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Morris K, Taylor NF, Freeman-Sanderson A. Safety-related outcomes for patients with a tracheostomy and the use of flexible endoscopic evaluation of swallowing (FEES) for assessment and management of swallowing: A systematic review. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2025; 27:70-80. [PMID: 38462820 DOI: 10.1080/17549507.2023.2293633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
PURPOSE The purpose of this systematic review was to examine safety-related outcomes for patients with tracheostomy after flexible endoscopic evaluation of swallowing (FEES) to assess and manage their swallow, when compared to other non-instrumental swallow assessments such as clinical swallowing examination (CSE) and/or a modified Evans blue dye test (MEBDT). METHOD Three databases were searched for articles referring to safety-related outcome data for adults with a tracheostomy, who underwent FEES and CSE and/or MEBDT. Articles were screened using predefined inclusion/exclusion criteria. RESULT The search strategy identified 2097 articles; following abstract and full-text screening, seven were included for review. The summary of evidence found low to very low certainty that FEES was associated with improved outcomes across swallow safety, physiological outcomes, tracheostomy cannulation duration, functional outcomes, and detection of upper airway pathologies. CONCLUSION This systematic review demonstrated low to very low certainty evidence from seven heterogeneous studies with low sample sizes that incorporating FEES may be associated with improved safety-related outcomes. There is less evidence supporting the accuracy of other swallow assessments conducted at the point of care (i.e. CSE and MEBDT). Future research requires studies with larger sample sizes and routine reporting of safety-related outcomes with use of FEES.
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Affiliation(s)
- Katherine Morris
- Speech Pathology Department, Eastern Health, Melbourne, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Amy Freeman-Sanderson
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
- Speech Pathology Department, Royal Prince Alfred Hospital, Sydney, Australia
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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2
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Wilson SE, Brown B, Burns CL. Clinical Swallow Examination Following Laryngectomy: An International e-Delphi Consensus Process. Dysphagia 2025:10.1007/s00455-024-10785-0. [PMID: 39838111 DOI: 10.1007/s00455-024-10785-0] [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: 07/08/2024] [Accepted: 11/07/2024] [Indexed: 01/23/2025]
Abstract
Clinical swallow examination (CSE) following laryngectomy (± pharyngeal resection) remains a critical step in dysphagia evaluation. Whilst the core components of a standard CSE service a broad spectrum of patient populations, no evidence exists examining the essential assessment items specific to CSE in the laryngectomy population. The aim of this study was to identify the tasks, measures and observations considered necessary to include in a CSE post laryngectomy. Using an e-Delphi approach, a 4-round online survey series was undertaken with 34 speech pathologists experienced in laryngectomy swallowing management from 6 countries. In the first round (item generation) participants were provided with the questions from the swallowing outcomes after laryngectomy (SOAL) as stimulus, to generate a list of tasks, measures and observations as well as clarifying questions they would ask the patient during a CSE. In the subsequent e-Delphi rounds the participants rated the importance of the compiled assessment items. A total of 34 items were rated of critical importance for inclusion in a laryngectomy CSE by ≥ 75% of participants. Two thirds of the consensus items (23 items) were patient history and interview questions incorporating medical and swallowing history (4 items) and patient interview (19 items). The remaining 11 items related to swallow tasks and observations (9 items) and onward referral (2 items). These 34 consensus items can be considered as a draft framework for laryngectomy CSE to guide clinical practice and research.
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Affiliation(s)
- Sarah E Wilson
- Speech Pathology & Audiology Department, Royal Brisbane & Women's' Hospital, Level 2, Dr James Mayne Building, Butterfield Street, Herston, Brisbane, QLD, Australia.
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
| | - Bena Brown
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Health, Brisbane, QLD, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Clare L Burns
- Speech Pathology & Audiology Department, Royal Brisbane & Women's' Hospital, Level 2, Dr James Mayne Building, Butterfield Street, Herston, Brisbane, QLD, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
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3
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Dodderi T, Flerisa LM, Fathima N, Balasubramanium RK. Assessing Swallowing and Mastication Using the Swallowing Proficiency for Eating and Drinking Protocol Among Healthy Adults. Indian J Otolaryngol Head Neck Surg 2024; 76:2590-2600. [PMID: 38883485 PMCID: PMC11169404 DOI: 10.1007/s12070-024-04575-1] [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: 01/01/2024] [Accepted: 02/19/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Objective evaluation of swallowing using single bolus consistency are popular among Speech-Language Pathologists (SLPs) but has limited generalization to other bolus consistencies. The Swallowing Proficiency for Eating and Drinking (SPEAD) test assesses the oral and pharyngeal phases of swallowing using three different consistencies. OBJECTIVES The aim of this study was to establish normative data for the SPEAD test among healthy individuals aged 20-79 years. METHOD AND MATERIALS One hundred and twelve healthy adults recruited from the community were divided into three age groups (20-39.11, 40-59.11, & 60-79.11 years). Participants swallowing 100 g of water and thickened Electral, and 6.67 g of Parle Monaco was video recorded for data analysis. RESULTS Cronbachs Alpha test indicated good to excellent internal consistency and inter-class correlation test revealed a high level of inter-rater reliability for all SPEAD parameters. Older adults exhibited a higher number of bites, chews, and swallows, and required more time to swallow compared to younger and middle adults. Similarly, speed of ingestion and SPEAD rate were lowest in older adults. SPEAD indices also showed significant differences across the three consistencies at p < 0.01. CONCLUSION In summary, the SPEAD test was found to be feasible, reliable, and valid in healthy adults of India between 20 and 79 years of age. The age and sex based normative data established in this study will enable SLPs in assessing the presence and / or absence of swallowing difficulties in the oral and pharyngeal phases across different consistencies using one test.
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Affiliation(s)
- Thejaswi Dodderi
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Luis Malvika Flerisa
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Nidha Fathima
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Radish Kumar Balasubramanium
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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Likar R, Aroyo I, Bangert K, Degen B, Dziewas R, Galvan O, Grundschober MT, Köstenberger M, Muhle P, Schefold JC, Zuercher P. Management of swallowing disorders in ICU patients - A multinational expert opinion. J Crit Care 2024; 79:154447. [PMID: 37924574 DOI: 10.1016/j.jcrc.2023.154447] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/19/2023] [Accepted: 10/10/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Dysphagia is common in intensive care unit (ICU) patients, yet it remains underrecognized and often unmanaged despite being associated with life-threatening complications, prolonged ICU stays and hospitalization. PURPOSE To propose an expert opinion for the diagnosis and management of dysphagia developed from evidence-based clinical recommendations and practitioner insights. METHODS A multinational group of dysphagia and critical care experts conducted a literature review using a modified ACCORD methodology. Based on a fusion of the available evidence and the panel's clinical experience, an expert opinion on best practice management was developed. RESULTS The panel recommends adopting clinical algorithms intended to promote standardized, high-quality care that triggers timely systematic dysphagia screening, assessment, and treatment of extubated and tracheostomized patients in the ICU. CONCLUSIONS Given the lack of robust scientific evidence, two clinical management algorithms are proposed for use by multidisciplinary teams to improve early systematic detection and effective management of dysphagia in ICU patients. Additionally, emerging therapeutic options such as neurostimulation have the potential to improve the quality of ICU dysphagia care.
