Studies about swallowing movement of dysphagic patients and clinical evaluation of disphagia on chew swallow

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We detected the bolus head at the start of swallowing reflex on the task of chew swallow for cerebrovascular accident cases and compared with age-matched volunteers. The bolus head position at the start of swallowing reflex was significantly more caudal in the pharynx when the task was two phase food (TPF; semisolid and liquid) and liquid (Barium water) though there was no difference within the task of semisolid food. We found aspiration in six CVA cases and no one in healthy volunteers. The aspirations were seen in 2 cases on liquid task, 1 case in semisolid task and 3 cases on TPF task.When we observed the motion of pharyngeal swallowing, we found the two different ways from the view points of tongue movement. One was a pharyngeal swallow with tongues movement that was observed in a part of the consecutive motion associated with bolus transport or consecutive pharyngeal swallow (CPS). The other was an isolated pharyngeal swallow (IPS) that was a pharyngeal swallow without the tongue … More movement relative to bolus transport. We evaluated the incidences of CPS and IPS in the swallows of CVA cases and healthy volunteers. The incidence of IPS was 10% for healthy volunteers and 15% for CVA cases. Within the task of TPF for healthy volunteers, IPS was observed in 20% trials for below 60 years old and 35% for over 60. For CVA cases IPS was observed in 20% cases for trials without aspiration and 40% for with aspiration. The aspiration was seen in 30% swallows of IPS while 10% of CPS. Though the incidence of IPS for healthy volunteers and for CVA cases was almost same, we detected more aspirations in the IPS of CVA cases. It suggests that CVA cases have some problems in the mechanism of IPS that considered as protective swallow.We analyzed the hyoid movement of swallowing of CPS and IPS for healthy volunteers by two-dimensional analyses. All IPSs occurred as the 1st swallow and only one time in sequence of swallows of two-phase food eating. All CPS occurred after the mandible stopping at upper point, while one IPS occurred at the closing phase of the mandible, and, two occurred the opening phase of the mandible. In IPS, hyoid elevation did not seem to be related to stopping of jaw movement. The results were consistent with the hypothesis that we made as IPS that has no tongue movement associated with bolus transport. The area of hyoid motion for IPS was smaller than that of CPS. The reason was considered, as the IPS is a swallow to protect air way not for transport of a bolus, the bolus volume in the pharynx was small. Less