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Regnier A, Mélotte E, Aubinet C, Alnagger N, Fischer D, Lagier A, Thibaut A, Laureys S, Kaux JF, Gosseries O. Swallowing dysfunctions in patients with disorders of consciousness: Evidence from neuroimaging data, assessment, and management. NeuroRehabilitation 2024; 54:91-107. [PMID: 38217621 DOI: 10.3233/nre-230135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
Following severe brain injuries, a subset of patients may remain in an altered state of consciousness; most of these patients require artificial feeding. Currently, a functional oral phase and the presence of exclusive oral feeding may constitute signs of consciousness. Additionally, the presence of pharyngo-laryngeal secretions, saliva aspiration, cough reflex and tracheostomy are related to the level of consciousness. However, the link between swallowing and consciousness is yet to be fully understood. The primary aim of this review is to establish a comprehensive overview of the relationship between an individual's conscious behaviour and swallowing (reflexive and voluntary). Previous studies of brain activation during volitional and non-volitional swallowing tasks in healthy subjects are also reviewed. We demonstrate that the areas activated by voluntary swallowing tasks (primary sensorimotor, cingulate, insula, premotor, supplementary motor, cerebellum, and operculum) are not specific to deglutitive function but are shared with other motor tasks and brain networks involved in consciousness. This review also outlines suitable assessment and treatment methods for dysphagic patients with disorders of consciousness. Finally, we propose that markers of swallowing could contribute to the development of novel diagnostic guidelines for patients with disorders of consciousness.
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Affiliation(s)
- Amandine Regnier
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
- Department of Physical and Rehabilitation Medicine, University Hospital of Liège, Liège, Belgium
| | - Evelyne Mélotte
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Charlène Aubinet
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Naji Alnagger
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - David Fischer
- Department of Neurology, Division of Neurocritical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Aude Lagier
- Department of Otorhinolaryngology, University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
- Joint International Research Unit on Consciousness, CERVO Brain Research Centre, CIUSS, Laval University, Québec, QC, Canada
| | - Jean-François Kaux
- Department of Physical and Rehabilitation Medicine, University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
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Morishita M, Sota J, Kobayashi M. Effects of carbonated beverages on sustained swallowing behavior changes in older inpatients. Physiol Behav 2023; 265:114172. [PMID: 36965570 DOI: 10.1016/j.physbeh.2023.114172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/23/2022] [Accepted: 03/21/2023] [Indexed: 03/27/2023]
Abstract
Sensory stimulation, including stimulation with carbonated liquids, has been known to influence swallowing activity. The aim of this study is to determine the effect of sustained changes in the swallowing behavior of hospitalized patients without dysphagia using the cervical auscultatory recordings of swallowing sounds. The study participants were hospitalized older adults without dysphagia. The participants were asked to initially swallow water and then a carbonated beverage. The sustained effects of the carbonated beverage in relation to swallowing movements were evaluated by measuring the swallowing sounds at the following time periods: (1) immediately and (2) at 1 to 9 minutes with intervals of 2 minutes after swallowing the carbonated beverage. The swallowing sounds before and after swallowing the same volume of water were also measured and compared on a different day. Analysis was performed to calculate the time from a sound signal to the beginning of the swallowing sound. Significant shortening of the swallowing sound time of the late pharyngeal phase was observed up to 7 minutes after swallowing the carbonated beverage, except during the 3 minutes after swallowing. Shortening of the whole swallowing sound time was observed only immediately after swallowing the carbonated beverage. Regarding the shortening of the acoustic signal in the late pharyngeal period, the effect of cerebral excitability changes due to carbonic acid stimulation was considered.
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Affiliation(s)
- Motoyoshi Morishita
- Department of Physical Therapy, Kibi International University, 8, Iga-machi, Takahashi, Okayama 716-8508, Japan.
