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Picó Munyoz R, Tárrega A, Laguna L. Exploring the impact of bubble type on sensory stimulation in drinks. Physiol Behav 2024; 286:114656. [PMID: 39111644 DOI: 10.1016/j.physbeh.2024.114656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 08/02/2024] [Accepted: 08/05/2024] [Indexed: 08/30/2024]
Abstract
This study explores the impact of various types of carbonation on sensory stimulation in the mouth, salivary secretion and the neurotransmitter substance P (SP), as well as body responses such as heart rate (HR) and Galvanic Skin Response (GSR). Three types of carbonation (one made using a soda machine, another carbonated with a gasifier, and the last commercial sparkling water) were used to produce different bubbles resulting in distinct sensory characteristics assessed by a trained panel. The impact of carbonation was measured by recording changes in salivary flow rate, SP levels, salivary secretory immunoglobulin A (SIgA), HR, and GSR in fifteen healthy participants. The results showed that the bubble type only affected the sensory perception of carbonation. Regardless of bubble type, carbonation increased salivary flow rate and SP values, SigA and HR. These characteristics are being sought to improve treatments for dysphagia or dry mouth. Therefore, these findings highlight the potential therapeutic application of carbonation in these situations.
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Affiliation(s)
- Ruth Picó Munyoz
- Consumer Perception and Behavior and Adapted Nutrition Laboratory, Institute of Agrochemistry and Food Technology (IATA, CSIC), Paterna, Spain
| | - Amparo Tárrega
- Consumer Perception and Behavior and Adapted Nutrition Laboratory, Institute of Agrochemistry and Food Technology (IATA, CSIC), Paterna, Spain
| | - Laura Laguna
- Consumer Perception and Behavior and Adapted Nutrition Laboratory, Institute of Agrochemistry and Food Technology (IATA, CSIC), Paterna, Spain.
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Iwamori H, Magara J, Onuki W, Ita R, Sasa A, Tsujimura T, Inoue M. Effect of carbonation and thickening on voluntary swallow in healthy humans. J Oral Rehabil 2024; 51:2043-2051. [PMID: 38978272 DOI: 10.1111/joor.13793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 05/21/2024] [Accepted: 06/17/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Liquid modification is a widely established strategy of treatment for patients with dysphagia. The modification of liquid particularly by thickening or carbonation is a common approach to promote safe swallowing. OBJECTIVE This study sought to investigate how carbonated and/or thickened water modulates swallowing behaviours during swallowing in healthy young individuals. METHODS Thirty-one healthy volunteers (9 men, 22 women; mean age ± standard deviation [SD], 25.7 ± 6.2 years) were instructed to swallow 20 mL of water, carbonated water and carbonated juice with and without added thickening agent. Electromyograms (EMGs) of the suprahyoid (S-hyo) muscles were recorded to evaluate swallowing behaviours. Obtained S-hyo EMG bursts was analysed using the following outcome parameters: onset latency, the time between swallowing que to onset of EMG burst; rising time and falling time, defined as the time between onset and peak, and between peak and offset, respectively; duration, defined as the time between onset and offset of EMG burst; and area integral value under the waveform. RESULTS Effects of thickening demonstrated the extended onset latency, EMG burst duration including falling time and the larger area of EMG in thickened liquid compared to thin liquid, but there was not much difference between thin and thickened carbonated liquids. Carbonation significantly decreased the duration including falling time for thickened but not for thin liquids. CONCLUSION Patients with dysphagia can benefit from use of carbonated or thickened water while the effects on swallowing physiology may differ between carbonation and thickening.
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Affiliation(s)
- Hajime Iwamori
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Department of Health and Nutrition Faculty of Health Science, Niigata University of Health and Welfare, Niigata, Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Unit of Dysphagia Rehabilitation, Niigata University Medical & Dental Hospital, Niigata, Japan
| | - Wakana Onuki
- Unit of Dysphagia Rehabilitation, Niigata University Medical & Dental Hospital, Niigata, Japan
| | - Reiko Ita
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Anna Sasa
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Unit of Dysphagia Rehabilitation, Niigata University Medical & Dental Hospital, Niigata, Japan
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Li K, Fu C, Xie Z, Zhang J, Zhang C, Li R, Gao C, Wang J, Xue C, Zhang Y, Deng W. The impact of physical therapy on dysphagia in neurological diseases: a review. Front Hum Neurosci 2024; 18:1404398. [PMID: 38903410 PMCID: PMC11187312 DOI: 10.3389/fnhum.2024.1404398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024] Open
Abstract
A neurogenic dysphagia is dysphagia caused by problems with the central and peripheral nervous systems, is particularly prevalent in conditions such as Parkinson's disease and stroke. It significantly impacts the quality of life for affected individuals and causes additional burdens, such as malnutrition, aspiration pneumonia, asphyxia, or even death from choking due to improper eating. Physical therapy offers a non-invasive treatment with high efficacy and low cost. Evidence supporting the use of physical therapy in dysphagia treatment is increasing, including techniques such as neuromuscular electrical stimulation, sensory stimulation, transcranial direct current stimulation, and repetitive transcranial magnetic stimulation. While initial studies have shown promising results, the effectiveness of specific treatment regimens still requires further validation. At present, there is a lack of scientific evidence to guide patient selection, develop appropriate treatment regimens, and accurately evaluate treatment outcomes. Therefore, the primary objectives of this review are to review the results of existing research, summarize the application of physical therapy in dysphagia management, we also discussed the mechanisms and treatments of physical therapy for neurogenic dysphagia.
