Repetitive Saliva Swallowing Test Research Articles

Effects of GAO's neck acupuncture on swallowing function and quality of life in patients with post-stroke pseudobulbar palsy:a randomized controlled trial

To observe the effects of GAO's neck acupuncture combined with swallowing rehabilitation on swallowing function and quality of life in patients with post-stroke pseudobulbar palsy. One hundred patients were randomly assigned in to an observation group and a control group, 50 cases in each one. The patients in the control group were treated with basic pharmaceutical treatment, including neurotrophy medication and free radical scavenging medication as well as swallowing rehabilitation; the patients in the observation group, on the basis of those in the control group, were treated with GAO's neck acupuncture at Fengchi (GB 20), Yiming (EX-HN 14), Gongxue (Extra), Lianquan (CV 23), Wai Jinjin Yuye (Extra), Tunyan (Extra), Zhiqiang (Extra), Fayin (Extra), once a day, five times a week for continuous eight weeks. The Repetitive saliva-swallowing test (RSST), standardized swallowing assessment (SSA) and swallow quality-of-life questionnaire (SWAL-QOL) before and after treatment in the two groups were observed; the relationship between disease location and frequency and efficacy of GAO's neck acupuncture was explored in the observation group. After treatment, the RSST, SSA and SWAL-QOL were superior to those before treatment (all P<0.01), with more significant results in the observation group (all P<0.01). The total effective rate was 91.7% (44/48) in the observation group, which was superior to 75.5% (37/49) in the control group (P<0.01). The frequency of disease onset was one in 11 patients and 2 and above in 37 patients in the observation group, and the efficacy of one onset of disease was 100.0% (11/11), which was superior to two and above of onset 89.2% (33/37, P<0.01). The number of patients with disease location at cortex and subcortex was 21, while that at capsula interna and basal ganglia was 27 in the observation group, the efficacy of two was similar (P>0.05). GAO's neck acupuncture combined with swallowing rehabilitation could effectively improve dysphagia and quality of life in patients with post-stroke pseudobulbar palsy. No correlation of lesion locations on acupuncture efficacy is observed, while onset frequency is inversely proportional to efficacy.

Change in tongue pressure in patients with head and neck cancer after surgical resection.

Tongue pressure is reportedly associated with dysphagia. This study investigated relationships among characteristics of head and neck cancer, tongue pressure and dysphagia screening tests performed in patients with head and neck cancer during the acute phase after surgical resection. Fifty-seven patients (36 men, 21 women; age range 26-95years) underwent surgical resection and dysphagia screening tests (Repetitive Saliva Swallowing Test, Water Swallowing Test, Modified Water Swallowing Test and Food Test) and pre- and postoperative measurement of tongue pressure at 5 time points (preoperatively, and 1-2weeks and 1, 2, and 3months postoperatively). Progression of cancer (stage), tracheotomy, surgical reconstruction, chemotherapy, radiotherapy and neck dissection were factors associated with postoperative tongue pressure. Data were analyzed by linear mixed-effect model, Spearman correlation coefficient and receiver operating characteristic (ROC) curve. Tongue pressure was significantly reduced 1-2weeks after surgery, and recovered over time. Changes in tongue pressure were significantly associated with stage, radiotherapy and reconstruction. All screening tests showed a significant relationship with tongue pressure. Analysis of ROC and area under the effect curve suggested that a tongue pressure of 15kPa can be used as a cut-off value to detect dysphagia after surgery for head and neck cancer. Our results suggest that tongue pressure evaluation might offer a safe, useful and objective tool to assess dysphagia immediately postoperatively in patients with head and neck cancer.

Alternating Motion Rate to Distinguish Elderly People With History of Pneumonia.