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Affiliation(s)
- Rudolf Likar
- Department for Anaesthesiology and Intensive Medicine, Klinikum Klagenfurt am Wörthersee, Austria
| | - Ilia Aroyo
- Department of Neurology and Neurointensive Care Medicine, Klinikum Darmstadt, Germany
| | - Katrin Bangert
- Clinic for Intensive Care Medicine, University Hospital Hamburg, Germany
| | - Björn Degen
- Clinic for Intensive Medicine, Dysphagia Centre, Vienna, Austria
| | - Rainer Dziewas
- Department of Neurology and Neurological Rehabilitation, Klinikum Osnabrück, Osnabrück, Germany
| | - Oliver Galvan
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Markus Köstenberger
- Department for Anaesthesiology and Intensive Medicine, Klinikum Klagenfurt am Wörthersee, Austria; Department for Anaesthesiology and Intensive Care Medicine, Medical University Graz, Graz, Austria.
| | - Paul Muhle
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Germany
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Patrick Zuercher
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Bice EM, Galek KE, Ward M. Dysphagia and Diets in Skilled Nursing Facilities When Patient's Health Status Changes: The Role of Imaging. J Am Med Dir Assoc 2024; 25:381-386. [PMID: 38109943 DOI: 10.1016/j.jamda.2023.11.008] [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: 07/26/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVES Research suggests that clinical decision making for assessing and treating patients with swallowing dysfunction varies significantly, and decisions may harm patients. The study aimed to investigate clinical practice of speech-language pathologists (SLPs) assessing and treating swallowing in skilled nursing facilities (SNFs). DESIGN Retrospective review of 120 medical records of patients recommended for a flexible endoscopic evaluation of swallowing (FEES). SETTING AND PARTICIPANTS 120 SNF patients. METHODS Records from 25 SNFs were reviewed to determine which patients were receiving swallowing therapy, their diet level pre- and post-FEES, and if they received prior imaging studies. Recordings of FEES were assigned severity ratings based on the Dynamic Imaging Grade of Swallowing Toxicity-FEES scores to determine the relationship between diet and liquid recommendations before and after FEES, how often patients consume a modified diet in the absence of dysphagia, percentage of patients without dysphagia receiving swallowing treatment, percentage of patients receiving alternative means of nutrition without dysphagia, and the percentage of patients with a feeding tube without an imaging assessment. RESULTS Chi-square tests revealed no agreement between pre- and postimaging diet levels. Ordinal regressions indicated preimaging diets did not fit the DIGEST severity rating model; however, investigators found a good fit with postimaging diet recommendations. Descriptive statistics indicated that 67% of the patients receiving a modified solid and/or liquid did not have dysphagia. Treatment was provided to 100% of the patients without dysphagia. Sixty-one percent of patients with feeding tubes had no dysphagia. Forty-five percent of NPO (nothing by mouth) patients had imaging during their acute stay. CONCLUSIONS AND IMPLICATIONS The results strongly suggest that the practice of continuing acute care diet recommendations in a SNF increases cost and may negatively impact patient quality of life. The practice may also lead to negative health consequences. A new imaging assessment is required to inform treatment when medical status changes.
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Affiliation(s)
- Ed M Bice
- IOPI Medical, LLC, Woodinville, WA, USA.
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Griffin L, Kamarunas E, Smith JB, Kuo C, O'Donoghue C. Dysphonia Outperforms Voice Change as a Clinical Predictor of Dysphagia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2676-2690. [PMID: 37669615 DOI: 10.1044/2023_ajslp-23-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
PURPOSE Changes in voice quality after consuming food or drink have been used as a clinical indicator of dysphagia during the clinical swallowing evaluation (CSE); however, there is conflicting evidence of its efficacy. This study investigated if dysphonia and/or voice change after swallowing are valid predictors of penetration, aspiration, or pharyngeal residue. Our approach aimed to improve current methodologies by collecting voice samples in the fluoroscopy suite, implementing rater training to improve interrater reliability and utilizing continuous measurement scales, allowing for regression analyses. METHOD In this prospective study, 30 adults (aged 49-97 years) referred for a videofluoroscopic swallowing study (VFSS) were audio-recorded completing a sustained /i/ prior to VFSS and again after swallowing each bolus during the VFSS. Swallowing function was measured using the reorganized Penetration-Aspiration Scale and the Normalized Residue Ratio Scale. Following listener training, 84 voice samples were perceptually rated using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Ordinal and logistic regression were used to determine whether voice quality and voice quality change after swallowing were predictors of airway invasion and pharyngeal clearance. RESULTS Results indicated that the presence of dysphonia at baseline during a sustained /i/ task as measured by the CAPE-V predicted airway invasion but not pharyngeal residue. Voice change after swallowing associated with vowel /i/ production as measured by the CAPE-V did not predict either dysphagia measure. CONCLUSION These results indicate that voice change during a sustained /i/ after swallowing appears unrelated to airway invasion or pharyngeal residue; however, in the absence of known laryngeal pathology, dysphonia prior to a CSE should alert speech-language pathologists of a possible comorbid dysphagia.
