Yoko Inamoto

Dysphagia Rehabilitation: Similarities and Differences in Three Areas of the World

Although the objective of dysphagia rehabilitation is the same, population needs, clinical practice patterns, availability of resources, and dysphagia research vary greatly around the world. The purpose of this review is to introduce the reader to the context in which dysphagia rehabilitation is practiced, to describe practice patterns, and to emphasize the dysphagia research being performed in three distinct regions of the world: North America, New Zealand and Australia, and Japan.

Extracting moving boundaries from dynamic, multislice CT images for fluid simulation

A method for extracting solid boundary motion from dynamic CT images of a human oropharyngeal swallow is presented. The data-set has high spatial resolution ( ) but low temporal resolution (10 Hz). The low temporal resolution results in motion artefacts (i.e. blurring, ghosting) due to the fast moving solid structures. Automated segmentation and registration methods were not successful, so a tool for manual 3D deformable registration was created as a plug-in for the open-source modelling software, Blender. The tool gives users a high level of control to sculpt a mesh to match 3D volumetric image data. The resulting series of meshes, each corresponding to an instance in time, can be used in a fluid simulation using a technique such as smoothed-particle hydrodynamics.

3D dynamic visualization of swallowing from multi-slice computed tomography

classroom use is granted without fee provided that copies are not made or distributed for commercial advantage and that copies bear this notice and the full citation on the first page. Copyrights for third-party components of this work must be honored. For all other uses, contact the Owner/Author. SIGGRAPH 2014, August 10 – 14, 2014, Vancouver, British Columbia, Canada. 2014 Copyright held by the Owner/Author. ACM 978-1-4503-2958-3/14/08 3D Dynamic Visualization of Swallowing from Multi-Slice Computed Tomography

Inferring the effects of saliva on liquid bolus flow using computer simulation

Computer simulation of liquid bolus flow is used to test the assumption that a slip boundary condition approximates a healthy swallow due to the presence of saliva lubricating the bolus. Six dynamic, 320-row area detector CT (ADCT) sequences of normal subjects swallowing thin, nectar, and honey-thick liquids are used in this work. The aerodigestive tract is segmented from the images in order to create a dynamic 3D geometry, which is subsequently used to drive a Smoothed Particle Hydrodynamics (SPH) fluid simulation of the bolus. The results show that the no-slip simulation, approximating no-lubrication, provides a closer match to the ADCT bolus images than the slip simulation, particularly in the oral phase. This finding suggests that the role of saliva in swallowing liquid boluses is not to lubricate the aerodigestive tract, and that there is another reason for its importance in normal swallowing of liquids.

Effect of visual biofeedback to acquire supraglottic swallow in healthy individuals: A randomized-controlled trial

The aim of this study is to evaluate the effect of visual biofeedback therapy in acquiring supraglottic swallow (SGS) in a randomized-controlled trial with healthy individuals. Eighteen individuals (mean age, 26 years) who could not close or keep closed the vocal folds before and during the swallow in SGS were allocated randomly to either a visual biofeedback group (eight individuals) or a nonbiofeedback group (10 individuals). A videoendoscope was inserted intranasally and an SGS exercise, using 4 ml of green-colored water, was performed 30 times per day up to 5 days. When the participant failed to perform SGS, the result was provided only to the participants in the visual biofeedback group. The median length of time until acquiring SGS was 1.5 days in the visual biofeedback group and 3.5 days in the nonbiofeedback group (P=0.040). We concluded that visual biofeedback effectively enabled participants to acquire SGS earlier.

Twenty Years of Trans-disciplinary Approach Development for Dysphagia Rehabilitation in Japan

