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Yang QL, Chen Y, Wang XJ, Qiu HY, Chen MT, Zhou XH, Jian CY, Zhao SF. Correlation between lesion location and dysphagia characteristics in post-stroke patients. J Stroke Cerebrovasc Dis 2024; 33:107682. [PMID: 38522758 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107682] [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: 11/28/2023] [Revised: 02/28/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVE To assess the correlation between lesion location and swallowing function characteristics in post-stroke dysphagia (PSD) patients. MATERIALS AND METHODS We enrolled 133 PSD. The patients were divided into supratentorial and infratentorial stroke groups. We compared the measurements in the videofluoroscopic swallowing study (VFSS) with 3ml and 5 ml of diluted and thickened barium liquid data between supratentorial and brainstem stroke groups. We further compared the difference of VFSS measurements between patients with left hemispheric or right hemispheric lesions (further divided into unilateral hemispheric cortical and subcortical subgroups) and brianstem leison stroke group.To explore the lesion location's effect on different bolus volume, the VFSS measurements of 3ml and 5ml in each subgroups were compared respectively. The measurements of VFSS included the oral transit time, soft palate elevation duration, hyoid bone movement duration (HMD), UES opening duration, pharyngeal transit duration (PTD), stage of ansition duration, and laryngeal closure duration (LCD), the upper esophageal sphincter opening (UESO), hyoid bone superior horizontal displacement, and hyoid bone anterior horizontal displacement. General swallowing function was assessed using the Penetration Aspiration Scale (PAS) and Functional Oral Intake Scale (FOIS). We performed the paired t-test, Spearman's correlation, and Kruskal-Wallis test analysis to characterize the parameters among the groups. RESULTS Fifty-eight patients were assessed in the final analysis. The HMD (p = 0.019), PTD (p = 0.048) and LCD (p = 0.013) were significantly different between the supratentorial and brainstem lesion groups in 5ml volume. The HMD was significantly different (p = 0.045) between the left cortical and brainstem lesion groups. Significant differences in the HMD (p = 0.037) and LCD (p = 0.032) between the left subcortical and brainstem lesion groups were found in 5ml volume bolus. There was no group different when taking the 3ml volume bolus. Regarding the relationship between food bolus volume and swallowing functions, only the UESO demonstrated a significant difference in the subcortical lesion of the right hemisphere (p = 0.0032) compared the 3 ml and 5 ml volume bolus. The PTD demonstrated a moderate correlation with the PAS scores (r = 0.38, p = 0.0044). The HMD (r = 0.32, p = 0.018) and LCD (r = 0.29, p = 0.039) demonstrated weak correlations with the PAS scores. We did not identify any correlation between the VFSS parameters and FOIS scores in each subgroup level. CONCLUSION The PSD with brainstem lesion shows more sever dysfunction in the pharyngeal phases. The left hemisphere was engaged in both the oral and pharyngeal phases. Lesions in the bilateral cortical, subcortical, and brainstem regions may impair sensory input.
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Affiliation(s)
- Qing-Lu Yang
- Department of Rehabilitation Medicine, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Yang Chen
- Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Xue-Jie Wang
- Department of Rehabilitation Medicine, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Hui-Ying Qiu
- Department of Rehabilitation Medicine, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Meng-Ting Chen
- Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Xu-Hui Zhou
- Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Chu-Yao Jian
- Department of Rehabilitation Medicine, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Shao-Feng Zhao
- Department of Rehabilitation Medicine, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.
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Garand KL(F, Armeson K, Hill EG, Blair J, Pearson W, Martin-Harris B. Quantifying Oropharyngeal Swallowing Impairment in Response to Bolus Viscosity. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:460-467. [PMID: 37902448 PMCID: PMC11001168 DOI: 10.1044/2023_ajslp-23-00082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/28/2023] [Accepted: 09/10/2023] [Indexed: 10/31/2023]
Abstract
PURPOSE The purpose of this study was to test the feasibility for quantifying changes in oropharyngeal swallowing impairment in response to alteration in bolus viscosity using a reliable and valid method of observational measurement-the Modified Barium Swallow Impairment Profile (MBSImP). METHOD This retrospective analysis included a heterogeneous cohort of 119 patients with suspected dysphagia that underwent a videofluoroscopic swallowing study as part of clinical care. Using consensus scoring, two expert clinicians assigned MBSImP scores to components related to oropharyngeal swallowing function between two bolus viscosities (thin liquid and pudding): epiglottic movement, laryngeal elevation, anterior hyoid excursion, tongue base retraction, pharyngeal stripping wave, and pharyngoesophageal segment opening (PESO). Comparisons between the two bolus viscosities were investigated for each component. RESULTS Higher (worse) scores were observed in the thin-liquid trial compared with the pudding trial for the following MBSImP components: anterior hyoid excursion (p = .03), epiglottic movement (p < .001), pharyngeal stripping wave (p < .001), and PESO (p = .002). Lower (better) scores were observed in the liquid trial compared with the pudding trial for one component-tongue base retraction (Component 15) only (p < .001). CONCLUSION These findings provide further evidence for positive influences of viscosity on the swallow mechanism, including influences of sensory feedback on the sensorimotor swallow program.
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Affiliation(s)
| | - Kent Armeson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Elizabeth G. Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Julie Blair
- Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston
| | - William Pearson
- Department of Biomedical Sciences (Anatomy), Edward Via College of Osteopathic Medicine, Auburn, AL
| | - Bonnie Martin-Harris
- Department of Communication Sciences Disorders, Northwestern University, Evanston, IL
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3
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Tsuchiya M, Kubo Y, Maruyama N, Omori C, Fukami H. Observational study of effects of pharyngeal stimulation by carbonated solution on repetitive voluntary swallowing in humans. Medicine (Baltimore) 2023; 102:e34889. [PMID: 37653745 PMCID: PMC10470714 DOI: 10.1097/md.0000000000034889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
In this study, we conducted observational study to examine the effects of pharyngeal stimulation by a bolus of carbonated solution on repetitive voluntary swallowing in humans. Twelve healthy participants had a fine silicone tube inserted into their pharyngeal region, through which various solutions were slowly infused (0.2 mL/minute) to stimulate the pharyngeal mucosa without activating mechanoreceptors. The solutions included 0.3M NaCl (NaCl), carbonated 0.3M NaCl (NaCl + CA), 0.3M NaCl with acetic acid, distilled water, and carbonated distilled water. We used NaCl to inhibit water-sensitive neurons in the pharyngeal mucosa and enable the evaluation of the effects of carbonic acid stimulation on swallowing. Participants were instructed to repeat swallows as rapidly as possible during the infusion, and the swallowing interval (SI) was measured via submental surface electromyographic activity. SI was significantly shorter during the infusion of NaCl + CA, distilled water, and carbonated distilled water than during the infusion of NaCl. There was a significant positive correlation between SI with NaCl stimulation and the facilitative effects of the other solutions. Longer SIs with NaCl stimulation indicated potent facilitative effects. Thus, stimulation with NaCl + CA facilitated swallowing by reducing SI. Furthermore, the facilitative effects of SI were more pronounced in participants who had difficulty with repetitive voluntary swallowing. The sensation induced by carbonated solution may enhance the ability for repetitive voluntary swallowing, making it a potentially useful approach for rehabilitating patients with dysphagia.
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Affiliation(s)
- Mika Tsuchiya
- Department of Oral Health Sciences, Faculty of Nursing and Health Care, Baika Women's University, Ibaraki, Osaka, Japan
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4
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Benli ET, Avci Ş, Öğün MN. Feel it or deal with it: Oral perception and aspiration risk in early stroke. J Oral Rehabil 2023; 50:217-222. [PMID: 36533879 DOI: 10.1111/joor.13402] [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: 03/21/2022] [Revised: 08/26/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Sensation and perception impairments are significant problems faced by individuals with early-stage stroke. Sensory inputs needed in swallowing guide the perceptual process with the involvement of cognitive functions. In the absence of sensory input, bolus perception may be altered, and swallowing safety may be compromised. OBJECTIVES This study aims to evaluate the oral perception of volume change and the aspiration risk of individuals with stroke and determine the relationship between oral perception and aspiration risk. METHODS Total participants were 35. The Gugging Swallowing Screening Test (GUSS) was used to determine individuals' risk of aspiration and divide them into groups 'aspiration risk' and 'non-aspiration risk'. The Oral Perception of Liquid Volume Changes Test (OPLVCT) was used to determine the level of oral perception. RESULTS The groups were statistically similar in terms of age and other descriptives. When the OPLVC test was examined, the scores of the aspiration risk group were significantly lower (p < .001). In addition, a moderate negative correlation was found between aspiration risk and the OPLVC scores (r: -0.502; p < .001). CONCLUSION In this study, a relationship was found between aspiration risk and oral perception. It also revealed that individuals with stroke who are at risk of aspiration have low oral perception abilities. Based on these results, it was concluded that these individuals cannot reliably determine the maximum volume of liquid to be consumed without assistance. We suggest that evaluations and training of oral perception should be added to the rehabilitation of individuals with stroke.
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Affiliation(s)
- Enes Tayyip Benli
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Şebnem Avci
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Muhammed Nur Öğün
- Faculty of Medicine, Department of Neurology, Bolu Abant İzzet Baysal University, Bolu, Turkey
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5
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Pongpipatpaiboon K, Inamoto Y, Aihara K, Kagaya H, Shibata S, Mukaino M, Saitoh E, Gonzalez-Fernandez M. Thin Liquid Bolus Volume Alters Pharyngeal Swallowing: Kinematic Analysis Using 3D Dynamic CT. Dysphagia 2022; 37:1423-1430. [PMID: 34981256 DOI: 10.1007/s00455-021-10397-y] [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: 07/17/2021] [Accepted: 12/06/2021] [Indexed: 12/16/2022]
Abstract
The previous studies reported that different volumes of thick liquid had an impact on spatiotemporal characteristics and pharyngeal response of swallowing. However, the bolus flow and swallowing motion pattern were different between thick and thin liquids. The effects of thin bolus volume on pharyngeal swallowing, especially true vocal cord (TVC) closure is still unclear. This study assessed the temporal characteristics when swallowing different volumes of thin liquid to determine the mechanical adaptation using 320-row area detector computed tomography (320-ADCT) and investigated a change of swallowing physiology including laryngeal closure, particularly TVC closure. Fourteen healthy women (28-45 years) underwent 320-ADCT while swallowing of 3, 10, and 20 ml of thin liquid barium in 45° semi-reclining position. Kinematic analysis was performed for each swallow including temporal characteristic, structural movements while swallowing, and maximal cross-sectional area of the upper esophageal sphincter (UES) opening. Bolus head reached to pharynx and esophagus earlier in larger volume significantly, indicating faster bolus transport as volume increased. There were significant effects on swallowing mechanism revealing earlier TVC closure and UES opening with increasing volume. Maximum cross-sectional area of the UES opening was increased to accommodate a larger bolus. Differences in mechanical adaptation through bolus transit and motion of swallowing structures were detected across increasing volumes. These volume-dependent adaptations potentially reduce the risk of aspiration. Understanding the swallowing physiological changes as volume increased is helpful for diagnosis and treatment of dysphagia patients as well as outcomes of swallowing rehabilitation in clinical practice.
