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Ebihara S, Naito T. A Systematic Review of Reported Methods of Stimulating Swallowing Function and their Classification. TOHOKU J EXP MED 2022; 256:1-17. [DOI: 10.1620/tjem.256.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Satoru Ebihara
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine
| | - Toru Naito
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College
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2
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Cheng I, Sasegbon A, Hamdy S. A systematic review and meta-analysis of the effects of intraoral treatments for neurogenic oropharyngeal dysphagia. J Oral Rehabil 2021; 49:92-102. [PMID: 34800341 DOI: 10.1111/joor.13274] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/01/2021] [Accepted: 10/25/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rehabilitative treatments for oropharyngeal dysphagia, including oromotor exercises and sensory stimulation, have been widely adopted into clinical practice. However, the effects of these treatments are mainly supported by exploratory studies. As such, their clinical efficacy remains uncertain. OBJECTIVE Our systematic review and meta-analysis aimed to evaluate the efficacy of intraoral treatments for neurogenic oropharyngeal dysphagia based on evidence from randomised controlled trials (RCTs). METHODS Six electronic databases were systematically searched between January 1970 and July 2021. Data were extracted and analysed by two independent reviewers. The outcome measure was changes in (any) relevant clinical swallowing-related characteristics. RESULTS Data from 285 dysphagic patients were collected from 8 RCT studies across a range of intraoral dysphagia treatments. The pooled effect size of all intraoral dysphagia treatments was non-significant compared to control comparators (SMD [95%CI] = 0.23 [-0.22, 0.69], p = .31; I2 = 73%). Subgroup analysis revealed that the pooled effect sizes were also non-significant for oromotor exercises (device-facilitated lip resistance exercises and tongue exercises) (SMD [95%CI] = 0.11 [-0.76, 0.97]; p = .81; I2 = 88%) and sensory stimulation (thermal-tactile, thermo-chemical and electrical stimulation) (SMD [95%CI] = 0.35 [-0.03, 0.72]; p = .07; I2 = 0%). CONCLUSIONS Our results showed that overall, intraoral dysphagia treatments, including oromotor exercises and sensory stimulation, do not show beneficial effects for neurogenic oropharyngeal dysphagia. The evidence for these treatments remains weak and currently inadequate to support clinical use. Large-scale, multi-centre RCTs are warranted to fully explore their clinical efficacy.
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Affiliation(s)
- Ivy Cheng
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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3
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Electrical, taste, and temperature stimulation in patients with chronic dysphagia after stroke: a randomized controlled pilot trial. Acta Neurol Belg 2021; 121:1157-1164. [PMID: 33586087 DOI: 10.1007/s13760-021-01624-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
The objective of present study was compare a traditional swallowing therapy program with a new combined swallowing therapy program including neuromuscular electrical stimulation in patients with oropharyngeal dysphagia after stroke. This pilot study included eight patients with chronic oropharyngeal dysphagia after stroke. These patients underwent traditional therapy with gustative-thermic-tactile stimulation (group A), or a new combined program adding neuromuscular electrical stimulation (group B). Study participants were evaluated before and after the intervention using fiberoptic endoscopic evaluation of swallowing with temporal measures of posterior oral spillage and whiteout time, functional oral intake scale and a visual analog scale classifies an individual's swallowing ability. The two groups did not differ in terms of posterior oral spillage time, whiteout time and functional oral intake scale. Subjects in group B exhibited significant increases in visual analog scale scores. However, both groups demonstrated improvement with decreases in posterior oral spillage time, increased whiteout time, and increased functional oral intake scale and visual analog scale scores. There was no difference in the parameters studied in both therapeutic programs in individuals with chronic oropharyngeal dysphagia after stroke.