| | - Junya Sota
- Rehabilitation Center, Watanabe Hospital, Shiseikai Medical Corporation, 2278-1, Takao, Niimi, Okayama 718-0003, Japan
| | - Mariko Kobayashi
- Rehabilitation Center, Watanabe Hospital, Shiseikai Medical Corporation, 2278-1, Takao, Niimi, Okayama 718-0003, Japan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Michou E, Hamdy S. Reversal of the effects of focal suppression on pharyngeal corticobulbar tracts by chemesthesis coupled with repeated swallowing. Neurogastroenterol Motil 2022; 34:e14286. [PMID: 34729879 DOI: 10.1111/nmo.14286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/27/2021] [Accepted: 10/12/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Previous reports suggested the potential benefit of chemesthesis in the form of carbonated water (CW) integrated within dysphagia rehabilitation protocols. Here, we examined the effects of CW within a repeated swallowing protocol following focal suppression to pharyngeal cortical representation as a prelude to its application in dysphagic patients. METHODS Fourteen healthy volunteers participated in a 3-arm study. Each participant underwent baseline corticobulbar pharyngeal and thenar motor-evoked potential (MEP) measurements with Transcranial Magnetic Stimulation (TMS). Subjects were then conditioned with 1Hz repetitive (r)TMS to induce focal unilateral suppression of the corticopharyngeal hotspot before randomization to each of three arms with 40 swallows of CW, non-CW and saliva swallowing on separate days. Corticobulbar and thenar MEPs were collected for up to 1 h and analyzed using repeated measures (rm)ANOVA. RESULTS A 2-way rmANOVA for Intervention x Time showed a significant effect of Intervention (F(1,13) = 7.519, p = 0.017) in both ipsi- and contra-lesional corticopharyngeal projections. Carbonation showed superiority in facilitating change by increasing pharyngeal cortical MEPs compared to non-CW (z = -3.05, p = 0.002) and saliva swallowing (z = -2.6, p = 0.008). No change in thenar representation (control) was observed nor in MEP latencies from both pharyngeal and thenar musculature. CONCLUSIONS We conclude that interventional paradigms with CW have the capacity to reverse the effects of a focal suppression with 1Hz rTMS more strongly than non-CW or saliva swallowing alone, producing site specific bi-hemispheric changes in corticopharyngeal excitability. Our data suggest that carbonation produces the effects through a mainly cortical mechanism.
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Affiliation(s)
- Emilia Michou
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, Clinical Sciences Building, Salford Royal Hospital, University of Manchester, Salford, UK.,Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, Clinical Sciences Building, Salford Royal Hospital, University of Manchester, Salford, UK
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Magara J, Onuki W, Ita R, Tsujimura T, Inoue M. Chewing modulates the human cortical swallowing motor pathways. Physiol Behav 2022; 249:113763. [PMID: 35219703 DOI: 10.1016/j.physbeh.2022.113763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 01/12/2023]
Abstract
When eating, mastication is always followed by swallowing. The present study assessed the effect of mastication on swallowing-related neural pathways in humans. Twenty healthy volunteers participated and underwent baseline transcranial magnetic stimulation to evaluate cortico-pharyngeal and cortico-hand motor-evoked potentials (MEPs). Next, they performed a chewing task and a swallowing task. Repeated-measures ANOVA revealed that pharyngeal MEPs were significantly higher after the swallowing task than after the chewing task, even though the number of swallows across tasks was matched. This implies that chewing movements suppress swallowing-related activity in the pharyngeal motor circuit.
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Affiliation(s)
- Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Japan.
| | - Wakana Onuki
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Reiko Ita
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Japan
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Cheng I, Hamdy S. Metaplasticity in the human swallowing system: clinical implications for dysphagia rehabilitation. Neurol Sci 2022; 43:199-209. [PMID: 34654983 DOI: 10.1007/s10072-021-05654-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Chen YJ, Chen YT, Lin LC, Chen SC, Wang CT, Hsieh CM. Effects of Olfactory Stimulation on Swallowing Function in Taiwanese Older Adults. Gerontol Geriatr Med 2021; 7:23337214211015449. [PMID: 34104681 PMCID: PMC8155783 DOI: 10.1177/23337214211015449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/26/2021] [Accepted: 04/01/2021] [Indexed: 11/21/2022] Open
Abstract
This pretest-posttest pilot study was to examine the effects of how
olfactory stimulation (OS) influenced swallowing function in older
adults. Forty-four community-dwelling older residents (24 OS & 20
control) from southern Taiwan were recruited. Participants in the
intervention group administered pre-meal OS using odor and flavor
inhalation. The study found that physiological responses for different
food textures significantly differed between groups at post-test
(p ≤ .02). Within the
experimental group, swallowing function, and individual satisfaction
showed significant differences before and after the odor inhalation
over time (p < .01, ηp2 = 0.16–0.33). An individual’s satisfaction to their
own swallowing capacity was largely enhanced by the significant
interaction between time and group (F[1, 42] = 11.34,
p = .002, ηp2 = 0.21), but not for physiological response to OS
and swallowing function. The results suggest OS may be advantageous to
improving physiological response to OS, swallowing function and
satisfaction with swallowing capacity in older adults.
