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Journal Cover Dysphagia
  [SJR: 0.66]   [H-I: 59]   [132 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1432-0460 - ISSN (Online) 0179-051X
   Published by Springer-Verlag Homepage  [2354 journals]
  • European Society for Swallowing Disorders FEES Accreditation Program for
           Neurogenic and Geriatric Oropharyngeal Dysphagia
    • Authors: R. Dziewas; The European Society for Swallowing Disorders; L. Baijens; A. Schindler; E. Verin; E. Michou; P. Clave
      Pages: 725 - 733
      PubDate: 2017-12-01
      DOI: 10.1007/s00455-017-9828-9
      Issue No: Vol. 32, No. 6 (2017)
  • Trends in Research Literature Describing Dysphagia in Motor Neuron
           Diseases (MND): A Scoping Review
    • Authors: Ashley A. Waito; Teresa J. Valenzano; Melanie Peladeau-Pigeon; Catriona M. Steele
      Pages: 734 - 747
      Abstract: Dysphagia in motor neuron diseases (MNDs) is highly complex, affecting all stages of swallowing and leading to impaired swallowing safety and efficiency. In order to explore the degree to which research is capturing the symptom of dysphagia in MND, we conducted a scoping review of the existing literature. The primary aims of this review were to identify common themes within the literature on dysphagia in MND, explore patterns and trends in research focus, and identify if any imbalances exist between the research themes related to dysphagia description and management. A comprehensive search strategy yielded 1690 unique articles for review. Following relevance screening, a total of 157 articles were included in the synthesis. Relevant data and keywords were extracted from each article and grouped into themes. Frequency estimates were calculated for each theme to identify trends across research literature. Swallowing impairment in MNDs is described in a variety of ways across current research. The most commonly reported theme was Aspiration/Penetration, mentioned in 73.2% of all included articles; a significant imbalance was identified between reports of swallowing safety and efficiency (p = 0.008). The most frequently reported theme related to dysphagia management was Enteral Nutrition, and very few studies have reported on the efficacy of Rehabilitation/Compensatory recommendations. It is suggested that researchers and clinicians remain mindful of imbalances and gaps in research, and aim to characterize dysphagia in MNDs in a comprehensive manner. Further research investigating discrete, measureable changes in swallowing pathophysiology would be beneficial to delineate the key factors contributing to impaired swallowing safety and efficiency.
      PubDate: 2017-12-01
      DOI: 10.1007/s00455-017-9819-x
      Issue No: Vol. 32, No. 6 (2017)
  • Erratum to: Trends in Research Literature Describing Dysphagia in Motor
           Neuron Diseases (MND): A Scoping Review
    • Authors: Ashley A. Waito; Teresa J. Valenzano; Melanie Peladeau-Pigeon; Catriona M. Steele
      Pages: 748 - 748
      PubDate: 2017-12-01
      DOI: 10.1007/s00455-017-9829-8
      Issue No: Vol. 32, No. 6 (2017)
  • Measurement of Pharyngo-laryngeal Volume During Swallowing Using 320-Row
           Area Detector Computed Tomography
    • Authors: Takatoshi Iida; Hitoshi Kagaya; Yoko Inamoto; Seiko Shibata; Eiichi Saitoh; Daisuke Kanamori; Shuji Hashimoto; Kazuhiro Katada; Haruka Tohara; Koichiro Ueda
      Pages: 749 - 758
      Abstract: This study aimed to (1) evaluate changes in bolus and air volumes in the pharyngo-laryngeal cavity during swallowing and (2) determine how differences in these volumes during swallowing are influenced by bolus amount using 320-row area detector computed tomography (320-ADCT). Three-, 10-, and 20-ml honey-thick liquids (5% w/v) were presented to ten healthy subjects placed in a 45° reclining position. 3D images were created in 29 phases at an interval of 0.1 s for 3.15 s. Changes in bolus and air volumes in the pharyngo-laryngeal cavity were calculated. The two one-sided tests were used to determine equivalency of the pharyngo-laryngeal volume of each event (i.e., onset of hyoid elevation, soft palate closure, true vocal cord closure, closure of laryngeal vestibule, epiglottis inversion, pharyngo-esophageal sphincter opening) for each bolus volume. The pharyngo-laryngeal volume during swallowing was about 20 ml before swallowing. The volume temporarily increased with tongue loading, but decreased to about 0 ml with pharyngeal contraction. Subsequently, the volume returned to the original volume after airway opening. Most of the air was released from the pharyngo-laryngeal space before the bolus flowed into the esophagus during swallowing. As the bolus volume to be swallowed increased, the maximal pharyngo-laryngeal volume increased, but changes in air volume remained constant. 320-ADCT allowed for analysis of dynamic volume changes in the pharyngo-laryngeal cavity, which will increase our knowledge of kinematic and volumetric mechanisms during swallowing.
