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At least 1,009 records · Page 56Linked to original sources
PubMed1993

Swallowing therapy with neurologic patients: results of direct and indirect therapy methods in 66 patients suffering from neurological disorders.

The results of direct and indirect therapy methods applied to 66 patients suffering from neurological disorders are presented. Variables considered were age, time since lesion, localization of central nervous system lesion, type of swallowing disorder (defined according to swallowing phase, type of aspiration and degree of aspiration), cognitive deficits (memory, planning/problem-solving, and attention deficits), and duration of therapy. Success of therapy was defined by progress in type, ease, and safety of feeding and by range of diet. Therapeutic outcome was correlated with the above-listed variables. The findings suggest that swallowing therapy is effective for patients with neurological disorders.

Adult↗
PubMed1989

Neural mechanisms of swallowing: neurophysiological and neurochemical studies on brain stem neurons in the solitary tract region.

Neurophysiological studies of the nuclei of the tractus solitarius (NTS) and adjacent regions have provided a partial understanding of the integrative brainstem network underlying swallowing and related functions such as respiration. The NTS is also richly endowed with an abundance of neuropeptides and other neuroactive substances, but only limited information is available on their influences on neurons involved specifically in swallowing. Since dysfunction of these neurophysiological and neurochemical regulatory mechanisms in the NTS region may be important in pathophysiological conditions such as dysphagia, increased awareness of and focus on these mechanisms are warranted. This paper outlines recent neurophysiological and neurochemical data that provide information on the afferent inputs and neurophysiological properties of neurons in NTS and adjacent caudal brainstem regions implicated in swallowing, respiration, and respiratory-related reflexes.

Angiotensin II↗
PubMed1989

Effects of intraoral prosthetics on swallowing in patients with oral cancer.

The swallowing patterns of four patients with oral cancer with intraoral palate reshaping/lowering protheses were studied with and without their prostheses 3 months postoperatively. The prostheses resulted in improved swallow efficiency, increased duration of tongue contact to the pharyngeal wall, and improved speed of movement of the bolus from the valleculae to the pyriform sinus. These results emphasize the effects of the tongue on the pharyngeal as well as oral stage of the swallow.

Deglutition↗
PubMed1989

Electromyography of the muscles of oropharyngeal swallowing: basic concepts.

Electromyography (EMG) has a valuable role in the evaluation of swallowing and its disorders, because it can assess the activity of individual muscles. Electromyographic kinesiology is a method for examining the physiology of swallowing. Analysis of individual myoelectric potentials is a technique for studying the integrity of the motor unit. This paper introduces the concepts of the motor unit, explains basic principles of EMG, and explores their relevance to the study of oropharyngeal swallowing. Several cases are presented to illustrate how EMG contributes to clinical diagnosis.

Deglutition↗
PubMed1990

Test-retest variability in normal swallowing.

The test-retest variability of the modified barium swallow study using videofluoroscopy was analyzed. Sixteen normal subjects (8 men, 8 women) were organized into 2 age groups: middle-aged group (mean, 45 years) and old-age group (mean, 66 years). Nine durational measures of the swallow were evaluated. There were no statistically significant differences for any of the measures between the initial test and a retest conducted days later. The findings suggest that, on the whole, normal subjects perform similarly on test and a retest. However, the variability displayed by these normal subjects may be clinically significant, indicating that test-retest swallowing duration measures require careful interpretation.

Adult↗
PubMed1990

Approaches to the patient with aspiration and swallowing disabilities.

Aspiration, or soiling of the tracheobronchial tree, can produce life-threatening pulmonary disease. Intermittent or persistent aspiration may cause symptoms including cough, intermittent fever, recurrent tracheobronchitis, atelectasis, pneumonia, and/or empyema. The pulmonary disease may be associated with weight loss, cachexia, and dehydration. In many cases the aspiration is caused by laryngeal dysfunction, allowing pulmonary contamination by swallowed material. In other cases the aspiration is caused by a dysfunction of the oral, pharyngeal, or esophageal phases of swallowing. In some cases the aspiration is caused by a combination of laryngeal and swallowing dysfunction. Geriatric patients are more likely to experience aspiration, since muscle weakness causing mechanical disability and neurologic impairment are more common in this age group. Therefore, with the ever-increasing aging of our population, these disabilities will be on the rise, with an associated increase in pulmonary disease and death. The approach to evaluation and management of these disorders must be based on an understanding of the underlying functional impairment.

