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At least 505 records · Page 28Linked to original sources
PubMed2005

Comparison of clinician judgments and measurements of swallow response time: a preliminary report.

Practicing clinicians frequently offer judgments about aspects of swallowing physiology rather than performing actual measurements. Little is known about the accuracy of those judgments. The purpose of this preliminary study was to explore agreement of clinicians' judgments of pharyngeal swallow response time (PSRT) with temporal measurements of PSRT. In preparation for a larger study, PSRT was measured from the first 3 ml liquid bolus swallow that appeared in each of 20 videofluorographic swallowing evaluations. The same 20 swallows were then shown to 3 clinicians who were instructed to subjectively rate PSRT. The reliability of the PSRT measurements was strong (r > .95). Intrajudge and interjudge agreement was better than chance in all but 1 interjudge comparison. Percentage agreement between clinicians' judgments and the measurements, when the measurements were categorized as either not delayed or delayed, ranged from 60% to 95%. Chi-square and Phi statistics comparing the outcomes of clinicians' ratings with the measurement outcomes were significant, supporting the agreement of the judgments with the measurements. Although the results of tests of agreement were found to be acceptable, clinician experience and training remain important issues whenever clinical judgments are involved. Larger studies are needed to establish the accuracy and importance of clinicians' judgments of PSRT and observations of swallowing physiology.

Adult↗
PubMed2006

Biomechanical correlates of surface electromyography signals obtained during swallowing by healthy adults.

PURPOSE: The purpose of this study was to describe biomechanical correlates of the surface electromyographic signal obtained during swallowing by healthy adult volunteers. METHOD: Seventeen healthy adults were evaluated with simultaneous videofluoroscopy and surface electromyography (sEMG) while swallowing 5 mL of liquid barium sulfate. Three biomechanical swallowing events were analyzed: hyoid elevation, pharyngeal constriction, and opening-closing of the pharyngoesophageal segment. For each biomechanical event and from the sEMG signal, the authors identified onset, peak, and offset time points. From these points, duration measures were calculated. Means and 95% confidence intervals were calculated for each measure. Subsequently, correlations were evaluated between timing aspects of the sEMG traces and each biomechanical event. RESULTS: Swallow onset in the sEMG signal preceded the onset of all biomechanical events. All biomechanical events demonstrated a strong correspondence to the sEMG signal. The strongest relationship was between hyoid elevation-anterior displacement and the sEMG signal. CONCLUSIONS: These results suggest that the sEMG signal is a useful indicator of major biomechanical events in the swallow. Future studies should address the impact of age and disease processes, as well as bolus characteristics, on the biomechanical correlates of sEMG signals obtained during swallowing.

Adult↗
PubMed1998

Lingual action in normal sequential swallowing.

Current knowledge about the flexibility in lingual motor control and performance during swallowing is incomplete. The present study aimed at gaining a better understanding of the tongue's motor flexibility and at identifying variable versus invariant lingual motor program parameters in light of changing swallowing task demands (discrete vs. sequential). Specifically, the timing and patterns of tongue-palate contact and the associated changes in tongue shape and action were examined in 5 normal adults using simultaneous electropalatography and ultrasound. Tasks for discrete swallowing included 5 and 30 cc of water; tasks for sequential swallowing involved drinking 200 cc of water at normal and fast rates. Results showed little variation in propulsive contact pattern as a function of task or subject. However, the tongue demonstrated shorter movement duration and overlapping gestures during sequential swallowing. Thus, continuous drinking was performed without changes in motor strategies per se but with changes in the timing coordination of the "drink" and "swallow" action sequences. These findings support the theory that the deglutitive lingual motor program has both invariant and variant parameters, and that movement pattern and action sequence reflect fixed elements within the structure of the motor program, but movement timing can be modified according to the demands of the task at hand.

Adult↗
PubMed2000

Motor strategy in rapid sequential swallowing: new insights.