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Affiliation(s)
- Kannit Pongpipatpaiboon
- Department of Rehabilitation Medicine, Samitivej Srinakarin Hospital, Bangkok, Thailand.,Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Yoko Inamoto
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan. .,Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan.
| | - Keiko Aihara
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Seiko Shibata
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.,Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
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6
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Son WC, Min JY, Shin HT, Seo KC, Choi KH. Adapting the International Dysphagia Diet Standardisation Initiative in East Asia: Feasibility study. Medicine (Baltimore) 2022; 101:e31137. [PMID: 36281173 PMCID: PMC9592427 DOI: 10.1097/md.0000000000031137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In dysphagia, food or water cannot be delivered safely through the oral cavity to the stomach; both are treated using texture-modified food and thickened fluid. Before, each country had its own diet modifications and texture measurement standards. In 2012, the International Dysphagia Diet Standardisation Initiative (IDDSI) was developed by several countries. Owing to cultural differences, it was necessary to determine whether the IDDSI could well be applied to clinicians and patients without difficulties in East Asia countries. To evaluate the IDDSI scale to find out the difficulties applying this scale in East Asia countries to educate the clinicians and patients. In May 2021, we enrolled physicians, nurses, nutritionists, and swallowing therapists involved in dysphagia treatment at a single center in Seoul. To evaluate the degree of understanding and difficulties of adapting IDDSI to clinicians in East Asia countries, we used the 17-item questionnaire with IDDSI sample foods and foods in Asian countries. In first 7 items, we compared IDDSI with the previously used scale based on the National Dysphagia Diet (NDD). In the next 10 questions, only the IDDSI levels were answered, and the absolute values of the answer-response differences were calculated. The IDDSI showed a significantly high intraclass correlation with the previously used NDD-based scale; the coefficient was higher for the nutritionists (0.988) and swallowing therapists (0.991). When evaluating whether the IDDSI could applied well in East Asia countries, the absolute values of the answer-response differences were lower than 0.5 in majority of levels, except for Level 4. Because the IDDSI framework might successfully be applied universally regardless of food culture, a worldwide standard for food rheology in dysphagia treatment might be possible.
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Affiliation(s)
- Woo Chul Son
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yeon Min
- Dietetics and Nutrition Services Team, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Tae Shin
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Cheon Seo
- Department of Rehabilitation Medicine, 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
- *Correspondence: Kyoung Hyo Choi, Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-gu, Seoul 05505, Korea (e-mail: )
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7
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Koyama Y, Ohmori N, Momose H, Yamada SI, Kurita H. Detection of swallowing disorders with a multiple-channel surface electromyography sensor sheet. J Dent Sci 2022; 17:1185-1192. [PMID: 35784131 PMCID: PMC9236893 DOI: 10.1016/j.jds.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/18/2021] [Indexed: 11/29/2022] Open
Abstract
Background/purpose A sensor sheet comprising multiple electromyography electrodes that can be used to measure a series of multiple muscle activities related to swallowing was recently developed. In this study, we aimed to evaluate its utility in detecting swallowing disorders with a new method for the identification of muscle activity. Materials and methods All participants were evaluated by using the repetitive saliva swallowing test and modified water swallowing test and were classified accordingly into participants with (n = 21; mean age, 81.6 [standard deviation, 10.1] years) and those without (n = 41; mean age, 70.0 [8.4] years) dysphagia. The sheet contains four pairs of electrodes, and surface electromyography (sEMG) was performed on the suprahyoid (position A: upper front of the suprahyoid muscles; position B: bottom rear of the suprahyoid muscles) and infrahyoid (position C: above the infrahyoid muscles; position D: beneath the infrahyoid muscles) muscles while the participants swallowed liquid, thickened water, paste, and jelly. The sEMG findings, including the duration of swallowing waveforms and the delay in swallowing onset from position A to positions B, C, and D, were compared between the groups. Results The duration of muscle activity differed between the groups in the infrahyoid muscles when jelly (Mann–Whitney U test; position C, P = 0.007 and position D, P = 0.018) and thickened water (position C, P = 0.033) were swallowed. Conclusion Our study demonstrates the utility of a novel sensor sheet developed for detecting swallowing disorders by using visual methods for identification of muscle activity.
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Affiliation(s)
- Yoshito Koyama
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
- Department of Dentistry and Oral Surgery, Omachi General Hospital, Omachi, Japan
- Corresponding author. Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. Fax: +81 0263 37 2676.
| | - Nobuyuki Ohmori
- Material Technology Department, Nagano Prefecture General Industrial Technology Center, Nagano, Japan
| | | | - Shin-ichi Yamada
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroshi Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Nollet JL, Cajander P, Ferris LF, Ramjith J, Omari TI, Savilampi J. Pharyngo-Esophageal Modulatory Swallow Responses to Bolus Volume and Viscosity Across Time. Laryngoscope 2021; 132:1817-1824. [PMID: 34928519 PMCID: PMC9545908 DOI: 10.1002/lary.29987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 12/19/2022]
Abstract
Objectives/Hypothesis Modulation of the pharyngeal swallow to bolus volume and viscosity is important for safe swallowing and is commonly studied using high‐resolution pharyngeal manometry (HRPM). Use of unidirectional pressure sensor technology may, however, introduce variability in swallow measures and a fixed bolus administration protocol may induce time and order effects. We aimed to overcome these limitations and to investigate the effect of time by repeating randomized measurements using circumferential pressure sensor technology. Study Design Sub‐set analysis of data from the placebo arm of a randomized, repeated measures trial. Methods HRPM with impedance was recorded using a solid‐state catheter with 36 circumferential pressure sensors and 18 impedance segments straddling from hypopharynx to stomach. Testing included triplicates of 5, 10, and 20 ml thin liquid and 10 ml thick liquid boluses, the order of the thin liquid boluses was randomized. The swallow challenges were repeated approximately 10 minutes after finishing the baseline measurement. Results We included 19 healthy adults (10/9 male/female; age 24.5 ± 4.1 year). Intrabolus pressure, all upper esophageal sphincter (UES) opening and relaxation metrics, and flow timing metrics increased with larger volumes. A thicker viscosity decreased UES relaxation time, UES basal pressure, and flow timing metrics, whereas UES opening extent increased. Pre‐swallow UES basal pressure and post‐swallow UES contractile integral decreased over time. Conclusion Using circumferential pressure sensor technology, the effects of volume and viscosity were largely consistent with previous reports. UES contractile pressures reduced over time. The growing body of literature offers a benchmark for recognizing aberrant pharyngo‐esophageal motor responses. Level of Evidence 3 Laryngoscope, 132:1817–1824, 2022
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Affiliation(s)
- Joeke L Nollet
- Department of Intensive Care Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Per Cajander
- Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Lara F Ferris
- Department of Human Physiology, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jordache Ramjith
- Department for Health Evidence, Section Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Taher I Omari
- Department of Human Physiology, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Johanna Savilampi
- Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
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O'Brien MK, Botonis OK, Larkin E, Carpenter J, Martin-Harris B, Maronati R, Lee K, Cherney LR, Hutchison B, Xu S, Rogers JA, Jayaraman A. Advanced Machine Learning Tools to Monitor Biomarkers of Dysphagia: A Wearable Sensor Proof-of-Concept Study. Digit Biomark 2021; 5:167-175. [PMID: 34723069 DOI: 10.1159/000517144] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/10/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Difficulty swallowing (dysphagia) occurs frequently in patients with neurological disorders and can lead to aspiration, choking, and malnutrition. Dysphagia is typically diagnosed using costly, invasive imaging procedures or subjective, qualitative bedside examinations. Wearable sensors are a promising alternative to noninvasively and objectively measure physiological signals relevant to swallowing. An ongoing challenge with this approach is consolidating these complex signals into sensitive, clinically meaningful metrics of swallowing performance. To address this gap, we propose 2 novel, digital monitoring tools to evaluate swallows using wearable sensor data and machine learning. Methods Biometric swallowing and respiration signals from wearable, mechano-acoustic sensors were compared between patients with poststroke dysphagia and nondysphagic controls while swallowing foods and liquids of different consistencies, in accordance with the Mann Assessment of Swallowing Ability (MASA). Two machine learning approaches were developed to (1) classify the severity of impairment for each swallow, with model confidence ratings for transparent clinical decision support, and (2) compute a similarity measure of each swallow to nondysphagic performance. Task-specific models were trained using swallow kinematics and respiratory features from 505 swallows (321 from patients and 184 from controls). Results These models provide sensitive metrics to gauge impairment on a per-swallow basis. Both approaches demonstrate intrasubject swallow variability and patient-specific changes which were not captured by the MASA alone. Sensor measures encoding respiratory-swallow coordination were important features relating to dysphagia presence and severity. Puree swallows exhibited greater differences from controls than saliva swallows or liquid sips (p < 0.037). Discussion Developing interpretable tools is critical to optimize the clinical utility of novel, sensor-based measurement techniques. The proof-of-concept models proposed here provide concrete, communicable evidence to track dysphagia recovery over time. With refined training schemes and real-world validation, these tools can be deployed to automatically measure and monitor swallowing in the clinic and community for patients across the impairment spectrum.
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Affiliation(s)
- Megan K O'Brien
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
| | - Olivia K Botonis
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Elissa Larkin
- Think and Speak Lab, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Julia Carpenter
- Think and Speak Lab, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Bonnie Martin-Harris
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois, USA
| | - Rachel Maronati
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | | | - Leora R Cherney
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA.,Think and Speak Lab, Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois, USA
| | - Brianna Hutchison
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Shuai Xu
- Departments of Materials Science and Engineering, Center for Bio-Integrated Electronics, Biomedical Engineering, Electrical Engineering and Computer Science, Northwestern University, Evanston, Illinois, USA
| | - John A Rogers
- Departments of Materials Science and Engineering, Center for Bio-Integrated Electronics, Biomedical Engineering, Electrical Engineering and Computer Science, Northwestern University, Evanston, Illinois, USA
| | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
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10
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Abstract
The purposes of this study were to compare poststroke liquid swallowing methods by including a cup and a straw in videofluoroscopic swallowing studies (VFSS) and to test the hypothesis that increased aspiration would be observed with the cup compared to the straw. Eighty-five poststroke patients who had undergone VFSS using a spoon, cup, and straw were included. Penetration-aspiration scale and functional dysphagia scale (FDS) were used for assessment. These scores did not differ significantly between the cup and the straw. Higher FDS scores were found with the cup than with the straw in patients who had penetration/aspiration with both the cup and the straw and with the cup only. However, FDS scores did not differ significantly between the cup and the straw in patients who had penetration/aspiration with the straw only. Although advantages of the straw over the cup were clear, some patients showed penetration/aspiration only with the straw.
