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Bonilha HS, Reedy EL, Wilmskoetter J, Nietert PJ, Martin-Harris B. Impact of Reducing Fluoroscopy Pulse Rate on Adult Modified Barium Swallow Studies. Dysphagia 2024:10.1007/s00455-023-10643-5. [PMID: 38265506 DOI: 10.1007/s00455-023-10643-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/02/2023] [Indexed: 01/25/2024]
Abstract
Modified Barium Swallow Studies (MBSS) are a critical part of the evaluation, treatment planning, and outcome assessment for persons with swallowing disorders. Since MBSSs use ionizing radiation with associated cancer risks, many clinicians have reduced radiation exposure by reducing the fluoroscopic pulse rate. However, by reducing pulse rate, we also decrease the temporal resolution of MBSSs which has been shown in pilot studies to significantly reduce diagnostic accuracy. Two hundred MBSSs from patients routinely undergoing MBSS as standard of care conducted at 30 pulses per second (pps) using the Modified Barium Swallow Study Impairment Profile (MBSImP™) standardized administration protocol were selected. A stratified sampling method ensured that a full range of swallowing impairments (etiology, type, and severity) was represented. Recordings were down sampled from 30 pps to 15, 7.5, and 4 pps. MBSSs were rated using the MBSImP components and Penetration-Aspiration Scale (PAS) score for each swallow. Percent agreement was calculated across raters for MBSImP and PAS scores by bolus type and volume. The Least-Squares Method was used for hypothesis testing. Statistically significant and clinically meaningful changes in scores of swallowing physiology and penetration/aspiration occurred when reducing pulse rate below 30pps. These changes were evident across bolus types and volumes. Given the impact on diagnostic accuracy and the low radiation risks to adults undergoing MBSSs, reducing pulse rate to 15pps or below is not aligned with the As Low As Reasonably Achievable (ALARA) principle and should not be used as a viable method to reduce radiation exposure from MBSSs.
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Affiliation(s)
- Heather Shaw Bonilha
- Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, MSC 700, Charleston, SC, 29425-2503, USA.
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA.
- Department of Communication Sciences and Disorders, University of South Carolina, 915 Greene Street, Room 202B, Columbia, SC, 29208, USA.
| | - Erin L Reedy
- Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, MSC 700, Charleston, SC, 29425-2503, USA
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 70 Arts Circle Drive, Evanston, IL, 60208, USA
- Edward J. Hines Veteran's Affairs Medical Center, 5000 5th Avenue, Hines, IL, 60141-3030, USA
| | - Janina Wilmskoetter
- Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, MSC 700, Charleston, SC, 29425-2503, USA
- College of Medicine, Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 606, Charleston, SC, 29425-2503, USA
| | - Paul J Nietert
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 135 Cannon Street, MSC 835, Charleston, SC, 29425-2503, USA
| | - Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 70 Arts Circle Drive, Evanston, IL, 60208, USA
- Feinberg School of Medicine, Otolaryngology - Head & Neck Surgery, Radiation Oncology, Northwestern University, 420 E Superior Street, Chicago, IL, 60611, USA
- Edward J. Hines Veteran's Affairs Medical Center, 5000 5th Avenue, Hines, IL, 60141-3030, USA
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Martin-Harris B, Kantarcigil C, Reedy EL, McFarland DH. Cross-System Integration of Respiration and Deglutition: Function, Treatment, and Future Directions. Dysphagia 2023; 38:1049-1058. [PMID: 36378345 PMCID: PMC10266896 DOI: 10.1007/s00455-022-10538-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
Swallowing occurs preferentially in the expiratory phase of the quiet breathing cycle and at mid-to-low tidal volume. This coordinative pattern imparts important biomechanical advantages to swallowing and airway protection and facilitate laryngeal elevation, laryngeal vestibular and vocal fold closure, and cricopharyngeal sphincter opening. This preferred coordinative relationship between breathing and swallowing is impaired in a variety of patient populations, including head and neck cancer survivors with dysphagia. We developed a training protocol to re-establish more optimal phasing of swallowing with breathing in these patients with striking outcomes, including reduced swallowing physiological impairments and improved airway protection. This motivated us to continue to refine and expand this training protocol and develop new assistive technologies for swallowing monitoring outside of the lab. In this review, we highlight the origins of our optimal respiratory-swallowing coordination hypothesis, describe the biomechanical advantages it provides, carefully describe our training protocol and findings, and chart a course for the next phase of this work. Our overall goal is to harness technology combined with carefully constructed learning paradigms to improve the lives of patients with impaired respiratory-swallowing coordination consequent to a variety of pathologies including head and neck cancer and degenerative neurological conditions such as Parkinson's disease.
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Affiliation(s)
- Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA.
- Otolaryngology - Head & Neck Surgery, Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Veterans Affairs Medical Center, Edward J. Hines, Jr., Hines, IL, USA.
| | - Cagla Kantarcigil
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA
| | - Erin L Reedy
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA
- Veterans Affairs Medical Center, Edward J. Hines, Jr., Hines, IL, USA
| | - David H McFarland
- Faculties of Medicine, Université de Montréal and McGill University, Montreal, CA, USA
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Montreal, CA, USA
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Reedy EL, Simpson AN, O'Rourke AK, Bonilha HS. Characterizing Swallowing Impairment in a Post-Lung Transplant Population. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1236-1251. [PMID: 37000923 DOI: 10.1044/2023_ajslp-22-00266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Lung transplant recipients carry significant pre- and post-lung transplant dysphagia risk factors related to altered respiratory-swallow coordination as well as acute injury and decompensation resulting in the acute post-lung transplant recovery period. However, we are only beginning to understand the potential physiological contributors to altered swallowing in this population. METHOD A retrospective, cross-sectional, cohort study of post-lung transplant patients was performed. All participants received a modified barium swallow study (MBSS) as part of standard care during their acute hospitalization using the Modified Barium Swallow Impairment Profile (MBSImP) protocol and scoring metric. A combination of MBSImP scores, Penetration-Aspiration Scale (PAS) scores, Functional Oral Intake Scale (FOIS) scores, International Dysphagia Diet Standardization Initiative (IDDSI) scale levels, and the time from lung transplant to MBSS was collected, as well as measures of swallowing impairment and swallowing-related outcomes. Differences in swallowing physiology and swallowing-related outcomes between participants with typical versus atypical PAS were explored. RESULTS Forty-two participants met our prespecified inclusion criteria. We identified atypical laryngeal penetration and/or aspiration in 52.4% of our post-lung transplant cohort. Silent aspiration occurred in 75% of those patients who aspirated. Comparing typical versus atypical PAS scores, we found statistically significant associations with laryngeal elevation (Component 8), p < .0001; anterior hyoid excursion (Component 9), p = .0046; epiglottic movement (Component 10), p = .0031; laryngeal vestibule closure (Component 11), p < .0001; pharyngeal stripping (Component 12), p = .0058; pharyngeal total scores, p = .0001; FOIS scores, p = .00264; and IDDSI liquid levels, p = .0009. CONCLUSIONS Swallowing impairment resulting in abnormal bolus invasion is prevalent in post-lung transplant patients. Airway invasion in this cohort was related to pharyngeal swallow impairment and resulted in modified oral intake. Our findings help expand upon prior literature, which only reported the incidence of aspiration and pathological laryngeal penetration. Our results suggest that the potential for aerodigestive system impairment and negative sequela should not be underestimated in the post-lung transplant population.
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Affiliation(s)
- Erin L Reedy
- Health Sciences and Research, The Medical University of South Carolina, Charleston
| | - Annie N Simpson
- Health Sciences and Research, The Medical University of South Carolina, Charleston
- Department of Otolaryngology-Head & Neck Surgery, The Medical University of South Carolina, Charleston
| | - Ashli K O'Rourke
- Department of Otolaryngology-Head & Neck Surgery, The Medical University of South Carolina, Charleston
| | - Heather Shaw Bonilha
- Health Sciences and Research, The Medical University of South Carolina, Charleston
- Department of Otolaryngology-Head & Neck Surgery, The Medical University of South Carolina, Charleston
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA
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Myung JH, Pyun SB. Effect of Oral Apraxia on Dysphagia in Patients with Subacute Stroke. Dysphagia 2023; 38:227-235. [PMID: 35508738 DOI: 10.1007/s00455-022-10458-w] [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: 09/03/2021] [Accepted: 04/18/2022] [Indexed: 01/27/2023]
Abstract
Aim of this study was to investigate the effect of post-stroke oral apraxia on dysphagia in patients with subacute stroke. We retrospectively analyzed the clinical data of 130 supratentorial stroke patients from January 2015 to February 2021 who underwent a formal limb and oral apraxia test and videofluoroscopic swallowing study (VFSS), and we compared the patients in two groups: the apraxia and non-apraxia (oral apraxia score > 45 and ≤ 45 points, respectively). All the patients participated in the standardized testing battery. The test variables were videofluoroscopic dysphagia scale (VDS), oral transit time (OTT), pharyngeal delay time (PDT), pharyngeal transit time, and penetration-aspiration scale (PAS); we conducted multivariable regression analysis with those parameters to confirm the significance of oral apraxia as a clinical determinant of post-stroke dysphagia. The mean oral apraxia scores were 38.4 and 47.6 points in the apraxia and non-apraxia groups, respectively (p < 0.001). The apraxia group had a higher proportion of delayed OTT for the 2-mL-thick liquid than the non-apraxia group (17.6% and 4.2%, respectively; p = 0.011). Oral apraxia was a significant determinant of VDS (p < 0.001), delayed OTT of 2-mL-thick liquids (p = 0.028), delayed PDT of cup drinking for thin liquid (p = 0.044), and PAS scores (p = 0.003). The presence of oral apraxia was significantly associated with dysphagia, especially with the VFSS parameters of the oral phase (thick liquid), pharyngeal phase (cup drinking for thin liquid) of swallowing, and increased risk of aspiration in subacute stroke patients. Thus, a formal assessment of oral apraxia is needed for stroke patients with dysphagia.
