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At least 667 records · Page 37Linked to original sources
PubMed1996

The cushion scanning technique: a method of dynamic tongue sonography and its comparison with the transducer-skin coupling scanning technique during swallowing.

RATIONALE AND OBJECTIVES: We describe the cushion scanning technique (CST), which solves common difficulties encountered during ultrasound investigations of swallowing. These problems arise when the transducer is held in direct contact with the submental area. Some of these problems include movements of the ultrasound transducer during swallowing and compression of the submental region, which causes abnormal swallowing patterns. METHODS: To compare ultrasound images produced with the conventional hand-held transducer-skin coupling scanning technique with the CST, we studied five participants with no clinical signs of tongue dysfunction. All tongue movements were recorded by real-time B+M-mode sonography. RESULTS: Images produced with the hand-held transducer were found to be unstable because the transducer moved during swallowing, thereby changing the scanning section. By contrast, the transducer and the participant's head remained in a constant position throughout the CST trial. There was no obvious compression of the submental muscles. CONCLUSION: The CST allows for a better intraindividual reproducibility of the swallowing pattern and for a more standardized and objective ultrasound examination than the hand-held transducer-skin coupling scanning technique.

Adult↗
PubMed2003

Swallowing disorders in Parkinson's disease.

The aim of this study was to assess the reflex and oral, pharyngeal, esophageal phase of swallowing in patients with Parkinson's disease (PD). Eighteen patients with PD and 22 healthy control subjects were investigated using electromyography (EMG) and esophageal scintigraphy. This study demonstrated delayed triggering of the swallowing reflex (443+/-84 ms in patients with PD vs. 230+/-96 ms in controls, p<0.05) and prolongation of laryngeal movement (980+/-140 vs. 649+/-145 ms, p<0.05). We found prolongation of the esophageal phase of swallowing (14.46+/-5.30 vs. 7.45+/-1.64 s, p<0.001) in PD patients. The dysphagia limit i.e. the maximum amount of water swallowed at once was smaller in PD patients than in controls (6.23+/-3.67 vs. >20 ml). Dysphagia was observed in all patients studied although only 13 of them complained about it. In the remaining five cases swallowing impairment was subclinical and it consisted of decreased dysphagia limit and prolongation of the esophageal phase. Dysphagia at the subclinical level may be one of the early symptoms of PD.

Aged↗
PubMed2001

Abnormal developmental patterns of suck and swallow rhythms during feeding in preterm infants with bronchopulmonary dysplasia.

Infants with bronchopulmonary dysplasia (BFD) often have difficulty achieving coordinated suckle feeding. To analyze rhythmic differences during feeding in infants with BPD we performed weekly studies of 14 infants with BPD (eight male, six female; postmenstrual age [PMA] 32.1 to 39.7 weeks); and a PMA-matched control group without BPD (n=20), from initiation of bottle feeding until discharge, with simultaneous digital recordings of pharyngeal and nipple (teat) pressure. Unlike the control group, there was no significant correlation between PMA and stability of suckle rhythm, aggregation of suckles or swallows into runs, or length of suckle runs. Comparing those infants >35 weeks' PMA, the group with BPD had significantly decreased stability of suckle rhythm (increased coefficient of variation of suckle-suckle intervals: 0.34, SE 0.02 vs 0.254, SE 0.014; p=0.003), decreased aggregation into suckle runs (71.1, SE 3.4% vs 85.4, SE 2%;p=0.001), and decreased length of suckle runs (7.2, SE 0.9 vs 13.1, SE 1.9 suckles/run; p=0.003). Percentage of swallows in runs was also decreased in the cohort with BPD (58, SE 3.8% vs 77.2, SE 3.5%; p<0.001), as was length of swallow run (5.3, SE 0.5 vs 10.7, SE 1.1;p<0.001). Thus, in infants with BPD, anticipated maturational patterns of suckle and swallow rhythms did not occur. Delay in attainment of stable suckle and swallow rhythms in preterm infants, especially after 35 weeks' PMA, may predict subsequent feeding and neurological problems.

Bronchopulmonary Dysplasia↗
PubMed2004

Dynein light chain LC8 promotes assembly of the coiled-coil domain of swallow protein.

