training using patakara for patients of dementia and … · 2016. 7. 31. · comparison of the...

Myofunctional Therapy Device 1/11 Report

Using Myofunctional Therapy Device (Lip Trainer Patakara®)

in order to rehabilitate patients of Dementia and Dysarthria

(Report No. 1) April 2003

Healthcare Foundation Toshisada-kai, Okuno Hospital, Tokyo, Japan Speech therapists;

Ms.Ruriko Matsumoto, Ms.Chiomi Aoshima, Mr.Kohei Tsumura Dr. Akira Shindo, Hospital Director

1. INTRODUCTION

Myofunctional Therapy Apparatus: Lip Trainer Patakara® ( u.com) made by

Dental YUMI Ltd. (former name of Patakara Co., Ltd), a rehabilitof the muscular functions of the mouth cavity, is made by combiplastic and rubber so as to utilize its resilience to directly apply loamouth / cheek muscle, thereby promoting the strengthening of muscl

This research aims to investigate the following three poinMyofunctional Therapy Apparatus: Patakara® (hereafter referred between the Labia Closure Strength (hereafter referred to as LCSpatients (hereafter referred to as Dementia) (2) Relationship betwethe use of Patakara® will increase the blood flow in the frontal lobecommon intelligence that deteriorates due to dementia, this will resuability thought to be located in the nerve center of the frontal lobe.

Dysarthria refers to an abnormality in articulation due to termovement caused by the occurrence of lesion somewhere along thnerve center of the brain movement to the peripheral muscles. It isymptoms as shown at Table 1. Among these, the Dysarthria typcerebral blood vessel clearly shows an unsymmetrical state of the lipcausing the lips to be pulled to one side. When the patient is asketongue being moved in / out and up / down, it is very evident that move fast enough within a comfortable region. Also, the lower jawmaking it obviously easier to drool. In terms of speech, besides difficmany mistakes in pronunciation and the speech as a whole becomesspeaking is slow, without utterance, unnatural and monotonous. (Dr.S

Using Patakara® to stimulate around the lips will in turn also stimtraining of the muscles of facial expression and thus strengthening thof the lips, the tip of the tongue will contact the roof of the mouth at the tongue as a whole will move forward to the upper area. By repeathealthier half of the tongue will pull along the paralyzed side. Theimprove Dysarthria. (Dr Noro, 2001).

The use of Patakara® until now showing cases of improvestrengthening of the LCS, starting with the case of the wordings beco

www.liptrainerguru.com

www.liptrainergur

ed by Okuno Hospital Tokyo, Japan

ation training tool for the treatment ning the elastic properties of both d onto the orbicular muscle of the

es. (Dr.Noro, 2001). ts by conducting training using

to as Patakara®). (1) Relationship ) and speech clarity of Dysarthria en lower LCS and dementia (3) If , the assumption is that, among the lt in the improvement in judgment

minal damage to the articulatory e motor nervous system from the

s classified into 6 types of speech e that occurs after damage to the s movement due to facial paralysis d to open the mouth to reveal the the movement is bad and it cannot drops and the mouth remains open ulty in delivering sounds, there are

unclear. Furthermore, the speed of hibata, 2001). ulate the facial nerves, resulting in

e LCS. In addition, with the closure the front teeth of the upper jaw and ing this coordinated movement, the above series of activities will help

ment to Dysarthria following the ming crisp and clear after carrying

Myofunctional Therapy Device 2/11 Reported by Okuno Hospital Tokyo, Japan

out rehabilitation of patients who were paralyzed on the left side of the body due to brain hemorrhage, have been reported by (Dr Noro, 2001).

But, there is still very little research reports by speech therapists (hereafter referred to as ST) of objective measurements of the relationship between LCS and auditory speech clarity. Thus, this research aims to investigate the relationship between LCS and auditory speech clarity.