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11
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Takatsu J, Higaki E, Hosoi T, Yoshida M, Yamamoto M, Abe T, Shimizu Y. Clinical benefits of a swallowing intervention for esophageal cancer patients after esophagectomy. Dis Esophagus 2021; 34:5942925. [PMID: 33123720 DOI: 10.1093/dote/doaa094] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/28/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023]
Abstract
Dysphagia after esophagectomy is the main cause of a prolonged postoperative stay. The present study investigated the effects of a swallowing intervention led by a speech-language-hearing therapist (SLHT) on postoperative dysphagia. We enrolled 276 consecutive esophageal cancer patients who underwent esophagectomy and cervical esophagogastric anastomosis between July 2015 and December 2018; 109 received standard care (control group) and 167 were treated by a swallowing intervention (intervention group). In the intervention group, swallowing function screening and rehabilitation based on each patient's dysfunction were led by SLHT. The start of oral intake, length of oral intake rehabilitation, and length of the postoperative stay were compared in the two groups. The patient's subgroups in the 276 patients were examined to clarify the more effectiveness of the intervention. The start of oral intake was significantly earlier in the intervention group (POD: 11 vs. 8 days; P = 0.009). In the subgroup analysis, the length of the postoperative stay was also significantly shortened by the swallowing intervention in patients without complications (POD: 18 vs. 14 days; P = 0.001) and with recurrent laryngeal nerve paralysis (RLNP) (POD: 30 vs. 21.5 days; P = 0.003). A multivariate regression analysis identified the swallowing intervention as a significant independent factor for the earlier start of oral intake and a shorter postoperative stay in patients without complications and with RLNP. Our proposed swallowing intervention is beneficial for the earlier start of oral intake and discharge after esophagectomy, particularly in patients without complications and with RLNP. This program may contribute to enhanced recovery after surgery.
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Affiliation(s)
- Jun Takatsu
- Department of Rehabilitation, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
- Department of Speech Pathology, Aichi-Gakuin University,Nisshin, 470-0195, Japan
| | - Eiji Higaki
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Takahiro Hosoi
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Masahiro Yoshida
- Department of Rehabilitation, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
- Department of Orthopedic Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Masahiko Yamamoto
- Department of Speech Pathology, Aichi-Gakuin University,Nisshin, 470-0195, Japan
| | - Tetsuya Abe
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
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12
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Brooks L, Liao J, Ford J, Harmon S, Breedveld V. Thickened Liquids Using Pureed Foods for Children with Dysphagia: IDDSI and Rheology Measurements. Dysphagia 2021; 37:578-590. [PMID: 33954811 DOI: 10.1007/s00455-021-10308-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Abstract
Children with dysphagia, or swallowing disorder, are at an increased risk for developing respiratory compromise, failure to thrive, and aversion. Thickened liquids can be recommended for children with dysphagia, if shown to be effective on instrumental examination and if strategies/interventions with thin liquids are not successful. Thickened liquids have many benefits, including creating a more cohesive bolus, slowing oropharyngeal transit time, and reducing aspiration. However, preparing thickened liquids with commercially available thickeners can result in poor compliance due to concerns regarding taste, texture, accessibility, cost, thickness variability, and potential negative impact of these substances on a child's immature digestive tract. The purpose of this study was to determine if liquids could be successfully thickened with widely available, commercial pureed foods, and to assess how these mixtures compare to starch and gum based thickening agents. The International Dysphagia Diet Standardisation Initiative (IDDSI) flow test was performed for each sample of puree thickened liquids, gum based thickened water, and cornstarch based thickened water. In addition, rheology testing was performed on each category of the samples to measure viscosity at various shear rates and temperatures, and to assess the presence of yield stress. Results revealed that liquids thickened with smooth textured purees were comparable to commercial starch and gum based thickeners, and may be offered as a viable alternative.
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Affiliation(s)
- Laura Brooks
- Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA, 30322, USA.
| | - Jianshan Liao
- School of Chemical & Biomolecular Engineering and Renewable Bioproducts Institute, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Jaclyn Ford
- Department of Psychology and Neuroscience, Boston College, Boston, MA, USA
| | - Sarah Harmon
- Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Victor Breedveld
- School of Chemical & Biomolecular Engineering and Renewable Bioproducts Institute, Georgia Institute of Technology, Atlanta, GA, 30332, USA
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13
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Dharmarathna I, Miles A, Allen J. Predicting penetration-aspiration through quantitative swallow measures of children: a videofluoroscopic study. Eur Arch Otorhinolaryngol 2021; 278:1907-1916. [PMID: 33564910 DOI: 10.1007/s00405-021-06629-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Quantitative measures have improved the reliability and accuracy in interpretation and reporting of videofluoroscopy (VFSS). Associations between quantitative VFSS measures and swallow safety in children are not widely reported. The ability to predict aspiration in children, even if not observed during brief VFSS, will improve diagnostic reporting and potentially reduce the need for extended radiation time. The aims of this study were to determine associations between quantitative fluoroscopic swallow measures and penetration-aspiration and to predict likelihood of penetration-aspiration. METHODS We selected videofluoroscopic data of 553 children from a pediatric hospital database for this single-center retrospective observational study. A standard protocol of VFSS administration was used and data were recorded at 30 frames-per-second. A set of quantitative and descriptive swallow measures was obtained using a specialized software with satisfactory inter-rater and intra-rater reliability. Binomial logistic regression with backward likelihood ratio was conducted, while controlling for age, gender, and etiology. RESULTS We found bolus clearance ratio (BCR), pharyngeal constriction ratio (PCR), duration to hyoid maximal elevation (Hdur), and total pharyngeal transit time (TPT) to be predictive of penetration-aspiration in children. PCR was the most predictive of penetration-aspiration in children (61.5%). Risk of aspiration was more than 100 times, when BCR = ≥ 0.1, TPT = ≥ 2 s, Hdur = > 1 s or PCR = ≥ 0.2 (p < 0.05 for all measures). CONCLUSION The results confirm the potential of objective quantitative swallow measures in predicting the risk of aspiration in children with dysphagia. These parameters provide predictive measures of aspiration risk that are clinically useful in identifying children of concern, even if no aspiration is observed during VFSS.
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Affiliation(s)
- Isuru Dharmarathna
- Speech Science, School of Psychology, Faculty of Science, The University of Auckland, Building 507, Level 2 (B.065), 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand. .,Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
| | - Anna Miles
- Speech Science, School of Psychology, Faculty of Science, The University of Auckland, Building 507, Level 2 (B.065), 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand
| | - Jacqui Allen
- Department of Surgery, The University of Auckland, Auckland, New Zealand
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14
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Jang SH, Kim MS. Dysphagia in Lateral Medullary Syndrome: A Narrative Review. Dysphagia 2020; 36:329-338. [PMID: 32654058 DOI: 10.1007/s00455-020-10158-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/06/2020] [Indexed: 12/24/2022]
Abstract
Dysphagia is a common clinical feature of lateral medullary syndrome (LMS) and is clinically relevant because it is related to aspiration pneumonia, malnutrition, increased mortality, and prolonged hospital stay. Herein, the pathophysiology, prognosis, and treatment of dysphagia in LMS are reviewed. The pathophysiology, prognosis, and treatment of dysphagia in LMS are closely interconnected. Although the pathophysiology of dysphagia in LMS has not been fully elucidated, previous studies have suggested that the medullary central pattern generators coordinate the pharyngeal phases of swallowing. Investigation of the extensive neural connections of the medulla oblongata is important in understanding the pathophysiologic mechanism of dysphagia in LMS. Previous studies have reported that most patients with dysphagia in LMS have a relatively good prognosis. However, some patients require tube feeding for several months, even years, due to severe dysphagia, and little has been reported about conditions associated with a poor prognosis of dysphagia in LMS. Concerning specific therapeutic modalities for dysphagia in LMS, in addition to general modalities used for dysphagia treatment in stroke patients, non-invasive modalities, including repetitive transcranial magnetic stimulation and transcranial direct current stimulation, as well as invasive modalities, such as botulinum toxin injection, balloon catheter dilatation, and myotomy for relaxation of the cricopharyngeal muscle, have been applied. For the appropriate application of therapeutic modalities, clinicians should be aware of the recovery mechanisms and prognosis of dysphagia in LMS. Further studies on this topic, as well as studies involving large numbers of subjects on specific therapeutic modalities, should be encouraged.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Daegu, 705-717, Republic of Korea
| | - Min Son Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Daegu, 705-717, Republic of Korea.
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15
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Bourdiol P, Hennequin M, Peyron MA, Woda A. Masticatory Adaptation to Occlusal Changes. Front Physiol 2020; 11:263. [PMID: 32317982 PMCID: PMC7147355 DOI: 10.3389/fphys.2020.00263] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/09/2020] [Indexed: 12/17/2022] Open
Abstract
This review deals with the frequent wide variability of masticatory capacity/incapacity. Neither researchers nor clinicians have taken sufficient account of this variability despite its implications for nutrition. Mastication in normal healthy oral conditions is first described, followed by a short presentation of the mechanisms of masticatory adaptation in the nervous system. Capacity, incapacity, and successful compensatory adaptation of mastication are then defined, along with the different methods used for their evaluation. Examples of adaptation needs are given, such as those concomitant with dental wear or occlusal changes. Finally, given its vital importance for deeply impaired mastication/deglutition function, the impact of masticatory adaptation processes on nutrition is examined.
