Publications by authors named "Yoichiro Aoyagi"

25 Publications

  • Page 1 of 1

Impact of heart failure severity on bone mineral density among older patients with heart failure.

Heart Vessels 2021 Jun 3. Epub 2021 Jun 3.

Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan.

The study aimed to identify factors related to bone mineral density (BMD) among older patients with heart failure (HF). A total of 70 consecutive patients with HF aged 65 years or older who were admitted to an acute hospital due to worsening condition were enrolled before discharge. BMD of the femoral neck was evaluated using the DEXA method. Physical function, as well as echocardiographic and laboratory findings including biomarker of HF severity were collected. Bivariate and multiple regression analyses were employed to determine the association between BMD and the clinical variables. Bivariate analysis determined that age, grip strength, walking speed, serum albumin, and N-terminal pro B-type natriuretic peptide (NT-proBNP) were significantly correlated with BMD (P < 0.01), whereas other clinical parameters were not. The multiple regression analysis identified NT-proBNP as an independent related factor for BMD after adjusting with confounding clinical variables. NT-proBNP was independently related to BMD among older patients with HF. Our results suggest the inclusion of bone fracture prevention strategies in disease management programs, especially for older patients with HF.
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http://dx.doi.org/10.1007/s00380-021-01884-1DOI Listing
June 2021

Effect of ankle joint fixation on tibialis anterior muscle activity during split-belt treadmill walking in healthy subjects: A pilot study.

Turk J Phys Med Rehabil 2021 Mar 4;67(1):11-16. Epub 2021 Mar 4.

Department of Rehabilitation, Fujita Health University Bantane Hospital, Nagoya, Japan.

Objectives: This study aims to examine the characteristics of muscle activity change of the tibialis anterior (TA) muscle in healthy adults while they walked on a split-belt treadmill with one fixed ankle.

Patients And Methods: This randomized controlled trial was conducted between November 2017 and July 2018. Fourteen healthy male individuals (mean age 31.4 years; range, 23 to 50 years) were divided into two groups: right ankle joint fixed by ankle-foot orthosis (fixation group) and no orthosis (control group). Both groups were asked to walk on a treadmill with the same belt speed. After familiarizing with walking on both belts at 5.0 km/h, they walked for 6 min with the right belt slower (2.5 km/h) and the left faster (5.0 km/h). For analysis, the 6 min were divided equally among three time periods. The TA muscle activity was calculated at first and last time periods. We compared muscle activities in time periods (early and late phase) and in groups (fixation and control) using two-way mixed analysis of variance.

Results: The TA muscle activity decreased in the late phase regardless of ankle joint fixation, and also decreased in the fixation group regardless of the time periods. There was an interaction between these factors.

Conclusion: These data show that changes in the TA muscle activity were smaller in the fixation group, suggesting that the ankle joint fixation reduces the adaptation.
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http://dx.doi.org/10.5606/tftrd.2021.4980DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088797PMC
March 2021

Clinical Manifestation, Evaluation, and Rehabilitative Strategy of Dysphagia Associated With COVID-19.

Am J Phys Med Rehabil 2021 05;100(5):424-431

From the Department of Rehabilitation Medicine, School of Medicine, Fujita Health University, Toyoake, Japan (YA, SS, HK, YO, ES); Faculty of Rehabilitation, Fujita Health University, Toyoake, Japan (YI); and Department of Rehabilitation Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (YA).

Abstract: Dysphagia is the difficulty in swallowing because of the presence of certain diseases; it particularly compromises the oral and/or pharyngeal stages. In severe acute respiratory syndrome coronavirus 2 infection, neuromuscular complications, prolonged bed rest, and endotracheal intubation target different levels of the swallowing network. Thus, critically ill patients are prone to dysphagia and aspiration pneumonia. In this review, we first discuss the possible cause and pathophysiology underlying dysphagia associated with coronavirus disease 2019, including cerebrovascular events, such as stroke, encephalomyelitis, encephalopathy, peripheral neuropathy, and myositis, that may lead to the dysphagia reported as a complication associated with the coronavirus disease 2019. Next, we present some recommendations for dysphagia evaluation with modifications that would allow a safe and comprehensive assessment based on available evidence to date, including critical considerations of the appropriate use of personal protective equipment and optimization individual's noninstrumental swallowing tasks evaluation, while preserving instrumental assessments for urgent cases only. Finally, we discuss a practical managing strategy for dysphagia rehabilitation to ensure safe and efficient practice in the risks of severe acute respiratory syndrome coronavirus 2 exposure, in which swallowing therapy using newer technology, such as telerehabilitation system or wearable device, would be considered as a useful option.
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http://dx.doi.org/10.1097/PHM.0000000000001735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032217PMC
May 2021

Effect of Tongue-Hold Swallow on Pharyngeal Contractile Properties in Healthy Individuals.