Although there is no coherent understanding of the concept of dementia, the DSM-III-R of the American Psychiatry Society states that for standardized diagnosis, a necessary symptom of memory disorder must display any one of the following 4 symptoms: (1) disorder in abstract thinking, (2) judgment disorder, (3) other higher order brain dysfunctions (loss of speech, loss of movement, loss of recognition, organizational disorder), (4) character changes.

A simple test used in the diagnosis of dementia is the Hasegawa Method Simple Intelligence Assessment Scale Revised Edition (hereafter referred to as HDS-R), which mainly assesses the linguistic “memory” and “orientation”. Dementia is suspected if the score is less than 20 out of 30 marks. We shall investigate if the HDS-R marks can be used to determine the difference in the LCS.

As described earlier, while HDS-R mainly focuses on “memory” as a necessary symptom of dementia, the Raven Color Progressive Matrices test (hereafter referred to as RCPM) used concurrently this time assesses the “judgment ability”. Generally, it is said that for “linguistic function” and “memory”, the nerve center lies in the temporal lobe, and for “judgment ability”, the nerve center lies in the frontal lobe. But, in recent research, it has become clear that the frontal lobe is related to “memory” search (Chunichi Shinbun, 7th August 1998). Thus, from the results of both HDS-R and RCPM, we shall prove that the increased blood flow due to Patakara® contributes to the improvement in functions of the frontal lobe. Also, training on 1 page of intellectual work will be carried out in all groups. This intellectual work centers on writing topics, and is divided into 3 levels (1~3) according to the intellectual level of the patients. Contents are filling out of the name, date, age, weather, with topics on explanation of 2 ~4 panel cartoons, maze, capping verses, reading comprehension problems, word memory, etc to be conducted. The topics can be completed within 10 ~15 minutes. The aim is to synergistically improve the intellectual functions by concurrently using the intellectual work together with the lips closure training.

2. METHOD (1) Object From among the hospitalized patients, Table 2-1 Group I is the Dysarthria group comprising 7 patients (spastic 5: male 3, female 2; hypo kinesis 2: male 1, female 1; average age 72.7 years old), Table 2-2 Group II is a low level mental function group of 9 patients with HDS-R scores of less than 20 marks (male 3, female 6, average age 70.3 years old), and Table 2-3 Group III is a control group of 8 patients with HDS-R scores of 21 marks and above (male 5, female 3, average age 73.3 years old), total of 24 patients. Table 2 shows the patients in each Group.



(2) Method 1) Duration 37 days from 27th April 2002 to 2nd June 2002, with the first measurement and assessment conducted from 22nd to 26th April 2002, and the second conducted from 3rd to 9th June 2002. 2) Measurement Method The LCS is measured by an instrument called “Lip De Cum” (made by Cosmo Instruments Co., Ltd). During this time, the position is supine and the ST in charge will measure after breakfast (between 8am to 9am), having considered the fluctuations of LCS within the day. 3) Training Method All the Groups I(Table 2-1), II(2-2) and III(2-3) will be divided into Patakara® group and PET bottle-type group. In the Patakara® group, use Patakara® (rehabilitation type) 3 times a day (after meals), each time 3 minutes of labia closure training. In the PET bottle group, the water intake is from the PET bottle opening with a “PET Bottle-type Patakara®” attached. Also, all Groups will have 1 page of intellectual training a day. 4) Assessment Method Group I(Table 2-1) shall be assessed on auditory speech clarity (Tokyo University method of articulation test), LCS, HDS-R and RCPM. Group II(Table 2-2) and III(Table 2-3) shall be assessed on LCS. HDS-R, and RCPM. The auditory speech clarity (Table 3) is assessed based on the assessment card of paralytic Dysarthria by Dr Fukusako and his team (1983). 3. RESULTS (1) Dysarthria Group Comparison of the respective 4 items of HDS-R, RCPM, LCS and auditory speech clarity (the HDS-R and RCPM assessments are taken by controlling the control group and the low level mental function group). Table 4 shows the results. From the test results of April and May, in all the HDS-R, RCPM and LCS, a significant difference is observed (Fig. 1, 2 and 3). Also, between LCS and HDS-R, R2 = 0.251, meaning correlation is observed (Fig. 4), and between LCS and RCPM, R2 = 0.6598, meaning a high correlation is observed (Fig. 5). In speech clarity, no change was observed. (2) Low Level Mental Function Group Table 5 shows the test results of the HDS-R, RCPM and LCS of the low level mental function group. From the test results of April and May, in all the HDS-R, RCPM and LCS, a significant difference is observed (Fig. 6, 7 and 8). Also, between LCS and HDS-R, R2 = 0.1268, meaning some correlation is observed (Fig. 9), and between LCS and RCPM, R2 = 0.0035, meaning no correlation is observed (Fig. 10).