Under the hypothesis that elderly people in the community may have deficient oropharyngeal dysfunction, the purpose of this case-control study was to compare oral and physical characteristics in elderly people with and without a history of pneumonia and to identify factors distinguishing them. In 2014, we examined 1,311 elderly people who agreed to participate in a longitudinal and intervention study for the community-dwelling elderly. We looked at such physical characteristics as body composition, grip power, gait, and balance and at oropharyngeal characteristics, such as alternating motion rate (AMR) in speech and the repetitive saliva-swallowing test (RSST). The subjects were also asked about past history of pneumonia and other morbid conditions. From that information, we extracted 24 subjects reporting to have had pneumonia within the previous 5 y as well as 172 other subjects who matched the pneumonia subjects with respect to age, sex, and number of other morbidities to form 2 groups for comparisons. We also subjected the data to a logistic regression analysis, with having or not having pneumonia as the dependent variable, oral and physical characteristics as independent variables, and age and sex as covariates. No significant differences were seen in physical characteristics between the 2 groups. Among the oropharyngeal characteristics, AMR was significantly lower in the pneumonia subjects (P = .005, effect size = 0.20), whereas RSST exhibited no significant difference between the 2 groups. Logistic regression revealed AMR to be the only factor related to pneumonia (P = .002, odds ratio 0.169, 95% CI 0.056-0.508). In community-dwelling elderly people, association of pneumonia with skilled tongue control (AMR) rather than with swallowing (RSST) prompts a reexamination of what constitutes being at risk for pneumonia.

Screening tests for predicting the prognosis of oral intake in elderly patients with acute pneumonia.

Many elderly patients with pneumonia have aspiration pneumonia. Therefore they must temporarily abstain from oral intake. However, it is difficult to predict whether or not they will be able to start oral intake. The reason is the standard method to evaluate deglutition about pneumonia patients has not been established. In this study we aimed to develop a simple and convenient method that predicts the prognosis of oral intake as nutrition among elderly patients with acute stage pneumonia. Participants were 77 inpatients fasting due to aspiration risk with acute pneumonia. (86.0±7.7years; range 68-105years; men: n=34, women: n=43) during September 2011 and August 2013. Their consciousness levels were determined by Glasgow coma scale (GCS) and swallowing function and cough reflex were evaluated by repetitive saliva swallowing test (RSST), modified water swallow test, simple swallowing provocation test and cough test. Oral intake status at discharge was considered as the objective variable, and these tests were considered as explanatory variables. Then receiver operating characteristic (ROC) curve and the area under the curve (AUC) for each was done. From the ROC curve analysis, GCS ≥14 had the largest AUC (0.79) with a sensitivity and specificity of 0.71 and 0.80. That was followed by RSST ≥1, AUC (0.77) with a sensitivity and specificity of 0.81 and 0.67. These results suggest that GCS and RSST could be useful screening tests for prognostic prediction of oral intake capability in elderly patients with acute pneumonia.

Longitudinal Evaluation of Community Support Project to Improve Oral Function in Japanese Elderly.

Change in oral function was evaluated longitudinally in elderly persons participating in an Exercises for Healthy Oral Function program implemented as part of the Long-Term Care Prevention Project. The participants comprised high-risk and healthy persons aged 65 yr or over. A questionnaire was used to classify them into two groups ('every day or sometimes' or 'rarely') at the end of the study for a comparison of change in repetitive saliva swallowing test (RSST) scores and oral diadochokinesis between 3 time points: at before, at immediately after, and at 1 yr after completion of the program. The average RSST score showed a decrease at 1 yr after intervention, but the difference was not statistically significant. Oral diadochokinesis showed a significant increase for all syllables upon completion of the program compared with at the beginning. This was followed by a significant decrease at 1 yr later compared with at the time of completion in the 'rarely' group for all syllables, but not in the 'every day or sometimes' group. In addition, the number of repetitions was significantly lower in the 'rarely' group than in the 'every day or sometimes' group for all syllables at 1 yr after completion. The results of the present study suggest that Long-Term Care Prevention Projects are necessary to maintain and improve oral function.