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Affiliation(s)
- Yea-Jyh Chen
- University of North Carolina at Wilmington, Wilmington, USA
| | - Yea-Tzy Chen
- National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,University of Taipei, Taipei, Taiwan
| | - Li-Chu Lin
- Cathay General Hospital (Sijhih Branch), Taipei, Taiwan
| | - Su-Chiu Chen
- National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chi-Te Wang
- University of Taipei, Taipei, Taiwan.,Far Eastern Memorial Hospital, New Taipei, Taiwan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Iida T, Kothari M, Sekihata S, Shimada A, Komiyama O, Svensson P. Plasticity in corticomotor pathways linked to a jaw protrusion training task: Potential implications for management of patients with obstructive sleep apnea. Brain Res 2020; 1749:147124. [DOI: 10.1016/j.brainres.2020.147124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/20/2020] [Accepted: 09/08/2020] [Indexed: 12/13/2022]
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Takeuchi C, Takei E, Ito K, Kulvanich S, Magara J, Tsujimura T, Inoue M. Effects of Carbonation and Temperature on Voluntary Swallowing in Healthy Humans. Dysphagia 2020; 36:384-392. [PMID: 32556801 DOI: 10.1007/s00455-020-10147-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/08/2020] [Indexed: 02/07/2023]
Abstract
We investigated how swallowing behaviors are affected by the temperature and carbonation of water in healthy humans. Twenty-nine healthy volunteers were instructed to drink as much natural water, carbonated water, or cider as they wanted, and we recorded the volume of solution swallowed and electromyographic (EMG) activity of the masseter and suprahyoid muscles. Sensory tests regarding the ease of holding the solution in the mouth and ease of swallowing were also performed. The volume of carbonated water swallowed was significantly lower than that of natural water and cider. The ease of holding and swallowing the solution significantly differed between solution types such that natural water was the easiest solution to hold and swallow, followed by cider and then carbonated water in both tests. EMG activity was also affected by the solution type. Masseter EMG activity was significantly lower when swallowing natural water compared with carbonated water. Suprahyoid EMG activity was significantly lower when swallowing natural water compared with carbonated water and cider. The volume of solution swallowed was significantly correlated with the ease of holding and swallowing the solution, but not with masseter or suprahyoid EMG activities. The ease of holding and swallowing the solution significantly affected masseter and suprahyoid EMG activities. The results suggested that when participants experienced difficulty holding and swallowing the solution, masseter and suprahyoid EMG activity increased. Considering our findings that mechanical stimulation with bubbles decreased the volume of solution swallowed and increased EMG activities, carbonated water swallowing may be useful in treating deglutition disorders.
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Affiliation(s)
- Chikako Takeuchi
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Eri Takei
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Kayoko Ito
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Sirima Kulvanich
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan.
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da Rosa FB, Pasqualoto AS, Steele CM, Mancopes R. Oral and Oropharyngeal Sensory Function in Adults With Chronic Obstructive Pulmonary Disease. Am J Speech Lang Pathol 2020; 29:864-872. [PMID: 32202915 DOI: 10.1044/2019_ajslp-19-00095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Introduction The oral cavity and pharynx have a rich sensory system composed of specialized receptors. The integrity of oropharyngeal sensation is thought to be fundamental for safe and efficient swallowing. Chronic obstructive pulmonary disease (COPD) patients are at risk for oropharyngeal sensory impairment due to frequent use of inhaled medications and comorbidities including gastroesophageal reflux disease. Objective This study aimed to describe and compare oral and oropharyngeal sensory function measured using noninstrumental clinical methods in adults with COPD and healthy controls. Method Participants included 27 adults (18 men, nine women) with a diagnosis of COPD and a mean age of 66.56 years (SD = 8.68). The control group comprised 11 healthy adults (five men, six women) with a mean age of 60.09 years (SD = 11.57). Spirometry measures confirmed reduced functional expiratory volumes (% predicted) in the COPD patients compared to the control participants. All participants completed a case history interview and underwent clinical evaluation of oral and oropharyngeal sensation by a speech-language pathologist. The sensory evaluation explored the detection of tactile and temperature stimuli delivered by cotton swab to six locations in the oral cavity and two in the oropharynx as well as identification of the taste of stimuli administered in 5-ml boluses to the mouth. Analyses explored the frequencies of accurate responses regarding stimulus location, temperature and taste between groups, and between age groups ("≤ 65 years" and "> 65 years") within the COPD cohort. Results We found significantly higher frequencies of reported use of inhaled medications (p < .001) and xerostomia (p = .003) in the COPD cohort. Oral cavity thermal sensation (p = .009) was reduced in the COPD participants, and a significant age-related decline in gustatory sensation was found in the COPD group (p = .018). Conclusion This study found that most of the measures of oral and oropharyngeal sensation remained intact in the COPD group. Oral thermal sensation was impaired in individuals with COPD, and reduced gustatory sensation was observed in the older COPD participants. Possible links between these results and the use of inhaled medication by individuals with COPD are discussed.
