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Wei KC, Wang TG, Hsiao MY. The Cortical and Subcortical Neural Control of Swallowing: A Narrative Review. Dysphagia 2024; 39:177-197. [PMID: 37603047 DOI: 10.1007/s00455-023-10613-x] [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: 09/24/2022] [Accepted: 08/03/2023] [Indexed: 08/22/2023]
Abstract
Swallowing is a sophisticated process involving the precise and timely coordination of the central and peripheral nervous systems, along with the musculatures of the oral cavity, pharynx, and airway. The role of the infratentorial neural structure, including the swallowing central pattern generator and cranial nerve nuclei, has been described in greater detail compared with both the cortical and subcortical neural structures. Nonetheless, accumulated data from analysis of swallowing performance in patients with different neurological diseases and conditions, along with results from neurophysiological studies of normal swallowing have gradually enhanced understanding of the role of cortical and subcortical neural structures in swallowing, potentially leading to the development of treatment modalities for patients suffering from dysphagia. This review article summarizes findings about the role of both cortical and subcortical neural structures in swallowing based on results from neurophysiological studies and studies of various neurological diseases. In sum, cortical regions are mainly in charge of initiation and coordination of swallowing after receiving afferent information, while subcortical structures including basal ganglia and thalamus are responsible for movement control and regulation during swallowing through the cortico-basal ganglia-thalamo-cortical loop. This article also presents how cortical and subcortical neural structures interact with each other to generate the swallowing response. In addition, we provided the updated evidence about the clinical applications and efficacy of neuromodulation techniques, including both non-invasive brain stimulation and deep brain stimulation on dysphagia.
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Affiliation(s)
- Kuo-Chang Wei
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan
| | - Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan.
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan.
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Ross CF, Laurence-Chasen JD, Li P, Orsbon C, Hatsopoulos NG. Biomechanical and Cortical Control of Tongue Movements During Chewing and Swallowing. Dysphagia 2024; 39:1-32. [PMID: 37326668 PMCID: PMC10781858 DOI: 10.1007/s00455-023-10596-9] [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: 04/08/2022] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
Tongue function is vital for chewing and swallowing and lingual dysfunction is often associated with dysphagia. Better treatment of dysphagia depends on a better understanding of hyolingual morphology, biomechanics, and neural control in humans and animal models. Recent research has revealed significant variation among animal models in morphology of the hyoid chain and suprahyoid muscles which may be associated with variation in swallowing mechanisms. The recent deployment of XROMM (X-ray Reconstruction of Moving Morphology) to quantify 3D hyolingual kinematics has revealed new details on flexion and roll of the tongue during chewing in animal models, movements similar to those used by humans. XROMM-based studies of swallowing in macaques have falsified traditional hypotheses of mechanisms of tongue base retraction during swallowing, and literature review suggests that other animal models may employ a diversity of mechanisms of tongue base retraction. There is variation among animal models in distribution of hyolingual proprioceptors but how that might be related to lingual mechanics is unknown. In macaque monkeys, tongue kinematics-shape and movement-are strongly encoded in neural activity in orofacial primary motor cortex, giving optimism for development of brain-machine interfaces for assisting recovery of lingual function after stroke. However, more research on hyolingual biomechanics and control is needed for technologies interfacing the nervous system with the hyolingual apparatus to become a reality.
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Affiliation(s)
- Callum F Ross
- Department of Organismal Biology & Anatomy, The University of Chicago, 1027 East 57th St, Chicago, IL, 60637, USA.
| | - J D Laurence-Chasen
- National Renewable Energy Laboratory, National Renewable Energy Laboratory, Golden, Colorado, USA
| | - Peishu Li
- Department of Organismal Biology & Anatomy, The University of Chicago, 1027 East 57th St, Chicago, IL, 60637, USA
| | - Courtney Orsbon
- Department of Radiology, University of Vermont Medical Center, Burlington, USA
| | - Nicholas G Hatsopoulos
- Department of Organismal Biology & Anatomy, The University of Chicago, 1027 East 57th St, Chicago, IL, 60637, USA
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Garand KL(F, Armeson K, Hill EG, Blair J, Pearson W, Martin-Harris B. Quantifying Oropharyngeal Swallowing Impairment in Response to Bolus Viscosity. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:460-467. [PMID: 37902448 PMCID: PMC11001168 DOI: 10.1044/2023_ajslp-23-00082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/28/2023] [Accepted: 09/10/2023] [Indexed: 10/31/2023]
Abstract
PURPOSE The purpose of this study was to test the feasibility for quantifying changes in oropharyngeal swallowing impairment in response to alteration in bolus viscosity using a reliable and valid method of observational measurement-the Modified Barium Swallow Impairment Profile (MBSImP). METHOD This retrospective analysis included a heterogeneous cohort of 119 patients with suspected dysphagia that underwent a videofluoroscopic swallowing study as part of clinical care. Using consensus scoring, two expert clinicians assigned MBSImP scores to components related to oropharyngeal swallowing function between two bolus viscosities (thin liquid and pudding): epiglottic movement, laryngeal elevation, anterior hyoid excursion, tongue base retraction, pharyngeal stripping wave, and pharyngoesophageal segment opening (PESO). Comparisons between the two bolus viscosities were investigated for each component. RESULTS Higher (worse) scores were observed in the thin-liquid trial compared with the pudding trial for the following MBSImP components: anterior hyoid excursion (p = .03), epiglottic movement (p < .001), pharyngeal stripping wave (p < .001), and PESO (p = .002). Lower (better) scores were observed in the liquid trial compared with the pudding trial for one component-tongue base retraction (Component 15) only (p < .001). CONCLUSION These findings provide further evidence for positive influences of viscosity on the swallow mechanism, including influences of sensory feedback on the sensorimotor swallow program.
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Affiliation(s)
| | - Kent Armeson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Elizabeth G. Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Julie Blair
- Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston
| | - William Pearson
- Department of Biomedical Sciences (Anatomy), Edward Via College of Osteopathic Medicine, Auburn, AL
| | - Bonnie Martin-Harris
- Department of Communication Sciences Disorders, Northwestern University, Evanston, IL
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Fu X, Li H, Yang W, Li X, Lu L, Guo H, Guo K, Huang Z. Electroacupuncture at HT5 + GB20 promotes brain remodeling and significantly improves swallowing function in patients with stroke. Front Neurosci 2023; 17:1274419. [PMID: 38027487 PMCID: PMC10656700 DOI: 10.3389/fnins.2023.1274419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background This study compared the differences in the degree of brain activation, and swallowing function scales in patients with post-stroke dysphagia after treatment. We explored the mechanism of cortical remodeling and the improvement effect of electroacupuncture on swallowing function in patients and provided a theoretical basis for the clinical application of electroacupuncture. Methods Fifty patients with post-stroke dysphagia were randomized to the control or electroacupuncture group. The control group underwent conventional swallowing rehabilitation for 30 min each time for 12 sessions. In the electroacupuncture group, electroacupuncture was performed based on conventional swallowing rehabilitation for 30 min each time for 12 sessions. Cortical activation tests and swallowing function assessments were performed before and after treatment. Statistical analyses were used to investigate the differences within and between the two groups to explore the treatment effects. Results There were no statistical differences in clinical characteristics and baseline data between the two groups before treatment. Cortical activation and swallowing function were improved to different degrees in both groups after treatment compared with before treatment. After treatment, the electroacupuncture group showed higher LPM (t = 4.0780, p < 0.001) and RPM (t = 4.4026, p < 0.0001) cortical activation and tighter functional connectivity between RS1 and LM1 (t = 2.5336, p < 0.05), RM1 and LPM (t = 3.5339, p < 0.001), RPM and LM1 (t = 2.5302, p < 0.05), and LM1 and LPM (t = 2.9254, p < 0.01) compared with the control group. Correspondingly, the improvement in swallowing function was stronger in the electroacupuncture group than in the control group (p < 0.05). Conclusion This study demonstrated that electroacupuncture based on conventional treatment activated more of the cerebral cortex associated with swallowing and promoted functional connectivity and remodeling of the brain. Accompanying the brain remodeling, patients in the electroacupuncture group also showed greater improvement in swallowing function. Clinical trial registration ClinicalTrials.gov, ChiCTR2300067457.
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Affiliation(s)
- Xuefeng Fu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Hao Li
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Wen Yang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Xuezheng Li
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Lijun Lu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Hua Guo
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Kaifeng Guo
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Zhen Huang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
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Fu X, Li H, Yang W, Li X, Lu L, Guo H, Wu Z, Guo K, Xu H, Huang Z. Electroacupuncture at HT5 + GB20 produces stronger activation effect on swallowing cortex and muscle than single points. Heliyon 2023; 9:e21922. [PMID: 38034817 PMCID: PMC10682618 DOI: 10.1016/j.heliyon.2023.e21922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/25/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction This study aimed to investigate the effects of electroacupuncture on cortical activation and swallowing muscle groups. The study examined brain activation in healthy subjects performing swallowing tasks during electroacupuncture. Additionally, the study analyzed electromyographic signals of swallowing muscle groups after electroacupuncture. Methods Twenty-seven healthy subjects were randomly separated into three groups. They underwent electroacupuncture at HT5 acupoint (HT5 group), or GB20 acupoint (GB20 group), or HT5 + GB20 acupoint (HT5 + GB20 group) for 30 min of intervention. Subjects performed a swallowing task while receiving electroacupuncture. Functional near-infrared spectroscopy (fNIRS) was used to detect cortical activation and functional connectivity (FC). The mean amplitude values of the swallowing muscle groups after electroacupuncture were also measured. Statistical analysis was used to investigate the differences between the three groups. The protocol was registered with the China Clinical Trials Registry with the registration number ChiCTR2300067457. Results Compared with the HT5 group, the HT5 + GB20 group showed higher cortical activation in the LM1 (t = 2.842, P < 0.05) and a tighter FC in the RM1 and LM1 (t = 2.4629, P < 0.05) with considerably increased mean amplitude values of the swallowing muscle groups (t = 5.2474, P < 0.0001). Increased FC was found in the HT5 + GB20 group compared to the GB20 group between the RM1 and RS1 (t = 2.9997, P < 0.01), RM1 and RPM (t = 2.2116, P < 0.05), RM1 and LM1 (t = 3.2078, P < 0.01), RPM and LM1 (t = 2.7440, P < 0.05). However, there were no statistically significant differences in cortical activation or mean amplitude values of swallowing muscle groups. Conclusion This study showed that electroacupuncture at HT5 + GB20 acupoints particularly engaged the cerebral cortex related to swallowing, resulting in tighter functional connectivity and higher amplitude values of swallowing muscle groups than electroacupuncture at single acupoints. The results may reveal the mechanism of electroacupuncture for post-stroke swallowing dysphagia.
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Affiliation(s)
- Xuefeng Fu
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
| | - Hao Li
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
| | - Wen Yang
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China
| | - Xuezheng Li
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China
| | - Lijun Lu
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China
| | - Hua Guo
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China
| | - Zhehao Wu
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China
| | - Kaifeng Guo
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China
| | - Haoming Xu
- South China Normal University, Guangzhou, Guangdong, 510631, China
| | - Zhen Huang
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
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Ogawa A, Koganemaru S, Takahashi T, Takemura Y, Irisawa H, Goto K, Matsuhashi M, Mima T, Mizushima T, Kansaku K. Swallow-related Brain Activity in Post-total Laryngectomy Patients: A Case Series Study. Prog Rehabil Med 2023; 8:20230026. [PMID: 37663527 PMCID: PMC10468693 DOI: 10.2490/prm.20230026] [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: 02/03/2023] [Accepted: 07/26/2023] [Indexed: 09/05/2023] Open
Abstract
Background Total laryngectomy is a surgical procedure to completely remove the hyoid bone, larynx, and associated muscles as a curative treatment for laryngeal cancer. This leads to insufficient swallowing function with compensative movements of the residual tongue to propel the food bolus to the pharynx and esophagus. However, the neurophysiological mechanisms of compensative swallowing after total laryngectomy remain unclear. Recently, swallowing-related cortical activation such as event-related desynchronization (ERD) during swallowing has been reported in healthy participants and neurological patients with dysphagia. Abnormal ERD elucidates the pathophysiological cortical activities that are related to swallowing. No report has investigated ERD in post-total laryngectomy patients. Case We investigated ERD during volitional swallowing using electroencephalography in three male patients after total laryngectomy for laryngeal cancer (age and time after surgery: Case 1, 75 years, 10 years; Case 2, 85 years, 19 years; Case 3, 73 years, 19 years). In video fluorographic swallowing studies, we observed compensatory tongue movements such as posterior-inferior retraction of the tongue and contact on the posterior pharyngeal wall in all three cases. Significant ERD was localized in the bilateral medial sensorimotor areas and the left lateral parietal area in Case 1, in the bilateral frontal and left temporal areas in Case 2, and in the left prefrontal and premotor areas in Case 3. Discussion These results suggest that cortical activities related to swallowing might reflect cortical reorganization for modified swallowing movements of residual tongue muscles to compensate for reduced swallowing pressure in patients after total laryngectomy.