      PubDate: 2017-12-01
      DOI: 10.1007/s00455-017-9818-y
      Issue No: Vol. 32, No. 6 (2017)
  • The Influence of Oropalatal Dimensions on the Measurement of Tongue
    • Authors: Laura L. Pitts; Julie A. G. Stierwalt; Carlin F. Hageman; Leonard L. LaPointe
      Pages: 759 - 766
      Abstract: Tongue strength is routinely evaluated in clinical swallowing evaluations since lingual weakness is an established contributor to dysphagia. Tongue strength may be clinically quantified by the maximum isometric tongue pressure (MIP) generated by the tongue against the palate; however, wide ranges in normal performance remain to be fully explained. Although orthodontic theory has long suggested a relation between lingual function and oral cavity dimensions, little attention has been given to the potential influence of oral and palatal structure(s) on healthy variance in MIP generation. Therefore, anterior and posterior tongue strength measures and oropalatal dimensions were obtained across 147 healthy adults (aged 18–88 years). Age was confirmed as a significant, independent predictor explaining approximately 10.2% of the variance in anterior tongue strength, but not a significant predictor of posterior tongue strength. However, oropalatal dimensions predicted anterior tongue strength with over three times the predictive power of age alone (p < .001). Significant models for anterior tongue strength (R 2 = .457) and posterior tongue strength (R 2 = .283) included a combination of demographic predictors (i.e., age and/or gender) and oropalatal dimensions. Palatal width, estimated tongue volume, and gender were significant predictors of posterior tongue strength (p < .001). Therefore, oropalatal dimensions may warrant consideration when accurately differentiating between pathological lingual weakness and healthy individual difference.
      PubDate: 2017-12-01
      DOI: 10.1007/s00455-017-9820-4
      Issue No: Vol. 32, No. 6 (2017)
  • Development of Pyriform Sinus Suctioning Programs for Aspiration Pneumonia
           Prevention During the Acute Stroke
    • Authors: Yuki Inui; Yayoi Kamakura; Junko Fukada; Masahiko Yoneda; Emiko Kataoka; Yasuko Usami; Miki Sugiura; Tetsuya Nagatani; Yukio Seki; Norikazu Hatano; Keizo Yasui
      Pages: 767 - 776
      Abstract: Aspiration due to dysphagia is a factor associated with pneumonia during acute stroke. In such cases, it is likely that secretions in the pyriform sinuses enter the laryngeal inlet. The present study was based on the idea that it is possible to reduce aspiration pneumonia by periodically suctioning and removing such secretions (pyriform sinus suctioning), a study was conducted in a single facility. The incidence of pneumonia as a dependent variable was compared between before (control) and after (intervention group) intervention with pyriform sinus suctioning as an independent variable. With a view of unifying the quality and frequency of intervention, two programs to: initially confirm the safety of such suctioning; subsequently enhance/evaluate knowledge and skills related to the procedure (educational); and specify conditions for the implementation and criteria for determining its appropriateness (practical), were developed. The study involved 33 (mean age: 74.6 ± 12.4) and 30 (80.0 ± 8.8) control and intervention group members, respectively, 25 (83.3%) of the latter were treated with pyriform sinus suctioning for 5 days after a stroke. Pneumonia developed in 7 (21.2%) and 2 (6.7%) of the former and latter, respectively. As individuals with a Japan Coma Scale (JCS) score of III or a midline shift on head CT tend to develop pharyngeal dysphagia, the patients were also divided into 2 groups to compare the incidence of pneumonia based on the risk level: low: Japan Coma Scale scores of I-II without a midline shift on head CT; and high: scores of II-III with it. In the latter, the incidence after intervention was markedly lower (p = 0.06, φ = 0.326), while the former did not show changes (p = 0.574, φ = 0.066), supporting the effectiveness of pyriform sinus suctioning to prevent aspiration pneumonia among patients with a low risk level.