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4
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Furkim AM, da Silva RG, Vanin G, Martino R. The association between temporal measures of swallowing with penetration and aspiration in patients with dysphagia: A meta-analysis. NeuroRehabilitation 2019; 44:111-129. [PMID: 30776021 DOI: 10.3233/nre-182553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Temporal features of swallowing physiology vary with age in healthy normals and have the potential to impact swallow safety and efficiency in patients with dysphagia. We conducted a meta-analysis to assess the relation between temporal features of swallowing with penetration, aspiration and residue in adult patients with dysphagia regardless of etiology. METHODS Operational definitions of relevant terms were defined a priori. A search of 5 databases was conducted to November 2016 without restriction to language. Two independent raters reviewed abstracts and full articles, with discrepancies resolved by consensus. All accepted articles advanced to data extraction and critical appraisal according to Cochrane standards. Analysis of pooled data compared measures between groups. RESULTS Of the 11 articles accepted, the temporal measures used in three or more studies were grouped into morphofunctional categories: bolus transit time; pharyngeal response time; laryngeal closure time; and upper esophageal opening time. Across all selected articles, definitions varied for abnormal swallow and only 4 articles reported rater blinding and reliability for measures related to timing. Pooled data identified two main findings: a. longer pharyngeal response time was associated with penetration and/or aspiration (MD = 0.40 95% CI 0.59 - 0.22), and longer upper esophageal opening duration was associated with only aspiration (PAS ≥ 6) (MD = 0.09 95% CI 0.16 - 0,02). No studies were found that related temporal measures and residue. CONCLUSION Our pooled findings identified an association of two temporal measures with penetration and/or aspiration but none with residue. The current evidence remains limited due to the heterogeneity across studies in how swallow measures were operationalized. Future work with a standardized and reproducible approach is direly needed.
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Affiliation(s)
- Ana Maria Furkim
- Department of Speech-Language Pathology, University of Toronto, Canada.,Department of Speech-Language Pathology and Hearing Sciences, Federal University of Santa Catarina, Brazil
| | - Roberta Gonçalves da Silva
- Department of Speech-Language Pathology and Hearing Sciences, São Paulo State University-UNESP at Marília, Brazil
| | - Gabriela Vanin
- Swallowing Lab, University of Toronto, University Health Network, Canada
| | - Rosemary Martino
- Swallowing Lab, University of Toronto, University Health Network, Canada.,Department of Speech-Language Pathology, Rehabilitation Sciences Institute, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada.,Affiliate Scientist, Krembil Research Institute, University Health Network, Toronto, ON, Canada
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5
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Magara J, Watanabe M, Tsujimura T, Hamdy S, Inoue M. Cold thermal oral stimulation produces immediate excitability in human pharyngeal motor cortex. Neurogastroenterol Motil 2018; 30:e13384. [PMID: 29856098 DOI: 10.1111/nmo.13384] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/24/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Current strategies of swallowing therapy include facilitation of swallowing initiation by sensory modulation. Although thermal tactile oral stimulation is a common method to treat dysphagic patients to improve swallowing movement, little is known about the possible mechanisms. This study is aimed to investigate whether thermal oral (tongue) stimulation can modulate the cortico-pharyngeal neural motor pathway in humans. METHODS Eighteen healthy volunteers participated and were intubated with an intraluminal catheter for recording pharyngeal electromyography. Each participant underwent baseline transcranial magnetic stimulation (TMS) cortico-pharyngeal motor evoked potential (MEP) measurements bilaterally. MEPs were then measured during thermal stimulation over the dorsal tongue, applied using the Peltier device at three different temperatures; 45°C, 37°C, and 15°C, in a pre-ordered manner. Each of the three temperatures was given twice with a 5-min resting time between each trial. Averaged MEP amplitude changes were analyzed using ANOVA and post-hoc t-tests. KEY RESULTS Two-way repeated measures ANOVA with factors of Temperature × Trial in amplitude of MEP demonstrated a significant effect of Temperature both in the stronger (F2,34 = 5.775, P = .007) and weaker (F2,34 = 4.771, P = .017) pharyngeal hemispheres. Subsequent post-hoc tests showed the significant increase in pharyngeal MEPs at 15° compared to 37° in both hemispheres (P < .05). CONCLUSIONS & INFERENCES Cold oral stimulation was able to induce significant changes in pharyngeal cortical excitability, demonstrating evidence for a sensorimotor interaction between oral and pharyngeal cortical areas.
