Rheological evaluation of the bolus flow on the tongue base

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The first role of video fluoroscopic swallowing examination (VF) for patients with dysphagia is to diagnose aspiration. Simultaneously, compensatory feeding postures and changed food properties are tested during the sequence of VF examination.The compensatory postural maneuvers are applied to reduce posterior spillage of food and improve pharyngeal clearance. By modifying the consistency and texture of foods and fluids, the risks of aspiration are decreased.In our dental hospital, patients including cerebral palsy, after stroke, and after treatment for oral cancer were received VF examination. To provide adequate compensatory strategies, each patient's familiar foods were used as the VF test material. VF examinations were performed along patient's daily routine feeding process and posture. In addition, food texture analyzer was used to measure stickiness, hardness, and cohesiveness property of test materials. It should be noted that soft pureed foods have variation in the texture. Sticky paste diet may reduce the risk of aspiration. However it is difficult for damaged oral-pharyngeal motor function to transport such a diet.To study the flow velocity and direction of various food boluses, a VF simulation system using a life-size oral-pharyngeal model based on CT image data as a phantom was designed. Simulation system enables to check the behavior of spilled bolus into the pharynx without patient's irradiation. This study revealed that reclined feeding position increases the risk of liquid aspiration following posterior spillage.To feed their patient safely, caregivers are eager for practical suggestions based on VF examination. Several useful advices can be given regarding feeding posture, consistency and texture of foods and drinks, volume of a mouthful of food, oral care and others. Although some hospital using a standardized VF protocol for all patients, advantages of more functional tailor-made studies are obvious.