LC8 is a highly conserved light-chain subunit of cytoplasmic dynein that is thought to play a fundamental role in both the assembly of the motor complex and the recruitment of cargo. An interaction between LC8 and the Drosophila protein swallow has been previously characterized and supports a role for dynein in the localization of maternal morphogens during oogenesis. Swallow is required for the proper localization of bicoid mRNA, the anterior determinant that plays a critical role in establishment of the Drosophila embryonic axis. In this work, we prepared constructs of swallow, each containing a predicted coiled-coil domain and variable surrounding segments that lie within the domain proposed to interact with LC8. The interaction between LC8 and swallow domains was characterized by glutathione S-transferase (GST) pull-down assays, limited proteolysis followed by mass spectrometry, and circular dichroic spectroscopy. Hydrodynamic measurements, covalent cross-linking, and circular dichroic spectroscopy show that this domain of swallow is an unstable dimeric coiled-coil. Upon LC8 binding, however, the coiled-coil becomes significantly more stable. A possible general role for LC8 in macromolecular assembly is discussed.

Amino Acid Sequence↗
PubMed2003

Relationships among subjective and objective measures of tongue strength and oral phase swallowing impairments.

A growing literature documents the relationship between tongue strength and oral phase swallowing function. Objective measures of strength have been recommended as more valid and reliable than subjective measures for the assessment of tongue function, yet subjective measures remain the more commonly used clinical method for assessing tongue strength. This study assessed the relationships among subjective and objective measures of tongue strength and oral phase swallowing impairments. Both subjective and objective measures of tongue strength were observed to be good predictors of the presence of oral phase swallowing impairments. The specific oral phase swallowing functions of bolus manipulation, mastication, and clearance were moderately correlated with subjective ratings of tongue strength. Experienced and inexperienced raters appeared to judge tongue strength differently, with the ratings of experienced raters being more predictive of swallowing function.

Adult↗
PubMed2004

Use of electromagnetic midsagittal articulography in the study of swallowing.

The tongue functions as the primary articulator during the oropharyngeal stages of swallowing. However, detailed descriptions of the kinematics and spatiotemporal variability of tongue behaviors during swallowing are limited to a handful of analyses of data from the X-ray microbeam database. In this article, a new technique, electromagnetic midsagittal articulography (EMMA), is introduced for the high-resolution description of oral articulatory movements during swallowing. Data from 8 healthy, nondysphagic participants are used to illustrate the methods used for data collection and analysis. Movement data were collected for 3 fleshpoint positions on the tongue (blade, body, dorsum) during sequences of repeated discrete water swallows, and were characterized for variables of spatiotemporal variability and 4 discrete kinematic parameters (movement amplitude, peak velocity, duration, and kinematic stiffness). These data show that the movement trajectories measured using EMMA are consistent with descriptions from previous X-ray microbeam studies, indicating that EMMA is a feasible method for the detailed study of tongue movements during swallowing.

Adult↗
PubMed2005

Persistence of respiratory-swallowing coordination after laryngectomy.

The present study was designed to provide additional insights into the neural mechanisms underlying respiratory-swallowing coupling by studying potential alterations in movement coordination when upper airway protection is no longer necessary. Twelve laryngectomized participants, all at least 3 years postsurgery, were compared to age- and sex-matched controls. Respiration and swallowing were monitored before, during, and after mastication. No significant differences were found between the laryngectomized and normal control participants in the distribution of the respiratory phase in which swallowing occurs, our primary measure of respiratory-swallowing stability. Data suggest that the coupling between the swallowing and respiratory pattern generators is highly stable. Pronounced masticatory-related apnea was observed in 3 of the laryngectomized participants but in none of the controls, suggesting that masticatory/respiratory interactions may become abnormal in these patients.

Adult↗
PubMed1993

Speech and swallow function after tonsil/base of tongue resection with primary closure.

Speech and swallowing function was examined in 11 patients who underwent surgical resection of greater than 1 cm of tongue base, tonsil, and faucial arch with mandible resected on the side of the tumor and reconstruction by primary closure. Preoperatively and 1 and 3 months post-healing, high fidelity audio recordings were made of a 6- to 7-minute conversational speech sample, the sentence version of The Fisher Logemann Test of Articulation Competence was administered, and videofluoroscopic assessment of oropharyngeal swallow was conducted. All subjects exhibited changes in speech and swallowing function postoperatively, with little improvement during the study. Patients exhibited greatest difficulty on stop and fricative consonants and bolus propulsion. Comparison with patients who received anterior tongue and floor of mouth resections and distal flap reconstruction revealed consistently better speech performance by the tonsil/base of tongue patients, although the same phonemes were affected. Swallow function was equally affected in the two groups. Results are discussed in terms of locus of surgical resection, nature of reconstruction, and need for swallowing therapy.

