Effect of comprehensive nursing on the quality of life and swallowing function in individuals diagnosed with ischemic stroke

BACKGROUND Ischemic stroke(IS)is a widely recognized disease characterized by high preva-lence,mortality,morbidity,disability,and recurrence rates.It ranks prominently in terms of mortality,constituting 60%-80%of stroke cases.AIM To explore the impact of comprehensive nursing care on the quality of life and swallowing function in individuals diagnosed with IS.METHODS This study comprised 172 patients with IS admitted to our hospital between February 2018 to March 2021.The participants were divided into two groups,namely the control group(n=80)receiving routine care and the research group(n=92)receiving comprehensive care.Various assessment scales,including the standard swallowing function assessment scale(SSA),National Institutes of Health Stroke scale(NIHSS),European stroke scale(ESS),self-rating anxiety scale(SAS),self-rating depression scale(SDS),Barthel index(BI),and the motor func-tion assessment scale(MAS),were employed to evaluate the improvement in swallowing function,neurological deficits,clinical outcomes,anxiety,depression,daily living activities,and motor function before and after care.Furthermore,the study compared the occurrence of adverse reactions during the nursing period,life quality before and after the intervention,rehabilitation compliance,and nursing satisfaction between the two groups.RESULTS After the nursing intervention,the research group exhibited significantly improved SSA and NIHSS scores compared to the control group(P<0.05).Moreover,both groups demonstrated significant reductions in SAS and SDS scores(P<0.05),with the research group showing more obvious advantages(P<0.05).Compared to the control group,the research group displayed significantly better ESS,BI,and MAS scores(P<0.05),coupled with a lower incidence of adverse reactions(P<0.05).Additionally,the research group demonstrated markedly higher levels of life quality,rehabilitation compliance,and nursing satisfaction compared to the control group(P<0.05).CONCLUSION Comprehensive nursing effectively improved swallowing function,quality of life,and patient satisfaction,high-lighting its clinical significance.

Effect of comprehensive nursing on swallowing function and quality of life in patients with ischemic stroke

Hu et al explored the impact of comprehensive nursing model on swallowing function and quality of life in patients with ischemic stroke.They divided 172 patients into the control group(routine care)and the research group(comprehensive care),and used standard scales to evaluate the swallowing function,neurological deficit,anxiety and depression,daily living ability,and exercise of the two groups of patients before and after care.Changes in indicators of function,quality of life,and compliance.The results showed that compared with the control group,patients in the study group achieved significant improvements in various indicators,with a lower incidence of adverse reactions and higher satisfaction with care.These data suggest that the comprehensive nursing model can significantly improve the swallowing function,quality of life and satisfaction of patients with ischemic stroke.In the future,the development of comprehensive nursing models needs to focus on technological innovation,humanized services,continuing education and training,multi-disciplinary collaboration,optimal allocation of resources,standardized practice and evaluation,etc.,in order to improve nursing effects and promote the improvement of medical service quality.

Evaluation of the Application Effect of "One Disease, One Product" Nursing Program in Improving Swallowing Function and ADL of Stroke Patients

[Objectives] To observe the effect of "One Disease, One Product" nursing program in improving swallowing function and activities of daily living (ADL) of stroke patients.[Methods] 240 patients with stroke complicated with dysphagia were divided into intervention group and control group according to the random number table method, with 120 cases in each group. The patients in the intervention group were treated with "One Disease, One Product" nursing program for standardized process nursing, and the control group was treated with routine nursing for stroke. Three weeks later, the swallowing function of the two groups of patients was evaluated by water swallowing test. At the same time, Barthel life index was used to evaluate patients activities of daily living (ADL) before nursing, after 3 weeks and after 3 months of nursing.[Results] After 3 weeks, the proportion of stroke patients with normal swallowing function in both groups increased compared with before, and the increase was more obvious in the intervention group. The difference in the proportion of stroke patients with normal swallowing function between the intervention group and the control group was statistically significant. The BI index scores after 3 weeks or at the follow-up three months later showed that compared with the same group before care, the BI index scores of patients in both groups increased significantly compared with before, but the increase was even greater in the intervention group, close to normal.[Conclusions] The "One Disease, One Product" nursing program can significantly improve the swallowing function of stroke patients, and can improve the near and long-term activities of daily living of patients, thus creating a high-quality nursing service brand.