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Affiliation(s)
- Jei Hak Myung
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sung-Bom Pyun
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea.
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, Republic of Korea.
- Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea.
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Yu L, Li Y, Zhang D, Huang W, Li R, Zhu J, Li R, Zhao J, Wang J. A risk prediction model for dysphagia in older patients: a single-center prospective study. Geriatr Nurs 2022; 44:24-29. [PMID: 35007867 DOI: 10.1016/j.gerinurse.2021.12.013] [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: 10/18/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022]
Abstract
Surveys based on western populations have identified many risk factors for dysphagia in older people, but the potential risk factors consistent with the demographic characteristics of older, hospitalized Chinese patients require further study. This single-center prospective study aimed to determine the incidence of dysphagia in western China, and to develop and validate a model to predict the risk of dysphagia among older patients. A total of 343 inpatients (aged ≥ 65 years without dysphagia and cognitive impairment) were included. A score ≥ 2 on the Eating Assessment Tool-10 was defined as dysphagia. After a six-month follow-up, 70 (20.4%) patients were found to have dysphagia. The final model included age, wearing dentures, activities of daily living, cerebral vascular disease, coronary heart disease, and malignancy. The developed model has high predictive accuracy and can be easily implemented in daily practice.
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Affiliation(s)
- Lili Yu
- Dianjiang Traditional Chinese Medical Hospital, Chongqing, China; School of Nursing, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | | | - Dongyun Zhang
- School of Nursing, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Wanyun Huang
- Dianjiang Traditional Chinese Medical Hospital, Chongqing, China
| | - Runping Li
- Dianjiang Traditional Chinese Medical Hospital, Chongqing, China
| | - Junxia Zhu
- Dianjiang Traditional Chinese Medical Hospital, Chongqing, China
| | - Rongxiu Li
- Dianjiang Traditional Chinese Medical Hospital, Chongqing, China
| | - Jun Zhao
- Center for Environment and Health in Water Source Area of South-to-North Water Diversion, Hubei University of Medicine, Shiyan, Hubei, China.
| | - Jing Wang
- Center for Environment and Health in Water Source Area of South-to-North Water Diversion, Hubei University of Medicine, Shiyan, Hubei, China.
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Garand KL, Beall J, Hill EG, Davidson K, Blair J, Pearson W, Martin-Harris B. Effects of Presbyphagia on Oropharyngeal Swallowing Observed during Modified Barium Swallow Studies. J Nutr Health Aging 2022; 26:973-980. [PMID: 36437764 PMCID: PMC10324474 DOI: 10.1007/s12603-022-1854-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Understanding how aging impacts swallowing can help differentiate typical from atypical behaviors. This study aimed to quantify age-related swallowing alterations observed during a modified barium swallow study. DESIGN Cross-sectional study. SETTING Adult fluoroscopy suite in a metropolitan hospital at an academic center. PARTICIPANTS 195 healthy adults distributed across 3 age categories: 21-39; 40-59; 60+ years. MEASUREMENTS 17 physiologic components of swallowing across three functional domains (oral, pharyngeal, esophageal), including summed composite scores (Oral Total [OT] and Pharyngeal Total [PT]), from the validated and standardized Modified Barium Swallow Impairment Profile. RESULTS Most components (65%) demonstrated no impairment (scores of "0"). The odds of a worse (higher) score increased significantly with age for: Tongue Control during Bolus Hold, Hyolaryngeal Movement, Laryngeal Closure, Pharyngeal Contraction, and Pharyngoesophageal Segment Opening. OT and PT scores for 40-59-year-olds were worse than the youngest group (p=.01 and p <.001, respectively). Adults 60+ years had significantly worse PT scores among all groups (p-values <.01). CONCLUSION Oropharyngeal swallowing physiology evolves as healthy adults age and should be considered during clinical decision-making.
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Affiliation(s)
- K L Garand
- Kendrea Garand, University of South Alabama, Mobile, AL, USA,
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Gatto AR, Cola PC, da Silva RG, Ribeiro PW, Spadotto AA, Henry MADAC. Influence of Thermal and Gustatory Stimulus in the Initiation of the Pharyngeal Swallow and Bolus Location Instroke. J Stroke Cerebrovasc Dis 2021; 30:105349. [PMID: 33549862 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 08/26/2020] [Accepted: 09/20/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION/OBJECTIVE The aim of this study is to analyze the influence of sour taste and cold temperature in the initiation of the pharyngeal swallow (IPS) and bolus location at pharyngeal swallow onset in individuals after stroke. METHODS Cross-sectional prospective study. The study included 52 individuals with unilateral ischemic stroke. Each individual was assessed by videofluoroscopic swallowing study with 5ml of paste bolus offering four different stimuli (natural, cold, sour, and sour-cold). The individuals were divided into two groups according to the offer sequence. Group 1 (G1) - received a randomized sequence of stimuli (24 individuals), and Group 2 (G2) -the stimuli were offered in the following order: natural, cold, sour, and sour-cold(28 individuals). The IPS time and bolus location at pharyngeal swallow onset were analyzed. The bolus location at pharyngeal swallow onset was defined using six different levels. RESULTS Individuals in G1 did not show a significant difference in IPS time between stimuli. However, individuals in G2 presented a significantly shorter IPS time with the sour and sour-cold stimuli than with natural or cold stimuli. The bolus location at pharyngeal swallow onset did not show significant difference between stimuli in both groups. On the other hand, in the G2 it was observed higher frequency of swallowing with sour-cold stimulus at level 1 (the bolus head was located in any region between the fauces pillar and the point where the tongue crosses the inferior border of the mandible). CONCLUSION The sour and sour-cold stimuli influenced the IPS time when they were offered in a sequential order. Moreover, both the IPS time and bolus location at pharyngeal swallow onset were not influenced by the sour and sour cold-bolus when offered in a random sequence.
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Affiliation(s)
- Ana Rita Gatto
- Department of Neurology and Psiquiatry, Sao Paulo State University-UNESP, Botucatu SP, Brazil.
| | | | | | - Priscila Watson Ribeiro
- Department of Neurology and Psiquiatry, Sao Paulo State University-UNESP,Botucatu SP, Brazil
| | - André Augusto Spadotto
- Department of Neurology and Psiquiatry, Sao Paulo State University-UNESP,Botucatu SP, Brazil
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Results of pretreatment swallowing evaluation in patients with stage III/IV laryngeal and hypopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2020; 278:3011-3018. [PMID: 33165732 DOI: 10.1007/s00405-020-06460-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Laryngeal and hypopharyngeal carcinoma are among the common head and neck cancers causing considerable swallowing dysfunction. The functional status of the organ (larynx) is an important point of contention while considering the patients for organ preservation protocol. METHODOLOGY The aim of this retrospective study was to assess the swallowing status in stage III/IV laryngeal and hypopharyngeal carcinoma and its influence on treatment decision. We evaluated all treatment naïve patients who were referred to the swallowing clinic in 2017 (Jan-Dec) for assessment of swallowing prior to treatment initiation. RESULTS One hundred patients satisfied the eligibility criteria and were included in the study. The site and stage of laryngeal and hypopharyngeal cancer cases were almost equal in number. Their median age was 58 years. Fiberoptic endoscopic evaluation of swallowing (FEES) was done in all patients. 30% of the patients only had swallowing difficulties. Only advanced T-stage (p = 0.04) had an influence on the pretreatment swallowing status. Thirty-seven patients required nasogastric tube (NGT) for feeding. By 2 month post-treatment completion, most patients on NGT could resume oral feeding. CONCLUSIONS Pretreatment swallowing assessment alone did not significantly seem to influence our decisions for organ preservation treatment. However, patients with aspiration could be identified and managed appropriately. Most patients on NGT could resume oral feeds post-treatment completion.
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Martin-Harris B, Canon CL, Bonilha HS, Murray J, Davidson K, Lefton-Greif MA. Best Practices in Modified Barium Swallow Studies. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1078-1093. [PMID: 32650657 PMCID: PMC7844340 DOI: 10.1044/2020_ajslp-19-00189] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/01/2020] [Accepted: 04/11/2020] [Indexed: 05/22/2023]
Abstract
Purpose The modified barium swallow study (MBSS) is a widely used videofluoroscopic evaluation of the functional anatomy and physiology of swallowing that permits visualization of bolus flow throughout the upper aerodigestive tract in real time. The information gained from the examination is critical for identifying and distinguishing the type and severity of swallowing impairment, determining the safety of oral intake, testing the effect of evidence-based frontline interventions, and formulating oral intake recommendations and treatment planning. The goal of this review article is to provide the state of the science and best practices related to MBSS. Method State of the science and best practices for MBSS are reviewed from the perspectives of speech-language pathologists (SLPs) and radiologists who clinically practice and conduct research in this area. Current quandaries and emerging clinical and research trends are also considered. Results This document provides an overview of the MBSS and standards for conducting, interpreting, and reporting the exam; the SLPs' and radiologist's perspectives on standardization of the exam; radiation exposure; technical parameters for recording and reviewing the exam; the importance of an interdisciplinary approach with engaged radiologists and SLPs; and special considerations for examinations in children. Conclusions The MBSS is the primary swallowing examination that permits visualization of bolus flow and swallowing movement throughout the upper aerodigestive tract in real time. The clinical validity of the study has been established when conducted using reproducible and validated protocols and metrics applied according to best practices to provide accurate and reliable information necessary to direct treatment planning and limit radiation exposure. Standards and quandaries discussed in this review article, as well as references, provide a basis for understanding the current best practices for MBSS.