Analysis of Variance↗
PubMed1995

Biomechanical analysis of the pharyngeal swallow in postsurgical patients with anterior tongue and floor of mouth resection and distal flap reconstruction.

The purpose of this study was to examine changes in the biomechanics of pharyngeal swallow after surgery in eight patients (six men and two women) with anterior tongue and floor of mouth resections with distal flap reconstruction. Eight normal age-matched subjects were also studied. Swallowing performance was assessed following a standardized protocol with videofluoroscopy preoperatively and at 1 and 3 months postoperatively for the oral cancer patients. The normal subjects received a single videofluoroscopic study. Computer-assisted biomechanical analysis was used to mark the movements of specific oropharyngeal structures over time throughout the swallow of calibrated boluses. Statistical analyses revealed that tongue base, pharyngeal wall, hyoid, laryngeal, and cricopharyngeal movements during the swallow were altered significantly after surgery for the cancer patients. Some oropharyngeal structural movements differed from those of normal control subjects before surgery. In this study, biomechanical measures indicated that there was recovery in some aspects of the pharyngeal swallow in this patient group. The duration of tongue base to pharyngeal wall contact, which was significantly reduced preoperatively and at 1 month after surgery, increased significantly to within normal levels by the 3-month postoperative evaluation. Duration of laryngeal closure and the onset of laryngeal closure relative to cricopharyngeal opening also improved significantly to within normal levels by the 3-month postoperative evaluation.

Adult↗
PubMed1995

Quantitative assessment of hyoid bone displacement from video images during swallowing.

Given the relationship between hyoid displacement and aspiration, a simple, accurate, clinically useful method for identification of reduced hyoid displacement is needed. The purpose of this investigation was to validate a quantitative method for clinically assessing hyoid bone movement during swallowing. Videofluoroscopic evaluations of 20 male subjects--10 who had been subjectively assessed as demonstrating normal hyoid displacement during swallowing, and 10 who had been subjectively assessed as demonstrating reduced displacement during swallowing--were analyzed. A video measuring gauge was used, and a software spreadsheet was developed to perform trigonometric calculations for determination of anterior/superior hyoid trajectories. Statistically significant differences were found between groups in both the anterior and superior directions of hyoid movement. No significant differences were found between liquid and paste swallows within groups. This method is simple in that it is necessary to identify only three to five points on two video images. Those values are then input onto a preprogrammed spreadsheet that automatically performs the necessary calculations. Although the present investigation focused on the movements of the hyoid bone during swallowing, this method of tracking displacement can be used for virtually any task or structure whose movements can be captured on videotape.

Deglutition Disorders↗
PubMed1998

Prognostic factors for swallowing after treatment of head and neck cancer.

In order to investigate prognostic factors for swallowing after curative treatment of head and neck cancer, the records of 82 consecutively treated patients were analysed retrospectively. All patients had an exhaustive assessment of swallowing after the oncological treatment, and all had an adequate follow-up. In general, a major improvement in swallowing was observed after rehabilitation, although some patients (9/82) still had major problems. Patients with transport problems have a significantly better prognosis than patients with aspiration. No single parameter was strongly correlated with the outcome of swallowing. A weighted score (presence/absence of pharyngeal reflexes combined with the quality of laryngeal sphincter function) was of satisfactory prognostic value for improvement in the quality of swallowing.

Adult↗
PubMed2003

Report on the determination of occlusal vertical dimension and centric relation using swallowing in edentulous patients.

When constructing a complete denture, the correct vertical dimension of occlusion (VDO) and centric relation (CR) can be difficult to determine. The aim of this study was to compare the swallowing technique used to determine the maxillomandibular relationship with a conventional technique. Fifteen edentulous patients were selected, each having a complete denture. The VDO and CR were assessed using acrylic base plates and a Boley gauge. First, the VDO was established by means of the vertical dimension of rest (VDR) and interocclusal rest space, and the CR was obtained by mandibular manipulation. Secondly, the VDO and the antero-posterior mandibular position were determined using swallowing. All measurements were repeated three times and the average was calculated. The results showed that (i). the VDO determined by means of the swallowing method was reproducible and significantly higher than the one established from the VDR (P < 0.01), and (ii). the swallowing position was located 2 mm anterior to CR (P < 0.01) and was moderately reproducible. This study suggests that swallowing can be used to determine the vertical position but no as a reference position in the sagittal plane.