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Affiliation(s)
- Akari Ogawa
- Cognitive Motor Neuroscience, Human Health Sciences,
Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Regenerative Systems Neuroscience, Human Brain
Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoko Koganemaru
- Department of Regenerative Systems Neuroscience, Human Brain
Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Physiology, Dokkyo Medical University, Mibu,
Japan
| | | | - Yuu Takemura
- Department of Rehabilitation Medicine, Dokkyo Medical
University, Mibu, Japan
| | - Hiroshi Irisawa
- Department of Rehabilitation Medicine, Dokkyo Medical
University, Mibu, Japan
| | - Kazutaka Goto
- Department of Otorhinolaryngology, Head and Neck Surgery,
Dokkyo Medical University, Mibu, Japan
| | - Masao Matsuhashi
- Department of Epilepsy, Movement Disorders and Physiology,
Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuya Mima
- The Graduate School of Core Ethics and Frontier Sciences,
Ritsumeikan University, Kyoto, Japan
| | - Takashi Mizushima
- Department of Rehabilitation Medicine, Dokkyo Medical
University, Mibu, Japan
| | - Kenji Kansaku
- Department of Physiology, Dokkyo Medical University, Mibu,
Japan
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7
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Wen X, Peng J, Zhu Y, Bao X, Wan Z, Hu R, Liu H, Li F, Liu Z. Hemodynamic signal changes and functional connectivity in acute stroke patients with dysphagia during volitional swallowing: a pilot study. Med Phys 2023; 50:5166-5175. [PMID: 37314082 DOI: 10.1002/mp.16535] [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: 12/04/2022] [Revised: 02/20/2023] [Accepted: 05/22/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Dysphagia is one of the major post-stroke complications, understanding post-stroke changes in cortical excitability and promoting early remodeling of swallowing-related cortical areas to enable accurate treatment is essential for recovery of patients. OBJECTIVES We aimed to investigate hemodynamic signal changes and functional connectivity in acute stroke patients with dysphagia compared to age-matched healthy participants in response to volitional swallowing using functional near-infrared spectroscopy (fNIRS) in this pilot study. METHODS Patients with first-ever post-stroke dysphagia having an onset of 1-4 weeks and age-matched right-handed healthy subjects were recruited in our study. fNIRS with 47 channels was utilized to detect the oxyhemoglobin (HbO2 ) and reduced hemoglobin (HbR) concentration changes when volitional swallowing. Cohort analysis was performed by a one-sample t-test. Two-sample t-test was utilized to compare the difference in cortical activation between patients with post-stroke dysphagia and healthy subjects. Furthermore, the relative changes in the concentration of the HbO2 throughout the experimental procedure were extracted for the functional connectivity analysis. The Pearson correlation coefficients of the HbO2 concentration of each channel were analyzed on a time series, and then a Fisher Z transformation was then performed, and the transformed values were defined as the functional connection strengths between the channels. RESULTS In this present study, a total of nine patients with acute post-stroke dysphagia were enrolled in the patient group and nine age-matched healthy participants in the healthy control group. Our study observed that the extensive regions of the cerebral cortex were activated in the healthy control group, while the activation area of patient group's cortical regions was quite limited. The mean functional connectivity strength of participants was 0.485 ± 0.105 in the healthy control group, and 0.252 ± 0.146 in the patient group, with a significant difference between the two groups (p = 0.001). CONCLUSION Compared to the healthy individuals, cerebral cortex regions of acute stroke patients were only marginally activated during volitional swallowing task, and the average functional connectivity strength of cortical network in patients was relatively weaker.
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Affiliation(s)
- Xin Wen
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, Guangdong, China
- School of Rehabilitation Medicine Gannan Medical University, Ganzhou, Jiangxi, China
| | - Junwei Peng
- Department of Chinese Integrative Medicine, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yanying Zhu
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, Guangdong, China
| | - Xiao Bao
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, Guangdong, China
| | - Zihao Wan
- College of Physical Education and Health, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Rongliang Hu
- Department of Rehabilitation Medicine, Jiangmen Central Hospital, Jiangmen, Guangdong, China
| | - Huiyu Liu
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, Guangdong, China
| | - Fang Li
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, Guangdong, China
| | - Zicai Liu
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, Guangdong, China
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Fujiki M, Hata N, Anan M, Matsushita W, Kawasaki Y, Fudaba H. Monophasic-quadri-burst stimulation robustly activates bilateral swallowing motor cortices. Front Neurosci 2023; 17:1163779. [PMID: 37304027 PMCID: PMC10248141 DOI: 10.3389/fnins.2023.1163779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
A stable, reliable, non-invasive, quantitative assessment of swallowing function remains to be established. Transcranial magnetic stimulation (TMS) is commonly used to aid in the diagnosis of dysphagia. Most diagnostic applications involve single-pulse TMS and motor evoked potential (MEP) recordings, the use of which is not clinically suitable in patients with severe dysphagia given the large variability in MEPs measured from the muscles involved in swallowing. Previously, we developed a TMS device that can deliver quadripulse theta-burst stimulation in 16 monophasic magnetic pulses through a single coil, enabling the measurement of MEPs related to hand function. We applied a system for MEP conditioning that relies on a 5 ms interval-monophasic quadripulse magnetic stimulation (QPS5) paradigm to produce 5 ms interval-four sets of four burst trains; quadri-burst stimulation (QBS5), which is expected to induce long-term potentiation (LTP) in the stroke patient motor cortex. Our analysis indicated that QBS5 conditioned left motor cortex induced robust facilitation in the bilateral mylohyoid MEPs. Swallowing dysfunction scores after intracerebral hemorrhage were significantly correlated with QBS5 conditioned-MEP parameters, including resting motor threshold and amplitude. The degree of bilateral mylohyoid MEP facilitation after left side motor cortical QBS5 conditioning and the grade of severity of swallowing dysfunction exhibited a significant linear correlation (r = -0.48/-0.46 and 0.83/0.83; R2 = 0.23/0.21 and 0.68/0.68, P < 0.001; Rt./Lt. side MEP-RMT and amplitudes, respectively). The present results indicate that RMT and amplitude of bilateral mylohyoid-MEPs after left motor cortical QBS5 conditioning as surrogate quantitative biomarkers for swallowing dysfunction after ICH. Thus, the safety and limitations of QBS5 conditioned-MEPs in this population should be further explored.
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Alfonsi E, Todisco M, Fresia M, Tassorelli C, Cosentino G. Electrokinesiographic Study of Oropharyngeal Swallowing in Neurogenic Dysphagia. Dysphagia 2023; 38:543-557. [PMID: 34313849 DOI: 10.1007/s00455-021-10336-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/23/2021] [Indexed: 01/04/2023]
Abstract
Electrokinesiographic study of swallowing (EKSS) can be useful for the assessment of patients with suspected or overt neurogenic dysphagia. EKSS consists of multichannel recording of the electromyographic (EMG) activity of the suprahyoid/submental muscle complex (SHEMG), the EMG activity of the cricopharyngeal muscle (CPEMG), and the laryngopharyngeal mechanogram (LPM). The LPM is an expression of the mechanical changes that the laryngopharyngeal structures undergo during the pharyngeal phase of swallowing. This method allows detailed evaluation of the magnitude, duration and temporal relations of the different events that characterize oropharyngeal swallowing, and thus in-depth exploration both of physiological deglutition mechanisms and of pathophysiological features of swallowing in neurogenic dysphagia. Furthermore, EKSS can guide dysphagia treatment strategies, allowing identification of optimal solutions for single patients. For instance, CPEMG recording can identify incomplete or absent relaxation of the upper esophageal sphincter during the pharyngeal phase of swallowing, thus suggesting a therapeutic approach based on botulinum toxin injection into the cricopharyngeal muscle. More recently, the 'shape' of SHEMG and the reproducibility of both SHEMG and LPM over repeated swallowing acts have been implemented as novel electrokinesiographic parameters. These measures could be valuable for straightforward non-invasive investigation of dysphagia severity and response to dysphagia treatment in clinical practice.
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Affiliation(s)
- Enrico Alfonsi
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.
| | - Massimiliano Todisco
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Mauro Fresia
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Giuseppe Cosentino
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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10
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Niu C, Zhou W, Wang H, Zhang Y, Cai J, Lu N, Wang Y. The effect of voice training interventions on patients with oropharyngeal dysphagia: a systematic review. Eur Arch Otorhinolaryngol 2023; 280:973-984. [PMID: 36342516 PMCID: PMC9899714 DOI: 10.1007/s00405-022-07719-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Voice training has been proposed as an intervention to improve swallowing function in patients with dysphagia. However, little is known about the effects of voice training on swallowing physiology. OBJECTIVES This systematic review investigates the effect of voice training on the swallowing function of patients with oropharyngeal dysphagia and provides the theoretical basis for improving the swallowing function and life quality of patients with oropharyngeal dysphagia. DATA SOURCES A systematic review using a narrative synthesis approach of all published studies was sought with no date restrictions. Five electronic databases (EMBASE, PubMed, CINAHL, Web of Science, and The Cochrane Library) were searched from inception to April 2022. STUDY SELECTION Eight studies were included. Two researchers screened the literature according to inclusion and exclusion criteria, extracted data, and carried out quality control according to the Cochrane handbook5.1.0. Data were analyzed narratively and descriptively. CONCLUSIONS In general, statistically significant positive therapy effects were found. Voice training improves the oral and pharyngeal stages of swallowing in patients with neurological causes of dysphagia, such as stroke, and in patients with non-neurological causes of dysphagia, such as head and neck cancer. However, the current literature is limited and further primary research is required to provide more evidence to support voice training intervention in dysphagia. Future studies could further refine the content of voice training interventions, increase the number of patients enrolled, assess the long-term effects of voice training interventions and add associated assessments of the quality of life after treatment.
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Affiliation(s)
- Chunyan Niu
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Wenyan Zhou
- Changshu Second People's Hospital, Changshu, 215500, China
| | - Haifang Wang
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
| | - Yingying Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
| | - Jianzheng Cai
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Nini Lu
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Yalan Wang
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
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11
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Huang H, Yan J, Lin Y, Lin J, Hu H, Wei L, Zhang X, Zhang Q, Liang S. Brain functional activity of swallowing: A meta-analysis of functional magnetic resonance imaging. J Oral Rehabil 2023; 50:165-175. [PMID: 36437597 DOI: 10.1111/joor.13397] [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: 05/11/2022] [Revised: 11/01/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Swallowing is one of the most important activities in our life and serves the dual roles of nutritional intake and eating enjoyment. OBJECTIVE The study aimed to conduct a meta-analysis to investigate the brain activity of swallowing. METHODS Studies of swallowing using functional magnetic resonance imaging were reviewed in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP) and Wan Fang before 30 November 2021. Two authors analysed the studies for eligibility criteria. The final inclusion of studies was decided by consensus. An activation likelihood estimation (ALE) meta-analysis of these studies was performed with GingerALE, including 16 studies. RESULTS For swallowing, clusters with high activation likelihood were found in the bilateral insula, bilateral pre-central gyrus, bilateral post-central gyrus, left transverse temporal gyrus, right medial front gyrus, bilateral inferior frontal gyrus and bilateral cingulate gyrus. For water swallowing, clusters with high activation likelihood were found in the bilateral inferior frontal gyrus and the left pre-central gyrus. For saliva swallowing, clusters with high activation likelihood were found in the bilateral cingulate gyrus, bilateral pre-central gyrus, left post-central gyrus and left transverse gyrus. CONCLUSION This meta-analysis reflects that swallowing is regulated by both sensory and motor cortex, and saliva swallowing activates more brain areas than water swallowing, which would promote our knowledge of swallowing and provide some direction for clinical and other research.
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Affiliation(s)
- Haiyue Huang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jin Yan
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yinghong Lin
- College of Integrated Chinese and Western Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jiaxin Lin
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Huimin Hu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Linxuan Wei
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xiwen Zhang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Qingqing Zhang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Shengxiang Liang
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
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12
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Qin Y, Tang Y, Liu X, Qiu S. Neural basis of dysphagia in stroke: A systematic review and meta-analysis. Front Hum Neurosci 2023; 17:1077234. [PMID: 36742358 PMCID: PMC9896523 DOI: 10.3389/fnhum.2023.1077234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/05/2023] [Indexed: 01/21/2023] Open
Abstract
Objectives Dysphagia is a major cause of stroke infection and death, and identification of structural and functional brain area changes associated with post-stroke dysphagia (PSD) can help in early screening and clinical intervention. Studies on PSD have reported numerous structural lesions and functional abnormalities in brain regions, and a systematic review is lacking. We aimed to integrate several neuroimaging studies to summarize the empirical evidence of neurological changes leading to PSD. Methods We conducted a systematic review of studies that used structural neuroimaging and functional neuroimaging approaches to explore structural and functional brain regions associated with swallowing after stroke, with additional evidence using a live activation likelihood estimation (ALE) approach. Results A total of 35 studies were included, including 20 studies with structural neuroimaging analysis, 14 studies with functional neuroimaging analysis and one study reporting results for both. The overall results suggest that structural lesions and functional abnormalities in the sensorimotor cortex, insula, cerebellum, cingulate gyrus, thalamus, basal ganglia, and associated white matter connections in individuals with stroke may contribute to dysphagia, and the ALE analysis provides additional evidence for structural lesions in the right lentiform nucleus and right thalamus and functional abnormalities in the left thalamus. Conclusion Our findings suggest that PSD is associated with neurological changes in brain regions such as sensorimotor cortex, insula, cerebellum, cingulate gyrus, thalamus, basal ganglia, and associated white matter connections. Adequate understanding of the mechanisms of neural changes in the post-stroke swallowing network may assist in clinical diagnosis and provide ideas for the development of new interventions in clinical practice.
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Affiliation(s)
- Yin Qin
- Department of Rehabilitation Medicine, The 900th Hospital of Joint Logistic Support Force, People’s Liberation Army (PLA), Fuzhou, China,*Correspondence: Yin Qin,
| | - Yuting Tang
- Department of Rehabilitation Medicine, The 900th Hospital of Joint Logistic Support Force, People’s Liberation Army (PLA), Fuzhou, China,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xiaoying Liu
- Department of Rehabilitation Medicine, The 900th Hospital of Joint Logistic Support Force, People’s Liberation Army (PLA), Fuzhou, China
| | - Shuting Qiu
- Department of Rehabilitation Medicine, The 900th Hospital of Joint Logistic Support Force, People’s Liberation Army (PLA), Fuzhou, China,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
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Herbella FAM, Neto RML, Azevedo R, Patti MG. Normal swallowing physiology. Dysphagia 2023. [DOI: 10.1016/b978-0-323-99865-9.00005-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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14
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Cheng I, Takahashi K, Miller A, Hamdy S. Cerebral control of swallowing: An update on neurobehavioral evidence. J Neurol Sci 2022; 442:120434. [PMID: 36170765 DOI: 10.1016/j.jns.2022.120434] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/07/2022] [Accepted: 09/18/2022] [Indexed: 01/07/2023]
Abstract
This review aims to update the current knowledge on the cerebral control of swallowing. We review data from both animal and human studies spanning across the fields of neuroanatomy, neurophysiology and neuroimaging to evaluate advancements in our understanding in the brain's role in swallowing. Studies have collectively shown that swallowing is mediated by multiple distinct cortical and subcortical regions and that lesions to these regions can result in dysphagia. These regions are functionally connected in separate groups within and between the two hemispheres. While hemispheric dominance for swallowing has been reported in most human studies, the laterality is inconsistent across individuals. Moreover, there is a shift in activation location and laterality between swallowing preparation and execution, although such activation changes are less well-defined than that for limb motor control. Finally, we discussed recent neurostimulation treatments that may be beneficial for dysphagia after brain injury through promoting the reorganization of the swallowing neural network.