This study examined the physiological properties and movement strategies of normal, rapid sequential swallowing during simultaneous videofluoroscopy (VFS) and submental surface electromyography (EMG). Ten subjects performed discrete (5 and 15 cc) and sequential (150 cc in tilted and upright head postures) swallowing tasks. Analyses included VFS event timing, movement/bolus passage characteristics, EMG amplitude waveforms, and peak and offset EMG amplitudes. Results revealed that sequential swallows were significantly shorter than discrete swallows in several VFS event durations, but significantly longer in pharyngeal transit and stage transition times. The hyolaryngeal system exhibited a cyclical "rise and partial fall" movement pattern during sequential swallows on VFS, corresponding to a repetitive "activation and partial deactivation" characteristic on EMG. Greater peak EMG amplitude for sequential than discrete swallows was found in 6/10 subjects. Pharyngeal bolus merging, preparatory laryngeal gestures, and penetration without aspiration were also observed in some subjects on VFS. Intersubject differences were significant in timing measures and EMG amplitude. Our findings of individual variability and subject-specific strategies for task accommodation support the notion of built-in plasticity in the deglutitive motor complex.

Adult↗
PubMed1996

Oropharyngeal accommodation to swallow volume.

BACKGROUND & AIMS: The oropharyngeal swallow accommodates a range of bolus volumes with substantial impact on its dynamic radiographic appearance despite being a nearly reflexive sequence. The aim of this study was to analyze the mechanism of volume accommodation. METHODS: Coordination of the glossopalatal junction, velopharyngeal junction, laryngeal vestibule, and upper esophageal sphincter (UES) and intraluminal pharyngeal dimensions were measured from biplane videofluoroscopic swallowing studies in 8 volunteers during 1- and 20-mL swallows. These measurements were applied to three-dimensional reconstructions of the pharyngeal swallow, permitting analysis of their effect on intraluminal volume and propulsive function. RESULTS: Dividing the pharyngeal swallow into periods of reconfiguration, sustained reconfiguration, and offset of reconfiguration, volume accommodation occurred by a 0.2-second prolongation of reconfiguration, preserving the coordination of the onset and offset events. Augmented reconfiguration increased the dimensions of the pharyngeal chamber, caused more rapid bolus expulsion, and increased UES distention. However, maximal transphincteric flow per unit area across the UES was constant, showing its compliance. CONCLUSIONS: Volume accommodation is accomplished by augmenting and prolonging pharyngeal reconfiguration from a respiratory to deglutitive pathway. This modification in the timing of neurally mediated events is amplified by its mechanical consequences, resulting in the different cineradiographic appearance and propulsive attributes of large and small volume swallows.

Adult↗
PubMed2003

Evaluation of swallowing function after intraoral soft tissue reconstruction with microvascular free flaps.

This study assessed swallowing function after tumour resection and reconstruction utilizing free vascularized flap closures in patients with oral cancer. Swallowing function was evaluated postoperatively in 23 patients (21 men and 2 women) who had undergone reconstruction with either a lateral upper arm free flap (LUFF, n=16) or a radial forearm free flap (RFFF, n=7). Videofluoroscopy was used to assess tongue mobility and abnormalities of swallowing function. All patients who underwent reconstruction with LUFF or RFFF free flaps had decreased tongue mobility, except for the tip of the tongue. Patients who underwent anterior or posterior resection had greater decreases in tongue mobility than those who underwent medial resection. Swallowing impairment was similar in patients with LUFFs and those with RFFFs. Anterior resection of the oral cavity had a significant negative effect on swallowing function. Silent aspiration occurred in five patients. In conclusion the resection site affected swallowing function, but the type of flap did not, in patients with oral carcinoma, who underwent tumour resection with reconstruction

Adult↗
PubMed2001

Relationship between the size of neopharynx after laryngectomy and long-term swallowing function: an assessment by scintigraphy.

OBJECTIVES: To study the relationship between the size of neopharynx after total laryngectomy and long-term swallowing function by means of scintigraphy. STUDY DESIGN: The width of pharyngeal remnant was measured during surgery in 11 patients. Their swallowing function was assessed by scintigraphy 8 to 10 years after surgery. METHODS: The width of pharyngeal remnant at its narrowest point in both relaxed and stretched state was measured during surgery. Postoperative scintigraphy data on swallowing were obtained and computed along 3 lines, (1) transit time through neopharynx, (2) percentage of bolus transferred, and (3) swallowing efficiency. The relationship between the 2 sets of data was analyzed by linear regression analysis. RESULTS: (1) No statistically significant relationship was found between the size of neopharynx and swallowing function. (2) All patients are clinically asymptomatic. CONCLUSIONS: The swallowing function is not affected by the size of the neopharynx in 11 patients with pharyngeal remnant width ranging from 3 to 8 cm (stretched).

Aged↗
PubMed2006

Effect of teeth clenching on swallowing motor patterns in humans.

