20

S1

S1

S2

20 S7

S9

S23

S26

20 S27

S28

S28

S29

S29

S34

1 S40

1 S85

2 S173

2 S233

S1

PL

PT

OTST

1992 4

1994 6

200012

PTOT

2000 12

14

PTOTST

1 1

6 9

ADL

2

IL1

Mechanisms and Strategies for Altering and Modu-lating Swallowing and What Seems Promising

Department of Orofacial Sciences, School of Dentistry,

University of California at San Francisco

Arthur J. Miller, PhD

Research into modulating and evoking swallowing in

subjects with dysphagia has involved researchers from

around the world including from Japan, which has made

some major contributions to concepts in neuroplasticity

and swallowing disorders. External intervention includes

enhancing peripheral stimulation of the pharynx with elec-

trical stimulation, air puffs, and foods with acidic tasting

material. Studies in rats have shown that acetic and citric

acids as sour stimuli have the highest efficiency of eliciting

183S1S304, 2014

20

26 9 2627

NS

S2

reflex swallowing as compared to water. In humans, sour

lemon juice elicits stronger contraction of supra-hyoid

muscles in swallowing. Enhancing pharyngeal stimulation

with direct electrical stimulation can modify the sensorimo-

tor cortex as tested with transcranial magnetic stimulation.

Transcranial magnetic stimulation, either as single or

repeated pulses, can excite or suppress the sensorimotor

cortex depending on the frequency of stimulation. Repeated

tongue protrusion exercises in trained monkeys alter the

sensorimotor cortex for representation of that type of

tongue movement suggesting potential exercises to

strengthen muscles used in swallowing. Surface neck stimu-

lation can improve the Functional Oral Intake Score in

patients who had a cerebral stroke raising a question of

what external surface stimulation for several days really

accomplishes. Multiple studies evaluating the swallowing

central pathway using functional magnetic resonance in

humans have been complemented by using transcranial

magnetic stimulation as well as near infrared spectroscopy

and electromagnetic brain mapping or magnetoen-

cephalography. These multiple research techniques are

providing creative approaches to diagnosing and treating

dysphagia.

Bibliography:

Martin RE, Neuroplasticity and swallowing, Dysphagia, 24:

218229, 2009.

Shaker R, et al, Principles of Deglutition, Springer, New

York, 2013.

IL2

Functional Outcomes after Head and Neck Cancer Treatment

Department of Otolaryngology Head & Neck Sur-

gery, Icahn School of Medicineat Mount Sinai, NY,

Thyroid Head and Neck Research Center, Thyroid

Head and Neck CancerTHANCFoundation,

Department of Otolaryngology Head & Neck Sur-

gery, Mount Sinai Beth Israel, NY

Cathy Lazarus, PhD, BCS-S, FASHA

This talk focuses on functional outcomes after treatment

for head and neck cancer. Surgery and chemoradiotherapy

can have a profound effect on voice, speech, swallowing

and overall quality of life. Outcome variables and scales

used to assess voice, speech, swallowing and quality of life

will be reviewed. Specific types of oral outcomes assessed

in head and neck cancer patients treated with surgery and

primary chemoradiotherapy will be reviewed. Data from

surveys regarding typical protocols used by speech patholo-

gists working with head and neck cancer patients will be

reviewed. Research on use of prophylactic PEGs and

outcomes in the primary chemoradiotherapy population

will be discussed. Long-term effects of radiotherapy on

cranial nerve function and voice, speech and swallowing

will be reviewed. Data on effects of prophylactic swallow

exercise programs in patients treated with primary chemo-

radiotherapy will be discussed. Future research needs will

be addressed.

EL1

VF

videofluoroscopic examination of swallowing

VFVF X

X

VF

VF

VF

VF

X

20

S3

X C

VF

DVD

VF

VF

VF

EL2-1

8

EL2-2

STPT

10 70

5 95

STPT

183S1S304, 2014

S4

EL3

1985

intermittent use of oral catheter for feeding

19911992

1993 Taylor

oro-esophageal tube feeding1988 OE

1994 intermittent

tube feedingITF

1997

IOC1998

OE IOE

OGIOG

ING ICintermittent catheteri-

zation

2010

Zenker

IC

INGIC

IOGIOE

IC

CNG

IC

IC IC

IC

IOC

IOC 3

IC

IOC

H26

IC

IC

IC

EL4-1

2007 8.9

5%4

QOL

STPT

ST

20

S5

EL4-2

12

1 2

Franchin, 2009

Atasoy, 2011

Buntzel, 2012

Ishizuka, 2012

Mctey, JCO, 2008

Langmore, 2011

20102014

72

1

Kotz, 2003,

Kathryn, 2008, Pauloski, 2006

1

Ozawa, 2009, Maruo, 2013

Eisbruch, 2002

QOL

1

2

NST3

EL5-1

12

3

12

34

2012

183S1S304, 2014

S6

ELS5-2

EL6

MRIMEGNIRS

fMRIMEGPETfNIRS

SMA

20

S7

20

MS-1

I

30

1980

VF

2008 CT

/

PDCA

check Check

KRKP 2

KR

KP

VF

CT

Role of evaluation methods in dysphagia rehabili-tation

Vice President, Fujita Health University, Professor

and Chairperson, Department of Rehabilitation Medi-

cine I, School of Medicine, Fujita Health University

Eiichi Saitoh M.D., D.M.Sc.

The dysphagia rehabilitation in Japan only has a short

history of about thirty years. However, its development

has been so smooth and fast, and now, this area becomes

one of the most important categories in rehabilitation

medicine.

The role of evaluation methods in the formation of

this area is so critical. Actually the introduction of

videofluorography VFopened the door of dysphagia

rehabilitation. After that, videoendoscopyVEprovided

more convenient checking ways in clinical interventions.

And then, emergence of swallowing CTSCTin 2008 that

enables precise and quantitative assessment of dynamic

swallowing process is making a new edge of this area.

Here, I will discuss the role of evaluation methods in

dysphagia rehabilitation in context of clinical setting.

In general, impact of evaluation is determined in the

order corresponding to its properties of discoverability,

quantitative capability, and recordability / communicability.

However, more than these aspects, for clinical usability, the

aspect in direct guidance of intervention, that is, clinical

oriented aspect is actu-ally important. It is the check proc-

ess in the PDCA cycle. The checkfeedbackprocess

consists of KRknowledge of resultsand KPknowledge

of performance. In motor learning, that is centered in swal-

low exercise, the most important KR is to find out limit

difficulty tasks, and the most important KP is to find out

tips in exercise. In this talk, I will revisit to the concept of

motor learning and then discuss how VF contributes to

these two checks and also how SCT is making new findings

in these two checks.

MS-2

2013

2013

tDCS

rTMS

183S1S304, 2014

S8

20

UDF

2013

MS-3

K-pointK-point

1

K

K

K

K -method

MS-4

1987

1993

20

20

S9

MS-5

2000

ADL

6.820143

75

5 4 1

3

1

Gr. 6n641

3

57% 2014

71%

SY1-1

1

VF

VE

2

3

183S1S304, 2014

S10

SY1-2

2013

2013 0

1 0j 0t

/

SY1-3

2

1

BMITSF

AMC

GNRI

2

6

3

20

S11

SY2

12

1 2

DVD

all Japan

SY3-1

QOL

17

2021

22

DVD

3,000

2030

25

SY3-2

QOL

23

24

25

183S1S304, 2014

S12

SY3-3

24 7

4

1

2

3

4

SY4-1

1

SY4-2

QOL

20

S13

2013

QOL

SY4-3

stage two transport

SY4-4

texture

QOL

183S1S304, 2014

S14

SY4-5

SY5-1

1234567

12345 67

6

20

S15

SY5-2

1

PTOT

ST

H 26.45

5/31W73KA

6/2M77TA

0W83ME

7/7M82NK

0W77KK

0W84MN

SY5-3

TOUCH

2012

3,350 85%

41%

212,555

59

TOUCH 18

183S1S304, 2014

S16

21

TOUCH

SY5-4

SY6-1

30

NPO

KTSM

SY6-2

40

20097

20

S17

31

2

3 10

NST

325,000 65,000

10,000

SY6-3

SY6-4

1

183S1S304, 2014

S18

SY6-5

123 KTSM456789

1011

123 24 235

26 26 237

38 39 310

311

ST

PEG

6

SY7-1

SY7-2

20

S19

36

173060

25% 39% 20%

16%

SY7-3

SY7-4

4

183S1S304, 2014

S20

SY7-5

SY8-1

Oral careAustin H,

Kutscher2007.6The Terminal PatientOral care

1973

SY8-2

20

S21

24

1

SY8-3

462 65 15%85

40%

1015

SY8-4

23 3

65

95%7

Stroke Care UnitSCU SCU

Oral Health

Assessment ToolOHAT

OHAT8 3

OHAT

183S1S304, 2014

S22

SY9-1

3

1

23

1 1 3 2

150365

1202

34

5

Ns.

PT.OT.ST.DH.RD.