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Affiliation(s)
- Ivy Cheng
- Centre for Gastrointestinal Sciences, Division of Diabetes, Gastroenterology and Endocrinology, School of Medical Sciences, University of Manchester, UK.
| | - Kazutaka Takahashi
- Department of Organismal Biology and Anatomy, University of Chicago, USA
| | - Arthur Miller
- Division of Orthodontics, Department of Orofacial, Sciences, School of Dentistry, University of California at San Francisco, USA
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Division of Diabetes, Gastroenterology and Endocrinology, School of Medical Sciences, University of Manchester, UK
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15
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Xiong H, Chen JJ, Gikaro JM, Wang CG, Lin F. Activation Patterns of Functional Brain Network in Response to Action Observation-Induced and Non-Induced Motor Imagery of Swallowing: A Pilot Study. Brain Sci 2022; 12:brainsci12101420. [PMID: 36291353 PMCID: PMC9599111 DOI: 10.3390/brainsci12101420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/09/2022] [Accepted: 10/18/2022] [Indexed: 11/20/2022] Open
Abstract
Action observation (AO) combined with motor imagery (MI) was verified as more effective in improving limb function than AO or MI alone, while the underlying mechanism of swallowing was ambiguous. The study aimed at exploring the efficacy of AO combined with MI in swallowing. In this study, twelve subjects performed the motor imagery of swallowing (MI-SW) during magnetoencephalography (MEG) scanning, and trials were divided into three groups: the non-induced group (control group, CG), male AO-induced group (M-AIG), and female AO-induced group (F-AIG). We used event-related spectral perturbations (ERSPs) and phase locking value (PLV) to assess the degree of activation and connectivity of the brain regions during MI-SW in the three groups. The results showed that compared to CG, F-AIG and M-AIG significantly activated more brain regions in the frontoparietal, attention, visual, and cinguloopercular systems. In addition, M-AIG significantly activated the sensorimotor cortex compared to CG and F-AIG. For the brain network, F-AIG and M-AIG increased the diffusion of non-hub hot spots and cold hubs to the bilateral hemispheres which enhanced interhemispheric functional connectivity and information transmission efficiency in the MI-SW task. This study provided supporting evidence that AO induction could enhance the effect of MI-SW and supported the application of AO-induced MI-SW in clinical rehabilitation.
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Affiliation(s)
- Hao Xiong
- Department of Rehabilitation Medicine, Sir Run Run Hospital Nanjing Medical University, Nanjing 211100, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing 210029, China
| | - Jin-Jin Chen
- Department of Rehabilitation Medicine, Sir Run Run Hospital Nanjing Medical University, Nanjing 211100, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing 210029, China
| | - John M. Gikaro
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing 210029, China
| | - Chen-Guang Wang
- Department of Rehabilitation Medicine, Sir Run Run Hospital Nanjing Medical University, Nanjing 211100, China
| | - Feng Lin
- Department of Rehabilitation Medicine, Sir Run Run Hospital Nanjing Medical University, Nanjing 211100, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- Correspondence: ; Tel.: +86-025-87115719
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Cheng I, Hamad A, Sasegbon A, Hamdy S. Advances in the Treatment of Dysphagia in Neurological Disorders: A Review of Current Evidence and Future Considerations. Neuropsychiatr Dis Treat 2022; 18:2251-2263. [PMID: 36268265 PMCID: PMC9578488 DOI: 10.2147/ndt.s371624] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/08/2022] [Indexed: 11/19/2022] Open
Abstract
Dysphagia, which refers to difficult and/or disordered swallowing, is a common problem associated with various neurological diseases such as stroke, motor neuron diseases and neurodegenerative diseases. Traditionally, dysphagia treatments are either compensatory, which includes modifications of bolus texture or feeding posture, or rehabilitative, which includes behavioral exercises and sensory stimulation. Despite being widely adopted in clinical practice, recent views have challenged the clinical efficacy of these treatments due to the low level of evidence supported by mainly non-controlled studies. As such, with advancements in technology and scientific research methods, recent times have seen a surge in the development of novel dysphagia treatments and an increasing number of robust randomized controlled clinical trials. In this review, we will review the clinical evidence of several newly introduced treatments for dysphagia in the last two decades, including rehabilitative exercises, biofeedback, pharmacological treatments, neuromodulation treatments and soft robotics. Despite the recent improvements in the quality of evidence for the efficacy of dysphagia treatments, several critical issues, including heterogeneity in treatment regimens, long-term treatment effects, underlying mechanisms of some neuromodulation treatments, and the effects of these techniques in non-stroke dysphagia, remain to be addressed in future clinical trials.
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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
| | - Adeel Hamad
- 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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Gallois Y, Neveu F, Gabas M, Cormary X, Gaillard P, Verin E, Speyer R, Woisard V. Can Swallowing Cerebral Neurophysiology Be Evaluated during Ecological Food Intake Conditions? A Systematic Literature Review. J Clin Med 2022; 11:jcm11185480. [PMID: 36143127 PMCID: PMC9505443 DOI: 10.3390/jcm11185480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022] Open
Abstract
Swallowing is a complex function that relies on both brainstem and cerebral control. Cerebral neurofunctional evaluations are mostly based on functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), performed with the individual laying down; which is a non-ecological/non-natural position for swallowing. According to the PRISMA guidelines, a review of the non-invasive non-radiating neurofunctional tools, other than fMRI and PET, was conducted to explore the cerebral activity in swallowing during natural food intake, in accordance with the PRISMA guidelines. Using Embase and PubMed, we included human studies focusing on neurofunctional imaging during an ecologic swallowing task. From 5948 unique records, we retained 43 original articles, reporting on three different techniques: electroencephalography (EEG), magnetoencephalography (MEG) and functional near infra-red spectroscopy (fNIRS). During swallowing, all three techniques showed activity of the pericentral cortex. Variations were associated with the modality of the swallowing process (volitional or non-volitional) and the substance used (mostly water and saliva). All techniques have been used in both healthy and pathological conditions to explore the precise time course, localization or network structure of the swallowing cerebral activity, sometimes even more precisely than fMRI. EEG and MEG are the most advanced and mastered techniques but fNIRS is the most ready-to-use and the most therapeutically promising. Ongoing development of these techniques will support and improve our future understanding of the cerebral control of swallowing.
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Affiliation(s)
- Yohan Gallois
- Laboratory LNPL—UR4156, University of Toulouse-Jean Jaurès, 31058 Toulouse, France
- ENT, Otoneurology and Pediatric ENT Department, Pierre Paul Riquet Hospital, University Hospital of Toulouse, 31059 Toulouse, France
- Correspondence: ; Tel.: +33-561772039
| | - Fabrice Neveu
- Independent Researcher, Swallis Medical, 31770 Colomiers, France
| | - Muriel Gabas
- Laboratory CERTOP—UMR CNRS 5044, Maison de la Recherche, University of Toulouse-Jean Jaurès, 31058 Toulouse, France
| | | | - Pascal Gaillard
- Laboratory CLLE CNRS UMR5263, University of Toulouse-Jean Jaurès, 31058 Toulouse, France
| | - Eric Verin
- Department of Physical and Rehabilitation Medicine, Rouen University Hospital, 76000 Rouen, France
| | - Renée Speyer
- Department Special Needs Education, University of Oslo, 0318 Oslo, Norway
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| | - Virginie Woisard
- Laboratory LNPL—UR4156, University of Toulouse-Jean Jaurès, 31058 Toulouse, France
- Voice and Deglutition Unit, Department of Otorhinolaryngology and Head and Neck Surgery, Larrey Hospital, University Hospital of Toulouse, 31059 Toulouse, France
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18
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Liu H, Peng Y, Liu Z, Wen X, Li F, Zhong L, Rao J, Li L, Wang M, Wang P. Hemodynamic signal changes and swallowing improvement of repetitive transcranial magnetic stimulation on stroke patients with dysphagia: A randomized controlled study. Front Neurol 2022; 13:918974. [PMID: 36034299 PMCID: PMC9403609 DOI: 10.3389/fneur.2022.918974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveOur study aims to measure the cortical correlates of swallowing execution in patients with dysphagia after repetitive transcranial magnetic stimulation (rTMS) therapy using functional near-infrared spectroscopy (fNIRS), and observe the change of pattern of brain activation in stroke patients with dysphagia after rTMS intervention. In addition, we tried to analyze the effect of rTMS on brain activation in dysphagia patients with different lesion sides. This study also concentrated on the effect of stimulating the affected mylohyoid cortical region by 5 Hz rTMS, providing clinical evidence for rTMS therapy of dysphagia in stroke patients.MethodsThis study was a sham-controlled, single-blind, randomized controlled study with a blinded observer. A total of 49 patients completed the study, which was randomized to the rTMS group (n = 23) and sham rTMS group (n = 26) by the random number table method. The rTMS group received 5 Hz rTMS stimulation to the affected mylohyoid cortical region of the brain and the sham rTMS group underwent rTMS using the same parameters as the rTMS group, except for the position of the coil. Each patient received 2 weeks of stimulation followed by conventional swallowing therapy. Standardized Swallowing Assessment (SSA), Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), Penetration-Aspiration Scale (PAS), and functional oral intake status were assessed at two times: baseline (before treatment) and 2 weeks (after intervention). Meanwhile, we use the fNIRS system to measure the cerebral hemodynamic changes during the experimental procedure.ResultsThe rTMS group exhibited significant improvement in the SSA scale, FEDSS scale, and PAS scale after rTMS therapy (all P < 0.001). The sham rTMS group had the same analysis on the same scales (all P < 0.001). There was no significant difference observed in clinical assessments at 2 weeks after baseline between the rTMS group and sham rTMS group (all P > 0.05). However, there were statistically significant differences between the two groups in the rate of change in the FEDSS score (P = 0.018) and PAS score (P = 0.004), except for the SSA score (P = 0.067). As for the removal rate of the feeding tube, there was no significant difference between the rTMS group and sham rTMS group (P = 0.355), but there was a significant difference compared with the baseline characteristics in both groups (PrTMS < 0.001, PshamrTMS = 0.002). In fNIRS analysis, the block average result showed differences in brain areas RPFC (right prefrontal cortex) and RMC (right motor cortex) significantly between the rTMS group and sham rTMS group after intervention (Pchannel30 = 0.046, Pchannel16 = 0.006). In the subgroup analysis, rTMS group was divided into left-rTMS group and right-rTMS group and sham rTMS group was divided into sham left-rTMS group and sham right-rTMS group. The fNIRS results showed no significance in block average and block differential after intervention between the left-rTMS group and sham left-rTMS group, but differences were statistically significant between the right-rTMS group and sham right-rTMS group in block average: channel 30 (T = −2.34, P = 0.028) in LPFC (left prefrontal cortex) and 16 (T = 2.54, P = 0.018) in RMC. After intervention, there was no significance in left-rTMS group compared with baseline, but in right-rTMS group, channel 27 (T = 2.18, P = 0.039) in LPFC and 47 (T = 2.17, P = 0.039) in RPFC had significance in block differential. In the sham rTMS group, neither sham left-rTMS group and sham right-rTMS group had significant differences in block average and block differential in each brain area after intervention (P > 0.05).ConclusionsThe present study confirmed that a 5-Hz rTMS is feasible at the affected mylohyoid cortical region in post-stroke patients with dysphagia and rTMS therapy can alter cortical excitability. Based on previous studies, there is a dominant hemisphere in swallowing and the results of our fNIRS analysis seemed to show a better increase in cortical activation on the right side than on the left after rTMS of the affected mylohyoid cortical region. However, there was no difference between the left and right hemispheres in the subgroup analysis. Nevertheless, the present study provides a novel and feasible method of applying fNIRS to assessment in stroke patients with dysphagia.
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Affiliation(s)
- Huiyu Liu
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Yang Peng
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Zicai Liu
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
- School of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
| | - Xin Wen
- School of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
| | - Fang Li
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Lida Zhong
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Jinzhu Rao
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Li Li
- Yue Bei People's Hospital, Shaoguan, China
- *Correspondence: Li Li
| | - Minghong Wang
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
- Minghong Wang
| | - Pu Wang
- Department of Rehabilitation Medicine, The 7th Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
- Pu Wang
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Balcerak P, Corbiere S, Zubal R, Kägi G. Post-stroke Dysphagia: Prognosis and Treatment-A Systematic Review of RCT on Interventional Treatments for Dysphagia Following Subacute Stroke. Front Neurol 2022; 13:823189. [PMID: 35547370 PMCID: PMC9082350 DOI: 10.3389/fneur.2022.823189] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Post-stroke dysphagia is an underdiagnosed but relevant complication, associated with worse outcome, dependency and quality of life of stroke survivors. Detailed mechanisms of post-stroke dysphagia are not very well understood, but established therapeutic concepts are needed. Different interventional studies have been published dealing with post-stroke dysphagia. This systematic review wants to collect and give an overview over the published evidence. Methods PubMed, Embase, Cochrane, CINAHL were searched for relevant interventional studies on post-stroke dysphagia in the (sub-)acute setting (within 3 months of stroke onset). The search has been filtered for randomized trials with an inactive control and the relevant data extracted. Results After initially finding 2,863 trials, finally 41 trials have been included. Seven different therapeutic concepts have been evaluated (Acupuncture, behavioral/physical therapy, drug therapy, neuromuscular electrical stimulation, pharyngeal electrical stimulation, transcranial direct current stimulation and repetitive transcranial magnetic stimulation). Studies of all modalities have shown some effect on post-stroke dysphagia with several studies raising concerns about the potential bias. Conclusion The amount and quality of studies are not enough to suggest certain therapies. Some therapeutical concepts (intensive physical therapy, transcranial magnetic stimulation, drug therapy) seem to be good potential therapeutic options, but further research is needed.