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Affiliation(s)
- Lindsay Griffin
- Department of Communication Sciences & Disorders, School of Communication, Emerson College, Boston, MA
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
- Voice and Swallow Clinic, Sentara Rockingham Memorial Hospital, Harrisonburg, VA
| | - Erin Kamarunas
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
- Voice and Swallow Clinic, Sentara Rockingham Memorial Hospital, Harrisonburg, VA
| | - Julian Bergen Smith
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
- Department of Communication Disorders, College of Health and Human Services, Southern Connecticut State University, New Haven
| | - Christina Kuo
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
| | - Cynthia O'Donoghue
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
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7
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Aihara K, Inamoto Y, Saitoh E, Shibata S, Sato Y, Harada M, Otaka Y. Development and validation of a device for monitoring laryngeal motion during swallowing. Front Robot AI 2023; 10:1259257. [PMID: 38023590 PMCID: PMC10652282 DOI: 10.3389/frobt.2023.1259257] [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: 07/22/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives: Hyolaryngeal movement during swallowing is essential to airway protection and bolus clearance. Although palpation is widely used to evaluate hyolaryngeal motion, insufficient accuracy has been reported. The Bando Stretchable Strain Sensor for Swallowing (B4S™) was developed to capture hyolaryngeal elevation and display it as waveforms. This study compared laryngeal movement time detected by the B4S™ with laryngeal movement time measured by videofluoroscopy (VF). Methods: Participants were 20 patients without swallowing difficulty (10 men, 10 women; age 30.6 ± 7.1 years). The B4S™ was attached to the anterior neck and two saliva swallows were measured on VF images to determine the relative and absolute reliability of laryngeal elevation time measured on VF and that measured by the B4S™. Results: The intra-class correlation coefficient of the VF and B4S™ times was very high [ICC (1.1) = 0.980]. A Bland-Altman plot showed a strong positive correlation with a 95% confidence interval of 0.00-3.01 for the mean VF time and mean B4S™ time, with a fixed error detected in the positive direction but with no proportional error detected. Thus, the VF and B4S™ time measurements showed high consistency. Conclusion: The strong relative and absolute reliability suggest that the B4S™ can accurately detect the duration of superior-inferior laryngeal motion during swallowing. Further study is needed to develop a method for measuring the distance of laryngeal elevation. It is also necessary to investigate the usefulness of this device for evaluation and treatment in clinical settings.
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Affiliation(s)
- Keiko Aihara
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Yoko Inamoto
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Seiko Shibata
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yuriko Sato
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
| | - Maki Harada
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
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8
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Yang S, Park JW, Min K, Lee YS, Song YJ, Choi SH, Kim DY, Lee SH, Yang HS, Cha W, Kim JW, Oh BM, Seo HG, Kim MW, Woo HS, Park SJ, Jee S, Oh JS, Park KD, Jin YJ, Han S, Yoo D, Kim BH, Lee HH, Kim YH, Kang MG, Chung EJ, Kim BR, Kim TW, Ko EJ, Park YM, Park H, Kim MS, Seok J, Im S, Ko SH, Lim SH, Jung KW, Lee TH, Hong BY, Kim W, Shin WS, Lee YC, Park SJ, Lim J, Kim Y, Lee JH, Ahn KM, Paeng JY, Park J, Song YA, Seo KC, Ryu CH, Cho JK, Lee JH, Choi KH. Clinical Practice Guidelines for Oropharyngeal Dysphagia. Ann Rehabil Med 2023; 47:S1-S26. [PMID: 37501570 PMCID: PMC10405672 DOI: 10.5535/arm.23069] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one's physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. METHODS Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. RESULTS Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. CONCLUSION This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.
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Affiliation(s)
- Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jin-Woo Park
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Kyunghoon Min
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Yoon Se Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Jin Song
- Department of Occupational Therapy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Hee Choi
- Department Audiology and Speech-Language Pathology, Daegu Catholic University, Gyoungsan, Korea
| | - Doo Young Kim
- Department of Rehabilitation Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Seung Yang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji Won Kim
- Department of Otolaryngology, Inha University College of Medicine, Incheon, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Wook Kim
- Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Hee-Soon Woo
- Department of Occupational Therapy, School of Medicine, Wonkwang University, Iksan, Korea
| | - Sung-Jong Park
- Department of Speech Therapy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Ju Sun Oh
- Department of Rehabilitation Medicine, Seoul Medical Center, Seoul, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Young Ju Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Sungjun Han
- Department of Otolaryngology-Head and Neck Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - DooHan Yoo
- Department of Occupational Therapy, Konyang University, Daejeon, Korea
| | - Bo Hae Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Hyun Haeng Lee
- Deptartment of Rehabilitation Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Yeo Hyung Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Gu Kang
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae-Woo Kim
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Jae Ko
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hanaro Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Min-Su Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jungirl Seok
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University & Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Hee Lee
- Department of Gastroenterology, Konyang University College of Medicine, Daejeon, Korea
| | - Bo Young Hong
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woojeong Kim
- Deptartment of Nutrition & Food Control, Gangnam Severance Hospital, Seoul, Korea
| | - Weon-Sun Shin
- Deptartment of Food & Nutrition, College of Human Ecology, Hanyang University, Seoul, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Joon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Jeonghyun Lim
- Department of Food Service & Nutrition Care, Seoul National University Hospital, Seoul, Korea
| | - Youngkook Kim
- Department of Rehabilitation Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Kang-Min Ahn
- Department of Oral and Maxillofacial Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun-Young Paeng
- Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - JeongYun Park
- Department of Clinical Nursing, University of Ulsan, Seoul, Korea
| | - Young Ae Song
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung Cheon Seo
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, Korea
| | - Chang Hwan Ryu
- Department of Otolaryngology-Head and Neck Surgery, Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jee-Ho Lee
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kothari S, Krishnamurthy R, Balasubramanium RK, Huckabee ML. The Test of Masticating and Swallowing Solids (TOMASS): Reliability, Validity and Normative Data for the Adult Indian Population. Indian J Otolaryngol Head Neck Surg 2021; 73:327-332. [PMID: 34471621 DOI: 10.1007/s12070-021-02429-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/25/2021] [Indexed: 12/01/2022] Open
Abstract
The Test of Masticating and Swallowing Solids (TOMASS) is a reliable and well-validated tool to assess the effectiveness of solid bolus ingestion. Previous studies have established normative values for 4 to 80+ years across a range of commercially available crackers and countries. The current study aimed to establish normative data for the TOMASS across age and gender groups for a commercially available biscuit (cracker) for the adult Indian population. A total of 300 typical individuals in the age range of 21 to 80 years grouped by age and sex participated in the study. Participants were instructed to eat a commercially (locally) available biscuit 'as quickly and comfortably as possible,' and the task was video recorded. The recorded video samples were analyzed to obtain measures of the number of bites, number of masticatory cycles, number of swallows, and total time taken to complete the ingestion of biscuit. Cronbach's α values revealed a moderate to good (0.71 to 0.82) test-retest reliability; ICC values were suggestive of a high level (> 0.76) of interrater reliability for all the measures of TOMASS. The results of the one-way ANOVA revealed a significant main effect of age (F = 3.12, p < 0.01) and gender (F = 4.37, p < 0.01), but not an interaction between the two. Normative data stratified by age and gender were also generated. The TOMASS assessment procedure was feasible, reliable, and valid. In the current study, we observed that males took fewer bites, took less time, chewed less, and swallowed fewer times than females. A definitive age effect was observed for the number of bites, masticatory cycles, and total time. The normative data generated by the current study can serve as clinical benchmarks to assess the ingestion of solid bouls in the adult Indian population.
