Event Sequence Variability in Healthy Swallowing: Building on Previous Findings

Molfenter, Sonja M.; Leigh, Chelsea; Steele, Catriona M.

doi:10.1007/s00455-013-9501-x

Cited by 32 publications

(33 citation statements)

References 20 publications

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“…Between-individual pharyngeal swallowing variability is well-recognized [51–61], but within-individual pharyngeal swallowing pressure variability during a repeated task appears to be a novel measurement parameter that may be powerful in distinguishing healthy behavior from dysphagia. Within-individual motor variability in patients with PD has been described in limb forces and movements [62–69] and in gait [70–76], but this is the first study to describe swallowing pressure variability in the same patient population (CV in the velopharynx).…”

Section: Discussionmentioning

confidence: 99%

Multimodal Swallowing Evaluation with High-Resolution Manometry Reveals Subtle Swallowing Changes in Early and Mid-Stage Parkinson Disease

Jones

Ciucci

2016

Journal of Parkinson’s Disease

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Background Parkinson disease (PD) has detrimental effects on swallowing function. Treatment options are largely behavioral; thus, patients would benefit from an earlier start to therapy. Early swallowing changes in PD are not well-known, so patients do not typically receive swallowing treatment until later in the progression of PD. Objective We used predictive modeling to determine what quantitative swallowing variables best differentiate individuals with early to mid-stage PD from healthy controls. Methods Participants included twenty-six individuals with early to mid-stage PD and 26 healthy, age- and sex-matched controls. Swallowing was evaluated by simultaneous high-resolution manometry and videofluoroscopy as well as the Sydney Swallow Questionnaire (SSQ). Binomial logistic regression was performed on 4 sets of data: 1) high-resolution manometry only; 2) videofluoroscopy only; 3) SSQ only; and 4) all data combined. Results A model from a combined data set had the highest accuracy in differentiating individuals with PD from controls. The model included maximum pressure in the velopharynx (soft palate), pressure variability in the velopharynx, and the SSQ item concerning difficulty with saliva swallowing. No significant models could be generated using the videofluoroscopy data. Conclusions Individuals with PD show quantitative changes in pressure generation and are able to self-assess aspects of swallowing function in the early and mid-stages of PD, even in the absence of swallowing changes seen on videofluoroscopy. A multimodal approach for the assessment of swallowing may be more accurate for determining subtle swallowing changes that occur in the early stages of PD.

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Section: Discussionmentioning

confidence: 99%

Multimodal Swallowing Evaluation with High-Resolution Manometry Reveals Subtle Swallowing Changes in Early and Mid-Stage Parkinson Disease

Jones

Ciucci

2016

Journal of Parkinson’s Disease

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“…The random variables at the moment of swallow may have led to the high inter-subject variability in the respiratory-swallow measures included in this study. Prevailing airway-deglutition literature with inconclusive evidences in physiology, function, and sequence of swallowing events [35][36][37][38] supports this opinion of variability.…”

Section: Discussionmentioning

confidence: 85%

The Effect of Chin-Down Position and Bolus Volume on Swallow-Induced Respiratory Measures in Young Healthy Adults

Krishnan

Goswami

2019

SN Compr. Clin. Med.

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Though head positioning strategies are widely used in the rehabilitation of swallowing dysfunction, little is yet known about its effect on the respiratory-swallow interaction. We hypothesised that a chin-down positioning would alter the respiratory behaviour in healthy young individuals. In a within-group study, we compared the characteristics of nasal airflow and its coordination with swallow events before, after, and during the swallow of liquid in a group of 30 young healthy individuals. The measures were obtained with simultaneous recording of surface electromyography, nasal airflow, and swallow sound recording during spontaneous drinking of 5, 15, and 20 ml water. Duration of swallowing apnoea (SAD) and the slope (Spre & Spost), duration (Dpre & Dpost), and direction (Expiration/Inspiration) of respiratory phases surrounding the apnoea were obtained. The statistical comparisons revealed that chin-down position significantly prolonged breathing arrest (SAD) and pharyngeal transit time (event interval) during swallow. The Dpost of large volume swallows were shorter indicating a quick resumption of breathing, indicating high post-swallow respiratory demand. The other statistically significant differences in various event intervals suggested the influence of chin-down position and bolus volume on the oral and pharyngeal transit time. Also, there was an increase in the incidence of inspiratory swallows in the chin-down position with large bolus volumes. We conclude that the chin-down position can provide longer airway decoupling but may increase the respiratory demand during swallows. Use of smaller bolus volumes should be recommended for chin-down swallows in persons with respiratory distress and dysphagia.

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“…Timing of LVC also changed, occurring earlier during the chin‐up swallows (phase 2) when compared to the first neutral swallows (phase 1; see Figure ) Even though remarkable variability has been found in the sequence of events in healthy swallowing, including variations in the sequence of LVC and hyoid kinematics, measures of peak hyoid velocity have previously been linked to LVC in healthy subjects swallowing thin liquids . In the current study, the peak hyoid elevation occurred consistently later and LVC occurred consistently earlier in the sequence of events during chin‐up swallowing compared with head neutral swallows, showing a relationship between the 2 events' occurrences.…”

Section: Discussionmentioning

confidence: 99%

Effects of chin‐up posture on the sequence of swallowing events

et al. 2017

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Background Chin-up posture is frequently used to manage oral dysphagia after head and neck cancer. This prospective study investigates the effects of chin-ups on the sequence of pharyngeal swallowing events. Methods Twelve healthy young adults performed 45 consecutive swallows of 5 mL water across 3 phases on videofluoroscopy: 5 swallows in the neutral head position; 30 swallows during chin-up posture; and 10 swallows in the neutral head position. Swallowing kinematic and bolus flow measures for 9 swallowing events were recorded. Linear trends were analyzed across 30 chin-up swallows; pairwise comparison was used to compare the 3 phases. Results Time to hyoid peak and laryngeal vestibule closure changed abruptly during chin-up swallowing compared to the initial neutral position. No measure changed across 30 chin-up swallows. Time of hyoid burst decreased upon returning to the neutral position. Conclusion Our findings indicate that chin-up posture challenges the pharyngeal sequence of events for both swallowing kinematics and bolus flow.

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Event Sequence Variability in Healthy Swallowing: Building on Previous Findings

Cited by 32 publications

References 20 publications

Multimodal Swallowing Evaluation with High-Resolution Manometry Reveals Subtle Swallowing Changes in Early and Mid-Stage Parkinson Disease

Multimodal Swallowing Evaluation with High-Resolution Manometry Reveals Subtle Swallowing Changes in Early and Mid-Stage Parkinson Disease

The Effect of Chin-Down Position and Bolus Volume on Swallow-Induced Respiratory Measures in Young Healthy Adults

Effects of chin‐up posture on the sequence of swallowing events

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