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Affiliation(s)
- Philipp Balcerak
- Department of Neurology and Stroke Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Sydney Corbiere
- Department of Neurology and Stroke Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Richard Zubal
- Department of Neurology and Stroke Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Georg Kägi
- Department of Neurology and Stroke Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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Dong L, Ma W, Wang Q, Pan X, Wang Y, Han C, Meng P. The Effect of Repetitive Transcranial Magnetic Stimulation of Cerebellar Swallowing Cortex on Brain Neural Activities: A Resting-State fMRI Study. Front Hum Neurosci 2022; 16:802996. [PMID: 35572005 PMCID: PMC9094708 DOI: 10.3389/fnhum.2022.802996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/22/2022] [Indexed: 11/24/2022] Open
Abstract
Objective The effects and possible mechanisms of cerebellar high-frequency repetitive transcranial magnetic stimulation (rTMS) on swallowing-related neural networks were studied using resting-state functional magnetic resonance imaging (rs-fMRI). Method A total of 23 healthy volunteers were recruited, and 19 healthy volunteers were finally included for the statistical analysis. Before stimulation, the cerebellar hemisphere dominant for swallowing was determined by the single-pulse TMS. The cerebellar representation of the suprahyoid muscles of this hemisphere was selected as the target for stimulation with 10 Hz rTMS, 100% resting motor threshold (rMT), and 250 pulses, with every 1 s of stimulation followed by an interval of 9 s. The motor evoked potential (MEP) amplitude of the suprahyoid muscles in the bilateral cerebral cortex was measured before and after stimulation to evaluate the cortical excitability. Forty-eight hours after elution, rTMS was reapplied on the dominant cerebellar representation of the suprahyoid muscles with the same stimulation parameters. Rs-fMRI was performed before and after stimulation to observe the changes in amplitude of low-frequency fluctuation (ALFF) and regional homology (ReHo) at 0.01–0.08 Hz, 0.01–0.027 Hz, and 0.027–0.073 Hz. Results After cerebellar high-frequency rTMS, MEP recorded from swallowing-related bilateral cerebral cortex was increased. The results of rs-fMRI showed that at 0.01–0.08 Hz, ALFF was increased at the pons, right cerebellum, and medulla and decreased at the left temporal lobe, and ReHo was decreased at the left insular lobe, right temporal lobe, and corpus callosum. At 0.01–0.027 Hz, ALFF was decreased at the left temporal lobe, and ReHo was decreased at the right temporal lobe, left putamen, and left supplementary motor area. Conclusion Repetitive transcranial magnetic stimulation of the swallowing cortex in the dominant cerebellar hemisphere increased the bilateral cerebral swallowing cortex excitability and enhanced pontine, bulbar, and cerebellar spontaneous neural activity, suggesting that unilateral high-frequency stimulation of the cerebellum can excite both brainstem and cortical swallowing centers. These findings all provide favorable support for the application of cerebellar rTMS in the clinical practice.
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Affiliation(s)
- Linghui Dong
- Department of Rehabilitation Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenshuai Ma
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qiang Wang
- Department of Rehabilitation Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaona Pan
- Department of Rehabilitation Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuyang Wang
- Department of Rehabilitation Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chao Han
- Department of Rehabilitation Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Pingping Meng
- Department of Rehabilitation Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
- *Correspondence: Pingping Meng
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21
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Muhle P, Konert K, Suntrup-Krueger S, Claus I, Labeit B, Ogawa M, Warnecke T, Wirth R, Dziewas R. Oropharyngeal Dysphagia and Impaired Motility of the Upper Gastrointestinal Tract-Is There a Clinical Link in Neurocritical Care? Nutrients 2021; 13:nu13113879. [PMID: 34836134 PMCID: PMC8618237 DOI: 10.3390/nu13113879] [Citation(s) in RCA: 2] [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: 10/13/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/18/2022] Open
Abstract
Patients in the neurological ICU are at risk of suffering from disorders of the upper gastrointestinal tract. Oropharyngeal dysphagia (OD) can be caused by the underlying neurological disease and/or ICU treatment itself. The latter was also identified as a risk factor for gastrointestinal dysmotility. However, its association with OD and the impact of the neurological condition is unclear. Here, we investigated a possible link between OD and gastric residual volume (GRV) in patients in the neurological ICU. In this retrospective single-center study, patients with an episode of mechanical ventilation (MV) admitted to the neurological ICU due to an acute neurological disease or acute deterioration of a chronic neurological condition from 2011–2017 were included. The patients were submitted to an endoscopic swallowing evaluation within 72 h of the completion of MV. Their GRV was assessed daily. Patients with ≥1 d of GRV ≥500 mL were compared to all the other patients. Regression analysis was performed to identify the predictors of GRV ≥500 mL/d. With respect to GRV, the groups were compared depending on their FEES scores (0–3). A total of 976 patients were included in this study. A total of 35% demonstrated a GRV of ≥500 mL/d at least once. The significant predictors of relevant GRV were age, male gender, infratentorial or hemorrhagic stroke, prolonged MV and poor swallowing function. The patients with the poorest swallowing function presented a GRV of ≥500 mL/d significantly more often than the patients who scored the best. Conclusions: Our findings indicate an association between dysphagia severity and delayed gastric emptying in critically ill neurologic patients. This may partly be due to lesions in the swallowing and gastric network.
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Affiliation(s)
- Paul Muhle
- Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus, 1 A, University Hospital Muenster, 48149 Muenster, Germany; (K.K.); (S.S.-K.); (I.C.); (B.L.); (T.W.)
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149 Muenster, Germany
- Correspondence:
| | - Karen Konert
- Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus, 1 A, University Hospital Muenster, 48149 Muenster, Germany; (K.K.); (S.S.-K.); (I.C.); (B.L.); (T.W.)
| | - Sonja Suntrup-Krueger
- Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus, 1 A, University Hospital Muenster, 48149 Muenster, Germany; (K.K.); (S.S.-K.); (I.C.); (B.L.); (T.W.)
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149 Muenster, Germany
| | - Inga Claus
- Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus, 1 A, University Hospital Muenster, 48149 Muenster, Germany; (K.K.); (S.S.-K.); (I.C.); (B.L.); (T.W.)
| | - Bendix Labeit
- Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus, 1 A, University Hospital Muenster, 48149 Muenster, Germany; (K.K.); (S.S.-K.); (I.C.); (B.L.); (T.W.)
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149 Muenster, Germany
| | - Mao Ogawa
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan;
| | - Tobias Warnecke
- Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus, 1 A, University Hospital Muenster, 48149 Muenster, Germany; (K.K.); (S.S.-K.); (I.C.); (B.L.); (T.W.)
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, University Hospital Ruhr-Universität Bochum, 44625 Herne, Germany;
| | - Rainer Dziewas
- Department of Neurology, Klinikum Osnabrück, Am Finkenhügel 1, 49076 Osnabrück, Germany;
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22
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Metaplasticity in the human swallowing system: clinical implications for dysphagia rehabilitation. Neurol Sci 2021; 43:199-209. [PMID: 34654983 PMCID: PMC8724108 DOI: 10.1007/s10072-021-05654-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 10/05/2021] [Indexed: 02/03/2023]
Abstract
Dysphagia is a common and devastating complication following brain damage. Over the last 2 decades, dysphagia treatments have shifted from compensatory to rehabilitative strategies that facilitate neuroplasticity, which is the reorganization of neural networks that is essential for functional recovery. Moreover, there is growing interest in the application of cortical and peripheral neurostimulation to promote such neuroplasticity. Despite some preliminary positive findings, the variability in responsiveness toward these treatments remains substantial. The purpose of this review is to summarize findings on the effects of neurostimulation in promoting neuroplasticity for dysphagia rehabilitation and highlight the need to develop more effective treatment strategies. We then discuss the role of metaplasticity, a homeostatic mechanism of the brain to regulate plasticity changes, in helping to drive neurorehabilitation. Finally, a hypothesis on how metaplasticity could be applied in dysphagia rehabilitation to enhance treatment outcomes is proposed.
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23
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Cheng I, Hamdy S. Current perspectives on the benefits, risks, and limitations of noninvasive brain stimulation (NIBS) for post-stroke dysphagia. Expert Rev Neurother 2021; 21:1135-1146. [PMID: 34530656 DOI: 10.1080/14737175.2021.1974841] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/27/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Studies have shown that noninvasive brain stimulation (NIBS), including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), can promote neuroplasticity, which is considered important for functional recovery of swallowing after stroke. Despite extensive studies on NIBS, there remains a gap between research and clinical practice. AREAS COVERED In this article, we update the current knowledge on the benefits and challenges of rTMS and tDCS for post-stroke dysphagia. We identify some key limitations of these techniques that hinder the translation from clinical trials to routine practice. Finally, we discuss the future of NIBS as a treatment for post-stroke dysphagia in real-world settings. EXPERT OPINION Current evidence suggests that rTMS and tDCS show promise as a treatment for post-stroke dysphagia. However, these techniques are limited by the response variability, uncertainty on the safety in patients with comorbidities and difficulties in clinical study designs. Such limitations call for further work to enhance their utility through individualized approaches. Despite this, the last decade has seen a growing acceptance toward these techniques among clinical personnel. As such, we advocate caution but support optimism that NIBS will gradually be recognized as a mainstream treatment approach for post-stroke dysphagia in the future.
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Affiliation(s)
- Ivy Cheng
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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24
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Huang PL, Wang SJ, Sun RF, Zhu ZM, Li XL, Li WS, Wang MY, Lin M, Gong WJ. Increased activation of the caudate nucleus and parahippocampal gyrus in Parkinson's disease patients with dysphagia after repetitive transcranial magnetic stimulation: a case-control study. Neural Regen Res 2021; 17:1051-1058. [PMID: 34558532 PMCID: PMC8552866 DOI: 10.4103/1673-5374.324863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has been shown to effectively improve impaired swallowing in Parkinson's disease (PD) patients with dysphagia. However, little is known about how rTMS affects the corresponding brain regions in this patient group. In this case-control study, we examined data from 38 PD patients with dysphagia who received treatment at Beijing Rehabilitation Medicine Academy, Capital Medical University. The patients received high-frequency rTMS of the motor cortex once per day for 10 successive days. Changes in brain activation were compared via functional magnetic resonance imaging in PD patients with dysphagia and healthy controls. The results revealed that before treatment, PD patients with dysphagia showed greater activation in the precentral gyrus, supplementary motor area, and cerebellum compared with healthy controls, and this enhanced activation was weakened after treatment. Furthermore, before treatment, PD patients with dysphagia exhibited decreased activation in the parahippocampal gyrus, caudate nucleus, and left thalamus compared with healthy controls, and this activation increased after treatment. In addition, PD patients with dysphagia reported improved subjective swallowing sensations after rTMS. These findings suggest that swallowing function in PD patients with dysphagia improved after rTMS of the motor cortex. This may have been due to enhanced activation of the caudate nucleus and parahippocampal gyrus. The study protocol was approved by the Ethics Committee of Beijing Rehabilitation Hospital of Capital Medical University (approval No. 2018bkky017) on March 6, 2018 and was registered with Chinese Clinical Trial Registry (registration No. ChiCTR 1800017207) on July 18, 2018.
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Affiliation(s)
- Pei-Ling Huang
- Department of Neurological Rehabilitation, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Song-Jian Wang
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Rui-Feng Sun
- Department of Neurological Rehabilitation, Beijing Rehabilitation Medicine Academy, Capital Medical University, Beijing, China
| | - Zi-Man Zhu
- Department of Neurological Rehabilitation, Beijing Rehabilitation Medicine Academy, Capital Medical University, Beijing, China
| | - Xiao-Ling Li
- Department of Neurological Rehabilitation, Beijing Rehabilitation Medicine Academy, Capital Medical University, Beijing, China
| | - Wen-Shan Li
- Department of Neurological Rehabilitation, Beijing Rehabilitation Medicine Academy, Capital Medical University, Beijing, China
| | - Meng-Yue Wang
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Meng Lin
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Wei-Jun Gong
- Department of Neurological Rehabilitation, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
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25
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Alvar A, Hahn Arkenberg R, McGowan B, Cheng H, Malandraki GA. The Role of White Matter in the Neural Control of Swallowing: A Systematic Review. Front Hum Neurosci 2021; 15:628424. [PMID: 34262441 PMCID: PMC8273764 DOI: 10.3389/fnhum.2021.628424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/26/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Swallowing disorders (dysphagia) can negatively impact quality of life and health. For clinicians and researchers seeking to improve outcomes for patients with dysphagia, understanding the neural control of swallowing is critical. The role of gray matter in swallowing control has been extensively documented, but knowledge is limited regarding the contributions of white matter. Our aim was to identify, evaluate, and summarize the populations, methods, and results of published articles describing the role of white matter in neural control of swallowing. Methods: We completed a systematic review with a multi-engine search following PRISMA-P 2015 standards. Two authors screened articles and completed blind full-text review and quality assessments using an adapted U.S. National Institute of Health's Quality Assessment. The senior author resolved any disagreements. Qualitative synthesis of evidence was completed. Results: The search yielded 105 non-duplicate articles, twenty-two of which met inclusion criteria. Twenty were rated as Good (5/22; 23%) or Fair (15/22; 68%) quality. Stroke was the most represented diagnosis (n = 20; 91%). All studies were observational, and half were retrospective cohort design. The majority of studies (13/22; 59%) quantified white matter damage with lesion-based methods, whereas 7/22 (32%) described intrinsic characteristics of white matter using methods like fractional anisotropy. Fifteen studies (68%) used instrumental methods for swallowing evaluations. White matter areas commonly implicated in swallowing control included the pyramidal tract, internal capsule, corona radiata, superior longitudinal fasciculus, external capsule, and corpus callosum. Additional noteworthy themes included: severity of white matter damage is related to dysphagia severity; bilateral white matter lesions appear particularly disruptive to swallowing; and white matter adaptation can facilitate dysphagia recovery. Gaps in the literature included limited sample size and populations, lack of in-depth evaluations, and issues with research design. Conclusion: Although traditionally understudied, there is sufficient evidence to conclude that white matter is critical in the neural control of swallowing. The reviewed studies indicated that white matter damage can be directly tied to swallowing deficits, and several white matter structures were implicated across studies. Further well-designed interdisciplinary research is needed to understand white matter's role in neural control of normal swallowing and in dysphagia recovery and rehabilitation.
