The purpose of this study was to investigate the influence of chin-down posture and bolus size on tongue pressure during swallowing. Eleven healthy volunteers (7 men, 4 women; age range = 26-59 years) participated in the experiments. Tongue pressure during dry and 5- and 15-ml water swallows in neutral and chin-down postures was measured using a sensor sheet system with five measuring points on the hard palate. Sequential order, maximal magnitude, duration, and integrated value of tongue pressure at each measuring point were compared between postures and bolus sizes. Onset of tongue pressure at posterior-circumferential parts occurred earlier in dry swallow than in 5- and 15-ml water swallows in each posture. Chin-down posture was most effective for increasing tongue pressure in the 5-ml water swallow compared with dry swallow and the 15-ml water swallow, but it had almost no influence on tongue pressure with the 15-ml water swallow. These results suggest that chin-down posture increases the tongue driving force for small boluses in healthy subjects, which can be interpreted to mean that oropharyngeal swallowing in a chin-down posture requires more effort.

We have experienced dysphagia rehabilitation by SpeechLanguage-Hearing Therapists (SLHTs) under nutritional management (nutrition support team, NST) which has been effective for patients' recovery especially in the acute stage. However, available information on the relation among recovery status, rehabilitation by SLHTs, and NST in the acute stage is limited. Hospitals where are not any or are only a few SLHTs, even in some urban areas of Japan still exist. Our aim of this study is to clarify the efficacy of dysphagia rehabilitation under nutritional management in an acute care hospital. The data of 750 patients admitted in a tertiary care hospital provided for this study. They were divided into four groups; SLHT group who were rehabilitated by SLHTs, both SLHT and NST (Abreast) group who were rehabilitated by SLHTs under NST, NST only (NST) group and Nonintervention (NI) group. The patients in SHLT and Abreast groups were older, more demented and with lower scores of FIM on average than the other two groups. 55.4% of SLHT group and 46.7% of Abreast group showed moderate to severe dysarthria. The percentage of tube fed patients was significantly higher in SLHT and Abreast group than others. However their inpatient periods and FIM score improvements did not show significant differences from others. The rate of their secession from tube feeding was significantly higher than others. We concluded that Dysphagia rehabilitation by SLHTs under nutritional management is effective for patients' recovery not only in convalescent stage but also in the acute stage. Medicine, Hebrew Home at Riverdale, Bronx, New York Improving the quality of care to the elderly is a fundamental cornerstone of the practice of geriatric medicine. Reducing the frequency of avoidable hospitalizations is an area of particular focus. Inpatient hospitalizations in the elderly population are often also associated with the development of multiple complications, which, in turn, increase lengths-of-stay. These include hospital-acquired infections, development of new decubiti, physical declines resulting from prolonged immobility, and the untoward effects of acute adjustment reaction from an unfamiliar hospital environment. The development of well-designed interventions in the nursing home can significantly reduce the number of potentially avoidable hospitalizations in this population. "Development of an Outpatient Transfusion Protocol to Reduce Avoidable Hospitalizations" is a quality improvement initiative that was implemented at The Hebrew Home at Riverdale, a skilled nursing facility in Bronx, NY. The objective of this program was to develop a favorable alternative to the hospitalization of postacute and long-term care patients requiring blood transfusion. In our experience, all patients being sent to the hospital for blood transfusion were being admitted as an inpatient, irrespective of the goals of care. This program is being successfully utilized for the patient who is evaluated for anemia at the skilled nursing facility and a clinical decisio...

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