No abstract

It was suggested that once-a-week functional training of dysphagia with professional oral care might be effective in preventing pneumonia for elderly people who were being tube fed.

It is necessary to continue professional oral care at intervals of 1 week for 12 consecutive weeks and at intervals of 2 weeks for more than 20 weeks. The oral hygiene state could be improved by professional intervention at intervals of three or four weeks in long-term oral care, but this was limited to subjects whose Functional Independence Measure (FIM) scores were higher than 3.

A portable device to measure laryngeal movements was developed with a Piezoelectric Pulse Transducer. Simultaneous recordings of the laryngeal movements, EMG, and VF elucidated the PPT waveforms and could detect bolus passage during the pharyngeal phase of swallow. This portable system has the possibility to measure the dynamic state of swallowing without VF. AbstractPurpose: Since a Piezoelectric Pulse Transducer (PPT) detects finger peripheral pulse-waves, the PPT has already been used to simply record the laryngeal upward-downward movements. However, a relation between the sensor output and movements of the pharynx, larynx, and esophagus was not clear. This study was aimed to elucidate a relation between the PPT waveforms and food bolus passage during the pharyngeal phase of swallow. Methods:The laryngeal movements by the PPT, surface electromyography of the geniohyoideus muscle, and videofluorography were simultaneously recorded. To synchronize VF, the PPT waveforms, and EMG, we touched the neck surface lightly using a small metal ball both before and after swallowing, thereby putting marks on the VF and the waves of the PPT. Then, features in the waveform of the PPT were analyzed with a personal computer. Results:The swallowed food bolus was stopped for a moment on the epiglottic vallecula, as observed by VF. This stop was also observed in the PPT waveform as a return to the baseline. The epiglottis returned to the original position at the end of swallowing, as can be observed by VF and by a small peak in the PPT waveform. The food bolus passage was divided into two periods on the PPT waveform: TA (transit period from the base of the tongue to the epiglottic vallecula), and TB (transit period from the epiglottic vallecula to the esophagus). Conclusion:The PPT waveforms could detect bolus passage from the base of the tongue through the epiglottic vallecula to the esophagus.

Exteroceptive suppression (ES) periods in human jaw-closing muscles can be conditioned by a wide range of somatosensory stimuli and cognitive states. The aim of this study was to examine the effects of subanaesthetic doses of midazolam, ketamine and propofol on the short latency (ES1) and long latency (ES2) reflex in the jaw-closing muscles. First, we tried to evaluate the various methodological criteria for ES recording. We then examined the effect of subanaesthetic doses of midazolam (0·035 mg kg(-1)), ketamine (0·30 mg kg(-1)) and propofol (0·35 mg kg(-1)) on these reflexes of recording left masseter and temporalis muscle. ES duration did not differ greatly in the present study, recorded with the correct adjustment of stimulating and recording conditions. None of the subanaesthetic doses of the agents influenced ES1, and no significant effects on ES2 were observed with midazolam and ketamine. However, significant inhibitory change was observed in ES2 with propofol. ES2 is thought to be mediated by afferents, which descend in the spinal trigeminal tract and connect with a polysynaptic chain of excitatory interneurones located in the lateral reticular formation. Our observations indicate that propofol is uniquely effective not only through involvement of the gamma-aminobutyric acid type A receptor, but also through a range of other effects.