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Affiliation(s)
- Ann Alvar
- I-EaT Swallowing Research Laboratory, Speech Language and Hearing Sciences, Purdue University, West Lafayette, IN, United States
| | - Rachel Hahn Arkenberg
- I-EaT Swallowing Research Laboratory, Speech Language and Hearing Sciences, Purdue University, West Lafayette, IN, United States
| | - Bethany McGowan
- Libraries and School of Information Studies, Purdue University, West Lafayette, IN, United States
| | - Hu Cheng
- Psychological and Brain Sciences, Imaging Research Facility, Indiana University, Bloomington, IN, United States
| | - Georgia A Malandraki
- I-EaT Swallowing Research Laboratory, Speech Language and Hearing Sciences, Purdue University, West Lafayette, IN, United States.,Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
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26
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Hashimoto H, Takahashi K, Kameda S, Yoshida F, Maezawa H, Oshino S, Tani N, Khoo HM, Yanagisawa T, Yoshimine T, Kishima H, Hirata M. Motor and sensory cortical processing of neural oscillatory activities revealed by human swallowing using intracranial electrodes. iScience 2021; 24:102786. [PMID: 34308292 PMCID: PMC8283146 DOI: 10.1016/j.isci.2021.102786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/28/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022] Open
Abstract
Swallowing is attributed to the orchestration of motor output and sensory input. We hypothesized that swallowing can illustrate differences between motor and sensory neural processing. Eight epileptic participants fitted with intracranial electrodes over the orofacial cortex were asked to swallow a water bolus. Mouth opening and swallowing were treated as motor tasks, whereas water injection was treated as a sensory task. Phase-amplitude coupling between lower-frequency and high γ (HG) bands (75–150 Hz) was investigated. An α (10–16 Hz)-HG coupling appeared before motor-related HG power increases (burst), and a θ (5–9 Hz)-HG coupling appeared during sensory-related HG bursts. The peaks of motor-related coupling were 0.6–0.7 s earlier than that of HG power. The motor-related HG was modulated at the trough of the α oscillation, and the sensory-related HG amplitude was modulated at the peak of the θ oscillation. These contrasting results can help to elucidate the brain's sensory motor functions. Swallowing has two aspects; sensory input and motor output Phase-amplitude coupling showed differences of motor and sensory neural processing Coupling between the α and high γ band occurred before motor-related high γ activities Coupling between the θ and high γ band occurred during sensory-related high γ activities
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Affiliation(s)
- Hiroaki Hashimoto
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan.,Department of Neurosurgery, Otemae Hospital, Chuo-ku Otemae 1-5-34, Osaka, Osaka 540-0008, Japan.,Endowed Research Department of Clinical Neuroengineering, Global Center for Medical Engineering and Informatics, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan
| | - Kazutaka Takahashi
- Department of Organismal Biology and Anatomy, The University of Chicago, 1027 E 57 St, Chicago, IL 60637, USA
| | - Seiji Kameda
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan
| | - Fumiaki Yoshida
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan.,Department of Anatomy and Physiology, Saga Medical School Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, Saga 849-8501, Japan
| | - Hitoshi Maezawa
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan
| | - Satoru Oshino
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan
| | - Naoki Tani
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan
| | - Hui Ming Khoo
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan
| | - Takufumi Yanagisawa
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan
| | - Toshiki Yoshimine
- Endowed Research Department of Clinical Neuroengineering, Global Center for Medical Engineering and Informatics, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan
| | - Masayuki Hirata
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan.,Endowed Research Department of Clinical Neuroengineering, Global Center for Medical Engineering and Informatics, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan.,Department of Neurosurgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan
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27
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Krishnamurthy R, Philip R, Balasubramanium RK, Rangarathnam B. Effects of dual-task interference on swallowing in healthy aging adults. PLoS One 2021; 16:e0253550. [PMID: 34166461 PMCID: PMC8224877 DOI: 10.1371/journal.pone.0253550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/07/2021] [Indexed: 11/18/2022] Open
Abstract
A wide body of literature has demonstrated that the neural representation of healthy swallowing is mostly bilateral, with one hemisphere dominant over the other. While several studies have demonstrated the presence of laterality for swallowing related functions among young adults, the data on older adults are still growing. The purpose of this paper is to investigate potential changes in hemispheric dominance in healthy aging adults for swallowing related tasks using a behavioral dual-task paradigm. A modified dual-task paradigm was designed to investigate the potential reduction in hemispherical specialization for swallowing function. Eighty healthy right-handed participants in the study were divided into two groups [Group 1: young adults (18–40 years) and Group 2: older adults (65 and above)]. All the participants performed a timed water swallow test at baseline and with two interference conditions (silent word repetition, and facial recognition). The results of the study revealed the following 1) a statistically significant effect of age on swallow performance; 2) statistically significant effect of each of the interference tasks on two of the swallow measures (VPS and VPT) in younger adults; and 3) no significant effect of the interference tasks on the swallowing performance of older adults. These findings suggest that aging substantially affects swallowing in older individuals, and this potentially accompanies a reduction in the hemispheric specialization for swallowing related tasks.
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Affiliation(s)
- Rahul Krishnamurthy
- Department of Audiology and Speech-Language Pathology, Kasturba Medical College, Mangalore, India
- Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - Radish Kumar Balasubramanium
- Department of Audiology and Speech-Language Pathology, Kasturba Medical College, Mangalore, India
- Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Balaji Rangarathnam
- Department of Speech-Language Pathology, Midwestern University, Downers Grove, Illinois, United States of America
- * E-mail:
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28
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Hashimoto H, Takahashi K, Kameda S, Yoshida F, Maezawa H, Oshino S, Tani N, Khoo HM, Yanagisawa T, Yoshimine T, Kishima H, Hirata M. Swallowing-related neural oscillation: an intracranial EEG study. Ann Clin Transl Neurol 2021; 8:1224-1238. [PMID: 33949157 PMCID: PMC8164860 DOI: 10.1002/acn3.51344] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Swallowing is a unique movement due to the indispensable orchestration of voluntary and involuntary movements. The transition from voluntary to involuntary swallowing is executed within milliseconds. We hypothesized that the underlying neural mechanism of swallowing would be revealed by high-frequency cortical activities. METHODS Eight epileptic participants fitted with intracranial electrodes over the orofacial cortex were asked to swallow a water bolus and cortical oscillatory changes, including the high γ band (75-150 Hz) and β band (13-30 Hz), were investigated at the time of mouth opening, water injection, and swallowing. RESULTS Increases in high γ power associated with mouth opening were observed in the ventrolateral prefrontal cortex (VLPFC) with water injection in the lateral central sulcus and with swallowing in the region along the Sylvian fissure. Mouth opening induced a decrease in β power, which continued until the completion of swallowing. The high γ burst of activity was focal and specific to swallowing; however, the β activities were extensive and not specific to swallowing. In the interim between voluntary and involuntary swallowing, swallowing-related high γ power achieved its peak, and subsequently, the power decreased. INTERPRETATION We demonstrated three distinct activities related to mouth opening, water injection, and swallowing induced at different timings using high γ activities. The peak of high γ power related to swallowing suggests that during voluntary swallowing phases, the cortex is the main driving force for swallowing as opposed to the brain stem.
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Affiliation(s)
- Hiroaki Hashimoto
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan.,Department of Neurosurgery, Otemae Hospital, Chuo-ku Otemae 1-5-34, Osaka, Osaka, 540-0008, Japan.,Endowed Research Department of Clinical Neuroengineering, Global Center for Medical Engineering and Informatics, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Kazutaka Takahashi
- Department of Organismal Biology and Anatomy, The University of Chicago, 1027 E 57th St, Chicago, IL, 60637
| | - Seiji Kameda
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Fumiaki Yoshida
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan.,Department of Anatomy and Physiology, Saga Medical School Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, Saga, 849-8501, Japan
| | - Hitoshi Maezawa
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Satoru Oshino
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Naoki Tani
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Hui Ming Khoo
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Takufumi Yanagisawa
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Toshiki Yoshimine
- Endowed Research Department of Clinical Neuroengineering, Global Center for Medical Engineering and Informatics, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Masayuki Hirata
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan.,Endowed Research Department of Clinical Neuroengineering, Global Center for Medical Engineering and Informatics, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan.,Department of Neurosurgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
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29
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Kim JY, Yoon SY, Kim J, Wook Kim Y. Neural correlates of cricopharyngeal dysfunction after supratentorial stroke: A voxel-based lesion-symptom mapping with propensity score matched case-control. Int J Stroke 2021; 17:207-217. [PMID: 33724099 DOI: 10.1177/17474930211006300] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Poststroke cricopharyngeal dysfunction has been reported to occur in 50% of brainstem strokes; however, cricopharyngeal dysfunction also occurs commonly in patients with supratentorial stroke. The hemispheric neuroanatomical location of this dysfunction has not been clearly identified. AIM We aimed to analyze the relationship between cricopharyngeal dysfunction and supratentorial lesion location in poststroke patients through this retrospective case-control voxel-based lesion-symptom mapping study. METHODS Cricopharyngeal dysfunction was diagnosed when the residue after swallowing (pyriform sinus) accounted for more than 25% of volume of pyriform sinus. Medical records and the video fluoroscopic swallowing studies of first-ever stroke patients who were admitted to our hospital during acute to subacute phase from 2009 to 2019 were reviewed. After propensity score matching to reduce the likelihood of selection bias, 50 patients per group were included in the cricopharyngeal dysfunction and control groups. We used a P threshold of 0.01 corrected for multiple comparisons with permutation thresholding (5000 permutations). Dichotomized diagnosis of cricopharyngeal dysfunction and the magnitude of pyriform sinus were used as dependent variables. RESULTS Analysis using the Liebermeister statistics indicated that lesions of the right lentiform nucleus were associated with the development of cricopharyngeal dysfunction. After adjustment for age and total lesion volume, which are known effectors for the development of dysphagia, statistically significant correlations were found between pyriform sinus and lesions of the right lentiform nucleus and anterior corona radiata beneath the right middle frontal gyrus. CONCLUSION Thus, our study demonstrated for the first time that damages to the right lentiform nucleus, especially globus pallidus externa, and anterior corona radiata beneath the right middle frontal gyrus are associated with the development and severity of cricopharyngeal dysfunction.
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Affiliation(s)
- Jun Yup Kim
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Republic of Korea.,Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seo Yeon Yoon
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam-si, Republic of Korea
| | - Jinna Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Wook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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30
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Effect of Aging, Gender and Sensory Stimulation of TRPV1 Receptors with Capsaicin on Spontaneous Swallowing Frequency in Patients with Oropharyngeal Dysphagia: A Proof-of-Concept Study. Diagnostics (Basel) 2021; 11:diagnostics11030461. [PMID: 33799960 PMCID: PMC7999082 DOI: 10.3390/diagnostics11030461] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/26/2021] [Accepted: 03/03/2021] [Indexed: 11/16/2022] Open
Abstract
Spontaneous swallowing contributes to airway protection and depends on the activation of brainstem reflex circuits in the central pattern generator (CPG). We studied the effect of age and gender on spontaneous swallowing frequency (SSF) in healthy volunteers and assessed basal SSF and TRPV1 stimulation effect on SSF in patients with post-stroke oropharyngeal dysphagia (OD). The effect of age and gender on SSF was examined on 141 healthy adult volunteers (HV) divided into three groups: GI-18-39 yr, GII-40-59 yr, and GIII->60 yr. OD was assessed by the Volume-Viscosity Swallowing Test (VVST). The effect of sensory stimulation with capsaicin 10-5 M (TRPV1 agonist) was evaluated in 17 patients with post-stroke OD, using the SSF. SSF was recorded in all participants during 10 min using surface electromyography (sEMG) of the suprahyoid muscles and an omnidirectional accelerometer placed over the cricothyroid cartilage. SSF was significantly reduced in GII (0.73 ± 0.50 swallows/min; p = 0.0385) and GIII (0.50 ± 0.31 swallows/min; p < 0.0001) compared to GI (1.03 ± 0.62 swallows/min), and there was a moderate significant correlation between age and SFF (r = -0.3810; p < 0.0001). No effect of gender on SSF was observed. Capsaicin caused a strong and significant increase in SSF after the TRPV1 stimulation when comparing to basal condition (pre-capsaicin: 0.41 ± 0.32 swallows/min vs post-capsaicin: 0.81 ± 0.51 swallow/min; p = 0.0003). OD in patients with post-stroke OD and acute stimulation with TRPV1 agonists caused a significant increase in SSF, further suggesting the potential role of pharmacological stimulation of sensory pathways as a therapeutic strategy for CPG activation in patients with OD.
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Tae WS, Lee S, Choi S, Pyun SB. Effects of aging on brain networks during swallowing: general linear model and independent component analyses. Sci Rep 2021; 11:1069. [PMID: 33441738 PMCID: PMC7806781 DOI: 10.1038/s41598-020-79782-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/14/2020] [Indexed: 01/29/2023] Open
Abstract
Swallowing disorders occur more frequently in older adults. However, the effects of the aging process on neural activation when swallowing are unclear. We aimed to identify neural regions activated during swallowing and evaluate changes in neural activation and neural networks with aging. Using a general linear model (GLM) and independent component (IC) analyses, blood oxygen level-dependent (BOLD) signals were observed in the lateral precentral gyrus, postcentral gyrus, anterior insular cortices, supramarginal gyri, and medial frontal gyrus during swallowing. The right thalamus and anterior cingulate gyri were found to be active areas by GLM and IC analyses, respectively. In the correlational analyses, age was negatively correlated with BOLD signals of the lateral precentral gyri, postcentral gyri, and insular cortices in swallowing tasks. Additionally, correlation analyses between ICs of all participants and age revealed negative correlations in the right supramarginal gyrus, both anterior cingulate cortices, putamen, and cerebellum. In the network analysis, the BOLD signal positively correlated with age in the default mode network (DMN), and was negatively correlated in the lateral precentral gyri, postcentral gyri, and insular cortices. The amplitude of low-frequency fluctuations was significantly decreased in the DMN and increased in swallowing-related areas during swallowing tasks. These results suggest that aging has negative effects on the activation of swallowing-related regions and task-induced deactivation of the DMN. These changes may be used to detect early functional decline during swallowing.