Analysis of the Relationship between Eating and Swallowing Function and Lifestyle of the Elderly Living in the Community-A Secondary Publication

Objectives:The relationship between eating and swallowing function,and lifestyle among community-dwelling elderly people has not been extensively studied.This study aimed to analyze the characteristics of eating and swallowing function and their association with the lifestyle among the elderly.Methods:A self-administered questionnaire survey was conducted on 419 elderly people who participated in the oral function improvement project operated by the Community Comprehensive Support Center.A total of 288 valid responses(58 males,230 females,average age 73.6 years)were analyzed.The survey items included basic demographics,health status,lifestyle,and eating and swallowing functions.The chi-square(χ2)test was used to compare for a difference in the risk of dysphagia.Results:72 patients(25.0%)were judged to be at risk for dysphagia,and 216(75.0%)were judged to be not at risk for dysphagia using the revised dysphagia risk assessment scale.The mean score for oral preparatory dysphagia was the highest,while the mean score for pharyngeal dysphagia was the lowest.The group at risk of dysphagia had significant difficulty in chewing and had bad sleep quality as compared to the group that was not at risk.Conclusion:Concerning the risk of dysphagia,there is a need to maintain and improve masticatory function.In addition,improving the swallowing function of the elderly may prevent insomnia and improve sleep quality.

Biting force and tongue muscle strength as useful indicators for eating and swallowing capability assessment among elderly patients

Weakened capability of eating and swallowing is common among elderly population,affecting negatively on their health and well-being.This work measured occlusal force and tongue muscle strength of elderly patients and then assessed whether correlations existed between oral physiological properties and the eating and swallowing capability.A total of 26 elderly patients with potential swallow disorder were recruited in this work.Participants’denture status and daily diet texture were determined by a pre-questionnaire analysis.Their swallowing capability was assessed and rated by water drinking test.Maximum tongue pressure,incisor occlusal force and hand gripping force were measured for each subject.It was observed that participating subjects have on average a significantly lower biting force and maximum tongue pressure than that of normal adults.The swallowing grades assessed by water drinking test showed significant correlations with both the biting force(r=−0.498,P<0.05)and the tongue muscle strength(r=−0.544,P<0.05).The biting force of dysphagia participants correlates significantly with dental conditions(P<0.05).The observed correlation between tongue pressure and diet texture indicates that tongue muscle strength could be used as a reliable indicator of the eating and swallowing capability for elderly people.

Impaired swallowing mechanics of post radiation therapy head and neck cancer patients: A retrospective videofluoroscopic study

AIM: To determine swallowing outcomes and hyolaryngeal mechanics associated with post radiation therapy head and neck cancer(rt HNC) patients using videofluoroscopic swallow studies. METHODS: In this retrospective cohort study, video-fluoroscopic images of rt HNC patients(n = 21) were compared with age and gender matched controls(n = 21). Penetration-aspiration of the bolus and bolus residue were measured as swallowing outcome variables. Timing and displacement measurements of the anterior and posterior muscular slings elevating the hyolaryngeal complex were acquired. Coordinate data of anatomical landmarks mapping the action of the anterior muscles(suprahyoid muscles) and posterior muscles(long pharyngeal muscles) were used to calculate the distance measurements, and slice numbers were used to calculate time intervals. Canonical variate analysis with post-hoc discriminant function analysis was performed on coordinate data to determine multivariate mechanics of swallowing associated with treatment. Pharyngeal constriction ratio(PCR) was also measured to determine if weak pharyngeal constriction is associated with post radiation therapy.RESULTS: The rt HNC group was characterized by poor swallowing outcomes compared to the control group in regards to: Penetration-aspiration scale(P < 0.0001), normalized residue ratio scale(NRRS) for the valleculae(P = 0.002) and NRRS for the piriform sinuses(P = 0.003). Timing and distance measurements of the anterior muscular sling were not significantly different in the two groups, whereas for the PMS time of displacement was abbreviated(P = 0.002) and distance of excursion was reduced(P = 0.02) in the rt HNC group. A canonical variate analysis shows a significant reduction in pharyngeal mechanics in the rt HNC group(P < 0.0001). The PCR was significantly higher in the test group than the control group(P = 0.0001) indicating reduced efficiency in pharyngeal clearance. CONCLUSION: Using videofluoroscopy, this study shows rt HNC patients have worse swallowing outcomes associated with reduced hyolaryngeal mechanics and pharyngeal constriction compared with controls.

