Modulation of Tongue Pressure According to Liquid Flow Properties in Healthy Swallowing

Steele, Catriona M.; Péladeau-Pigeon, Melanie; Barbon, Carly A. E.; Guida, Brittany T.; Tapson, Melanie S.; Valenzano, Teresa J.; Waito, Ashley A.; Wolkin, Talia S.; Hanson, Ben; Ong, Jane Jun-Xin; Duizer, Lisa

doi:10.1044/2018_jslhr-s-18-0229

Cited by 18 publications

(22 citation statements)

References 47 publications

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“…Thus, the strength of the tongue and certain parameters observable by videofluoroscopic assessments were measured in healthy adult subjects (age range: 21-58 year.) while swallowing thickened water of different IDDSI Levels [51,52]. Consistent with previous literature [65], the results showed that the force exerted by the tongue during swallowing increased with the consistency of the liquid (n = 38) [52].…”

Section: Discrimination Ability Of the Iddsi Flow Testsupporting

confidence: 89%

“…while swallowing thickened water of different IDDSI Levels [51,52]. Consistent with previous literature [65], the results showed that the force exerted by the tongue during swallowing increased with the consistency of the liquid (n = 38) [52]. However, this increase was not proportional in each of the IDDSI levels.…”

Section: Discrimination Ability Of the Iddsi Flow Testsupporting

confidence: 89%

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Is IDDSI an Evidence-Based Framework? A Relevant Question for the Frail Older Population

Côté

Giroux²,

Villeneuve-Rhéaume

et al. 2020

Geriatrics

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To delay impacts of aging, optimal nutritional status is essential. Several factors can reduce food intake, such as isolation, income, and cognitive/physical decline. Additionally, chewing and swallowing difficulties, or dysphagia, often disrupt the ability to consume life-long favorite dishes. Food and liquids could require modification of texture or consistency to ensure a comfortable or safe swallow. The food industry, foodservices facilities, and caregivers need quality control benchmarks to provide adequate nourishment and meet these new feeding challenges. The International Dysphagia Diet Standardisation Initiative (IDDSI) is proposing the IDDSI framework and testing methods to describe food used in nutritional care plans to circumvent dysphagia and improve communication among caregivers. This systematic review assesses the validity and reliability of the IDDSI testing methods using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). Two publications presented content validity whereas 19 publications looked at construct validity or reliability for the IDDSI testing methods. One study was conducted in older adults presenting dysphagia. This review concludes that there is insufficient evidence to recommend the IDDSI testing methods. Further research, conducted with robust methodological design and reporting, is needed to develop and assess nutritious adapted food for frail older populations.

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Section: Discrimination Ability Of the Iddsi Flow Testsupporting

confidence: 89%

Section: Discrimination Ability Of the Iddsi Flow Testsupporting

confidence: 89%

Is IDDSI an Evidence-Based Framework? A Relevant Question for the Frail Older Population

Côté

Giroux²,

Villeneuve-Rhéaume

et al. 2020

Geriatrics

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“…Participants were instructed to take comfortable sips of thin, slightly thick, and mildly thick liquids, as well as comfortable teaspoons of moderately and extremely thick liquids, defined by the International Dysphagia Diet Standardisation Initiative (IDDSI) framework ( Cichero et al, 2017 ). Each cup was weighed before and after the participant took a sip to obtain measures of bolus weight, which were converted to bolus volume using published conversions ( Steele, Peladeau-Pigeon, Barbon, Guida, Tapson, et al, 2019 ). All liquids were mixed following standardized recipes ( Barbon & Steele, 2018 ) to a 20% weight-to-volume concentration of barium contrast (Bracco Diagnostics E-Z-PAQUE barium sulfate) and thickened with a xanthan gum thickener (Nestlé Resource ThickenUp Clear).…”

Section: Methodsmentioning

confidence: 99%

A Cross-Sectional, Quantitative Videofluoroscopic Analysis of Swallowing Physiology and Function in Individuals With Amyotrophic Lateral Sclerosis