(3) Control Group Table 6 shows the test results of the HDS-R, RCPM and LCS of the control group.

From the test results of April and May, no significant difference is observed in HDS_R (Fig. 11). But, in RCPM and LCS, a significant difference is observed (Fig. 12 and 13). Between LCS and HDS-R, R2 = 0.0073, meaning no correlation is observed (Fig. 14), and between LCS and RCPM, R2 = 0.0584, meaning no correlation is observed (Fig. 15).

4. DISCUSSION

Other than HDS-R of the control group and auditory speech clarity of the Dysarthria group, significant difference is observed in RCPM and LCS. Also, between LCS and HDS-R and between LCS and RCPM of the Dysarthria group, a high correlation is observed; even in the low level mental function group, some correlation is observed between LCS and HDS-R.

The control group showed a normal value of above 21 marks in HDS-R scoring, thus in April and May no significant difference is observed definitely. But, in RCPM of control group, from the significant difference observed, even though HDS-R is normal it clearly shows a drop in “judgment ability”. It can be said HDS-R and RCPM assess separate aspects of the intellectual ability.

In all the groups, RCPM and LCS showed an increase in May when compared to April. This is thought to be due to the influence of the lips closure training and the intellectual work. But, it cannot be concluded outright for this time since no data was measured when LCS and intellectual work were not carried out in the control group. Henceforth, there may be a need to include the control group in this research.

Regarding the aim of “relationship between speech clarity and LCS” in this research, no difference is observed in speech clarity when the LCS is improved. This is likely to be due to the short 1 month duration in comparing the training before and the training after in this report. Functional training using Patakara® requires diligent and patient effort to be put in gradually, and it will take months for one to be aware of the effect (Dr. Noro, 2001). Nevertheless, in one patient with symptom of spastic Dysarthria, though there is no change to speech clarity before and after the training, it is observed that salivation has reduced as opined not only by the patient himself but also objectively, and the face line has refreshed. Henceforth, by continuing the rehabilitation using Patakara® to stimulate the facial nerves that control the articulatory organs, it is thought that it is possible to affect the change in auditory speech clarity particularly in the spastic Dysarthria patients with observable paralysis.

Regarding the second aim of “relationship between LCS and dementia”, it can be said that the relationship exists as observed from the positive correlation between LCS and HDS-R.

Regarding the third aim of “relationship between judgment ability in the frontal lobe function and LCS”, only the Dysarthria group is observed to have correlation between LCS and RCPM. But, as described earlier, this is also due to the short training duration. Henceforth, training shall continue so as to determine if there is possibility of any observable correlation. In other words, while similarly improving the LCS and HDS-R (“memory” “orientation”), it is thought that there is possibility to improve RCPM (“judgment ability”) after improving the LCS.