Salivary level of antimicrobial protein chromogranin A in relation to the salivary flow rate and swallowing function

Background: Dysphagia is one of the problems in elderly persons in this aging society. The inhibition of the secretion of the antimicrobial proteins could lead to oral dryness and oral dryness could lead to swallowing problems. The aim of this study was to examine salivary levels of antimicrobial protein in relation to the salivary flow rate and swallowing function.Methods: In all, 26 patients with subjective oral dryness taking some medicines were studied. The unstimulated salivary flow rate was examined by ejecting gathered saliva from the mouth into a test tube for 10 min. The chromogranin A level was determined by an enzyme-linked immunosorbent assay. Swallowing function was evaluated using the repetitive saliva-swallowing test. Correlations among the salivary chromogranin A level, salivary flow rate, and swallowing function were analyzed using Spearman’s correlation coefficient by rank.Results: Statistically significant correlations were found between the salivary chromogranin A level and the unstimulated salivary flow rate (r = 0.735, P &lt; 0.01) and between the salivary chromogranin A level and swallowing function (r = 0.459, P &lt; 0.05). There was also a correlation between the unstimulated salivary flow rate and swallowing function (r = 0.585, P &lt; 0.01).Conclusion: The results of this study suggested that the salivary antimicrobial protein chromogranin A level was related to both the salivary flow rate and swallowing function. This result suggested that the inhibition of the secretion of the antimicrobial proteins could lead to oral dryness and oral dryness could lead to swallowing problems.

Peripheral and central control of swallowing initiation in healthy humans

We investigated (1) how peripheral inputs might assist central inputs in the control of voluntary evoked swallowing, (2) inter-individual variation in involuntary and voluntary swallowing initiation, and (3) whether natural chewing behavior affects the initiation of involuntary swallowing in healthy humans. Eleven participants completed a repetitive saliva swallowing test (RSST), chewing test (CHEW), and rest period (REST). In RSST, participants repetitively swallowed as quickly as possible. In CHEW, subjects chewed gum freely. We delivered pharyngeal electrical stimulation (PEStim) to the laryngopharynx and compared the number of swallows that occurred with and without PEStim. PEStim significantly increased the number of voluntary evoked swallows in RSST, as well as the number of swallows in CHEW and REST trials, although this facilitatory effect was larger in REST trials. We found a positive correlation between the number of swallows at RSST without PEStim and that at REST with PEStim within individuals. Additionally, we found a significant positive correlation between the number of swallows at RSST with PEStim and the sum of that at RSST without PEStim and at REST with PES. Based on the current results, we suggest that (1) peripheral inputs within a certain range appear to facilitate the central inputs that control voluntary swallowing, (2) inter-individual variations in swallowing initiation may arise from differences in the excitability of the common neural network in the lower brainstem, and (3) during chewing, food reduction in the oral cavity is prioritized, such that the neural network associated with chewing may regulate swallowing initiation.

Physical fitness and oral function in community-dwelling older people: a pilot study.

The aim of the present study was to quantify the relation between physical fitness and oral function, including tongue and lip movements. Physical fitness and oral function influence quality of life and activities of daily living in older individuals. Occlusal contact and mastication performance are associated with physical fitness, but the association between tongue and lip movements and physical fitness is unclear. Sixty-six independent community-dwelling older individuals (24 men, 42 women; mean age, 70.3±5.9years) participated in this study. Measures of physical fitness were the one-leg standing time with eyes open, the functional reach test, anteflexion, the timed up and go test, and grip strength. Measures of oral function were tongue pressure, lip pressure, tongue movement from side to side, the repetitive saliva-swallowing test (RSST), oral diadochokinesis and masticatory efficiency. Multiple regression analysis was used to quantify the relation between physical fitness and oral function. After adjustment for age, sex, BMI, exercise habits and number of remaining teeth, the tongue movement from side to side and/or oral diadochokinesis were chosen as significant factors in each physical fitness measurement. Furthermore, the lip pressure and masticatory efficiency were associated with handgrip strength. Oral function, including tongue and lip movements, was associated with physical fitness in older people in this study. Tongue dexterity as characterised by tongue movement from side to side and oral diadochokinesis particularly associated with physical fitness.

Effects on caregiver burden of a donepezil hydrochloride dosage increase to 10 mg/day in patients with Alzheimer's disease.