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Affiliation(s)
- Siddarth Kothari
- Department of Audiology and Speech-Language Pathology, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Rahul Krishnamurthy
- Department of Audiology and Speech-Language Pathology, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Radish Kumar Balasubramanium
- Department of Audiology and Speech-Language Pathology, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Maggie-Lee Huckabee
- Department of Communication Disorders, The Rose Centre for Stroke Recovery and Research, The University of Canterbury, Christchurch, New Zealand
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Pillay T, Pillay M. Contextualising clinical reasoning within the clinical swallow evaluation: A scoping review and expert consultation. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2021; 68:e1-e12. [PMID: 34342487 PMCID: PMC8335787 DOI: 10.4102/sajcd.v68i1.832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND This study explored the available literature on the phenomenon of clinical reasoning and described its influence on the clinical swallow evaluation. By exploring the relationship between clinical reasoning and the clinical swallow evaluation, it is possible to modernise the approach to dysphagia assessment. OBJECTIVES This study aimed to contextualise the available literature on clinical reasoning and the CSE to low-middle income contexts through the use of a scoping review and expert consultation. METHOD A scoping review was performed based on the PRISMA-ScR framework. The data was analysed using thematic analysis. Articles were considered if they discussed the clinical swallow evaluation and clinical reasoning, and were published in the last 49 years. RESULTS Through rigorous electronic and manual searching, 12 articles were identified. This review made an argument for the value of clinical reasoning within the clinical swallow evaluation. The results of the study revealed three core themes related to the acquisition, variability and positive impact of clinical reasoning in the clinical swallow evaluation. CONCLUSION The results of this review showed that the clinical swallow evaluation is a complex process with significant levels of variability usually linked to the impact of context. This demonstrates that in order to deliver effective and relevant services, despite challenging conditions, healthcare practitioners must depend on clinical reasoning to make appropriate modifications to the assessment process that considers these salient factors.
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Affiliation(s)
- Thiani Pillay
- Discipline of Speech-Language Pathology, School of Health Sciences, University of KwaZulu-Natal, Durban.
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11
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Solomon BI, Smith AC, Sinaii N, Farhat N, King MC, Machielse L, Porter FD. Association of Miglustat With Swallowing Outcomes in Niemann-Pick Disease, Type C1. JAMA Neurol 2021; 77:1564-1568. [PMID: 32897301 DOI: 10.1001/jamaneurol.2020.3241] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Niemann-Pick disease, type C1 (NPC1) is a progressive neurovisceral disease with no US Food and Drug Administration-approved therapy. Miglustat, a drug used off-label in the United States for the treatment of NPC1, appears to stabilize neurologic disease progression. Several prospective trials suggest that miglustat stabilizes oropharyngeal swallowing function; however, its effect on dysphagia and aspiration risk has not been demonstrated instrumentally. Objective To determine if miglustat therapy is associated with stabilized swallowing dysfunction in individuals with NPC1. Design, Setting, and Participants Patients with confirmed NPC1 diagnoses were evaluated in a single-center cohort study of NPC1 from April 1997 to November 2019. Longitudinal data from individuals with neurologic disease onset prior to age 15 years were analyzed. The study population was divided into those with neurologic disease onset in early childhood (age <6 years) and late childhood (age ≥6 years and <15 years). Analysis began September 2019. Exposures Oral miglustat at baseline and at follow-up. Main Outcomes and Measures Oropharyngeal swallowing function was assessed with videofluoroscopic swallowing studies. Overall swallowing ability and aspiration risk were evaluated using the American Speech-Language-Hearing Association National Outcome Measurement System swallowing domain and an adapted Rosenbek aspiration-penetration scale, respectively. Results Overall, 50 participants were evaluated at baseline (median [interquartile range] age, 9.4 [3.4-16.4] years; 26 [52%] female). The median (interquartile range) duration of follow-up was 3.0 (1.1-4.4) years. Miglustat use was associated with decreased odds of worse American Speech-Language-Hearing Association National Outcome Measurement System swallowing domain outcomes in all 3 subsets (overall: odds ratio [OR], 0.09 [95% CI, 0.02-0.36); P < .001; early childhood: OR, 0.17 [95% CI, 0.04-0.67]; P = .01; late childhood: OR, 0.05 [95% CI, 0.01-0.29]; P = .001). Miglustat use was associated with decreased odds of worse Rosenbek aspiration-penetration scale outcomes in the overall cohort (OR, 0.28 [95% CI, 0.08-0.95]; P = .04) but not in each subgroup (early childhood: OR, 0.27 [95% CI, 0.06-1.22]; P = .09; late childhood: OR, 0.38 [95% CI, 0.06-2.33]; P = .29). Conclusions and Relevance These data suggest that miglustat use is associated with stabilized swallowing function and reduced aspiration risk in NPC1, thus supporting its use in this population. In addition, these data demonstrate that a quantification of swallowing dysfunction can be used as a clinically relevant, functional outcome measure in future therapeutic trials in NPC1.
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Affiliation(s)
- Beth I Solomon
- Speech-Language Pathology Section, Rehabilitation Medicine Department, Mark O. Hatfield Clinical Center, Bethesda, Maryland
| | - Andrew C Smith
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Ninet Sinaii
- Biostatistics and Clinical Epidemiology Service, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Nicole Farhat
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Monique C King
- Speech-Language Pathology Section, Rehabilitation Medicine Department, Mark O. Hatfield Clinical Center, Bethesda, Maryland
| | - Leonza Machielse
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Forbes D Porter
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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12
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Dziewas R, Allescher HD, Aroyo I, Bartolome G, Beilenhoff U, Bohlender J, Breitbach-Snowdon H, Fheodoroff K, Glahn J, Heppner HJ, Hörmann K, Ledl C, Lücking C, Pokieser P, Schefold JC, Schröter-Morasch H, Schweikert K, Sparing R, Trapl-Grundschober M, Wallesch C, Warnecke T, Werner CJ, Weßling J, Wirth R, Pflug C. Diagnosis and treatment of neurogenic dysphagia - S1 guideline of the German Society of Neurology. Neurol Res Pract 2021; 3:23. [PMID: 33941289 PMCID: PMC8094546 DOI: 10.1186/s42466-021-00122-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies. Recommendations This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with. Conclusions The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online (https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf).
