Noninvasive Monitoring of Breathing and Swallowing Interaction

Terzi, Nicolas; David, Olivier; Prigent, Hélène; Denise, Pierre; Normand, Hervé; Lofaso, Frédéric

doi:10.5772/25779

Cited by 5 publications

(8 citation statements)

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“…35,36 Furthermore, respiration monitoring instrumentation was added to this instrument, which enabled the analysis of oropharyngeal swallowing impairment and respiration coordination in elderly patients 37 and those with neuromuscular dysphagia. 38 The purpose of this study was to understand oropharyngeal swallowing and respiration coordination after a stroke and its recovery. We used novel, non-invasive swallowing studies to characterize the physiological changes of swallowing and respiration coordination in healthy controls and patients with unilateral stroke at different follow-up time periods.…”

Section: Key Resultsmentioning

confidence: 99%

“…Furthermore, it should be easily carried or worn, and portable . Equally important, this non‐invasive swallowing study tool should be capable of being combined with respiration monitoring for swallowing and respiration coordination studies . The priority of swallowing safety is to secure the airway.…”

Section: Discussionmentioning

confidence: 99%

“…52 Equally important, this non-invasive swallowing study tool should be capable of being combined with respi- ration monitoring for swallowing and respiration coordination studies. 38 The priority of swallowing safety is to secure the airway. For clinical application of this non-invasive assessment of swallowing and respiration coordination, we suggest that if patients had piece-meal swallowing, smaller bolus volumes would be necessary.…”

Section: Assessment Tools For Swallowing and Respiration Coordinationmentioning

confidence: 99%

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Integrated non‐invasive measurements reveal swallowing and respiration coordination recovery after unilateral stroke

Wang

Chen

2015

Neurogastroenterology Motil

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Key Messages• Oropharyngeal dysphagia (OD) is common after a stroke, and OD is a potential cause of aspiration, dehydration, malnutrition, increased length of hospital stay.• The fine coordination between oropharyngeal swallowing and respiration is essential to ensure the safety of swallowing without aspiration, and stroke insults affect swallowing and respiration coordination, but no longitudinal follow-up study of this coordination after unilateral stroke was demonstrated in a literature review.• A non-invasive swallowing assessment method was used to detect oropharyngeal swallowing parameters and respiration coordination simultaneously during the swallowing process.• Results show that oropharyngeal swallowing and respiration coordination in unilateral stroke patients deviate from normal controls after stroke insult and improved during the subacute phase poststroke. AbstractBackground Oropharyngeal dysphagia is common after a stroke. Understanding the physiology of swallowing and its coordination with respiration in stroke recovery is crucially important. Methods A noninvasive swallowing assessment method was used to detect oropharyngeal swallowing and respiration coordination simultaneously during the swallowing process. This system detected movement of the larynx, submental muscle activity, and nasal airflow. Six different sizes of water boluses (maximum of 20 mL) were swallowed and assessed for each subject. Key ResultsWe recruited 59 healthy participants and 38 first ever unilateral stroke patients completed baseline and follow-up assessments at 3, 6, and 9 months poststroke. The results showed that oropharyngeal swallowing parameters in unilateral stroke deviate from normal patterns. For respiration coordination, the unilateral stroke group had longer swallowing apnea duration but similar frequencies of preand postswallowing respiratory phase patterns compared with the healthy controls. The probability of piece-meal deglutition was higher in the stroke group than in the control group. Additionally, there were gradually decreasing piece-meal deglutition probabilities among the stroke patients at follow-up, and none differed statistically from those of the controls at 6 months poststroke. Conclusions & Inferences The non-invasive swallowing and respiration assessment method applied in this study detected the changes manifested in swallowing and respiration during the subacute phase of recovery in 6 months after a unilateral stroke. The study results serve as a baseline for

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Section: Key Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Assessment Tools For Swallowing and Respiration Coordinationmentioning

confidence: 99%

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Integrated non‐invasive measurements reveal swallowing and respiration coordination recovery after unilateral stroke

Wang

Chen

2015

Neurogastroenterology Motil

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“…Generally, MI contains on the one hand ME programs for muscle contractions, but, on the other hand, these programs might be blocked at some level of the motor system by inhibitory mechanisms, which might in turn lead to a decreased activation level in swallowing-related brain areas ( 7 , 74 ). In the present pilot study, we did not have the opportunity to assess the activity of muscles involved in swallowing, e.g., suprahyoid muscles, by using, for instance, the electromyogram EMG ( 75 ). Possible muscle activity during MI of swallowing was controlled by visual inspection.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Signal Changes Accompanying Execution and Imagery of Swallowing in Patients with Dysphagia: A Multiple Single-Case Near-Infrared Spectroscopy Study

Kober

Bauernfeind

Woller³

et al. 2015

Front. Neurol.

