Evaluation of Normal Deglutition with the Help of Rectified Surface Electromyography Records

Abstract

Surface electromyographic (sEMG) studies were performed on 300 normal adults to estimate normal values of sEMG records of muscle activity in the detection and evaluation of stages of normal swallowing. Our study was a prospective observational study of healthy volunteers. The parameters evaluated during swallowing include the timing, amplitude (voltage), and graphic patterns of activity of the orbicularis oris, masseter, submental, and laryngeal strap muscles covered by the platysma. Three tests were examined: voluntary single swallows of saliva ("dry" swallow), voluntary single water swallows ("normal"), and voluntary single swallows of excessive amounts of water (20 ml, "stress test"). Duration and amplitude of muscle activity in oral, pharyngeal, and initial esophageal stages of swallowing (mean + standard deviation, range + standard deviation) were measured for groups of adults of different ages (18-40, 41-70, 70+ years). Shapes of graphic records were evaluated relative to timing and voltage. The overall normal mean values for stage-by-stage duration of muscle activity during single swallowing were established for healthy adults. The duration of muscle activity in all tests showed insignificant increases with age except for the elderly group (70+) in which it was statistically significant (SPSS, chi2 criterion, 95% confidence interval, p < 0.05). There were no statistically significant gender-related differences in duration or amplitude of muscle activity during single swallowing for any age group (p > or = 0.05). We conclude that the rectified and filtered sEMG provides a noninvasive means to assess certain aspects of complex muscle activity in deglutition. Surface EMG of swallowing is a simple and reliable noninvasive screening method for evaluating swallowing with low levels of discomfort. Stage-by-stage evaluation of duration can be very important for diagnosing the etiology of dysphagia. The combined normative timing of events, amplitude, and graphic data can be used for evaluating complaints and symptoms, as well as for comparison purposes in pre- and postoperative stages and in EMG monitoring during otolaryngological or neurological treatment. These parameters represent stages required for normal deglutition and provide a basis for the comparison of swallowing performance both within and between patients.

Evaluation of the location of capsules swallowed with food during the pharyngeal phase triggering in asymptomatic adults

“…Therefore, it is an additional tool for the establishment and location -oral, pharyngeal, and esophageal -of the causes for dysphagia and odynophagia (14) . Participants were instructed as follows: "place the capsule on your tongue, together with the customary amount of food you use when taking any medication.…”

A Predictive Model Based on Surface Electromyography to Assess the Easiness of Deglutition of Dysphagia Diets

“…Surface electromyography (sEMG) has been reported to provide a non-invasive method of assessing certain aspects of complex muscle activity for deglutition [4]. Miura et al [5] reported that the carbonated or cooled beverages have effect on the submental muscles and these responses can be examined by sEMG.…”

Mapping the Spatial and Temporal Dynamics of Sensorimotor Integration During the Perception and Performance of Wallowing

“…To address this issue, Neuroscan EEG systems include two bipolar surface EMG electrodes, which can be placed over a particular muscle group to identify muscle activity during movement. The following muscle complexes are known to provide physiological references for analyzing muscular activity during swallowing: the orbicularis oris muscles represent the oral phase; the masseter muscles represent the oral phase; the submental muscle group represent oral and pharyngeal phases (Perlman & Schulze-Delrieu, 1998;Vaiman et al, 2004); the infrahyoid muscle group represent the pharyngeal and esophageal phases (Balata et al, 2012;Ding, Larson, Logemann, & Rademaker, 2002;Ertekin et al, 1997;Spiro & Gay, 2004;Vaiman, Gabriel, Eviatar, Segal, 2005;Vaiman & Eviatar, 2011). While electrophysiological data obtained from the submental muscle group measures muscular activity during both the oral and pharyngeal phases (Ding et al, 2002), the infrahyoid muscle group allows for interpretation of pharyngeal phase activity that is dissociated from the oral phase.…”

“…The electrooculogram (EOG) recorded eye movements using two VEOG electrodes placed superior and inferior to the left eye and two HEOG electrodes placed lateral and medial to the left eye. In an attempt to identify the time course of muscle activity generated during hyolaryngeal excursion, two bipolar surface electromyography (EMG) electrodes were placed over the infrahyoid muscle complex (Logemann, 1998;Perlman, Palmer, McCulluch & Vandaele, 1999;Vaiman, Eviatar & Segal, 2004;Vaiman & Nahlieli, 2009). Additionally, cardiac-related artifacts were recorded using two electrocardiography (ECG) electrodes placed over the right and left common carotid arteries.…”

“…This was done to in an attempt to completely dissociate oral phase SMI from pharyngeal phase SMI. As an alternative, selecting the suprahyoid muscle complex in the future may provide a slightly more precise measure of the 'onset' of pharyngeal phase activity (Vaiman et al, 2004). Finally, recent studies suggest differences in the strength and timing of swallowing physiology (Logemann et al, 2000;Robbins et al, 2008) and the degree of cortical sensorimotor activity during swallowing (Malandraki, Perlman, Karampinos, Sutton, 2010;Humbert & Robbins, 2011) in individuals over the age of 65.…”