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Affiliation(s)
- Rainer Dziewas
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany. .,Klinik für Neurologie und Neurologische Frührehabilitation, Klinikum Osnabrück, Am Finkenhügel 1, 49076, Osnabrück, Germany.
| | - Hans-Dieter Allescher
- Zentrum für Innere Medizin, Klinikum Garmisch-Partenkirchen GmbH, Auenstraße 6, 82467, Garmisch-Partenkirchen, Germany
| | - Ilia Aroyo
- Klinik für Neurologie und Neurointensivmedizin, Klinikum Darmstadt, Grafenstr. 9, 64283, Darmstadt, Germany
| | | | | | - Jörg Bohlender
- Universitätsspital Zürich, ORL-Klinik, Abteilung für Phoniatrie und Klinische Logopädie, Frauenklinikstr. 24, 8091, Zürich, Schweiz
| | - Helga Breitbach-Snowdon
- Schule für Logopädie, Universitätsklinikum Münster, Kardinal-von-Galen-Ring 10, 48149, Münster, Germany
| | | | - Jörg Glahn
- Universitätsklinik für Neurologie und Neurogeriatrie, Johannes Wesling Klinikum Minden, Hans-Nolte Strasse 1, 32429, Minden, Germany
| | - Hans-Jürgen Heppner
- Private Universität Witten/Herdecke gGmbH, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Karl Hörmann
- University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christian Ledl
- Abteilung Sprach-, Sprech- und Schlucktherapie, Schön Klinik Bad Aibling SE & Co. KG, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany
| | - Christoph Lücking
- Schön Klinik München Schwabing, Parzivalplatz 4, 80804, München, Germany
| | - Peter Pokieser
- Medizinische Universität Wien, Teaching Center / Unified Patient Program, AKH Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Joerg C Schefold
- Universitätsklinik für Intensivmedizin, Inselspital, Universitätsspital Bern, 3010, Bern, Schweiz
| | | | - Kathi Schweikert
- REHAB Basel, Klinik für Neurorehabilitation und Paraplegiologie, Im Burgfelderhof 40, 4012, Basel, Schweiz
| | - Roland Sparing
- VAMED Klinik Hattingen GmbH, Rehabilitationszentrum für Neurologie, Neurochirurgie, Neuropädiatrie, Am Hagen 20, 45527, Hattingen, Germany
| | - Michaela Trapl-Grundschober
- Klinische Abteilung für Neurologie, Therapeutischer Dienst, Universitätsklinikum Tulln, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Alter Ziegelweg 10, 3430, Tulln an der Donau, Österreich
| | - Claus Wallesch
- BDH-Klinik Elzach gGmbH, Am Tannwald 1, 79215, Elzach, Germany
| | - Tobias Warnecke
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany
| | - Cornelius J Werner
- Sektion Interdisziplinäre Geriatrie, Klinik für Neurologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Johannes Weßling
- Zentrum für Radiologie, Neuroradiologie und Nuklearmedizin, Clemenskrankenhaus Münster, Düesbergweg 124, 48153, Münster, Germany
| | - Rainer Wirth
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Katholische Kliniken Rhein-Ruhr, Hölkeskampring 40, 44625, Herne, Germany
| | - Christina Pflug
- Klinik und Poliklinik für Hör-, Stimm- und Sprachheilkunde, Universitäres Dysphagiezentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Birchall O, Bennett M, Lawson N, Cotton SM, Vogel AP. Instrumental Swallowing Assessment in Adults in Residential Aged Care Homes: A Scoping Review. J Am Med Dir Assoc 2021; 22:372-379.e6. [PMID: 33069625 DOI: 10.1016/j.jamda.2020.08.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To systematically describe evidence on the use of instrumental swallowing assessment for residents of aged care homes. DESIGN Scoping review using the Joanna Briggs Institute methodology for scoping reviews. SETTING AND PARTICIPANTS Published peer-reviewed and gray literature written in English between 2000 and 2020 about instrumental swallowing assessment (ISA) in adults in residential aged care homes (RACHs). MEASURES A systematic, 3-tiered search of databases including Medline, CINAHL, Embase, Scopus, and Cochrane Database of Systematic Reviews, and gray literature databases was conducted. Content analysis identified common themes. RESULTS Forty-two sources, 30 from peer-reviewed journals, 12 gray literature publications, and 66 websites of mobile ISA providers that discussed videofluoroscopic swallowing studies (VFSS) and/or fiberoptic endoscopic evaluation of swallowing (FEES) use in RACHs were included. Most peer-reviewed sources were referenced narratives or surveys of speech pathology practice patterns (53.3%). Researchers in 3 studies used onsite mobile FEES and in 2 studies off-site VFSS, with adults living in RACHs, as part of their research design (16.7%). There were 66 mobile instrumental swallowing assessment provider websites, based within the United States. Three countries (Australia, United States, United Kingdom) had professional guidelines that stipulated minimal requirements for the safe and appropriate provision of ISA services across settings. Themes identified across sources included (1) the approach to swallowing management and clinical indicators for ISA, (2) the role of ISA, (3) service and consumer influences on ISA, and (4) mobile FEES. CONCLUSIONS AND IMPLICATIONS There is a paucity of quality research on instrumental swallowing assessment in adults living in RACHs. There are broad regional and international variances in the way that videofluoroscopy and FEES are accessed and used. A more robust evidence base is required to guide health professionals to design tailored ISA care pathways for residents of RACHs, to achieve high-quality health, social, and economic outcomes.
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Affiliation(s)
- Olga Birchall
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia; Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia.
| | - Michelle Bennett
- School of Allied Health, Australian Catholic University, North Sydney, Australia
| | - Nadine Lawson
- Speech Pathology Department, Cabrini Hospital, Malvern, Australia
| | - Susan M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia; Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; Redenlab, Melbourne, Australia
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14
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Namasivayam-MacDonald AM, Riquelme LF. Speech-Language Pathology Management for Adults With COVID-19 in the Acute Hospital Setting: Initial Recommendations to Guide Clinical Practice. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1850-1865. [PMID: 32692584 DOI: 10.1044/2020_ajslp-20-00096] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose This document outlines initial recommendations for speech-language pathology management of adult patients with COVID-19 in the acute hospital setting. Method The authors initially developed these recommendations by adapting those developed for physical therapists working with patients with COVID-19 by Thomas et al. (2020). The recommendations then underwent review by 14 speech-language pathologists and rehabilitation-focused academics representing seven countries (Belgium, Brazil, Canada, Ireland, Japan, New Zealand, the United States). The authors consolidated and reviewed the feedback in order to decide what should be included or modified. Applicability to a global audience was intended throughout the document. Results The authors had 100% agreement on the elements of the recommendations that needed to be changed/modified or added. The final document includes recommendations for speech-language pathology workforce planning and preparation, caseload management, service delivery and documentation, as well as recommendations for the selection of appropriate personal protective equipment and augmentative and alternative communication equipment in the acute care hospital setting. Conclusions Speech-language pathologists play a critical role in the assessment, management, and treatment of patients with COVID-19. Several important considerations need to be made in order to meet the needs of this unique patient population. As more is learned about the impact of the virus on swallowing and communication, the role of the speech-language pathologist on interdisciplinary care teams will remain paramount.