4

3 3 8

2 20

312

3

4

SY9-2

591

8

31

2

3

3

3

SY9-3

173

6 9 10

20

S23

320131j4

PA1-1

2

18 23

21 910 28

18

21 82%28

23 18

10.86.5 2.8

21 17.66.8

6.05.9

PA1-2

29

2025

10

26

4 5 6

PA1-3

183S1S304, 2014

S24

1980 12

DMFT

5.92010 1.4

1020

PA1-4

2003

PA2-1

1

23

201336.8%

IT

WG

20

15 55

5

3 1

WG

20

S25

PA2-2

IT

IT

Excel

12.8%6.0%2013

ADLFIM

PA2-3

VFVE

VEVF

2002

VF

VHS

2004DVD

DVDHDD

HD

2008

VEVF

2014

PA2-4

183S1S304, 2014

S26

MSW

/ VE/VF

URL

ID

/

TL-1

1234

1 2 1 1

3 4

PD

PD

PD

Troche et al, Dysphagia 2011, 26218224

20

22

c22500490

Deglutition 20121400412European Society

of Swallowing DisorderBarcelona2012, 10PD

PD 205987 76.3

Hohen-Yahr 14 2.5

202587 64.3

3 ml

BIOPAC System

MP150WSW

3

0.61 Hz 66

PD

18% PD

31%37%

PD 33%

36% PD

28%32%

PD

TL-2

12

1 2

paradoxical

gait

20

S27

22 14

8 2022

Rolando

4

1

4

a

b

c 3

3

4

a

b

p1106

c

p0.0275

20

PP

12

1 2

ADL QOL

1

URL

/NPO

183S1S304, 2014

S28

SS

1

2

1 2

10

/

SP1-1

20

S29

SP1-2

6

ICU

3

PTOT6

PTOT

11

50%

PC

ST

1

SP2

26 Q & A

PC

1

EM1-1

40%

70%

183S1S304, 2014

S30

10%

EM1-2

1 PT

23

ST

1

2ST

3PT

4

5 6

6

NST

EM1-3

80

QOL

EM1-4

QOL

5%

20

S31

EM1-5

/

6123

45

6

EM1-6

2012 462

5

Produced by

EM1-1

EM1-2EM1-3

EM1-4

EM1-5

EM1-6

2

EM2

6 10

183S1S304, 2014

S32

12 4

65

/

3STPTOT

EM3-1

10

50

6

1

3STPTOT

EM3-2

ADL

3

DSS 4

DSS 34 /

46.3%

20

S33

DSS 12 /

10.3%

4

EM4

2

TVCM

1

1

/

EM

2

183S1S304, 2014

S34

LS1

Chew Swallow Managing food

I

2

1 3

41

stage II transport

2

Chew Swal-

low Managing food

Chew Swallow Managing food

LS2

23

8

20

S35

LS3

LS4

9

2013

1

2013

2013

1

3

2013

UDF

LS5

2025

183S1S304, 2014

S36

LS6-1

QOL

300400 kcal

1,0005,000 mPas

150

18 Fr

2014

LS6-2

LS7

PES

2014 4

12,7298653,189

865 25.1% 4

1 65

20136

462

20

S37

ADAlzheimer

Deschaintre Y

BPSD

AD

GNRIGeriatric Nutri-

tional Risk Index

12

BPSD3BPSD

PES

LS8

LS9

23

4

QOL

AP-PLE 34

25

183S1S304, 2014

S38

LS10

3

173

8

23

2013 100

2013 3

3

LS11-1

10

6.82014 3

LS11-2

POS

LS11-3

6

ADL

2

20

S39

LS12

FIM ADL

ADL

1 1

153

53.6%

183S1S304, 2014

S40

1

1KD-O1-01

2013 4 12014 3 31

2 ST

9 5 4

80.082.6

76.8

93

9 6

3 5 1

3

2014

7

VE

1KD-O1-02

1

23

1 2 3

3 1 1

VF

70

13VF

2 VF

3 VF

4

VF

VF

20

S41

1KD-O1-03

123

13 1 1

1 1 23

79

A2 ICU

30

16Fr

10Fr

1ST

MPT 34

MPT 8

A

1KD-O1-04

12345

1 2 2

3 4 4

5 5

2013 48

190

160

214

8398%

160 13785.6%

16

72314.4%

1452

154 5737.0%

21 18

0.86 0.71

0.61

0.56

2

1KD-O1-05

i-EALD

i-EALD

2012 10 2014 3

37 22 15

84.1110.24

i-EALD

i-EALD

i-EALD 3.002.94

5.132.47 6.913.11

183S1S304, 2014

S42

i-EALD

i-EALD 6

1KD-O1-06

20

77.215

12 1

123

0 54

5

1234

2

1

r0.63

2713

1

2

1KD-O1-07

12

1 1 1

1 2

83 509781.68.0

53 30

22

t

5

05 6

42 41

35.518.6 47.821.7

p0.01

5

20

S43

1KE-O2-01

1

2 I

3

1 2 3

2 2 2

1

VFVE

VFVE

VFVE

Penetration Aspiration ScalePAS

50 74

35 ml35 ml

4 gVF VE

PASVFVE

VF 103 64

27 12VE

4875% 2178%

8 67% 26VF PAS 1

VE PAS 3 1425%

VFVE

2

2042% 210% 514%

VEVF

VE

VF

1KE-O2-02

LST1

LSTLine Spread Test

LST

20

P

III1 3

LST 3

2013

T1T2T3 30

4050 w/v% Steel

Adwassp0.01

Spearmanp0.01

T1T2T3

rsT10.7T20.9T30.9

LST

LSTT2

40 A50 w/v% 3 mm 2 mmT3

30 A40 w/v% 3 mm 1 mm

LSTrs

0.9

LST

1KE-O2-03

LST2

LSTLine Spread Test

183S1S304, 2014

S44

B

LST

III

2013

T1T2T3

P304050 w/v%

Bp0.01

rs30 w/v%0.840 w/v%0.950 w/v%0.9

50 w/v% B

p0.01 70% 279 mPas

LST B 13% 5 mmT1

50 w/v% B

p0.01rs

0.9T3

LST

LST

1KE-O2-04

VF

7

6 1 27.93.1

1 cm

20

50100150 gf

1KE-O2-05

123

1 1 1

1 2 2

1 3

VE

VF

VEVF

VE

10

20

S45

1KE-O2-06

320 CT

1

I23

4

12 1 1

3 1 1

4 2

Wallenberg syndromeWS

5191%

UES

VFVF

WS

UES

WS 5 3 69.0

5.1 320 CT

Aquilion One

3D0.11

2UES3

UES

UES

UES

CPG

UES

1KE-O2-07

CT

1

I2

34

1 2 1

1 1 1

3 4

320 CT320ADCT

3

8 2 6

397 45

5%w/v10 mlthickthin

1 320-

ADCTCT 10

/Air

Bolus 3DACT

AirBolusAirBolus

AirBolus /

thick thin

AirBolus thick 0.9 mlthin 0.4

ml thick 97.9%thin 95.5%

thickthin

Bolus thinAir thick

thick thin

Air Bolus

thick thin

183S1S304, 2014

S46

1KE-O3-01

1234

1 1 1

2 2 2

3 4

1 RSST

2013 10 2014 2

1,581

RSST 619

2

31

RSST

RSST

2.411.33RSST 1.57

1.31 RSST

b0.349p0.001RSST

RSST

RSST

RSST

1KE-O3-02

7

75%

RSST

SRTSRTRSST

RSST RSST

10

1060 SRTRSST 60 RSST

60 SRT

RSST

RSST 60 RSST

5

SRTRSST

10

1KE-O3-03

3DCG

1

23

4

1 1 2

3 4 4

3DCG

25 CT

Mimics

3DCG3dsMax

20

S47

1KE-O3-04

1

12

1 1 2

2 2 2

2

Swallow Vision

Swallow Vision

CT

VF3 CG

3ds Max Particleworks

4.0 Particleworks

78

25

Swallow Vision

1KE-O3-05

2

12

1 1 1

1 1 2

2

Swallow Vision

4

183S1S304, 2014

S48

1KE-O3-06

3

12

1 1 1

1 1 2

2

Swallow Vision

Swallow Vision

SP 2%

Swallow Vision

1KE-O4-01

21

123

1 2 3

2

17 2

8VP

17

40

2

2

1KE-O4-02

LP

12

1 2

LP

60X2 4

20

S49

X 6

3

X 11X1 1

VFLEDT

1

LP

1KE-O4-03

1 1

1

2

1 1 1

2 2 2

2

1

301

1 5 kg

67

8

13VF

44

68VF

119

126

4

1KE-O4-04

123

1 2 3

4 3

30

3

3 6

4

QOL

QOD

183S1S304, 2014

S50

1KE-O5-01

12345

1 1 1

2 3 4

5

77

1

600 kcal1,335 kcal

UP

1,000 kcal600 kcal

1KE-O5-02

4 4

6

123

45

456

LSTLine Spread

TestStable MicroSystems

6

LST

1KE-O5-03

4

50%

4

20

S51

4

14

2

1

3

4

1KE-O5-04

3

12

1 1 1

1 1 1

2

24

30%

3

70

H2H9

Alb 2.2

VF

ST

3

Alb 3.0

3

1KE-O5-05

12

1 2 1

2013

Line spread test

1 22

50

2013

n922.33.1 mm

n918.82.6 mmn3226.53.8 mm

2013

24 mm

VF

1KE-O5-06

183S1S304, 2014

S52

15

7

12/15

1KE-O5-07

2

1234

1 1 2

3 4

20112010

1,230

7,0051 10.5% 85.18.06

46 110 2 9

2,40934.4%

3,81654.5%

2,62437.5%

1,74724.9%

2,61337.3%

2,35333.6% 1,73024.7%

5

1KF-O6-01

123

1 2 3

200 ml

1/212 3

2

1

1/2

20

S53

1KF-O6-02

VF

2013 E

311518 mPas

2013

105216 mPas

VF

1KF-O6-03

12

345 Team21Shinei

145 15 1

1 24 24

34 14

2010 4 30

2014 1 16 4 15

3

8

86 103

86

55.8% 44.2%

55.8% 23.3%

17.4% 3.5%JCS

175.6%220.9%33.5%

4.7% 1.2%

2.3% 33.7% 48.8%

9.3% 1

183S1S304, 2014

S54

1KF-O6-04

123456

14 24 34

4 4 45

46

H 23

H 25.5

1

H 25.5H 26.41

2

1KF-O6-05

NST

NST 25 4

NST

25 4 26 3

59

83.961102

Alb

Gr.

