Examination of swallowing maneuver training and transfer of practiced behaviors to laryngeal vestibule kinematics in functional swallowing of healthy adults

Guedes, Renata Lígia Vieira; Azola, Alba; Macrae, Phoebe; Sunday, Kirstyn L.; Mejia, Veerley; Vose, Alicia; Humbert, Ianessa A.

doi:10.1016/j.physbeh.2017.03.018

Cited by 23 publications

(36 citation statements)

References 43 publications

(54 reference statements)

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“…Guedes et al have also demonstrated adaption learning influencing LVCrt using a volitional laryngeal vestibule closure maneuver, which incorporated resistance to relaxation of laryngeal muscles during the pharyngeal stage of swallowing (i.e., similar to a Mendelsohn maneuver) [ 10 ]. As in the present study, the authors reported effects of LVCrt during natural swallowing in healthy participants immediately after a training period of 20 volitional swallows using the maneuver.…”

Section: Discussionmentioning

confidence: 99%

“…LVCd represented the temporal duration between the endpoint of the LVCrt measure and the initiation of arytenoid descent from the epiglottis, verified by reappearance of the supraglottal air space. Both LVCrt and LVCd have been previously reported in existing literature [ 10 ]. Both measurements were calculated in milliseconds (ms), and obtained from the pre-stimulation and post-stimulation swallows.…”

Section: Methodsmentioning

confidence: 99%

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The effect of transcutaneous neuromuscular electrical stimulation on laryngeal vestibule closure timing in swallowing

Dumican

2018

BMC Ear Nose Throat Disord

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BackgroundThe purpose of this study was to investigate the effect of transcutaneous neuromuscular electrical stimulation (NMES) on the timing of laryngeal vestibule closure during the pharyngeal stage of swallowing in healthy adults. The theoretical framework proposed that NMES applied to these muscles would present a perturbation to laryngeal vestibular closure reaction time (the amount of time for the laryngeal vestibule to close once the swallowing reflex has been triggered) by providing an antagonistic force to the direction of vestibule closure.MethodsNine healthy adults (2 males, 7 females) received ten consecutive stimulations applied to the submandibular hyolaryngeal muscles while performing dry swallows. Laryngeal vestibule closure reaction time (LVCrt) and the laryngeal vestibule closure duration (LVCd) were measured from videoflouroscopic images pre-stimulation and post-stimulation.ResultsResults indicated a significant effect of stimulation on LVCrt but not LVCd. LVCrt was significantly reduced (timing was faster) during swallows immediately after stimulation compared to pre-stimulation.ConclusionsFindings from this study support the supposition that laryngeal muscles respond to perturbations via adaptation learning, which might be used for rehabilitation of neuromuscular swallowing impairment. This pilot study supports the need for further research.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The effect of transcutaneous neuromuscular electrical stimulation on laryngeal vestibule closure timing in swallowing

Dumican

2018

BMC Ear Nose Throat Disord

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“…Second, the TVC is independent of other structures and thus can be a target for rehabilitative exercises to strengthen airway protection. A recent study of volitional LV closure maneuvers found that training TVC closure can induce safe and functional swallowing behavior as an adaptable component [19]. Third, velopharyngeal isthmus closure, epiglottis inversion, and TVC closure were prolonged in a reclining position with an increased tilting angle.…”

Section: Discussionmentioning

confidence: 95%

Effects of bolus consistency and reclining position on kinematic swallowing events in analysis using 320-row area detector computed tomography

et al. 2020

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This study used 320-row area detector computed tomography (320-ADCT) to determine whether kinematic swallowing events and bolus movement through the oropharynx are affected by bolus consistency and angle of recline. Fourteen healthy adults (4 men, 10 women; age, 22-90 years) underwent 320-ADCT assessment during three 10-mL barium swallow tests, with honey-thick liquid at 60° recline (60°thick), thin liquid at 60° recline (60°thin), and thin liquid at 45° recline (45°thin). The times of swallowing events were measured and compared among the different tests. Bolus propulsion, onset time of true vocal cord (TVC) closure, and upper esophageal sphincter opening were significantly earlier for 60°thin than for 60°thick. Onset time did not significantly differ between 60°thin and 45°thin; however, greater variability was noted for onset of TVC closure with 45°thin, as the TVC started to close before onset of swallowing in 30% of participants. Modulation of TVC closure depends on bolus transport in different reclining positions. The 45° reclining position elicited preswallow TVC closure in some participants, which suggests that excessive recline can increase perceived risk of airway invasion during swallowing.