BackgroundIn this study, we evaluated changes in functioning and caregiver burden in Alzheimer’s disease (AD) patients after a dosage increase that was made based on pharmacists’ evaluation of AD patients’ behavior in daily life.MethodsPharmacists used a checklist, a questionnaire, and the Repetitive Saliva Swallowing Test (RSST) to gather data on the daily life of AD patients taking donepezil 5 mg/day and their caregivers. In 27 cases, pharmacists suggested a dosage change to 10 mg/day to AD patients’ physicians. Pharmacists then evaluated these patients for 16 weeks after the increase to determine changes in functional assessment staging, caregiver burden, and swallowing function.ResultsDuring the 16-week study, 20 of the 27 patients showed at least one-stage improvement in relation to the five assessed aspects of daily life (time/place, speech, bathing, dressing, and toileting). The mean score for caregiver burden due to personal strain was significantly lower after the dosage increase than before (5.15±3.76 at baseline; from 3.89±3.42 at week 4 to 3.59±3.90 at week 16; P<0.05), as was the mean score due to role strain (2.19±2.80 at baseline; 1.56±2.64 at week 8; P<0.05). After the dosage increase, the impaired swallowing function that accompanies AD was improved in the patients with swallowing problems, as indicated by a higher mean RSST score (1.22±0.67 at baseline; from 2.78±1.72 at week 4 to 2.78±1.79 at week 16; P<0.05).ConclusionThe dosage increase not only decreased caregiver burden, but also appeared to improve impaired swallowing function. Medication therapy management by pharmacists of AD patients, including the use of a checklist, contributed to the correct use of donepezil and improved quality of life for caregivers.

Effectiveness of an oral health educational program on community-dwelling older people with xerostomia.

The purpose of the present study was to evaluate the changes in oral health and function through an oral health educational program for the independent older people with xerostomia. Community-dwelling older people with xerostomia aged over 65 years who participated in a preliminary comprehensive health survey in 2011 were recruited for the educational program. A total of 47 participants were randomly assigned into two groups, the intervention group (n = 26) and the control group (n = 21). The intervention group attended a 90-min oral health education program every 2 weeks for 3 months. The program consisted of oral hygiene instruction, facial and tongue muscle exercise, and salivary gland massage. The control group was provided only general information about oral health. The assessments of oral function, such as oral diadochokinesis of articulation, swallowing, taste threshold and salivary flow rate, were carried out before and after 3 months with or without intervention. A total of 38 participants (21 of intervention group and 17 of control group) completed the study protocol. In the intervention group, resting salivation significantly improved after the program. The second and third cumulated Repetitive Saliva Swallowing Test times significantly improved in the intervention group. The threshold for bitterness significantly lowered in the intervention group, whereas the sour threshold significantly heightened in the control group after 3 months (P < 0.05). The present study suggests that the educational program targeting oral function improvement is effective among the independent older population.

The prevalence and signs of Dysphagia among stroke patients in rehabilitation units

Dysphagia, a very common post-stroke symptom, has been linked to aspiration pneumonia, malnutrition, and increased length of hospitalization. While patients are typically monitored for dysphagia continuously following their transfer to a rehabilitation unit, little is known about the results of dysphagia reassessments. This study investigates the prevalence and signs of dysphagia among stroke patients in rehabilitation units. We analyzed patients with stroke admitted to a rehabilitation unit of a medical center in southern Taiwan. The procedure included chart review, the repetitive saliva swallowing test (RSST), and the modified water swallowing test (MWST). Dysphagia was defined as either RSST or MWST abnormal. JMP 9.0 was used to perform descriptive statistics, t-test, chi-square test and logistic regression analysis. At clinical examination, 53.61% of the study subjects demonstrated dysphagia. Chi-square analysis showed that five abnormal signs (could not close mouth with water, without mastication, food stuck in the throat, obvious sputum sound, and choking after swallowing) are all associated with dysphagia. Multiple logistic regression analysis revealed choking is a significant predictor variable of dysphagia. Over half of the rehabilitation unit stroke patients in this study had dysphagia. Nurses are the primary care providers for dysphagia patients. Therefore, there is a need for ward nurses to have skills to assess, recognize, and manage dysphagia and to enhance patient safety.