In addition, age, auditory disorder and visual disorder are also likely important causes. In this research, 2 patients in their eighties in Table 2-1 Group I (both spastic Dysarthria, one on Patakara® and the other on PET bottle-type and 3 patients in their eighties in Table 2-3 Group III are also included as test patients. Compared with other test patients, they are observed to have lower intellectual level or auditory and visual disorders, and there was difficulty to get them to understand the instructions during measurement of LCS and training, etc. Thus, in using Patakara®, there may be a need for a level of ability to understand and follow instructions. Also, in the 3 groups in PET bottle-type group and Patakara® group, although the results showed no significant difference, there is likelihood of rejection due to difficulty in drinking and water leakage even in using PET bottle-type that there is no certainty of success if training is by PET bottle-type just because Patakara® is difficult.

5. SUMMARY

This research was carried out to investigate the relationship between LCS and HDS-R, RCPM, auditory speech clarity, and as a whole significant difference is observed. It is important that changes were observed because of the short verification duration and the reduced intellectual level due to old age. Henceforth, by further lengthening the verification duration, we shall investigate the changes in the relationship between LCS and HDS-R, RCPM, auditory speech clarity.

In addition, in the Dysarthria group, to investigate the changes of movement range, speed, muscles of the mouth cavity articulatory function, besides the change of auditory speech clarity, the test shall be done in conjunction with the Asahi Method Speech Mechanism Test Revised Edition (ASMT-R) which can quantitatively measure the above changes, and comparison made.

It can be said that there is relationship between LCS and dementia. However, there is a need to note that there will be patient with low HDS-R score despite having more than 10N of LCS, and there will be patient with high HDS-R score despite having less than 10N of LCS. This is likely to be due to dental influence, which shall be an investigation item henceforth.

There is a need to investigate at what level of reduction of LCS the level of mental function would be reduced.

With regards to dementia, there is a need to investigate not just the HDS-R (“memory disorder” “orientation disorder”) and RCPM (“judgment disability”) carried out in this assessment, but also “mobility problem”, which is one of the major causes of difficulty in nursing care in families and facilities. “Mobility problem” is considered to be one of the disorders of frontal lobe function, and like HDS-R and RCPM, by carrying out assessments using certain assessment yardstick, it may be able to clarify the influence of LCS training on the improvement of frontal lobe function.

Henceforth, training shall continue in order to discuss the relationship between HDS-R, RCPM, changes in LCS and intelligence, as well as relationship with “mobility problem”.



ACKNOWLEDGEMENTS We would like to take this opportunity to express my gratitude to the following people for their great support in the course of writing this paper: Dr. Yoshiaki Akihiro of Akihiro Dental Clinic: Dr. Sohei Hosokawa of Tokyo Dental University Suidobashi Hospital for helping with dental measurements and treatment; Dental Hygienist Ms. Yoshiko Kita and Yuka Omori of Dental YUMI; Staffs of Cosmo Instruments Co., Ltd: Mr. Takashi Akihiro for helping with statistics organization; Nurses of nursing and caring department of Okuno Hospital; and lastly, but not at all the least, all personnel who has been involved in this project.