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Affiliation(s)
- Pierre Bourdiol
- CROC EA 4847, Faculty of Dentistry, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Martine Hennequin
- CROC EA 4847, Faculty of Dentistry, Université Clermont Auvergne, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marie-Agnes Peyron
- Human Nutrition Unit, Institut National de la Recherche Agronomique, Paris, France
| | - Alain Woda
- CROC EA 4847, Faculty of Dentistry, Université Clermont Auvergne, Clermont-Ferrand, France
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16
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Umemoto G, Furuya H. Management of Dysphagia in Patients with Parkinson's Disease and Related Disorders. Intern Med 2020; 59:7-14. [PMID: 30996170 PMCID: PMC6995701 DOI: 10.2169/internalmedicine.2373-18] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 01/23/2019] [Indexed: 01/02/2023] Open
Abstract
Various methods of rehabilitation for dysphagia have been suggested through the experience of treating stroke patients. Although most of these patients recover their swallowing function in a short period, dysphagia in Parkinson's disease (PD) and Parkinson-related disorder (PRD) degenerates with disease progression. Muscle rigidity and bradykinesia are recognized as causes of swallowing dysfunction, and it is difficult to easily apply the strategies for stroke to the rehabilitation of dysphagia in PD patients. Disease severity, weight loss, drooling, and dementia are important clinical predictors. Silent aspiration is a pathognomonic sign that may lead to aspiration pneumonia. Severe PD patients need routine video fluoroscopy or video endoscopy to adjust their food and liquid consistency. Patients with PRD experience rapid progression of swallowing dysfunction. Nutrition combined with nasogastric tube feeding or percutaneous endoscopic gastrostomy feeding should be considered owing to the increased risk of aspiration and difficulty administrating oral nutrition.
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Affiliation(s)
- George Umemoto
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Fukuoka University, Japan
| | - Hirokazu Furuya
- Department of Neurology, Kochi Medical School, Kochi University, Japan
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17
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Saconato M, Leite FC, Lederman HM, Chiari BM, Gonçalves MIR. Temporal and Sequential Analysis of the Pharyngeal Phase of Swallowing in Poststroke Patients. Dysphagia 2019; 35:598-615. [DOI: 10.1007/s00455-019-10069-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 10/01/2019] [Indexed: 01/25/2023]
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18
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Lenell C, Brates D, Pearson WG, Molfenter S. Variations in Healthy Swallowing Mechanics During Various Bolus Conditions Using Computational Analysis of Swallowing Mechanics (CASM). Dysphagia 2019; 35:272-280. [PMID: 31165260 DOI: 10.1007/s00455-019-10026-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/20/2019] [Accepted: 05/25/2019] [Indexed: 01/09/2023]
Abstract
Bolus properties such as volume, consistency, and density have been shown to influence swallowing through the analysis of kinematics and timing in both normal and disordered swallowing. However, inherent intra- and inter-person variability of swallowing cloud interpretation of group data. Computational analysis of swallow mechanics (CASM) is an established methodology that uses coordinate tracking to map structural movements during swallowing and yields statistically powerful analyses at both the group and individual levels. In this study, the CASM method was used to determine how different bolus properties (volume, consistency, and density) altered swallow mechanics in healthy young adults at the group and individual levels. Videofluoroscopic swallow studies of 10 (4 females) healthy young adults were analyzed using CASM. Five bolus types were administered in each study (3 × 5 ml 40% w/v nectar, 3 × 5 ml 22% w/v thin, 3 × 5 ml 40% w/v thin, 3 × 10 ml 22% w/v thin, and 3 × 20 ml 22% w/v thin). Canonical variate analyses demonstrated that bolus condition did not affect swallowing mechanics at the group level, but bolus condition did affect pharyngeal swallow mechanics at the individual level. Functional swallow adaptations (e.g., hyoid movement) to bolus conditions were not uniform across participants, consistent with the nonsignificant group finding. These results suggest that individual swallowing systems of healthy young individuals vary in how they respond to bolus different conditions, highlighting the intrinsic variability of the swallow mechanism and the importance of individually tailored evaluation and treatment of swallowing. Findings warrant further investigation with different bolus conditions and aging and disordered populations.
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Affiliation(s)
- Charles Lenell
- Department of Communicative Sciences and Disorders, New York University, 665 Broadway, New York, NY, 10012, USA
| | - Danielle Brates
- Department of Communicative Sciences and Disorders, New York University, 665 Broadway, New York, NY, 10012, USA
| | - William G Pearson
- Department of Cellular Biology and Anatomy, Augusta University, 1120 15th Street, Augusta, GA, 30912, USA
| | - Sonja Molfenter
- Department of Communicative Sciences and Disorders, New York University, 665 Broadway, New York, NY, 10012, USA.
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19
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Steele CM, Peladeau-Pigeon M, Barbon CAE, Guida BT, Namasivayam-MacDonald AM, Nascimento WV, Smaoui S, Tapson MS, Valenzano TJ, Waito AA, Wolkin TS. Reference Values for Healthy Swallowing Across the Range From Thin to Extremely Thick Liquids. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:1338-1363. [PMID: 31021676 PMCID: PMC6808317 DOI: 10.1044/2019_jslhr-s-18-0448] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/16/2018] [Accepted: 01/07/2019] [Indexed: 05/03/2023]
Abstract
Purpose Thickened liquids are frequently used as an intervention for dysphagia, but gaps persist in our understanding of variations in swallowing behavior based on incremental thickening of liquids. The goal of this study was to establish reference values for measures of bolus flow and swallowing physiology in healthy adults across the continuum from thin to extremely thick liquids. Method A sex-balanced sample of 38 healthy adults underwent videofluoroscopy and swallowed 20% weight-to-volume concentration barium prepared in thin and slightly, mildly, moderately, and extremely thick consistencies using a xanthan gum thickener. Participants took comfortable sips and swallowed without a cue; sip volume was measured based on presip and postsip cup weights. A standard operating procedure (the ASPEKT method: Analysis of Swallowing Physiology: Events, Kinematics and Timing) was used to analyze videofluoroscopy recordings. Results The results clarify that, for thin liquid sips (10-14 ml), a single swallow without clearing swallows is typical and is characterized by complete laryngeal vestibule closure, complete pharyngeal constriction, and minimal postswallow residue. Aspiration was not seen, and penetration was extremely rare. Bolus position at swallow onset was variable, extending as low as the pyriform sinuses in 37% of cases. With thicker liquids, no changes in event sequencing, laryngeal vestibule closure, pharyngeal constriction, or postswallow residue were seen. The odds of penetration were significantly reduced. A longer timing interval until onset of the hyoid burst movement was seen, with an associated higher bolus position at swallow onset. Other timing measures remained unaffected by changes in bolus consistency. Conclusion The results include new reference data for swallowing in healthy adults across the range from thin to extremely thick liquids.
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Affiliation(s)
- Catriona M. Steele
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Melanie Peladeau-Pigeon
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Carly A. E. Barbon
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Brittany T. Guida
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Ashwini M. Namasivayam-MacDonald
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Department of Communication Sciences and Disorders, Adelphi University, New York, NY
| | - Weslania V. Nascimento
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Faculdade de Medicina, University of São Paulo, Ribeirão Preto, Brazil
| | - Sana Smaoui
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Melanie S. Tapson
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Teresa J. Valenzano
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Ashley A. Waito
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Talia S. Wolkin
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
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20
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Cervenka B, Pipkorn P, Fagan J, Zafereo M, Aswani J, Macharia C, Kundiona I, Mashamba V, Zender C, Moore M. Oral cavity cancer management guidelines for low-resource regions. Head Neck 2019; 41:799-812. [DOI: 10.1002/hed.25423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 07/24/2018] [Accepted: 09/12/2018] [Indexed: 12/27/2022] Open
Affiliation(s)
- Brian Cervenka
- Department of Otolaryngology-Head and Neck Surgery; University of California at Davis, Resident; Sacramento California
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery; Washington University, Assistant Professor; St. Louis Missouri
| | - Johannes Fagan
- Department of Otolaryngology-Head and Neck Surgery; The University of Cape Town, Professor; Cape Town South Africa
| | - Mark Zafereo
- Department of Head and Neck Surgery; The University of Texas, MD Anderson Cancer Center, Associate Professor; Houston Texas
| | - Joyce Aswani
- Department of Otolaryngology-Head and Neck Surgery; University of Nairobi; Nairobi Kenya
| | - Chege Macharia
- Department of General Surgery; AIC Kijabe Hospital; Kijabe Kenya
| | | | - Victor Mashamba
- Department of Otorhinolaryngology; Muhimbili National Hospital; Dar es Salaam Tanzania
| | - Chad Zender
- Department of Otolaryngology-Head and Neck Surgery; Case Western Reserve MC; Cleveland Ohio
| | - Michael Moore
- Department of Otolaryngology-Head and Neck Surgery; University of California at Davis, Associate Professor; Sacramento California
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21
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Piecemeal Deglutition and the Implications for Pressure Impedance Dysphagia Assessment in Pediatrics. J Pediatr Gastroenterol Nutr 2018; 67:713-719. [PMID: 29985873 DOI: 10.1097/mpg.0000000000002080] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES High-resolution impedance manometry (HRIM) enables biomechanical swallow assessment. Piecemeal deglutition (PD) defines swallowing of a single bolus in 2 or more portions. We investigated PD sequences on HRIM recordings to ascertain appropriate swallow selection for analysis and to determine the impact of PD on swallow function measures. METHODS Pharyngo-esophageal motility and bolus flow were assessed in 27 children (19 M, mean age 15 months) with repaired esophageal atresia and trachea-esophageal fistula, but who were asymptomatic of oropharyngeal dysphagia. A consistent volume of between 2 and 5 mL saline boluses was given to each patient. Retrospectively, PD sequences were defined based on the number of swallows required to clear the bolus from the oral cavity: pattern A = 1-2 swallows; pattern B = 3 swallows; and pattern C = 4+ swallows. The largest bolus volume swallowed was noted as the dominant swallow in each pattern. Pressure Flow Analysis defined contractility, distension and flow timing metrics. Data were averaged for each PD pattern, and compared with dominant swallows from each pattern. RESULTS PD pattern B (43.7%) was the most prevalent across the cohort. PD patterns were similarly distributed across age groups (G1: <1 years, G2: 1-4 years). Differences in upper esophageal sphincter distension and pharyngeal flow timing measures were, however, seen in relation to both age and PD pattern, whereby a larger pharynx in older children elicited greater distension for a longer latency, and for larger volumes. CONCLUSIONS PD reduces bolus volume, and biomechanical swallow measures are impacted. PD is a necessary consideration for accurate HRIM analysis of swallow function. Selection of dominant swallows from a PD sequence provides a swallow profile which best represents a child's swallow function, and should always be reported and interpreted in context of the PD sequence observed.