Deglutition Disorders↗
PubMed1990

Acoustic technique for determining timing of velopharyngeal closure in swallowing.

A pure tone sound source was introduced at a nostril and monitored by a miniature accelerometer on the throat. During velopharyngeal closure in a swallow, the pure tone component in the accelerometer signal was attenuated. Throat accelerometer recordings were made simultaneously with videofluoroscopy of a modified barium swallow in adults with normal velopharyngeal mechanisms. It was verified that the period of sound attenuation corresponded to the period of velar closure. This noninvasive method of monitoring otherwise silent velopharyngeal closure holds promise for normative studies on swallowing function, as an adjunct method in longitudinal assessment, and as a training aid.

Adult↗
PubMed1991

Dietary management of swallowing disorders.

Two major concerns in the dietary management of the dysphagic patient are to maintain adequate nutrition and to ensure safety during oral feeding. Dysphagic patients require modifications of standard hospital diets. Kitchen or nursing staff must remove from standard diet trays solid foods and liquids that pose swallowing hazards. Training kitchen and nursing staff and removing food are time consuming. It is also hazardous if certain foods are served to dysphagic patients through error or lack of knowledge. In addition, there is risk of inadequate nutrition when food is removed from trays. This paper proposes a four-level diet plan for patients who have difficulty swallowing solids and liquids. These diets gradually advance for patients undergoing treatment to improve swallowing function. The proposed diets save time for kitchen and nursing staff, reduce the risk of aspiration among patients, and serve as models for families as they prepare for discharge and meal planning at home. Diet guidelines are based on recommendations of the American Dietetic Association.

Deglutition Disorders↗
PubMed2003

Comparison of barium swallow, CT and thallium-201 SPECT in evaluating responses of patients with esophageal squamous cell carcinoma to preoperative chemoradiotherapy.

The aims of this study were to compare the results of thallium-201 (Tl-201) SPECT, barium swallow and CT in the assessment of the effect of preoperative chemoradiotherapy. This study consisted of 28 patients with advanced esophageal squamous cell carcinoma (AESCC) who underwent the three imaging modalities before and after preoperative chemoradiotherapy. The results were quantified using the bidimensional method for barium swallow and contrast-enhanced CT and the tumor-to-lung ratio for SPECT. The percent decrease in these quantitative values after therapy was defined as %Dba, %Dct and %Dtl respectively. The histological effect of the chemoradiotherapy was determined from the resected surgical specimen of the esophagus: grade 0, 100% viable tumor cells; grade 1a, 99-67%; grade 1b, 66-34%; grade 2, 33-1%; grade 3, no viable cells. A statistically significant difference of %Dtl between the subgroups of each grade was evident (p = 0.0433), whereas no significant differences were evident for %Dba (p = 0.1778) or %Dct (p = 0.7377). However, the overlap of %Dtl between these groups was marked. Although thallium-201 SPECT cannot be used to evaluate the therapeutic effect with acceptable accuracy, SPECT may be of additional value to barium swallow and CT in assessing the response of AESCC to preoperative chemoradiotherapy.

Administration, Oral↗
PubMed2006

Mechanical reconfiguration mediates swallowing and rejection in Aplysia californica.

Muscular hydrostats, such as tongues, trunks or tentacles, have fewer constraints on their degrees of freedom than musculoskeletal systems, so changes in a structure's shape may alter the positions and lengths of other components (i.e., induce mechanical reconfiguration). We studied mechanical reconfiguration during rejection and swallowing in the marine mollusk Aplysia californica. During rejection, inedible material is pushed out of an animal's buccal cavity. The grasper (radula/odontophore) closes on inedible material, and then a posterior muscle, I2, pushes the grasper toward the jaws (protracts it). After the material is released, an anterior muscle complex (the I1/I3/jaw complex) pushes the grasper toward the esophagus (retracts it). During swallowing, the grasper is protracted open, and then retracts closed, pulling in food. Grasper closure changes its shape. Magnetic resonance images show that grasper closure lengthens I2. A kinetic model quantified the changes in the ability of I2 and I1/I3 to exert force as grasper shape changed. Grasper closure increases I2's ability to protract during rejection, and increases I1/I3's ability to retract during swallowing. Motor neurons controlling radular closure may therefore affect the behavioral outputs of I2's and I1/I3's motor neurons. Thus, motor neurons may modulate the outputs of other motor neurons through mechanical reconfiguration.