Dysphagia 2021 Jan 1. Epub 2021 Jan 1.

Department of Rehabilitation Medicine, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.

Tongue-hold swallow (THS) is a swallow exercise in which an individual swallows saliva while holding the anterior portion of the tongue between the front teeth. The effect of THS on pharyngeal contractile vigor is still unclear. The purpose of this study was to quantify THS using high-resolution manometry with a contractile integral analysis. Twenty-two healthy participants performed three different saliva swallow tasks: normal swallow, weak THS (in which the tongue was protruded 1 cm outside the upper incisors), and strong THS (in which the tongue was protruded 2 cm outside the upper incisors). The participants repeated each task twice randomly. Pharyngeal and upper esophageal sphincter metrics, including the pharyngeal contractile integral, were analyzed. Both weak and strong THS enhanced the velopharyngeal contractile integral and peak pressure compared with normal swallow (P < 0.01). THS also prolonged mesopharyngeal contraction (P < 0.01). Holding the tongue anteriorly during swallow requires significant biomechanical changes to pharyngeal contractile properties at the superior and middle pharyngeal constrictor levels; thus, it may serve as a resistance exercise for the muscles that are involved in bolus propulsion.
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http://dx.doi.org/10.1007/s00455-020-10217-9DOI Listing
January 2021

The effect of bolus consistency on pharyngeal volume during swallowing: Kinematic analysis in three dimensions using dynamic Area Detector CT.

J Oral Rehabil 2020 Oct 26;47(10):1287-1296. Epub 2020 Aug 26.

Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, USA.

Objective: This study investigated the effects of bolus consistency on pharyngeal volume during swallowing using three-dimensional kinematic analysis.

Methods: Eight subjects (2 males and 6 females, mean ± SD 44 ± 10 years old) underwent a 320-row area detector scan during swallows of 10 mL of honey-thick liquid and thin liquid. Critical event timing (hyoid, soft palate, UES) and volume of pharyngeal cavity and bolus were measured and compared between two swallows.

Results: The pharynx is almost completely obliterated by pharyngeal constriction against the tongue base for both consistencies. There were no significant differences in maximum volume, minimum volume and pharyngeal volume constriction ratio values between thick and thin liquids. However, the pattern of pharyngeal volume change (decrease) was different. For thick liquids, the air volume started to decrease before the onset of hyoid anterosuperior movement and decreased rapidly after onset of hyoid anterosuperior movement. During thin liquid swallowing, air volume remained relatively large throughout the swallow and started to decrease later when compared to swallowing thick liquids. At onset of UES opening, the bolus volume was not significantly different between thin and thick liquids; however, air volume was significantly larger when swallowing thin liquids, which made the total volume of the pharyngeal cavity larger.

Conclusion: This difference between the two consistencies is associated with differences in tongue motion to propel the bolus and clear the pharynx from possible residue.
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http://dx.doi.org/10.1111/joor.13062DOI Listing
October 2020

Neuronal intranuclear inclusion disease presenting with dysphagia: a report of three cases.

Neurocase 2020 08 3;26(4):252-257. Epub 2020 Jul 3.

Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University , Toyoake, Japan.

Neuronal intranuclear inclusion disease (NIID) is a rare neurodegenerative disease that is pathologically characterized by the presence of eosinophilic hyaline intranuclear inclusions in neurons, astrocytes, and specific somatic cells. Previously reported cases of NIID displayed various neurological symptoms, including dementia, muscle weakness, ataxia, etc. However, dysphagia associated with NIID have rarely been reported. Here, we report on three cases of NIID with dysphagia. Bolus mastication and transport were impaired in all three cases. Delay of the initiation of pharyngeal swallowing and silent aspiration was observed in two cases. Combined with the brain magnetic resonance imaging (MRI) findings, oropharyngeal dysphagia associated with NIID was suggested to be attributed to diffuse subcortical lesions.
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http://dx.doi.org/10.1080/13554794.2020.1788607DOI Listing
August 2020

Oropharyngeal Dysphagia and Aspiration Pneumonia Following Coronavirus Disease 2019: A Case Report.

Dysphagia 2020 08 12;35(4):545-548. Epub 2020 Jun 12.

Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.

