Incidents and Sudden Patient Deteriorations Occurring During Their Rehabilitation Sessions in an Acute Care Hospital: A Retrospective Cohort Study.

Objective: To investigate the occurrence of incidents and sudden deteriorations during rehabilitation in an acute care setting by disease category based on the International Classification of Diseases and Related Health Problems, 10th Revision. Design: Retrospective cohort study. Setting: University hospital in Japan with 1376 beds. Participants: A total of 49,927 patients who were admitted to the acute care wards and underwent rehabilitation over 8 years, from April 1, 2013, to March 31, 2021. Interventions: Rehabilitation in an acute care setting. Main Outcome Measures: Incidents and sudden deteriorations reported in medical charts. Results: Among 49,927 admissions, 455 incidents and 683 sudden deteriorations occurred during rehabilitation. The incidents and sudden deteriorations occurred at rates of 0.009/person (0.50 case/1000 h) and 0.012/person (0.75 case/1000 h), respectively. The 3 most frequent incidents were "route-related incidents" (178 cases, 39.1%), followed by "bleeding/abrasions" (131 cases, 28.8%) and "falls" (125 cases, 27.5%). Among 12 disease categories with over 500 admissions and 10,000 rehabilitation hours, the highest incident rate occurred in "certain infectious and parasitic diseases" (0.81 case/1000 h), followed by "diseases of the musculoskeletal system and connective tissue" (0.67 case/1000 h) and "diseases of the genitourinary system" (0.66 case/1000 h). The commonest sudden deterioration was "vomiting" (460 cases, 67.3%), followed by "decreased level of consciousness (with reduced blood pressure)" (42 cases, 6.1%) and "seizure" (39 cases, 5.7%). Furthermore, the highest sudden deterioration rate was in the "endocrine, nutritional, and metabolic diseases" (1.19 case/1000 h) category, followed by "neoplasms" (1.04 case/1000 h) and "certain infectious and parasitic diseases" (0.99 case/1000 h). Conclusions: An incident and sudden deterioration occurred every 2000 and 1333 h, respectively, during rehabilitation. Therefore, understanding the actual occurrence of incidents and sudden deteriorations during rehabilitation may provide valuable insights into preventing incidents and emergencies.

Effects of head flexion posture in patients with dysphagia.

BACKGROUND: The chin-down posture is often used as a compensatory manoeuvre for patients with dysphagia. This posture presumably involves flexion of the head and/or neck, but this is not clearly defined. OBJECTIVE: This study aimed to assess the effects of head flexion posture in a retrospective study of videofluoroscopic examination of swallowing (VF). METHODS: A total of 73 patients who underwent VF both with and without head flexion posture in the lateral projection were included in the analysis. The head and neck angles at the initiation of the swallowing reflex, penetration-aspiration scale (PAS), nasopharyngeal closure time, stage transition duration, duration of laryngeal closure, time from swallowing reflex to laryngeal closure and to the opening of upper oesophageal sphincter (UES), duration of UES opening, location of the bolus leading edge at swallowing reflex, and bolus transition time were evaluated. RESULTS: The head flexion angle increased (p < 0.001), but the neck flexion angle did not change in the head flexion posture. Moreover, PAS improved (p < 0.001), aspiration was reduced (p < 0.001), the time between the swallowing reflex and the onset of laryngeal closure was shortened (p = 0.006), and the leading edge of the bolus at swallowing reflex became shallower (p = 0.004) in the head flexion posture. Other parameters did not significantly change. CONCLUSION: The head flexion posture resulted in earlier laryngeal closure and a shallower position of the leading bolus edge at swallowing reflex, resulting in PAS improvement and decreased aspiration.

Positional effects of head and/or neck flexion as chin-down posture in normal subjects.

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."

Repetitive Peripheral Magnetic Stimulation for Strengthening of the Suprahyoid Muscles: A Randomized Controlled Trial.

OBJECTIVE: Head lift exercise is a widely known form of training in the rehabilitation of patients with dysphagia. This study aimed to compare muscular strength reinforcement training of the suprahyoid muscles using repetitive peripheral magnetic stimulation (rPMS) with head lift exercises in a randomized controlled trial. MATERIALS AND METHODS: Twenty-four healthy adults were randomly assigned to either the magnetic stimulation group (M group) or the head lift exercise group (H group). Both groups underwent training five days a week for two weeks. The primary outcome was the cervical flexor strength, and secondary outcomes were jaw-opening force, tongue pressure, muscle fatigue of the hyoid and laryngeal muscles, displacement of the hyoid bone and opening width of the upper esophageal sphincter (UES) while swallowing 10 mL of liquid, training performance rate, and pain. RESULTS: No dropouts were reported during the two-week intervention period. Cervical flexor strength significantly increased solely in the M group. Tongue pressure significantly improved in both groups. There were no significant differences in the jaw-opening force, median frequency rate of the anterior belly of the digastric muscle, sternohyoid muscle, sternocleidomastoid muscle, anterior and superior hyoid bone displacement, and UES opening width in both groups. CONCLUSIONS: Two-week rPMS of the suprahyoid muscles increased the strength of these muscles compared with the head lift exercise during the same period.

Effects of dental treatment on the quality of life and activities of daily living in institutionalized elderly in Japan.

Impairment of oral health has a negative impact on the quality of life (QOL) of the elderly. Activities of daily living (ADL) are known to be an important determinant of their QOL. A controlled study was conducted between September and November 2007 to determine the effects of dental treatments on the QOL and ADL among 30 institutionalized Japanese elderly who were allocated into two groups, an intervention group and a control group. Their mean age was 80+/-9 years. Outcome data were collected 6 weeks after baseline in both groups. QOL and ADL were assessed using General Oral Health Assessment Index (GOHAI) and Functional Independence Measure (FIM). The intervention group, which had received dental treatment, showed significant increases in GOHAI scores between baseline and 6 weeks (p=0.04), whereas no significant difference was found between baseline and 6 weeks in the control group. The differences in the changes in the FIM scores for expression were significant in the model adjusted for covariables (p=0.03). Our findings showed that dental treatments increased the oral health-related QOL and the expression function in the ADL. Promoting dental care service at nursing facilities may be beneficial for maintaining the residents' QOL.