The purpose of this study was to investigate the effect of teeth clenching on swallowing motor patterns. Seven healthy humans participated in this study. Electromyograms (EMGs) were recorded from the right masseter muscle, the suprahyoid muscles, and the right infrahyoid muscles. Three motor tasks were performed while the EMGs were recorded: swallowing without teeth clenching, and two tasks of swallowing with teeth clenching, one with masseter EMG activity at 20% of maximum, and one with masseter EMG activity at 40% of maximum. The duration of suprahyoid EMG activity with teeth clenching was significantly longer than that without teeth clenching. The duration of infrahyoid EMG activity with teeth clenching was significantly shorter than that without teeth clenching. The whole duration of swallowing with teeth clenching was significantly shorter than that without teeth clenching. Teeth clenching changes the swallowing motor pattern, indicating that activity of the masticatory center affects activity of the swallowing center.

Adult↗
PubMedDate not supplied

Elevation of the soft palate in speech and swallowing in normal female participants and females with motor neuron disease: an innovative procedure for measuring palatal elevation.

The aim was to measure the angle of elevation of the soft palate during the separate conditions of swallowing of pudding, swallowing of liquid and during production of 'may/pay', using videofluroscopy and innovative computer software. We then determined whether soft palate elevation (as reflected in measures of an angle) differed in those separate conditions. Twelve female participants were studied, aged 40-70 years. The trends observed were that the highest soft palate elevation was displayed in the liquid-swallowing condition and the lowest soft palate elevation was displayed in the speech conditions. The results did not reach statistical significance, but the findings support the suggestions of Rubesin et al. (1987) and Fritzell (1969) that soft palate elevation is higher during swallowing than during speech. This same method was then used to measure soft palate elevation under the same three conditions in nine females, all aged > 40 years, who had motor neuron disease. Again, the highest soft palate elevation was displayed when swallowing liquid, but this time the lowest elevation occurred when swallowing pudding. Owing to small numbers, results did not reach statistical significance, but the trends may be important to replicate in a larger study. This pilot study developed a comprehensive and accurate method of measuring the soft palate elevation using digitization and computer software.

Adult↗
PubMed1994

An analysis of studies comparing electrical impedance tomography with x-ray videofluoroscopy in the assessment of swallowing.

Electrical impedance tomography can be used to record the conductivity change occurring in the neck during a swallow. X-ray videofluoroscopy provides excellent anatomical detail of the structures involved in swallowing and of the position of the swallowed bolus. The two techniques have been performed simultaneously on seven patients with swallowing problems to establish what produces the peak change in conductivity when a solution of low conductivity is swallowed. The results suggest that the exclusion of air from the larynx and pharynx is the major factor influencing the change in conductivity when a solution of low conductivity is swallowed.

Deglutition↗
PubMed1994

Asymptomatic swallowing disorders in elderly patients with Parkinson's disease: a description of findings on clinical examination and videofluoroscopy in sixteen patients.

We sought to ascertain whether patients with Parkinson's disease without symptoms of dysphagia have abnormalities of swallowing, and to describe the characteristics as seen on clinical examination and videofluoroscopy. Patients with stable Parkinson's disease were interviewed for symptoms of dysphagia and 16 asymptomatic patients were enrolled. Whilst on their usual medication, an examination of facial, tongue and palatopharyngeal musculature was made, and a modified barium swallow performed. All patients had at least one abnormality on videofluoroscopic examination of their swallowing. Three patients showed aspiration and 14 had evidence of vallecular residue considered a risk for aspiration. Oropharyngeal transit time was invariably prolonged as was delay in the initiation of swallow. The majority of patients also demonstrated an increased number of tongue elevations and number of swallows to clear their pharynx of the bolus. Despite having no symptoms of dysphagia, the patients demonstrated widespread abnormalities of swallowing.

Aged↗
PubMed2006

Hard to swallow: dysphagia in Parkinson's disease.