Cranial nerve involvement is a finding often observed in patients infected with severe acute respiratory syndrome coronavirus 2 during the pandemic outbreak of coronavirus disease 2019 (COVID-19). To our knowledge, this is the first report of oropharyngeal dysphagia associated with COVID-19. A 70-year-old male developed dysphagia and consequent aspiration pneumonia during recovery from severe COVID-19. He had altered sense of taste and absent gag reflex. Videoendoscopy, videofluorography, and high-resolution manometry revealed impaired pharyngolaryngeal sensation, silent aspiration, and mesopharyngeal contractile dysfunction. These findings suggested that glossopharyngeal and vagal neuropathy might have elicited dysphagia following COVID-19. The current case emphasizes the importance of presuming neurologic involvement and concurrent dysphagia, and that subsequent aspiration pneumonia might be overlooked in severe respiratory infection during COVID-19.
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http://dx.doi.org/10.1007/s00455-020-10140-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290133PMC
August 2020

Effect of Laryngeal Suspension and Upper Esophageal Sphincter Myotomy for Severe Dysphagia Due to Brainstem Disease.

Ann Otol Rhinol Laryngol 2020 Jul 10;129(7):689-694. Epub 2020 Feb 10.

Department of Otolaryngology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan.

Objectives: Surgical procedure is considered in patients with severe dysphagia when conservative treatment fails. This study aimed to evaluate laryngeal suspension (LS) and upper esophageal sphincter (UES) myotomy for treating severe dysphagia due to brain disease.

Methods: Fourteen patients underwent LS and UES myotomy, with a median follow-up of 5 years and 6 months when conservative treatment failed. The penetration-aspiration scale (PAS), the Dysphagia Severity Scale (DSS), the Eating Status Scale (ESS), and diet contents were evaluated just before surgery, at discharge, and at the last follow-up.

Results: Preoperative intake was tube feeding in all patients. The patients learned the extended head and flexed neck posture to open the esophageal inlet. PAS, DSS and ESS scores, and diet contents were significantly improved at discharge compared with before surgery, and were maintained until the last follow-up. Eight patients had pneumonia during their hospital stay, and five had pneumonia between discharge and at the last follow-up. Age was significantly, negatively correlated with DSS and ESS at the last follow-up.

Conclusion: Although LS and UES myotomy require a long inpatient rehabilitation and the risk of pneumonia after surgery is high, the outcome is favorable and the effects last for a long time.
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http://dx.doi.org/10.1177/0003489420904741DOI Listing
July 2020

Repetitive Peripheral Magnetic Stimulation for Strengthening of the Suprahyoid Muscles: A Randomized Controlled Trial.

Neuromodulation 2020 Aug 30;23(6):778-783. Epub 2019 Oct 30.

Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan.

Objective: Head lift exercise is a widely known form of training in the rehabilitation of patients with dysphagia. This study aimed to compare muscular strength reinforcement training of the suprahyoid muscles using repetitive peripheral magnetic stimulation (rPMS) with head lift exercises in a randomized controlled trial.

Materials And Methods: Twenty-four healthy adults were randomly assigned to either the magnetic stimulation group (M group) or the head lift exercise group (H group). Both groups underwent training five days a week for two weeks. The primary outcome was the cervical flexor strength, and secondary outcomes were jaw-opening force, tongue pressure, muscle fatigue of the hyoid and laryngeal muscles, displacement of the hyoid bone and opening width of the upper esophageal sphincter (UES) while swallowing 10 mL of liquid, training performance rate, and pain.

Results: No dropouts were reported during the two-week intervention period. Cervical flexor strength significantly increased solely in the M group. Tongue pressure significantly improved in both groups. There were no significant differences in the jaw-opening force, median frequency rate of the anterior belly of the digastric muscle, sternohyoid muscle, sternocleidomastoid muscle, anterior and superior hyoid bone displacement, and UES opening width in both groups.

Conclusions: Two-week rPMS of the suprahyoid muscles increased the strength of these muscles compared with the head lift exercise during the same period.
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http://dx.doi.org/10.1111/ner.13057DOI Listing
August 2020

Elicitation of the Swallowing Reflex by Esophageal Stimulation in Healthy Subjects: An Evaluation Using High-Resolution Manometry.

Dysphagia 2020 08 19;35(4):657-666. Epub 2019 Oct 19.

Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan.