Application value research of swallowing treatment device combined with swallowing rehabilitation training in the treatment of swallowing disorders after stroke

BACKGROUND Stroke is a common disabling disease,whether it is ischemic stroke or hemorrhagic stroke,both can result in neuronal damage,leading to various manifestations of neurological dysfunction.AIM To explore of the application value of swallowing treatment device combined with swallowing rehabilitation training in the treatment of swallowing disorders after stroke.METHODS This study selected 86 patients with swallowing disorders after stroke admitted to our rehabilitation department from February 2022 to December 2023 as research subjects.They were divided into a control group(n=43)and an observation group(n=43)according to the treatment.The control group received swallowing rehabilitation training,while the observation group received swallowing treatment device in addition to the training.Both groups underwent continuous intervention for two courses of treatment.RESULTS The total effective rate in the observation group(93.02%)was higher than that in the control group(76.74%)(P=0.035).After intervention,the oral transit time,swallowing response time,pharyngeal transit time,and laryngeal closure time decreased in both groups compared to before intervention.In the observation group,the oral transit time,swallowing response time,and pharyngeal transit time were shorter than those in the control group after intervention.However,the laryngeal closure time after intervention in the observation group was compared with that in the control group(P=0.142).After intervention,average amplitude value and duration of the genioglossus muscle group during empty swallowing and swallowing 5 mL of water are reduced compared to before intervention in both groups.After intervention,the scores of the chin-tuck swallowing exercise and the Standardized Swallowing Assessment are both reduced compared to pre-intervention levels in both groups.However,the observation group scores lower than the control group after intervention.Additionally,the Functional Oral Intake Scale scores of both groups are increased after intervention compared to pre-intervention levels,with the observation group scoring higher than the control group after intervention(P<0.001).The cumulative incidence of complications in the observation group is 9.30%,which is lower than the 27.91%in the control group(P=0.027).CONCLUSION The combination of swallowing therapy equipment with swallowing rehabilitation training can improve the muscle movement level of the genioglossus muscle group,enhance swallowing function,and prevent the occurrence of swallowing-related complications after stroke.

Swallowing Function before and after Subtotal Glossectomy and Reconstruction with a Rectus Abdominis Musculocutaneous Flap: A Case Report

Purpose: Swallowing function was in a patient with tongue cancer that was evaluated with video fluorography before and after subtotal glossectomy and reconstruction with a rectus abdominis muscuocutaneous flap. Materials and Methods: A 41-year-old man underwent subtotal glossectomy and retained the unilateral posterior mylohyoid and unilateral stylohyoid muscles. The structure of the flap was evaluated postoperatively. To assess swallowing function, video fluorography was performed before surgery, 1 month after surgery and 1 year after surgery. Testing involved 1) ability to hold 10 mL of liquid in the oral cavity, 2) epiglottis turnover, 3) the presence of aspiration, 4) hyoid bone movement, and 5) maximum width of the esophageal entrance. Results: The flap was protuberant postoperatively. The patient was able to hold the test diet in the oral cavity before and after surgery. Epiglottis turnover was good before surgery but insufficient after surgery. Aspiration during swallowing was not observed before or after surgery. At rest, the hyoid bone sagged postoperatively, in comparison with preoperatively. Hyoid bone movement and width of the esophageal entrance decreased after surgery;however, they demonstrated gradual recovery. Conclusions: For good postoperative swallowing function after subtotal glossectomy, it is necessary to perform reconstruction with protuberant flap and to retain the suprahyoid muscles as much as possible.