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22
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Waito AA, Tabor-Gray LC, Steele CM, Plowman EK. Reduced pharyngeal constriction is associated with impaired swallowing efficiency in Amyotrophic Lateral Sclerosis (ALS). Neurogastroenterol Motil 2018; 30:e13450. [PMID: 30129164 PMCID: PMC6249041 DOI: 10.1111/nmo.13450] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Swallowing inefficiency is a prevalent but understudied problem in individuals with Amyotrophic Lateral Sclerosis (ALS). Although reduced pharyngeal constriction has been identified as a mechanism contributing to swallowing inefficiency following stroke, this relationship has not been empirically tested in the ALS population. This study sought to characterize profiles of swallowing efficiency in a sample of ALS patients and investigate relationships between pharyngeal constriction and swallowing efficiency. METHODS Twenty-six adults with ALS underwent videofluoroscopic swallowing studies, involving 3 mL-thin, 20 mL-thin, and 3 mL-pudding boluses. Full-length recordings were segmented into bolus clips and randomized for analysis. We recorded the total number of swallows per bolus and obtained normalized pixel-based measures of pharyngeal constriction area and post-swallow residue in the vallecular and pyriform sinuses. Linear mixed models with Spearman's correlations were used to determine relationships between pharyngeal constriction and swallowing efficiency, with added factors of bolus volume and thickness. KEY RESULTS Individuals with ALS demonstrated reduced pharyngeal constriction and increased vallecular and pyriform sinus residue, compared to norms. Reduced pharyngeal constriction had a significant effect on the presence of vallecular and pyriform sinus residue as well as the number of swallows per bolus. Increased bolus thickness was associated with increased vallecular residue, while increased bolus volume was associated with reduced pharyngeal constriction. Results were significant at P < 0.05. CONCLUSIONS & INFERENCES Our results suggest that reduced pharyngeal constriction is a significant physiological parameter related to swallow inefficiency in ALS. Future work is needed to corroborate these preliminary results and investigate factors to mitigate such impairments.
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Affiliation(s)
- A. A. Waito
- Toronto Rehabilitation Institute – University Health Network,University of Toronto – Rehabilitation Sciences Institute
| | - L. C. Tabor-Gray
- Swallowing Systems Core – University of Florida,Phil Smith Neuroscience Institute – Holy Cross Hospital
| | - C. M Steele
- Toronto Rehabilitation Institute – University Health Network,University of Toronto – Rehabilitation Sciences Institute
| | - E. K. Plowman
- Swallowing Systems Core – University of Florida,Department of Speech - Language and Hearing Sciences – University of Florida,Department of Neurology – University of Florida
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23
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Im I, Jun JP, Hwang S, Ko MH. Swallowing outcomes in patients with subcortical stroke associated with lesions of the caudate nucleus and insula. J Int Med Res 2018; 46:3552-3562. [PMID: 29865925 PMCID: PMC6136008 DOI: 10.1177/0300060518775290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective The present study was performed to investigate the relationships between swallowing outcomes and lesion location, bolus characteristics, and age in patients with subcortical stroke. PATIENTS Patients with subcortical and insular stroke (mean age, 57.38 ± 12.71 years) were investigated. All patients (n = 21) completed both brain magnetic resonance imaging studies and videofluoroscopic swallowing studies. Main Outcome Measures The oral transit duration, pharyngeal transit duration (PTD), laryngeal response duration, and Penetration-Aspiration Scale (PAS) score were applied to examine the efficiency of propulsion and airway protection in three swallowing tasks. Path analyses were performed to assess the relationships between swallowing outcomes and lesion location, age, bolus viscosity, and bolus volume. Results Caudate nucleus (CN) lesions were associated with higher PAS scores. Insular lesions were associated with a longer PTD. Advanced age was associated with a longer PTD. Bolus viscosity significantly moderated the association between CN lesions and higher PAS scores. Conclusions In the present cohort, CN lesions impacted airway protection and insular lesions impacted pharyngeal transit. An increased bolus viscosity reduced the aspiration severity. These results suggest that lesion location is an important indicator to predict subsequent dysphagia in patients with subcortical stroke.
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Affiliation(s)
- Ikjae Im
- 1 Graduate Program in Speech-Language Therapy, Chonbuk National University, Jeonju, Republic of Korea.,2 Swallowing Research Laboratory, University of Central Florida, Orlando, FL, USA
| | - Je-Pyo Jun
- 1 Graduate Program in Speech-Language Therapy, Chonbuk National University, Jeonju, Republic of Korea
| | - Seungbae Hwang
- 5 Department of Radiology, Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Myoung-Hwan Ko
- 1 Graduate Program in Speech-Language Therapy, Chonbuk National University, Jeonju, Republic of Korea.,3 Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Republic of Korea.,4 Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
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Shibata S, Inamoto Y, Saitoh E, Kagaya H, Aoyagi Y, Ota K, Akahori R, Fujii N, Palmer JB, González-Fernández M. The effect of bolus volume on laryngeal closure and UES opening in swallowing: Kinematic analysis using 320-row area detector CT study. J Oral Rehabil 2017; 44:974-981. [PMID: 28891595 DOI: 10.1111/joor.12573] [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] [Accepted: 09/06/2017] [Indexed: 01/09/2023]
Abstract
This study investigated the effects of three different volumes of honey-thick liquid on the temporal characteristics of swallowing. Twenty-six healthy subjects (15 males, 11 females) underwent 320-row area detector CT scan while swallowing 3, 10 and 20 mL of honey-thick liquid barium. Three-dimensional images were created at 10 images/s. Kinematic events involving six structures (velopharynx, hyoid bone, epiglottis, laryngeal vestibule (LV), true vocal cords (TVC), upper esophageal sphincter (UES)) and timing of bolus movement were timed using frame by frame analysis. The overall sequence of events did not differ across three volumes; however, increasing bolus volume significantly changed the onset and termination of events. The bolus head reached to pharynx and esophagus earlier and the duration of bolus passing through UES was significantly longer in 10 and 20 mL compared to 3 mL (P < .05). Consequently, the onset of UES opening was significantly earlier with increased volume (P < .05). LV and TVC closure occurred later in 20 mL compared to 3 mL (P < .05). These changes in motion of pharynx and larynx appeared to promote swallow safety by preventing aspiration, suggesting that anatomical structure movements adapt in response to bolus volume. Our findings also suggest that the pharyngeal swallow behaviours may be modified by afferents in the oral cavity. The three-dimensional visualization and quantitative measurements provided by 320-ADCT provide essential benchmarks for understanding swallowing, both normal and abnormal.
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Affiliation(s)
- S Shibata
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Y Inamoto
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan.,Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - E Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - H Kagaya
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Y Aoyagi
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - K Ota
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - R Akahori
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - N Fujii
- Department of Radiology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - J B Palmer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
| | - M González-Fernández
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
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Ferris L, Schar M, McCall L, Doeltgen S, Scholten I, Rommel N, Cock C, Omari T. Characterization of swallow modulation in response to bolus volume in healthy subjects accounting for catheter diameter. Laryngoscope 2017; 128:1328-1334. [DOI: 10.1002/lary.26820] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 05/31/2017] [Accepted: 06/30/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Lara Ferris
- Gastroenterology DepartmentWomen's and Children's HospitalAdelaide Australia
- Gastroenterology Department and Human Physiology DepartmentFlinders UniversityAdelaide Australia
| | - Mistyka Schar
- Gastroenterology Department and Human Physiology DepartmentFlinders UniversityAdelaide Australia
| | - Lisa McCall
- Gastroenterology DepartmentWomen's and Children's HospitalAdelaide Australia
| | - Sebastian Doeltgen
- School of Health SciencesDiscipline of Speech Pathology, Flinders UniversityAdelaide Australia
| | - Ingrid Scholten
- School of Health SciencesDiscipline of Speech Pathology, Flinders UniversityAdelaide Australia
| | - Nathalie Rommel
- Neurosciences DepartmentResearch Group Experimental Otorhinolaryngology, University of LeuvenLeuven Belgium
| | - Charles Cock
- Gastroenterology Department and Human Physiology DepartmentFlinders UniversityAdelaide Australia
| | - Taher Omari
- Gastroenterology Department and Human Physiology DepartmentFlinders UniversityAdelaide Australia
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26
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Yamada T, Matsuo K, Izawa M, Yamada S, Masuda Y, Ogasawara T. Effects of age and viscosity on food transport and breathing-swallowing coordination during eating of two-phase food in nursing home residents. Geriatr Gerontol Int 2017; 17:2171-2177. [PMID: 28425188 DOI: 10.1111/ggi.13056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/10/2017] [Accepted: 02/20/2017] [Indexed: 11/29/2022]
Abstract
AIM When eating food that contains both liquid and solid phases, the liquid component frequently enters the hypopharynx before swallowing and can increase the risk of aspiration. Thus, we examined whether the initial viscosity of mixed consistency food could alter pre-swallow food transport and breathing-swallowing coordination in older adults. METHODS Fiberoptic endoscopy was recorded while 18 healthy young adults and 19 older adults ate 5 g of steamed rice combined with 3 mL of blue-dye water. Liquid viscosity was set at three levels by the addition of a thickening agent (0 wt%, thin; 2 wt%, thicker; 4 wt%, higher-viscosity, respectively). We measured the timing of swallow initiation and its corresponding respiratory phase for each participant. RESULTS For thin mixed consistency food, whereas the timing of swallow initiation was comparable between young and older participants, swallowing was initiated during inspiration significantly more often in older participants (31.6 %) than in young participants (5.6 %). In contrast, the timing of swallow initiation was delayed in older participants for thicker and higher-viscosity foods, although swallowing was commonly initiated during expiration in both groups. CONCLUSIONS In older adults, we observed that swallow initiation function was preserved for thin mixed consistency samples, but breathing-swallowing coupling was diminished. For higher-viscosity foods, swallow initiation was delayed in this group, but breathing-swallowing coordination was not disturbed, probably as a result of the slow bolus flow into the hypopharynx. Thus, it appears the initial viscosity of mixed consistency food profoundly affects food transport before swallowing as well as breathing-swallowing coordination in nursing home residents. Geriatr Gerontol Int 2017; 17: 2171-2177.