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Affiliation(s)
- Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Cheri L. Canon
- Department of Radiology, The University of Alabama at Birmingham School of Medicine
| | - Heather Shaw Bonilha
- Department of Health Science and Research, Medical University of South Carolina, Charleston
- Department of Otolaryngology—Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Joseph Murray
- Audiology and Speech-Language Pathology Service, VA Ann Arbor Healthcare System, MI
| | - Kate Davidson
- Department of Otolaryngology—Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Maureen A. Lefton-Greif
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
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Milford EM, Wang B, Smith K, Choi D, Martin-Harris B, Garand KL(F. Aging and Sex Effects on Mastication Performance in Healthy, Nondysphagic, Community-Dwelling Adults. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:705-713. [PMID: 32163297 PMCID: PMC7842865 DOI: 10.1044/2019_ajslp-19-00097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/06/2019] [Accepted: 12/06/2019] [Indexed: 06/10/2023]
Abstract
Purpose This study investigated the impact of age and sex on mastication performance in healthy, nondysphagic, community-dwelling adults as observed during videofluoroscopy. Method Videofluoroscopic swallowing study imaging and mastication performance metrics (cycles, duration) were used to evaluate 185 healthy individuals (102 women, 83 men) aged 21-89 years. Results A significant effect of age on mastication cycles was not observed; however, a significant but weak effect of age on mastication duration was found. Female participants were observed to have significantly more mastication cycles and longer mastication durations compared to male participants. Three behavioral patterns of mastication performance emerged. Conclusions The results of this study contribute to normative data of mastication performance. An individual's sex was found to have a significant effect on mastication performance, although, in contrast to previous studies, age was not observed to significantly alter mastication performance. Differences in study methodologies likely explain the latter finding.
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Affiliation(s)
- Erin M. Milford
- Department of Speech Pathology and Audiology, University of South Alabama, Mobile
| | - Bin Wang
- Statistical Consulting Center, Department of Math and Statistics, University of South Alabama, Mobile
| | - Kimberly Smith
- Department of Speech Pathology and Audiology, University of South Alabama, Mobile
| | - Dahye Choi
- Department of Speech Pathology and Audiology, University of South Alabama, Mobile
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Álvarez G, Dias FJ, Lezcano F, Arias A, Navarro P, Fuentes R. Description of tongue movements on swallowing patterns. Arch Oral Biol 2020; 113:104706. [PMID: 32199154 DOI: 10.1016/j.archoralbio.2020.104706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/25/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the different swallowing patterns regarding tongue movement during saliva swallowing in healthy participants. DESIGN Seventeen participants (23.0 ± 3.6 years old) were included in this cross-sectional study. The movement of the tongue (anterior, middle and posterior portions) on the three axes of space (inferior-superior, anterior-posterior and medial-lateral) was recorded using a 3D electromagnetic articulograph. The tongue movement patterns registered during saliva swallowing were classified according to Bourdiol et al. (2014) into Type I, II or III. RESULTS Three swallowing patterns were identified (Type I, 64.7 %; Type II, 5.9 %; and Type III, 29.4 %). On the anterior-posterior axis, the displacement of the three portions of the tongue was significantly higher in Type III pattern compared with the Type I pattern. Furthermore, on the superior-inferior axis, the displacement of the anterior portion was significantly higher in Type III pattern compared with Type I pattern. In Type I pattern, on the inferior-superior axis, the smallest range of displacement occurred in the anterior portion of the tongue, followed by the middle and, finally, the posterior portion. In the analysis of Type III swallowing pattern, no significant differences were found on the range of displacement of the tongue portions on the three axes. CONCLUSION Statistical differences were found between swallowing patterns Type I and III regarding tongue movement. The frequency of pattern II found in the participants of this study was not high enough to compare the three patterns. However, the results obtained indicate that the methodology applied could be used to identify the patterns based on quantitative data.
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Affiliation(s)
- Giannina Álvarez
- Research Centre in Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile
| | - Fernando José Dias
- Research Centre in Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile; Department of Integral Adults Dentistry, Dental School, Universidad de La Frontera, Temuco, Chile
| | - Florencia Lezcano
- Research Centre in Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile; Department of Integral Adults Dentistry, Dental School, Universidad de La Frontera, Temuco, Chile
| | - Alain Arias
- Research Centre in Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile; Department of Integral Adults Dentistry, Dental School, Universidad de La Frontera, Temuco, Chile; Research Group of Health Sciences, Faculty of Health Sciences, Universidad Adventista de Chile, Chillán, Chile
| | - Pablo Navarro
- Research Centre in Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile; Universidad Autónoma de Chile, Chile
| | - Ramón Fuentes
- Research Centre in Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile; Department of Integral Adults Dentistry, Dental School, Universidad de La Frontera, Temuco, Chile.
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A Systematic Review of Physiological Changes in Swallowing in the Oldest Old. Dysphagia 2019; 35:509-532. [PMID: 31489507 DOI: 10.1007/s00455-019-10056-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/21/2019] [Indexed: 02/02/2023]
Abstract
Age-related swallowing changes are well-researched in deglutology, usually distinguishing those over 60 years as older aged. World-wide, older adults are healthier and forecast to live longer: many over 85 years. It is necessary for clinicians to understand healthy swallowing changes in this 'oldest old' in order to appropriately manage swallowing complaints in older patients. This systematic review collated and critically appraised studies investigating swallowing changes in adults over 85 years using instrumental assessment. Criteria for inclusion were healthy subjects over 85 years. Exclusion criteria included studies focused on anatomy and oral processing. Studies published until December 2018 were retrieved from BIOSIS, CINAHL, Embase, Medline, and Scopus, totaling 2125 articles. During data screening, 64% of studies investigating age-related swallowing changes were excluded, as the oldest old were not recruited. After PRISMA screening, 44 articles met criteria. These were further reviewed for data extraction, bias and quality. Main quantitative age-related changes in swallowing included increases in delay in swallow onset, bolus transit times, duration of UES opening, pressure above the UES and UES relaxation pressure, and reduction in pressure at the UES. Few studies detected increased residue or airway compromise in the form of aspiration. Results were not easily comparable due to differences in age ranges, methods for deeming participants 'healthy', measures used to define swallowing physiology, and swallowing tasks. Age-related swallowing changes are identified that do not compromise safety. The oldest old are underrepresented in normative deglutition research. It is essential future studies plan accordingly to recruit those over 85 years.
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Garand KL(F, Armeson KE, Hill EG, Martin-Harris B. Identification of Phenotypic Patterns of Dysphagia: A Proof of Concept Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:988-995. [PMID: 29800022 PMCID: PMC6195027 DOI: 10.1044/2018_ajslp-17-0173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/02/2018] [Accepted: 02/12/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE The purpose of the current project was to explore the feasibility for subtyping dysphagia traits or patterns of scores in a subset of data from the Modified Barium Swallow Impairment Profile global registry in patients referred to videofluoroscopic swallowing studies across 5 common medical categories: (a) cardiothoracic, (b) gastroenterology, (c) head and neck cancer, (d) neurology, and (e) pulmonary. METHOD Videofluoroscopic swallowing study imaging and Modified Barium Swallow Impairment Profile metrics were used to evaluate 235 patients with dysphagia grouped into 1 of the 5 categories. Two summative domain scores (oral total [OT] and pharyngeal total [PT]) and 17 component scores were tested for differences among the categories. RESULTS When compared with the gastroenterology category, significantly higher OT/PT scores were observed in neurology and pulmonary categories (all p values < .05). Four oral and 6 pharyngeal domain components significantly differed across medical categories: tongue control during bolus hold (all p values < .04). CONCLUSIONS The results of this feasibility study demonstrate that summative scores of swallowing physiology alone are not sufficiently robust to distinguish subtypes of dysphagia in broad, heterogeneous medical categories. Using OT/PT as subtypes only separated gastroenterology from the other categories, suggesting overlap in OT/PT scores between the latter categories.
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Affiliation(s)
| | - Kent E. Armeson
- Biostatistics Shared Resource, Hollings Cancer Center, Medical University of South Carolina, Charleston
| | - Elizabeth G. Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
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McFarland DH, Martin-Harris B, Fortin AJ, Humphries K, Hill E, Armeson K. Respiratory-swallowing coordination in normal subjects: Lung volume at swallowing initiation. Respir Physiol Neurobiol 2016; 234:89-96. [PMID: 27612587 DOI: 10.1016/j.resp.2016.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/23/2016] [Accepted: 09/05/2016] [Indexed: 10/21/2022]
Abstract
This study was designed to investigate the significance of bolus types and volumes, delivery methods and swallowing instructions on lung volume at swallowing initiation in normal subjects in a single experiment using a multifactorial approach. Our broad range goal was to determine optimal lung volume range associated with swallowing initiation to provide training targets for dysphagic patients with disordered respiratory-swallow coordination. Our hypothesis was that swallows would be initiated within a limited range of quiet breathing lung volumes regardless of bolus volume, consistency or task. Results confirmed this hypothesis and revealed that swallows were initiated at mean lung volume=244ml. Cued swallows were initiated at lower quiet breathing volumes than un-cued swallows (cued=201ml; un-cued=367ml). Water boluses were initiated at slightly higher quiet breathing volumes than solids. Data suggest that swallows occur within a restricted range of lung volumes with variation due to instructions, bolus type and other experimental variables.