Swallowing threshold parameters of subjects with complete dentures and overdentures

Aim: To compare the chewing process and swallowing threshold parameters of subjects with complete dentures and overdentures with data obtained from subjects with complete natural dentitions. Metho-dology: The chewing process in terms of swallowing threshold parameters of four groups of subjects with complete dentures (all females) was quantified by sieving particles after chewing of an artificial test ‘food’ and compared with that of subjects with com-plete natural dentitions as a reference group (33 sub-jects). All subjects (except those of the reference group) had a complete denture in the upper jaw. Regarding the lower jaw two groups with complete dentures (with high (24 subjects), respectively low mandible (12 subjects)) and two groups with overdentures (implant-retained (22 subjects), respectively natural root supported (19 subjects)) were composed. Results: The ‘overdenture-implants’ group needed significantly more chewing cycles and time (mean: 45 cycles in 32 seconds) until ‘swallowing’ compared to the group with complete natural dentitions (mean: 26 cycles in 19 seconds until ‘swallowing’). Also the ‘complete denture-low mandible’ group needed sig-nificantly more cycles and time (mean: 52 cycles in 44 seconds) until ‘swallowing’ than the complete dentition group. In the ‘overdenture-natural roots’ group these outcomes (33 cycles in 24 seconds) were not significantly different compared with the complete dentition group. The ‘complete denture-high mandi-ble’ group (32 cycles in 26 seconds) needed not sig-nificantly more cycles until ‘swallowing’, however time until ‘swallowing’ was significantly longer com-pared to the complete dentition group. All denture groups had significantly larger mean particle sizes when ‘swallowing’ (sizes in the order of 3 mm) than the natural dentition group (about 2 mm). Conclusion: Despite efforts to compensate for a reduced chewing efficiency, subjects with complete dentures (including overdentures) had 50% larger median particle sizes when ‘swallowing’ compared to subjects with complete natural dentitions.

Association of Oral Diadochokinesis, Physical Function and Swallowing Function in Community-Dwelling Elderly People

Objective: Oral diadochokinesis (ODK) has been shown to be associated with oral frailty. In this study, we investigate the relationship between physical function, swallowing function, nutritional evaluation, and each syllable of ODK. Methods: The subjects are 26 elderly people living in an area where they can walk. ODK, tongue pressure, modified water swallowing test, EAT-10, grip strength, MNA-SF, skeletal muscle index, height, weight, and BMI were evaluated. For statistical analysis based on ODK values, the subjects were divided into two groups on the basis of the number of times the syllables /pa/, /ta/, and /ka/ were repeated: 1) The first group with >6 repetitions exceeded six; 2) the second group with ≤5 repetitions. Both groups were compared using the Mann-Whitney U test (Model 1). In addition, the syllables /pa/, /ta/, and /ka/ were also divided among the groups and a comparison was performed (Model 2). Results: In Model 1, the tongue pressure value was significantly higher in the good group (p < 0.01). In Model 2, the good group showed significantly higher values for the syllables /pa/ (p < 0.01) and /ta/ (p < 0.05). There was no significant difference in the values for the syllable /ka/. Conclusion: In community-dwelling elderly people, tongue pressure was positively associated with ODK values for the syllables /pa/ and /ta/, suggesting that tongue pressure may be associated with strength of the lip and tongue tip muscles. Furthermore, it was suggested that the ODK values may even be lower than normal values in the elderly who maintain skeletal muscle mass and thus have adequate tongue pressure;therefore, these indicators may be used as a guideline to assess oral frailty.