Animals↗
PubMed2001

Effect of bolus consistency on swallowing--does altering consistency help?

The influence of food bolus consistency on the pharyngeal wave during swallowing was investigated using a four-sensor manometry probe in 22 healthy volunteers. Pharyngeal pressures were recorded for 5 ml boluses of water, pudding and buttered bread via a manometry probe placed transnasally. The distal sensor was sited within the upper oesophageal sphincter (UOS); the three proximal sensors were then located 2, 4 and 6 cm above the UOS. The amplitude and timing of the swallow waveforms for pudding and buttered bread were recorded and compared with those for water. Increased bolus viscosity led to increased amplitude of the bolus wave and clearing contraction within the pharynx. In the UOS, increased bolus viscosity was associated with a larger pressure nadir (sub-atmospheric pressure) on opening and intra bolus pressure during transit. Bolus consistency also influenced the coordination of the swallow response with delayed pharyngeal clearance. The putative relevance of these findings to dietary modification for patients with neurological and neuromuscular dysphagia is discussed.

Adult↗
PubMed2002

Detection of swallowing sounds: methodology revisited.

Cervical auscultation is in the process of gaining clinical credibility. In order for it to be accepted by the clinical community, the procedure and equipment used must first be standardized. Takahashi et al. [Dysphagia 9:54-62, 1994] attempted to provide benchmark methodology for administering cervical auscultation. They provided information about the acoustic detector unit best suited to picking up swallowing sounds and the best cervical site to place it. The current investigation provides contrasting results to Takahashi et al. with respect to the best type of acoustic detector unit to use for detecting swallowing sounds. Our study advocates an electret microphone as opposed to an accelerometer for recording swallowing sounds. However, we agree on the optimal placement site. We conclude that cervical auscultation is within reach of the average dysphagia clinic.

Acoustics↗
PubMed2002

Variability in tongue movement kinematics during normal liquid swallowing.

This study sought to develop a quantitative kinematic description of tongue movement for liquid swallowing in a group of 12 healthy subjects. X-ray microbeam technology was used to track the positions of six small pellets attached to the tongue and jaw while subjects swallowed water at 2- and 10-mL bolus volumes. A feature common to all subjects was a prominent rostral movement of the dorsal region of the tongue. In addition, all subjects consistently increased the displacement and maximum speed of this tongue movement with increased bolus volume. However, detailed movement analysis showed a variety of tongue movement patterns for the group. This variability across subjects was large enough that it was surprisingly difficult to provide a low-dimension quantitative description of the tongue kinematics during liquid swallowing.

Adult↗
PubMed2002

Using ultrasound to investigate intrapersonal variability in durational aspects of tongue movement during swallowing.

The purpose of this study was to determine the extent of intrapersonal variability in durational aspects of tongue movement during swallowing. Using ultrasound, the entire duration of tongue movement and the duration of the oral transport stage during swallowing was measured in a group of patients with neurogenic swallowing disorder and a group of matched healthy control subjects. The results indicate considerable intrapersonal variability in both groups. The patient group performed significantly more variably in terms of the duration of the transport stage. However, when looking at individual results, this finding can not be generalized, in that some patients showed rather decreased variability. Other differences between patient the group and control subjects were not statistically significant. Ultrasound was found to be a highly suitable technique for the purpose of this study.

Adult↗
PubMed2002

Interjudge and intrajudge reliabilities in fiberoptic endoscopic evaluation of swallowing (fees) using the penetration-aspiration scale: a replication study.