To the Editor, We are pleased to report on the development and progress of the trans-disciplinary field of Deglutology in Japan as the Japanese Society of Dysphagia Rehabilitation (JSDR) commemorates its 20th year of establishment. The JSDR includes a broad range of disciplines in order to integrate diverse knowledge and expertise and pave the way for the emerging field of Deglutition. The percentage of individuals aged over 65 years reached 25.0 % of the Japanese population in 2013 [1]. With this rapid increase in the elderly, a substantially greater demand for dysphagia rehabilitation comes up. As the progression of dysphagia diminishes both the function of swallowing and the enjoyment of eating, the objective of dysphagia rehabilitation should therefore address both the recovery of swallowing function and the restoration of pleasure while eating. Dysphagia rehabilitation is performed for a wide range of disease stages, from acute medical care to terminal support. Although a team approach is essential for effective rehabilitation, treatment can be challenging because support strategies vary considerably over time and require numerous approaches and caregivers. We normally divide the team approach in dysphagia rehabilitation into three categories according to the relationships among participating disciplines as follows: (1) the multi-disciplinary approach, where disciplines treat patients independently and have little communication with each other, (2) the inter-disciplinary approach, where related disciplines exchange information at team conferences to reach a consensus on treatment, thus promoting inter-disciplinary cooperation, and (3) the trans-disciplinary approach, where participating disciplines complement the scope of others to more efficiently integrate a team approach. The trans-disciplinary approach is particularly suitable for dysphagia rehabilitation because the size and composition of a support team may change significantly over time; complementing the scopes of associated disciplines without establishing a rigid inter-disciplinary border enables seamless care over a wider range of individuals, symptom stages, and circumstances. The JSDR was founded in 1995 under the concept of a trans-disciplinary approach for dysphagia rehabilitation. As the society now celebrates 20 years of progress and innovation, its membership has grown to more than 11,000 medical professionals (11,653 as of August 30, 2014) and involves numerous disciplines (Fig. 1) in line with the original JSDR trans-disciplinary tenets. Recently, the 20th annual conference of the JSDR held in Tokyo in September 2014 featured an international symposium that included 12 E. Saitoh Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan e-mail: esaitoh@fujita-hu.ac.jp

Dysphagia Evaluation and Treatment

This chapter discusses common dysphagia terminology. A common understanding of important terms relevant to dysphagia enables healthcare professionals to communicate clearly and rapidly. The basic knowledge of anatomical structures associated with swallowing is fundamental to understanding the whole swallow process including the evaluation and treatment of dysphagia. 1.1 Terminology of Dysphagia Swallowing is one of the most frequent activities of humans. Swallowing serves as a vital primary function to ensure nutrition and hydration and contributes to quality of life. Specific terminology is used among healthcare workers to communicate in a common language and is used every day for speaking and writing in medical charts. A description of the common terms used in the field of dysphagia is provided in Table 1.1. K. Pongpipatpaiboon • Y. Aoyagi • S. Shibata • H. Kagaya Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan e-mail: ning665@gmail.com; yyy@rc5.so-net.ne.jp; sshibata@fujita-hu.ac.jp; hkagaya2@fujita-hu.ac.jp Y. Inamoto (*) Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan e-mail: inamoto@fujita-hu.ac.jp K. Matsuo Department of Dentistry, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan e-mail: kmatsuo@fujita-hu.ac.jp

Clinical Evaluation of Dysphagia

Clinical evaluation, both instrumental and noninstrumental, plays an important role in the swallowing assessment of the patients with dysphagia. The gathered information from thorough evaluation contributes the presence of dysphagia, dysphagia severity level, rehabilitation planning, and both the problem and the potential solution. The dysphagia screening, clinical and instrumental assessment, and new perspectives in advanced swallowing assessment will be described in this chapter.

Simulated volume loss in the base of tongue in a virtual swallowing model

Abstract Dysphagia often occurs in patients with oropharyngeal cancer, particularly in those with base of tongue lesions after surgery both with and without chemoradiation therapy. Tongue volume loss is related to functional impairment in swallowing; however, the physiological mechanisms related to the impairment are still unclear. This study aimed to clarify possible causal links between volume loss and swallowing outcomes by simulating volume loss in a 3D computer fluid model of swallowing. An artificial volume loss was introduced to a reference swallowing model of a healthy subject. Swallowing assessments that are commonly used in clinical practice were used to evaluate the simulations. The simulation of impairment showed an increase in oral and pharyngeal residue. Tongue volume loss appeared to be the mechanism which caused increased pharyngeal residue in the virtual simulations. Major limitations of the simulations were oversimplified models and volume loss as a single parameter with no consideration of biophysical compensations. Discussion of limitations suggested that with improved simulation techniques, mechanisms of dysphagia could be better understood. In conclusion, this study indicated that volume loss of the base of tongue may contribute to increased oropharyngeal residue.