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In the present multiple case study, we examined hemodynamic changes in the brain in response to motor execution (ME) and motor imagery (MI) of swallowing in dysphagia patients compared to healthy matched controls using near-infrared spectroscopy (NIRS). Two stroke patients with cerebral lesions in the right hemisphere, two stroke patients with lesions in the brainstem, and two neurologically healthy control subjects actively swallowed saliva (ME) and mentally imagined to swallow saliva (MI) in a randomized order while changes in concentration of oxygenated hemoglobin (oxy-Hb) and deoxygenated hemoglobin (deoxy-Hb) were assessed. In line with recent findings in healthy young adults, MI and ME of swallowing led to the strongest NIRS signal change in the inferior frontal gyrus in stroke patients as well as in healthy elderly. We found differences in the topographical distribution and time course of the hemodynamic response in dependence on lesion location. Dysphagia patients with lesions in the brainstem showed bilateral hemodynamic signal changes in the inferior frontal gyrus during active swallowing comparable to healthy controls. In contrast, dysphagia patients with cerebral lesions in the right hemisphere showed more unilateral activation patterns during swallowing. Furthermore, patients with cerebral lesions showed a prolonged time course of the hemodynamic response during MI and ME of swallowing compared to healthy controls and patients with brainstem lesions. Brain activation patterns associated with ME and MI of swallowing were largely comparable, especially for changes in deoxy-Hb. Hence, the present results provide new evidence regarding timing and topographical distribution of the hemodynamic response during ME and MI of swallowing in dysphagia patients and may have practical impact on future dysphagia treatment.

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“…Specifically, the raw data were corrected from artifacts (criterion for rejection: amplitude of Hb-signal > +/- 3 SD; visual inspection) and filtered with a 0.01 Hz high pass filter to remove baseline drifts and a 0.90 Hz low pass filter. To control for active movements during the MI task and also during the NF training sessions, the activity of the suprahyoid muscles (including mylohyoid, genohyoid, and anterior digastric muscles), which are involved during swallowing, was recorded using the electromyogram (EMG) [ 66 ]. Generally, EMG activity that is assessed at the suprahyoid muscles provides considerable information about the oropharyngeal swallowing phase [ 66 ].…”

Section: Methodsmentioning

confidence: 99%

Voluntary Modulation of Hemodynamic Responses in Swallowing Related Motor Areas: A Near-Infrared Spectroscopy-Based Neurofeedback Study

et al. 2015

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In the present study, we show for the first time that motor imagery of swallowing, which is defined as the mental imagination of a specific motor act without overt movements by muscular activity, can be successfully used as mental strategy in a neurofeedback training paradigm. Furthermore, we demonstrate its effects on cortical correlates of swallowing function. Therefore, N = 20 healthy young adults were trained to voluntarily increase their hemodynamic response in swallowing related brain areas as assessed with near-infrared spectroscopy (NIRS). During seven training sessions, participants received either feedback of concentration changes in oxygenated hemoglobin (oxy-Hb group, N = 10) or deoxygenated hemoglobin (deoxy-Hb group, N = 10) over the inferior frontal gyrus (IFG) during motor imagery of swallowing. Before and after the training, we assessed cortical activation patterns during motor execution and imagery of swallowing. The deoxy-Hb group was able to voluntarily increase deoxy-Hb over the IFG during imagery of swallowing. Furthermore, swallowing related cortical activation patterns were more pronounced during motor execution and imagery after the training compared to the pre-test, indicating cortical reorganization due to neurofeedback training. The oxy-Hb group could neither control oxy-Hb during neurofeedback training nor showed any cortical changes. Hence, successful modulation of deoxy-Hb over swallowing related brain areas led to cortical reorganization and might be useful for future treatments of swallowing dysfunction.

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Noninvasive Monitoring of Breathing and Swallowing Interaction

Cited by 5 publications

References 50 publications

Integrated non‐invasive measurements reveal swallowing and respiration coordination recovery after unilateral stroke

Integrated non‐invasive measurements reveal swallowing and respiration coordination recovery after unilateral stroke

Hemodynamic Signal Changes Accompanying Execution and Imagery of Swallowing in Patients with Dysphagia: A Multiple Single-Case Near-Infrared Spectroscopy Study

Voluntary Modulation of Hemodynamic Responses in Swallowing Related Motor Areas: A Near-Infrared Spectroscopy-Based Neurofeedback Study

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