69%

Alb 3.5 98%97%

11 Gr.

51% 25% 24%

59%76%

75%61%

NST

1KF-O6-06

123 NTT

1 2 3

22 11

20

S55

25 11 1

5

038

1KF-O6-07

6

12

1 2 1

6

20 5

1

21 3

226

PLPPAP

24 6

NST

25 12

1KG-O7-01

12

1 2 12

IC

26 81.07.1

52

2

A

BA B

B

183S1S304, 2014

S56

1KG-O7-02

1

234

12 3 4

30 5 25 86.15.9

3

3 cc 5

123

456

Tukey p0.05

3

1KG-O7-03

40 155

15547

FFQg Vre3.5

5

21 6 23

IBM SPSS

Statistics22t

63.67.0Age Matched

111.811.7% 2.70.5BMI 22.82.8

1

5.90.96.01.05.81.0

p0.001

1KG-O7-04

2

1234

12 1 2

3 1 1

4 2

19

5 g 3 ml

0% 24

wt% 3

3

20

S57

32%6/19

1KG-O7-05

1

/2

3

45

1 2 1

3 4 5

3 1

1

68 767.7

39

6 U 15 MHz

r0.39p0.0001

r0.37p0.002

r0.30p0.012

1KG-O7-06

123

ESR

1 2 2

1 3

9

2

HO

O2 1O2

HO Fe2/H2O2 13.579.51%H2O2-UV

2.821.44O2 2.562.17%1O2

5.112.07% HO O2 1O2

183S1S304, 2014

S58

1KG-O8-01

12

1 1 1

1 1 2

2 2

31 65.816.5

7

Panasonic

12

319101920

1KG-O8-02

1

12

1 1 2

81

2

ADL

1

14 kg ADL

44

4VE

VE

3

131

1KG-O8-03

PTOTST

3

2010 4 2014 3

ST 344 197

147 83.212.1

2010 4 2012 3A2012 4 2014

3 B

A 2.5B 1.7

p0.05 A

5B 3.9p0.05

3 A 169 101

59.8%B 175 12672%

A 32.6B 24.1p

0.05 4

3A 101 79

20

S59

78.2%B 126 10583.3%

3

4

3

1KG-O8-04

1234

5678

1 2 3

4 5 6

7 8

VF & VE 62

WBC CRP

BMI

CRP

WBC

BMI

36.7

BMI

1KG-O8-05

12

1 1 1

2

24

72

ST

60

2012 9 112 36

84.19.4 18 2013

9 111 5085.87.3 222

31,000 kcal /

2 A 1DROP

DSSST

5.2 2.8

p0.03 16.76%p0.11

13.810.1 p0.01 32.325.6

p0.11

QOL

1KG-O8-06

34

183S1S304, 2014

S60

2

25 6

9

8

8

13 0

1KG-O9-01

1KG-O9-02

40

30

1KG-O9-03

1

1234

1 3 2

4 12

20

S61

2 3

78 cm 8.2 kg1

800 cc

1KG-O9-04

12

1 1 2

2

2010142

42013

6

11y1m 10/20

21y6m 16/20

31y7m

16/20

41y9m16/20

50y11m 6/20

60y11m 6/20

13

156

4

1KG-O9-05

6 2

NPO

6

1

2 16

33

36

183S1S304, 2014

S62

1KG-O10-01

123

1 2 3

2013 12 2014 3

60 93

83.67.5 16 77

ST 33

24 ST ST

60 ST2

ST

ST 62.5%15/24ST 36.7%22/60

p0.03ST

4

79.2%19/2414

3 2

4

1KG-O10-02

123

1 2 3

66

Mini-Mental State Exami-

nationMMSE 40 cm 80 cm

1

2 3

MMSE

3MMSE

p0.000

MMSE 3

1 2 p

0.0082 3 p0.0001 3 p0.000

MMSE

1KG-O10-03

12 TOUCH

1 1 1

2

MPF

20

20 5

4 MPF

20 MPF

20

S63

20MPF

1KG-O10-04

1

2

1 1 1

1 1 1

2 1

2012 4 2014 3

11423

20%231211

809

3618 22

1

p0.407

9 7

14

5 7

p0.006

7

p0.052

1KG-O10-05

1234

12 123 23

1 4 4

20

1,360 693 667 72.05.1

LOGIQ BOOK XP

4.830.474 mm

p0.018r0.064

p0.0001r0.102

p0.003 r0.081Skeletal Muscle

IndexSMIp

0.0001r0.120SMIp0.0001r0.109

70

H 24 002

183S1S304, 2014

S64

1KG-O10-06

1

2

3

4

1 123 1

1 23 4

3

25 8 1 26 1 31

115

35 9 158

ICFICF

ICF

ICF

ADL

1KG-O10-07

12

1 2 1

1

2013 112 1 VF

65

2006

135449185.8

17 11

227411

1 25

2 57 3 53

11181.5% 111

2/3 64

1/3 17 1/3 12 83.8%

116

8875.9%

81.5%

1KH-O11-01

1234

1 2 2

2 2 3

4

PLPPAP

20

S65

1

26 9

17

3DQOL

1KH-O11-02

PAP

12

1 1 2

PAP

85

14PAP42

VF

30

L013

49 PAP

51 501 1

61L179PAP

92

127

PAP

134 VF

162171

PAP

PAP

1KH-O11-03

PAP

12

1 2 1

1

PAP

PAP

PAP

17

PAP

PAP3

PAP

1302

176

14 13

6

1

183S1S304, 2014

S66

1KH-O11-04

1

2

1 1 1

1 1 2

1

PAP

PAP

PAP

61 22 1

2/3

PAP

SwallowScan

PAP

PAP

1KH-O11-05

VE

VE

VE

1KH-O11-06

123

1 2 2

1 1 2

3 3

3

45

RSSTMWST 3

40 36

31 63.97.6 BMI

21.3 11.1 29.6

19.0

7 4

RSSTMWST

3

42.2% 13 75.9%

3 98.6%

13 88.9%

20

S67

1KH-O11-07

QOL2

12

1 2

QOL

QOL

2

160

260

1KH-O11-08

1

2

1 1 2

1 2 1

2 1

2009 1 2013 12

259

147 112 65.8

12648.6% 6424.7%

T T3

T4 6223.9%

51.9%

T

1KH-O12-01

12 NST

1 2 2

183S1S304, 2014

S68

NST NST

BMI 22

1518

NST

BMI NST

1KH-O12-02

12

1 2

11

2

11 10

180 cc 568

1

56

2 5 ST 6 11

153

1

1

1KH-O12-03

1

23

12 3 3

2

ASD

ASD

ASD

ASD 3 6 17 50.8

10.9 2 6 24 52.9

17.5

VTR

12

1

ASD

23.9%

55.5%20.6%

43.1%50.3%6.5%

ASD

ASD

20

S69

1KH-O12-04

30 7

1

1KH-O12-05

3

3

3

2003 4 11

3 77

019134224

55

7 5 27

14 7

36 28 9

4

41 12 8

13

7

1KH-O13-01

12

RSST

SRT 30

0.1 ml/

10 5 ml 10

300 ml10

60 RSST SRT

SRT 60

60

SRT

RSST

SRT RSST

183S1S304, 2014

S70

1KH-O13-02

12

1 2 1

1

16 6 1021.1

0.2

20 ml 1

2

1

20 ml

92.67.2

mg/dl 110.421.2 mg/dl

1.610.43 s 1.870.47 s

1.440.46 s

1.440.28 s

1KH-O13-03

1234

1 2 1

3 4 1

1

2009 4 2014 3

ST 15 54

Gr. 19 Gr. 10

4.34ST

14 31

Gr. 19 20Gr. 10 34

Gr. 19

1KH-O13-04

12 3 NPO

13 123

8

8 16

AND

SV10 250 mPas

113.2 mPas13.5208 mPas 198.7 mPas

64.5537 mPas

20

S71

1KH-O13-05

10 20

0%10%

20% 3

5

30

01020% 2

t 20% 0%

20%

20%

1KH-O13-06

1

2

1 1 1

2

324 56

10 ml

5 ml10 ml

5

42.55.3 N

5 ml

19.62.3 N10 ml 38.63.5 N

1KH-O14-01

12

1 2

3 2

183S1S304, 2014

S72

61

2

3

4

5

6

1KH-O14-02

1 JA2 JA

1 2 2

2 1 2

2

53

c2

80%

p0.03

p0.01

1

2

3

1KH-O14-03

A 70

22.5% 11.5%

6

QOL

20

S73

1KH-O14-04

ADL

10

2 3 L

5

10152530

5

1KH-O14-05

2

1

234

NST56

12 13 16

15 15 16

14 13

2005

2011

2012

2011 2012

2011 2012

280

121 159

183S1S304, 2014

S74

1NI-O15-01

2

170 46

VF

2

280

23 VF

squeeze back

1

squeeze back

1NI-O15-02

1

23

1 2 3

3 1 1

MMT

43161.5

1 1 1

1 NIPRO

S12 FR 12 CC

1

31

JMS

3

21.2 kPa 23.9 kPa2.7 kPa

1NI-O15-03

12

1 1 1

2 1

SSc

SSc

SSc

ST

505

SSc

IVH ST

20

S75

ST 4

SSc

ST

QOL

1NI-O15-04

3

60

T3N3M0 StageIII

32

30

36

71

1NI-O15-05

123

13 2 2

A

BA B

32 1434.7

1833.7 A

B10

103

MEB2306

3 2

Ekuseru-Toukei2012 t

A B

p0.05

A B

1NI-O15-06

123

1 2 2

3 1 1

2

183S1S304, 2014

S76

7010

4

3 VF

1NI-O15-07

1234

1 1 2

3 4

31 19

12 72.212.4

2 JMS

80%

5

3 540

DSSESSFunctional Oral Intake Scale

FOIS

18.211.8 23.4

12.9 kPa 27.09.2 29.211.8

kPap0.01

DSSESSFOIS

1NI-O15-08

1

23

1 1 1

1 2 2

3

23 26 4

483

JMP10

2

48 33 15 76.9

69% 1 60

3 56%

183

8.43

5

ALB 3.6 g/dlC1

3

20

S77

1BJ-O16-01

Wallenberg

1

234

1 23 3

1 1 4

Wallenberg

78

32

MPT 9 2/5RSST 0

VF

63

141

152

VF

208

ADL

1BJ-O16-02

Wallenberg 2

123

1 2 2

1 3 1

1 1

ADL

Wallenberg

WS 2

174 WS

246

WS

BI 60

ST

1 57

3251

6022

1BJ-O16-03

Wallenberg 1

183S1S304, 2014

S78

66 24 9

Wallenberg

PEG 12

Gr.2 VF

25 3

Gr. 3

9

VF

11 1Gr. 6

VF 4 VF

1

1

1BJ-O16-04

12

12

8

6534

Mag Venture MagProR30

90%

1261

20 Hz 3 30 20

10

MASAPASLEDTSWALQOLFOIS Wilcoxon

signed-rank test

6

MASAPASLEDTSWALQOL

4

1BJ-O16-05

1

66

Jackson

20

S79

1BJ-O16-06

123

1 1 2

3

24

ST

ST

1BK-O17-01

1

2

1 2 2

2

QOL

FAST

BI BMIALB

MNA

1

QOL

1BK-O17-02

12345

1 1 2

35 45

21

1

23

45

25

183S1S304, 2014

S80

1 61

0 5

4.24.5

345

2

3

1BK-O17-03

2013

1234

1 12 2

3 4

2

LST

2

2013 50s1

LST

3

50s1

50s1

LST

LST 2013

1j

1BK-O17-04

1

234

1 2 3

4 4

75 4089.84.9

20

S81

1BK-O17-05

UDF 2013

12

1 1 2

2 2 2

2 1

2013

UDF

UDF

UDF 14 24 40

1030

6

1

0.50 3

TPA

/ 80%

UDF

6 4.75

UDF

UDF

1BK-O17-06

1

123

1 1 1

3 2 3

4

50 s1

1,8005,600 N/m2 40180 J/m3

0.40.8

1BK-O18-01

12

1 2

COPD

183S1S304, 2014

S82

COPD 2

COPD

COPD

COPD

COPD 2

Fisher test

COPD

p0.01p0.05 14

p0.05COPD

HOT

p0.05p0.05

COPD

HOTCOPD

1BK-O18-02

PT ST

123

1 2 3

2

PTST

ST

VF

701

NG 3

PTST

PTST

4

PT

ST

1BK-O18-03

GagWallenberg

12

1 1 2

gag reflex

gag12 Fr

gag

3

70 Wallen-

bergWS

ST gag

14 Fr gag

12 Fr

2

WS

gag

20

S83

1BK-O18-04

503

1

0

Gr.II-4

Lv.4

GS 3

5 2 Gr.