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Affiliation(s)
- Woo-Suk Tae
- grid.222754.40000 0001 0840 2678Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sekwang Lee
- grid.222754.40000 0001 0840 2678Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sunyoung Choi
- grid.418980.c0000 0000 8749 5149Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sung-Bom Pyun
- grid.222754.40000 0001 0840 2678Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea ,grid.222754.40000 0001 0840 2678Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea ,Department of Physical Medicine and Rehabilitation, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Dual Tasking Influences Cough Reflex Outcomes in Adults with Parkinson's Disease: A Controlled Study. Dysphagia 2021; 36:959-973. [PMID: 33387000 DOI: 10.1007/s00455-020-10223-x] [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: 07/06/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
Coughing is an essential airway protective reflex. In healthy young adults, cough somatosensation changes when attention is divided (dual tasking). Whether the same is true in populations at risk of aspiration remains unknown. We present findings from a controlled study testing the effects of divided attention (via a dual-task paradigm) on measures of reflex cough in Parkinson's disease. Volunteers with Parkinson's disease (n = 14, age = 43-79 years) and 14 age-matched controls underwent five blocks of capsaicin-induced cough challenges. Within each block, capsaicin ranging from 0 to 200 μM was presented in a randomized order. Two blocks consisted of cough testing only (single task), and two blocks consisted of cough testing with simultaneous tone counting (dual task). Finally, participants completed a suppressed cough task. Measures of cough motor response, self-reported urge to cough, cough frequency, and cough airflow were collected. Historical data from healthy young adults was included for comparison. Between-group analyses revealed no differences between single- and dual-cough-task responses. However, post hoc analysis revealed a significant relationship between dual-task errors and cough frequency that was strongest in people with Parkinson's disease [p = 0.004, r2 = 0.52]. Specifically, greater errors were associated with fewer reflexive coughs. Unlike healthy participants, participants with Parkinson's disease did not change the number of coughs between the single-, dual-, and suppressed-task conditions [p > 0.05]. When distracted, people with Parkinson's disease may prioritize coughing differently than healthy controls. Abnormal cortical resource allocation may be a mechanism involved in aspiration in this population.
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Magara J, Watanabe M, Tsujimura T, Hamdy S, Inoue M. Lasting modulation of human cortical swallowing motor pathways following thermal tongue stimulation. Neurogastroenterol Motil 2021; 33:e13938. [PMID: 32656920 DOI: 10.1111/nmo.13938] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Thermal tactile oropharyngeal stimulation has been clinically used to facilitate swallowing initiation in dysphagic patients. We previously demonstrated that thermal stimulation applied to the oral cavity provokes an immediate excitability in pharyngeal motor cortex. The aim of the current study was to investigate whether thermal stimulation can produce longer lasting effects on the corticopharyngeal neural pathway. METHODS Healthy volunteers (n = 8/12) underwent baseline pharyngeal motor evoked potential (PMEP) measurements evoked by transcranial magnetic stimulation. In the first experiment, subjects received thermal stimulation alternating 30 seconds of 15 and 36°C applied to the tongue surface for either 10 minutes, 5 minutes, or sham. In the second experiment, one of three intermittent thermal stimulus patterns was delivered: cold (alternating 30 seconds of 15 and 36°C), warm (continuous 36°C), or hot (alternating 30 seconds of 45 and 36°C) for 10 minutes. In both experiments, PMEP were remeasured every 15 minutes up to 60 minutes following thermal stimulation. KEY RESULTS Repeated measures ANOVA for each stimulus time in the first experiment showed a significant increased change in PMEP amplitude at 30 minutes following only 10-minute stimulation compared with sham (P < .05). In the second experiment, we found that cold stimulation was more effective than the other stimulation (P < .05) at increasing PMEP amplitudes. CONCLUSIONS AND INFERENCES Ten-minute cold stimulation on the tongue can induce a delayed (30 minutes) increase in pharyngeal cortical excitability, providing a clinically useful therapeutic window for its application in dysphagic patients.
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Affiliation(s)
- Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University, Niigata, Japan
| | - Masahiro Watanabe
- Division of Dysphagia Rehabilitation, Niigata University, Niigata, Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University, Niigata, Japan
| | - Shaheen Hamdy
- Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Salford, UK
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University, Niigata, Japan
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Electroacupuncture Involved in Motor Cortex and Hypoglossal Neural Control to Improve Voluntary Swallowing of Poststroke Dysphagia Mice. Neural Plast 2020; 2020:8857543. [PMID: 33061953 PMCID: PMC7537716 DOI: 10.1155/2020/8857543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/20/2020] [Accepted: 09/06/2020] [Indexed: 11/17/2022] Open
Abstract
The descending motor nerve conduction of voluntary swallowing is mainly launched by primary motor cortex (M1). M1 can activate and regulate peripheral nerves (hypoglossal) to control the swallowing. Acupuncture at “Lianquan” acupoint (CV23) has a positive effect against poststroke dysphagia (PSD). In previous work, we have demonstrated that electroacupuncture (EA) could regulate swallowing-related motor neurons and promote swallowing activity in the essential part of central pattern generator (CPG), containing nucleus ambiguus (NA), nucleus of the solitary tract (NTS), and ventrolateral medulla (VLM) under the physiological condition. In the present work, we have investigated the effects of EA on the PSD mice in vivo and sought evidence for PSD improvement by electrophysiology recording and laser speckle contrast imaging (LSCI). Four main conclusions can be drawn from our study: (i) EA may enhance the local field potential in noninfarction area of M1, activate the swallowing-related neurons (pyramidal cells), and increase the motor conduction of noninfarction area in voluntary swallowing; (ii) EA may improve the blood flow in both M1 on the healthy side and deglutition muscles and relieve PSD symptoms; (iii) EA could increase the motor conduction velocity (MCV) in hypoglossal nerve, enhance the EMG of mylohyoid muscle, alleviate the paralysis of swallowing muscles, release the substance P, and restore the ability to drink water; and (iv) EA can boost the functional compensation of M1 in the noninfarction side, strengthen the excitatory of hypoglossal nerve, and be involved in the voluntary swallowing neural control to improve PSD. This research provides a timely and necessary experimental evidence of the motor neural regulation in dysphagia after stroke by acupuncture in clinic.
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Jing YH, Lin T, Li WQ, Wu C, Li X, Ding Q, Wu MF, Xu GQ, Lan Y. Comparison of Activation Patterns in Mirror Neurons and the Swallowing Network During Action Observation and Execution: A Task-Based fMRI Study. Front Neurosci 2020; 14:867. [PMID: 32973431 PMCID: PMC7472888 DOI: 10.3389/fnins.2020.00867] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/27/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Observation of a goal-directed motor action can excite the respective mirror neurons, and this is the theoretical basis for action observation (AO) as a novel tool for functional recovery during stroke rehabilitation. To explore the therapeutic potential of AO for dysphagia, we conducted a task-based functional magnetic resonance imaging (fMRI) study to identify the brain areas activated during observation and execution of swallowing in healthy participants. METHODS Twenty-nine healthy volunteers viewed the following stimuli during fMRI scanning: an action-video of swallowing (condition 1, defined as AO), a neutral image with a Chinese word for "watching" (condition 2), and a neutral image with a Chinese word for "swallowing" (condition 3). Action execution (AE) was defined as condition 3 minus condition 2. One-sample t-tests were performed to define the brain regions activated during AO and AE. RESULTS Many brain regions were activated during AO, including the middle temporal gyrus, inferior frontal gyrus, pre- and postcentral gyrus, supplementary motor area, hippocampus, brainstem, and pons. AE resulted in activation of motor areas as well as other brain areas, including the inferior parietal lobule, vermis, middle frontal gyrus, and middle temporal gyrus. Two brain areas, BA6 and BA21, were activated with both AO and AE. CONCLUSION The left supplementary motor area (BA6) and left middle temporal gyrus (BA21), which contains mirror neurons, were activated in both AO and AE of swallowing. In this study, AO activated mirror neurons and the swallowing network in healthy participants, supporting its potential value in the treatment of dysphagia.
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Affiliation(s)
- Ying-hua Jing
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Tuo Lin
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Wan-qi Li
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Cheng Wu
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xue Li
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Qian Ding
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Man-feng Wu
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Guang-qing Xu
- Department of Rehabilitation Medicine, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yue Lan
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
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Cosentino G, Tassorelli C, Prunetti P, Bertino G, De Icco R, Todisco M, Di Marco S, Brighina F, Schindler A, Rondanelli M, Fresia M, Mainardi L, Restivo DA, Priori A, Sandrini G, Alfonsi E. Anodal transcranial direct current stimulation and intermittent theta-burst stimulation improve deglutition and swallowing reproducibility in elderly patients with dysphagia. Neurogastroenterol Motil 2020; 32:e13791. [PMID: 31975493 DOI: 10.1111/nmo.13791] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/24/2019] [Accepted: 12/13/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Dysphagia in the elderly, known as presbydysphagia, has become a relevant public health problem in several countries. Swallowing disorders may be a consequence of different neurological disorders (secondary presbydysphagia) or the expression of the aging process itself (primary presbydysphagia). We aimed to test the therapeutic potential of two different non-invasive brain stimulation (NIBS) techniques in subjects with primary or secondary presbydysphagia. METHODS A blinded randomized controlled trial with crossover design was carried out in 42 patients, randomly assigned to anodal transcranial direct current stimulation (tDCS) or intermittent theta-burst stimulation (TBS) group. Both tDCS and TBS were applied for 5 consecutive days over the right swallowing motor cortex. The swallowing function was assessed before and 1 and 3 months after the stimulation using the Dysphagia Outcome and Severity Scale (DOSS), scored based on clinical assessment and fiberoptic endoscopic evaluation of swallowing. An electrophysiological method was also applied to evaluate changes in the reproducibility of the swallowing behavior. KEY RESULTS Both real tDCS and TBS had beneficial effects on the swallowing function in patients with primary and secondary presbydysphagia. Anodal tDCS resulted in an improvement of 0.5 points in DOSS at 1-month follow-up (P = .014), whereas intermittent TBS induced an increase of 0.7 and 0.6 points at 1- and 3-month follow-up evaluations, respectively (P = .0001 and P = .005, respectively). Reproducibility of both the oral and pharyngeal phases of swallowing significantly increased at 1-month follow-up. CONCLUSIONS AND INFERENCES Our results suggest that non-invasive cortical stimulation may be useful for dysphagia recovery in elderly patients.
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Affiliation(s)
- Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Paolo Prunetti
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Giulia Bertino
- Department of Otolaryngology, University of Pavia, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Roberto De Icco
- Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Salvatore Di Marco
- Department of Biomedicine Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Filippo Brighina
- Department of Biomedicine Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Antonio Schindler
- Department of Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Mariangela Rondanelli
- Section of Human Nutrition and Dietetics, Department of Public Health and Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Mauro Fresia
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Luca Mainardi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | - Alberto Priori
- Department of Neurological Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giorgio Sandrini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Enrico Alfonsi
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
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Sasegbon A, Smith CJ, Bath P, Rothwell J, Hamdy S. The effects of unilateral and bilateral cerebellar rTMS on human pharyngeal motor cortical activity and swallowing behavior. Exp Brain Res 2020; 238:1719-1733. [PMID: 32232540 PMCID: PMC7413876 DOI: 10.1007/s00221-020-05787-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/16/2020] [Indexed: 11/16/2022]
Abstract
The cerebellum is recognised to bilaterally modulate sensorimotor function and has recently been shown to play a role in swallowing. Unilateral cerebellar repetitive trans-cranial magnetic stimulation (rTMS) excites corticobulbar motor pathways to the pharynx but the effects of bilateral versus unilateral cerebellar rTMS on these pathways are unknown. In this three-part cross-over study, healthy participants (n = 13) were randomly allocated to receive unilateral or bilateral 10 Hz cerebellar rTMS. Participants were intubated with pharyngeal electromyography and/or manometry catheters for motor evoked potentials (MEPs) and pressure recordings. In part 1 of the study, single pulse TMS was used to measure baseline motor cortical pharyngeal MEP (PMEP) and hemispheric cerebellar MEP (CMEP) amplitudes, before cerebellar rTMS was administered. Repeat measures of PMEP amplitude were performed at 15-min intervals for an hour post unilateral and bilateral rTMS. Thereafter, in two further studies, a cortical ‘virtual lesion’ (V/L) was applied prior to cerebellar rTMS with pre and post PMEPs (part 2) and measurements of swallowing accuracy (part 3) using a behavioural task. Compared to baseline, unilateral and bilateral cerebellar rTMS provoked increases in pharyngeal cortical excitation (P = 0.028, 0.0005, respectively). Bilateral rTMS was significantly more effective than unilateral in causing cortical excitation (P = 0.0005) and in reversing the suppressive neurological (P = 0.0005) and behavioural (P = 0.0005) effects of a cortical V/L. Our findings suggest bilateral cerebellar rTMS has greater facilitatory effects on corticobulbar motor pathways to the pharynx than unilateral stimulation with the potential to be a more effective clinical therapy if its effects are reproduced in populations with neurogenic dysphagia.
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Affiliation(s)
- Ayodele Sasegbon
- Gastrointestinal (GI) Sciences, Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Salford Royal Hospital (part of the Manchester Academic Health Sciences Center (MAHSC)), Clinical Sciences Building, Eccles Old Road, Salford, M6 8HD, UK
| | - Craig J Smith
- Division of Cardiovascular Sciences, Manchester Centre for Clinical Neurosciences, Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Salford Royal Hospital, Manchester Academic Health Sciences Centre (MAHSC), Salford, UK
| | - Philip Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.,Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - John Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London, London, UK
| | - Shaheen Hamdy
- Gastrointestinal (GI) Sciences, Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Salford Royal Hospital (part of the Manchester Academic Health Sciences Center (MAHSC)), Clinical Sciences Building, Eccles Old Road, Salford, M6 8HD, UK.