This study used Fiberoptic Endoscopic Evaluation of Swallowing (FEES(R)) to assess the reliability of the Penetration-Aspiration Scale (PAS) using 79 swallows and four judges in a replication of a study using videofluoroscopy (VFSS). The swallows were diagnosed using FEES, which allowed for comparison between the two techniques. The findings indicated that all categories of the PAS achieved adequate reliability, both on intrajudge and interjudge assessments. Reliabilities, with the exception of Scale Score 7, were higher in this study than in the original study by Rosenbek and associates. Data analysis indicated that judges were more highly consistent on second ratings compared with their original ratings, indicating a learning curve on the PAS. In addition, findings suggested that the FEES was more reliable on assessing penetration than VFSS, but that VFSS was more reliable on the assessment of the various severities of aspiration. The two techniques were equally effective in discriminating between penetration and aspiration. This study found that FEES was just as reliable as VFSS when using the PAS.

Deglutition Disorders↗
PubMed2003

Activation of cerebellum and basal ganglia on volitional swallowing detected by functional magnetic resonance imaging.

Although regions of the sensorimotor cortex, insula, and anterior cingulate gyrus are reported to be activated during swallowing, findings concerning contributions of the cerebellum and basal ganglia have been contradictory. We investigated cerebellar and basal ganglionic activation using functional magnetic resonance imaging (fMRI). In 11 subjects, single-shot gradient-echo echoplanar image volumes sensitive to BOLD contrast were acquired in block design fashion using an oblique orientation covering both cerebrum and cerebellum. Using statistical parametric mapping, regional activation upon swallowing was observed in the sensorimotor cortex, insula, cerebellum, putamen, globus pallidus, thalamus, anterior cingulate gyrus, supplementary motor area, superior temporal gyrus, and substancia nigra. The cerebellum was activated bilaterally, especially on the left; activation of the putamen and globus pallidus was also found bilaterally. Thus, volitional swallowing involves the cerebellum and basal ganglia as well as cortical structures. The method used was well tolerated by normal subjects and should also be applicable to patients with dysphagia.

Adult↗
PubMed2004

Dysphagia referrals to a district general hospital gastroenterology unit: hard to swallow.

The aim of our study was to audit dysphagia referrals received by a specialist gastroenterology unit during an entire year. We used a prospective audit carried out over a 12-month period at the District General Hospital gastroenterology unit. The audit included 396 consecutive patients who were referred with swallowing difficulties. We found that 60 referrals (15.2%) were inaccurate and the patients had no swallowing problem. Of the 336 patients with genuine dysphagia, only 29 (8.6%) were new cancer cases. The large majority of subjects had benign disease mostly related to acid reflux. Weight loss was significantly associated with malignancy but also occurred in one third of patients with reflux alone. The temporal pattern of dysphagia was not significantly predictive of cancer. All the cancer patients were above the age of 50 years. Although patients were in general assessed rapidly after hospital referral, the productivity, in terms of early tumor diagnosis, was extremely low. We conclude that there is a substantial rate of inaccurate referrals of dysphagia patients. Most true cases of swallowing difficulty relate to benign disease. Even the devotion of considerable resources to the early diagnosis of esophago gastric malignancy in an attempt to conform with best practice guidelines results in a very low success rate in terms of the detection of potentially curable tumors.

Adult↗
PubMed2004

Influence of bolus consistency on lingual behaviors in sequential swallowing.

Thickened liquids are a commonly recommended intervention for dysphagia. Previous research has documented differences in temporal aspects of bolus transit for paste versus liquid consistencies; however, the influence of liquid viscosity on tongue movements during swallowing remains unstudied. We report an analysis of the influence of bolus consistency on lingual kinematics during swallowing. Electromagnetic midsagittal articulography was used to trace tongue body and dorsum movement during sequential swallows of three bolus consistencies: thin, nectar-thick, and honey-thick liquids. Rheological profiling was conducted to characterize viscosity and density differences among six liquids (two of each consistency). Eight healthy volunteers participated; four were in a younger age cohort (under age 30) and four were over the age of 50. The primary difference observed across the liquids of interest was a previously unreported phenomenon of sip-mass modulation; both flavor and density appeared to influence sip-sizing behaviors. Additionally, significantly greater variability in lingual movement patterns was observed in the older subject group. Systematic variations in lingual kinematics related to bolus consistency were restricted to the variability of downward tongue dorsum movement. Otherwise, the present analysis failed to find empirical evidence of significant modulations in tongue behaviors across the thin to honey-thick consistency range.

Adult↗