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Affiliation(s)
- J Magara
- Division of Dysphagia Rehabilitation, Niigata University, Niigata, Japan
| | - M Watanabe
- Division of Dysphagia Rehabilitation, Niigata University, Niigata, Japan
| | - T Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University, Niigata, Japan
| | - S Hamdy
- GI Sciences, School of Medical Sciences, University of Manchester, MAHSC, Salford, UK
| | - M Inoue
- Division of Dysphagia Rehabilitation, Niigata University, Niigata, Japan
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Humbert IA, Sunday KL, Karagiorgos E, Vose AK, Gould F, Greene L, Azola A, Tolar A, Rivet A. Swallowing Kinematic Differences Across Frozen, Mixed, and Ultrathin Liquid Boluses in Healthy Adults: Age, Sex, and Normal Variability. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:1544-1559. [PMID: 29800050 PMCID: PMC6195055 DOI: 10.1044/2018_jslhr-s-17-0417] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 02/09/2018] [Indexed: 05/04/2023]
Abstract
PURPOSE The aim of this study was to examine the effects of frozen and mixed-consistency boluses on the swallowing physiology of younger and older adults. We also aimed to quantify factors that lead to increased variability in swallowing outcomes (i.e., age, sex, bolus type). METHOD Forty-one healthy adults (18-85 years old) swallowed 5 blocks of 5 different boluses: 10-ml ultrathin liquid, a teaspoon of iced barium, a teaspoon of room-temperature pudding, a teaspoon of frozen pudding, and ultrathin barium with chocolate chips. All data were recorded with videofluoroscopy and underwent detailed timing kinematic measurements. RESULTS Neither barium ice nor frozen pudding sped up swallow responses. Many healthy adults initiated swallowing with the bolus as deep as the pyriform sinuses. Swallowing temporal kinematics for ultrathin liquid consistencies are most different from all others tested, requiring the best possible physiological swallowing performance in younger and older healthy individuals (i.e., faster reaction times, longer durations) compared with other bolus types tested. In each measure, older adults had significantly longer durations compared with the younger adults. More variability in swallowing kinematics were seen with age and laryngeal vestibule kinematics. CONCLUSION This study provides important contributions to the literature by clarifying normal variability within a wide range of swallowing behaviors and by providing normative data from which to compare disordered populations.
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Affiliation(s)
- Ianessa A. Humbert
- Swallowing Systems Core, Department of Speech, Language, Hearing Sciences, University of Florida, Gainesville
- Department of Neurology, University of Florida, Gainesville
- Rehabilitation Sciences, College of Health and Health Professions, University of Florida, Gainesville
| | - Kirstyn L. Sunday
- Swallowing Systems Core, Department of Speech, Language, Hearing Sciences, University of Florida, Gainesville
| | - Eleni Karagiorgos
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
| | - Alicia K. Vose
- Department of Neurology, University of Florida, Gainesville
- Rehabilitation Sciences, College of Health and Health Professions, University of Florida, Gainesville
| | - Francois Gould
- Department of Anatomy and Neurobiology, North East Ohio Medical University, Akron
| | - Lindsey Greene
- Swallowing Systems Core, Department of Speech, Language, Hearing Sciences, University of Florida, Gainesville
| | - Alba Azola
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD
| | - Ara Tolar
- Swallowing Systems Core, Department of Speech, Language, Hearing Sciences, University of Florida, Gainesville
| | - Alycia Rivet
- Swallowing Systems Core, Department of Speech, Language, Hearing Sciences, University of Florida, Gainesville
- Rehabilitation Sciences, College of Health and Health Professions, University of Florida, Gainesville
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Schwarz M, Ward EC, Ross J, Semciw A. Impact of thermo-tactile stimulation on the speed and efficiency of swallowing: a systematic review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2018; 53:675-688. [PMID: 29566298 DOI: 10.1111/1460-6984.12384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/29/2018] [Accepted: 02/23/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND A delayed or absent swallow reflex is common in dysphagia and can have a significant impact on swallow safety. Recent clinical practice survey data have supported the fact that clinicians continue to use thermo-tactile stimulation (TTS) as a strategy to stimulate key nerve pathways and evoke a swallow reflex for patients with a delayed or absent swallow reflex. AIMS To conduct a systematic review of the effectiveness of TTS as a compensatory and/or rehabilitative tool. METHODS & PROCEDURES A search performed on CINAHL, Medline and Speech Bite identified 599 articles. After removing duplicates, the titles and abstracts of 458 articles were assessed for eligibility; 426 articles were deemed to be clearly ineligible and the remaining 32 full-text articles were further screened for inclusion. Ten of these studies were included in this review. MAIN CONTRIBUTION The results of this review highlight the lack of available evidence in this area and give support to the view that there is only low-level evidence for use of TTS as a compensatory strategy immediately before a swallow. CONCLUSIONS & IMPLICATIONS There is low-level evidence to support the use of TTS. Current best practice would be to use TTS on a case-by-case basis, following detailed instrumental assessment and evaluation of its efficacy for an individual.