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Affiliation(s)
- Tsuyoshi Yamada
- Department of Dentistry, Fujita Health University, Toyoake, Aichi, Japan.,Department of Special Care Dentistry, Matsumoto Dental University, Shiojiri, Nagano, Japan
| | - Koichiro Matsuo
- Department of Dentistry, Fujita Health University, Toyoake, Aichi, Japan
| | - Masayuki Izawa
- Department of Special Care Dentistry, Matsumoto Dental University, Shiojiri, Nagano, Japan
| | | | - Yuji Masuda
- Division of Oral and Maxillofacial Biology, Graduate School of Oral Medicine, Matsumoto Dental University, Shiojiri, Nagano, Japan
| | - Tadashi Ogasawara
- Department of Special Care Dentistry, Matsumoto Dental University, Shiojiri, Nagano, Japan
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Abstract
BACKGROUND Swallowing is a systematic process. Any structural, physiological or neurological disturbance in this process may cause dysphagia. Although there are studies that report head/neck movements during mastication, there are fewer studies that show the effect of different head/neck postures on difficulty while swallowing. OBJECTIVES To observe the effect of different body postures on the self-perceived difficulty while swallowing in normal healthy subjects. METHODS Participants were asked to swallow 25 ml of water in one go while sitting upright, sitting with head/neck flexed, head/neck extended and lying supine. Following this, they had to rate their self-perceived difficulty while swallowing on a scale of 0-10, 0 being most easy and 10 being most difficult. RESULTS 186 subjects with mean age 32.7 SD 9.04 participated in this study. It was found to be least difficult to swallow when subjects were asked to swallow in upright sitting position. Statistically significant differences were found between sitting upright, sitting with head/neck flexed, head/neck extended and lying supine. CONCLUSION Postural modification may help in rehabilitation of patients with dysphagia by affecting bolus flow to improve speed and safety of swallowing by closure of airways to prevent aspiration.
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Affiliation(s)
- Ahmad H Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, KSA
| | - Hamayun Zafar
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, KSA
| | - Einas S Al-Eisa
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, KSA
| | - Zaheen A Iqbal
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, KSA
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Effect of Different Viscosities on Pharyngeal Pressure During Swallowing: A Study Using High-Resolution Manometry. Arch Phys Med Rehabil 2017; 98:487-494. [DOI: 10.1016/j.apmr.2016.07.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/02/2016] [Indexed: 01/20/2023]
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Hwang JM, Cheong YS, Kang MG, Chun SM, Min YS, Lee YS, Jung TD. Recommendation of Nasogastric Tube Removal in Acute Stroke Patients Based on Videofluoroscopic Swallow Study. Ann Rehabil Med 2017; 41:9-15. [PMID: 28289630 PMCID: PMC5344831 DOI: 10.5535/arm.2017.41.1.9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/21/2016] [Indexed: 01/22/2023] Open
Abstract
Objective To evaluate the safety of nasogastric tube (NGT) removal and change to oral feeding with a food thickener for acute stroke patients in whom a videofluoroscopic swallow study (VFSS) confirmed thin liquid aspiration. Methods We retrospectively examined data of 199 patients with first stroke who were diagnosed with dysphagia from 2011 to 2015. Swallowing function was evaluated using VFSS. Patients included in this study were monitored for 4 weeks to identify the occurrence of aspiration pneumonia. The penetration-aspiration scale (PAS) was used to assess VFSS findings. The patients were divided into thin-liquid aspiration group (group 1, n=104) and no thin-liquid aspiration group (group 2, n=95). Results The feeding method was changed from NGT feeding to oral feeding with food thickener (group 1) and without food thickener (group 2). The PAS scores of thin and thick liquids were 6.46±0.65 and 1.92±0.73, respectively, in group 1 and 2.65±0.74 and 1.53±0.58, respectively, in group 2. Aspiration pneumonia developed in 1.9% of group 1 and 3.2% of group 2 (p=0.578), with no significant difference between the groups. Conclusion We concluded that removing the NGT and changing to oral feeding with a food thickener is a safe food modification for acute stroke patients with thin liquid aspiration. Therefore, we recommend that VFSS should be conducted promptly in acute stroke patients to avoid unnecessary prolonged NGT feeding.
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Affiliation(s)
- Jong-Moon Hwang
- Department of Rehabilitation Medicine, Kyungpook National University College of Medicine, Daegu, Korea
| | - Youn-Soo Cheong
- Department of Rehabilitation Medicine, Kyungpook National University College of Medicine, Daegu, Korea
| | - Min-Gu Kang
- Department of Rehabilitation Medicine, Kyungpook National University College of Medicine, Daegu, Korea
| | - Seong Min Chun
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Yu-Sun Min
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University College of Medicine, Daegu, Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, Kyungpook National University College of Medicine, Daegu, Korea.; Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
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30
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Peyron MA, Woda A, Bourdiol P, Hennequin M. Age-related changes in mastication. J Oral Rehabil 2017; 44:299-312. [DOI: 10.1111/joor.12478] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2016] [Indexed: 11/26/2022]
Affiliation(s)
- M. A. Peyron
- Human Nutrition Unit; Institut National de la Recherche Agronomique; Saint Genès-Champanelle France
| | - A. Woda
- Université Clermont Auvergne, CROC; Clermont-Ferrand France
| | - P. Bourdiol
- Université Clermont Auvergne, CROC; Clermont-Ferrand France
| | - M. Hennequin
- Université Clermont Auvergne, CROC; Clermont-Ferrand France
- CHU Clermont-Ferrand; Clermont-Ferrand France
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Lazarus CL. History of the Use and Impact of Compensatory Strategies in Management of Swallowing Disorders. Dysphagia 2017; 32:3-10. [PMID: 28130600 DOI: 10.1007/s00455-016-9779-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/30/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Cathy L Lazarus
- Department of Otolaryngology Head and Neck Surgery, Mount Sinai Beth Israel, New York, NY, 10003, USA. .,Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA. .,THANC Foundation, 10 Union Square East, New York, NY, 10003, USA.
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32
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Park JW, Sim GJ, Yang DC, Lee KH, Chang JH, Nam KY, Lee HJ, Kwon BS. Increased Bolus Volume Effect on Delayed Pharyngeal Swallowing Response in Post-stroke Oropharyngeal Dysphagia: A Pilot Study. Ann Rehabil Med 2016; 40:1018-1023. [PMID: 28119831 PMCID: PMC5256331 DOI: 10.5535/arm.2016.40.6.1018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 07/05/2016] [Indexed: 11/17/2022] Open
Abstract
Objective To confirm a relationship between the pharyngeal response and bolus volume, and examine whether increasing the fluid bolus volume can improve penetration and aspiration for stroke dysphagic patients. Methods Ten stroke patients with a delayed pharyngeal response problem confirmed by a videofluoroscopic swallowing study (VFSS) were enrolled. Each subject completed two swallows each of 2 mL, 5 mL, and 10 mL of barium liquid thinned with water. The pharyngeal delay time (PDT) and penetration-aspiration scale (PAS) were measured and the changes among the different volumes were analyzed. Results PDTs were shortened significantly when 5 mL and 10 mL of thin barium were swallowed compared to 2 mL. However, there was no significant difference in PAS as the bolus volume increased. Conclusion The increased fluid bolus volume reduced the pharyngeal delay time, but did not affect the penetration and aspiration status.
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Affiliation(s)
- Jin-Woo Park
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Gyu-Jeong Sim
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Dong-Chan Yang
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Kyoung-Hwan Lee
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Ji-Hea Chang
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Ki-Yeun Nam
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Ho-Jun Lee
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Bum-Sun Kwon
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Goyang, Korea
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Kothari M, Bjerrum K, Nielsen LH, Jensen J, Nielsen JF. Influence of External Subglottic Air Flow on Dysphagic Tracheotomized Patients With Severe Brain Injury. Ann Otol Rhinol Laryngol 2016; 126:199-204. [PMID: 28006951 DOI: 10.1177/0003489416683192] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to determine if external subglottic air flow (ESAF) influences swallowing frequency in severely dysphagic tracheotomized patients with brain injury. METHODS Ten patients were recruited at the neurological intensive care unit. The ESAF intervention was provided through the standard cuffed suction aid tracheotomy tube, which primarily is used to suction residual secretion volume from the subglottic area. Sessions were 150 minutes, and ESAF was provided at 60-65, 90-95, and 120-125 minutes at 3 L/min. Outcome measures included swallowing frequency (swallows/5 min) at 0-5 minutes (pre-baseline), 25-30 and 55-60 minutes (baseline/control), and 85-90, 115-120, and 145-150 minutes (postintervention). The residual secretion volume (ml) from the subglottic area was collected using a syringe at 0 minutes (pre-baseline), 30 and 60 minutes (baseline/ control), and at 90, 120, and 150 minutes (postintervention). RESULTS The mean (±SEM) swallowing frequency (swallows/5 min) increased from 0.60 ± 0.30 to 2.10 ± 0.70 during the ESAF intervention ( P < .001). The mean (±SEM) residual secretion volume reduced from 3.10 ± 0.31 ml to 0.50 ± 0.30 ml after the ESAF intervention ( P < .001). CONCLUSION The increase in swallowing frequency and reduction in residual secretion volume may indicate that ESAF influences swallowing parameters in patients with tracheotomy tubes.
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Affiliation(s)
- Mohit Kothari
- 1 Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark.,2 Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Katje Bjerrum
- 1 Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark.,3 Intensive Care Unit, Regional Hospital, Silkeborg, Denmark
| | | | - Jim Jensen
- 1 Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Jørgen Feldbæk Nielsen
- 1 Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark.,2 Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Frakking TT, Chang AB, O'Grady KAF, Yang J, David M, Weir KA. Acoustic and Perceptual Profiles of Swallowing Sounds in Children: Normative Data for 4-36 Months from a Cross-Sectional Study Cohort. Dysphagia 2016; 32:261-270. [PMID: 27830392 DOI: 10.1007/s00455-016-9755-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/18/2016] [Indexed: 12/12/2022]
Abstract
Limited data on cervical auscultation (CA) sounds during the transitional feeding period of 4-36 months in healthy children exist. This study examined the acoustic and perceptual parameters of swallowing sounds in children aged 4-36 months over a range of food and fluid consistencies. Using CA, swallowing sounds were recorded from a microphone as children ate or drank. Acoustic parameters of duration, peak frequency and peak intensity were determined. Perceptual parameters of swallowing/breath sounds heard pre-, during and post-swallow were rated ('present', 'absent', 'cannot be determined') for each texture. 74 children (35 males; mean age = 17.1 months [SD 10.0]) demonstrated mean swallow durations of <1 s. Increasing age correlated to reduced peak frequency on puree (r = -0.48, 95 % CI -0.66, -0.24). Age correlated to peak amplitude when swallowing puree (r = 0.27, 95 % CI 0.02, 0.49), chewable solids (r = 0.31, 95 % CI 0.02, 0.56) and thin fluids (r = 0.48, 95 % CI 0.27, 0.64). The bolus transit sound was present in all swallows. A majority of children had normal breathing sounds and coordinated swallows. A swallow duration of <1 s and the presence of a quick bolus transit sound with normal breathing sounds were found in healthy children. The normative data reported in this study provide a platform for future comparison to abnormal swallowing sounds in children.