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Affiliation(s)
- Fernanda Borowsky da Rosa
- Graduate Program of Human Communication Disorders, Dysphagia Laboratory, Federal University of Santa Maria, Rio Grande do Sul, Brazil
| | - Adriane Schmidt Pasqualoto
- Graduate Program of Human Communication Disorders, Dysphagia Laboratory, Federal University of Santa Maria, Rio Grande do Sul, Brazil
- Department of Physiotherapy, Federal University of Santa Maria, Rio Grande do Sul, Brazil
| | - Catriona M Steele
- Swallowing Rehabilitation Research Laboratory, KITE, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Department of Speech-Language Pathology, Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Renata Mancopes
- Graduate Program of Human Communication Disorders, Dysphagia Laboratory, Federal University of Santa Maria, Rio Grande do Sul, Brazil
- Swallowing Rehabilitation Research Laboratory, KITE, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
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Iida T, Komoda Y, Kothari M, Sekihata S, Komiyama O, Sessle B, Svensson P. Combination of jaw and tongue movement training influences neuroplasticity of corticomotor pathways in humans. Exp Brain Res 2019; 237:2559-71. [PMID: 31346648 DOI: 10.1007/s00221-019-05610-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 07/18/2019] [Indexed: 01/30/2023]
Abstract
Since humans in daily life perform multiple motor behaviors that often involve the simultaneous activation of both jaw and tongue muscles, it is essential to understand the effects of combined orofacial sensorimotor tasks on plasticity in corticomotor pathways. Moreover, to establish novel rehabilitation programs for patients, it is important to clarify the possible interrelationships in corticomotor excitability between jaw and tongue motor control. The aim of this study was to examine the effect of a combination of a repetitive tooth bite task (TBT) and a repetitive tongue lift task (TLT) on corticomotor excitability of the tongue and jaw muscles as assessed by transcranial magnetic stimulation (TMS). Sixteen healthy individuals participated in three kinds of training tasks consisting of 41-min TBT, 41-min TLT, and 82-min TBT + TLT. Motor-evoked potentials (MEPs) from the tongue muscle, masseter muscle, and first dorsal interosseous muscle were measured before and after the training tasks. The amplitude of tongue MEPs after training with TLT and TLT + TBT, and masseter MEPs after training with TBT and TLT + TBT, were significantly higher than before training (P < 0.05). Tongue MEPs and masseter MEPs were significantly higher after TLT + TBT than after TBT or TLT (P < 0.05). The present results suggest that a task combining both jaw and tongue movement training is associated with a greater degree of neuroplasticity in the corticomotor control of jaw and tongue muscles than either task alone.
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Kawakami M, Simeoni S, Tremblay S, Hannah R, Fujiwara T, Rothwell JC. Changes in the Excitability of Corticobulbar Projections Due to Intraoral Cooling with Ice. Dysphagia 2019; 34:708-712. [PMID: 30617523 DOI: 10.1007/s00455-018-09975-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 12/31/2018] [Indexed: 11/26/2022]
Abstract
The aim of this study was to assess the effects of ice applied to the oral cavity on the excitability of corticobulbar projections to the swallowing muscles. The subjects were 8 healthy adult volunteers (mean age 29.0 ± 4.9 years). Motor-evoked potentials (MEPs) were recorded from the suprahyoid muscle complex using surface electrodes. Two blocks of 20 MEPs with a test stimulus intensity of 120% of the resting motor threshold were recorded at rest (baseline). Subjects then underwent 5-min thermal stimulation by either of 3 different types: (1) "ice-stick inside mouth," (2) "ice-stick on neck," and (3) "room temperature inside mouth." Blocks of 20 MEPs were then recorded immediately and at 5-min intervals for the following 15 min. There was a significant difference in the effects of the 3 interventions on the amplitude of the MEPs following stimulation (two-way ANOVA: INTERVENTION × TIME; F8,84 = 3.76, p < 0.01). One-way ANOVA was used to evaluate the changes over time for each intervention type. Only "ice-stick inside mouth" caused an increase in the MEPs (one-way ANOVA main effect of TIME: F4,28 = 4.04, p = 0.010) with significant differences between baseline and P10 (mean difference 0.050; confidence interval (CI) 95% 0.019-0.079; p = 0.004). There were no significant effects of either "ice-stick on neck" or "room temperature inside mouth" (F4,28 = 1.13, p = 0.36; F4,28 = 1.36, p = 0.27, respectively). Ice stimulation within the oral cavity increases the excitability of the cortical swallowing motor pathway.
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Affiliation(s)
- Michiyuki Kawakami
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK.
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Sara Simeoni
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Sara Tremblay
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Ricci Hannah
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Toshiyuki Fujiwara
- Department of Physical Medicine and Rehabilitation, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
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