Use of Diffusion Tensor Imaging to Determine Correlations between the Repetitive Saliva Swallowing test and the Brain Regions Involved in Swallowing

〔目的〕拡散テンソル画像（DTI）を用い，嚥下に関係する脳領域と反復唾液嚥下テスト（RSST）の関連性を明らかにすることとした．〔対象〕年齢27～75歳の右利きの健常成人48名（男性37名，女性11名）とした．〔方法〕MRI （1.5テスラ）を用いてDTIを撮像し，f-MRI研究により嚥下に関係するとされている脳領域を関心領域（ROI）とした．各ROIの拡散異方性値とみかけの拡散係数（ADC）を計測し，これらとRSSTとの関連性をSpearmanの順位相関係数により解析した．〔結果〕RSSTと左側の島のADC値との間に負の相関が認められた．〔結語〕左側の島は嚥下時の感覚運動を統合し，随意的かつ連続的な嚥下に関与している可能性が示唆される．

入院患者の経口摂取再開時の嚥下機能評価

There is much concern about the acute phase of restarting an oral diet for hospital inpatients who have been prohibited from any oral intake. We found predictive factors for the successful resumption of oral intake in such patients. A total of 186 subjects who had been hospitalized without oral intake were screened for dysphagia between January 1st and December 31st in 2010 (mean age 80.9 years), and formed the study population. We observed them from the initial consultation day until the discharge. (mean days 32.6) We examined factors of age, sex, appetite, gag reflex, tongue activity, the repetitive saliva swallowing test (RSST), obeying commands, the status of the laryngopharynx, laryngeal sensation and the 3 ml water swallowing test under endoscopy. We excluded those who died in hospital after dysphagia screening because they were obviously lost to follow-up. One hundred and twelve patients (60.2%) could resume oral intake, 54 patients could not and 20 (10.8%) died. Logistic regression analysis identified seven significant factors in predicting the resumption of oral intake : 1) age (p = 0.01, OR = 0.938, 95% CI 0.903-0.976); 2) sex (p = 0.21, OR = 2.15, 95% CI 1.124-4.128); 3) appetite (p = 0.041, OR = 1.983, 95% CI 1.029-3.821); 4) gag reflex (p = 0.06, OR = 1.932, 95% CI 0.971-3.844); 5) tongue activity (P = 0.002, OR = 3.825, 95% CI 1.647-8.883); 6) RSST (P = 0.013, OR = 2.284, 95% CI 1.186-4.397); 7) obeying commands (p = 0.02, OR = 3.005, 95% CI 1.507-5.993); 8) the status of the laryngopharynx (P = 0.668, OR = 0.668, 95% CI 0.351-1.272); 9) laryngeal sensation (P = 0.081, OR = 1.841, 95% CI 0.928-3.650); and the 3 ml water swallowing test under endoscopy (P = 0.000, OR = 0.226, 95% CI 0.102-0.499). These predictive factors could be very useful for dysphagia screening to help forecast the successful resumption of oral intake in affected patients. When the likelihood of dysphagia and the onset of aspiration pneumonia are suggested by dysphagia screening, these factors must be taken into careful consideration when oral intake is to be resumed.

Effect of Swallowing Exercises in Independent Elderly

The aim of this study was to investigate the effects of swallowing exercises on oral function in independent elderly patients visiting the Department of Prosthodontics at Tokyo Dental College Chiba Hospital. Twenty-nine patients aged over 65 years (15 men and 14 women; mean age, 75.0 years) in whom treatment was completed at this college were enrolled in the study. The patients were instructed on how to perform swallowing exercises monthly (including at baseline) for the first 2 months from the start of the study and asked to perform those exercises at least once daily. At the beginning and end of the study (a 3-month study period), the Repetitive Saliva Swallowing Test was conducted and occlusal force, oral diadochokinesis, unstimulated whole saliva flow rate, stimulated whole saliva flow rate, salivary pH at rest, and salivary buffering capacity measured to determine the effects of the exercises on oral function. Analyses demonstrated significant increases in diadochokinesis rate (/ta/ and /ka/) and unstimulated whole saliva flow rate (p<0.05), suggesting that the swallowing exercises promote the maintenance and improvement of oral function in the independent elderly.