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Affiliation(s)
| | - Luis F Riquelme
- School of Health Sciences and Practice, New York Medical College, Valhalla, NY
- Barrique Speech-Language Pathology, PC, Brooklyn, NY
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15
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Garand KLF, McCullough G, Crary M, Arvedson JC, Dodrill P. Assessment Across the Life Span: The Clinical Swallow Evaluation. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:919-933. [PMID: 32650662 DOI: 10.1044/2020_ajslp-19-00063] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose This clinical focus article considers the roles of the clinical swallow examination (CSE) as a clinically meaningful assessment method used in both adult and pediatric populations. Method This clinical focus article explores the utility of the CSE across the life span. Specifically, components, reliability, standardized assessments, and limitations of the CSE within the adult and pediatric populations are highlighted. Conclusions The CSE remains a crucial assessment tool for the speech-language pathologist. The experienced clinician can make important judgments regarding patient safety and function. If the CSE is conducted mindfully and methodically, findings can help chart the course of care for individuals needing additional assessment and possibly intervention.
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Affiliation(s)
| | - Gary McCullough
- Department of Communication Sciences and Disorders, Appalachian State University, Boone, NC
| | - Michael Crary
- School of Communication Sciences and Disorders, University of Central Florida, Orlando
| | - Joan C Arvedson
- Department of Pediatrics, Children's Hospital of Wisconsin, Medical College of Wisconsin-Milwaukee
| | - Pamela Dodrill
- Department of Otolaryngology, Boston Children's Hospital Boston, MA
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16
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Birchall O, Bennett M, Lawson N, Cotton S, Vogel AP. Fiberoptic endoscopic evaluation of swallowing and videofluoroscopy swallowing assessment in adults in residential care facilities: a scoping review protocol. JBI Evid Synth 2020; 18:599-609. [PMID: 32197020 DOI: 10.11124/jbisrir-d-19-00015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This scoping review will identify and explore existing evidence on the use of instrumental swallowing assessment in the diagnosis and management of dysphagia in adults living in residential care facilities. INTRODUCTION Oropharyngeal dysphagia is prevalent among adults living in residential care facilities. Videofluoroscopy and fiberoptic endoscopic evaluation of swallowing are instrumental assessment procedures commonly utilized in the evaluation of oropharyngeal dysphagia in hospital and community settings. However, little is known about the use of these procedures in residential care facilities. To ensure evidence-based assessment of oropharyngeal dysphagia and to guide future research, exploration of the current use and clinical utility of videofluoroscopy and fiberoptic endoscopic evaluation of swallowing in residential care facilities is needed. INCLUSION CRITERIA Published and gray literature written in English from 2000 onward that discusses instrumental swallowing assessment of adults in residential care facilities will be included in the review. METHODS A three-step search strategy will be used to explore relevant literature. All citations and articles retrieved during the searches will be imported into a software application for systematic reviews. Once duplicates are removed, two reviewers will screen the titles and abstracts against predefined inclusion criteria. Information will be extracted from literature that meets the selection criteria using a purposefully developed charting form. The search strategy and results will be illustrated through a Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram. Key findings and their relationship to the research questions will be summarized in a chart and discussed in interpretive narrative form.
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Affiliation(s)
- Olga Birchall
- Centre for Neurosciences of Speech, The University of Melbourne, Melbourne, Australia
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia
| | - Michelle Bennett
- School of Allied Health, Australian Catholic University, North Sydney, Australia
| | - Nadine Lawson
- Speech Pathology Department, Cabrini Hospital, Malvern, Australia
| | - Susan Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Adam P Vogel
- Centre for Neurosciences of Speech, The University of Melbourne, Melbourne, Australia
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Redenlab, Melbourne, Australia
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Duncan DR, Growdon AS, Liu E, Larson K, Gonzalez M, Norris K, Rosen RL. The Impact of the American Academy of Pediatrics Brief Resolved Unexplained Event Guidelines on Gastrointestinal Testing and Prescribing Practices. J Pediatr 2019; 211:112-119.e4. [PMID: 31103259 PMCID: PMC6984037 DOI: 10.1016/j.jpeds.2019.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To determine if hospitalization, testing, diagnosis, and management of suspected gastroesophageal reflux, and follow-up visits decreased since introduction of American Academy of Pediatrics guidelines for brief resolved unexplained events (BRUEs). STUDY DESIGN We performed a retrospective cohort study of infants with BRUE evaluated at Boston Children's Hospital in the year before and after guideline implementation to determine if practice patterns have changed. Outcomes included hospitalization rates, frequency of swallow assessments, other diagnostic testing, and reflux diagnoses, cost of care, and number of repeat visits. Groups were compared based on whether they presented before or after guideline implementation. RESULTS In total, 359 subjects (186 pre-, 173 post-guidelines) were identified. There were no significant differences in practice patterns or outcomes before or after guideline implementation. Subjects had mean age 2.53 ± 0.15 months, and 80% were hospitalized for 2.49 ± 0.26 days. Each subject had 2.47 diagnostic tests performed, and 89% were noncontributory. Despite only 13% having videofluoroscopic swallow study performed, 72% showed aspiration/penetration. No subject had gastroesophageal reflux testing, yet reflux was implicated as the cause for admission in 40% of subjects, resulting in increased odds of discharge on acid suppressing medications (OR 2.88, 95% CI 1.68-4.92, P = .0001). In follow-up, 28% of subjects had repeat hospitalizations or emergency department visits for persistent symptoms. CONCLUSIONS Infants with BRUE continue to undergo low-yield diagnostic testing and after admission remain symptomatic and frequently re-present to medical care. Swallow testing remains infrequent despite its high-yield, reflux continues to be implicated and children are still being discharged on acid suppression despite lack of efficacy.