      PubDate: 2017-12-01
      DOI: 10.1007/s00455-017-9821-3
      Issue No: Vol. 32, No. 6 (2017)
  • The Relationship Between Lesion Localization and Dysphagia in Acute Stroke
    • Authors: Stephanie K. Daniels; Shweta Pathak; Shalini V. Mukhi; Carol B. Stach; Robert O. Morgan; Jane A. Anderson
      Pages: 777 - 784
      Abstract: Factors that can facilitate early identification of individuals at risk of dysphagia such as stroke location are potentially of great benefit. The aim of this study was to examine the role of hemisphere and lesion location in assessing dysphagia pattern and airway invasion as identified through the use of validated, standardized interpretation measures for the videofluoroscopic swallowing study. Consecutive patients (N = 80) presenting with stroke symptoms who had a first-time acute ischemic stroke confirmed on diffusion-weighted magnetic resonance imaging (DW-MRI) scan participated. Three swallowing outcome variables were assessed using regression models: modified barium swallow impairment profile (MBSImP) oral impairment (OI) and pharyngeal impairment (PI) scores and penetration aspiration scale (PAS) score. Subjects were primarily male and demonstrated mild stroke and mild to moderate dysphagia. There was a significantly higher likelihood of abnormal PAS scores for infratentorial lesions compared to right hemisphere location (Odds ratio: 3.1, SE: 1.8, p = 0.046) and for Whites compared to African Americans (Odds ratio: 5.5, SE: 2.6, p = <0.001). However, OI scores were higher (worse) in African Americans compared to Whites (Beta = −1.2; SE: 0.56; p = 0.037). PI scores had no significant association with race or lesion location. Using DW-MRI to identify infratentorial stroke can help identify individuals at risk of airway invasion; however, imaging information concerning supratentorial infarct hemisphere and location may not be useful to predict which individuals with mild stroke are at risk for dysphagia and aspiration when admitted with acute stroke symptoms. Future studies should explore the role of race in the development of stroke-related dysphagia.
      PubDate: 2017-12-01
      DOI: 10.1007/s00455-017-9824-0
      Issue No: Vol. 32, No. 6 (2017)
  • How Swallow Pressures and Dysphagia Affect Malnutrition and Mealtime
           Outcomes in Long-Term Care
    • Authors: Ashwini M. Namasivayam-MacDonald; Jill M. Morrison; Catriona M. Steele; Heather Keller
      Pages: 785 - 796
      Abstract: Malnutrition is a major cause of hospitalization for residents of long-term care facilities (LTC). Dysphagia is thought to contribute to malnutrition. Tongue weakness is suggested to predict poor food intake, longer meals, and dysphagia. We explored the relationships between tongue strength, dysphagia, malnutrition and mealtime outcomes in LTC residents. Data were collected from 639 LTC residents (199 male), aged 62–102 (mean 87). Maximum isometric tongue pressures (MIPs) and saliva swallow pressures (MSPs) were measured using the Iowa Oral Performance Instrument. Participants also completed the Screening Tool for Acute Neuro Dysphagia. Nutrition status was assessed using the Patient-Generated Subjective Global Assessment. A series of repeated meal observations provided measures of meal duration and calories consumed. Mean MIPs were 33 kPa (95% CI 29–37) and MSPs were 26 kPa (95% CI 23–29). The odds of showing signs of dysphagia were 3.7 times greater in those with MSPs less than 26 kPa (p < 0.05). The odds of being malnourished were almost double in those showing signs of dysphagia. Co-occurrence of dysphagia and malnutrition was seen in 29%. Residents with low MSPs also had significantly longer mealtime durations (MTD) (p < 0.05). Moreover, those with both low swallowing pressures and suspected dysphagia consumed fewer calories/minute (p < 0.05) and had significantly longer MTDs (p < 0.05). This study confirms associations between tongue weakness, signs of dysphagia, mealtime outcomes and malnutrition among LTC residents. These findings suggest that saliva swallow pressure measures may be helpful for early identification of dysphagia and nutritional risk in this population.
