Shear Rate Evaluation for the Viscosimetry of Thickened Liquids by a Sensory Test Using Five Concentrations of Newtonian Fluids / The Japanese Journal of Rehabilitation Medicine

Objective：The aim of this study is to obtain information for setting a common shear rate for the viscosimetry of thickened liquids.Materials & Methods：The panelists (healthcare professionals involved in dysphagia) drank five maltose syrups, and organized them in the order of viscosity based on their pharyngeal sense. Then, they drank three thickened liquids, i.e., 1.4% and 0.95% xanthan gum (XAN) solutions, and 1.4% guar gum (GUA) solution, and aligned them with the maltose syrups. We carried out the test twice using different concentrations of maltose syrups and obtained 126 answers. Results：Of all panelists, 77% could correctly arrange the five maltose syrups in the order of viscosity. The answers of the panelists who could serialize the five maltose syrups and the two XAN solutions were as follows. There were few answers that corresponded to shear rate of less than 11 sec^-1 for each of the thickened liquids. Meanwhile, most frequently answers corresponded to the shear rates of 61-140 sec^-1, 80-240 sec^-1, 210-620 sec^-1 for 1.4% XAN, 0.95% XAN, and 1.4 GUA solutions, respectively. Conclusion：The common shear rate for the viscosimetry of thickened liquids was not equivalent to the shear rate of 3 sec^-1 historically adopted in Japan；it was at least 50 sec^-1 according to the results of the sensory evaluation.

A Questionnaire Survey about the Use and Preparation of Test Foods for Videofluoroscopic Swallowing Examinations / The Japanese Journal of Rehabilitation Medicine

Objective : To understand how test foods used in videofluoroscopic swallowing examinations (VF) are prepared and used. Methods : A survey was conducted using participants in a workshop organized by the Japanese Association of Rehabilitation Medicine (October 27, 2012). Results : Among 129 participants, the survey collection rate was 48.8 %. The percentage who had conducted VF was 66.7 %. The test foods used were thickened liquid 97.6 %, jelly 92.9 %, and test foods other than liquid, thickened liquid or jelly were used by 64.3 %. A little less than 20 % answered that the test foods did not always or possibly did not always have the same physical property and texture. The contrast agents used in test foods were barium sulfate 50.0 %, amidotrizoic acid (Gastrografin^®) 33.3 % and iodinated contrast agent for angiography 7.1 %. Conclusions : In addition to thickened liquid and jelly, many solid test foods were also used. The uniformity and safety of these test foods and their properties need to be examined and considered in their preparation.

A Case Report of Isolated ACTH Deficiency with Severe Dysphasia / The Japanese Journal of Rehabilitation Medicine

The following report illustrates a rare case of dysphagia caused by secondary adrenal insufficiency in a patient with isolated ACTH deficiency. A 76-year-old man with progressive appetite loss, weight loss and general fatigue was hospitalized due to dehydration, aspiration pneumonia and hypoglycemia. He was unable to stand and walk by himself. His serum cortisol and ACTH levels were both low. An endocrinological examination resulted in a diagnosis of isolated ACTH deficiency. Following the administration of 15mg of glucocorticoids daily, his symptoms diminished without dysphagia. Furthermore, we investigated his swallowing function using a videofluoroscopic examination of swallowing (VF). The VF showed an impaired laryngeal movement as well as an upper esophageal opening and severe aspiration without a delay in his swallowing reflex. Oral intake was judged to be impossible, but his swallowing function gradually improved and he was able to resume eating all of his meals 2 months after treatment. Dysphagia is not a common symptom in ACTH deficient patients but a few similar cases have been reported. The swallowing function of the patients in these cases was not evaluated in detail, so we evaluated this case according to the results of the VF and the patient's process of recovery. Careful monitoring of swallowing function and appropriate treatment for both dysphagia and adrenocortical failure are required for the recovery of such patients. In conclusion, practitioners should be wary of isolated ACTH deficiency in elderly patients with progressive weight loss and dysphagia.