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Affiliation(s)
- Daniel R Duncan
- Aerodigestive Center, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA
| | - Amanda S Growdon
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA
| | - Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA
| | - Kara Larson
- Aerodigestive Center, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA
| | - Madeline Gonzalez
- Department of Reimbursement and Decision Support, Boston Children's Hospital, Boston, MA
| | - Kerri Norris
- Department of Reimbursement and Decision Support, Boston Children's Hospital, Boston, MA
| | - Rachel L Rosen
- Aerodigestive Center, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA.
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18
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Preliminary design and validation of the “6-K-scale” for bulbar symptoms evaluation in SBMA. Neurol Sci 2019; 40:1393-1401. [DOI: 10.1007/s10072-019-03850-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/14/2019] [Indexed: 12/13/2022]
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Varindani Desai R. Build a Case For Instrumental Swallowing Assessments in Long-Term Care. ACTA ACUST UNITED AC 2019. [DOI: 10.1044/leader.otp.24032019.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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20
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Toscano M, Viganò A, Rea A, Verzina A, Sasso D'Elia T, Puledda F, Longo L, Mancini V, Ruggiero M, Jannini TB, Giuliani G, Albino F, Altieri M, Vicenzini E, Fattapposta F, Pauri F, Giacomini P, Ruoppolo G, Di Piero V. Sapienza Global Bedside Evaluation of Swallowing after Stroke: the GLOBE-3S study. Eur J Neurol 2018; 26:596-602. [PMID: 30414300 DOI: 10.1111/ene.13862] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 11/06/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Dysphagia occurs in up to 50% of all patients with acute stroke. There is debate regarding which is the most effective screening tool in identifying aspiration in patients with acute stroke. We assessed the accuracy of the Sapienza Global Bedside Evaluation of Swallowing after Stroke (GLOBE-3S), which combines the Toronto Bedside Swallowing Screening Test (TOR-BSST©) with oxygen desaturation and laryngeal elevation measurement during swallowing. METHODS We prospectively enrolled consecutive patients with stroke within 72 h of symptom onset. All patients with stroke firstly underwent a standard neurological examination, then the GLOBE-3S evaluation and finally the fiberoptic endoscopic evaluation of swallowing (FEES). Two different assessors, a neurologist and a speech pathologist, blind to both the clinical data and each other's evaluation, administered the GLOBE-3S and FEES examination. We assessed the accuracy of the GLOBE-3S in detecting post-stroke swallow impairment with aspiration using the FEES as the standard. RESULTS We enrolled 50 patients with acute stroke, 28 of whom (56%) had swallowing impairment with aspiration at FEES evaluation. A total of 33 patients (66%) failed the GLOBE-3S evaluation. The GLOBE-3S reached a sensitivity of 100% and a specificity of 77.3% (negative predictive value, 100%; positive likelihood ratio, 4.34). The median time required for the GLOBE-3S to be performed was 297 s. CONCLUSIONS GLOBE-3S is quick to perform at the bedside and can accurately identify aspiration in patients with acute stroke. By including the measurement of laryngeal elevation and monitoring of oxygen desaturation, it could represent a highly sensitive instrument to avoid the misdiagnosis of silent aspirators.
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Affiliation(s)
- M Toscano
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy.,Department of Neurology, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - A Viganò
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy.,Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, 'Sapienza' University of Rome, Rome, Italy
| | - A Rea
- Department of Sensorial Organs, 'Sapienza' University of Rome, Rome, Italy
| | - A Verzina
- Neurology Clinic, University of Perugia - Perugia General Hospital, Perugia, Italy
| | - T Sasso D'Elia
- Physical Medicine and Rehabilitation Division, 'Sapienza' University of Rome, Rome, Italy
| | - F Puledda
- Institute of Psychiatry, Psychology and Neuroscience, King's College of London, London, UK
| | - L Longo
- Department of Sensorial Organs, 'Sapienza' University of Rome, Rome, Italy
| | - V Mancini
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - M Ruggiero
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - T B Jannini
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - G Giuliani
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - F Albino
- Department of Sensorial Organs, 'Sapienza' University of Rome, Rome, Italy
| | - M Altieri
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - E Vicenzini
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
| | - F Fattapposta
- Department of Sensorial Organs, 'Sapienza' University of Rome, Rome, Italy
| | - F Pauri
- Department of Sensorial Organs, 'Sapienza' University of Rome, Rome, Italy
| | - P Giacomini
- Department of Sensorial Organs, 'Sapienza' University of Rome, Rome, Italy
| | - G Ruoppolo
- Department of Sensorial Organs, 'Sapienza' University of Rome, Rome, Italy
| | - V Di Piero
- Department of Human Neuroscience, 'Sapienza' University of Rome, Rome, Italy
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Duncan DR, Mitchell PD, Larson K, Rosen RL. Presenting Signs and Symptoms do not Predict Aspiration Risk in Children. J Pediatr 2018; 201:141-146. [PMID: 29960768 PMCID: PMC6412137 DOI: 10.1016/j.jpeds.2018.05.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/02/2018] [Accepted: 05/16/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To determine if any presenting symptoms are associated with aspiration risk, and to evaluate the reliability of clinical feeding evaluation (CFE) in diagnosing aspiration compared with videofluoroscopic swallow study (VFSS). STUDY DESIGN We retrospectively reviewed records of children under 2 years of age who had evaluation for oropharyngeal dysphagia by CFE and VFSS at Boston Children's Hospital and compared presenting symptoms, symptom timing, and CFE and VFSS results. We investigated the relationship between symptom presence and aspiration using the Fisher exact test and stepwise logistic regression with adjustment for comorbidities. CFE and VFSS results were compared using the McNemar test. Intervals from CFE to VFSS were compared using the Student t test. RESULTS A total of 412 subjects with mean (±SD) age 8.9 ± 6.9 months were evaluated. No symptom, including timing relative to meals, predicted aspiration on VFSS. This lack of association between symptoms and VFSS results persisted even in the adjusted multivariate model. The sensitivity of CFE for predicting aspiration by VFSS was 44%. Patients with a reassuring CFE waited 28.2 ± 8.5 days longer for confirmatory VFSS compared with those with a concerning CFE (P < .05). CONCLUSIONS Presenting symptoms are varied in patients with aspiration and cannot be relied upon to determine which patients have aspiration on VFSS. The CFE does not have the sensitivity to consistently diagnose aspiration so a VFSS should be performed in persistently symptomatic patients.