      PubDate: 2017-12-01
      DOI: 10.1007/s00455-017-9825-z
      Issue No: Vol. 32, No. 6 (2017)
  • Dysphagia Research Society 25th Anniversary Meeting: President’s
           2017 Report
    • Authors: Stephanie K. Daniels
      Pages: 797 - 798
      PubDate: 2017-12-01
      DOI: 10.1007/s00455-017-9817-z
      Issue No: Vol. 32, No. 6 (2017)
  • Dysphagia Research Society Annual Meeting March 2–4, 2017
    • Pages: 799 - 858
      PubDate: 2017-12-01
      DOI: 10.1007/s00455-017-9805-3
      Issue No: Vol. 32, No. 6 (2017)
  • Effect of Body Position on Pharyngeal Swallowing Pressures Using
           High-Resolution Manometry
    • Authors: Sarah P. Rosen; Suzan M. Abdelhalim; Corinne A. Jones; Timothy M. McCulloch
      Abstract: The effect of body position and gravitational pull on the complex pressure-driven process of pharyngeal swallowing remains unknown. Using high-resolution manometry (HRM), this study aims to identify positional adaptations of pharyngeal physiology by evaluating swallowing pressure patterns in a series of inverted body positions. Ten healthy adults each underwent swallowing tasks with pharyngeal HRM at six body positions using an inversion table (0°[upright], 45°, 90°[supine], 110°, 135°, and 180°[fully inverted]). Repeated measures ANOVA was used to assess impact of position on pressure parameters, and pharyngeal-UES pressure gradients translate. Velopharyngeal pressures varied by position (P < 0.001), with significantly higher pressures generated with inversion ≥90°, compared with upright and 45°. Change in position did not significantly affect common mesopharyngeal pressures or swallowing pressure durations. UES valving mechanisms were preserved during inversion, with subtle variations observed in integral pressures (P = 0.011). Pharyngeal-UES pressure gradients changed with position (P < 0.01), increasing with inversion > 90° compared to upright and 45°. Mechanisms of deglutition may differ with position and relative direction of gravity, particularly when at > 45° inclination. Increased palatal pressure is generated in the upside-down position to achieve nasopharyngeal closure and prevent regurgitation. While other classically measured pressures may not consistently differ with positioning, many individuals exhibit adaptations in pressure gradients when inverted, likely due to a combination of changes in pharyngeal driving force and UES opening mechanisms. Identification of these changes, relative to position, further builds on our understanding of the adaptability of the pharyngeal swallowing system.
      PubDate: 2017-12-07
      DOI: 10.1007/s00455-017-9866-3
  • Functional Cause of Dysphagia Improved with Cognitive Behavioural
    • Authors: Burak Acikel; Mehmet Ak
      PubDate: 2017-12-06
      DOI: 10.1007/s00455-017-9869-0
  • Relationship Between Frequency of Spontaneous Swallowing and Salivary
           Substance P Level in Patients with Acute Stroke
    • Authors: Masachika Niimi; Gentaro Hashimoto; Takatoshi Hara; Naoki Yamada; Masahiro Abo; Hiroto Fujigasaki; Takafumi Ide
      Abstract: The frequency of spontaneous swallowing is useful for screening of dysphagia in acute stroke. Low levels of substance P (SP) in saliva attenuate the swallowing reflex. The aim of this study was to determine the relationship between the frequency of spontaneous swallowing and salivary SP levels. In 40 subjects, saliva was collected within 72 h after stroke onset and salivary SP levels were measured using ELISA kit at a later date. The frequency of spontaneous swallowing was measured over 1 h using a microphone placed on the neck. Pneumonia was diagnosed by the presence of pyrexia and at least two respiratory problems of four categories (sputum, cough or breathing pattern, breath sound, and gas change). The presence of detectable levels of SP in the saliva was confirmed in 17 patients (high SP group), whereas the level was below the detection limit of the ELISA kit in 23 patients (low SP group). The frequency of spontaneous swallowing was significantly lower in low SP group (16.1 ± 11.6 per hour) than in the high SP group (30.4 ± 20.4, p = 0.016). As the result of multiple regression analysis, salivary SP levels were correlated with frequency of spontaneous swallowing independently of age, NIHSS, and GCS. The incidence of pneumonia was significantly higher in the low than high SP group (p < 0.001). In conclusion, the frequency of spontaneous swallowing was decreased in acute stroke patients with low salivary SP levels. Salivary SP levels can be potentially a useful biomarker of risk of stroke-associated pneumonia in the acute stage.