Evaluation of a Japanese “Prevention of Long‐term Care” project for the improvement in oral function in the high‐risk elderly

The purpose of this study was to analyze the improvement in oral function and environment in high-risk elderly persons participating in a program to improve oral function organized by their local government. Participants comprised 36 high-risk elderly and the mean age was 77.11 ± 7.24 years. The program involved training sessions carried out five or six times every 2-3 weeks for 3 months. Oral function and environment was evaluated before and after the program. The research period extended from 2008 to 2010. The effects of intervention were clearly observed in oral diadochokinesis score in the high-risk elderly. Persons with a lower repetitive saliva swallowing test (RSST) and oral diadochokinesis score before intervention showed a tendency toward even greater improvement. No significant changes were observed in saliva secretion or total amounts of Streptococcus mutans, Lactobacilli, Candida or total microorganisms. The effects of intervention were clearly recognized in regards to oral diadochokinesis. Improvement in RSST and oral diadochokinesis scores was marked in those persons showing a lower number of articulations before intervention.

Usefulness of Suprahyoid Muscles Palpation during Repetitive Saliva Swallowing Test in Healthy and Dysphagic Adults

Usefulness of Suprahyoid Muscles Palpation during Repetitive Saliva Swallowing Test in Healthy and Dysphagic Adults

MI sensor-aided screening system for assessing swallowing dysfunction: Application to the repetitive saliva-swallowing test

Assessment of swallowing dysfunction, particularly the risk of aspiration, is extremely important to clinicians because it provides crucial information for preventing morbidity and mortality from dysphagia. The purpose of this study was to describe a magneto-impedance sensor-aided screening system (MISS) for assessing swallowing function and clarify its effectiveness with the repetitive saliva-swallowing test (RSST). An MI sensor attached to the skin over the sternum detected the distance from a magnet attached to the skin over the thyroid cartilage during swallowing as the change of magnetic fields. The MISS was validated by videofluoroscopic and videoendoscopic observations. Further, the swallowing behavior of 93 individuals was assessed by using the MISS and then analyzed with the RSST. Swallowing behavior can be recorded and investigated objectively by signal inspection in the MISS compared with the conventional methods. The MISS is a simple and straightforward method for recording and safe because of dry swallow. The MISS system was validated by using simultaneous recordings with videofluoroscopic or videoendoscopic examinations, and compared with the conventional RSST method. The MISS combined with the RSST is an effective screening test for swallowing function.

Usefulness of Suprahyoid Muscles Palpation during Repetitive Saliva Swallowing Test in Healthy Adults

Usefulness of Suprahyoid Muscles Palpation during Repetitive Saliva Swallowing Test in Healthy Adults

Evaluation of swallowing function by two screening tests in primary COPD: Table 1—

To the Editors: Swallowing is an important function to separate the airway and the oesophagus. Dysfunction of this mechanism may lead to aspiration of pathogenic oropharyngeal contents. The disorder of swallowing function can be evaluated by the simple two-step swallowing provocation test (STS-SPT) and repetitive saliva swallowing test (RSST) 1, 2. Both screening tests are safe, rapid and of low cost. Recently, it has been reported that the swallowing dysfunction may be a risk factor for an exacerbation of chronic obstructive pulmonary disease (COPD) 3. Therefore, detection of the swallowing dysfunction at an earlier stage of COPD may be very important in management of COPD patients and to prevent advancing stages of the disease. Swallowing dysfunction in advancing stages of COPD has been reported 3, 4. However, it …

錠剤の大きさが虚弱高齢者の服薬に与える影響―服薬模擬調査による検討―

The purpose of the present study was to examine the effect of the size of tablets on the status of swallowing and handling during taking medicine among frail elderly persons. The subjects of the present study were 73 frail elderly persons. After they conducted simulation taking medicine, they determined the desirable size of tablets using subjective evaluation. Their behavior and the time required for the simulation were examined. We also evaluated their activities of daily living using the ADL20, and swallowing ability using the repetitive saliva swallowing test (RSST). There was a significant difference in behavior during taking medicine between the frail elderly with low swallowing ability and other subjects with normal swallowing ability, that is, the elderly persons with low swallowing ability tend to swallow three tablets after several trials (p<0.05). Also, the required time for simulation taking medicine was related significantly to the size of tablets (p<0.01). The most desirable size based upon easiness of swallowing and handling is 7-8mm. These results suggest that medicine taking behavior was influenced greatly by the decline of swallowing ability and ADL, and the prescriptions for the frail elderly are needed to meet their swallowing ability.