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Affiliation(s)
- D H McFarland
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, C.P. 6128, Succ. Centre-Ville, Montréal, QC H3C 2J7, Canada; School of Communication Sciences and Disorders, Faculty of Medicine, McGill University, 2001 McGill College, 8th floor, Montreal, QC H3A 1G1, Canada.
| | - B Martin-Harris
- Medical University of South Carolina, 171 Ashley Ave., Charleston, SC 19425, USA; Ralph H. Johnson VAMC, 109 Bee St., Charleston, SC 29401, USA; Department of Otolaryngology-Head and Neck Surgery, 135 Rutledge Ave., MSC 550, Charleston, SC 29425, USA; Evelyn Trammell Institute for Voice and Swallowing, 135 Rutledge Ave., MSC 550, Charleston, SC 29425, USA; Deparment of Public Health Sciences, 135 Cannon Street, Suite 303, MSC 835, Charleston, SC 29425, USA; The Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, 70 Arts Circle Drive, Evanston, IL, 60208, USA.
| | - A-J Fortin
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, C.P. 6128, Succ. Centre-Ville, Montréal, QC H3C 2J7, Canada.
| | - K Humphries
- Medical University of South Carolina, 171 Ashley Ave., Charleston, SC 19425, USA; Department of Otolaryngology-Head and Neck Surgery, 135 Rutledge Ave., MSC 550, Charleston, SC 29425, USA; Evelyn Trammell Institute for Voice and Swallowing, 135 Rutledge Ave., MSC 550, Charleston, SC 29425, USA.
| | - E Hill
- Medical University of South Carolina, 171 Ashley Ave., Charleston, SC 19425, USA; Deparment of Public Health Sciences, 135 Cannon Street, Suite 303, MSC 835, Charleston, SC 29425, USA.
| | - K Armeson
- Medical University of South Carolina, 171 Ashley Ave., Charleston, SC 19425, USA; Deparment of Public Health Sciences, 135 Cannon Street, Suite 303, MSC 835, Charleston, SC 29425, USA.
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Martin-Harris B, McFarland D, Hill EG, Strange CB, Focht KL, Wan Z, Blair J, McGrattan K. Respiratory-swallow training in patients with head and neck cancer. Arch Phys Med Rehabil 2015; 96:885-93. [PMID: 25498307 PMCID: PMC4410058 DOI: 10.1016/j.apmr.2014.11.022] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/04/2014] [Accepted: 11/28/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To test a novel intervention to train swallowing to occur in the midexpiratory to low expiratory phase of quiet breathing to improve swallowing safety and efficiency. DESIGN Safety and efficacy nonrandomized controlled trial with 1-month follow-up. SETTING Ambulatory clinics. PARTICIPANTS Patients (N=30) with head and neck cancer (HNC) and chronic dysphagia completed the intervention. Fifteen of these patients participated in a 1-month follow-up visit. INTERVENTIONS Training protocol based on hierarchy of motor skill acquisition to encourage autonomous and optimal respiratory-swallowing coordination. Visual feedback of respiratory phase and volume for swallowing initiation was provided by nasal airflow and rib cage/abdomen signals. MAIN OUTCOME MEASURES Respiratory-swallow phase pattern, Modified Barium Swallow Impairment Profile (MBSImP) scores, Penetration-Aspiration Scale (PAS) scores, and MD Anderson Dysphagia Inventory scores. RESULTS Using visual feedback, patients were trained to initiate swallows during the midexpiratory phase of quiet breathing and continue to expire after swallowing. This optimal phase patterning increased significantly after treatment (P<.0001). Changes in respiratory-swallowing coordination were associated with improvements in 3 MBSImP component scores: laryngeal vestibular closure (P=.0004), tongue base retraction (P<.0001), and pharyngeal residue (P=.01). Significant improvements were also seen in PAS scores (P<.0001). Relative to pretreatment values, patients participating in 1-month follow-up had increased optimal phase patterning (P<.0001), improved laryngeal vestibular closure (P=.01), tongue base retraction (P=.003), and pharyngeal residue (P=.006) MBSImP scores and improved PAS scores (P<.0001). CONCLUSIONS Improvements in respiratory-swallowing coordination can be trained using a systematic protocol and respiratory phase-lung volume-related biofeedback in patients with HNC and chronic dysphagia, with favorable effects on airway protection and bolus clearance.
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Affiliation(s)
- Bonnie Martin-Harris
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC; Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, SC; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC.
| | - David McFarland
- Faculty of Medicine, University of Montréal, Montréal, QC, Canada; Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Elizabeth G Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Charlton B Strange
- Division of Pulmonary and Critical Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Kendrea L Focht
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC; Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, SC; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Zhuang Wan
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Julie Blair
- Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, SC; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Katlyn McGrattan
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC; Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, SC
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Scheeren B, Maciel AC, Barros SGSD. Videofluoroscopic swallowing study: esophageal alterations in patients with dysphagia. ARQUIVOS DE GASTROENTEROLOGIA 2015; 51:221-5. [PMID: 25296083 DOI: 10.1590/s0004-28032014000300011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 04/28/2014] [Indexed: 11/21/2022]
Abstract
CONTEXT Videofluoroscopic swallowing study is a dynamic exam and allows the evaluation of the complete swallowing process. However, most published studies have only reported alterations in the oropharynx and pharyngoesophageal transition, leaving the analysis of the esophagus as a secondary goal. OBJECTIVES The goal of this study was to investigate the prevalence of alterations in the esophageal phase thorough videofluoroscopic swallowing study in patients with dysphagia. METHODS Consecutive patients with dysphagia who underwent videofluoroscopic swallowing study including esophageal analysis between May 2010 and May 2012 had their exams retrospectively reviewed. Patients were classified into two groups: Group I - without a pre-established etiological diagnosis and Group II - with neurological disease. During the exam, the patients ingested three different consistencies of food (liquid, pasty and solid) contrasted with barium sulfate and 19 items were analyzed according to a protocol. The esophageal phase was considered abnormal when one of the evaluated items was compromised. RESULTS Three hundred and thirty-three (n = 333) consecutive patients were studied - 213 (64%) in Group I and 120 (36%) in Group II. Esophageal alterations were found in 104 (31%) patients, with a higher prevalence in Group I (36.2%), especially on the items esophageal clearance (16.9%) and tertiary contractions (16.4%). It was observed that 12% of individuals in Group I only presented alterations on the esophageal phase. CONCLUSION Evaluation of the esophageal phase of swallowing during videofluoroscopic swallowing study detects abnormalities in patients with cervical dysphagia, especially in the group without pre-established etiological diagnosis.
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Affiliation(s)
- Betina Scheeren
- Programa de Pós-Graduação de Gastroenterologia e Hepatologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Antônio Carlos Maciel
- Fonoaudiologia, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
| | - Sérgio Gabriel Silva de Barros
- Programa de Pós-Graduação de Gastroenterologia e Hepatologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
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Pharyngeal function and breathing pattern during partial neuromuscular block in the elderly: effects on airway protection. Anesthesiology 2014; 120:312-25. [PMID: 24162461 DOI: 10.1097/aln.0000000000000043] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Intact pharyngeal function and coordination of breathing and swallowing are essential for airway protection and to avoid respiratory complications. Postoperative pulmonary complications caused by residual effects of neuromuscular-blocking agents occur more frequently in the elderly. Moreover, elderly have altered pharyngeal function which is associated with increased risk of aspiration. The purpose of this study was to evaluate effects of partial neuromuscular block on pharyngeal function, coordination of breathing and swallowing, and airway protection in individuals older than 65 yr. METHODS Pharyngeal function and coordination of breathing and swallowing were assessed by manometry and videoradiography in 17 volunteers, mean age 73.5 yr. After control recordings, rocuronium was administered to obtain steady-state train-of-four ratios of 0.70 and 0.80 followed by spontaneous recovery to greater than 0.90. RESULTS Pharyngeal dysfunction increased significantly at train-of-four ratios 0.70 and 0.80 to 67 and 71%, respectively, compared with 37% at control recordings, and swallowing showed a more severe degree of dysfunction during partial neuromuscular block. After recovery to train-of-four ratio of greater than 0.90, pharyngeal dysfunction was not significantly different from the control state. Resting pressure in the upper esophageal sphincter was lower at all levels of partial neuromuscular block compared with control recordings. The authors were unable to demonstrate impaired coordination of breathing and swallowing. CONCLUSION Partial neuromuscular block in healthy elderly individuals causes an increased incidence of pharyngeal dysfunction from 37 to 71%, with impaired ability to protect the airway; however, the authors were unable to detect an effect of partial neuromuscular block on coordination of breathing and swallowing.
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The Effect of Voluntary Pharyngeal Swallowing Maneuvers on Esophageal Swallowing Physiology. Dysphagia 2014; 29:262-8. [DOI: 10.1007/s00455-013-9505-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 12/12/2013] [Indexed: 01/17/2023]
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Bonilha HS, Blair J, Carnes B, Huda W, Humphries K, McGrattan K, Michel Y, Martin-Harris B. Preliminary investigation of the effect of pulse rate on judgments of swallowing impairment and treatment recommendations. Dysphagia 2013; 28:528-38. [PMID: 23559454 PMCID: PMC3762944 DOI: 10.1007/s00455-013-9463-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 03/09/2013] [Indexed: 10/27/2022]
Abstract
Reducing fluoroscopic pulse rate, a method used to reduce radiation exposure from modified barium swallow studies (MBSSs), decreases the number of images available from which to judge swallowing impairment. It is necessary to understand the impact of pulse rate reduction on judgments of swallowing impairment and, consequentially, treatment recommendations. This preliminary study explored differences in standardized MBSS measurements [Modified Barium Swallow Impairment Profile (MBSImP™©) and Penetration Aspiration Scale (PAS) Scores] between two pulse rates: 30 and simulated 15 pulses per second (pps). Two reliable speech-language pathologists (SLPs) scored all five MBSSs. Five SLPs reported treatment recommendations based on those scores. Differences in judgments of swallowing impairment were found between 30 and simulated 15 pps in all five MBSSs. These differences were in six physiological swallowing components: initiation of pharyngeal swallow, anterior hyoid excursion, epiglottic movement, pharyngeal contraction, pharyngeal-esophageal segment opening, and tongue base retraction. Differences in treatment recommendations were found between 30 and simulated 15 pps in all five MBSSs. These findings suggest that there are differences in both judgment of swallowing impairment and treatment recommendations when pulse rates are reduced from 30 to 15 pps to minimize radiation exposure.