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“…Given our swallowing maneuver targets impaired LVC, all patients underwent videofluoroscopy to confirm the presence of an LVC impairment. Quantitative LVC timing measures were calculated for each patient and were compared with the research literature impairment thresholds to determine if LVC timing was in or out of normal range . LVC was also rated using the MBSimP criteria for Component 11 (LVC) and Component 9 (Epiglottic Inversion).…”

Section: Methodsmentioning

confidence: 99%

“…Quantitative LVC timing measures were calculated for each patient and were compared with the research literature impairment thresholds to determine if LVC timing was in or out of normal range. [15][16][17] LVC was also rated using the MBSimP criteria for Component 11 (LVC) and Component 9 (Epiglottic Inversion). Raters judged LVC as 1 = impaired or 0 = not impaired for each patient.…”

Section: Lvc Impairment Identificationmentioning

confidence: 99%

Kinematic Visual Biofeedback Improves Accuracy of Swallowing Maneuver Training and Accuracy of Clinician Cues During Training in Stroke Patients with Dysphagia

Vose

Marcus

Humbert

2019

PM&R

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Background Dysphagia (swallowing impairment) is a common and often life‐threatening problem after stroke. Submental surface electromyography (ssEMG) visual biofeedback is a commonly used clinical tool to train novel swallowing maneuvers, even though its effectiveness has been questioned. Objective To compare the effect of ssEMG and videofluoroscopy (VF) visual biofeedback on swallowing airway protection accuracy when training the volitional laryngeal closure swallowing maneuver (vLVC) in poststroke patients with dysphagia. Researchers also examined whether clinicians accurately judged vLVC performance. The hypothesis was that patient vLVC accuracy and clinician verbal cue accuracy will be greatest with VF (kinematic) visual biofeedback. Patients Nineteen patients with dysphagia post stroke. Setting Outpatient swallowing research laboratory. Design Randomized clinical trial. Methods Patients underwent 2 study phases. Phase 1: first demonstrated ability to perform the vLVC accurately. Phase 2: vLVC training. Participants were randomized into three biofeedback groups including the ssEMG group (ssEMG biofeedback in both phases), the VF group (VF biofeedback in both phases), and the mixed group (VF phase 1, ssEMG phase 2). To promote the best vLVC performance, a clinician provided real‐time, verbal cueing using only the visual biofeedback type also seen by the patient, although both VF and ssEMG were recorded for all participants. Main Outcome Measure Patient performance accuracy and clinician feedback accuracy for performing the vLVC maneuver. Results Both accuracy of vLVC training performance and clinician feedback accuracy were worse in the ssEMG group compared with the VF and mixed groups (P < .001). Conclusions Swallowing airway protection requires precisely timed movements of small, hidden laryngeal and pharyngeal structures. Kinematic biofeedback (VF) may be required, at some point, to ensure that target swallowing movements are being trained during rehabilitation, rather than maladaptive movements. Level of Evidence I.

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Examination of swallowing maneuver training and transfer of practiced behaviors to laryngeal vestibule kinematics in functional swallowing of healthy adults

Cited by 23 publications

References 43 publications

The effect of transcutaneous neuromuscular electrical stimulation on laryngeal vestibule closure timing in swallowing

The effect of transcutaneous neuromuscular electrical stimulation on laryngeal vestibule closure timing in swallowing

Effects of bolus consistency and reclining position on kinematic swallowing events in analysis using 320-row area detector computed tomography

Kinematic Visual Biofeedback Improves Accuracy of Swallowing Maneuver Training and Accuracy of Clinician Cues During Training in Stroke Patients with Dysphagia

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