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Affiliation(s)
- Maria Schwarz
- Speech Pathology Department, Logan Hospital, Metro South Hospital and Health Service, Logan, QLD, Australia
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, QLD, Australia
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
| | - Jane Ross
- Speech Pathology Department, Logan Hospital, Metro South Hospital and Health Service, Logan, QLD, Australia
| | - Adam Semciw
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, QLD, Australia
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
- Physiotherapy Department, Princes Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
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Lazarus CL. History of the Use and Impact of Compensatory Strategies in Management of Swallowing Disorders. Dysphagia 2017; 32:3-10. [PMID: 28130600 DOI: 10.1007/s00455-016-9779-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/30/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Cathy L Lazarus
- Department of Otolaryngology Head and Neck Surgery, Mount Sinai Beth Israel, New York, NY, 10003, USA. .,Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA. .,THANC Foundation, 10 Union Square East, New York, NY, 10003, USA.
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9
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Aguirre Bravo AN, Sampallo Pedroza RM. Fonoaudiología en los Cuidados Paliativos. REVISTA DE LA FACULTAD DE MEDICINA 2015. [DOI: 10.15446/revfacmed.v63n2.48539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p>Los Cuidados Paliativos (CP), al generar calidad de vida en el paciente con enfermedad terminal y a su familia; no se aplican únicamente cuando un tratamiento curativo no tiene un efecto favorable y/o en la fase final de vida; ya que, la atención física, emocional y espiritual, es importante desde el momento del diagnóstico de una enfermedad potencialmente mortal; durante su progresión y desenlace. Con el objetivo de documentar, describir y caracterizar el quehacer del Fonoaudiólogo, en los CP; se realizó una revisión bibliográfica narrativa, en la cual por medio de bases de datos especializadas, libros, guías de manejo, páginas electrónicas de instituciones y organizaciones reconocidas a nivel nacional e internacional en CP, Fonoaudiología, Dolor cráneo-facial, Cáncer, Enfermedades Crónicas, entre otras. Se logró realizar una contextualización de diferentes conceptos, identificar la situación de los CP en Colombia y elaborar una propuesta de evaluación diagnóstico e intervención en el final de la vida; referente a la comunicación, el dolor cráneo-facial y la disfagia. Se concluyó que existe poca información que determine el rol del Fonoaudiólogo en los CP; a pesar del gran reporte de la importancia de la comunicación, el manejo de dolor cráneo-facial y la repercusión de la disfagia en la calidad de vida del paciente con enfermedad terminal y su familia. Se destaca que las actividades del Fonoaudiólogo en los CP se alinean a los componentes establecidos por la Organización Mundial de la Salud, al buscar un cuidado que garantice “buena vida”, en los últimos días.<strong></strong></p>
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Abstract
This article provides an overview of nonsurgical and nonpharmacologic treatments for oropharyngeal dysphagia. The speech-language pathologist (SLP) is the primary member of the swallowing management team who will provide this type of dysphagia management. The primary focus of the SLP for dysphagia management is first to eliminate or reduce aspiration risk, as well as to improve or restore swallowing function. Ultimately, the management plan will depend on the physiologic underpinnings of the disorder and patient variables such as cognition, motivation, and ability to attend therapy sessions or participate in therapy.
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12
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Cola PC, Gatto AR, da Silva RG, Spadotto AA, Ribeiro PW, Schelp AO, Carvalho LR, Henry MACA. Taste and temperature in swallowing transit time after stroke. Cerebrovasc Dis Extra 2012; 2:45-51. [PMID: 23139681 PMCID: PMC3493000 DOI: 10.1159/000339888] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Oropharyngeal dysphagia is common in individuals after stroke. Taste and temperature are used in dysphagia rehabilitation. The influence of stimuli, such as taste and temperature, on swallowing biomechanics has been investigated in both healthy individuals and in individuals with neurological disease. However, some questions still remain unanswered, such as how the sequence of offered stimuli influences the pharyngeal response. The goal of the present study was to determine the influence of the sequence of stimuli, sour taste and cold temperature, on pharyngeal transit time during deglutition in individuals after stroke. Methods The study included 60 individuals with unilateral ischemic stroke, 29 males and 31 females, aged 41–88 years (mean age: 66.2 years) examined 0–50 days after ictus (median: 6 days), with mild to moderate oropharyngeal dysphagia. Exclusion criteria were hemorrhagic stroke patients, patients with decreased level of consciousness, and clinically unstable patients, as confirmed by medical evaluation. The individuals were divided into two groups of 30 individuals each. Group 1 received a nonrandomized sequence of stimuli (i.e. natural, cold, sour, and sour-cold) and group 2 received a randomized sequence of stimuli. A videofluoroscopic swallowing study was performed to analyze the pharyngeal transit time. Four different stimuli (natural, cold, sour, and sour-cold) were offered. The images were digitalized and specific software was used to measure the pharyngeal transit time. Since the values did not present regular distribution and uniform variances, nonparametric tests were performed. Results Individuals in group 1 presented a significantly shorter pharyngeal transit time with the sour-cold stimulus than with the other stimuli. Individuals in group 2 did not show a significant difference in pharyngeal transit time between stimuli. Conclusions The results showed that the sequence of offered stimuli influences the pharyngeal transit time in a different way in individuals after stroke and suggest that, when the sour-cold stimulus is offered in a randomized sequence, it can influence the response to the other stimuli in stroke patients. Hence, the sour-cold stimulus could be used as a therapeutic aid in dysphagic stroke patients.