The purposes of this human study using high-resolution manometry were to verify whether the swallowing reflex can be evoked by intra-esophageal fluid injection and whether the reflex latency and manometric variables differ depending on the injected location, amount, or speed. Ten healthy individuals participated in this study. The tip of the intranasal catheter for injection was placed at 5 cm (upper), 10 cm (upper-middle), 15 cm (lower-middle), or 20 cm (lower) from the distal end of the upper esophageal sphincter (UES). An intra-esophageal injection of 3 mL or 10 mL of thickened water was administered and controlled at 3 mL/s or 10 mL/s. Latencies from the start of the injection to the onset of UES relaxation were compared regarding injection locations, amounts, and rates. Manometric variables of intra-esophageal injection and voluntary swallowing were compared. The latency became shorter when the upper region was injected. Latency after the 10-mL injection was shorter than that after the 3-mL injection (p < 0.01) when faster injection (10 mL/s) was used. Faster injection induced shorter latency (p < 0.01) when a larger volume (10 mL) was injected. Pre-maximum and post-maximum UES pressures during voluntary swallowing or during spontaneous swallowing when injecting the upper esophageal region were significantly higher than spontaneous swallowing at other regions (p < 0.01). Intra-esophageal fluid injection induces the swallowing reflex in humans. The most effective condition for inducing the swallowing reflex involved a larger fluid amount with a faster injection rate in the upper esophagus.
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http://dx.doi.org/10.1007/s00455-019-10068-zDOI Listing
August 2020

Predictive impact of early mobilization on rehospitalization for elderly Japanese heart failure patients.

Heart Vessels 2020 Apr 26;35(4):531-536. Epub 2019 Sep 26.

Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan.

The aim of this study was to determine whether early mobilization was associated with rehospitalization among elderly heart failure patients. We measured the time from admission to mobilization and other clinical characteristics for 190 heart failure patients (mean age, 80.7 years). The primary outcome was heart failure rehospitalization. Kaplan-Meier survival curves were plotted and the hazard ratios for rehospitalization were determined using Cox proportional hazards regression models. During a median follow-up period of 750 days, 58 patients underwent rehospitalization. The time from admission to mobilization was significantly longer for these patients than for those who were not rehospitalized. Univariate and multivariate Cox proportional hazards analyses showed that the time from admission to mobilization was an independent predictor of rehospitalization, and receiver-operating characteristic analysis determined an optimal cutoff value of 3 days for differentiating the patients more likely to experience a subsequent cardiac event (sensitivity, 76%; specificity, 69%; area under the curve, 0.667). Kaplan-Meier survival curve analysis showed a significantly lower event rate in the ≤ 3-day group (p = 0.001, log-rank test). In conclusion, the time from admission to mobilization may be one of the strongest predictors of rehospitalization in elderly heart failure patients. Early mobilization within 3 days may be an initial target for the acute phase treatment of heart failure.
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http://dx.doi.org/10.1007/s00380-019-01517-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222093PMC
April 2020

Feedback protocol of 'fading knowledge of results' is effective for prolonging motor learning retention.

J Phys Ther Sci 2019 Aug 9;31(8):687-691. Epub 2019 Aug 9.

Faculty of Rehabilitation, Fujita Health University Bantane Hospital, Japan.

[Purpose] "Knowledge of results" (KR) is information about the success of an action relative to a goal. A reduced frequency of "knowledge of results" reportedly promotes motor learning more than a high frequency. However, the effect of gradually diminishing or increasing "knowledge of results" pattern has been rarely studied and is controversial. We investigated the effectiveness of diminishing "knowledge of results" pattern in motor learning. [Participants and Methods] Forty-six healthy adults were randomly assigned to either the 100% KR, 50% KR, or faded KR group. Participants were tasked with exerting 60% of their maximum voluntary contraction of their left shoulder flexion muscle in an isometric exercise. Participants practiced the task 20 times a day for 4 days. A pretest and posttest were conducted before and immediately after the acquisition, respectively. Retention tests were conducted 1 day, 1 week, and 2 weeks after the acquisition. [Results] The absolute error was significantly reduced in the posttest in the faded KR and 50% KR cohorts. However, there was no significant difference in the 100% KR group. In the faded KR subjects, the improvement effect was observed up to 1 week following acquisition. [Conclusion] Faded "knowledge of results" productively prolongs the effect of motor learning.
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http://dx.doi.org/10.1589/jpts.31.687DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698475PMC
August 2019

The difference in determinant factor of six-minute walking distance between sarcopenic and non-sarcopenic elderly patients with heart failure.

J Cardiol 2020 01 4;75(1):42-46. Epub 2019 Aug 4.

Department of Rehabilitation Medicine I, Fujita Health University, Toyoake, Japan.

Background: The purpose of this study was to identify the factors determining exercise capacity in elderly patients with heart failure (HF) with and without sarcopenia.

Methods: We studied 186 consecutive patients with HF who met the criteria of being >60 years, with no physical disability. During hospitalization, we measured the 6-min walking distance (6MWD) and other physical functional parameters and evaluated echocardiographic and laboratory measurements indicating the severity of HF. First, we divided patients into two groups (the sarcopenia group and the nonsarcopenia group) according to the presence of sarcopenia defined as fulfilling more than or equal to two criteria-body mass index <18.5, walking speed <0.8m/s, and grip strength <26kg in males, or <18kg in females. Then the association between the 6MWD and the clinical variables mentioned above was analyzed by univariate and multiple logistic regression analyses.