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Affiliation(s)
- Heather Shaw Bonilha
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, Charleston, SC, 29425, USA,
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Dysphagia in Head and Neck Cancer Patients: Pretreatment Evaluation, Predictive Factors, and Assessment during Radio-Chemotherapy, Recommendations. Clin Exp Otorhinolaryngol 2013; 6:117-26. [PMID: 24069513 PMCID: PMC3781223 DOI: 10.3342/ceo.2013.6.3.117] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 03/06/2013] [Accepted: 05/15/2013] [Indexed: 12/02/2022] Open
Abstract
Progress in head and neck cancer (HNC) therapies has improved tumor response, loco-regional control, and survival. However, treatment intensification also increases early and late toxicities. Dysphagia is an underestimated symptom in HNC patients. Impairment of swallowing process could cause malnutrition, dehydration, aspiration, and pneumonia. A comprehensive literature review finalized in May 2012 included searches of electronic databases (Medline, Embase, and CAB abstracts) and scientific societies meetings materials (American Society of Clinical Oncology, Associazione Italiana Radioterapia Oncologica, Associazione Italiana di Oncologia Cervico-Cefalica, American Head and Neck Society, and European Society for Medical Oncology). Hand-searches of HNC journals and reference lists were carried out. Approximately one-third of dysphagia patients developed pneumonia requiring treatment. Aspiration pneumonia associated mortality ranged from 20% to 65%. Unidentified dysphagia caused significant morbidity, increased mortality, and decreased the quality of life. In this review we underline definition, causes, predictive factors of dysphagia and report on pretreatment and on-treatment evaluation, suggesting some key points to avoid underestimation. A multi-parameter assessment of swallowing problems may allow an earlier diagnosis. An appropriate evaluation might lead to a better treatment of both symptoms and cancer.
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Gao Z, Taniwaki M, Shimada H, Ishihara S, Nakauma M, Funami T, Kohyama K. Ultrasound Analysis of the Effects of Food Bolus Volume on Tongue Movement at the Initiation of Swallowing. J Texture Stud 2013. [DOI: 10.1111/jtxs.12026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Zhihong Gao
- National Food Research Institute; National Agriculture and Food Research Organization; 2-1-12 Kannondai Tsukuba Ibaraki 305-8642 Japan
| | - Mitsuru Taniwaki
- National Food Research Institute; National Agriculture and Food Research Organization; 2-1-12 Kannondai Tsukuba Ibaraki 305-8642 Japan
| | - Hiromi Shimada
- National Food Research Institute; National Agriculture and Food Research Organization; 2-1-12 Kannondai Tsukuba Ibaraki 305-8642 Japan
| | | | | | | | - Kaoru Kohyama
- National Food Research Institute; National Agriculture and Food Research Organization; 2-1-12 Kannondai Tsukuba Ibaraki 305-8642 Japan
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Archer SK, Garrod R, Hart N, Miller S. Dysphagia in Duchenne Muscular Dystrophy Assessed Objectively by Surface Electromyography. Dysphagia 2012. [DOI: 10.1007/s00455-012-9429-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gullung JL, Hill EG, Castell DO, Martin-Harris B. Oropharyngeal and Esophageal Swallowing Impairments: Their Association and the Predictive Value of the Modified Barium Swallow Impairment Profile and Combined Multichannel Intraluminal Impedance—Esophageal Manometry. Ann Otol Rhinol Laryngol 2012. [DOI: 10.1177/000348941212101107] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Deglutition is a highly integrated process of neural signaling and coordinated muscular contraction that begins with bolus preparation in the oral cavity and ends with closure of the lower esophageal sphincter after bolus passage. The goal of this study was to examine the relationship between measures of oropharyngeal and esophageal swallow function. Methods: A retrospective review was performed of patients who underwent modified barium swallow study (MBSS) and multichannel intraluminal impedance–esophageal manometry (MII-EM) over 7 years at an academic institution. The MBSS was scored with the Modified Barium Swallow Impairment Profile (MBSImP). Associations between impairments as measured by the MBSImP and MII-EM were assessed with a 2-sided Fisher's exact test. Results: One hundred sixty-four patients met the inclusion criteria for the study. Comparison of MBSImPcomponent and oral and pharyngeal total regional scores to MII-EM scores revealed a significant association between abnormal esophageal clearance on MBSS (MBSImP component 17) and abnormal findings on MII-EM (p < 0.001). Delay in initiation of pharyngeal swallow (MBSImPcomponent 6) was significantly associated with abnormal esophageal clearance on MBSS (p = 0.023). Conclusions: Abnormal esophageal clearance on MBSS (MBSImP component 17) indicates a need for further esophageal testing. A functional interrelationship between abnormalities of oropharyngeal and esophageal swallowing does exist, illuminating the importance of thorough pharyngoesophageal examination for dysphagia symptoms.
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Fishbein M, Branham C, Fraker C, Walbert L, Cox S, Scarborough D. The Incidence of Oropharyngeal Dysphagia in Infants With GERD‐Like Symptoms. JPEN J Parenter Enteral Nutr 2012; 37:667-73. [DOI: 10.1177/0148607112460683] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Mark Fishbein
- Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Christina Branham
- Department of Pediatrics, SIU School of Medicine, Springfield, Illinois
| | - Cheryl Fraker
- The Center for Selective Eating and Pediatric Feeding Disorders, Kids at Koke Mill, Memorial Medical Center, Springfield, Illinois
| | - Laura Walbert
- The Center for Selective Eating and Pediatric Feeding Disorders, Kids at Koke Mill, Memorial Medical Center, Springfield, Illinois
| | - Sibyl Cox
- Department of Pediatrics, SIU School of Medicine, Springfield, Illinois
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Knösel M, Klein S, Bleckmann A, Engelke W. Coordination of tongue activity during swallowing in mouth-breathing children. Dysphagia 2012; 27:401-7. [PMID: 22207245 PMCID: PMC3417098 DOI: 10.1007/s00455-011-9383-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 12/02/2011] [Indexed: 12/02/2022]
Abstract
Habitual mouth breathing is often accompanied by habitual anterior tongue thrust, instead of a lip closure, in order to create the anterior seal necessary for the initiation of physiological deglutition. We tested the null hypothesis of no significant influence of oral maneuver and the use of oral screens on tongue coordination and position during deglutition in 29 subjects (age = 6-16; mean = 9.69 years; 13/16 female/male) with habitual open-mouth posture using intraoral polysensography. The target parameters for swallowing were swallowing-associated nasal airflow interruption (NAI) and coordination of tongue-palate contact during NAI. Conventional myofunctional maneuvers could be facilitated and made more efficient, in terms of increasing the numbers of favorable early tongue-palate contacts typical of somatic swallowing, if accompanied by the application of an oral screen. Habitual open-mouth breathing does not necessarily coincide with distinctively pronounced proportions of late tongue-palate contact.
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Affiliation(s)
- Michael Knösel
- University of Göttingen, Robert-Koch-Strasse 40, Göttingen, Germany.
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St Pierre AE, Reelie BA, Dolan AR, Stokes RH, Duivestein JA, Holsti L. Terms used to describe pediatric videofluoroscopic feeding studies: a Delphi survey. The Canadian Journal of Occupational Therapy 2012; 79:159-66. [PMID: 22822693 DOI: 10.2182/cjot.2012.79.3.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The prevalence of pediatric feeding and swallowing disorders is high in the special needs population. Videofluoroscopic feeding studies (VFFS) are used to assess feeding, but the accurate interpretation of VFFS depends on consistent use of terminology for describing a physiological swallow. No consensus exists regarding the terminology used for reporting VFFS findings. PURPOSE The goal of this study was to achieve consensus among pediatric therapists on definitions for terminology used to describe the results of VFFS. METHODS Using a Delphi process, therapists from British Columbia rated definitions most appropriate for each term. They also were asked to add definitions that they thought would more accurately describe the terms. FINDINGS. Consensus was achieved on at least one definition for each of the terms used to describe the results of VFFS. IMPLICATIONS Accurate interpretation of swallowing issues may improve the care of infants and children with feeding and swallowing difficulties.
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Affiliation(s)
- Astrid E St Pierre
- Feeding and Swallowing Clinic/Spinal Cord Clinic/HomeTrach and Vent Program, British Columbia Children's Hospital, 4480 Oak Street, Vancouver, BC, Canada V6H 4C9.
