Tomoyuki Ogino

Head lifting strength can be easily measured without special equipment. The relationship between head lifting strength and dysphagia is well-established. However, its association with Pharyngeal residuals—a risk factor for aspiration—has not yet been explored. This study aimed to determine the association between head lifting strength and Pharyngeal residuals, as assessed through a Videofluoroscopic swallowing study (VFSS), in older inpatients with suspected dysphagia. A total of 50 patients who underwent VFSS for suspected dysphagia were included. Head lifting strength was measured as the number of repetitions of maximum head lifting and the time to maintain maximum head lifting. The Normalized Residue Ratio Scale (NRRS) was scored at the valleculae (NRRSv) and piriform sinus (NRRSp) while swallowing 3 ml of a moderately thick liquid during the VFSS. Univariate and multiple regression analyses examined the relationship between head lifting strength and NRRSv and NRRSp. The time to maintain maximum head lifting and the number of repetitions of maximum head lifting were significantly negatively correlated with the NRRSv and NRRSp. However, in the adjusted multiple regression analysis model, only the number of repetitions of maximum head lifting was related to NRRSv and NRRSp. This study implies that a simple head lifting strength test can be implemented in the clinic to determine the risk of pharyngeal residuals after swallowing and, consequently, the possibility of aspiration.

Aim: How possible sarcopenia affects functional prognosis in patients with premorbid disability remains unclear. This study aimed to compare and investigate the impact of possible sarcopenia at admission on functional outcomes at discharge in patients with acute stroke with and without premorbid disability.Methods: This cohort study enrolled patients who were consecutively admitted to a single center for acute stroke. Calf circumference and grip strength were measured within 7 days of admission, and possible sarcopenia was determined using the Asian Working Group for Sarcopenia 2019 criteria. The Functional Independence Measure (FIM) score at discharge during the acute phase was the primary outcome. To examine the impact of possible sarcopenia on FIM scores at discharge, patients were divided into two groups according to being with or without premorbid disability according to the modified Rankin Scale, and multiple linear regression analysis was performed in each group.Results: This study included 456 patients with acute stroke (median age, 80 years). In the premorbid‐disability group (n = 166), possible sarcopenia was present in 140 patients (84%). Patients without possible sarcopenia had significantly higher FIM scores at discharge compared with those with possible sarcopenia (P < 0.001). However, multiple linear regression analysis showed that possible sarcopenia was not associated with FIM scores at discharge in the premorbid‐disability group (β = −0.054, P = 0.346).Conclusions: The results of this study demonstrated that a high rate of possible sarcopenia was observed in patients with stroke with premorbid disability; however, this did not affect functional prognosis. Geriatr Gerontol Int 2024; 24: 359–363.

Although chronic obstructive pulmonary disease patients get relief from their dyspnea by arm bracing, the mechanics of this effect are unknown. This study aimed to investigate the mechanisms by which arm bracing affects dyspnea by measuring the work of breathing (WOB) in the arm bracing posture. Six normal male subjects were studied in two standing postures: erect and with their arms braced. For the arm bracing posture, the subjects leaned forward with their arms stretched and rested their hands on a platform. Respiratory frequency was set at 20 tidal breaths/min with the use of a metronome, and tidal volume was set at 1 L by observing the lung volume on a monitor. All the subjects randomly adopted the two postures, and a preset respiratory pattern was measured for 30 s in each posture. Lung volume and flow rate were measured using a hot-wire flowmeter. Esophageal pressure was measured using a 12-cm balloon catheter. The WOB was estimated using modified Campbell diagrams. Lung volume increased and inspiratory resistive WOB decreased, while inspiratory elastic WOB increased significantly with arm bracing compared with that of the erect posture (P < 0.05). Arm bracing posture increases the chest wall expansion thereby increasing the end-expiratory lung volume and decreasing the inspiratory resistive WOB among healthy individuals.