Results: The sarcopenia group comprised 77 patients (41.2%). In univariate analysis, age, grip strength, walking speed, and knee extensor muscle strength were significantly correlated with the 6MWD (p<0.05), whereas other clinical parameters were not. In multivariate analysis, walking speed was selected as an independent factor determining the 6MWD in both groups; however, knee extensor muscle strength was selected as an independent factor determining the 6MWD only in the sarcopenia group.

Conclusion: We demonstrated that knee extensor muscle strength was an independent factor determining exercise capacity-especially in elderly patients with HF with sarcopenia, and provided useful information in terms of exercise prescription.
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http://dx.doi.org/10.1016/j.jjcc.2019.07.002DOI Listing
January 2020

Pharyngeal swallowing in older adults: Kinematic analysis using three-dimensional dynamic computed tomography.

J Oral Rehabil 2018 Dec 14;45(12):959-966. Epub 2018 Sep 14.

Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland.

Objectives: To assess the effect of age on swallowing with a focus on structural movement, timing and duration of physiologic events.

Design: Cross-sectional study.

Setting: Tertiary University Medical Center.

Participants: Community-dwelling adults (3 age groups): younger 20 to 39 (n = 23; mean 32 ± 5), middle-aged 40 to 59 (n = 29; mean 49 ± 5) and older adults 60 to 74 (n = 15; mean 67 ± 5).

Intervention: One 10-mL honey-thick liquid (1700 mPa) swallow was studied using 320-row area detector computed tomography scanning.

Measurements: Kinematic analysis was performed for each swallow including temporal characteristics and structural movements.

Results: The duration of velopharyngeal closure and laryngeal closure (including epiglottis inversion, laryngeal vestibule closure, true vocal cord closure) was significantly different by age group (P = 0.002, P < 0.001, P = 0.017, P = 0.041, respectively). Events were prolonged in older adults compared with middle-aged and younger adults. The pharyngeal phase was longer for older adults. Velopharyngeal closure started earlier and continued until after complete UES opening. In younger adults, velopharyngeal and laryngeal opening occurred before complete UES opening. No differences were found in bolus movement through the oropharynx by group.

Conclusion: During swallowing, older adults had a longer pharyngeal phase characterised by prolonged velopharyngeal and laryngeal closure. This difference may be a protective mechanism to compensate for age-related weakness. A better understanding of the mechanism by which this adaptation occurs is needed to tailor rehabilitation strategies and to maintain swallowing function during the lifespan.
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http://dx.doi.org/10.1111/joor.12703DOI Listing
December 2018

Hyoid Bone Movement at Rest by Peripheral Magnetic Stimulation of Suprahyoid Muscles in Normal Individuals.

Neuromodulation 2019 Jul 2;22(5):593-596. Epub 2018 Apr 2.

Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan.

Objectives: Neuromuscular electrical stimulation has been widely used in patients with dysphagia. However, obtaining sufficient hyoid bone movement through surface electrodes seems difficult. The aim of this study was to evaluate hyoid bone movement at rest through peripheral magnetic stimulation of the suprahyoid muscles in normal individuals.

Methods: Healthy adult men were recruited. A specially designed coil was connected to the peripheral magnetic stimulator. The coil was placed on the submental area of the subjects. Magnetic stimulation was performed at 30 Hz for 2 sec. The intensity level selected induces hyoid bone movement without causing intolerable pain to the subjects. The hyoid bone at rest between on- and off-magnetic stimulations of the suprahyoid muscles were identified using fluoroscopy at 30 frames/sec in lateral projection. Pain during peripheral magnetic stimulation was evaluated using the numerical rating scale (NRS).

Results: Eleven subjects aged 32 ± 9 years participated in this study. Magnetic stimulation resulted in 10.9 ± 2.8 mm forward displacement and 8.3 ± 4.1 mm (mean ± SD) upward displacement of the hyoid bone. The median NRS score during magnetic stimulation was 1.

Conclusions: Peripheral magnetic stimulation is noninvasive and easy to perform. It does not require skin preparation, facilitates sufficient hyoid bone movement, and causes minimum level of pain.
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http://dx.doi.org/10.1111/ner.12777DOI Listing
July 2019

Effect of bolus volume and flow time on temporospatial coordination in oropharyngeal pressure production in healthy subjects.

Physiol Behav 2018 05 6;189:92-98. Epub 2018 Mar 6.

Senri Rehabilitation Hospital, 4-6-1 Onoharanishi, Minoh, Osaka 562-0032, Japan.