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Monaco A, Cattaneo R, Masci C, Spadaro A, Marzo G. Effect of ill-fitting dentures on the swallowing duration in patients using polygraphy. Gerodontology 2011; 29:e637-44. [PMID: 21923894 DOI: 10.1111/j.1741-2358.2011.00536.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surface electromyography (SEMG) has been widely used in the recent years to study swallowing physiology, offering a valid and reliable tool for identifying normal swallowing. The goal of our study was to assess the contribution of denture fitness in the age-related increase of swallowing duration. METHODS Twenty denture wearers and 20 dentate individuals were analysed using SEMG and a computerised kinesiography of mandibular movement. Three spontaneous saliva swallowings were recorded for each patient with both their old and new prostheses. Three spontaneous saliva swallowings were recorded for each dentate person in two different recording sessions. RESULTS Old prosthesis mean swallowing time was 1.84 (SD ± 0.85) seconds while the new well-fitting prostheses needed a 1.28 (SD ± 0.55) (p = 0.0009) swallowing time. The difference in swallowing time was significant (p = 0.01) between dentate subjects and individuals wearing an old prosthesis. No significant difference was found between dentate subjects and the same prosthesis wearers when a new well-fitting prosthesis was worn. CONCLUSION Data presented in this work suggest that part of the increased duration of swallowing showed by elderly and healthy people is because of incorrect an dental prosthesis. Prolongation of swallowing duration in the elderly population could be reconsidered in the light of the quality of dental device worn by the aged population.
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Affiliation(s)
- Annalisa Monaco
- Department of Gnathology and Prosthetic Dentistry, School of Dentistry, University of L'Aquila, L'Aquila, Italy.
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Brodsky MB, McFarland DH, Michel Y, Orr SB, Martin-Harris B. Significance of nonrespiratory airflow during swallowing. Dysphagia 2011; 27:178-84. [PMID: 21748449 DOI: 10.1007/s00455-011-9350-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 06/22/2011] [Indexed: 10/18/2022]
Abstract
This study was designed to further our understanding of a potentially significant clinical event of negative nasal airflow near the end of the respiratory pause (inhibition) to accommodate swallowing. This negative flow, referred to as "SNIF," or swallow noninspiratory flow, occurs at the onset of airway reestablishment at the conclusion of the oropharyngeal swallow. Using simultaneous digital video fluoroscopic and nasal respiratory airflow recordings on 82 healthy adults (21-97 years old), the objectives of this study were to determine (1) the frequency of occurrence of SNIF during a 5-ml natural cup-drinking task, (2) differences in SNIF occurrence by age group, and (3) the temporal relationship between SNIF and other swallowing events. Results revealed that for most participants SNIF was observed in both swallowing trials. There was a statistically significant difference in SNIF occurrence by age category, with SNIF observed less frequently in the oldest participants. The peak onset of SNIF is closely related to the first release of contact between the soft palate and tongue base with the posterior pharyngeal wall and opening of the laryngeal vestibule. Based on this, and in agreement with previous investigators, we suggest that this negative flow may be related to a partial vacuum established by the relaxation of pharyngeal contraction near the conclusion of the pharyngeal swallow. The more frequent occurrence of SNIF in younger adults and less in older adults suggests a reduction in pharyngeal pressure associated with healthy aging.
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Affiliation(s)
- Martin B Brodsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
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Knösel M, Klein S, Bleckmann A, Engelke W. Tongue position after deglutition in subjects with habitual open-mouth posture under different functional conditions. Orthod Craniofac Res 2011; 14:181-8. [PMID: 21771274 DOI: 10.1111/j.1601-6343.2011.01515.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To test the null hypothesis of no significant differences in (1) the duration of the post-deglutory, cranial tongue rest position (CTP) between different functional orofacial conditions and (2) the presence or absence of an oral screen (OS) in subjects with a habitual open-mouth posture. SUBJECTS Twenty-nine subjects (aged 6-16; mean: 9.69 years; 13/16 girls/boys) were selected according to the inclusion criterion of a habitual, daytime open-mouth posture. METHODS Deglutition was screened at baseline during resting respiration using orofacial polysensography and simultaneous assessment of tongue-to-palate position and nasal airstream, during five functional intervals of 8 min each: F1 without instruction (RR); F2 the same, but including an oral screen (RROS); F3 with OS and the instruction to maintain a tongue-to-palate contact (IROS); F4 with OS and the instruction to perform tongue repositioning manoeuvres at the time of spontaneous swallowing (TRMOS); and F5 corresponds to F3 omitting OS (IR). Duration and frequency of deglutition were analysed descriptively as well as by anova and subsequent multiple comparisons, and the CTP was evaluated with chi-square tests and paired comparisons at a significance level of 5%. RESULTS Of 542 identified swallowing acts, 75% were accompanied by a post-deglutory CTP. Mean duration of CTP increased for functional conditions RR/1.01s > RROS/2.56s > IR/3.21s > IROS/6.53s > TRMOS/6.58s. The null hypothesis (1) was rejected in comparison of resting respiration (F1, F2) with IROS and TRMOS, whereas the use of an oral screen alone did not significantly prolong the duration of CTP.
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Affiliation(s)
- M Knösel
- Michael Knösel, University of Göttingen, Göttingen, Germany.
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Horner J, Minifie FD. Research ethics II: Mentoring, collaboration, peer review, and data management and ownership. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2011; 54:S330-S345. [PMID: 21081679 DOI: 10.1044/1092-4388(2010/09-0264)] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE In this series of articles--Research Ethics I, Research Ethics II, and Research Ethics III--the authors provide a comprehensive review of the 9 core domains for the responsible conduct of research (RCR) as articulated by the Office of Research Integrity. In Research Ethics II, the authors review the RCR domains of mentoring, collaboration, peer review, and data management and ownership. METHOD They relied on authoritative documents, both historical and contemporary, insightful commentary, and empirical research in order to identify current issues and controversies of potential interest to both faculty and students. CONCLUSIONS The authors close by urging readers to stay abreast of the manifold ethics issues facing today's community of scientists, policymakers, and research institutions, and to adhere to best practices as they evolve.
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Affiliation(s)
- Jennifer Horner
- College of Health Sciences and Professions, Ohio University, W380 Grover Center, Athens, OH 45701, USA.
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Cassiani RA, Santos CM, Parreira LC, Dantas RO. The relationship between the oral and pharyngeal phases of swallowing. Clinics (Sao Paulo) 2011; 66:1385-8. [PMID: 21915488 PMCID: PMC3161216 DOI: 10.1590/s1807-59322011000800013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 05/09/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study was designed to investigate a possible relationship between the duration of the oral and pharyngeal phases of swallowing. INTRODUCTION The oral and pharyngeal phases of swallowing are independent from each other but may be related. METHODS We used videofluoroscopy to evaluate 30 healthy volunteers between 29 and 77 years of age who swallowed 5- and 10-ml liquid and paste boluses in duplicate. The duration of the oral phase, pharyngeal transit, and pharyngeal clearance were measured. RESULTS There were no differences in oral or pharyngeal transit times between the liquid and paste boluses or between the volumes of 5 and 10 ml (p > 0.40). The pharyngeal clearance time for the paste bolus (0.48 ± 0.27 s) was longer than for the liquid bolus (0.38 ± 0.11 s, ρ = 0.03) with no difference between the volumes of 5 and 10 ml. There was no significant correlation between the oral transit time and the duration of pharyngeal transit for the liquid (5 ml, Spearman's coefficient ρ: -0.14; 10 ml, ρ: 0.18) or the paste (5 ml, p: 0.08; 10 ml, p: 0.10). The correlation between the oral transit time and the pharyngeal clearance time was not significant for the liquid bolus (5 ml, ρ: 0.31; 10 ml, ρ: 0.18), but it was significant for both the 5 ml (ρ: 0.71) and 10 ml (ρ: 0.64) paste boluses. DISCUSSION The relationship between the oral and pharyngeal phases of swallowing can be affected by bolus consistency. CONCLUSION There is a correlation between the duration of oral transit and the duration of pharyngeal clearance during the swallowing of paste boluses.
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Affiliation(s)
- Rachel Aguiar Cassiani
- Clínica Médica - Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Brown L, Rieger JM, Harris J, Seikaly H. A Longitudinal Study of Functional Outcomes After Surgical Resection and Microvascular Reconstruction for Oral Cancer: Tongue Mobility and Swallowing Function. J Oral Maxillofac Surg 2010; 68:2690-700. [DOI: 10.1016/j.joms.2010.05.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 02/08/2010] [Accepted: 05/07/2010] [Indexed: 10/19/2022]
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Troche MS, Huebner I, Rosenbek JC, Okun MS, Sapienza CM. Respiratory-swallowing coordination and swallowing safety in patients with Parkinson's disease. Dysphagia 2010; 26:218-24. [PMID: 20623304 DOI: 10.1007/s00455-010-9289-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 06/22/2010] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to determine if individuals with Parkinson's disease (PD) demonstrate abnormal respiratory events when swallowing thin liquids. In addition, this study sought to define associations between respiratory events, swallowing apnea duration, and penetration-aspiration (P-A) scale scores. Thirty-nine individuals with PD were administered ten trials of a 5-ml thin liquid bolus. P-A scale score quantified the presence of penetration and aspiration during the swallowing of a 3-oz sequential bolus. Participants were divided into two groups based on swallowing safety judged during the 3-oz sequential swallowing: Group 1 = P-A ≤ 2; Group 2 = P-A ≥ 3. Swallows were examined using videofluoroscopy coupled with a nasal cannula to record respiratory signals during the event(s). Findings indicated that expiration was the predominant respiratory event before and after swallowing apnea. The data revealed no differences in our cohort versus the percentages of post-swallowing events reported in the literature for healthy adults. In addition, individuals with decreased swallowing safety, as measured by the P-A scale, were more likely to inspire after swallows and to have shorter swallowing apnea duration. Individuals who inspired before swallow also had longer swallowing apnea duration. The occurrence of inspiratory events after a swallow and the occurrence of shorter swallowing apnea durations may serve as important indicators during clinical swallowing assessments in patients at risk for penetration or aspiration with PD.
