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Many children with physical disability have feeding difficulties. In cases of children with cerebral palsy, feeding difficulties can be seen in abnormal oral motor activity and defective swallowing coordination. These problems originate from neurological lesions. The purpose of this study was to investigate the effect of trunk and neck position on the following aspects of swallowing: stages of oral preparation, pharyngeal swallowing reflex, pharyngeal clearing and aspiration. Sixteen subjects with quadriplegic cerebral palsy were examined to assess their swal-lowing ability using videofluoroscopy(VFS). Subjects were evaluated in four different positions 1) trunk erect with the neck flexed 30°2) trunk reclined 30°posteriorly with the eck positioned neutrally 3) trunk reclined 30°posteriorly with the neck flexed 30° 4) trunk in supine with the neck flexed 30°. Friedman's test was used to analyze the effect of posi tion of the neck and trunk on swallowing. The results were as follows: 1. Ability of oral preparation was significantly better with the subject's trunk recli-ned 30°posteriorly and the neck flexed 30°than with the trunk erect and the neck flexed 30°(p < 0.05). 2. Ability of pharyngeal clearing was significantly better with the subject's trunk er-ect and the neck flexed 30° than in supine with the neck flexed 30°(p < 0.05). 3. Incidence of swallowing reflex was not significantly different among the four posi- tions (p >0.05). 4. Prevention of aspiration was significantly better with the subject's trunk reclined 30°posteriorl y and the neck flexed 30° than with the trunk reclined 30°posteriorly and the neck neutrally positi oned or in supine with the neck flexed 30°(p < 0.05). These results suggest that positions of both the neck and the trunk have an effect on swallowing in children with cerebral palsy. The position with the trunk reclined 30°posteriorly and the n eck flexed 30°was found to be optimal for oral preparation and prevention of aspiration. Further research to study swallowing ability in conjunc- tion with respiratory function is indicated.

Dysphagia secondary to peripheral cranial nerve injury originates from weak and uncoordinated contraction-relaxation of cricopharyngeal muscle. We report on two patients who suffered vagus nerve injury during surgery and showed sudden dysphagia by opening dysfunction of upper esophageal sphincter (UES). Videofluoroscopy-guided balloon dilatation of UES was performed. We confirmed an early improvement of the opening dysfunctions of UES, although other neurologic symptoms persisted. While we did not have a proper comparison of cases, the videofluoroscopy-guided balloon dilatation of UES is thought to be helpful for the early recovery of dysphagia caused by postoperative vagus nerve injury.

Purpose: The purpose of this study was to determine the significant factors for risk estimate of aspiration and to evaluate the efficiency of the dysphagia assessment tool. Methods: A consecutive series of 210 stroke patients with aspiration symptoms such as cough and dysphagia who had soft or regular diet without tube feeding were examined. The dysphagia assessment tool for aspiration was compared with videofluoroscopy using Classification and Regression Tree (CART) analysis. Results: In CART analysis, of 34 factors, the significant factors for estimating risk of aspiration were cough during swallowing, oral stasis, facial symmetry, salivary drooling, and cough after swallowing. The risk estimate error of the revised dysphagia assessment tool was 25.2%, equal to that of videofluoroscopy. Conclusion: The results indicate that the dysphagia assessment tool developed and examined in this study was potentially useful in the clinical field and the primary risk estimating factor was cough during swallowing. Oral stasis, facial symmetry, salivary drooling, cough after swallowing were other significant factors, and based on these results, the dysphagia assessment tool for aspiration was revised and complemented.

Purpose: To examine correlations among rating scales and findings suggestive of tracheal aspiration and pharyngeal residue betweenfiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS) in dysphagia patients. Materials and Methods: We studied patients referred to our hospital for dysphagia assessment. Three raters judged the residue severityand laryngeal penetration or tracheal aspiration of FEES and VFSS. The raters applied the Penetration-Aspiration Scale (PAS)for tracheal aspiration and pixel-based circumscribed area ratio and Yale Pharyngeal Residue Severity for post-swallow residue inVFSS and FEES, respectively. Anatomy-physiologic findings during FEES associated with tracheal aspiration were also analyzed. Results: A total of 178 participants were enrolled in our study. In correlation analysis, PAS (r=0.74), vallecula retention (r=0.76),and pyriform sinus retention (r=0.78) showed strong positive correlations between FEES and VFSS. Intra-rater agreement betweenVFSS and FEES was good for PAS (κ=0.65) and vallecula (κ=0.65) and pyriform sinus retention (κ=0.69). Among 72 patients whoshowed subglottic shelf residue, a suspected finding of aspiration, in FEES, 68 had concomitant tracheal aspiration during VFSS. Both vocal fold hypomobility and glottic gap during phonation were significantly associated with findings suggestive of trachealaspiration during FEES (p<0.05). Conclusion: Quantitative and reliable aspiration and post swallow residue rating scales showed strong positive correlations andgood agreement between VFSS and FEES.

Backgrounds and Objectives：The aim of this study was to investigate the value of videofluoroscopy (VF) inpatients with laryngopharyngeal reflux (LPR) suspected on the basis of reflux symptom index (RSI) and refluxfinding score (RFS). Materials and Methods：The patients with RSI ＞13 and RFS ＞7 were enrolled. The VFwas conducted in all patients, who were divided into the reflux and the no reflux group. Proton pump inhibitor(PPI) was prescribed to all patients for more than 8 weeks. Results：Sixty-six patients were followed for 8 weeks. On VF, 32 patients (48.5%) had reflux and 34 patients had no reflux. The two groups showed no significant differ -ences in demographic data, baseline characteristics, the mean changes in RSI and RFS after treatment. There wasno correlation between the presence or absence of reflux and the effectiveness of PPI treatment. Conclusions：Among our patient population, a subgroup including about half of the patients was found to have reflux on VF. Therefore, at least in this subgroup, VF may have a role to support the diagnosis of the patients with suspectedLPR.