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Affiliation(s)
- Thuy T Frakking
- Centre for Children's Health Research, The University of Queensland, Level 7, 62 Graham St, South Brisbane, QLD, 4101, Australia. .,Speech Pathology Department, Caboolture Hospital, McKean St, Caboolture, QLD, 4510, Australia.
| | - Anne B Chang
- Queensland Children's Respiratory Centre, Lady Cilento Children's Hospital, 501 Stanley St, South Brisbane, QLD, 4101, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia.,Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, Level 7, 62 Graham St, South Brisbane, QLD, 4101, Australia
| | - Kerry-Ann F O'Grady
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, Level 7, 62 Graham St, South Brisbane, QLD, 4101, Australia
| | - Julie Yang
- Centre for Children's Health Research, The University of Queensland, Level 7, 62 Graham St, South Brisbane, QLD, 4101, Australia
| | - Michael David
- School of Public Health, The University of Queensland, Herston Rd, Herston, QLD, 4029, Australia
| | - Kelly A Weir
- School of Medicine, The University of Queensland, St Lucia, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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Cornwell PL, Cowie B, Geraghty R. Examining nurse-led dysphagia screening tools in the general medical hospital population. SPEECH LANGUAGE AND HEARING 2016. [DOI: 10.1080/2050571x.2016.1204747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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36
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Lan Y, Xu GQ, Yu F, Lin T, Jiang LS, Liu F. The effect of bolus consistency on swallowing function measured by high-resolution manometry in healthy volunteers. Laryngoscope 2016; 127:173-178. [PMID: 27297524 DOI: 10.1002/lary.26085] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/05/2016] [Accepted: 04/25/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Yue Lan
- Department of Rehabilitation Medicine; Guangzhou First People's Hospital; Guangzhou Medical University; Guangzhou Guangdong People's Republic of China
| | - Guang-qing Xu
- Department of Rehabilitation Medicine; The First Affiliated Hospital; Sun Yat-sen University; Guangzhou Guangdong People's Republic of China
| | - Fan Yu
- Department of Rehabilitation Medicine; Shang Hai General Hospital; Shanghai People's Republic of China
| | - Tuo Lin
- Department of Rehabilitation Medicine; Guangzhou First People's Hospital; Guangzhou Medical University; Guangzhou Guangdong People's Republic of China
| | - Li-sheng Jiang
- Department of Rehabilitation Medicine; Guangzhou First People's Hospital; Guangzhou Medical University; Guangzhou Guangdong People's Republic of China
| | - Feng Liu
- Department of Geriatrics; Guangzhou First People's Hospital; Guangzhou Medical University; Guangzhou Guangdong People's Republic of China
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Chen PC, Chuang CH, Leong CP, Guo SE, Hsin YJ. Systematic review and meta-analysis of the diagnostic accuracy of the water swallow test for screening aspiration in stroke patients. J Adv Nurs 2016; 72:2575-2586. [PMID: 27237447 DOI: 10.1111/jan.13013] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 01/25/2023]
Abstract
AIM The aim of this study was to determine the diagnostic accuracy of the water swallow test for screening aspirations in stroke patients. BACKGROUND The water swallow test is a simple bedside screening tool for aspiration among stroke patients in nursing practice, but results from different studies have not been combined before. DESIGN A systematic review and meta-analysis was conducted to provide a synthetic and critical appraisal of the included studies. DATA SOURCES Electronic literature in MEDLINE, EMBASE, CINAHL and other sources were searched systemically in this study. Databases and registers were searched from inception up to 30 April 2015. REVIEW METHODS This systematic review was conducted using the recommendations from Cochrane Collaboration for Systematic Reviews of Diagnostic Test Accuracy. Bivariate random-effects models were used to estimate the diagnostic accuracy across those studies. The tool named Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to evaluate the quality of the studies. RESULTS There were 770 stroke patients in the 11 studies for the meta-analysis. The water swallow test had sensitivities between 64-79% and specificities between 61-81%. Meta-regression analysis indicated that increasing water volume resulted in higher sensitivity but lower specificity of the water swallow test. CONCLUSIONS This systematic review showed that the water swallow test was a useful screening tool for aspiration among stroke patients. The test accuracy was related to the water volume and a 3-oz water swallow test was recommended for aspiration screening in stroke patients.
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Affiliation(s)
- Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hui Chuang
- College of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Taiwan. .,Department of Nursing, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan.
| | - Chau-Peng Leong
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Su-Er Guo
- Chronic Diseases and Health Promotion Research Center, Chiayi, Taiwan.,College of Nursing and Graduate Institute of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Yi-Jung Hsin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan
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38
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Lee KD, Song SH, Koo JH, Park HS, Kim JS, Jang KH. Proposed Use of Thickener According to Fluid Intake on Videofluoroscopic Swallowing Studies: Preliminary Study in Normal Healthy Persons. Ann Rehabil Med 2016; 40:206-13. [PMID: 27152269 PMCID: PMC4855113 DOI: 10.5535/arm.2016.40.2.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/11/2015] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To examine the characteristics and changes in the pharyngeal phase of swallowing according to fluid viscosity in normal healthy persons, to help determine fluid intake methods in more detail than the use of standardized fluid. METHODS This was a prospective observational study involving 10 normal healthy adults. While the participants sequentially took in fluids with 10 different viscosities changes in the pharyngeal phase of the swallowing process were monitored using videofluoroscopic swallowing studies (VFSS). Twenty parameters of the pharyngeal phase, including epiglottis contact, laryngeal elevation, pharyngeal constriction, and upper esophageal sphincter opening, were determined and compared. RESULTS No significant viscosity-based changes in epiglottis contact, laryngeal elevation, or upper esophageal sphincter-opening duration of the pharyngeal phase were observed. However, pharyngeal transit time and time from the start of the pharyngeal phase to peak pharyngeal constriction were significantly delayed upon intake of fluid with viscosities of 150.0 centipoise (cP) and 200.0 cP. CONCLUSION VFSS analysis of fluid intake may require the use of fluids of various concentrations to determine a suitable viscosity of thickener mixture for each subject.
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Affiliation(s)
- Kyung Duck Lee
- Department of Rehabilitation Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Sun Hong Song
- Department of Rehabilitation Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Jung Hoi Koo
- Department of Rehabilitation Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hee Seon Park
- Department of Rehabilitation Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Jae Sin Kim
- Department of Rehabilitation Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Ki Hyo Jang
- Department of Food & Nutrition, College of Health & Welfare, Kangwon National University, Samcheok, Korea
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Cheney DM, Marks SL, Pollard RE. EFFECT OF BOLUS SIZE ON DEGLUTITION AND ESOPHAGEAL TRANSIT IN HEALTHY DOGS. Vet Radiol Ultrasound 2016; 57:359-65. [DOI: 10.1111/vru.12362] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Diane M. Cheney
- William R. Pritchard Veterinary Medical Teaching Hospital; School of Veterinary Medicine, University of California, Davis; Davis CA 95616
| | - Stanley L. Marks
- Department of Medicine and Epidemiology; School of Veterinary Medicine, University of California, Davis; Davis CA 95616
| | - Rachel E. Pollard
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine, University of California, Davis; Davis CA 95616
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Vilardell N, Rofes L, Arreola V, Speyer R, Clavé P. A Comparative Study Between Modified Starch and Xanthan Gum Thickeners in Post-Stroke Oropharyngeal Dysphagia. Dysphagia 2015; 31:169-79. [DOI: 10.1007/s00455-015-9672-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 11/11/2015] [Indexed: 11/30/2022]
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Age-Related Differences in Pressures Generated During Isometric Presses and Swallows by Healthy Adults. Dysphagia 2015; 31:90-6. [DOI: 10.1007/s00455-015-9662-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 10/14/2015] [Indexed: 01/16/2023]
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Hayashi H, Hori K, Taniguchi H, Nakamura Y, Tsujimura T, Ono T, Inoue M. Biomechanics of human tongue movement during bolus compression and swallowing. J Oral Sci 2015; 55:191-8. [PMID: 24042584 DOI: 10.2334/josnusd.55.191] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
We evaluated the effects of gel consistency and bolus volume on ingestion in humans. Eight healthy men were asked to ingest liquids, and sample foods of different gel consistencies and volumes, as usual. Tongue pressure against the hard palate was recorded at five points, and bolus flow was recorded using videoendoscopic images. The number of squeezes increased as gel consistency and volume increased. The integrated magnitude of tongue pressure during squeezing increased with increasing gel consistency. Bolus propulsion into the pharynx was affected by bolus characteristics, and location of the bolus head at the onset of pharyngeal swallowing was not related to squeezing behavior. The trigger point at which pharyngeal swallowing began was subject-dependent. During swallowing, the magnitude of tongue pressure moderately increased with increasing gel consistency, as compared with squeezing. Tongue pressure was not related to bolus volume. The current results suggest that patterns of tongue pressure during squeezing and swallowing are differentially affected by bolus conditions. However, healthy subjects differed in the techniques used for squeezing and swallowing.
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Affiliation(s)
- Hirokazu Hayashi
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences
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Santos RRDD, Cola PC, Jorge AG, Peres FM, Lauris JRP, Silva RGD. Correlação entre tempo de trânsito oral e faríngeo no acidente vascular cerebral. AUDIOLOGY - COMMUNICATION RESEARCH 2015. [DOI: 10.1590/s2317-64312015000300001567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objetivo Correlacionar o tempo de trânsito oral total (TTOT) com o início da resposta faríngea (IRF) e o tempo de trânsito faríngeo (TTF) no indivíduo, após acidente vascular cerebral (AVC).Métodos O estudo incluiu 61 exames de videofluoroscopia de deglutição de indivíduos após AVC hemisférico isquêmico. Destes, 28 eram do gênero masculino e 33 do gênero feminino, com faixa etária variando de 40 a 101 anos (média de 65 anos). Para análise dos resultados, os indivíduos foram divididos em dois grupos. O Grupo 1 (G1) constou de 17 indivíduos com tempo de trânsito oral total até 2000 ms, conforme normalidade, e o Grupo 2 (G2), de 44 indivíduos com tempo de trânsito oral total maior que 2000 ms. Foi realizada análise quantitativa da deglutição orofaríngea. Cada indivíduo foi observado durante a deglutição de uma colher de 5 ml com alimento na consistência pastosa. Foi aplicado o teste de correlação de Spearman.Resultados Não houve correlação entre o G1 e a IRF e o TTF. Houve fraca correlação entre o G2 e os parâmetros estudados.Conclusão O aumento do tempo de trânsito oral total no indivíduo após AVC possui correlação fraca com o aumento do tempo na fase faríngea.