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Affiliation(s)
- Daniel R. Duncan
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Paul D. Mitchell
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA
| | - Kara Larson
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Rachel L. Rosen
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
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22
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Brates D, Molfenter SM, Thibeault SL. Assessing Hyolaryngeal Excursion: Comparing Quantitative Methods to Palpation at the Bedside and Visualization During Videofluoroscopy. Dysphagia 2018; 34:298-307. [PMID: 30043080 DOI: 10.1007/s00455-018-9927-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/17/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Hyolaryngeal excursion (HE) is typically assessed via palpation during clinical swallowing exams (CSE) or visually during videofluoroscopy (VFSS). Minimal evidence exists to support the use of these perceptual methods for judging HE. We investigated whether binary judgment of HE differentiates quantitative measures of hyoid movement, using frame-by-frame VFSS analysis to measure anatomically scaled peak hyoid positions. METHODS Medical records of patients who received a CSE and VFSS within a 24-h period were reviewed. Clinician ratings of HE ('reduced' or 'normal') were collected from CSE and VFSS reports, along with rater experience. Five ml puree swallows were extracted from each VFSS for randomized, blinded analysis. Peak hyoid position from C4 was captured in anterior, superior, and hypotenuse positions and expressed relative to C2-C4 length. T-test comparisons of hyoid positions between patients judged to have reduced versus normal HE on palpation and VFSS were conducted. RESULTS Eighty-seven patients (56 male, mean age 61) met criteria. Peak anterior hyoid position was significantly different between patients judged to have reduced (mean = 89.2% C2-C4) and normal (mean = 110.6% C2-C4) HE on palpation (p = 0.001). Further analysis revealed no effect of clinician experience on differentiation of objective measures based on palpation. No differences were found across any objective measures when compared to clinician VFSS ratings. CONCLUSIONS Clinicians appeared to be able to differentiate peak anterior hyoid movement but not superior or hypotenuse movement on palpation. On VFSS visualization, no significant differences were found between swallows judged to have reduced versus normal HE in any directional dimension. While perceptual methods may contribute to clinical decision-making, clinicians should remain cautious when making judgments about HE using these methods.
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Affiliation(s)
- Danielle Brates
- Department of Communicative Sciences and Disorders, NYU Steinhardt, 665 Broadway, 9th Floor, New York, NY, 10012, USA.,Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Wisconsin Institutes for Medical Research (WIMR), BLDG. 1485, 1111 Highland Avenue, Madison, WI, 53705-2275, USA
| | - Sonja M Molfenter
- Department of Communicative Sciences and Disorders, NYU Steinhardt, 665 Broadway, 9th Floor, New York, NY, 10012, USA
| | - Susan L Thibeault
- Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Wisconsin Institutes for Medical Research (WIMR), BLDG. 1485, 1111 Highland Avenue, Madison, WI, 53705-2275, USA.
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23
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Britton D, Karam C, Schindler JS. Swallowing and Secretion Management in Neuromuscular Disease. Clin Chest Med 2018; 39:449-457. [DOI: 10.1016/j.ccm.2018.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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24
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Reasoning and Decision Making in Clinical Swallowing Examination. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0191-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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25
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Checklin M, Pizzari T. Impaired Tongue Function as an Indicator of Laryngeal Aspiration in Adults with Acquired Oropharyngeal Dysphagia: A Systematic Review. Dysphagia 2018; 33:778-788. [DOI: 10.1007/s00455-018-9902-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 04/19/2018] [Indexed: 01/03/2023]
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26
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Nakamura Y, Iriarte-Diaz J, Arce-McShane F, Orsbon CP, Brown KA, Eastment M, Avivi-Arber L, Sessle BJ, Inoue M, Hatsopoulos NG, Ross CF, Takahashi K. Sagittal Plane Kinematics of the Jaw and Hyolingual Apparatus During Swallowing in Macaca mulatta. Dysphagia 2017; 32:663-677. [PMID: 28528492 PMCID: PMC5767546 DOI: 10.1007/s00455-017-9812-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 05/11/2017] [Indexed: 11/28/2022]
Abstract
Studies of mechanisms of feeding behavior are important in a society where aging- and disease-related feeding disorders are increasingly prevalent. It is important to evaluate the clinical relevance of animal models of the disease and the control. Our present study quantifies macaque hyolingual and jaw kinematics around swallowing cycles to determine the extent to which macaque swallowing resembles that of humans. One female and one male adult Macaca mulatta were trained to feed in a primate chair. Videofluoroscopy was used to record kinematics in a sagittal view during natural feeding on solid food, and the kinematics of the hyoid bone, thyroid cartilage, mandibular jaw, and anterior-, middle-, and posterior-tongue. Jaw gape cycles were defined by consecutive maximum gapes, and the kinematics of the swallow cycles were compared with those of the two consecutive non-swallow cycles preceding and succeeding the swallow cycles. Although there are size differences between macaques and humans, and macaques have shorter durations of jaw gape cycles and hyoid and thyroid upward movements, there are several important similarities between our macaque data and human data reported in the literature: (1) The durations of jaw gape cycles during swallow cycles are longer than those of non-swallow cycles as a result of an increased duration of the jaw-opening phase; (2) Hyoid and thyroid upward movement is linked with a posterior tongue movement and is faster during swallow than non-swallow cycles; (3) Tongue elevation propagates from anterior to posterior during swallow and non-swallow cycles. These findings suggest that macaques can be a useful experimental model for human swallowing studies.
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Affiliation(s)
- Yuki Nakamura
- Department of Organismal Biology and Anatomy, University of Chicago, 1025 E 57th St. Culver Rm 206, Chicago, IL, 60637, USA.
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Jose Iriarte-Diaz
- Department of Oral Biology, University of Illinois at Chicago College of Dentistry, Chicago, IL, USA
| | - Fritzie Arce-McShane
- Department of Organismal Biology and Anatomy, University of Chicago, 1025 E 57th St. Culver Rm 206, Chicago, IL, 60637, USA
| | - Courtney P Orsbon
- Department of Organismal Biology and Anatomy, University of Chicago, 1025 E 57th St. Culver Rm 206, Chicago, IL, 60637, USA
| | - Kevin A Brown
- Center for Neural Science, New York University, New York, NY, USA
| | - McKenna Eastment
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | | | - Barry J Sessle
- Department of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Nicholas G Hatsopoulos
- Department of Organismal Biology and Anatomy, University of Chicago, 1025 E 57th St. Culver Rm 206, Chicago, IL, 60637, USA
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL, USA
| | - Callum F Ross
- Department of Organismal Biology and Anatomy, University of Chicago, 1025 E 57th St. Culver Rm 206, Chicago, IL, 60637, USA
| | - Kazutaka Takahashi
- Department of Organismal Biology and Anatomy, University of Chicago, 1025 E 57th St. Culver Rm 206, Chicago, IL, 60637, USA.
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