BACKGROUND: swallowing changes occur from the earliest stages of Parkinson's disease (PD), even in cases asymptomatic for dysphagia. Little empirical evidence exists concerning the individual's own perception of changes, the impact these have on their life and coping strategies to deal with them. OBJECTIVE: to establish if and how changes in swallowing impact on the lives of people with PD. DESIGN: in-depth interviews with qualitative analysis of content. SETTING: community. SUBJECTS: a total of 23 men and 14 women and their carers. METHODS: participants were purposively sampled to give a mix of men, women, family circumstances, stage and duration of PD and severity of swallowing symptoms. Individuals were interviewed at home. Interviews were transcribed. Emergent themes were identified and fed back to participants for confirmation and clarification. RESULTS: two broad themes emerged: (i) effects on swallowing of underlying physical changes, with subthemes of oral-pharyngeal-laryngeal changes, manual changes, effects of fatigue and (ii) psychosocial impact, with subthemes of alterations to eating habits, feelings of stigma, need for social adjustment and carers' issues. Coping strategies could aid swallowing problems but often to the detriment of others in the family through altered demands on preparation and organisation. Presence of significant impact was not necessarily associated with abnormal range scores on objective swallowing assessments. CONCLUSIONS: the psychosocial consequences of the physical changes concerned people most. The importance of the early detection of changes for health and quality of life is underlined.

Aged↗
PubMed2006

The influence of taste on swallowing apnea, oral preparation time, and duration and amplitude of submental muscle contraction.

Prior research has documented a modulating effect of taste on swallowing. We hypothesized that presentation of tastant stimuli would be a significant variable in swallowing-respiratory coordination, duration of oral bolus preparation, and submental muscle contraction. Twenty-three healthy females were presented with 1-cm(3) gelatin samples flavored with 4 tastants of increasing intensities. Visual analogue scale ratings of perceived intensity of each were used to identify relative equivalent concentrations across the 4 tastants. Data were then collected during ingestion of 5 trials of the 4 equivalent tastants using measurements of nasal airflow and submental surface electromyography (sEMG) to record biomechanical measures. Chi-square analysis failed to identify a statistically significant influence of taste on the phase location of swallowing apnea. Repeated measures analysis of variance demonstrated significant taste effects for oral preparation time, submental sEMG amplitude, and duration (P < 0.02). Sweet tastants were prepared for a shorter time when compared with bitter tastants. Swallow duration for sour, salty, and bitter tastants were longer than sweet and neutral tastants. Sour tastants resulted in the greatest amplitude of submental muscle contraction during swallowing. This study supports existing research that found that sour substances were swallowed with more effort when compared with other tastes.

Adult↗
PubMed2003

Differential diagnosis between infantile and mature swallowing with ultrasonography.

In order to investigate the difference in tongue movement between visceral (infantile) and somatic (mature) swallowing patterns, 12 visceral (seven females, five males) and 14 somatic (eight females, six males) swallowers were examined with the B+M-mode ultrasound technique. Movements of the tongue tip and submental musculature during swallowing were recorded on video cassette and evaluated with a personal computer. The results demonstrated that the tongue dorsal surface, which was thought to be ideal for observing tongue function, was not suitable for differentiating between visceral and somatic swallowing patterns. Conversely, the movements of the genioglossus muscle were found to be identical within groups but significantly different (P < 0.01) from each other between the two swallowing patterns. Therefore, the genioglossus muscle can serve as a reliable means for differentiating between visceral and somatic swallowers.

Adolescent↗
PubMed1993

Pharyngeal swallowing. The major factor in clearance of esophageal reflux episodes.

OBJECTIVE: This study defined the clearance mechanisms of naturally occurring reflux episodes in normal subjects and patients with gastroesophageal reflux disease. SUMMARY BACKGROUND: Previous studies on acid clearance have been performed in the laboratory setting in supine subjects using acid instillation and stationary motility. The mechanisms of clearance have not been studied using ambulatory pH and motility monitoring. METHODS: A new system capable of monitoring simultaneously for 24 hours pharyngeal pressure, esophageal motility, and pH was used to study the clearance of naturally occurring reflux episodes in 10 normal subjects and 18 patients with gastroesophageal reflux disease. Esophageal contraction waves were classified as primary (i.e., initiated by a pharyngeal swallow) and secondary (i.e., unrelated to a pharyngeal swallow). RESULTS: A total of 1288 reflux episodes were analyzed, during which 2781 contraction waves occurred. Clearance (i.e., restoration of pH to > 4) occurred after primary peristalsis in 83% of reflux episodes. An additional 11% were cleared by pharyngeal swallows without an esophageal body response. Secondary waves were rare and when they occurred, only 19% were peristaltic. Secondary peristalsis cleared only 9 of the 1288 reflux episodes. Patients and normal subjects cleared reflux episodes similarly. Baseline swallowing frequency was 0.87/min during the daytime and increased to 2.59/min (p < 0.01) during daytime reflux episodes. Swallowing frequency in response to nighttime reflux episodes was less (1.42/min; p < 0.05). CONCLUSIONS: Pharyngeal swallowing is the most important mechanism for esophageal acid clearance. Secondary waves are rare, usually disorganized, and unimportant in clearing a reflux episode. During sleep, the mechanisms of clearance are depressed.