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Brodsky MB, McFarland DH, Dozier TS, Blair J, Ayers C, Michel Y, Gillespie MB, Day TA, Martin-Harris B. Respiratory-swallow phase patterns and their relationship to swallowing impairment in patients treated for oropharyngeal cancer. Head Neck 2010; 32:481-9. [PMID: 19780056 DOI: 10.1002/hed.21209] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Unstable respiratory-swallowing coordination has been associated with disorders and disease. The goals of this study were (1) to describe respiratory-swallow patterns in patients with dysphagia consequent to treatments for cancers of the oropharynx and (2) to determine the association between respiratory-swallow patterns, airway invasion, and overall severity of swallowing impairment. METHODS This prospective, cross-sectional design compared respiratory-swallow patterns in 20 patients treated for oropharyngeal cancer and 20 healthy, age-matched control participants. Nasal airflow direction was synchronously recorded with videofluoroscopic imaging in participants who swallowed 5-mL thin liquid barium boluses. RESULTS Respiratory-swallow patterns differed between groups. Most control participants initiated and completed swallowing bracketed by expiratory airflow. Swallowing in patients often interrupted inspiratory flow and was associated with penetration or aspiration of the bolus. CONCLUSIONS We suggest nonexpiratory bracketed respiratory-swallowing phase patterns in patients with oropharyngeal cancer may place patients at greater risk of airway penetration or aspiration during swallowing.
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Affiliation(s)
- Martin B Brodsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
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Boden K, Cedborg AIH, Eriksson LI, Hedström HW, Kuylenstierna R, Sundman E, Ekberg O. Swallowing and respiratory pattern in young healthy individuals recorded with high temporal resolution. Neurogastroenterol Motil 2009; 21:1163-e101. [PMID: 19614871 DOI: 10.1111/j.1365-2982.2009.01352.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The coordination of swallowing and respiration is essential for a safe swallow. Swallowing consists of several subsecond events. To study this, it is important to use modalities with high temporal resolution. In this study, we have examined young healthy individuals with simultaneous videofluoroscopy, videomanometry and respiratory recording, all with high temporal resolution. The onset of 13 predetermined swallowing and respiratory events and the surrounding respiratory phase pattern were studied in different body positions and during different respiratory drives. An increased respiratory drive was induced by breathing 5% CO(2). The results demonstrated a highly repeatable and fixed temporal coordination of the swallowing pattern despite body position and respiratory drive. Previous studies have demonstrated a period of centrally controlled apnoea during swallowing. This apnoea period has a variable length, varying from 1 to 5 s. During increased respiratory drive, we could demonstrate a significantly shorter period of apnoea during swallowing, mainly due to an earlier resumption of respiration. The high temporal recordings in this study have revealed that swallowing during expiration is present basically in all healthy individuals. This swallowing respiratory pattern seems to be appropriate for a safe swallow. This knowledge will be used as a reference for future studies on how swallowing and respiratory coordination might be altered due to ageing and diseases.
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Affiliation(s)
- K Boden
- Department of Radiology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.
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Abstract
PURPOSE OF REVIEW Chemotherapy has been found to result in comparable survival rates to surgery for head and neck cancer. However, toxicity can often be worse after chemoradiotherapy, with impairment in voice, swallowing, nutrition, and quality of life. Investigators are attempting to modify radiotherapy treatment regimens to spare organs that have an impact on swallowing. This review will highlight voice and swallowing impairment seen after chemoradiotherapy, as well as treatment for voice and swallowing disorders in this population. Results of newer radiotherapy regimens will also be highlighted. RECENT FINDINGS Specific oropharyngeal swallowing motility disorders after chemoradiotherapy have been identified. Damage to specific structures has been correlated with specific pharyngeal phase swallow impairment. Swallowing function and quality of life have been examined over time, with improvement seen in both. Preventive/prophylactic swallow exercise programs have been encouraging. Chemoradiotherapy effects on voice have been identified in terms of acoustic, aerodynamic, and patient and clinician-rated perception of function. Improvement in voice has also been observed over time after chemoradiotherapy. Voice therapy has been found to have a positive impact on voice and perceptual measures in this population. SUMMARY Current studies show some improvement in swallow function after swallow and voice therapy in patients treated with chemoradiotherapy. Further, there is a suggestion of improved swallow function with sparing of organs with specific radiotherapy protocols. Future research needs to focus on specific voice and swallow treatment regimens in the head and neck cancer patient treated with chemoradiotherapy, specifically, timing, frequency, duration, and specific treatment types.
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Butler SG, Stuart A, Castell D, Russell GB, Koch K, Kemp S. Effects of age, gender, bolus condition, viscosity, and volume on pharyngeal and upper esophageal sphincter pressure and temporal measurements during swallowing. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2009; 52:240-253. [PMID: 19064903 DOI: 10.1044/1092-4388(2008/07-0092)] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE The purpose of this study was to determine the effects of trial (i.e., Trial 1 vs. Trial 2); viscosity (i.e., saliva, thin, nectar-thick, honey-thick, and pudding-thick water); volume (i.e., 5 mL vs. 10 mL); age (i.e., young vs. older adults); and gender on pharyngeal (i.e., upper and lower) and upper esophageal sphincter (UES) pressures, durations, and onsets (i.e., onset of upper pharyngeal pressures relative to onsets of UES relaxations and onset of lower relative to upper pharyngeal pressures). METHOD Twenty-three young adults (M=30 years) and 21 older healthy adults (M=75 years) participated. Measurements were acquired with a 2.1-mm catheter during simultaneous manometric and endoscopic swallowing assessment. Participants contributed 18 swallows, affording a study total of 792 swallows for analyses. RESULTS There was no significant effect of trial on any measurement of pressure, duration, and onset (ps=.63, .39, and .71, respectively). It was found that viscosity, volume, age, and gender affected pressure, duration, and onset measurements (e.g., onset of upper pharyngeal pressures relative to onsets of UES relaxations) but in varying degrees relative to the location in the pharynx or UES and the type of measurement (e.g., pressure, onset). CONCLUSIONS Manometric measurements vary with respect to age, gender, and bolus variables and interactions of each. Consideration of these variables is paramount in understanding normal and pathological swallowing if manometry is to develop as a quantitative adjunct to videofluoroscopic and endoscopic swallowing tools.
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Affiliation(s)
- Susan G Butler
- Wake Forest University School of Medicine, Department of Otolaryngology Center for Voice and Swallowing Disorders, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Daniels SK, Schroeder MF, DeGeorge PC, Corey DM, Foundas AL, Rosenbek JC. Defining and measuring dysphagia following stroke. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2009; 18:74-81. [PMID: 18930911 DOI: 10.1044/1058-0360(2008/07-0040)] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE To continue the development of a quantified, standard method to differentiate individuals with stroke and dysphagia from individuals without dysphagia. METHOD Videofluoroscopic swallowing studies (VFSS) were completed on a group of participants with acute stroke (n = 42) and healthy age-matched individuals (n = 25). Calibrated liquid volumes of 3, 5, 10, and 20 ml were administered during the VFSS. Six measures in 3 domains of bolus flow (timing, direction, and clearance) were measured. Values of these measures obtained from the control group were used to classify dysphagia within the participants. RESULTS The use of a single measure or single liquid volumes to classify dysphagia did not distinguish between healthy adults and individuals following stroke with and without dysphagia. Abnormality on more than 1 measure across multiple volumes appears to be a more robust method in defining dysphagia for liquids. CONCLUSIONS Our findings indicate that the definition of dysphagia is critical in determining whether persons are classified with disordered swallowing. The definition is dependent on materials and measures evaluated. Each measure provides independent aspects to the evaluation. Determining the level of importance of each depends on the purpose of the evaluation.
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Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, Maxwell R, Blair J. MBS measurement tool for swallow impairment--MBSImp: establishing a standard. Dysphagia 2008; 23:392-405. [PMID: 18855050 DOI: 10.1007/s00455-008-9185-9] [Citation(s) in RCA: 400] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Accepted: 08/06/2008] [Indexed: 02/07/2023]
Abstract
The aim of this study was to test reliability, content, construct, and external validity of a new modified barium swallowing study (MBSS) tool (MBSImp) that is used to quantify swallowing impairment. Multiple regression, confirmatory factor, and correlation analyses were used to analyze 300 in- and outpatients with heterogeneous medical and surgical diagnoses who were sequentially referred for MBS exams at a university medical center and private tertiary care community hospital. Main outcome measures were the MBSImp and index scores of aspiration, health status, and quality of life. Inter- and intrarater concordance were 80% or greater for blinded scoring of MBSSs. Regression analysis revealed contributions of eight of nine swallow types to impressions of overall swallowing impairment (p < or = 0.05). Factor analysis revealed 13 significant components (loadings >/= 0.5) that formed two impairment groupings (oral and pharyngeal). Significant correlations were found between Oral and Pharyngeal Impairment scores and Penetration-Aspiration Scale scores, and indexes of intake status, nutrition, health status, and quality of life. The MBSImp demonstrated clinical practicality, favorable inter- and intrarater reliability following standardized training, content, and external validity. This study reflects potential for establishment of a new standard for quantification and comparison of oropharyngeal swallowing impairment across patient diagnoses as measured on MBSS.
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Affiliation(s)
- Bonnie Martin-Harris
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425-5500, USA.