      PubDate: 2017-11-28
      DOI: 10.1007/s00455-017-9867-2
  • Tongue Pressure Production and Submental Surface Electromyogram Activities
           During Tongue-Hold Swallow with Different Holding Positions and Tongue
    • Authors: Shigehiro Fujiwara; Masako Fujiu-Kurachi; Kazuhiro Hori; Yoshinobu Maeda; Takahiro Ono
      Abstract: Our previous study regarding the tongue-hold swallow (THS) demonstrated that the tongue-to-palate contact during THS could be influenced by the maximum tongue protrusion length (MTPL) of individual subjects, resulting in two different patterns of pressure generation. The present study further analyzed the influence of MTPL on the tongue pressure production along with submental surface electromyography (sEMG) during THS, in order to establish an index to better control THS effects. Tongue pressure using a sensor sheet system and concurrent submental sEMG activities were measured during swallowing tasks in 18 healthy young adults. Task conditions comprised THS at two different degrees of tongue protrusion and dry swallow. Tongue pressures and sEMG activities were compared among three task conditions, and correlations of MTPL with tongue pressure were also investigated. Additionally, a ROC curve was used to find a cut-off value for MTPL to predict changes (increases and decreases) in tongue pressure during THS. The duration and the amount of submental muscle activity increased concurrently during THS. Two trends were shown on the change in tongue pressure at the posterior-circumferential part of the hard palate during THS compared to dry swallow; the maximal magnitude and the integrated value of tongue pressure increased in some subjects, while these values decreased in others. Thirty-two millimeters was found to be the cut-off value of MTPL, which distinguishes increase/decrease pattern of tongue pressure with sensitivities of 60.0–85.7%. The present finding suggests that more reliable THS effects should be attainable using MTPL to set the tongue-hold position.
      PubDate: 2017-11-24
      DOI: 10.1007/s00455-017-9865-4
  • Dysphagia in Multiple Sclerosis: Evaluation and Validation of the DYMUS
    • Authors: Dalal Alali; Kirrie Ballard; Steve Vucic; Hans Bogaardt
      Abstract: Objective The 10-item Dysphagia in Multiple Sclerosis (DYMUS) questionnaire is a self-administered tool used to identify swallowing problems in adults with MS. The questionnaire was not validated against other existing questionnaires to assess its convergent validity. Moreover, its test–retest reliability was not measured previously. Therefore, the purpose of this study was to assess the factor analysis, internal consistency and test–retest reliability of the DYMUS, as well as its convergent validity against an established and validated questionnaire, the EAT-10. Method English-speaking adults with MS in New South Wales, Australia who were seen for routine medical check-ups were invited to complete two questionnaires across two phases. One hundred participants completed phase 1, while 55 completed phase 2. Statistical analyses were performed to investigate the psychometric properties of the DYMUS questionnaire. Results Internal consistency (Cronbach’s Alpha) reduced the DYMUS questionnaire from ten to five items. The shortened version of the DYMUS showed high internal consistency (alpha = 0.904). It also showed satisfactory reproducibility, and adequate correlation with the 10-item Eating Assessment Tool (EAT-10). Conclusion Evaluation of the DYMUS resulted in a shortened version of the questionnaire with five questions related to dysphagia. This shortened version is considered an easy and useful tool in identifying patients with MS-related dysphagia.
