No abstract

Video fluoroscopy is commonly used in the study of swallowing kinematics. However, various procedures used in linear measurements obtained from video fluoroscopy may contribute to increased variability or measurement error. This study evaluated the influence of calibration referent and image rotation on measurement variability for hyoid and laryngeal displacement during swallowing. Inter- and intrarater reliabilities were also estimated for hyoid and laryngeal displacement measurements across conditions. The use of different calibration referents did not contribute significantly to variability in measures of hyoid and laryngeal displacement but image rotation affected horizontal measures for both structures. Inter- and intrarater reliabilities were high. Using the 95% confidence interval as the error index, measurement error was estimated to range from 2.48 to 3.06 mm. These results address procedural decisions for measuring hyoid and laryngeal displacement in video fluoroscopic swallowing studies.

Purpose This study assesses how the addition of intentional, left hand gestures to an intensive treatment for anomia affects two types of discourse, picture description and responses to open-ended questions. Methods Fourteen people with aphasia completed treatment for anomia comprising 30 treatment sessions over three weeks. Seven participants also incorporated intentional left hand gestures into each treatment trial. Results Both groups demonstrated significant changes in trained items and improved naming of untrained items but no change in WAB-AQ scores. Changes in discourse were limited to the 3-month follow-up assessment. Several discourse measures showed significant improvements in the picture description task and declines during question responses. Additionally, the Gesture group produced more words at each assessment, while the No-Gesture group produced fewer words at each assessment. These patterns led to large improvements in picture descriptions and minimal declines in question responses in the Gesture group. In contrast, the No-Gesture group showed minimal improvements in picture descriptions and production declines in question responses relative to pre-treatment levels. Conclusions The intensive treatment protocol is a successful method for improving picture naming even of untrained items. We hypothesize that the intentional left hand gesture played an essential role in enabling generalization of treatment to discourse.

Variability in magnitude of deglutitional hyolaryngeal excursion in patients with dysphagia suggests that it does not adequately represent the kinematics of swallowing difficulties or recovery following rehabilitation. On the other hand, reduced hyolaryngeal excursion velocity has been reported in patients with dysphagia. While increased movement velocity often accompanies clinical and functional recovery in many diseases, velocity changes in swallowing-related movement following dysphagia therapy have not been well studied. This study evaluated changes in hyoid and laryngeal excursion (magnitude, duration and velocity) before and following successful dysphagia therapy to provide a more comprehensive representation of improvement to swallowing kinematics in patients who have experienced successful rehabilitation. A secondary analysis of case series data was completed. Eight patients with severe, chronic dysphagia completed a standard course of an exercise-based dysphagia treatment programme (McNeill dysphagia therapy program, MDTP). Pre- and post-treatment, kinematic aspects of swallowing were evaluated for thin liquid, thick liquid and pudding swallows. Maximum hyoid and laryngeal excursion magnitude and excursion duration were measured. Excursion velocities were calculated from excursion magnitude and duration measures. Successful treatment for dysphagia facilitated increased hyolaryngeal excursion magnitude, duration and velocity. These changes were most prominent for the hyoid and most often observed with thin liquids. By examining hyoid and laryngeal excursion velocity in patients who have experienced successful dysphagia rehabilitation, this study demonstrated the value of evaluating spatial and temporal aspects of swallowing kinematics in a single measure for a more comprehensive representation of positive changes underlying functional recovery.