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Affiliation(s)
- Paula C Cola
- Department of Surgery, Botucatu Medical School, UNESP, Botucatu, Brazil
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13
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Michou E, Mastan A, Ahmed S, Mistry S, Hamdy S. Examining the role of carbonation and temperature on water swallowing performance: a swallowing reaction-time study. Chem Senses 2012; 37:799-807. [PMID: 22843761 DOI: 10.1093/chemse/bjs061] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Various therapeutic approaches for dysphagia management are based on modifications of bolus properties to change swallowing biomechanics and increase swallowing safety. Limited evidence exists for the effects of carbonation and bolus temperature on swallowing behavior. Here, we investigated the effects of carbonation and temperature on swallowing behavior using a novel automated and complex swallowing reaction time task via pressure signal recordings in the hypopharynx. Healthy participants (n = 39, 27.7±5 years old) were randomized in two different experiments and asked to perform 10 normal-paced swallows, 10 fast-paced swallows, and 10 challenged swallows within a predetermined time-window of carbonated versus still water (experiment 1) and of cold (4 °C) versus hot (45 °C) versus room temperature (21 °C) water (experiment 2). Quantitative measurements of latencies and percentage of successful challenged swallows were collected and analyzed nonparametrically. An increase in successfully performed challenged swallowing task was observed with carbonated water versus still water (P = 0.021), whereas only cold water shortened the latencies of normally paced swallows compared with room (P = 0.001) and hot (P = 0.004) temperatures. Therefore, it appears that chemothermal stimulation with carbonation and cold are most effective at modulating water swallowing, which in part is likely to be driven by central swallowing afferent activity.
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Affiliation(s)
- Emilia Michou
- School of Translational Medicine-Inflammation Sciences, Faculty of Medical and Human Sciences, University of Manchester (part of the Manchester Academic Health Sciences Centre (MAHSC)), Salford Royal Hospital, Eccles Old Road, Salford M6 8HD, UK
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Abstract
Patients who have cancers of the oral cavity, pharynx, or larynx may be treated with surgery, radiotherapy, chemotherapy, or a combination of these modalities. Each treatment type may have a negative impact on posttreatment swallowing function; these effects are presented in this article. A number of rehabilitative procedures are available to the clinician to reduce or eliminate swallowing disorders in patients treated for cancer of the head and neck. The various procedures-including postures, maneuvers, modifications to bolus volume and viscosity, range-of-motion exercises, and strengthening exercises-and their efficacy in patients treated for head and neck cancer are discussed.
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Affiliation(s)
- Barbara R Pauloski
- Communication Sciences and Disorders, Northwestern University, 2240 Campus Drive, Suite 3-331, Evanston, IL 60208-3540, USA.
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Theurer JA, Bihari F, Barr AM, Martin RE. Oropharyngeal stimulation with air-pulse trains increases swallowing frequency in healthy adults. Dysphagia 2006; 20:254-60. [PMID: 16633868 DOI: 10.1007/s00455-005-0021-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This study sought to determine whether air-pulse trains delivered to the peritonsillar area would facilitate swallowing in healthy subjects. Trains of unilateral or bilateral air pulses were delivered to the peritonsillar area via tubing embedded in a dental splint, while swallows were simultaneously identified from their associated laryngeal and respiratory movements. Results from four subjects indicated that oropharyngeal air-pulse stimulation evoked an irrepressible urge to swallow, followed by an overt swallow as verified by laryngeal and respiratory movements. Moreover, air-pulse stimulation was associated with a significant increase in swallowing frequency. Mean latency of swallowing following bilateral stimulation tended to be less than the latency of swallowing following unilateral stimulation. These findings in healthy adults suggest the possibility that oropharyngeal air-pulse stimulation may have clinical utility in dysphagic individuals.