III-8Lv. 8

GS 4

1BK-O18-05

OE

OE

80

MWST3RSST

Gr. 2MMSE 14

OEVF

MWST4RSST 1

Gr. 8MMSE 23

OE CPG

1BK-O18-06

1234

1 1 1

2 3 4

3

50 VP

ST

5

3

183S1S304, 2014

S84

1BK-O18-07

CT

1

2

I34 Department of Physical Medicine and Rehabilitation,

Johns Hopkins University

1 2 2

2 2 2

3Palmer Jeffrey4

320

CT320-ADCT

2012

6698

MM 1

320-ADCT

10 /

UES MM

MM

p0.05

3

UES6 4UES

5 4MM

MM

UES

UESMM

20

S85

1

1NL-P1-01

2010 1 2013 10

633

2

DSS3

3695 32

31

DSS

1 4 90%DSS 5

60% 3

10735.8

3

1

3

34

1NL-P1-02

A NIHSS

NIHSS

National Institute of Health Stroke Scale

NIHSS

NIHSSmRSmodified Rankin Scale

25 8 1 26 1 31

A

mRS 5 61

39 23 NIHSS mRS

MWSTRSST

72.1311.91

NIHSS6 4871410

153 4.664.94

2.285996.7%

NIHSS

RSSTMWST

p0.05

mRS 5

NIHSS

NIHSS

1NL-P1-03

123

1 1 1

1 2 3

2

4

3

443

183S1S304, 2014

S86

3 2

36.8 19.8

1NL-P1-04

Functional Assessment StagingFAST

12

34

12 1 1

3 3 4

Functional Assessment StagingFAST

A Y O

170

Clinical Dementia RatingFAST

FAST

FAST

1NL-P1-05

2

14

14

4

4

4

3

2

3

3

1NL-P1-06

1

23

1 2 1

3 3

2

20

S87

2012 2 2013 12

1042

I.

2

II.

35 14

147

4

FIM

1

1NL-P1-07

Clinical Dementia RatingCDR

1

23

1 2 2

2 3 3

1 1

A Y K Y

250Barthel Index

Clinical Dementia RatingCDRMini-

Nutrition Assessment Short FormMNA-SF

CDR

1NL-P1-08

123

1 1 1

1 2 3

1

PTOTST

ST

ST

22.9%

37.1%

13

183S1S304, 2014

S88

1NL-P1-09

1

23 II

4

1 2 4

4 1 1

1 3

2013 6 2014 31,200

kcal/ 49

TEETEEFIMFIM-

M

74.5% 1,200 kcal

TEETEE FIM-M

ADL FIM-M 39TEE

FIM-M 40 TEE 1,200

kcal

ADL

1,200 kcal/

TEEADL

TEE

TEE

TEE

ADL

TEE

1NL-P1-10

1

2345

12 2 3

4 15

A Gr.

48

311912

1

2

Gr.

p0.05

58%

79%

Gr.

20

S89

1NL-P1-11

123456

1 2 1

1 3 4

5 6

20092013420

72.813.0 260 160

1

Gr.122

363 7

JCSBarthel Index

RSST/MWST/FTAlbTP

TLCBMI Kruskal-Wallis

AB

C

1 932 1363 191

RSSTMWSTFT

AlbBMI 3p0.05

A 41B 193C 186

JCS BI

BIAlb

AlbBMI

1NL-P1-12

12345

1 2 3

3 4 1

1 5

53

RSST 2 / 30 30

30

3

VE

L3 3

3

183S1S304, 2014

S90

1NL-P2-01

ST

12

1 2 2

ST

72 JCS

23ADL

2H24 7

VE

VE

ST

VE

QOL

ST

1NL-P2-02

ADL

70

TPN2

PEG VE/VF

4

3 VE 13

PEG38VF

30

128

ST

41

VF

46

371 VF

74

ADL

1NL-P2-03

123

1 2 1

3

PAP

PAP

58

8

RSST1 /30MWSTPr. 3

VF

PAP VF

PAP

20

S91

PAP

1NL-P2-04

12345

1 2 3

4 5

2

ATLAS.ti

5 6

1,527

919

272/919265/919135/919

247/919575/919

251/919

14 30%

16 14

50%

1NL-P2-05

ST

RSSTMWST

ST

2013 10

20143

1.3 1.4

233 578 2.5

1NL-P2-06

1JA23

1 2 3

183S1S304, 2014

S92

1

80

1NL-P2-07

OTCVA

OT

50A

OT

A

A

OT

1NL-P2-08

VF 1

12

345

1 3 3

5 2 14

2

49

25 2 22

ADL

VF

Upper Esophageal Sphincter UES

45

UES

VE

8

VF

UES

1

VF UES

VF

20

S93

1NL-P2-09

HCU

CN ST

CNST

3

CNST

CN ST

20

1NL-P2-10

807

JCS III100

JCS I

27

36

1NL-P2-11

12

1 2

I V 5

V

7

183S1S304, 2014

S94

1NL-P3-01

22 12

MWSTRSST

1

40% 40%

10%

20% RSST

40% 70% 2MWST

7%

1NL-P3-02

1

123456

16 2 36

46 56 6

2

66T3N0M0

12

9 RSST

0MWST

15 VFVE

1

61

77

106

240312

1NL-P3-03

2013 8 2014 26

19 10

84.2% 100%

43.8%DVD 68.8%

40.0%

26.7% 40.0%

20

S95

20.9% 30.2%

18.6% 14.0%

DVD

1NL-P3-04

10 10

10

SSA-250A 7.5 MHz

10 g

M

5

M B

Tukey

5%

1NL-P3-05

12

1 1 2

2011 4 2012 3

15

10 5 54.33180

8

5

3

22.7

10 2

1NL-P3-06

1JA2JA

1 1 1

2 2 2

1

3

62ADLX1

183S1S304, 2014

S96

3ST

ST

Gr. 2

VF

4

6

7 VF 3 cc

8 45

113

Gr. 712

ST

3

1NL-P3-07

QOL

12

3

4

12 2 23

3 4 2

PAP

QOL

81

2

PAP

VF

2

EORTC-

C30 QOL

PAP

2004PAP

QOL

1NL-P3-08

1

123

1 2 3

1

58C

7

117 ST

VFVE

5

20

S97

1NL-P3-09

B

123

1 1 1

1 1 1

1 23

BDLBCL

52.8%

DLBCL 3.6%

DLBCL

61

20114

DLBCL

2011 8 2012 4

8

18 Gy/10 Fr

4 cm

QOL

1NL-P3-10

70200X Y

2

ST

18 VF

34VF

117 VF

1NL-P3-11

1

2

3

1 2 1

1 2 3

2 1

VF

19 25

8 6 2

3 cc

VF

VF

183S1S304, 2014

S98

3

1NL-P3-12

QOL

12

1 1 1

1 1 2

CCRT

CCRT

CCRT

2011 1 2013 3

CCRT 29

CCRT 20 Gy

RT

RT 10

1NL-P3-13

12

12 1 1

1

VF VE

MWSTMWST

MWST

2008 4 2014 3

MWST

VF VE

22 24 6 66.2

MWST

22 MWST 35

1MWST

MWST 3

1647%

MWST 0.87

0.84

MWST

1NL-P4-01

1

2

1 2 1

1 2

PD

20

S99

VF

2011 6 2014 7

PD 66 38 28

72Hoehn & Yahr 3

VF

VF Fisher

VF 13 19.7% 33

50.0%

30%98%p0.01 77%89%p0.01

46%85%p0.05

77%80%p0.01

18%100%p0.05

39%91%p0.01 33%91%

p0.05 55%85%p0.01

PD

PD

1NL-P4-02

1234

1 1 1

4 3 2

1 1

50X 1

10

X1 5

6 VF

VE

7

2 VF

8

1NL-P4-03

ADL

ST

73GPC

2

2

16 21 ST

3

Wearing-off

31

4

50

1 2

NG

3

Wearing-off

ST

183S1S304, 2014

S100

1NL-P4-04

3

12

1 2 1

40

HOT

BiPAP

12

BiPAP

21 ST

RSST1 / 30MWST 2

96

3

1NL-P4-05

5 VF 16

9 7 6 10

66

2

BMIALBCKVF

peak flow PF

A12B

4 A 64.63B 70 A

5 7B 4

0 A 25%B 50% A

17%B 25% BMI A 22.5B 19.6ALB

A 3.4B 2.8CK A 4,065B 2,727

A 75%B 0% VF A 75%

B 0%PC A 253.6 l/minB 165 l/min VF

1NL-P4-06

1234567

1 2 3

4 5 6

7

PD

PD

QOL

H&Y 24PD2012

8 62.57.4MNSQMFI

SDQ

NMSQ PDQ-8

PD

20

S101

PD

PD

PD

1NL-P4-07

123

12 23 1

ADL

50

74.95.9 24 26Hoehn-Yahr

I2II2III15IV14V17

GNRI

GNRI FIM

Hoehn-Yahr

H-YH-Y

GNRI mFIM

p0.05

2856%GNRI FIM

r0.66GNRI H-Y

r0.76

H-Y GNRI

mFIM r

0.44

ADL

1NL-P4-08

123

1 1 3

2 3

89

60

PD

MSAPPD

MSAP44871

Yahr 34PD66182 4

2Yahr 24 VF

SDQ-J

VF 3

MSAP VF

PD 1

MSA-P

PD

VF SDQ-J

SDQ-J

1NL-P4-09

BMI

PD

PD

BMI

183S1S304, 2014

S102

18 PD

27 14 13 76.8

80.7

92 BMI an15

bn12

Gr.