Effects of Image Presentation Using a Head-Mounted Display on Muscle and Brain Activity during Swallowing

Introduction: It is well known that humans have an increased sense of taste and consume more food when eating with others. This effect is called social facilitation of eating. We previously reported that self-images also have the effect of social facilitation of eating. In the present study, we investigated the effect of a head-mounted display (HMD) as a means of presenting self-images. Methods: Fourteen healthy adults (7 females and 7 males) were included in the study. The mean age of the participants was 20.4 years. The experimental conditions were as follows: the presentation conditions include the SG condition, in which an image was projected on the smart glasses, and the MT condition, in which an image was projected on the monitor. The stimulation conditions include the self-image condition (Self condition), in which the participant’s own image was projected, and the background image condition (Background condition), in which the background image was projected. Participants were asked to consume green tea jelly three times under the four conditions, which consisted of combinations of the presentation and stimulation conditions. Electromyography (EMG) and electroencephalography (EEG) were used to measure the muscle activity of the suprahyoid muscle group and brain activity, respectively. Results: The EMG of the “SG-Self” condition was significantly higher than that of “SG-Background” and “MT-Background” conditions. The EMG of the “MT-Self” condition was significantly higher than that of the “MT-Background” condition. In the EEG before the start of swallowing, “SG-Self” was significantly lower in the alpha band and higher in the beta band than “MT-Background”. The beta-alpha ratio was significantly higher for “SG-Self” than for “SG-Background” and “MT-Background” and higher for “MT-Self” than for “MT-Background”. Conclusion: These results suggest that self-images influence muscle and brain activities during swallowing, regardless of the presentation conditions, such as HMD or monitor.

Evaluation of Care Quality Related to Dietary Intake and Swallowing Functions of Residents at Long-Term Facilities in Japan

This study aimed to evaluate the quality of healthcare services pertaining to the dietary intake and swallowing functions of residents, nutrition management practices, and performance of residents at long-term care facilities. We investigated outcome indicators, such as changes in dietary intake and swallowing function levels of residents, and clarified which structural and process indicators were associated with the outcome indicators. This was a retrospective study, analyzing information on healthcare services from 1067 long-term care facilities during the fiscal year 2012, sampled from among those registered with the Welfare, Health and Medical Care Information Network of the Welfare and Medical Service Agency in Japan. Five outcome indicators were identified. Next, we examined the relationships between the outcome indicators and structural or process indicators using a multivariate linear regression model, adjusting for facility type. The findings showed how the five outcome indicators were used in long-term care facilities over a period of one year and determined the independent predictors of these outcome indicators. The amplification of dietary function 1 was associated with “assessment of oral functions using a feeding and swallowing assessment checklist every three months”, “holding care conferences related to ingestion and swallowing every three months”, and “maintaining a 1:2 ratio for meal-time assistants to residents”. To improve the quality of care, it is necessary to increase the number of staff (e.g., to provide meal assistance to residents) and to understand changes in the residents’ status through accurate assessment and monitoring.

Recognition and rejection of foreign eggs of different colors in Barn Swallows

Brood parasitic birds lay eggs in the nests of other birds,and the parasitized hosts can reduce the cost of raising unrelated offspring through the recognition of parasitic eggs.Hosts can adopt vision-based cognitive mechanisms to recognize foreign eggs by comparing the colors of foreign and host eggs.However,there is currently no uniform conclusion as to whether this comparison involves the single or multiple threshold decision rules.In this study,we tested both hypotheses by adding model eggs of different colors to the nests of Barn Swallows(Hirundo rustica)of two geographical populations breeding in Hainan and Heilongjiang Provinces in China.Results showed that Barn Swallows rejected more white model eggs(moderate mimetic to their own eggs)and blue model eggs(highly non-mimetic eggs with shorter reflectance spectrum)than red model eggs(highly nonmimetic eggs with longer reflectance spectrum).There was no difference in the rejection rate of model eggs between the two populations of Barn Swallows,and clutch size was not a factor affecting egg recognition.Our results are consistent with the single rejection threshold model.This study provides strong experimental evidence that the color of model eggs can has an important effect on egg recognition in Barn Swallows,opening up new avenues to uncover the evolution of cuckoo egg mimicry and explore the cognitive mechanisms underlying the visual recognition of foreign eggs by hosts.