The effects of bolus volume and flow time on the sequential coordination of tongue pressure (TP) and pharyngeal pressure (PP), which are important in the biomechanics of swallowing, are unclear. In this study, we measured TP and PP simultaneously in 10 healthy adults at multiple points during dry swallowing and the swallowing of 5 ml and 15 ml of liquids with different viscosities, and investigated changes in the timing of the onset, peak, and offset of these pressures. TP was measured using a sensor sheet system with five measuring points on the hard palate, and PP was measured using a manometry catheter with four measuring points. The order and correlations of sequential events, such as onset, peak, and offset times of pressure production, at each pressure measuring point were analyzed on the synchronized waveforms. We found that the differences between the TP and PP onset times decreased when the bolus volume was larger. The change in bolus volume had very little effect on peak time or offset time. The flow time of the bolus affected the appearance of onset and peak time for both TP and PP. A time difference between TP and PP emerged as the flow time increased, with TP starting to appear before PP. This may be the first detailed analysis of pressure-flow dynamics that treats the mouth and pharynx as a single functional unit. We believe that our analysis is an important step toward extending future research to include a wider range of age groups and dysphagia patients.
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http://dx.doi.org/10.1016/j.physbeh.2018.03.006DOI Listing
May 2018

The Mendelsohn Maneuver and its Effects on Swallowing: Kinematic Analysis in Three Dimensions Using Dynamic Area Detector CT.

Dysphagia 2018 08 26;33(4):419-430. Epub 2017 Dec 26.

Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, USA.

This study investigated the effects of Mendelsohn maneuver with three-dimensional kinematic analysis. Nine female speech-language pathologists (nine females, mean ± SD 27.1 ± 3.5 years old) underwent 320-row area detector scan during swallows of 4-ml nectar-thick liquid using with no maneuvers (control) and with Mendelsohn maneuver (MM). Critical event timing (hyoid, soft palate, epiglottis, laryngeal vestibule, true vocal cords (TVC), UES), hyoid and laryngeal excursion, cross-sectional area of UES, and volume of pharyngeal cavity and bolus were measured and compared between two swallows. In MM, all the events were significantly prolonged with delayed termination time (p < 0.05) except UES opening. The onset, termination, and duration of UES opening were not significantly affected by MM nor was timing of bolus transport. The hyoid bone was positioned significantly higher at maximum displacement (p = 0.011). Pharyngeal constriction ratio was 95.1% in control and 100% of all subjects in MM. Duration of minimum pharyngeal volume was significantly longer in MM than in control (p = 0.007). The MM produces several distinct changes in the kinematics of swallowing in healthy subjects with no dysphagia. The changes in the timing and magnitude of hyoid displacements and prolonged closure of the pharynx during swallowing suggest the utility of MM for improving the safety and efficiency of swallowing in selected cases.
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http://dx.doi.org/10.1007/s00455-017-9870-7DOI Listing
August 2018

Initiation of Pharyngeal Response during Discrete Swallowing and Chew-swallowing in Healthy Subjects.

Prog Rehabil Med 2016 15;1:20160002. Epub 2016 Jul 15.

Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi 470-1192, Japan.

Objective: The aim of this study was to measure the initiation of pharyngeal swallowing during discrete swallowing and during chew-swallowing in younger and older healthy subjects and to determine the normal range of the stage transition duration (STD) for different food boluses. The correlations between STDs were investigated.

Methods: Twenty-eight younger subjects (< 60 years old) and 25 older subjects (≥ 60 years old) were enrolled. While in the sitting position, the subjects swallowed 10 ml of thin liquid barium (LQ), 8 g of corned beef hash with barium (CB), 8 g of cookie with barium (CK), and a two-phase mixture of 4 g of corned beef hash with barium and 5 ml of thin liquid barium (MX). A videofluoroscopic examination of swallowing was performed at 30 frames/s in the lateral projection. The delay in pharyngeal swallowing (i.e., STD) was measured. The normal range (mean ± 2SD) of STDs for each bolus type was determined, and correlations were calculated to examine the relationship among STDs.

Results: The median STDs for LQ, CB, CK, and MX in all subjects were 0.0, 1.2, 2.4, and 1.9 s, respectively. The STDs were prolonged for CB, CK, and MX compared with LQ. Additionally, the median STD was longer for LQ, CB, and CK in older than in younger subjects. No significant correlations were found between STDs except for those between CB and CK.

Conclusions: A delayed pharyngeal response is commonly observed during chew-swallowing. Liquids, solids, and two-phase mixtures exhibit independent timings of pharyngeal swallow initiation.
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http://dx.doi.org/10.2490/prm.20160002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7372006PMC
July 2016

Delayed Pharyngeal Response in CHEW-SWALLOW Does Not Increase Risk of Aspiration in Individuals with Stroke.