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Kober SE, Grössinger D, Wood G. Effects of Motor Imagery and Visual Neurofeedback on Activation in the Swallowing Network: A Real-Time fMRI Study. Dysphagia 2019; 34:879-895. [PMID: 30771088 PMCID: PMC6825652 DOI: 10.1007/s00455-019-09985-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 01/25/2019] [Indexed: 12/01/2022]
Abstract
Motor imagery of movements is used as mental strategy in neurofeedback applications to gain voluntary control over activity in motor areas of the brain. In the present functional magnetic resonance imaging (fMRI) study, we first addressed the question whether motor imagery and execution of swallowing activate comparable brain areas, which has been already proven for hand and foot movements. Prior near-infrared spectroscopy (NIRS) studies provide evidence that this is the case in the outer layer of the cortex. With the present fMRI study, we want to expand these prior NIRS findings to the whole brain. Second, we used motor imagery of swallowing as mental strategy during visual neurofeedback to investigate whether one can learn to modulate voluntarily activity in brain regions, which are associated with active swallowing, using real-time fMRI. Eleven healthy adults performed one offline session, in which they executed swallowing movements and imagined swallowing on command during fMRI scanning. Based on this functional localizer task, we identified brain areas active during both tasks and defined individually regions for feedback. During the second session, participants performed two real-time fMRI neurofeedback runs (each run comprised 10 motor imagery trials), in which they should increase voluntarily the activity in the left precentral gyrus by means of motor imagery of swallowing while receiving visual feedback (the visual feedback depicted one's own fMRI signal changes in real-time). Motor execution and imagery of swallowing activated a comparable network of brain areas including the bilateral pre- and postcentral gyrus, inferior frontal gyrus, basal ganglia, insula, SMA, and the cerebellum compared to a resting condition. During neurofeedback training, participants were able to increase the activity in the feedback region (left lateral precentral gyrus) but also in other brain regions, which are generally active during swallowing, compared to the motor imagery offline task. Our results indicate that motor imagery of swallowing is an adequate mental strategy to activate the swallowing network of the whole brain, which might be useful for future treatments of swallowing disorders.
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Affiliation(s)
- Silvia Erika Kober
- Institute of Psychology, University of Graz, Universitaetsplatz 2/III, 8010 Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Doris Grössinger
- Institute of Psychology, University of Graz, Universitaetsplatz 2/III, 8010 Graz, Austria
| | - Guilherme Wood
- Institute of Psychology, University of Graz, Universitaetsplatz 2/III, 8010 Graz, Austria
- BioTechMed-Graz, Graz, Austria
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Cuellar ME, Harvey J. Predictive value of laryngeal adductor reflex testing in patients with dysphagia due to a cerebral vascular accident. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:593-601. [PMID: 30301381 DOI: 10.1080/17549507.2018.1512652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 06/27/2018] [Accepted: 07/19/2018] [Indexed: 06/08/2023]
Abstract
Purpose: To determine the relationship between air pulse vs. touch laryngeal adductor reflex (LAR) tests and the clinical sensory findings of fiberoptic endoscopic evaluations of swallowing.Method: A retrospective review was conducted for 43 patients with dysphagia due to stroke that underwent fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST). Each patient received LAR testing using air pulse or touch methodologies. Clinically, responsiveness to pharyngeal residue and responsiveness to penetration or aspiration were analysed.Result: The sensitivity, specificity, positive and negative predictive values for both LAR test groups indicate that LAR testing did not effectively predict sensory function during the clinical swallow evaluation. Across both LAR groups, specificity values were higher than sensitivity values. In fact, the specificity values for the light touch LAR test group were extremely high, but the negative predictive values did not support those findings. Sensitivity and positive predictive values were low for both groups.Conclusion: Although LAR testing provides valuable information regarding laryngeal sensory discrimination, the results of the current study suggest that a clinical evaluation of swallowing is critical for effectively assessing the way in which patients utilise sensory information during swallowing.
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Affiliation(s)
- Megan E Cuellar
- Speech-Language Pathology Program, Midwestern University, Downers Grove, IL, USA
| | - Jennine Harvey
- Communication Sciences and Disorders, Illinois State University, Normal, IL, USA
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Labeit B, Muhle P, Ogawa M, Claus I, Marian T, Suntrup-Krueger S, Warnecke T, Schroeder JB, Dziewas R. FEES-based assessment of pharyngeal hypesthesia-Proposal and validation of a new test procedure. Neurogastroenterol Motil 2019; 31:e13690. [PMID: 31381234 DOI: 10.1111/nmo.13690] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/09/2019] [Accepted: 07/18/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Intact pharyngeal sensation is essential for a physiological swallowing process, and conversely, pharyngeal hypesthesia can cause dysphagia. This study introduces and validates a diagnostic test to quantify pharyngeal hypesthesia. METHODS A total of 20 healthy volunteers were included in a prospective study. Flexible endoscopic evaluation of swallowing (FEES) and a sensory test were performed both before and after pharyngeal local anesthesia. To test pharyngeal sensation, a small tube was positioned transnasally in the upper third of the oropharynx with contact to the lateral pharyngeal wall. Increasing volumes of blue-dyed water were injected through the tube, and the latency of swallowing response (LSR) was determined by two independent raters from the endoscopic video recording. Three trials were performed for each administered volume starting with 0.1 mL and increased by 0.1 mL up to 0.5 mL. KEY RESULTS The average LSR without anesthesia was 2.24 ± 0.80 s at 0.1 mL, 1.79 ± 0.84 s at 0.2 mL, 1.29 ± 0.62 s at 0.3 mL, 1.17 ± 0.41 s at 0.4 mL, and 1.19 ± 0.52 s at 0.5 mL. With anesthesia applied, the average LSR was 2.65 ± 0.62 s at 0.1 mL, 2.64 ± 0.49 s at 0.2 mL, 2.44 ± 0.65 s at 0.3 mL, 2.10 ± 0.80 s at 0.4 mL, and 2.18 ± 0.85 s at 0.5 mL. LSR was significantly longer following anesthesia at 0.2 mL (t = -3.82; P = .001), 0.3 mL (t = -4.65; P < .000), 0.4 mL (t = -5.77; P < .000), and 0.5 mL (t = -3.49; P = .005). CONCLUSION AND INFERENCES Pharyngeal hypesthesia can be quantified with sensory testing using LSR. Suitable volumes to distinguish between normal and impaired pharyngeal sensation are 0.2 mL, 0.3 mL, 0.4 mL and 0.5 mL. Experimentally induced pharyngeal anesthesia represents a valid model of sensory dysphagia.
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Affiliation(s)
- Bendix Labeit
- Department of Neurology, University Hospital Muenster, Muenster, Germany
| | - Paul Muhle
- Department of Neurology, University Hospital Muenster, Muenster, Germany
| | - Mao Ogawa
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Inga Claus
- Department of Neurology, University Hospital Muenster, Muenster, Germany
| | - Thomas Marian
- Department of Neurology, University Hospital Muenster, Muenster, Germany
| | | | - Tobias Warnecke
- Department of Neurology, University Hospital Muenster, Muenster, Germany
| | | | - Rainer Dziewas
- Department of Neurology, University Hospital Muenster, Muenster, Germany
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41
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Age-related differences in the within-session trainability of hemodynamic parameters: a near-infrared spectroscopy–based neurofeedback study. Neurobiol Aging 2019; 81:127-137. [DOI: 10.1016/j.neurobiolaging.2019.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 05/02/2019] [Accepted: 05/30/2019] [Indexed: 11/21/2022]
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42
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Zhang G, Ruan X, Li Y, Li E, Gao C, Liu Y, Jiang L, Liu L, Chen X, Yu S, Jiang X, Xu G, Lan Y, Wei X. Intermittent Theta-Burst Stimulation Reverses the After-Effects of Contralateral Virtual Lesion on the Suprahyoid Muscle Cortex: Evidence From Dynamic Functional Connectivity Analysis. Front Neurosci 2019; 13:309. [PMID: 31105511 PMCID: PMC6491879 DOI: 10.3389/fnins.2019.00309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/19/2019] [Indexed: 12/27/2022] Open
Abstract
Contralateral intermittent theta burst stimulation (iTBS) can potentially improve swallowing disorders with unilateral lesion of the swallowing cortex. However, the after-effects of iTBS on brain excitability remain largely unknown. Here, we investigated the alterations of temporal dynamics of inter-regional connectivity induced by iTBS following continuous TBS (cTBS) in the contralateral suprahyoid muscle cortex. A total of 20 right-handed healthy subjects underwent cTBS over the left suprahyoid muscle motor cortex and then immediately afterward, iTBS was applied to the contralateral homologous area. All of the subjects underwent resting-state functional magnetic resonance imaging (Rs-fMRI) pre- and post-TBS implemented on a different day. We compared the static and dynamic functional connectivity (FC) between the post-TBS and the baseline. The whole-cortical time series and a sliding-window correlation approach were used to quantify the dynamic characteristics of FC. Compared with the baseline, for static FC measurement, increased FC was found in the precuneus (BA 19), left fusiform gyrus (BA 37), and right pre/post-central gyrus (BA 4/3), and decreased FC was observed in the posterior cingulate gyrus (PCC) (BA 29) and left inferior parietal lobule (BA 39). However, in the dynamic FC analysis, post-TBS showed reduced FC in the left angular and PCC in the early windows, and in the following windows, increased FC in multiple cortical areas including bilateral pre- and postcentral gyri and paracentral lobule and non-sensorimotor areas including the prefrontal, temporal and occipital gyrus, and brain stem. Our results indicate that iTBS reverses the aftereffects induced by cTBS on the contralateral suprahyoid muscle cortex. Dynamic FC analysis displayed a different pattern of alteration compared with the static FC approach in brain excitability induced by TBS. Our results provide novel evidence for us in understanding the topographical and temporal aftereffects linked to brain excitability induced by different TBS protocols and might be valuable information for their application in the rehabilitation of deglutition.
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Affiliation(s)
- Guoqin Zhang
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiuhang Ruan
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yuting Li
- The Second Affiliated Hospital, South China University of Technology, Guangzhou, China
| | - E Li
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Cuihua Gao
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yanli Liu
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lisheng Jiang
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lingling Liu
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xin Chen
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Shaode Yu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xinqing Jiang
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Guangqing Xu
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yue Lan
- The Second Affiliated Hospital, South China University of Technology, Guangzhou, China.,Department of Rehabilitation Medicine, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xinhua Wei
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China.,The Second Affiliated Hospital, South China University of Technology, Guangzhou, China
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43
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Zuercher P, Moret CS, Dziewas R, Schefold JC. Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:103. [PMID: 30922363 PMCID: PMC6438038 DOI: 10.1186/s13054-019-2400-2] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/18/2019] [Indexed: 12/14/2022]
Abstract
Dysphagia may present in all critically ill patients and large-scale clinical data show that e.g. post-extubation dysphagia (PED) is commonly observed in intensive care unit (ICU) patients. Recent data demonstrate that dysphagia is mostly persisting and that its presence is independently associated with adverse patient-centered clinical outcomes. Although several risk factors possibly contributing to dysphagia development were proposed, the underlying exact mechanisms in ICU patients remain incompletely understood and no current consensus exists on how to best approach ICU patients at risk.From a clinical perspective, dysphagia is well-known to be associated with an increased risk of aspiration and aspiration-induced pneumonia, delayed resumption of oral intake/malnutrition, decreased quality of life, prolonged ICU and hospital length of stay, and increased morbidity and mortality. Moreover, the economic burden on public health care systems is high.In light of high mortality rates associated with the presence of dysphagia and the observation that dysphagia is not systematically screened for on most ICUs, this review describes epidemiology, terminology, and potential mechanisms of dysphagia on the ICU. Furthermore, the impact of dysphagia on affected individuals, health care systems, and society is discussed in addition to current and future potential therapeutic approaches.
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Affiliation(s)
- Patrick Zuercher
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland.
| | - Céline S Moret
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland
| | - Rainer Dziewas
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland
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44
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Ruan X, Zhang G, Xu G, Gao C, Liu L, Liu Y, Jiang L, Zhang S, Chen X, Jiang X, Lan Y, Wei X. The After-Effects of Theta Burst Stimulation Over the Cortex of the Suprahyoid Muscle on Regional Homogeneity in Healthy Subjects. Front Behav Neurosci 2019; 13:35. [PMID: 30881294 PMCID: PMC6405436 DOI: 10.3389/fnbeh.2019.00035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 02/08/2019] [Indexed: 01/28/2023] Open
Abstract
Theta burst stimulation (TBS) is a powerful variant of repetitive transcranial magnetic stimulation (rTMS), making it potentially useful for the treatment of swallowing disorders. However, how dose TBS modulate human swallowing cortical excitability remains unclear. Here, we aim to measure the after-effects of spontaneous brain activity at resting-state using the regional homogeneity (ReHo) approach in healthy subjects who underwent different TBS protocols over the suprahyoid muscle cortex. Sixty healthy subjects (23.45 ± 2.73 years, 30 males) were randomized into three groups which completed different TBS protocols. The TMS coil was applied over the cortex of the suprahyoid muscles. Data of resting-state functional MRI (Rs-fMRI) of the subjects were acquired before and after TBS. The ReHo was compared across sessions [continuous TBS (cTBS), intermittent TBS (iTBS) and cTBS/iTBS] and runs (pre/post TBS). In the comparison between pre- and post-TBS, increased ReHo was observed in the right lingual gyrus and right precuneus and decreased ReHo in the left cingulate gyrus in the cTBS group. In the iTBS group, increased ReHo values were seen in the pre-/postcentral gyrus and cuneus, and decreased ReHo was observed in the left cerebellum, brainstem, bilateral temporal gyrus, insula and left inferior frontal gyrus. In the cTBS/iTBS group, increased ReHo was found in the precuneus and decreased ReHo in the right cerebellum posterior lobe, left anterior cerebellum lobe, and right inferior frontal gyrus. In the post-TBS inter-groups comparison, increased ReHo was seen in right middle occipital gyrus and decreased ReHo in right middle frontal gyrus and right postcentral gyrus (cTBS vs. cTBS/iTBS). Increased ReHo was shown in left inferior parietal lobule and left middle frontal gyrus (cTBS vs. iTBS). Increased ReHo was shown in right medial superior frontal gyrus and decreased ReHo in right cuneus (cTBS/iTBS vs. iTBS). Our findings indicate cTBS had no significant influence on ReHo in the primary sensorimotor cortex, iTBS facilitates an increased ReHo in the bilateral sensorimotor cortex and a decreased ReHo in multiple subcortical areas, and no reverse effect exhibits when iTBS followed the contralateral cTBS over the suprahyoid motor cortex. The results provide a novel insight into the neural mechanisms of TBS on swallowing cortex.