Aged↗
PubMed2000

Effect of mucosal anaesthesia on oropharyngeal swallowing.

The effect of the topical anaesthesia of the oropharyngeal mucosae was studied in order to evaluate the role of the mucosal sensory receptors on the oropharyngeal swallowing in 12 adult volunteers. Laryngeal vertical movements were detected by a piezoelectric sensor and electromyography of the submental muscle complex were simultaneously recorded. All subjects were instructed to swallow doses of water, gradually increasing in quantity from 3-20 mL and any recurrence of the signals related to swallowing within 8 s was accepted as a sign of dysphagia and its limit value measured. Before the topical anaesthesia of the oropharyngeal mucosae by xylocaine puffs; the dysphagia limit was never observed with less than 20 mL water. During topical mucosal anaesthesia lasting 4-6 min among the subjects, the dysphagia limit was less than 20 mL water and the recurrence of swallows two or more times was mainly recorded with 3-5 mL water. Five of the subjects demonstrated the clinical and electrophysiological signs of laryngeal aspiration at the earlier period of the topical anaesthesia. It is concluded that the sensory inputs from the mucosal receptors are important to trigger voluntary swallowing and their absence or dysfunction may contribute to oropharyngeal dysphagia and laryngeal aspiration.

Adult↗
PubMed1997

Survival estimates for patients with abnormal swallowing studies.

OBJECTIVE: To better understand the life expectancy of patients who have an abnormal videofluoroscopic swallowing study. DESIGN: Retrospective cohort study. The common starting point was the time of the severely abnormal swallowing study. Hospital charts were reviewed for clinical variables of potential prognostic significance by reviewers blinded to the outcome of interest, survival time. SETTING: A university-affiliated, community teaching hospital. PATIENTS: One hundred forty-nine hospitalized patients who were deemed nonoral feeders based on their swallowing study. Patients excluded were those with head, neck, or esophageal cancer, or those undergoing a thoracotomy procedure. MEASUREMENTS AND MAIN RESULTS: Clinical and demographic variables and time until death or censoring were measured. Overall 1-year mortality was 62%. Multivariable Cox proportional hazards analyses identified four variables that independently predicted death: advanced age, reduced serum albumin concentration, disorientation to person, and higher Charlson comorbidity score. Eighty patients (54%) subsequently underwent placement of a percutaneous endoscopic gastrostomy (PEG) tube after their swallowing study. CONCLUSIONS: Mortality is high in patients with severely abnormal swallowing studies. Common clinical variables can be used to identify groups of patients with particularly poor prognoses. This information may help guide discussions regarding possible PEG placement.

Aged↗
PubMed2001

Quantifying swallowing function after stroke: A functional dysphagia scale based on videofluoroscopic studies.

OBJECTIVE: To develop a sensitive, specific scale for quantifying functional dysphagia in stroke patients, using results obtained from videofluoroscopic swallowing studies. DESIGN: Data collected from a serial oral and pharyngeal videofluoroscopic swallowing study. SETTING: A dysphagia clinic in a department of rehabilitation medicine at a tertiary care university hospital. PARTICIPANTS: One hundred three consecutively admitted stroke patients. INTERVENTIONS: Videoflurorscopy to measure a scale of 11 variables: lip closure score, bolus formation, residue in oral cavity, oral transit time, triggering of pharyngeal swallow, laryngeal elevation and epiglottic closure, nasal penetration, residue in valleculae, coating of pharyngeal wall after swallow, and pharyngeal transit time. MAIN OUTCOME MEASURES: Polychotomous linear logistic regression analysis of videofluoroscopic and aspiration results. Scale sensitivity and specificity, and the correlation between the total score of the scale and aspiration grade were analyzed. RESULTS: The scale's sensitivity and specificity for detecting supraglottic penetration and subglottic aspiration were 81%, 70.7%, and 78.1%, 77.9%, respectively. A significant positive correlation was found between the scale's total score and the severity of aspiration (Spearman's r =.58943, p =.00001). CONCLUSION: This functional dysphagia scale, which was based on a videofluoroscopic swallowing study in stroke patients, is a sensitive and specific method for quantifying the severity of dysphagia.

Adult↗
PubMed2001

Swallowing in myotonic muscular dystrophy: a videofluoroscopic study.