J Am Geriatr Soc 2015 Aug;63(8):1698-9

Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan.

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http://dx.doi.org/10.1111/jgs.13570DOI Listing
August 2015

Sequential coordination between lingual and pharyngeal pressures produced during dry swallowing.

Biomed Res Int 2014 18;2014:691352. Epub 2014 Dec 18.

Kawasaki University of Medical Welfare, 288 Matsushima, Kurashiki, Okayama 701-0193, Japan.

The aim of this study was to investigate oropharyngeal pressure flow dynamics during dry swallowing in ten healthy subjects. Tongue pressure (TP) was measured using a sensor sheet system with five measuring points on the hard palate, and pharyngeal pressure (PP) was measured using a manometric catheter with four measuring points. The order and correlations of sequential events, such as onset, peak, and offset times of pressure production, at each pressure measuring point were analyzed on the synchronized waveforms. Onset of TP was earlier than that of PP. The peak of TP did not show significant differences with the onset of PP, and it was earlier than that of PP. There was no significant difference between the offset of TP and PP. The onset of PP was temporally time-locked to the peak of TP, and there was an especially strong correlation between the onset of PP and TP at the posterior-median part on the hard palate. The offset of PP was temporally time-locked to that of TP. These results could be interpreted as providing an explanation for the generation of oropharyngeal pressure flow to ensure efficient bolus transport and safe swallowing.
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http://dx.doi.org/10.1155/2014/691352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4281446PMC
August 2015

Dynamic change in hyoid muscle length associated with trajectory of hyoid bone during swallowing: analysis using 320-row area detector computed tomography.

J Appl Physiol (1985) 2013 Oct 22;115(8):1138-45. Epub 2013 Aug 22.

Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan;

Research on muscle activation patterns during swallowing has been limited. Newly developed 320-row area detector computed tomography (320-ADCT) has excellent spatial and temporal resolution, which facilitates identification of laryngopharyngeal structures and quantitative kinematic analysis of pharyngeal swallowing. We investigated muscle activity patterns by observing the changes in length of hyoid muscles. 320-ADCT was performed in 26 healthy males while swallowing. The following parameters were analyzed three-dimensionally: 1) origins and insertions of the stylohyoid, anterior and posterior digastric, mylohyoid, geniohyoid, and thyrohyoid muscles; and 2) movement of the hyoid bone. The stylohyoid, posterior digastric, and mylohyoid muscles began to shorten simultaneously during the initial stage of swallowing. The shortening of these muscles occurred during the upward movement of the hyoid bone. Subsequently, the geniohyoid, thyrohyoid, and anterior digastric muscles began to shorten, synchronizing with the forward movement of the hyoid bone. A significant correlation was observed between the shortened muscle lengths of the stylohyoid, posterior digastric, and mylohyoid muscles and the upward movement of the hyoid bone (r = 0.45-0.65). A correlation was also observed between the shortened muscle length of the geniohyoid muscle and the forward movement of the hyoid bone (r = 0.61). In this study, the sequence of muscle activity during pharyngeal swallowing remained constant. Serial shortening of the hyoid muscles influenced the trajectory of the hyoid bone. The stylohyoid, posterior digastric, and mylohyoid muscles initiated the swallowing reflex and contributed to upward movement of the hyoid bone. The geniohyoid is a key muscle in the forward movement of the hyoid bone.
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http://dx.doi.org/10.1152/japplphysiol.00467.2013DOI Listing
October 2013

Therapeutic orthosis and electrical stimulation for upper extremity hemiplegia after stroke: a review of effectiveness based on evidence.

Top Stroke Rehabil 2004 ;11(3):9-15

Department of Rehabilitation Medicine, Kawasaki Medical School, Okayama, Japan.

Upper extremity hemiplegia after stroke is common and disabling. Apart from conventional physical and occupational therapy, a number of additional approaches that use devices such as orthoses, prostheses, electrical stimulation, and robots have been introduced. The purpose of this review was to assess the clinical efficacy of such devices used for the affected upper extremities of acute, subacute, and chronic stroke patients. Assessments of their effectiveness and recommendations were based on the weight of published scientific evidence. The amount of evidence with respect to hand splints and shoulder slings is limited. Further study with a well-designed randomized controlled trial (RCT) is required to investigate accurately their short- and long-term efficacy. A number of studies suggested that the use of electrical stimulation for reducing shoulder subluxation or improving the function of wrist and finger extensors is effective during or shortly after the daily treatment period. The robotic approach to hemiplegic upper extremities appears to be a novel therapeutic strategy that may help improve hand and arm function. However, the longer term effectiveness after discontinuation as well as the motor recovery mechanism of electrical stimulation or robotic devices remains unclear. More research is needed to determine the evidence-based effectiveness of electrical stimulation or other devices for stroke survivors.
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http://dx.doi.org/10.1310/6Q5Q-69PU-NLQ9-AVMRDOI Listing
December 2004

Movements elicited by electrical stimulation of muscles, nerves, intermediate spinal cord, and spinal roots in anesthetized and decerebrate cats.