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Robbins J, Butler SG, Daniels SK, Diez Gross R, Langmore S, Lazarus CL, Martin-Harris B, McCabe D, Musson N, Rosenbek J. Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2008; 51:S276-S300. [PMID: 18230851 DOI: 10.1044/1092-4388(2008/021)] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE This review presents the state of swallowing rehabilitation science as it relates to evidence for neural plastic changes in the brain. The case is made for essential collaboration between clinical and basic scientists to expand the positive influences of dysphagia rehabilitation in synergy with growth in technology and knowledge. The intent is to stimulate thought and propose potential research directions. METHOD A working group of experts in swallowing and dysphagia reviews 10 principles of neural plasticity and integrates these advancing neural plastic concepts with swallowing and clinical dysphagia literature for translation into treatment paradigms. In this context, dysphagia refers to disordered swallowing associated with central and peripheral sensorimotor deficits associated with stroke, neurodegenerative disease, tumors of the head and neck, infection, or trauma. RESULTS AND CONCLUSIONS The optimal treatment parameters emerging from increased understanding of neural plastic principles and concepts will contribute to evidence-based practice. Integrating these principles will improve dysphagia rehabilitation directions, strategies, and outcomes. A strategic plan is discussed, including several experimental paradigms for the translation of these principles and concepts of neural plasticity into the clinical science of rehabilitation for oropharyngeal swallowing disorders, ultimately providing the evidence to substantiate their translation into clinical practice.
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Affiliation(s)
- Joanne Robbins
- University of Wisconsin and William S. Middleton VA Hospital, Geriatric Research Education and Clinical Center, Madison, WI, USA.
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Spadotto AA, Gatto AR, Cola PC, Montagnoli AN, Schelp AO, Silva RGD, Yamashita S, Pereira JC, Henry MACDA. Software para análise quantitativa da deglutição. Radiol Bras 2008. [DOI: 10.1590/s0100-39842008000100008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Apresentar um software que permita uma análise detalhada da dinâmica da deglutição. MATERIAIS E MÉTODOS: Participaram deste estudo dez indivíduos após acidente vascular encefálico, sendo seis do gênero masculino, com idade média de 57,6 anos. Foi realizada videofluoroscopia da deglutição e as imagens foram digitalizadas em microcomputador, com posterior análise do tempo do trânsito faríngeo da deglutição, por meio de um cronômetro e do software. RESULTADOS: O tempo médio do trânsito faríngeo da deglutição apresentou-se diferente quando comparados os métodos utilizados (cronômetro e software). CONCLUSÃO: Este software é um instrumento de análise dos parâmetros tempo e velocidade da deglutição, propiciando melhor compreensão da dinâmica da deglutição, com reflexos tanto na abordagem clínica dos pacientes com disfagia como para fins de pesquisa científica.
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Affiliation(s)
| | - Ana Rita Gatto
- Universidade Estadual Paulista Júlio de Mesquita Filho, Brasil
| | | | | | | | | | - Seizo Yamashita
- Universidade Estadual Paulista Júlio de Mesquita Filho, Brasil
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Roubeau B, Morinière S, Périé S, Martineau A, Falières J, St Guily JL. Use of reaction time in the temporal analysis of normal swallowing. Dysphagia 2008; 23:102-9. [PMID: 18204952 DOI: 10.1007/s00455-007-9099-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Accepted: 04/13/2007] [Indexed: 02/02/2023]
Abstract
This study was performed to establish the swallowing trigger by using the reaction time from an auditory stimulus. With this stable temporal starting point, we described the chronology of the different acoustic, electrophysiologic, and respiratory events that occurred during swallowing in a population of normal adults. We studied the swallowing reaction time (SRT) in 18 subjects aged 23 to 73 years by using acoustic, electroglottographic (EGG), and aerodynamic recordings. The chronology (the beginning of EGG activity, apnea, and respiratory sound and release) was identified in 91% of the recordings. The average SRT was 264 ms and the average swallowing duration was 977 ms, without any significant difference with respect to gender. The swallowing sound produced during apnea was composed of either two or three components. The reaction time procedure also demonstrated that the first sound component was unstable. By using this procedure for studying swallowing, we were able to stabilize the chronology of the different events, improve the subjects' attention, and establish a fixed benchmark for performing temporal measurements.
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Affiliation(s)
- Bernard Roubeau
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine University Pierre & Marie Curie, Tenon Hospital, Paris 6, Paris, France.
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Origin of the Sound Components During Pharyngeal Swallowing in Normal Subjects. Dysphagia 2007; 23:267-73. [DOI: 10.1007/s00455-007-9134-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Accepted: 09/26/2007] [Indexed: 10/22/2022]
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Martin-Harris B, Brodsky MB, Michel Y, Lee FS, Walters B. Delayed initiation of the pharyngeal swallow: normal variability in adult swallows. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2007; 50:585-94. [PMID: 17538102 DOI: 10.1044/1092-4388(2007/041)] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE The purpose of this investigation was to determine bolus head timing and location relations with the onset of hyoid movement at the initiation of the pharyngeal swallow and at the onset of swallow-related apnea. METHOD Bolus head timing and location and the timing of swallow-related apnea were recorded from frame-by-frame analyses of 5-ml single liquid swallows using dual-modality videofluoroscopy and nasal airflow recordings in 82 consecutive, healthy volunteers. The presence, depth, and response to airway entry were also recorded and related to the bolus head location and the onset of hyoid movement. RESULTS The majority of participants-80% on at least 1 trial-produced the onset of hyoid movement at pharyngeal swallow initiation after the bolus head passed the posterior angle of the mandible. There was a trend in older participants for later onset of hyoid movement and onset of apnea relative to bolus head arrival at the posterior angle of the mandible. CONCLUSION Although entry of the bolus head into the pharynx prior to hyoid movement may result in a threat to the laryngeal airway, these data demonstrate that a "delay" by itself cannot be assumed to indicate a disordered swallow without coexisting impairments of swallowing physiology.
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Affiliation(s)
- Bonnie Martin-Harris
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Suite 1141, Charleston, SC 29425, USA.
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Daniels SK, Schroeder MF, DeGeorge PC, Corey DM, Rosenbek JC. Effects of verbal cue on bolus flow during swallowing. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2007; 16:140-7. [PMID: 17456892 DOI: 10.1044/1058-0360(2007/018)] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE To examine the effects of verbal cuing to initiate swallowing on bolus flow measures in healthy adults. METHOD Videofluoroscopic examinations were completed in 12 healthy older adults (median age=69 years) as they swallowed 5 ml of self-administered liquid barium in 2 conditions: verbally cued and noncued swallows. In the cued condition, participants held the liquid in their mouths until instructed to swallow. In the noncued condition, participants swallowed in their usual manner. RESULTS Verbal cue affected bolus position at onset of timing measures, thereby influencing duration. The bolus was positioned more posterior in the oral cavity at onset of oral transit for cued as compared with noncued swallows. The leading edge of the bolus at onset of the pharyngeal swallow was more superior in the pharynx for cued as compared with noncued swallows. Durations of the cued swallows were significantly shorter than for noncued swallows for all timing measures. Bolus direction scores were not significantly different between conditions. CONCLUSIONS Findings suggest that swallowing is altered by the use of verbal cues to initiate swallowing in healthy adults. Determining whether shorter durations with implementation of verbal cues are evident in individuals with dysphagia and whether effects are beneficial or deleterious requires continued research.
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Affiliation(s)
- Stephanie K Daniels
- Southeast Louisiana Veterans Healthcare System and Tulane University Health Sciences Center, New Orleans, LA, USA.
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47
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Butler SG, Stuart A, Pressman H, Poage G, Roche WJ. Preliminary investigation of swallowing apnea duration and swallow/respiratory phase relationships in individuals with cerebral vascular accident. Dysphagia 2007; 22:215-24. [PMID: 17440776 DOI: 10.1007/s00455-007-9077-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Accepted: 01/18/2007] [Indexed: 11/25/2022]
Abstract
Swallowing apnea duration (SAD) and swallow-respiratory phase relationships were examined in individuals with cerebral vascular accident (CVA) and dysphagia who aspirated (n=11) and did not aspirate (n=15). Simultaneous videofluoroscopic and respiratory measures were recorded across 5-, 10-, 15-, and 20-ml thin and thick liquid bolus trials. These data were also compared with that previously acquired with healthy older adults (n=20). A moderate amount of systematic missing data was evidenced in the individuals who were dysphagic and especially those who aspirated subsequently limiting inferential analyses. Only 1 of the 11 participants who aspirated and 7 of the 15 who did not aspirate completed all 16 conditions. Six of the remaining ten who aspirated had missing data subsequent to termination of trials due to aspiration risk. The remaining four and seven of the eight who did not aspirate had missing data due to poor respiratory waveforms. From the remaining data, it was found that SAD and respiratory phase relationships differed among individuals with dysphagia and CVA (i.e., those who aspirate vs. those who do not aspirate) and healthy older adults. SAD was found to be longer for those who aspirated versus those who did not for all bolus viscosities and volumes with the exception of thick-liquid 10-ml boluses. In addition, SAD from those that aspirated was twice as long as that found in healthy older adults for all conditions. Regarding respiratory phase relationships, there was a difference between the proportions of respiratory patterns in those who aspirated versus those who did not. Those who aspirated demonstrated a markedly greater percentage of swallows that interrupted inhalation. In addition, the inhale-swallow-inhale pattern occurred with a greater frequency as swallowing severity increased. Healthy older adults, those who did not aspirate, and those who aspirated used the inhale-swallow-inhale pattern 0.1%, 3.0%, and 9.0%, respectively.
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Affiliation(s)
- Susan G Butler
- Center for Voice and Swallowing Disorders, Department of Otolaryngology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
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Martin-Harris B. Do We Have Valid and Reliable Means of Quantifying Severity of Oropharyngeal Dysphagia? ACTA ACUST UNITED AC 2007. [DOI: 10.1044/sasd16.1.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Bonnie Martin-Harris
- Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina Charleston, SC
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