      PubDate: 2017-11-17
      DOI: 10.1007/s00455-017-9864-5
  • Alterations to Swallowing Physiology as the Result of Effortful Swallowing
           in Healthy Seniors
    • Authors: Sonja M. Molfenter; Chuan-Ya Hsu; Ying Lu; Cathy L. Lazarus
      Abstract: A significant proportion of healthy seniors report difficulty swallowing, thought to result from age-related decline in muscle bulk/function. Effortful Swallowing (ES) is used both as a compensatory maneuver to improve pharyngeal propulsion/clearance and has been proposed as an exercise to improve pharyngeal strength. This study sought to quantify the immediate kinematic, temporal, and functional changes during an ES maneuver to quantify its exercise potential to combat age-related changes in swallowing. Videofluoroscopy data were collected from 44 healthy seniors (21 male) over 65 years old (mean = 76.9, SD = 7.1). Each participant swallowed six 5 ml boluses of Varibar nectar-thick liquids: three with regular effort and three using ES. Individual swallows (n = 260) were measured on pharyngeal constriction, pharyngeal shortening, laryngeal closure duration, hyoid movement duration, UES opening duration, stage transition duration, pharyngeal transit time, pharyngeal response duration, Normalized Residue Ratio Scale (NRRS), and the Penetration–Aspiration Scale (PAS). Non-parametric Wilcoxon Rank Sum for repeated measures tested the effect of ES on each outcome. Exact p-values were calculated based on permutation methods, individual p values < 0.008 was deemed to be significant. The ES maneuver significantly prolonged all temporal variables. While we found no significant differences for pharyngeal constriction, significantly less (i.e., worse) pharyngeal shortening was observed in ES condition compared with regular effort swallows. Further, significantly worse pyriform sinus residue (NRRSv) was observed in the ES condition. No differences between ES and regular effort swallows were noted for pharyngeal constriction, NRRSv or PAS. We speculate that these negative manifestations of worse kinematics (less pharyngeal shortening) and function (increase in NRRSp) may be the result of forced volitional manipulation of swallowing in the ES condition in an otherwise normal elderly swallow.
      PubDate: 2017-11-17
      DOI: 10.1007/s00455-017-9863-6
  • A Dramatic Case of Odynophagia
    • Authors: B. Sopeña; J. Limeres; L. García-Caballero; M. Diniz-Freitas; J. Seoane; P. Diz
      Abstract: We report the case of a 77-year-old male with a history of aortic stenosis and interstitial lung disease, who debuted 3 years ago with an outbreak of necrotic and very painful canker sores. The severity of the lesions and their refractory response to treatment led to several hospital admissions and multiple consultations to different specialists (ENT, rheumatology, dermatology, ophthalmology, cardiology, and internal medicine). During this time, the patient received central parenteral nutrition with an episode of catheter-related septicemia, and he came to require psychiatric assistance for autolytic ideation. Numerous diagnostic tests were performed with inconclusive results, including biopsy of the lesion (histological study, immunohistochemistry for CD68 + , CD4 + , CD8 + , CD20 + , MCT +, and cytomegalovirus, PAS, Grocott–Gomori and Zielh–Neelsen staining, and in situ hybridization for Epstein Barr virus). Numerous treatments were unsuccessfully tested until thalidomide was administered, thus completely remitting lesions but leaving retractable scarring sequelae. Since then, the patient has had two recurrences, coinciding with the reduction of thalidomide dosages, which were controlled by increasing the dose of the immunomodulator. Recurrent necrotizing major aphthous stomatitis (Sutton’s disease) is a clinical variant of recurrent aphthous stomatitis that may have a dramatic course. Unfortunately, the lack of etiopathogenetic uniformity precludes any specific treatment. In severe cases, immunomodulators, including thalidomide, may represent a valid therapeutic option.
      PubDate: 2017-11-11
      DOI: 10.1007/s00455-017-9861-8
  • Evaluation of Swallow Function in Patients with Craniofacial Microsomia: A
           Retrospective Study
    • Authors: Lara S. van de Lande; Cornelia J. J. M. Caron; Britt. I. Pluijmers; Koen F. M. Joosten; Marloes Streppel; David J. Dunaway; Maarten J. Koudstaal; Bonnie L. Padwa
      Abstract: Craniofacial microsomia (CFM) is characterized by underdevelopment of the structures derived from the first and second pharyngeal arches resulting in aesthetic, psychological, and functional problems including feeding and swallowing difficulties. The aim of this study is to gain more insight into swallowing difficulties in patients with CFM. A retrospective study was conducted in the population of patients diagnosed with CFM at three major craniofacial units. Patients with feeding difficulties and those who underwent video fluoroscopic swallow (VFS) studies were included for further analyses. The outcome of the VFS-studies was reviewed with regard to the four phases of swallowing. In our cohort, 13.5% of the 755 patients were diagnosed with swallowing difficulties. The outcome of the VFS-studies of 42 patients showed difficulties in the oral and pharyngeal phases with both thin and thick liquids. Patients with more severe mandibular hypoplasia showed more difficulties to form an appropriate bolus compared to patients who were less severely affected. This is the first study to document swallowing problems in patients with CFM. Difficulties were seen in both the oral and pharyngeal phases. We recommend routine screening for swallowing issues by a speech and language therapist in all patients with CFM and to obtain a VFS-study in patients with a type III mandible.