REFERENCES

(1)”Lip Training that improves Atopic Eczema, Periodontal Diseases” Yoshiaki Akihiro, Akio Yaro, Junichi Takahashi, Makino Publishing, Tokyo, 2001. (2)”Myofunctional Therapy by using oral rehabilitation apparatus [PATAKARA]” Akio Noro, Japan dental Society of Oriental Medicine, Issue 1&2, June 24, 2001. (3)”Basics and clinical profile of mimetic muscles (musculus orbicularis oris, buccinator muscles) therapy using new oral rehabilitation apparatus” (10th report), Akio Noro, Junichi Takahashi, Yoshiaki Akihiro, Akihito Nishimoto, Makoto Hosaka, Ippei Hosokawa, Takeyoshi Maseki, Yoshihito Hirai, Applications and changes observed in stroke patients using PATAKARA”, 2002 (4)”Inspection of WAIS-R operability examination of right-side paralyzed verbal aphasia patients, Speech language medicine” Etsuko Ida, Akira Uno, Kimitaka Kaga, Minako Nakajo, 40:228-233, 1998 (5)”Functional anatomy of the frontal cortex, General rehabilitation”, Satoshi Mochizuki, Michiru Kawamura, 26:513-518, 1998 (6)”Diagnostic imaging and general rehabilitation of frontal cortex lesion” Shunhan Hirai, Masanori Koro, Rikumasa Takahashi, 26:519-523, 1998 (7)”Neuropsychologic testing methods for functional disorder of frontal cortex, General Rehabilitation” Haruo Kajima, Genichiro Kato, 26:525-531, 1998 (8)”Rehabilitation for frontal cortex lesion, General Rehabilitation” Hiromi Hara, 26:533-539, 1998 (9)”Brain and language comprehension – Comparison between Alzheimer and Verbal Aphasia-, Aphasia Research”, Masayoshi Kurachi, Sae Matsui, Ben Fuji, 13:174-182, 1994 (10)”Consiousness of disease in Alzheimer patients, Aphasia Research” Yoshitaka Ikejiri, Etsuro Mori, Shinji Hirono, Toru Imamura, Hikaru Yamashita, Yoshitsugu Nakagawa, Shigeru Yamatori, 10:102-109, 1990 (11)For the research of Dimentia and Memory Disorder, Neuropsychology” Morihiro Sugishita, 7:100-104, 1991 (12)”Studies of articulatory disorder caused by movement disorder, for speech therapists” Hajime Hirose, Sadao Shibata, Yasutoshi Shirasaka, Ishiyaku Publishers, Inc. Tokyo, 2001 (13)”Oral and Maxillofacial Studies and Clinical Dentistry for Speech Therapists” Kenichi Dou, Ishiyaku Publishers, Inc. Tokyo, 2000 (14)”Guidance for Japan Raven Colour Matrices Test” Morihiro Sugishita, Kumiko Yamazaki, NihonBunka Kagakusha, Co., Ltd. Tokyo, 1993 (15)”Asahi Speech Method test”, Interuna Publishing, Tokyo, 1994



Table 1. Types and Causes of Dysarthria

Type Cause (Lesion Location) 1. Flaccid Dysarthria Damage to lower motoneuron 2. Spastic Dysarthria Damage to bilateral upper

motoneuron 3. Uncoordinated Dysarthria Damage to cerebella or cerebellar

tract 4. Hypo kinetic Dysarthria (Parkinson’s disease) Damage to extra pyramidal tract 5. Hyperkinetic Dysarthria

Chorea Dystonia

Damage to extra pyramidal tract Rapid hyper kinesis Slow hyper kinesis

6. Mixed Dysarthria Spastic–flaccid (amyotrophic lateral sclerosis) Spastic–uncoordinated–hypo kinesis (Wilson’s disease) Variable (multiple sclerosis)

Multiple damages

Table 2-1. Subject of Dysarthria Group (Group I)

Name(Initial) Sex Age Type Clearness Device 1 K.T M 58 Hypo kinetic 3 Patakara 2 Y.Y F 59 Spastic 2 Patakara 3 O.S F 71 Spastic 3 Patakara 4 K.E F 74 Hypo kinetic 2 Patakara 5 K.T M 89 Spastic 2 Pet bottle-type 6 K.H M 74 Spastic 3 Patakara 7 Y. I M 84 Spastic 4 Patakara

Average 72.7

Table 2-2. Subject of Dysarthria Group (Group II)

Name(Initial) Sex Age HDS-R RCPM Device Full score : 30 Full score : 36 1 S.K M 60 8 14 Patakara 2 S.K F 63 11 18 Pet bottle-type 3 N.E F 69 10 18 Pet bottle-type 4 T.T F 63 11 23 Patakara 5 T.S M 73 13 18 Patakara

6 H.K F 74 5 16 Pet bottle 7 S.T F 75 14 12 Pet bottle 8 S.T M 77 17 25 Patakara 9 U.N F 79 11 15 Patakara

Average 70.3 11.1 17.6

Table 2-3. Subject of Dysarthria Group (Group III)