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Affiliation(s)
- Kun Li
- Shandong Daizhuang Hospital, Jining, China
| | - Cuiyuan Fu
- Shandong Daizhuang Hospital, Jining, China
| | - Zhen Xie
- Shandong Daizhuang Hospital, Jining, China
| | - Jiajia Zhang
- Department of Psychology, Xinxiang Medical University, Xinxiang, China
| | | | - Rui Li
- Shandong Daizhuang Hospital, Jining, China
| | | | | | - Chuang Xue
- Affiliated Mental Health Center and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Wei Deng
- Affiliated Mental Health Center and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-Machine Intelligence, Zhejiang University, Hangzhou, China
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Morishita M, Sota J, Kobayashi M. Effects of carbonated beverages on sustained swallowing behavior changes in older inpatients. Physiol Behav 2023; 265:114172. [PMID: 36965570 DOI: 10.1016/j.physbeh.2023.114172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/23/2022] [Accepted: 03/21/2023] [Indexed: 03/27/2023]
Abstract
Sensory stimulation, including stimulation with carbonated liquids, has been known to influence swallowing activity. The aim of this study is to determine the effect of sustained changes in the swallowing behavior of hospitalized patients without dysphagia using the cervical auscultatory recordings of swallowing sounds. The study participants were hospitalized older adults without dysphagia. The participants were asked to initially swallow water and then a carbonated beverage. The sustained effects of the carbonated beverage in relation to swallowing movements were evaluated by measuring the swallowing sounds at the following time periods: (1) immediately and (2) at 1 to 9 minutes with intervals of 2 minutes after swallowing the carbonated beverage. The swallowing sounds before and after swallowing the same volume of water were also measured and compared on a different day. Analysis was performed to calculate the time from a sound signal to the beginning of the swallowing sound. Significant shortening of the swallowing sound time of the late pharyngeal phase was observed up to 7 minutes after swallowing the carbonated beverage, except during the 3 minutes after swallowing. Shortening of the whole swallowing sound time was observed only immediately after swallowing the carbonated beverage. Regarding the shortening of the acoustic signal in the late pharyngeal period, the effect of cerebral excitability changes due to carbonic acid stimulation was considered.
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Affiliation(s)
- Motoyoshi Morishita
- Department of Physical Therapy, Kibi International University, 8, Iga-machi, Takahashi, Okayama 716-8508, Japan.
| | - Junya Sota
- Rehabilitation Center, Watanabe Hospital, Shiseikai Medical Corporation, 2278-1, Takao, Niimi, Okayama 718-0003, Japan
| | - Mariko Kobayashi
- Rehabilitation Center, Watanabe Hospital, Shiseikai Medical Corporation, 2278-1, Takao, Niimi, Okayama 718-0003, Japan
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Price K, Isbister G, Long S, Mirams J, Smithard D. Are Bubbles the Future of Dysphagia Rehabilitation: A Systematic Review Analysing Evidence on the Use of Carbonated Liquids in Dysphagia Rehabilitation. Geriatrics (Basel) 2023; 8:geriatrics8010006. [PMID: 36648911 PMCID: PMC9844419 DOI: 10.3390/geriatrics8010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Dysphagia poses a huge health issue in our ageing population, impacting patients psychologically and through risk of aspiration, malnutrition and airway obstruction. The use of carbonated liquids to provide sensory enhancement as a tool to stimulate neuromuscular activity in dysphagia rehabilitation remains an area with limited research. This article reviews current evidence. METHOD A data search of PubMed, CINAHL, EMBASE and Cochrane was undertaken with set search terms. Abstracts were reviewed and selected by two clinicians according to inclusion criteria and papers were assessed using PRISMA methodology. RESULTS Selected publications (1992-2022) involved a median of 23 participants with predominantly neurogenic dysphagia. Despite the differences in study designs all used videofluroscopy (VF) to assess outcome measures except Morishita et al. who used fiberoptic endoscopic evaluation of swallow (FEES). The studies were small scale but showed encouraging results. However, there was heterogeneity between results of specific outcome measures. One study surveyed taste which was overall positively received. CONCLUSIONS There continues to remain limited evidence to direct the use of carbonated liquids in rehabilitation of dysphagia, however its role shows some promise. The heterogeneity of not just study designs but also study participants seems to be a primary barrier. Whilst evidence is encouraging, further prospective studies standardising patient cohorts, methodologies and quantitative outcome measures must be carried out. Longitudinal studies to look at the role of carbonated liquids in secretion management is another area of potential interest. In conclusion the use of carbonated liquid in dysphagia rehabilitation may have a potential role but without firm evidence-based research, successful use in clinical practice cannot be implemented.