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Patient-centred pharmaceutical design to improve acceptability of medicines: similarities and differences in paediatric and geriatric populations. Drugs 2015; 74:1871-1889. [PMID: 25274536 PMCID: PMC4210646 DOI: 10.1007/s40265-014-0297-2] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient acceptability of a medicinal product is a key aspect in the development and prescribing of medicines. Children and older adults differ in many aspects from the other age subsets of population and require particular considerations in medication acceptability. This review highlights the similarities and differences in these two age groups in relation to factors affecting acceptability of medicines. New and conventional formulations of medicines are considered regarding their appropriateness for use in children and older people. Aspects of a formulation that impact acceptability in these patient groups are discussed, including, for example, taste/smell/viscosity of a liquid and size/shape of a tablet. A better understanding of the acceptability of existing formulations highlights opportunities for the development of new and more acceptable medicines and facilitates safe and effective prescribing for the young and older populations.
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Su HK, Khorsandi A, Silberzweig J, Kobren AJ, Urken ML, Amin MR, Branski RC, Lazarus CL. Temporal and Physiologic Measurements of Deglutition in the Upright and Supine Position with Videofluoroscopy (VFS) in Healthy Subjects. Dysphagia 2015; 30:438-44. [DOI: 10.1007/s00455-015-9620-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 04/25/2015] [Indexed: 10/23/2022]
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Swan K, Speyer R, Heijnen BJ, Wagg B, Cordier R. Living with oropharyngeal dysphagia: effects of bolus modification on health-related quality of life--a systematic review. Qual Life Res 2015; 24:2447-56. [PMID: 25869989 DOI: 10.1007/s11136-015-0990-y] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Difficulty swallowing, oropharyngeal dysphagia, is widespread among many patient populations (such as stroke and cancer groups) and aged community-dwelling individuals. It is commonly managed with bolus modification: altering food (usually cutting, mashing or puréeing) or fluids (typically thickening) to make them easier or safer to swallow. Although this treatment is ubiquitous, anecdotal evidence suggests patients dislike this management, and this may affect compliance and well-being. This review aimed to examine the impact of bolus modification on health-related quality of life. METHODS A systematic review of the literature was conducted by speech pathologists with experience in oropharyngeal dysphagia. The literature search was completed with electronic databases, PubMed and Embase, and all available exclusion dates up to September 2012 were used. The search was limited to English-language publications which were full text and appeared in peer-reviewed journals. RESULTS Eight studies met the inclusion criteria. Generally, bolus modification was typically associated with worse quality of life. Modifications to foods appeared to be more detrimental than modifications to fluids, but this may be due to the increased severity of dysfunction that is implied by the necessity for significant alterations to foods. The number of studies retrieved was quite small. The diverse nature of methodologies, terminologies and assessment procedures found in the studies makes the results difficult to generalise. CONCLUSION Overall, even though the severity of dysphagia may have been a confounding factor, the impact of bolus modification on health-related quality of life in patients with oropharyngeal dysphagia appears to be negative, with increased modification of food and fluids often correlating to a decreased quality of life. Further, associated disease factors, such as decreased life expectancy, may also have affected health-related quality of life. More research is needed.
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Affiliation(s)
- Katina Swan
- Discipline of Speech Pathology, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, QLD, 4811, Australia.
| | - Renée Speyer
- Discipline of Speech Pathology, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, QLD, 4811, Australia. .,Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Bas J Heijnen
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Bethany Wagg
- Discipline of Speech Pathology, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, QLD, 4811, Australia
| | - Reinie Cordier
- Discipline of Speech Pathology, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, QLD, 4811, Australia.,School of Occupational Therapy and Social Work, Curtin University, Perth, WA, Australia
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Lever TE, Brooks RT, Thombs LA, Littrell LL, Harris RA, Allen MJ, Kadosh MD, Robbins KL. Videofluoroscopic Validation of a Translational Murine Model of Presbyphagia. Dysphagia 2015; 30:328-42. [PMID: 25783697 DOI: 10.1007/s00455-015-9604-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 02/25/2015] [Indexed: 01/19/2023]
Abstract
Presbyphagia affects approximately 40% of otherwise healthy people over 60 years of age. Hence, it is a condition of primary aging rather than a consequence of primary disease. This distinction warrants systematic investigations to understand the causal mechanisms of aging versus disease specifically on the structure and function of the swallowing mechanism. Toward this goal, we have been studying healthy aging C57BL/6 mice (also called B6), the most popular laboratory rodent for biomedical research. The goal of this study was to validate this strain as a model of presbyphagia for translational research purposes. We tested two age groups of B6 mice: young (4-7 months; n = 16) and old (18-21 months; n = 11). Mice underwent a freely behaving videofluoroscopic swallow study (VFSS) protocol developed in our lab. VFSS videos (recorded at 30 frames per second) were analyzed frame-by-frame to quantify 15 swallow metrics. Six of the 15 swallow metrics were significantly different between young and old mice. Compared to young mice, old mice had significantly longer pharyngeal and esophageal transit times (p = 0.038 and p = 0.022, respectively), swallowed larger boluses (p = 0.032), and had a significantly higher percentage of ineffective primary esophageal swallows (p = 0.0405). In addition, lick rate was significantly slower for old mice, measured using tongue cycle rate (p = 0.0034) and jaw cycle rate (p = 0.0020). This study provides novel evidence that otherwise healthy aging B6 mice indeed develop age-related changes in swallow function resembling presbyphagia in humans. Specifically, aging B6 mice have a generally slow swallow that spans all stages of swallowing: oral, pharyngeal, and esophageal. The next step is to build upon this foundational work by exploring the responsible mechanisms of presbyphagia in B6 mice.
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Affiliation(s)
- Teresa E Lever
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Drive MA314, Columbia, MO, 65212, USA,
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Rodrigues KA, Machado FR, Chiari BM, Rosseti HB, Lorenzon P, Gonçalves MIR. Swallowing rehabilitation of dysphagic tracheostomized patients under mechanical ventilation in intensive care units: a feasibility study. Rev Bras Ter Intensiva 2015; 27:64-71. [PMID: 25909315 PMCID: PMC4396899 DOI: 10.5935/0103-507x.20150011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 02/22/2015] [Indexed: 01/15/2023] Open
Abstract
Objective The aim of the present study was to assess the feasibility of the early
implementation of a swallowing rehabilitation program in tracheostomized patients
under mechanical ventilation with dysphagia. Methods This prospective study was conducted in the intensive care units of a university
hospital. We included hemodynamically stable patients under mechanical ventilation
for at least 48 hours following 48 hours of tracheostomy and with an appropriate
level of consciousness. The exclusion criteria were previous surgery in the oral
cavity, pharynx, larynx and/or esophagus, the presence of degenerative diseases or
a past history of oropharyngeal dysphagia. All patients were submitted to a
swallowing rehabilitation program. An oropharyngeal structural score, a swallowing
functional score and an otorhinolaryngological structural and functional score
were determined before and after swallowing therapy. Results We included 14 patients. The mean duration of the rehabilitation program was 12.4
± 9.4 days, with 5.0 ± 5.2 days under mechanical ventilation. Eleven
patients could receive oral feeding while still in the intensive care unit after 4
(2 - 13) days of therapy. All scores significantly improved after therapy. Conclusion In this small group of patients, we demonstrated that the early implementation of
a swallowing rehabilitation program is feasible even in patients under mechanical
ventilation.
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Affiliation(s)
- Katia Alonso Rodrigues
- Departamento de Fonoaudiologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Flávia Ribeiro Machado
- Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Brasília Maria Chiari
- Departamento de Fonoaudiologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Heloísa Baccaro Rosseti
- Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Paula Lorenzon
- Departamento de Otorrinolaringologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Kedlaya D, Brandstater ME. Swallowing, Nutrition, and Hydration During Acute Stroke Care. Top Stroke Rehabil 2015; 9:23-38. [PMID: 14523715 DOI: 10.1310/weha-aljx-9n2x-0vmu] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Dysphagia occurs in up to half of patients after an acute stroke and may cause dehydration, undernutrition, and aspiration pneumonia. Current evidence suggests that a systematic program of diagnosis and treatment of dysphagia in an acute stroke management plan may yield dramatic reductions in aspiration pneumonia rates. There is also some evidence that nutritional supplementation and proper hydration may reduce morbidity and mortality in acute stroke patients. This article focuses on the recent advances in the evaluation and management of dysphagia, undernutrition, and dehydration related to acute stroke. A summary of pertinent studies in the area of stroke dysphagia and nutrition is also included.
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Affiliation(s)
- Divakara Kedlaya
- Department of Physical Medicine & Rehabilitation, Loma Linda University Medical Center, Loma Linda, California, USA
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Nascimento WV, Cassiani RA, Santos CM, Dantas RO. Effect of bolus volume and consistency on swallowing events duration in healthy subjects. J Neurogastroenterol Motil 2015; 21:78-82. [PMID: 25540944 PMCID: PMC4288090 DOI: 10.5056/jnm14055] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 07/08/2014] [Accepted: 08/04/2014] [Indexed: 11/23/2022] Open
Abstract
Background/Aims Swallowing is a complex function with the control of the swallowing center being located in the brain stem. Our aim in this investigation was to evaluate, in healthy volunteers, the oral and pharyngeal transit of 2 bolus volumes and 2 consistencies, and the influence of these boluses on the proportion of pharyngeal clearance duration/hyoid movement duration. Methods Videofluoroscopic evaluation of swallows was performed in 30 healthy volunteers, aged 29–77 years (mean 58 years). The subjects swallowed in duplicate of 5 mL and 10 mL of thick liquid barium and honey thick barium. We measured the duration of oral transit, pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement, oropharyngeal transit, and the relation pharyngeal clearance duration/hyoid movement duration. Results A 10 mL bolus volume caused a longer UES opening duration than a 5 mL bolus volume, for both consistencies. The pharyngeal transit was longer for honey thick bolus consistency than for thick liquid, with both the volumes of 5 mL and 10 mL. For pharyngeal clearance, the difference was significant only with the 10 mL bolus volume. There was no difference associated with bolus volume or consistency in the relation between pharyngeal clearance duration and hyoid movement duration. Conclusions Increase in the swallowed bolus volume causes a longer UES opening duration and an increase in bolus consistency from thick liquid to honey thick causes a longer pharyngeal transit duration. The proportion between pharyngeal clearance and hyoid movement does not change with bolus volume or bolus consistency.
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Affiliation(s)
- Weslania V Nascimento
- Division of Gastroenterology of the Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto SP, Brazil
| | - Rachel A Cassiani
- Division of Gastroenterology of the Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto SP, Brazil
| | - Carla M Santos
- Division of Gastroenterology of the Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto SP, Brazil
| | - Roberto O Dantas
- Division of Gastroenterology of the Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto SP, Brazil
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