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Patients with dysphasia have a variety of motor deficits in orofacial and pharyngeal move‐ ments. Disorders in the orofacial region, such as dysphasia developed, may be induced by cerebral vessel disease, cancer in the orofacial and neck region, and other conditions. Func‐ tional assessment of mastication and the deglutition is most likely to be performed using videoendoscopy (VE) and videofluoroscopy (VF), although electromyography (EMG), ultrasonography (US), and other modalities are also used. Although VE is the primary method for examination of swallowing, projection of VE during instantaneous variations in swallow‐ ing cannot be observed because of whiteout. On the other hand, although VF is the best choice for functional assessment of eating and swallowing, we cannot avoid a bombing experience. Therefore, we devised a new method to reduce the reliance on VF examination.

Electrical thresholds of the sensation of structures with primary disease in the orofacial region of patients with stroke, head and neck tumor, external injuries, and other conditions following orofacial treatments were examined. The results suggested a close relationship between the electrical threshold of sensation and the recovery process, because patients with various orofacial and neck diseases showed a lower threshold of electrical sensation associated with treatment. Thus, changes in the oral and pharyngeal phases using VF in patients with brain tumors, stroke, external injuries, amyotrophic lateral sclerosis and myasthenia gravis were investigated.

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Many researchers have evaluated VF results based on the Videofluorographic Examination of Swallowing Worksheet developed by Logemann [8]. However, because the inspection items on this worksheet comprise many measurement items, numerous hospitals conduct their own modified VF assessments [2, 3, 5-7, 14]. Based on experiences in other hospitals, 11 key events were identified for the assessment of VF: bolus formation, tongue-to-palate contact, premature bolus loss, residue in the oral cavity, and oral transit time in the oral phase; and lift in the soft palate, triggering of the pharyngeal swallow, vallecula residue, pyriform sinus residue, pharyngeal transit time, and aspiration in the pharyngeal phase. Furthermore, these items were classified into three levels: grade 0 as normal, grade 1 as inadequate, and grade 2 as a true abnormality. The total scores for all items in the oral and pharyngeal phases separately are calculated and a higher sum in each phase represented a more serious condition is presumed. Electrical thresholds of sensation on the soft palate during the hospital visit were measured, too. Guidance regarding an accepted way of stretch training fitting various disorder parts, such as gum rubbing, the Mendelsohn maneuver, thermal tactile stimulation, the head lift exercise (Shaler exercise), the tongue holding maneuver and Sylvester maneuver. Trainings involved procedures suitable for each patient after obtaining first-person informed consent. For example, patients with the deglutition disorder were performed by thermal tactile stimulation during the hospital visit and Shaker exercise in the residence. Patients performed the training method best suited to their disease twice daily.

Finally, we examined the relationship between the total scores for all items in the oral and pharyngeal phases and the threshold of electrical sensation on the soft palate. We hypothesized that if electrical threshold measurement can be substituted for VF assessments, radiation exposure to patients can be reduced. Furthermore, electrical threshold stimuli on the soft palate and other areas are produced by an appeal of a loose press feeling in the stimulus area of subjects, not painful sensation.