7.8 8.4 BMI

a 21.1 20.1b

18.5 19.5a

1,633 kcal/b 1,550 kcal/ a

Alba 3.8 g/dlb

3.5 g/dl 3.6 g/dl a

Gr.a 8.5 8.9b

6.9 7.8 a FIM

a 20.2b 16.0 a

PD

PD

1NL-P4-10

3 1

3

60B

10/3 GIST

10/30ST

DH

5

11/28

15 1

OT

1NL-P4-11

12

1 2 2

2 2

24 8 25 5

37 24 13

The Frenchay Dysarthria Assessment testFDA

6.7

20

S103

1NL-P4-12

123

1 1 2

2 3 2

3 1

2012

12009 4 2011 3

75 2 2012 4

2014 3 97 2

3

2

3

12

1NM-P5-01

123

1 1 1

1 1 1

2 3

2012 1

2012 1 10 46

76.99.620131

7 23 79.916.4

48.1%

4

7

p0.033

1NM-P5-02

12

1 2 1

1 1 1

1 1

183S1S304, 2014

S104

SCTSCT

SCT

MWSTFT

43

16 27 8013

SCT 30

MWSTFT4

3

SCT

MWST FT

SCT 0.86

0.64 MWST

0.58 0.92FT 0.37

0.963

0.84

0.54

3

1NM-P5-03

1

VE

70

12

ST

VE

37

54

VE 3

Logemann

VE

1NM-P5-04

123

1 2 3

1 1 2

2 3

3

RH ST

2012 1 12 1

DPC

93

80.7 63 30

51.493RH

55 ST 38

ST 80.9 28

10 51.3ST

17

20

S105

1NM-P5-05

12

1 2 1

MCT

MCT

MCT

MCT

MCT

13

4 928.94.7

ST

12.5 ml

CT

13 CT 6.83.3

3 13.6ST 16.56.2

8 25.1CT ST

RS

0.553 MCT

1NM-P5-06

j7

510

1

5 3

1NM-P5-07

30

1

2

1 2 1

1

30

2013 11 16 2014 4 16

6 30

2 6

30

4/6

3/6

183S1S304, 2014

S106

1NM-P5-08

ST

2013

PT

ST

ST

3.4%

2013 1 ST 377

13

13 5/3111.6%

8/6612%

JCS 10

80ALB2.9 g/dl

1 4

ST

1NM-P5-09

VF 9

12

1 2 1

24 4 26 3 2

VF 87

9

VF 9

5

3 2 3

1

2 3

2 2

73.4 241.7

VF

1NM-P5-10

12

1 1 2

26

22 12 25 12

3 6 3

325

75.714.3

3

Wilcoxon p0.0001

a0.05

6

20

S107

1NM-P5-11

SSPT

12

1 2 2

1

SSPT

A 3 Fr 4 Fr

SSPT

1234

56

124 4 Fr

356

4 Fr

SSPT

1NM-P6-01

2

12

1 1 2

4 4

10% 10% 20%

1NM-P6-02

1234

1 2 2

2 3 4

ST

183S1S304, 2014

S108

25 7 ST

8

1 810

10

ST

ST

ST

1NM-P6-03

123

1 1 1

2 3

80

38

5

4

2 /

ADL

1 6

MWST

G-UP155

7VF

G-UP 15

14VF

28

1NM-P6-04

0

123

1 1 1

2 3

MWST

0

68

4

3

ADL

1

742 30

0 MWST 4

0 15

60 MWST

495

20

S109

0

1NM-P6-05

123

1 1 1

2 3

MWST

G-UP

60

38

ADL

1

5MWST

0 3

4

30 20

19

15G-UP

28

G-UP

1NM-P6-06

12

12 1 1

12 1 1

1 2

2010 11 2011 5

47 35 12

79

DSS

4DMFDecayed Missed Filled

25 4

13DSS1422573

DMF 24 1.1

22 3

2DSS14115711DMF

24 3.5

DSS

1NM-P6-07

183S1S304, 2014

S110

70

80

1NM-P6-08

2013

12

1 1 2

2004

4

20102013

2013 9 19

2013 2013 2013

2013 0t

1j

2010

2013 9 232014 2

0 jt 1j234 5

3

2013

1NM-P6-09

1.90

SpO2 932%

VEVE

SpO2 952%

2.90

VE

VE

VE

VE

20

S111

1NM-P6-10

2

12

1 2 1

1 1 1

400

20122

2012 3 1

2013 4 2

2013 11

2 5

1

6 2

5

20136

1NM-P6-11

12

12 12 12

1 2 12

1

17

19 4

19 4 25 3

6

19 4 1 25 3 31

653

Eichner

DSS

653 69.413.6

30.9%

63.7%

60.9%

82.8%

13.6%

2.6%

69.1%

49.9% 11.6%

Eichner B3B4C1-3 55.6%

18.8%

DSSDSS 1461.7%

57.0%

DSS14

183S1S304, 2014

S112

1NM-P7-01

12

3

1 2 1

1 1 1

3

25 7 30 11 13

65 112 33 79 79

RSST

14.3% 23.1%

15.4% RSST 2

16.1%

1NM-P7-02

1

12

1 1 1

1 1 1

12 1

2010 6 2014 2

216

82.4

96 44.4% 84

38.9%

Eichner indexEIClass ABC

EI ClassClass A

19 8.8%Class B28 13.0%Class C169

78.2% Class C

Class BC197

15578.7%

155 140

90.3%44

28.4%

20

S113

1NM-P7-03

2

12

12 1 1

1 1 1

1 1

2010 6 2014 2

216

82.4

96 44.4% 84

38.9%

Eichner indexEI

modified EIMEI Class

ABC Functional Oral

Intake ScaleFOISLevel 17

EIClassFOISA4.5

2.219B4.32.228C4.61.8169

EI FOIS

p0.925MEI Class FOIS

A4.71.8173B3.61.615

C3.81.828 FOIS

p0.005

1NM-P7-04

0

12

1 1 1

1 2

VF

0

0

170 5

FILSLv. 745

VF020

270PD 5FILSLv.

8VF0

30

12VF0

20300

30

VF 0

VF0

1NM-P7-05

MMASA

1

234

56

1 1 2

3 4 4

5 6

The Modified Mann Assessment of Swallowing

AbilityMMASA

MMASA

VE

MMASA MASAVE

183S1S304, 2014

S114

MMASA

94MMASA

MASA

VE

50VE MMASA MASA

ROC

MMASA 94

0.79 0.27 1.08MASA

178 0.90 0.27 1.23

MMASA 70

0.54 0.91 6.00AUC

MASA

MMASA

1NM-P7-06

2012 2014 18

13 68.8

AlbBMI

16

PA Scale

Stasis

Score

AlbBMI

6

PA Scale

Stasis Score 4

PA Scale

Stasis Score

1NM-P7-07

123

12 3 3

VF

2

VF

HD

L0L0L3L3

L0 TesCup 1.5 w/w%L3

R&E 2.9 w/w%

121 20

20 mm

5 mm 1 mm/s 2

L0HD 2,518 N/m2

0.45 58 J/m3

2,336 N/m2 0.40 62 J/m3L3

HD 416 N/m2 0.83

65 J/m3 458 N/m2

0.82 76 J/m3

L0L3L0

HDL3

1NM-P7-08

440

22VF

20

S115

22 2 25 3VF

133 72 / 61

73.41897

82PD 16PSP 5SCD 9ALS 12

SBMA 4 13 12

11 41 32 3

3 4 6CP 6 2

29

21.8%43

22 15

2015% 1310%

86% 54%

5944% 3123% 1612%

1612% 97% 21%

VF

1NM-P7-09

12

1 1 2

2008 4

2008 4 2013 3 6

250

100%

2008 9.8%2009 14%

20108.7%

2011 2013 16.2%21.1%

26.8%

75%15%

5%4%

6.5

6.2p0.01

1NM-P7-10

12

1 1 1

2

CT

CT VE

166 95 71 82.59.5

CT 1 54

0

1

2 3

Receiver Operating CharacteristicROC

CT2030

ROC 20301

0.6310.6930.692

123

302

0.7059 0.6719

CT 30 2

183S1S304, 2014

S116

1NM-P7-11

1

23

1 2 1

3 3 1

123

N

5

3 76.81.9

1NM-P8-01

VE

12

1 2 2

2

VE

VE

VE

28 83.57.5

RSST

VE

42.9% 25.0%

7.1% RSST 2

85.7% 7.1%

7.1%VE 82.1%

39.3% 7.1%VE

42.9%

32.1% 10.7%

32.1%

42.9% 10.7%

VE

VE

1NM-P8-02

12TMDU

3

12 23 23

1

1

6347 62

VE

9130

CT LDA

VE

CT

2

20

S117

1NM-P8-03

1

12

1 1 1

1 1 2

50

27 VF

39

41VF

51

62

69

VF

83

92

95

100 VF

106

1NM-P8-04

12

1 2 1

2 2 1

218 70 76

3838 491470

743737 78570

68 3533 816

3

9.7 kg

5.9 kg7.0 kg4.4 kg

4.5 kg 3.7 kg

3ANOVAp0.05

1NM-P8-05

183S1S304, 2014

S118

25 2 26 3

7

EC 10-012

1154

3

1

1NM-P8-06

10

VE

VE

VE

VE 9 44% 36%

04 3

1

582

1 8

1 5

912 3

70

VE

58

1NM-P8-07

MWST

VE

VE

VF

VE

MWST

VE

62

MWSTVE

3

1.

2. 3.

MWST

VE

MWST 55 88.7%

VE MWST

1NM-P8-08

NESSiE

20

S119

NESSiE

5 5

4 3 cc

NESSiE

NESSiEFG

CCD

FGCCD

1NM-P8-09

12

1 2 2

2

VF

24 6 26 4

VF 139

81.19.58563

VF

LES

3

3

VF

10.1%

73.4%LES 3.2%

VF

70%

1NM-P8-10

TMDU

3

1/5

3

2011 4 2012 3

videoendoscopic examination of swallowing:

VE 16 91

2014 3

46 18 28 4

VE

46 919.6%

VE

46 1839.1%

8

44.1%

VE

183S1S304, 2014

S120

1NM-P8-11

1 I

23

1 1 3

2 1 1

1 1

Dysphagia Severity ScaleDSSVF

DSSVF

DSS

DSS

VF 72

VF

4

normalmildmoderatesevere

4DSS

66.6DSS

DSS 23DSS 315DSS 429DSS 58

DSS 617 1

10 23 9 27

2DSS 3

DSS 4

DSS 3DSS 4

1NN-P9-01

1

1NN-P9-02

PT ST

PT 2ST 1

PT

PT ST

ST RSSTMWSTfoodtest

2518

1 ST

7

PT

20

S121

ST

ST

1NN-P9-03

ST

20114

ST

2

ST

185

291

ST

1NN-P9-04

20

NST

1

FAX

1

1NN-P9-05

1234

14 14 14

24 34 14

2013

4

183S1S304, 2014

S122

76

3 ST

18

33 VE

1j 21

40B

B 21

B 4

4

58

1NN-P9-06

1234567

1 2 3

4 4 5

6 7

6

1. 3782.