OBJECTIVES: (1) To determine how swallow function in patients with myotonic muscular dystrophy (MD) differs from that of healthy controls, (2) to identify the contributors to and predictors of improvement, and (3) to evaluate strategies that facilitate swallowing. DESIGN: Observational. SETTING: University medical center. PARTICIPANTS: Eighteen adults with myotonic MD (age range, 24-58 yr) and 60 healthy adult control subjects (age range, 18-73 yr). INTERVENTIONS: Swallow facilitation strategies. MAIN OUTCOME MEASURES: Between-group comparisons of mean bolus transit times, onsets of swallow gestures, and displacement measures obtained by dynamic lateral view videofluoroscopy. RESULTS: The MD patients' bolus transit times were significantly longer, and onsets of some swallow gestures were significantly delayed. Upper esophageal sphincter opening was prolonged (myotonic MD,.61 +/-.13s; control,.5 +/-.11s). Hyoid displacement was significantly less in men with myotonic MD (1.9 +/-.05 cm) than in male controls (2.4 +/-.68 cm); this difference was not observed between control and myotonic women. Of particular importance was the markedly reduced pharyngeal constriction found in the MD group. CONCLUSIONS: Weakness associated with the disease, as opposed to myotonia, was the most significant contributor to impairment. Persons at risk for aspiration may be identified by a measure of pharyngeal area. Selected strategies to facilitate pharyngeal clearing are worthwhile.

Adult↗
PubMed2001

The effect of head and neck positions on oropharyngeal swallowing: a clinical and electrophysiologic study.

OBJECTIVES: To determine the clinical usefulness of an electrophysiologic method for evaluating dysphagia and to identify the effects of various head and neck positions on oropharyngeal swallowing. DESIGN: Experimental, with control group. SETTING: An electromyography laboratory. PARTICIPANTS: Patients with neurogenic dysphagia (n = 51) and healthy controls (n = 24). Patients were divided into 2 groups: those patients with unilateral lower cranial lesions (n = 9) and those without laterality in the function of the oropharyngeal muscles (n = 42). INTERVENTIONS: Subjects were instructed to swallow doses of water, gradually increasing in quantity from 1 to 25 mL under 5 conditions: neutral, chin up, chin tucked, head rotated right, and head rotated left. MAIN OUTCOME MEASURES: Change in dysphagia limit through specified head and neck postures. Oropharyngeal swallowing was evaluated by laryngeal movements that were detected by a piezoelectric sensor and electromyography of the submental muscle complex. Laryngeal sensor signals occurring within 8 seconds of a swallow were accepted as a sign of the dysphagia limit. RESULTS: In the control group, dysphagia limit did not change significantly with changes in head and neck postures, except for the chin-up posture (p <.05) in which piecemeal deglutition occurred when subjects swallowed volumes less than 20 mL. Dysphagia limit improved significantly (p <.05) in 67% of the patients with unilateral lower cranial lesions when the head was rotated toward the paretic side. In dysphagic patients with bilateral symptoms, a significant (p <.01) improvement in dysphagia limit occurred in 50% of patients in chin-tuck position, but in the chin-up position, 55% of the patients experienced a significant (p <.01) decrease in dysphagia limit. CONCLUSION: The electrophysiologic method of measuring dysphagia limit confirms neurogenic dysphagia and its severity in the neutral head position. Changes in head and neck positions do not significantly alter dysphagia limit in unimpaired subjects except for the chin-up position. Although the results obtained were not compared with other techniques (eg, videofluoroscopy), this simple electrophysiologic method for describing dysphagia limit may have a place in the evaluation of dysphagia and its variability in various head and neck positions.

Adolescent↗
PubMed1997

Effects of aging on neuromotor processes of swallowing.

Isolated swallowing difficulties are present in a substantial percentage of elderly adults. Most have no known medical basis, although some may be caused by underlying, but undetected, medical conditions. Others may result from conditions that indirectly affect swallowing. After an overview of the neuroanatomy and neurophysiology of swallowing, this article reviews findings on changes in swallowing that accompany aging. Some of the differences reported have failed to be replicated consistently, and other changes are subtle, their significance unknown. Most studies, however, have found decreased sensitivity in both the oral and pharyngeal cavities. It is concluded that additional objective clinical measures are needed to isolate changes in swallowing due to age from those resulting from other causes. Clearly, further research is needed.

Adult↗