone ( r = 0.45–0.65). A correlation was also observed between the shortened muscle length of the geniohyoid muscle and the forward movement of the hyoid bone ( r = 0.61). In this study, the sequence of muscle activity during pharyngeal swallowing remained constant. Serial shortening of the hyoid muscles influenced the trajectory of the hyoid bone. The stylohyoid, posterior digastric, and mylohyoid muscles initiated the swallowing reflex and contributed to upward movement of the hyoid bone. The geniohyoid is a key muscle in the forward movement of the hyoid bone.

The present study examined the effect of bolus viscosity on the onset of laryngeal closure (relative to hyoid elevation), the duration of laryngeal closure, and other key events of swallowing in ten healthy volunteers. All volunteers underwent 320-row area detector computed tomography swallow studies while swallowing 10 ml of honey-thick barium (5 % v/w) and thin barium (5 % v/w) in a 45° reclining position. Three-dimensional images of both consistencies were created in 29 phases at an interval of 0.10 s (100 ms) over a 2.90-s duration. The timing of the motions of the hyoid bone, soft palate, and epiglottis; the opening and closing of the laryngeal vestibule, true vocal cords (TVC), and pharyngoesophageal segment; and the bolus movement were measured and compared between the two consistencies. The result showed differing patterns of bolus movement for thin and thick liquids. With thin liquids, the bolus reached the hypopharynx earlier and stayed in the hypopharynx longer than with thick liquids. Among events of laryngeal closure, only the timing of TVC closure differed significantly between the two consistencies. With thin liquids, TVC closure started earlier and lasted longer than with thick liquids. This TVC movement could reflect a response to the faster flow of thin liquids. The results suggest that bolus viscosity alters the temporal characteristics of swallowing, especially closure of the TVC.

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.