883.

34

5

/ /

/ / 76%

100% /72%100%

/

46%75% /

100%

1NN-P9-07

ST

4

60

20

S123

1NN-P9-08

1234

14 14 14

24 34 14

2013

2013

0 jt1j2

3 4

4

1 cm

1 cm

6

35 18

17

HP

1NN-P9-09

ST

ST

5

PC

ST

ST

1NN-P9-10

12345

12 2 3

4 4 5

1 2

20

3

1

21

20t 1 3 92 21 22

183S1S304, 2014

S124

2 1 3 8

1H2511

2 H26 4

12

1NN-P9-11

12

345

1 2 3

45

6

1 5

9

1NN-P9-12

12

1 2 1

QOL

1NN-P9-13

1234

1 2 3

4

18

20

S125

22 25 4

1

? 2

3

4

16910762

59%

1 2

3 4

1NN-P10-01

1NN-P10-02

12345678

1 2 3

4 5 6

7 8

2008

2012

2

183S1S304, 2014

S126

1NN-P10-03

1

2345678

1 2 3

4 5 6

7 8

2009

6332013

59 55

93.2% 2529 27%

2012

1NN-P10-04

NST

12

1 1 1

1 2 2

2 2

2009 NST

2013 4

1NST

2

3

12013 20 15

2

3

1 3

113

1

2

3

1NN-P10-05

12

1 1 2

20

S127

25 4 26 4

642498

1NN-P10-06

123

45678

1 2 3

4 5 6

7 8

60

& Ns & ST &

1NN-P10-07

A

1. A

2

80

2. A

A

ST

183S1S304, 2014

S128

1NN-P10-08

12 NPO34567

1 2 3

4 5 5

6 7

NPO

25

45 1

1

3040

162 151

93%

54%

9%8%

98.7%96%

91%

1NN-P10-09

2013

12345678

1 2 3

4 5 6

7 18

2013

2013

2 4

2013

2013

UDF

2

20

S129

1NN-P10-10

25

19 64

48

1NN-P10-11

12

12

130

ST

72

STST

40

45

1/467

93

3120

1NN-P10-12

VE

123

1 2 3

1 1 1

1

A 27% 11

2011

1

314

40

QOL

183S1S304, 2014

S130

1NN-P10-13

2

1

2345

1 23 4

5

2013

1NN-P11-01

12

1 12

Home care

team meeting 3

2

1NN-P11-02

12345

15 25 35

45 15 15

23 10

20

S131

2

23 10

25

2

24 4

25 8

1NN-P11-03

1234

5

1 2 3

4 5

5 2011

11

2013 34

2013

FAX

26 3

ST

1NN-P11-04

2

12 JA34 JA567

1 2 2

3 4 5

6 7

2011

45 2013 10

51.0%

78.3%

30.4%1

60.9%

78.3%

183S1S304, 2014

S132

91.3%

1NN-P11-05

12

1 1

200 ml

15 g

1 10 ml

1 50%

25

92

1

1NN-P11-06

2013

1

2

34

123 4

20132013

2013

20142

2013

78 52 110

66.7% 2013 42%

58%

33% 12% 18%

94% 2013

97%

2013

94%

2013

20

S133

1NN-P11-07

1234

12 13 13

14

I

25

I

I

1NN-P11-08

10,27365

4,006 39%

NST

1NN-P11-09

2013

12

12 12 1

1

20132013

2013

2

10jt4

QOL

183S1S304, 2014

S134

1NN-P11-10

123

1 2 3

1 1 1

1

A 27% 11

2011

2012 2 1

2 2013 2

1 2

100

1NN-P11-11

2013 1

2

QOLADL

1NN-P11-12

1

ADL

20

S135

87X 11

X 12

447.5 kg

B2 3B

/X1 1

21.8 kg

5 /

2,000 cc7 49 kg

X2 6

8 /10

/1

QOLADL

1NN-P11-13

SNS

12WOC3456Harvard School of Public Health

12 2 3

56 45 15

face to

face

facebook

ADLQOL

H26.5.1 10 13

5 8 4

2 2 2

1 1 4

SNS

SNS

1NN-P12-01

12

1 1 1

1 1 1

2

11

16

17

18 22

8

183S1S304, 2014

S136

1NN-P12-02

12

1 1 1

2 1 1

2A 4

B

2013

PT

OTSTA1

452

203PTOT

554ST

55B1

702

ST80

4

B

A 46B 24 A

5182%B2235

26%A

B

1NN-P12-03

ST

19ST

21

NST

137

21

10

ST

ST

ST

ST

1NN-P12-04

23 25 3

161

3

1. 2. 3.

4.

5.

161

70 35

18 14 1

1 1 83%

11%6%

86%

5% 33%2 62%

3 19%4 6 1%

7 80%

20

S137

74%

11%

RST

1NN-P12-05

12345

1 2 3

3 4 5

5

QOL

1.

2.

3.

1.

2.

3.

1NN-P12-06

1. 2.

3. 16

4.

5.

1

90%

55%

86%

6

96%

85%

95%

100%

1NN-P12-07

QC

12

1 2 2

24 TQMTotal

Quality Management

QC

QC

183S1S304, 2014

S138

QC

24

249

10

DPC

9

QC

QC

QC

0

1NN-P12-08

1 PL2 PL3 PL4 PL

1 1 1

14 24 34

2005

2012

2012 6 278

96.7% 76.6%

MWSTFT 48%

20142

291

96.2%MWST

FT 74.1%

90.3%

21%56

1.8%5

1NN-P12-09

1234

1 2 2

3 1 4

45

79 24 5

9

25 1

1 3 RSST2

MWSTFT5

1 1 4VF

1 2 1 2

1 3

120

VF

ST

20

S139

1NN-P12-10

1

27

4

1NN-P12-11

123

4

1 2 3

3 1 1

1 4

2013

1

2013 1 2014 3

2013 4

13 4412

3

414

193

4 5.02.6

4 14.83.9

13274.2%

92 51.7% 44

24.7%

1NN-P12-12

1

1

234

1 2 2

34

ST

1

ST

1

125 31

94

38 20

183S1S304, 2014

S140

ST 63

5 53 2

5

2 0

ST

1

1NN-P13-01

ST

123

12 12 2

3

ST

504

ST

ST

25 1 12

334 1 14

41%

65%

1

2.5

ST

QOL

1NN-P13-02

12

1 2

521

2012 9

10

NST

VF

2012 10 2014 3

157 81.7 100

2676

185040

9 8 8 8

7COPD 6 6 15

VE

1NN-P13-03

12 LSM

1 2 2

2

2012 5

2012 7

20

S141

2

ADL

102

1

51%

28% 20% 48% 48%

4% 13% 13%

74%

6

ADL

1

1NN-P13-04

2VF

170

29

VF L2 3

VF L4

260

1017

VF L3

24 VF

L3

VF

1NN-P13-05

1

23

4

1 1 2

2 3 4

4

24 1 VE

STCNCN

1DrST CN

1ST

CN 1

CN

VE

VE

NSTCNNST

VE

NST

183S1S304, 2014

S142

1NN-P13-06

12

12 1 1

12 1 1

1 1

555

2DR2DH

2ST13

9 12DH

20134

1

2 ST

3ST

430 DH

155

2013 10 206

129 90 29 71

1 7.7

1 20

1NN-P13-07

1234

1 2 2

3 3 4

4 4

166 21

25 12 26 4

134

9 78.5

RSSTMWSTFTFOIS

BMI

BMI

1NN-P13-08

24 10

26 10

87

95.4%83

5

20

S143

1NN-P13-09

1

234567

1 2 2

4 5 3

6 7

23

23 9 25 2

10% 81 87.26.6

47%

88

3

1NN-P13-10

12

1 2 1

A

B

2324 2 125

1 1 5

24

A

23 23%24 23%25

26%24

16 1925 22 70

246

10 525

12 12 3

1NN-P13-11

2009

25 8 26 3

183S1S304, 2014

S144

73 52.1% 47.9%

76.9 31.5%

20.5% 11.0% 14

38.4%

26.0% 17.8%

1NN-P13-12

NRT

NRT

2

NRT

NRT

1NN-P13-13

461

2014 4 6

8 2

365VFVE

2013 4 2014 3

150

806 56 5,559

92

1NN-P14-01

ADL 1

12345

1 1 2

3 4 5

477 3

25 3

20

S145

6

ADL QOL

1NN-P14-02

ADL

12

12

ADL

73

2010 11

20129

11

2013 6

12

6

1NN-P14-03

!