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Affiliation(s)
- Kathryn Price
- King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Grace Isbister
- Guy’s and St Thomas NHS Foundation Trust, London SE1 7EH, UK
| | - Susannah Long
- Guy’s and St Thomas NHS Foundation Trust, London SE1 7EH, UK
| | | | - David Smithard
- Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London SE9 4QH, UK
- Centre for Exercise and Active Rehabilitation, University of Greenwich, London SE9 2HB, UK
- Correspondence: ; Tel.: +44-020-836-64988
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Effects of thickened carbonated cola in older patients with dysphagia. Sci Rep 2022; 12:22151. [PMID: 36550151 PMCID: PMC9780357 DOI: 10.1038/s41598-022-25926-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Carbonated beverages initiate the swallowing reflex earlier than water and have a shorter pharyngeal transit time. However, the effects of carbonation in thickened beverages of the same flavor on swallowing dynamics have not been reported. Therefore, we investigated the effects of thickened carbonated beverages on swallowing in patients with dysphagia by comparing the swallowing dynamics between thickened carbonated and thickened non-carbonated beverages. We enrolled 38 patients with dysphagia and divided them into two groups. Thickened carbonated and thickened non-carbonated beverages were used. Videoendoscopic swallowing evaluations were performed. Aspiration, penetration, pharyngeal residue, and initiation position of the swallowing reflex were evaluated. The reduction in the amount of residue in both the vallecula (p = 0.007) and pyriform sinus (p = 0.004) was greater after ingestion of thickened carbonated cola than thickened non-carbonated cola. The onset of the swallowing reflex was significantly earlier after ingestion of thickened carbonated cola than thickened non-carbonated cola (p = 0.007). There were no significant differences in the extent of penetration. Thickened carbonated beverages positively affected swallowing compared with thickened non-carbonated beverages. Thus, the use of thickened carbonated beverages may be helpful for patients with dysphagia.
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Morishita M, Okubo M, Sekine T. Effects of Carbonated Thickened Drinks on Pharyngeal Swallowing with a Flexible Endoscopic Evaluation of Swallowing in Older Patients with Oropharyngeal Dysphagia. Healthcare (Basel) 2022; 10:healthcare10091769. [PMID: 36141382 PMCID: PMC9498686 DOI: 10.3390/healthcare10091769] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 11/30/2022] Open
Abstract
This study aimed to determine the efficacy of carbonated and sweetened drinks added to thickened liquids, which are routinely used for patients with dysphagia to improve dysphagia. Patients swallowed thin liquid (Thin), thickened liquid (Thick), carbonated thin drink (C-Thin), and carbonated thickened drink (C-Thick) in random order. Penetration and/or aspiration were scored using the Penetration−Aspiration Scale (PAS). The residue was scored using the Yale Pharyngeal Residue Severity Rating Scale (YPR-SRS). Swallowing reflex initiation was scored using the Hyodo score. The subjective difficulty of swallowing was scored on a face scale. We analyzed 13 patients with a mean age of 79.6 ± 9.6 years. PAS was significantly lower in the C-Thick group than the Thin group (p < 0.05). Swallowing reflex initiation was significantly different between the Thin and Thick (p < 0.01) groups; moreover, post hoc analysis revealed that it was significantly lower in the C-Thick group than the Thin group (p < 0.01). The subjective difficulty of swallowing in the C-Thick was significantly lower than the Thick group (p < 0.05). C-Thick was easier to swallow than Thick and may improve penetration and/or aspiration in older patients with dysphagia with complex diseases.
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Affiliation(s)
- Motoyoshi Morishita
- Department of Physical Therapy, Kibi International University, 8, Iga-machi, Takahashi 716-8508, Okayama, Japan
- Correspondence: (M.M.); (M.O.)
| | - Masahiko Okubo
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Saitama Medical University, 38, Morohongo, Moroyama-machi 350-0475, Saitama, Japan
- Department of Dentistry, Yokohama Izumidai Hospital, 7838, Izumi-cho, Izumi-ku, Yokohama 245-0016, Kanagawa, Japan
- Correspondence: (M.M.); (M.O.)
| | - Tatsuro Sekine
- Department of Otolaryngology, Faculty of Medicine, Saitama Medical University, 38, Morohongo, Moroyama-machi 350-0475, Saitama, Japan
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