The Efficacy of Electromyographic Biofeedback Combined with Swallowing Training on Post- Stroke Dysphagia

Objective:This paper focuses on the research and discussion of the efficacy of electromyographic biofeedback combined with swallowing training on post-stroke dysphagia.Methods:This study randomly sampled and analyzed 68 patients with post-stroke dysphagia from January 2023 to December 2023,34 cases of swallowing training intervention were grouped as the control group,and 34 cases of electromyography biofeedback combined with swallowing training intervention were grouped as the study group,and the clinical therapeutic effects of the two groups of patients after receiving the two different modes of intervention were compared.Results:The swallowing function of patients in both groups improved,and the VFSS score of patients in the seminar group was significantly higher than that of the control group,indicating that the clinical efficacy of the seminar group was more significant.The nasal feeding tube extraction rate,extraction time,and quality of life scores of the seminar group were better than those of the control group(P<0.05),which is of research value.Conclusion:For patients with post-stroke dysphagia,treatment with electromyography biofeedback combined with swallowing training mode can significantly improve their swallowing function.This effective intervention can not only shorten the time for patients to remove the nasal feeding tube but also help to improve the quality of life of patients,which is worth using.

Treatment of Post-stroke Dysphagia by VitalStim Therapy Coupled with Conventional Swallowing Training

To investigate the effects of VitalStim therapy coupled with conventional swallowing training on recovery of post-stroke dysphagia,a total of 120 patients with post-stroke dysphagia were randomly and evenly divided into three groups：conventional swallowing therapy group,VitalStim therapy group,and VitalStim therapy plus conventional swallowing therapy group.Prior to and after the treatment,signals of surface electromyography（sEMG） of swallowing muscles were detected,swallowing function was evaluated by using the Standardized Swallowing Assessment（SSA） and Videofluoroscopic Swallowing Study（VFSS） tests,and swallowing-related quality of life（SWAL-QOL） was evaluated using the SWAL-QOL questionnaire.There were significant differences in sEMG value,SSA,VFSS,and SWAL-QOL scores in each group between prior to and after treatment.After 4-week treatment,sEMG value,SSA,VFSS and SWAL-QOL scores were significantly greater in the VitalStim therapy plus conventional swallowing training group than in the conventional swallowing training group and VitalStim therapy group,but no significant difference existed between conventional swallowing therapy group and VitalStim therapy group.It was concluded that VitalStim therapy coupled with conventional swallowing training was conducive to recovery of post-stroke dysphagia.

Increased activation of the caudate nucleus and parahippocampal gyrus in Parkinson's disease patients with dysphagia after repetitive transcranial magnetic stimulation:a case-control study

Repetitive transcranial magnetic stimulation(r TMS)has been shown to effectively improve impaired swallowing in Parkinson's disease(PD)patients with dysphagia.However,little is known about how r TMS affects the corresponding brain regions in this patient group.In this casecontrol study,we examined data from 38 PD patients with dysphagia who received treatment at Beijing Rehabilitation Medicine Academy,Capital Medical University.The patients received high-frequency r TMS of the motor cortex once per day for 10 successive days.Changes in brain activation were compared via functional magnetic resonance imaging in PD patients with dysphagia and healthy controls.The results revealed that before treatment,PD patients with dysphagia showed greater activation in the precentral gyrus,supplementary motor area,and cerebellum compared with healthy controls,and this enhanced activation was weakened after treatment.Furthermore,before treatment,PD patients with dysphagia exhibited decreased activation in the parahippocampal gyrus,caudate nucleus,and left thalamus compared with healthy controls,and this activation increased after treatment.In addition,PD patients with dysphagia reported improved subjective swallowing sensations after r TMS.These findings suggest that swallowing function in PD patients with dysphagia improved after r TMS of the motor cortex.This may have been due to enhanced activation of the caudate nucleus and parahippocampal gyrus.The study protocol was approved by the Ethics Committee of Beijing Rehabilitation Hospital of Capital Medical University(approval No.2018 bkky017)on March 6,2018 and was registered with Chinese Clinical Trial Registry(registration No.Chi CTR 1800017207)on July 18,2018.