IEEE Trans Neural Syst Rehabil Eng 2004 Mar;12(1):1-11

Department of Rehabilitation Medicine, Kawasaki Medical School, Okayama 701-0192, Japan.

Electrical stimulation offers the possibility of restoring motor function of paralyzed limbs after spinal-cord injury or stroke, but few data are available to compare possible sites of stimulation, such as muscle, nerve, spinal roots, or spinal cord. The aim of this study was to establish some characteristics of stimulation at these sites in the anesthetized and midcollicular decerebrate cat. The hind limb was constrained to move in the sagittal plane against a spring load. Ventral-root stimulation only produced movements down and back; the direction moved systematically backward the more caudal the stimulated roots. In contrast, dorsal-root stimulation only produced movements up and forward. Thus, neither method alone could produce the full range of normal movements. Muscle, nerve, and intraspinal stimulation within the intermediate regions of the gray matter generated discrete, selective movements in a wide range of directions. Muscle stimulation required an order of magnitude more current. Single microwire electrodes located in the spinal gray matter could activate a synergistic group of muscles, and generally had graded recruitment curves, but the direction of movement occasionally changed abruptly as stimulus strength increased. Nerve stimulation produced the largest movements against the spring load (>80% of the passive range of motion) and was the most reproducible from animal to animal. However, recruitment curves with nerve stimulation were quite steep, so fine control of movement might be difficult. The muscle, nerve, and spinal cord all seem to be feasible sites to restore motor function. The pros and cons from this study may be helpful in deciding the best site for a particular application, but further tests are needed in the chronically transected spinal cord to assess the applicability of these results to human patients.
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http://dx.doi.org/10.1109/TNSRE.2003.823268DOI Listing
March 2004

Long-term stimulation and recording with a penetrating microelectrode array in cat sciatic nerve.

IEEE Trans Biomed Eng 2004 Jan;51(1):146-57

Center for Neural Interfaces, Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA.

We studied the consequences of long-term implantation of a penetrating microelectrode array in peripheral nerve over the time course of 4-6 mo. Electrode arrays without lead wires were implanted to test the ability of different containment systems to protect the array and nerve during contractions of surrounding muscles. Treadmill walking was monitored and the animals showed no functional deficits as a result of implantation. In a different set of experiments, electrodes with lead wires were implanted for up to 7 mo and the animals were tested at 2-4 week intervals at which time stimulation thresholds and recorded sensory activity were monitored for every electrode. It was shown that surgical technique highly affected the long-term stimulation results. Results between measurement sessions were compared, and in the best case, the stimulation properties stabilized in 80% of the electrodes over the course of the experiment (162 days). The recorded sensory signals, however, were not stable over time. A histological analysis performed on all implanted tissues indicated that the morphology and fiber density of the nerve around the electrodes were normal.
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http://dx.doi.org/10.1109/TBME.2003.820321DOI Listing
January 2004

Capabilities of a penetrating microelectrode array for recording single units in dorsal root ganglia of the cat.

J Neurosci Methods 2003 Sep;128(1-2):9-20

Department of Physiology and Centre for Neuroscience, University of Alberta, 513 Heritage Medical Research Centre, Edmonton Alta., Canada T6G 2S2.

The recording capability of a microelectrode array in the cat dorsal root ganglion (DRG) was studied in 11 acute experiments, 373 single, discriminable sensory units were recorded on 587 electrodes (0.64 units/electrode). Sensory action potentials as large as 1750 microV were obtained (mean=132 microV). These were comparable to literature reports of the best DRG extracellular recordings made with conventional electrodes. We were able simultaneously to activate and record over 50 discriminable, time-varying units from L6 and L7 DRGs during a cyclic ankle displacement. We also successfully recorded stable, phase dependent multiple sensory units with very little artifact or electromyographic (EMG) contamination during decerebrate walking. Thus, the array is capable of recording more effectively from more DRGs neurons than has been achieved by conventional recording techniques. The recording selectivity and stability of the array, coupled with the large number of neurons that can be recorded simultaneously, provide attractive features for better understanding sensorimotor control principles.
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http://dx.doi.org/10.1016/s0165-0270(03)00143-2DOI Listing
September 2003