Name(Initial) Sex Age HDS-R RCPM Device Full score : 30 Full score : 36 1 I.M M 60 27 14 Patakara

2 K.Y M 63 28 23 Pet bottle 3 S.M F 69 28 25 Pet bottle 4 S.H M 63 26 29 Patakara 5 S.H M 73 21 16 Patakara 6 S.K M 74 23 24 Pet bottle 7 K.N F 75 26 13 Pet bottle 8 T.K F 77 27 18 Patakara



Table 3. Auditory Speech Clarity index

1 All clear 2 Sometime unclear 3 Clear if the content is known 4 Sometime clear 5 Unclear

Table 4. Result of Dysarthria

Name(Initial) HDS-R (Full score : 30) RCPM (Full score : 36) Labia Closure Strength (N) April May April May April May 1 K.T 29 30 29 36 5.5 11.6 2 Y.Y 24 26 16 19 4.6 7.0 3 O.S 25 28 22 23 4.9 10.3 4 K.E 23 25 9 12 2.9 2.9 5 K.T 12 13 10 12 3.3 4.2 6 K.H 14 24 19 16 6.9 4.7 7 Y. I 17 21 15 24 2.1 3.2

Table 5. Result by Low Level Mental Function

Name(Initial) HDS-R (Full score : 30) RCPM (Full score : 36) Labia Closure Strength (N) April May April May April May 1 S.K 8 7 14 23 2.2 2.6 2 S.K 11 12 18 18 5.9 6.5 3 N.E 10 21 18 23 5.8 8.2 4 T.T 17 15 23 23 5.1 7.3

5 T.S 13 18 18 24 5.1 6.2 6 H.K 5 8 16 15 2.3 8.4

7 S.T 14 13 12 13 5.5 8.2 8 S.T 17 22 25 24 11.7 11.8

9 U.N 11 5 15 10 6.8 13.0

Table 6. Result by Control

Name(Initial) HDS-R (Full score : 30) RCPM (Full score : 36) Labia Closure Strength (N) April May April May April May 1 I.M 27 28 14 21 10.1 11.3 2 K.Y 28 26 23 28 7.3 15.0 3 S.M 28 27 25 27 6.7 6.4 4 S.H 26 26 29 31 10.0 13.3 5 S.H 21 21 16 21 10.7 9.2 6 S.K 23 23 24 29 10.4 11.6 7 K.N 26 27 13 11 8.9 8.5 8 T.K 27 23 18 22 11.4 5.8



Fig.1: Transition of HDS-R in Dysarthria Group Fig. 2: Transition of RCPM in Dysarthria Group

April May April May

Fig.3: Transition of Labia Closure Strength in Dysarthria Group

%

April May

Fig.4: Relationship Labia Closure Strength and HDR-S in Dysarthria Group

Labia Closure Strength (N)

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Fig.5: Relationship Labia Closure Strength and RCPM in Dysarthria Group

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Fig. 10: Relationship Labia Closure Strength and RCPM in Low Level Mental Function Group

Fig. 6: Transition of HDS-R in Low Level Mental Function Group

Fig. 7: Transition of RCPM in Low Level Mental Function Group

April May April May


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（S

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April May

Fig. 8: Transition of Labia Closure Strength in Low Level Mental Function Group

Fig. 6: Transition of HDS-R in Low Level

Mental Function Group Group

April May

Fig. 9: Relationship Labia Closure Strength and HDR-S in Low Level Mental Function Group



Fig.13: Transition of Labia Closure Strength in Control Group

April May

Fig.11: Transition of HDS-R in Control Group

April May

Fig.12: Transition of HDS-R in Control Group Fig.12: Transition of RCPM in Control Group

April May

Fig. 15: Relationship Labia Closure Strength and RCPM in Low Level Mental Function Group


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Fig. 14: Relationship Labia Closure Strength and HDR-S in Control Group


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training using patakara for patients of dementia and … · 2016. 7. 31. · comparison of the...

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