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Affiliation(s)
- Julie A Theurer
- Doctoral Program in Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada
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Martin RE, MacIntosh BJ, Smith RC, Barr AM, Stevens TK, Gati JS, Menon RS. Cerebral areas processing swallowing and tongue movement are overlapping but distinct: a functional magnetic resonance imaging study. J Neurophysiol 2004; 92:2428-43. [PMID: 15163677 DOI: 10.1152/jn.01144.2003] [Citation(s) in RCA: 179] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Although multiple regions of the cerebral cortex have been implicated in swallowing, the functional contributions of each brain area remain unclear. The present study sought to clarify the roles of these cortical foci in swallowing by comparing brain activation associated with voluntary saliva swallowing and voluntary tongue elevation. Fourteen healthy right-handed subjects were examined with single-event-related functional magnetic resonance imaging (fMRI) while laryngeal movements associated with swallowing and tongue movement were simultaneously recorded. Both swallowing and tongue elevation activated 1) the left lateral pericentral and anterior parietal cortex, and 2) the anterior cingulate cortex (ACC) and adjacent supplementary motor area (SMA), suggesting that these brain regions mediate processes shared by swallowing and tongue movement. Tongue elevation activated a larger total volume of cortex than swallowing, with significantly greater activation within the ACC, SMA, right precentral and postcentral gyri, premotor cortex, right putamen, and thalamus. Although a contrast analysis failed to identify activation foci specific to swallowing, superimposed activation maps suggested that the most lateral extent of the left pericentral and anterior parietal cortex, rostral ACC, precuneus, and right parietal operculum/insula were preferentially activated by swallowing. This finding suggests that these brain areas may mediate processes specific to swallowing. Approximately 60% of the subjects showed a strong functional lateralization of the postcentral gyrus toward the left hemisphere for swallowing, whereas 40% showed a similar activation bias for the tongue elevation task. This finding supports the view that the oral sensorimotor cortices within the left and right hemispheres are functionally nonequivalent.
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Affiliation(s)
- Ruth E Martin
- School of Communication Sciences and Disorders, Faculty of Health Sciences, Elborn College, Room 2568, University of Western Ontario, London, Ontario N6G 1H1, Canada.
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Hamdy S, Jilani S, Price V, Parker C, Hall N, Power M. Modulation of human swallowing behaviour by thermal and chemical stimulation in health and after brain injury. Neurogastroenterol Motil 2003; 15:69-77. [PMID: 12588471 DOI: 10.1046/j.1365-2982.2003.00390.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Few data support thermal or chemical stimulation as therapy for neurogenic dysphagia. Our aims were to explore the behavioural effects of thermal (cold) and chemical (citrus) modalities on water swallowing in health (n = 65, mean age 45 years, 44 females) and acute stroke (n = 22, mean age 67 years, eight females). Multiple randomized timed 50-mL swallowing tests were performed for each of four water conditions: (a) room temperature (RT), (b) cold (CD), (c) citrus (CT) and (d) combined cold and citrus (CD + CT). The inter-swallow interval (ISI), swallowing volume velocity (speed), and volume per swallow (capacity) were measured. In health, compared to RT, only CD + CT slowed the speed (12.3 +/- 0.5 vs 10.3 +/- 0.5 mL s(-1), P < 0.03) and decreased the capacity (16.4 +/- 0.9 vs 14.6 +/- 0.7 mL per swallow, P < 0.02) of swallowing. ISI was unaffected, except by CD + CT in healthy young subjects (<60 years) where it was reduced (1.44 +/- 0.02 vs 1.30 +/- 0.02 s, P < 0.02). Despite smaller volumes ingested by stroke patients, CD + CT, compared to RT, again slowed both the speed (3.8 +/- 0.4 vs 4.5 +/- 0.5 mL s(-1), P < 0.03) and capacity (7.6 +/- 0.7 vs 8.5 +/- 0.7 mL per swallow, P < 0.03) of swallowing but had no effect on ISI. We conclude that combined thermal and chemical modification of water consistently alters swallowing behaviour in health and after cerebral injury. These findings have relevance in the management of neurogenic swallowing problems.
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Affiliation(s)
- S Hamdy
- Department of GI Sciences, Hope Hospital, Salford, UK.
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