Adolescent↗
PubMed2002

Swallowed ocular prostheses: report of three cases in children with retinoblastoma.

PURPOSE: To report 3 instances of 2 children who swallowed their ocular prostheses. METHODS: A 30-month-old boy whose eye had been enucleated for retinoblastoma swallowed his ocular prosthesis on 2 different occasions, and a 32-month-old boy whose eye had also been enucleated for retinoblastoma swallowed his ocular prosthesis once. RESULTS: In the second child, an abdominal radiograph was obtained, but the swallowed prosthesis was not apparent, and radiographic imaging of the recovered prosthesis failed to demonstrate an identifiable object. In each case, the prosthesis was recovered in the child's stool without incident several weeks later. Neither child had physical complications as a result of the swallowing events. CONCLUSIONS: We report 3 instances in which a child fitted for an ocular prosthesis after enucleation swallowed his prosthesis and had no untoward effects. The failure of imaging to detect the prostheses in the second child is attributed to the radiolucent nature of materials used in the manufacture of the prosthesis. Each of the children was having life stresses in addition to his medical treatment that may have accounted for his behavior.

Child, Preschool↗
PubMed1995

Alteration in swallowing reflex after extubation in intensive care unit patients.

OBJECTIVES: To assess the swallowing reflex after prolonged endotracheal intubation and to assess the influence of age and duration of intubation on this reflex. DESIGN: Prospective, observational, clinical study. SETTING: The intensive care unit of a university teaching hospital. PATIENTS: The swallowing reflex was studied after extubation in 34 patients and compared with the deglutition in 30 nonintubated patients with a nasogastric tube and 15 nonintubated patients without a nasogastric tube. INTERVENTIONS: Four volumes of normal saline (0.25, 0.50, 0.75, and 1 mL) were injected at the epipharynx level. Swallowing efficiency was assessed by the latency between instillation and the first swallow, as identified on a submental electromyogram. The tests were performed immediately (day 0), and at 1 (day 1), 2 (day 2), and 7 (day 7) days after extubation in the intubated group. Nonintubated patients were tested once. MEASUREMENTS AND MAIN RESULTS: On day 0, the latency was increased for each bolus in the extubated group when compared with the control groups. Significant shortening of latency after 0.50, 0.75, and 1 mL injections of normal saline occurred on days 1 and 2 when compared with day 0, whereas no change was observed after 0.25 mL of normal saline was injected. On day 7, a significant improvement was observed, regardless of the volume injected. There was no correlation between swallowing latency and either the age of the patients or the duration of endotracheal intubation. CONCLUSIONS: These data indicate that prolonged endotracheal intubation impairs the swallowing reflex, with improvement within 1 wk. This phenomenon could contribute to microinhalations and aspiration pneumonia after extubation.

Aged↗
PubMed1985

Normal erect swallowing. Normal function and incidence of variations.

Of 871 candidates presenting for upper gastrointestinal examinations, 16 met the rigorous criteria established for selecting asymptomatic normal volunteers. Frame-by-frame evaluation of their videorecorded pharyngeal swallow confirmed many observations made previously utilizing cine recording at much higher radiation dosages. In addition, new observations were made: the nasopharynx may not occlude until the bolus is entirely within the pharynx; air mixes with the bolus if the swallow is an "open" type; the epiglottis always inverts in normal individuals regardless of the type of swallow ("open," air filled oro-and hypopharynx into which the swallowed bolus is dropped; "closed," airless oropharynx into which the swallowed bolus is pushed by a continuous peristaltic drive of the tongue and palate, thus reconstituting the pharyngeal space); laryngeal descent may aid in stripping the bolus from the pharynx; the vestibule may not completely close during the swallow and the larynx can still be impervious to the bolus; the peristaltic wave does not begin until the bolus has breeched the cricopharyngeus; the cricopharyngeus may be seen frequently in normal individuals, but does not delay the passage of the bolus; asymmetric flow of the bolus around the larynx is common and may not be the result of epiglottic tilt or head positioning.

Adolescent↗