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Affiliation(s)
- Xiuhang Ruan
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Guoqin Zhang
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Guangqing Xu
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Cuihua Gao
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lingling Liu
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yanli Liu
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lisheng Jiang
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Sijing Zhang
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xin Chen
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xinqing Jiang
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yue Lan
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China.,The Second Affiliated Hospital, South China University of Technology, Guangzhou, China
| | - Xinhua Wei
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China.,The Second Affiliated Hospital, South China University of Technology, Guangzhou, China
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45
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Sklerov M, Dayan E, Browner N. Functional neuroimaging of the central autonomic network: recent developments and clinical implications. Clin Auton Res 2018; 29:555-566. [PMID: 30470943 PMCID: PMC6858471 DOI: 10.1007/s10286-018-0577-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/07/2018] [Indexed: 12/08/2023]
Abstract
Purpose The central autonomic network (CAN) is an intricate system of brainstem, subcortical, and cortical structures that play key roles in the function of the autonomic nervous system. Prior to the advent of functional neuroimaging, in vivo studies of the human CAN were limited. The purpose of this review is to highlight the contribution of functional neuroimaging, specifically functional magnetic resonance imaging (fMRI), to the study of the CAN, and to discuss recent advances in this area. Additionally, we aim to emphasize exciting areas for future research. Methods We reviewed the existing literature in functional neuroimaging of the CAN. Here, we focus on fMRI research conducted in healthy human subjects, as well as research that has been done in disease states, to understand CAN function. To minimize confounding, papers examining CAN function in the context of cognition, emotion, pain, and affective disorders were excluded. Results fMRI has led to significant advances in the understanding of human CAN function. The CAN is composed of widespread brainstem and forebrain structures that are intricately connected and play key roles in reflexive and modulatory control of autonomic function. Conclusions fMRI technology has contributed extensively to current knowledge of CAN function. It holds promise to serve as a biomarker in disease states. With ongoing advancements in fMRI technology, there is great opportunity and need for future research involving the CAN.
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Affiliation(s)
- Miriam Sklerov
- Department of Neurology, University of North Carolina, 170 Manning Drive, CB# 7025, Chapel Hill, NC, 27599, USA.
| | - Eran Dayan
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina, 130 Mason Farm Road, CB# 7513, Chapel Hill, NC, 27599, USA
| | - Nina Browner
- Department of Neurology, University of North Carolina, 170 Manning Drive, CB# 7025, Chapel Hill, NC, 27599, USA
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46
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Drew PJ, Winder AT, Zhang Q. Twitches, Blinks, and Fidgets: Important Generators of Ongoing Neural Activity. Neuroscientist 2018; 25:298-313. [PMID: 30311838 DOI: 10.1177/1073858418805427] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Animals and humans continuously engage in small, spontaneous motor actions, such as blinking, whisking, and postural adjustments ("fidgeting"). These movements are accompanied by changes in neural activity in sensory and motor regions of the brain. The frequency of these motions varies in time, is affected by sensory stimuli, arousal levels, and pathology. These fidgeting behaviors can be entrained by sensory stimuli. Fidgeting behaviors will cause distributed, bilateral functional activation in the 0.01 to 0.1 Hz frequency range that will show up in functional magnetic resonance imaging and wide-field calcium neuroimaging studies, and will contribute to the observed functional connectivity among brain regions. However, despite the large potential of these behaviors to drive brain-wide activity, these fidget-like behaviors are rarely monitored. We argue that studies of spontaneous and evoked brain dynamics in awake animals and humans should closely monitor these fidgeting behaviors. Differences in these fidgeting behaviors due to arousal or pathology will "contaminate" ongoing neural activity, and lead to apparent differences in functional connectivity. Monitoring and accounting for the brain-wide activations by these behaviors is essential during experiments to differentiate fidget-driven activity from internally driven neural dynamics.
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Affiliation(s)
- Patrick J Drew
- Department of Engineering Science and Mechanics, Pennsylvania State University, University Park, PA, USA.,Department of Neurosurgery and Department of Biomedical Engineering, Pennsylvania State University, University Park, PA, USA
| | - Aaron T Winder
- Department of Engineering Science and Mechanics, Pennsylvania State University, University Park, PA, USA
| | - Qingguang Zhang
- Department of Engineering Science and Mechanics, Pennsylvania State University, University Park, PA, USA
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47
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Lee J, Yamate C, Taira M, Shinoda M, Urata K, Maruno M, Ito R, Saito H, Gionhaku N, Iinuma T, Iwata K. Prefrontal cortex activity during swallowing in dysphagia patients. J Oral Sci 2018; 60:329-335. [PMID: 29794397 DOI: 10.2334/josnusd.17-0238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Prefrontal cortex activity is modulated by flavor and taste stimuli and changes during swallowing. We hypothesized that changes in the modulation of prefrontal cortex activity by flavor and taste were associated with swallowing movement and evaluated brain activity during swallowing in patients with dysphagia. To evaluate prefrontal cortex activity in dysphagia patients during swallowing, change in oxidized hemoglobin (z-score) was measured with near-infrared spectroscopy while dysphagia patients and healthy controls swallowed sweetened/unsweetened and flavored/unflavored jelly. Total z-scores were positive during swallowing of flavored/unsweetened jelly and negative during swallowing of unflavored/sweetened jelly in controls but negative during swallowing of sweetened/unsweetened and flavored/unflavored jelly in dysphagia patients. These findings suggest that taste and flavor during food swallowing are associated with positive and negative z-scores, respectively. Change in negative and positive z-scores may be useful in evaluating brain activity of dysphagia patients during swallowing of sweetened and unsweetened food.
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Affiliation(s)
- Jun Lee
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry
| | - Chisato Yamate
- Department of Cognitive Neurobiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University.,Center for Brain Integration Research, Tokyo Medical and Dental University
| | - Masato Taira
- Department of Cognitive Neurobiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University.,Center for Brain Integration Research, Tokyo Medical and Dental University
| | - Masamichi Shinoda
- Department of Physiology, Nihon University School of Dentistry.,Division of Functional Morphology, Dental Research Center, Nihon University School of Dentistry
| | - Kentaro Urata
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry
| | - Mitsuru Maruno
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry
| | - Reio Ito
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry
| | - Hiroto Saito
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry
| | - Nobuhito Gionhaku
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry
| | - Toshimitsu Iinuma
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry
| | - Koichi Iwata
- Department of Physiology, Nihon University School of Dentistry.,Division of Functional Morphology, Dental Research Center, Nihon University School of Dentistry
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Mo SJ, Jeong HJ, Han YH, Hwang K, Choi JK. Association of Brain Lesions and Videofluoroscopic Dysphagia Scale Parameters on Patients With Acute Cerebral Infarctions. Ann Rehabil Med 2018; 42:560-568. [PMID: 30180525 PMCID: PMC6129704 DOI: 10.5535/arm.2018.42.4.560] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/18/2017] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate the characteristics and risk factors of dysphagia using the videofluoroscopic dysphagia scale (VDS) with a videofluoroscopic swallowing study (VFSS) in patients with acute cerebral infarctions. Methods In this retrospective study, the baseline VFSS in 275 stroke patients was analyzed. We divided patients into 8 groups according to lesion areas commonly observed on brain magnetic resonance imaging. Dysphagia characteristics and severity were evaluated using the VDS. We also analyzed the relationship between clinical and functional parameters based on medical records and VDS scores. Results In comparison studies of lesions associated with swallowing dysfunction, several groups with significant differences were identified. Apraxia was more closely associated with cortical middle cerebral artery territory lesions. Vallecular and pyriform sinus residue was more common with lesions in the medulla or pons. In addition, the results for the Korean version of the Modified Barthel Index (K-MBI), a functional assessment tool, corresponded to those in the quantitative evaluation of swallowing dysfunctions. Conclusion A large cohort of patients with cerebral infarction was evaluated to determine the association between brain lesions and swallowing dysfunction. The results can be used to establish a specific treatment plan. In addition, the characteristic factors associated with swallowing dysfunctions were also confirmed.
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Affiliation(s)
- Sang Jun Mo
- Department of Rehabilitation Medicine, Dong-Eui Medical Center, Busan, Korea
| | - Ho Joong Jeong
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| | - Yong Hyun Han
- Department of Rehabilitation Medicine, Dong-Eui Medical Center, Busan, Korea
| | - Kihun Hwang
- Department of Rehabilitation Medicine, Dong-Eui Medical Center, Busan, Korea
| | - Jong Kyoung Choi
- Department of Rehabilitation Medicine, Dong-Eui Medical Center, Busan, Korea
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49
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COSTA MMB. NEURAL CONTROL OF SWALLOWING. ARQUIVOS DE GASTROENTEROLOGIA 2018; 55Suppl 1:61-75. [DOI: 10.1590/s0004-2803.201800000-45] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/09/2018] [Indexed: 11/21/2022]
Abstract
ABSTRACT BACKGROUND: Swallowing is a motor process with several discordances and a very difficult neurophysiological study. Maybe that is the reason for the scarcity of papers about it. OBJECTIVE: It is to describe the chewing neural control and oral bolus qualification. A review the cranial nerves involved with swallowing and their relationship with the brainstem, cerebellum, base nuclei and cortex was made. METHODS: From the reviewed literature including personal researches and new observations, a consistent and necessary revision of concepts was made, not rarely conflicting. RESULTS AND CONCLUSION: Five different possibilities of the swallowing oral phase are described: nutritional voluntary, primary cortical, semiautomatic, subsequent gulps, and spontaneous. In relation to the neural control of the swallowing pharyngeal phase, the stimulus that triggers the pharyngeal phase is not the pharyngeal contact produced by the bolus passage, but the pharyngeal pressure distension, with or without contents. In nutritional swallowing, food and pressure are transferred, but in the primary cortical oral phase, only pressure is transferred, and the pharyngeal response is similar. The pharyngeal phase incorporates, as its functional part, the oral phase dynamics already in course. The pharyngeal phase starts by action of the pharyngeal plexus, composed of the glossopharyngeal (IX), vagus (X) and accessory (XI) nerves, with involvement of the trigeminal (V), facial (VII), glossopharyngeal (IX) and the hypoglossal (XII) nerves. The cervical plexus (C1, C2) and the hypoglossal nerve on each side form the ansa cervicalis, from where a pathway of cervical origin goes to the geniohyoid muscle, which acts in the elevation of the hyoid-laryngeal complex. We also appraise the neural control of the swallowing esophageal phase. Besides other hypotheses, we consider that it is possible that the longitudinal and circular muscular layers of the esophagus display, respectively, long-pitch and short-pitch spiral fibers. This morphology, associated with the concept of energy preservation, allows us to admit that the contraction of the longitudinal layer, by having a long-pitch spiral arrangement, would be able to widen the esophagus, diminishing the resistance to the flow, probably also by opening of the gastroesophageal transition. In this way, the circular layer, with its short-pitch spiral fibers, would propel the food downwards by sequential contraction.
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50
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Huang YC, Hsu TW, Leong CP, Hsieh HC, Lin WC. Clinical Effects and Differences in Neural Function Connectivity Revealed by MRI in Subacute Hemispheric and Brainstem Infarction Patients With Dysphagia After Swallowing Therapy. Front Neurosci 2018; 12:488. [PMID: 30079009 PMCID: PMC6062613 DOI: 10.3389/fnins.2018.00488] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 06/29/2018] [Indexed: 11/24/2022] Open
Abstract
Background: Early detection and intervention for post-stroke dysphagia could reduce the incidence of pulmonary complications and mortality. The aims of this study were to investigate the benefits of swallowing therapy in swallowing function and brain neuro-plasticity and to explore the relationship between swallowing function recovery and neuroplasticity after swallowing therapy in cerebral and brainstem stroke patients with dysphagia. Methods: We collected 17 subacute stroke patients with dysphagia (11 cerebral stroke patients with a median age of 76 years and 6 brainstem stroke patients with a median age of 70 years). Each patient received swallowing therapies during hospitalization. For each patient, functional oral intake scale (FOIS), functional dysphagia scale (FDS) and 8-point penetration-aspiration scale (PAS) in videofluoroscopy swallowing study (VFSS), and brain functional magnetic resonance imaging (fMRI) were evaluated before and after treatment. Results: FOIS (p = 0.003 in hemispheric group and p = 0.039 in brainstem group) and FDS (p = 0.006 in hemispheric group and p = 0.028 in brainstem group) were both significantly improved after treatment in hemispheric and brainstem stroke patients. In hemispheric stroke patients, changes in FOIS were related to changes of functional brain connectivity in the ventral default mode network (vDMN) of the precuneus in brain functional MRI (fMRI). In brainstem stroke patients, changes in FOIS were related to changes of functional brain connectivity in the left sensorimotor network (LSMN) of the left postcentral region characterized by brain fMRI. Conclusion: Both hemispheric and brainstem stroke patients with different swallowing difficulties showed improvements after swallowing training. For these two dysphagic stroke groups with corresponding etiologies, swallowing therapy could contribute to different functional neuroplasticity.
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Affiliation(s)
- Yu-Chi Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tun-Wei Hsu
- Department of Diagnostic Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chau-Peng Leong
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Han-Chin Hsieh
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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