Extraskeletal symptoms and comorbidities of diffuse idiopathic skeletal hyperostosis

Diffuse idiopathic skeletal hyperostosis(DISH) is a noninflammatory disease characterized by calcification and ossification of soft tissues, mainly enthesis and spinal ligaments. The clinical presentation primarily includes spinal involvement-induced pain and range of motion. Although rare, life-threatening gastrointestinal, respiratory or neurological events or severe morbidity due to bone compression on the adjacent structures may develop. There is a limited amount of data on DISHrelated events in the literature. In recent years, comorbid metabolic disorders are of great interest in patients with DISH. The early diagnosis of these conditions as well as rare entities allows an effective multidisciplinary approach for the treatment of DISH. In this article, we review extraskeletal symptoms and associated comorbidities in patients with DISH.

Tongue dysfunction in neurological and neuromuscular disorders: A narrative literature review

Evaluation of oral function is useful for tracking longitudinal changes in swallowing function. Using videofluoroscopic(VF) images, we can evaluate swallowing function, but it is extremely difficult to quantitatively evaluate the oral phase. Recently, several studies have tried to quantitatively assess tongue function by analyzing tongue movement on VF images, to measure tongue thickness by ultrasonography, and to measure tongue pressure as surrogate for tongue strength. In this review article,the current state of quantitative assessments of tongue function for identification and management of dysphagia in patients with neuromuscular and other neurological disorders(NNMD) has been outlined. Disturbed bolus transport in patients with NNMD has been quantitatively measured on VF images by analyzing tongue base movement and bolus transport from the mouth to the pharynx. Enlarged tongue in Duchenne muscular dystrophy patients were observed by measuring the transverse width of the tongue on ultrasound. Tongue pressures that were measured using a handheld probe in NNMD patients were less than half of those in healthy subjects. More studies are needed to develop guidelines what types of tongue dysfunction give an indication of adjusting diet and introducing tube feeding to NNMD patients.

Central swallowing in normal adults using functional magnetic resonance imaging

BACKGROUND： While brain-imaging studies in healthy adults have indicated that multiple cortical regions are involved in swallowing, these functional imaging techniques have not been extensively applied to the complete understand neurophysiology of swallowing in China. A full understanding of normal swallowing neurophysiology is important for improving functional outcomes for dysphagia due to neurologic disorders or damage with increasing age. Thus the interpretations of the functional contributions of various brain areas in swallowing should be scientifically researched. OBJECTIVE： To identify the activation and characteristic of swallowing center in healthy adults using functional magnetic resonance imaging. DESIGN, TIME AND SETTING： An uncontrolled neuroimaging study was performed at the Outpatient Clinic, Department of Radiology, West China Hospital of Sichuan University between March and November 2008. PARTICIPANTS： Ten healthy right-handed volunteers, aged over 20 years with a mean age of （34.2 ＋ 8.1） years, a range of 25-45 years and including five males and five females participated. A medical history was obtained from all potential subjects and all subjects were free of systemic diseases and neurological disorders. METHODS： The healthy volunteers were examined with event-related functional magnetic resonance imaging of blood oxygenation level-dependent while laryngeal swallow-related movements were recorded. Subjects were scanned during voluntary saliva swallowing and water bolus swallowing activation tasks. Data was processed using the General Linear Model. A voxel by voxel group comparison was performed using random effect analysis. Any cluster with a corrected P 〈 0.05 for spatial extent was considered significant. MAIN OUTCOME MEASURES： The cerebral cortical activation maps of voluntary swallowing of saliva and swallowing of water bolus in healthy adults were observed. RESULTS： A multifocal cortical representation of swallowing was in the precentral gyrus, postcentral gyrus, insula, anterior cingulate gyrus, thalamus, basal ganglia and cerebellum, in a bilateral and asymmetrical manner, predominantly on the left hemisphere in the volunteers （P 〈 0.05）. CONCLUSION： Activation of the cortex during normal swallowing tasks may be functionally linked to basal nuclei, thalamus, and cerebellum, greatly appearing in the left hemisphere.

Research Progress of Swallowing Therapy in Relieving Dysphagia after Stroke

This article summarizes the current rehabilitation treatment methods for dysphagia after stroke,including feeding-swallowing function treatment,acupuncture treatment,neuromuscular electrical stimulation,balloon catheter dilatation,etc.,all of which have many clinical applications,hoping to play a guiding role in future research.