Ultrasonographic evaluation of geniohyoid muscle mass in perioperative patients

Surgical invasion and postoperative disuse are known to promote systemic skeletal muscle atrophy; however, similar effects on the mass of the muscles of deglutition have yet to be confirmed. Our method of using ultrasonography to measure the area of the geniohyoid muscle (GM), to evaluate the mass of the muscles of deglutition, has been shown to have high reliability. In the present study, we measured the GM area before and after surgery in patients to investigate changes in their muscle mass. Parameters including GM area, quadriceps femoris muscle (QF) thickness, hand grip strength (HGS), and arm muscle circumference were measured preoperatively and at 7 and 14 days postoperatively in patients who underwent thoracotomy and laparotomy. Patient height, weight, and serum albumin (Alb) level were also obtained from medical charts. Comparison of each evaluation parameter between measurement time points demonstrated significant decreases in GM area, QF thickness, HGS, and Alb between preoperatively and both postoperative day (POD) 7 and POD 14. The patients were divided into good (n = 19) and poor (n = 12) postoperative oral intake groups for comparison of GM area. The percentage decrease in GM area was significantly greater in patients with poor oral intake. To our knowledge, this is the first study to demonstrate that muscle atrophy due to surgical invasion or disuse may occur in the muscles of deglutition, as in the limb muscles. The findings showed that muscle atrophy occurs in the early postoperative period and persists even at 2 weeks postoperatively. Furthermore, insufficient oral intake may promote disuse muscle atrophy

Predicting the Prognosis of Swallowing Function in Stroke Patients with Dysphagia Using the Videofluoroscopic Dysphagia Scale

The aim of the present study was to evaluate the correlation between parameters of the videofluoroscopic dysphagia scale (VDS) and the outcome of dysphagia to determine the usefulness of the VDS in patients admitted to convalescent rehabilitation wards. Patients (n = 23) with stroke-related dysphagia admitted to our rehabilitation hospital between April 2007 and March 2009. Medical records and videofluoroscopy findings on admission to hospital were reviewed retrospectively and the VDS score was calculated by adding individual VDS parameters. Subjects were divided into two groups: those who were able to ingest orally without tube feeding before discharge (Group 1) and those who still needed tube feeding on discharge (Group 2). The VDS scores were compared between the two groups. There were no significant differences in any individual parameter on the VDS between the two groups. However, the total VDS score was significantly lower in Group 1 patients (p < 0.05), as was the time from stroke onset to admission to our hospital (p < 0.05). There were no significant differences in any other parameters evaluated. The findings of the present study suggest that the total VDS score may be useful in predicting the prognosis of stroke-related dysphagia

Effects of revisions to the health insurance system on the recovery-phase rehabilitation ward

In the present study, we investigated the effects of revisions to the medical fee system made in April 2006 on the recovery-phase rehabilitation ward of our hospital. Subjects were patients admitted to the recovery-phase rehabilitation ward of our hospital between April 1, 2005 and September 30, 2006, and were discharged. Patients admitted between April 1, 2005 and March 31, 2006 were allocated to the pre-revision group and those admitted between April 1, 2006 and September 30, 2006 to the post-revision group. Their medical charts were investigated for comparison of the mean age, duration of hospitalization, and outcome.A total of 126 patients were allocated to the pre-revision group, and 72 to the post-revision group. The number of days from onset to admission to the recovery-phase rehabilitation ward was 41.3 days in the pre-revision group and 26.1 days in the post-revision group, while the duration of hospitalization was 71.4 days in the former group and 41.9 days in the latter. The outcomes were transfer to homecare/discharge to home in 84 patients (67%) and transfer to another department in our hospital in six patients (5%) in the pre-revision group, and 43 patients (60%) and 14 patients (19%), respectively, in the post-revision group. No significant differences in FIM were found between the two groups.The effects of the medical fee system revisions made in April 2006 on the recovery-phase rehabilitation ward of our hospital included shortening of the number of days between onset and admission, duration of hospitalization, increased transfer to other departments, and decreased rates of transfer to homecare/discharge to home. These findings indicate the importance of systemic management and team-based approaches for enabling more efficient rehabilitation

Assessment of chest movements in tetraplegic patients using a three-dimensional motion analysis system

We used optoelectronic plethysmography (OEP) to evaluate the effects of posture on chest and abdominal movements during respiration in patients with chronic-stage complete spinal cord injuries. The subjects were five cervical injury patients (male, C4-C8 injury, American Spinal Injury Association Impairment Scale grade A) and five healthy people matched to each of the cervical injury patients for age, height, and weight. The chest wall movement each of the subjects was recorded using OEP during six quiet breathing and three deep breathing periods in each of the following positions: supine, with the trunk elevated to 30°, and with the trunk elevated to 60°. Data on the chest wall volume and compartment volumes (upper thorax, lower thorax, abdomen) were then compared among the postures. During quiet breathing in the tetraplegic patients, the change in upper thorax volume was smaller at the end of inhalation than at the end of exhalation, presenting as a paradoxical breathing pattern. During deep breathing in the tetraplegic patients, abdominal volume accounted for a large portion of the change in total chest wall volume. Posture affected the recorded abdominal volume; volume was greatest in the supine position and decreased as the posture became more upright