      PubDate: 2017-11-04
      DOI: 10.1007/s00455-017-9851-x
  • Modification of Masticatory Rhythmicity Leading to the Initiation of the
           Swallowing Reflex in Humans
    • Authors: Masaki Yoneda; Kazuya Saitoh
      Abstract: Modification of movements by proprioceptive feedback during mastication has an important role in shifting from the oral to the pharyngeal phase of swallowing. The aim of this study was to investigate the kinetics of masticatory muscles throughout a sequence of oropharyngeal swallowing and to present a hypothetical model of the involvement of the nervous system in the transition from mastication to the swallowing reflex. Surface electromyographic signals were recorded from the jaw-closing masseter muscles and the jaw-opening suprahyoid muscle group when a piece of bread (3–5 g) was ingested. Participants were not provided any additional instruction regarding how to chew and swallow. In the final stage of mastication, compared with other stages of mastication, the duration between sequential peak times of rhythmic activity of the masseter muscles was prolonged. Electromyography revealed no significant change in the suprahyoid muscle group. Accordingly, contraction of the jaw-closing muscles and the jaw-opening muscles altered from out-of-phase to in-phase. We have presented a hypothetical model based on the results of the present study, in which mastication shifts to the swallowing reflex when feed-forward inputs from rhythm generators for the jaw-closing and the jaw-opening muscles converge onto an assumed “convertor” neuron group concurrently. This model should contribute to understanding the pathophysiology of dysphagia.
      PubDate: 2017-11-02
      DOI: 10.1007/s00455-017-9860-9
  • Evaluation of an Automated Swallow-Detection Algorithm Using Visual
           Biofeedback in Healthy Adults and Head and Neck Cancer Survivors
    • Authors: Gabriela Constantinescu; Kristina Kuffel; Daniel Aalto; William Hodgetts; Jana Rieger
      Abstract: Mobile health (mHealth) technologies may offer an opportunity to address longstanding clinical challenges, such as access and adherence to swallowing therapy. Mobili-T® is an mHealth device that uses surface electromyography (sEMG) to provide biofeedback on submental muscles activity during exercise. An automated swallow-detection algorithm was developed for Mobili-T®. This study evaluated the performance of the swallow-detection algorithm. Ten healthy participants and 10 head and neck cancer (HNC) patients were fitted with the device. Signal was acquired during regular, effortful, and Mendelsohn maneuver saliva swallows, as well as lip presses, tongue, and head movements. Signals of interest were tagged during data acquisition and used to evaluate algorithm performance. Sensitivity and positive predictive values (PPV) were calculated for each participant. Saliva swallows were compared between HNC and controls in the four sEMG-based parameters used in the algorithm: duration, peak amplitude ratio, median frequency, and 15th percentile of the power spectrum density. In healthy participants, sensitivity and PPV were 92.3 and 83.9%, respectively. In HNC patients, sensitivity was 92.7% and PPV was 72.2%. In saliva swallows, HNC patients had longer event durations (U = 1925.5, p < 0.001), lower median frequency (U = 2674.0, p < 0.001), and lower 15th percentile of the power spectrum density [t(176.9) = 2.07, p < 0.001] than healthy participants. The automated swallow-detection algorithm performed well with healthy participants and retained a high sensitivity, but had lowered PPV with HNC patients. With respect to Mobili-T®, the algorithm will next be evaluated using the mHealth system.
      PubDate: 2017-11-02
      DOI: 10.1007/s00455-017-9859-2
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