小野木 啓子

OBJECTIVE: The "chin-down" posture involves tucking the chin to the neck. However, clinicians and researchers have their own forms of the chin-down posture: some consider it to be head and neck flexion, whereas others consider it to be head flexion alone. The purpose of this study was to evaluate the effects of head, neck and combined head-and-neck flexion postures separately. METHODS: Ten healthy volunteers participated in the study. The head and neck were set in neutral (N), head flexion (HF), neck flexion (NF) or combined head-and-neck flexion (HFNF) positions. Participants were instructed to swallow 4 ml of thick barium liquid in an upright sitting position. Head and neck angles at rest, distances in the pharynx and larynx at rest, and duration of swallowing were measured. Statistical analysis was performed with a paired t-test with Bonferroni correction. RESULTS: Head angles in HF, NF and HFNF positions were significantly greater than in the N position. Neck angles were significantly greater in the NF position than in the N position. The distance between the tongue base and the posterior pharyngeal wall, the vallecular space and the airway entrance were smaller in the HF position than in the N position. The tongue base was in contact with the posterior pharyngeal wall longer in the HF position than in the N position. CONCLUSION: Because HF, NF and HFNF positions have different effects, we recommend the use of these terms instead of "chin-down position."

This study used 320-row area detector computed tomography (320-ADCT) to determine whether kinematic swallowing events and bolus movement through the oropharynx are affected by bolus consistency and angle of recline. Fourteen healthy adults (4 men, 10 women; age, 22-90 years) underwent 320-ADCT assessment during three 10-mL barium swallow tests, with honey-thick liquid at 60° recline (60°thick), thin liquid at 60° recline (60°thin), and thin liquid at 45° recline (45°thin). The times of swallowing events were measured and compared among the different tests. Bolus propulsion, onset time of true vocal cord (TVC) closure, and upper esophageal sphincter opening were significantly earlier for 60°thin than for 60°thick. Onset time did not significantly differ between 60°thin and 45°thin; however, greater variability was noted for onset of TVC closure with 45°thin, as the TVC started to close before onset of swallowing in 30% of participants. Modulation of TVC closure depends on bolus transport in different reclining positions. The 45° reclining position elicited pre-swallow TVC closure in some participants, which suggests that excessive recline can increase perceived risk of airway invasion during swallowing.

Onogi K, Kondo I, Asagai Y, Saitoh E. Differences in evaluation of functional skills of the Pediatric Evaluation of Disability Inventory (PEDI) between normally developing children and children with cerebral palsy. Jpn J Compr Rehabil Sci 2017; 8: 37-43.<br>Objective: The Pediatric Evaluation of Disability Inventory (PEDI) provides functional skills scales based on the data obtained from normally developing children. In the present study, we performed an analysis of children with cerebral palsy using the same methodology as set originally to examine differences in discrete skill items between the two groups of children.<br>Methods: Six hundred and two children with cerebral palsy were divided into groups based on the severity of disorder as described in the Gross Motor Function Classification System (GMFCS). The scaled scores for the PEDI functional skills were computed by Rasch analysis.<br>Results: Correlation coefficients between the scaled scores of children with cerebral palsy and those presented in the PEDI original data were r = 0.890 for self-care, r = 0.795 for mobility, and r = 0.943 for social function. In children in GMFCS level I, discrete scores increased with age, whereas in children in levels III, IV, and V, scores for mobility almost reached the plateau in the age band of 4 to <6 years.<br>Discussion: In the difficulty level of functional skills, the greatest difference was observed in mobility, suggesting the need to establish a difficulty level of functional skills that is adapted to the abilities of children with cerebral palsy.