1234

1 2 2

2 3 4

7524

6

29 VF

210

51

8

68

183S1S304, 2014

S146

1NN-P14-04

1234

1 1 2

3 3 3

4

2013

PT

95

5

PT

19

26

52

59

PT

1NN-P14-05

1

2

1 1 2

ST 1

A 80

FIM7/35

A

ST

ST

ST

1

A

1NN-P14-06

123

1 1 2

3

90

20

S147

ADL 153 cm

41 kgBMI 17.5

1

1 2

810

22

1NN-P14-07

2

12

1 2

2

IOC

QOL 2

2

21 6

IOC

IOC

IOC QOL

1NN-P14-08

1

123

1 2 1

3

1

802010 6

ADL10

A

9

4A

3

QOL

183S1S304, 2014

S148

1NN-P14-09

80

ST

ST

45 0t

1 3

40t4

1NN-P14-10

70

1A

B

2

3 CABG

4

1

4

VF

1

3

1NN-P15-01

24 2

24 4

1

149 146

260

2.88 2.56 2.60

5.14 4.63 4.52 26 3

1122.4%1532.6%

1935.4%3

6

2

2

20

S149

1NN-P15-02

2

12

1 1 2

4

1

4

2

1NN-P15-03

26

35%1

2.3%81.3%

24 4 26 3

1,826

309

298 11

171 14

66 15 32

38%

67%79%

39% 21%

27%

35%

1NN-P15-04

6073 7

66.65.6 7,000 350 /

3

3000

PVM-2703

CE

7

5

p0.05

183S1S304, 2014

S150

1NN-P15-05

12345 II

1 2 2

3 4 2

5

80 48.1 kgBMI 19.1

BMR 1,240 kcal 21.7 kg 11 ST

52

530 kcal500 m

62

48.4 kg 1,200 kcalBMR 1,228 kcal

21.2 kg 100 m

1NN-P15-06

OAG

ST

ST

OAG

254

6 Ns

18 69

10

OAG

112

89.2%72%

11% 11

OAGNs

5

OAG

1NN-P15-07

123

1 1 2

3

2

VF

2

1

20

S151

111 3

18 10

20 50

VF 30

63%

9

10%

1NN-P15-08

7 600

12

1 2

80.1

7

600

19 25

6031

2.6

473

48

58

QOL

1NN-P15-09

80 2

1

55

2

2

37

ADL

183S1S304, 2014

S152

1NN-P15-10

Oral Assessment GuideOAG

12

1 2

OAG

A B C

20 12 21 2 2C

20

2072.305.85

11 9

OAGOral Assessment GuideEILERS

8

1 2 3

IBM SPSS Statistics22OAG

Cronbach a

OAG 9.451.39

OAG 8 OAG

9Cronbacha0.784 a0.6

OAG

2009

1NN-P15-11

CPA

23 3

5

18

2011 4 2013 3 CPA

2011CPA 275201225

4 50 90

9 3 5

1 3

9 4 3

8 COPD

CPA2

1NN-P15-12

123

1 2 3

3

A70X

X1 4

HDS-R 3

MWST 4FT 4RSSTVF

X2

20

S153

X 4

1NN-P16-01

12345

1 23 4

5 5 3

RSST

24 40

RSST

4,998RSST 3

RSST

RSST 5.4%

28 2027

101959 RSST

4

04OR3.260OR4.8

RSSTp0.05

28

RSST

1NN-P16-02

VE 30

1

23

1 2 1

1 3 3

30

VE

VE

VE 30

2013 11 2014 3

VE83

5 87.112.5

301.5%

1 ccVE

2 cc

2Wilcoxon

30 0 cc 4

3 cc 37 cc 1 5 cc 47 cc

4 p

0.017

30

VE

183S1S304, 2014

S154

1NN-P16-03

12

1 2 2

2 2 1

2 1

7 5 g

3 ml

White out

1 mm

1NN-P16-04

1

234

1 1 2

1 1 3

4 1

10678.46.8 78.1

7.5 78.76.1

Consensus Report of the Asian Working Group for

Sarcopenia

1NN-P16-05

12

1 2 1

20

S155

MMSE

28 69100

82.0MMSE 24 823 20

2

30 cc

1

2

MMSE 23 24

1NN-P16-06

1234

1 2 3

4

9 10

746.0

2

2

16.776.3

10.43.47

p0.006 78.184.3

66.688.55

p0.001

2

1NN-P16-07

123

1 2 3

1

VF

5 g

1. 2. 3D

3. 3D

4.

5.

3D

183S1S304, 2014

S156

1NN-P16-08

12

1 12 12

12

20

1.2.

3.

4. 4

5

12.2

22.4 32.1 42.0

5

1NN-P16-09

12

1 1 1

2

65

3 8

RSST 3 13 77.38.3

7644

1111

1

RSST

3 ES-525

6

mA 5 RSST

RSSTRSST 31

62 34 1

5

3

1NN-P16-10

12

12 12 12

12 12 12

1

No.

01150

1076.4 30

27.8

4

Processing

PFATVATHTT

Process-

ing PFATVAT

HTT

PFATVAT

20

S157

1NO-P17-01

1

2

34

1 1 2

2 3 4

2006

2013

NST

1NO-P17-02

CONUT

Alb

Alb

CONUT

Gr. 7

2013 3 12

7 AlbTLCT-Cho

103 48 55

79.911.2 52 33

18c

c 2 48

3470.8% 55 2749.1%2

p0.025

CONUT

1.44p0.006

CONUT

CONUT

1NO-P17-03

183S1S304, 2014

S158

1

2

3 3

1

23

3

23

1NO-P17-04

H25

up

1NO-P17-05

1

1 LEOC23

1 1 1

2 3 3

3 3

18

1.

2.

3.

1. 2.

3.

20

S159

1NO-P17-06

2

1 LEOC23

1 1 1

2 3 3

3 3

1. 18

2.

3.

18

1NO-P17-07

1234

1 1 1

2 3 4

QOL

Ns

83

Ns

1

Ns

4

12

Ns

1NO-P17-08

III4

183S1S304, 2014

S160

2013

7

3

LST

LST

1

5

LST

LST

2013

1NO-P17-09

12

1 1 2

2

A

B

C

9820

10 40 mm 15 mm

20 45 2

1

tp0.05

20 A

2,8311,596B4,9564,125C4,2012,093 N/m2

A0.60.1B0.50.1C0.50.1

A2,0871,252B1,847927C1,345429 J/m3

A BCA

45

1NO-P17-10

1

2

3

1 2 3

ST

ST

10

2011 5 5 2014 4 30

ST

2011 2014

1.4

2

20

S161

1NO-P17-11

12

3

1 1 2

3 1

10

20 250 ml

2.5 g 90

3

3

107

90

0.333.0 Hz

0.53

1NO-P18-01

1NO-P18-02

123

1 2 2

3

60

2

2012 4 2014 3

43

7 5

VF

183S1S304, 2014

S162

1NO-P18-03

12

1 2 1

S

1

S

5

S

5

1NO-P18-04

2

1

234

1 124 13

1 24 4

4 1

17 6 11

84.8

4

1NO-P18-05

12

1 2

20

S163

BMI

2

25 10 26 2 4

15 0 15

2BMICONUT2

BMI13

CONUT 2

3 10

132

BMI 14101

CONUT8412

1NO-P18-06

2013

1234

1 3 1

4 2 1

2013

10

100

2013SPSS.19.0J

1j 34 1j

4 0j2

1

0j 11j 21 1 2

3

1NO-P18-07

1234

1 123 23

4 4

4

57

25 10 25 11

1

1

51

88.27.0

p0.05

p0.01p0.05

183S1S304, 2014

S164

1NO-P18-08

90

1NO-P18-09

1

12

1 1 1

2

13

B

No.312 rpm

11.62 kcal/ml 3 28

3%30

530

10

3,0007,000 mPas

2 kcal/ml

1NO-P18-10

123

1 1 2

3

10

20

S165

1 2

3

3

1NO-P18-11

12

1 1 2

2

5

NST

NST

1NO-P19-01

ST

12 NST3JA4JA

1 1 2

2 2 2

3 4

ST

ST2012 4 2014 3

VEVF 20

FIM

9 0 73.2

9 2 68.5

HbTPAlb

BMI16.718.6

FIM32.254.5

2

7

BMIFIM

ADL

1NO-P19-02

A 24

183S1S304, 2014

S166

104

91.3%95

46.3%17.2%

97.1%

73.2%355.0%

90.1%

84.2%

1NO-P19-03

1

12345

12 12 13

14 15

26

26 34 254

123

4

56

100126742

20 6630 2940 53 53

50 35 54

50 38 126 69 24

7

7

5

QOL

1NO-P19-04

A 58

50%

66%

67% 66%

60% 44% 33%

26%

66% 67%

20

S167

1NO-P19-05

5

5

21 4 26 3

18

24

321%

79%

54%

50% 39

041%

72%

85%

41%

73%

1NO-P19-06

22 5 25 10

48142

26

2 BMI

FIMALBCRP13

ALBCRP2

Mann-Whitney U

20 6 23%

2

BMIFIM

FIM0.57BMI0.46CRP

0.420.28

1NO-P19-07

5

3

1

20131

330 26867.5

14.9

124

26 26 23 18

15 8 7 21

ST 17.121.7

25.126.8 Gr.

13 110 45Gr. 46 46

27Gr. 710 112 196 102

Gr. 493

Gr. 3 3

56 Gr. 13

JCS Gr. MWST

Gr.

Gr.

183S1S304, 2014

S168

ST

1NO-P19-08

5

2425

5VEVE

VE

VE

152

VE5

VE

5

99%

5

97%

100%

97%

VE

1NO-P20-01

OCM

3 10

326OCM

OCM

46%SOAPIE

66%

48.6%

27.0%

37%

OCM

OCM

OCM

OCM

1NO-P20-02

1234

1 1 1

1 2 3

3 4

2 3

13

1 3 15

3815 5

2

20

S169

5

QOL

1NO-P20-03

2

2

170

260

133

1

2

2

1NO-P20-04

1

12

1 1 1

1 2 1

25 7 26 3

215

33.56.8

14 7

3 123 5 25

106101

1NO-P20-05

12

1 1 1

2 1 1

183S1S304, 2014

S170

22 4 26 4 4

126

3225.4% 26

20.6% 2318.3%

1NO-P20-06

12345

12 3 4

4 5 12

23

73.08.4 17 78.07.1

1 34

4DNA

Real Time PCR

1NO-P20-07

12

1 2

1

603

1 1

4 5

GCS

7

4

20

S171

1NO-P20-08

1 /

2 /

3 /

1 2 2

2 3

30 21.4

1/3 10

10 10 10

39.37.3 kPa

41.88.8 kPap0.05

25.82.3

28.11.7p0.01

1NO-P20-09

NST

25 10 29 3

6 6

NST 30

1. 2.

3.

4. 5.

1.

2. 3.

