Prevalence of sarcopenia and its association with activities of daily living and dysphagia in convalescent rehabilitation ward inpatients

Sarcopenia is associated with worse recovery of physical function and dysphagia and a lower rate of home discharge in Japanese hospitalized adults undergoing convalescent rehabilitation.

Background. Poststroke dysphagia can persist, leading to many complications. Objective. We investigated whether noninvasive brain stimulation to the pharyngeal motor cortex combined with intensive swallowing therapy can improve dysphagia. Methods. A total of 20 patients who had dysphagia for at least 1 month after stroke were randomly assigned to receive 10 sessions lasting 20 minutes each of either 1-mA anodal transcranial direct current stimulation (tDCS) or a sham procedure to the ipsilesional pharyngeal motor cortex, along with simultaneous conventional swallowing therapies. We evaluated swallowing function with the Dysphagia Outcome and Severity Scale (DOSS) before, immediately after, and 1 month after the last session. Results. Anodal tDCS resulted in an improvement of 1.4 points in DOSS (P = .006) immediately after the last session and 2.8 points (P = .004) 1 month after the last session. The sham tDCS group improved 0.5 points (P = .059) after the last session and 1.2 points (P = .026) 1 month aft...

https://journals.sagepub.com/doi/pdf/10.1177/1545968312474116

Transcranial direct current stimulation improves swallowing function in stroke patients.

Background Malnutrition affects the activities of daily living (ADLs) in convalescent patients with cerebrovascular disorders. We investigated the relationship between nutritional improvement, energy intake at admission, and recovery of ADLs. Methods We evaluated 67 patients with cerebrovascular disorders admitted to our rehabilitation hospital between April 2013 and April 2015. These patients received interventions from the rehabilitation nutritional support team according to the following criteria: weight loss of 2 kg or more and body mass index of 19 kg/m(2) or lower. Exclusion criteria included a body mass index of 25 kg/m(2) or higher, duration of intervention of less than 14 days, or transfer to an acute care hospital because of clinical deterioration. We assessed nutritional status using the Geriatric Nutritional Risk Index (GNRI) and ADL using the Functional Independence Measure (FIM) score, FIM gain, and FIM efficiency. Results The mean age of the patients was 78.7 ± 8.0 years. The numbers of patients in each category of cerebrovascular disorder were 39 with cerebral infarction, 16 with intracerebral hemorrhage, 8 with subarachnoid hemorrhage, and 4 others. Compared with the counterpart group, the group with an improvement in GNRI had a greater gain in FIM (median 17 and 20, respectively; P = .036) and a higher FIM efficiency (.14 and .22, respectively; P = .020). Multivariate stepwise regression analysis showed that an improvement in GNRI, increasing energy intake at admission, and intracerebral hemorrhage were associated independently with greater FIM efficiency. Conclusions This study suggested that nutritional improvement and energy intake at admission are associated with recovery of ADL after cerebrovascular disorders.

Nutritional Improvement and Energy Intake Are Associated with Functional Recovery in Patients after Cerebrovascular Disorders.

Ultrasonography to Measure Swallowing Muscle Mass and Quality in Older Patients With Sarcopenic Dysphagia.

Reliability and Validity of a Tool to Measure the Severity of Dysphagia: The Food Intake LEVEL Scale

The aim of this study was to confirm the response in patients stimulated at the trigger point (K-point). Since we have already clinically encountered patients with hyperactive bite reflexes who were able to open their mouth and swallow after stimulation of the trigger point, we investigated this response in other brain-damaged patients. The trigger point lies on the mucosa lateral to the palatoglossal arch and medial to the pterygomandibular fold at the height of the postretromolar pad. A total of 57 brain-damaged patients, including patients with pseudobulbar palsy due to bilateral upper motor neuron disease and bulbar palsy due to medulla oblongate. Other supratentorial brain-damaged patients and 20 non-brain-damaged subjects were also examined. The subjects were gently stimulated at the trigger point by a finger or a tongue depressor. We found that the pseudobulbar palsy patients with a hyperactive bite reflex responded by mouth opening and swallowing after a jaw movement similar to mastication elicited by the stimulation. The other pseudobulbar palsy patients, who did not have hyperactive bite reflexes and could open their mouth spontaneously, responded by swallowing with jaw movements similar to mastication after the stimulation. The bulbar palsy patients and the supratentorial brain-damaged patients showed no response to the stimulation. The non-brain-damaged subjects also did not respond, but all of the subjects reported a strange sensation after the stimulation. We concluded that stimulating the trigger point was useful for opening the mouth and facilitating swallowing in pseudobulbar palsy patients and that this technique may be of help in these patients in terms of oral health care and feeding.

Jaw opening and swallow triggering method for bilateral-brain-damaged patients: K-point stimulation.

Research into the effectiveness how well the balloon dilatation method causes the desired outcome for cricopharyngeal dysphagia at the chronic stage in cerebrovascular disease

An intraoral prosthesis with a soft flexible obturator was provided for a patient with a soft palate perforation after surgical and chemoradiotherapy treatments of a soft palate tumor. An obturator composed of movable and flexible silicone was attached to a structure similar to a palatal lift; it was therefore able to move according to the movement of the soft palate, which was confirmed by endoscopic examination. The application of this prosthesis resulted in complete disappearance of hypernasality and food reflux, and the patient was able to eat without particular limitation during daytime wearing. This type of prosthesis represents a potential prosthetic approach to a soft palate nasal-oral fistula.

Soft obturator prosthesis for postoperative soft palate carcinoma: A clinical report

PROBLEM TO BE SOLVED: To provide a device, method, and program for analyzing breath sound that has enhanced accuracy for detecting abnormal sound such as aspirationSOLUTION: The device 11 for analyzing breath sound includes: a breath sound information acquiring part 31 for acquiring breath sound information presenting continuous breath sounds made by a subject for a predetermined period; a breath sound extracting part 35 for extracting each breath sound from the continuous breath sounds based on the breath sound information acquired by the breath sound acquisition part 31; a suspicious breath sound detecting part 36 for extracting one breath sound or a plurality of breath sounds as a reference from the breath sounds extracted by the breath sound extracting part 35, and detecting, based on the reference breath sound, a suspicious breath sound suspected of an abnormal breath sound made by the subject when not in a normal condition

Kyoko Hojo

Papers

Reliability and Validity of a Tool to Measure the Severity of Dysphagia: The Food Intake LEVEL Scale

Jaw opening and swallow triggering method for bilateral-brain-damaged patients: K-point stimulation.

Research into the effectiveness how well the balloon dilatation method causes the desired outcome for cricopharyngeal dysphagia at the chronic stage in cerebrovascular disease

Soft obturator prosthesis for postoperative soft palate carcinoma: A clinical report

Device, method, and program for analyzing breath sound