Waito

Plowman

Barbon

et al. 2020

J Speech Lang Hear Res

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Purpose To date, research characterizing swallowing changes in individuals with amyotrophic lateral sclerosis (ALS) has primarily relied on subjective descriptions. Thus, the degree to which swallowing physiology is altered in ALS, and relationships between such alterations and swallow safety and/or efficiency are not well characterized. This study provides a quantitative representation of swallow physiology, safety, and efficiency in a sample of individuals with ALS, to estimate the degree of difference in comparison to published healthy reference data and identify parameters that pose risk to swallow safety and efficiency. Secondary analyses explored the therapeutic effect of thickened liquids on swallowing safety and efficiency. Method Nineteen adults with a diagnosis of probable-definite ALS (El-Escorial Criteria–Revised) underwent a videofluoroscopic swallowing study, involving up to 15 sips of barium liquid (20% w/v), ranging in thickness from thin to extremely thick. Blinded frame-by-frame videofluoroscopy analysis yielded the following measures: Penetration–Aspiration Scale, number of swallows per bolus, amount of pharyngeal residue, degree of laryngeal vestibule closure (LVC), time-to-LVC, duration of LVC (LVCdur), pharyngeal area at maximum constriction, diameter of upper esophageal sphincter opening, and duration of UES opening (UESOdur). Measures of swallow physiology obtained from thin liquid trials were compared against published healthy reference data using unpaired t tests, chi-squared tests, and Cohen’s d effect sizes (adjusted p < .008). Preliminary relationships between parameters of swallowing physiology, safety, and efficiency were explored using nonparametric Cochrane’s Q, Friedman’s test, and generalized estimating equations ( p < .05). Results Compared to healthy reference data, this sample of individuals with ALS displayed a higher proportion of swallows with partial or incomplete LVC (24% vs. < 1%), increased time-to-LVC ( d = 1.09), reduced UESwidth ( d = 0.59), enlarged pharyngeal area at maximum constriction, prolonged LVCdur ( d = 0.64), and prolonged UESOdur ( d = 1.34). Unsafe swallowing (i.e., PAS ≥ 3) occurred more frequently when LVC was partial/incomplete or time-to-LVC was prolonged. Pharyngeal residue was associated with larger pharyngeal areas at maximum constriction. Unsafe swallowing occurred less frequently with extremely thick liquids, compared to thin liquids. No significant differences in pharyngeal residue were observed based on liquid thickness. Conclusions Quantitative videofluoroscopic measurements revealed moderate-to-large differences in swallow physiology between this sample of individuals with ALS and healthy reference data. Increased time-to-LVC, noncomplete LVC, and enlarged pharyngeal area at maximum constriction were associated with impaired swallow safety or efficiency. Thickened liquids may mitigate the risk of acute episodes of aspiration in individuals with ALS. Further work is needed to corroborate these preliminary findings and explore how swallowing profiles evolve throughout disease progression.

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“…The nonbarium stimuli used in the study had a mild lemon flavoring, as judged by a blinded taste panel ( Steele et al, 2019 ). Although the intensity of sourness was significantly lower than has been previously reported to impact swallowing behaviors ( Nagy et al, 2014 ), the influence of taste cannot be ruled out.…”

Section: Discussionmentioning

confidence: 99%

“…The protocol also involved the concurrent measurement of tongue-palate pressures using a three-sensor tongue bulb array placed with adhesive on the palatal surface. Data regarding measures of tongue pressure during swallowing have been reported in a separate manuscript ( Steele et al, 2019 ).…”

Section: Methodsmentioning

confidence: 99%

Respiratory–Swallow Coordination in Healthy Adults During Drinking of Thin to Extremely Thick Liquids: A Research Note

Valenzano

Guida

Péladeau-Pigeon

et al. 2020

J Speech Lang Hear Res

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Purpose Respiratory–swallow coordination is vital for airway protection, preventing aspiration, or penetration of foreign material into the airway. With the implementation of the International Dysphagia Diet Standardization Initiative definitions for different liquid consistencies used in dysphagia management, it is important to establish whether respiratory–swallow coordination patterns differ across these consistencies. This study aimed to evaluate respiratory behaviors during swallowing across the spectrum from thin to extremely thick liquids in healthy adults less than 60 years of age. Method Thirty healthy adults, aged 21–55 years, each consumed 54 naturally sized cup sips or spoonfuls of liquid stimuli prepared in thin, slightly thick, mildly thick, moderately thick, and extremely thick consistencies. Half of the stimuli were prepared using barium and half with a lemon-flavored water. Concurrent respiratory and swallowing pressure signals were collected to evaluate the respiratory phase pattern and pause duration associated with the swallow. Results An expiration–swallow–expiration pattern was the dominant respiratory phase pattern, observed in 92.7% of the trials, with no significant effect of consistency. Respiratory pause duration was found to be significantly shorter with barium stimuli (0.73 s) compared to nonbarium stimuli (0.78 s) ( p < .001, Cohen's d = .2), with no notable effects based on the factors of sex or liquid consistency. Conclusions In a convenience sample of healthy adults under the age of 60 years, consistent respiratory–swallow phasing and stable timing across the spectrum from thin to extremely thick liquids was observed. The data from this study can serve as preliminary reference data to which assessment information for individuals with dysphagia or respiratory challenges can be compared.

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Modulation of Tongue Pressure According to Liquid Flow Properties in Healthy Swallowing

Cited by 18 publications

References 47 publications

Is IDDSI an Evidence-Based Framework? A Relevant Question for the Frail Older Population

Is IDDSI an Evidence-Based Framework? A Relevant Question for the Frail Older Population

A Cross-Sectional, Quantitative Videofluoroscopic Analysis of Swallowing Physiology and Function in Individuals With Amyotrophic Lateral Sclerosis

Respiratory–Swallow Coordination in Healthy Adults During Drinking of Thin to Extremely Thick Liquids: A Research Note

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