4 67%

2

1NO-P20-10

1234

1 2 3

4

B

183S1S304, 2014

S172

12

3 4

3

CRP

1

2

3

1NO-P20-11

OAG

1 2

3

1 2 3

ADL

Eilers Oral

Assessment GuideOAG

1 OAG

OAG

13 /151

1 /

1 /

OAG

1NO-P20-12

123

1 2 2

3

9

20

S173

2

2KD-O19-01

PCAPS

1

23

1 2 3

1

PCAPS

3

CPC

7

PCAPS

22

1568% 3

4

PCAPS

2KD-O19-02

123

1 2 2

2 3 1

70 14

JCS 100 3

5

3

1

2KD-O19-03

1

2

1 1 2

183S1S304, 2014

S174

70 CT

MMSE18/30ADAS16.7

Brs.VI

RSST 0MWST 4 4

MMSE 0/30

1 / 3

2KD-O19-04

12345

1 1 1

2 3 4

5 4

85

65 1.5

RE2 333005B2

1

5 g

100 ml101 mm

25080C

2KD-O19-05

3 1

12

1 1 1

2 1 1

ST3

70

HbA1C

4ST

PTOT

TPN

137 3

20

S175

2KD-O19-06

12345678

1 25 6

7 8 3

6 1 4

103 848

18 85 95

8

58.612.8 mg/ml 44.94.0 mg/mlp0.001

1 2 49 59 mg/ml 1

4 59 55 mg/ml 2

1 1 59 65 mg/ml 1 56 50 mg/ml11 mg/3

2KD-O20-01

Neuromuscular Electrical Stimula-tion NMES

12

3

1 2 3

1 1 1

2

Neuromuscular Electrical StimulationNMES

12 ES530

50 Hz 50 ms

/

NMES

p0.05

NMES

NMES

183S1S304, 2014

S176

2KD-O20-02

1

1234

1 1 2

3 4

3

2,500

1

2

3

2KD-O20-03

123

1 1 1

2 3

TPN

VE

3

80

22

1 3 3

FILSLv. 9ADL

Com

TPN

VE

VE

2KD-O20-04

123

1 1 1

2 3

VE

80

1 3 3

20

S177

FILSLv. 9ADL

Com

VE

VE

2KD-O20-05

EMST

123

I4

1 2 3

3 4 2

1 1

EMST

65 10

21 31 12

19 81.35.39

5 8

5 13 2

PCFBarthel Index

POMS EMST 4

1EMST

PCF%VC

2EMST PCFVC

%VC

3EMSTPOMSD

POMS

VC

EMST PCF

EMSTEMST

2KD-O20-06

Wallenberg

12

1 1 1

1 2

Wallenberg

Wallenberg

10

2013 4 12014 3 31

10 79.97.82

FILSTPAlb

HbCRPBMI

3.22.35 FILS

Lv. 4.92.18 Lv. 71.76

p0.01

Wallenberg

Wallenberg

183S1S304, 2014

S178

2KD-O20-07

12

345

12 2 3

4 1 5

2

18

NeuroPackS1

80 Hz0.2 ms

5 5 ml

10

12

2KD-O20-08

12

1 2 1

3

80

4

3

ADL

FIM 24MMSE 6 15 VF

1

3

ADL

FIM 66MMSE 141

37

37 VF

7

2012

2KD-O21-01

12

1 2

2013

11.8%60

3 4 77.4%46

25 11 3 4

20

S179

98 78.99.55642

BMIAlb A

B

21

2010

B 5.7

BMIkg/m2 20.5

3.5 20.13.3 p0.001Albg/dl 3.40.7 3.2

0.7 p0.00012B

75.4%

B1B2CD

2KD-O21-02

1234

1 2 2

2 2 3

4

210 1 4

ST

2KD-O21-03

1

2

1 2 2

21

R&E1jLite

/ H26 4 1

71

14VE PASPenetra-

tion Aspiration Scale

/ 24

4336435.9% 219

266.0% 1j2178.8%

30% VE 14

21 8PAS126371

82 3 3 1251 4

3 113181

183S1S304, 2014

S180

2KD-O21-04

1 2013

12

1 2

1

128

3

A4

30

2KD-O21-05

1

2345678

12 2 23

4 25 26

27 28

45

1/2

1 20 gE100 kcalP11 g

E900 kcalP

63g

9

20

S181

2KD-O21-06

1

2

1 1 1

2 2 2

1 2

TPU2D/2CL

1 2 2

2012

3

2012 12

2.8% 4.9%

2013

2KD-O22-01

1234

5678

1 2 3

4 5 6

7 8

15 16

2KD-O22-02

183S1S304, 2014

S182

40

3 43 48

8

5

2KD-O22-03

12

1 2 2

2 2 2

400

2013 4 2014 3

60 3

3 66.7% 33.3%

52.3 C-2

66.7%B-2 33.3%

66.7%

33.3%

33.3% 33.3% 33.3%

3

2KD-O22-04

1

234

12 2 1

1 3 3

4 4

1

14 9 5

62.810.8

AS-407

NE-U12

1%11

5

20

S183

2KD-O22-05

FIM Gr.

12

1 1 1

2

12.5

ST

20.5

FIM

Gr.

2012 4 2014 3

ST 80 145

2

4 2 57 23 34

85.9 1 2 FIM

301629

15

3 12 Gr. Kruskal-Wallis

Mann-Whitney

FIM12

Gr.12

FIM

Gr.ST

2 FIM

Gr.

2KD-O22-06

CT 3

1

I2

3

1 2 1

1 1 1

3 3

2 320 CT320-

ADCT 3

320-ADCT

3

5%/v

320-ADCT

CT 10 /

3D ACT 3

320-ADCT

3

183S1S304, 2014

S184

2KE-O23-01

ST

12345

12 2 3

4 5

25

ST 10

keyword 3

189

ST

280

381

10

ST

VE

ST

ST

QOL

2KE-O23-02

12

1 2 2

STST

80 4

ST

VF

ST

ST

2KE-O23-03

3

1234

1 2 2

3 4

23 6 25 3

20

S185

14 11 44

1

2,200 ml23

4

5

1 1223

5 186.3%

2KE-O23-04

12

1 2

IOC

IOC

IOC

IOC

92

49IOC

20PEG 17

IOC IOC

16IOC 38IOC

36 10 32060 860

705708011909

16 6

6 3

33 3

31IOC

2

1 1

IOC

IOC

2KE-O23-05

123456

12 13 14

15 16 14

18

7 5

23 25

26

ESTEat Support

Team

183S1S304, 2014

S186

2KE-O23-06

12

I

1 1 1

1 1 1

1 2

VF

2011 4 2014 3

VF 50

80 26 24

DSS

A 2856%

B 2244% 2

4 CVA 26

52%A 39%B 68%VF

A 1139%

1346%

DSS 4

A 27%B 523%

B 6

5

BCVA

23%A46%

2KE-O24-01

1234

1 1 2

2 2 3

4

71

STRSST 0 / 30

VE

15 VF

TPN

80

65

20

S187

2KE-O24-02

VF

12

3

1 1 2

3

1015%

VF

772005

CK

2013

VF

cricopharyngeal bar

Leonard 30%

2KE-O24-03

2

12

345

1 2 3

3 3 4

5 1

OPMDPABPN1

GCN 9

OPMD2

1631311

PABPN1GCN 12

5 VF

97.7 mmHg

95.1 mmHg 3.2 kPa

2578

PABPN1 17 GCN

3 VF

2

86.3 mmHg 33.1 mmHg

10.6 kPa2

2KE-O24-04

Shy-Drager

183S1S304, 2014

S188

Shy-Drager

70Shy-Drager

2

2KE-O24-05

123

1 1 1

2 3 3

3

DMD

DMD

3626 Bipap30

31

35

VF

DMD

VF

2KE-O24-06

12

1 2 1

1 2

ALS

8

2011

ALS

2013

ALS

2011 1 2014 4

ALS 22 8 14

ALSFRS-R

Standardised

Response MeanSRM

285.9 ALSFRS-R

38.58.47 26.511.1

7.51.6 6.02.3

SRM 0.87

ALS

20

S189

2KE-O24-07

12

34

5

12 3 4

1 5 1

2

PD

PD954 73.03.7

Chin-down3 ml

5Ch13

Ch45

SwallowScanNitta

Ch13

Chin-down

Chin-down

PDPD

2KE-O24-08

QOL

12

1 1 2

2

34

NPPV

1

1 1

QOL

2KE-O25-01

123

1 2 1

2 3

30

183S1S304, 2014

S190

2013 6 8

19 102

N-G

062.31

12.84

30 18

0

30

2KE-O25-02

12

1 2

60

20.5%

26.1%

24.6%

2KE-O25-03

5 ICU

12

1 1 2

5

24 12

26 2A ICU

69

10 OAGOAG

OAG Mann-

Whitney U 2010

OAG 24 12.2316.78

SD 1.414.17 25 13.0915.08SD 1.923.65

24 25 5 OAG

24 2.54.33

SD 0.71.84 25 2.913.750.791.61OAG

5

OAG 5

5

OAG

1 5

2012

20

S191

2KE-O25-04

12

1 2 2

1 1 1

1 1

ST

G

25 4 9 ST

162

87 75 2

G

G 4G13467

910

13

14.9% 1621.3%

G

1

5259.8% 4965.3%

4G

52 5198.1% 1

49 4285.7%

9

2KE-O25-05

?

123

1 1 2

3 1 1

1 1

E T

2280.99.3

1 13 3

11 9

3

HE

AB-PAS

HE

AB-PAS

183S1S304, 2014

S192

2KE-O25-06

123

1 2 2

1 3 1

2

13

b 2

Likert scale

14 5

14

10%

412 10 7

3

1820

b-

2KE-O25-07

123

456

1 2 4

3 1 2

5 6

b

T-RFLP

3

Eubacterium Actinobacterium

Peptostreptococcus 3

3

3

5

3

20

S193

2KE-O25-08

1 NPO234

1 2 2

2 3 4

3NST

2

3

2

NST

1

2

3

3

1 2

2KH-O26-01

320 CT

1234

1 12 1

3 1 1

1 4

320 CT

Okada et al, 2013

26 4616

320CTAquilionOne

4510 ml

3D 0.1

0 0.1

0.2

0.3

p0.05

2KH-O26-02

183S1S304, 2014

S194

ST

865

85 36265

34264 161

ST

865 77 384 481

ST39145.2%14.5

86 vs. 7018 vs. 11

291/47861%

41/8051% 17/4340% 23/14516%

123/48825% 239/327

73% 344/50269%

47/36313%

244/36267% 134/34239% 12/161

8% 60%

ST

55 14%

17 4% 10 7%

6 3%

ST

ST

2KH-O26-03

123

1 1 2

2 2 3

3 3

VF

VE

VFVE

VF 86

134

VF

0 2 3

3

50

30 20

2

FLAC

17 12

2928 /2997%

26 /2990%27 /2993%

2KH-O26-04

VE

VEVF

VE

2614

202

VE

202

2612.9%202191

191

15

VE

7 7

VE

5

20

S195

2KH-O26-05

12

1 2

Videoendoscopy VE

2

10

5 28.5 3.6 mm

3.6 mm 2.4 mm

2.4 mm JM-TPM

JMS

5

10 2.4 mm 83.7%3.6 mm 77%

5%

2.4 mm56%3.6 mm31%

1

VE

2KH-O26-06

1234

1 123 23

12 4 4

20

1,530 73.95.5

1 56.5%2

29.9%3 10.5%43.1%

p0.01

p0.05 Time Up

& Go

p0.05

H 24 002

2KH-O26-07

1

2

3

4

1 2 3

1 4

MNA-SF

MNA-SF

FIM

183S1S304, 2014

S196

25 11 26

5 65

MNA-SFThe Mann Assess-

ment of Swallowing AbilityMASAADL

FIM

CRP

MNA-SF 7