Pharyngeal Pressures During Swallowing Within and Across Three Sessions: Within-Subject Variance and Order Effects

Macrae, Phoebe; Myall, Daniel J.; Jones, Richard D.; Huckabee, Maggie‐Lee

doi:10.1007/s00455-010-9324-y

Cited by 9 publications

(6 citation statements)

References 24 publications

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“…It was found that the average amount of water for one comfortable swallow was on average 14 mL (12 mL for men and 16 mL for women), which is slightly higher than that observed by Macrae et al . (). The difference between the two studies is relatively small and is probably acceptable.…”

Section: Resultsmentioning

confidence: 97%

“…For the former, the comfortable size (volume) of liquid bolus can be conveniently determined by monitoring the amount of water sipped for a single swallow. Macrae et al (2011) reported that the frequent sipped water volume reaches roughly 10-12 mL during natural drinking conditions. In this work, 10 healthy subjects (4 men and 6 women) were invited to sip water from a pre-weighted cup with normal size of 150 mL for a natural swallowing while recording tongue pressure using IOPI.…”

Section: Determination Of the Optimum Bolus Sizementioning

confidence: 99%

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Studies of the Oral Capabilities in Relation to Bolus Manipulations and the Ease of Initiating Bolus Flow

Alsanei

Chen

2013

Journal of Texture Studies

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Bolus swallowing can be a difficult task and/or highly hazardous to people with dysphagia (swallowing impairment), involving a risk of choking and airway obstruction. Food and pharmaceutical industries are under growing pressure to design and provide quality food for safe consumption by these disadvantaged populations and urgently need knowledge and a proper understanding of the controlling mechanisms of bolus manipulation and swallowing. In this study, physiological capabilities related to oral food handling, including maximum isometric tongue pressure, the volume of oral cavity, optimum bolus size, and tongue pressures applied during bolus swallowing were investigated. A total of 106 healthy subjects of different ages, genders and ethnic groups were involved in the investigation. A wide range of maximum isometric tongue pressure (from as low as 10 kPa to as high as 70 kPa) and maximum oral volume (from as low as 25 mL to as high as 116 mL) were observed. Further analysis showed that gender had no significant influence on tongue pressure and oral volume capacities. For younger adults (22-64 years), age also appears to have little effect. However, for older adults (>65 years), both maximum isometric tongue pressure and the oral volume showed a gradual decrease with the increasing of age. By investigating basic factors of bolus swallowing, this project aimed to reveal critical controlling factors underlining the process and to test the hypothesis that, because tongue pressure provides the initial driving force for bolus flow, one's capability to generate tongue pressure could be related to the ease with which one can swallow. For this purpose, a selection of subjects with known maximum isometric tongue pressure was further invited to swallow food (bolus) of varying consistencies. A positive correlation was observed between maximum tongue pressure and the maximum consistency of bolus that one can swallow for those who had lower tongue pressure generation capacity (<40 kPa). However, for subjects capable of producing very high tongue pressures (>40 kPa), a tongue pressure reserve (around a third of their maximum capability) was observed during bolus swallowing. PRACTICAL APPLICATIONSThis article investigates a few interesting hypothesis on the bio-mechanics of food processing, especially tongue pressure for bolus management and transfer during oro-pharyngeal swallow. Swallowing is the final stage of food oral processing and is crucial for the transportation of orally processed food (the bolus) to the stomach for further digestion and nutrient absorption. As such, safe swallowing is a major concern for many disadvantaged populations, e.g., some elderly populations, infants, oral and/or pharyngeal dysphagia and cerebrovascular accident (stroke) patients, patients in the late-stage of Alzheimer's disease and other hospital patients. Food and pharmaceutical industries are under an increasing pressure to develop and provide foods that are not only healthy and tasty, but are also safe to consume by these disadvant...

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Section: Resultsmentioning

confidence: 97%

Section: Determination Of the Optimum Bolus Sizementioning

confidence: 99%

Studies of the Oral Capabilities in Relation to Bolus Manipulations and the Ease of Initiating Bolus Flow

Alsanei

Chen

2013

Journal of Texture Studies

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“…With regard to the stability of the reported measures, within session and across session variance is a critical component to consider. Though an analysis of repeat measure stability is outside the scope of this study, Macrae et al (2011) report an investigation of within-subject variance and order effects within and across three sessions. They report greater variability across sessions than within sessions for sensors 1 and 2 during both dry and 10-ml swallows; however, the variance at sensor 3 is comparable to the lower within session variance.…”

Section: Discussionmentioning

confidence: 99%

Normative data for pharyngeal pressure generation during saliva, bolus, and effortful saliva swallowing across age and gender

Lamvik¹,

Macrae²,

Doeltgen³

et al. 2014

Speech, Language and Hearing

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Pharyngeal manometry provides information on both temporal and amplitude aspects of pressure generation during swallowing. This report provides normative data for three channel pharyngeal manometry on these parameters of pressure generation, providing the normal range of swallowing pressure against which impaired swallowing pressures can be compared. Participants were equally divided into four groups according to age and sex: young females (n = 20), young males (n = 20), older females (n = 20), and older males (n = 20). A discrete-sensor 3-channel manometric catheter measured pharyngeal pressure during three swallowing conditions: saliva swallowing, 10 ml bolus swallowing, and effortful saliva swallowing. Amplitude of peak pressure (mmHg) was recorded for each sensor during the swallow. The latency (ms) between peak pressure at Sensor 1 (approximately BOT) and Sensor 2 (approximately laryngeal additus) and total duration of upper esophageal sphincter relaxation were recorded. Additionally, a pharyngeal composite measure, consisting of an average of the peak amplitude of the two sensors in the pharyngeal segment, was generated to compensate for potential imprecision in recording due to intra-swallow catheter movement. Statistical analyses included derivation of means and 95% confidence intervals across swallowing conditions and participant groups. Clinically, these data provide a comparative database for identification of pathologic pharyngeal functioning in patients with swallowing impairment, and may aid in future studies of swallowing biomechanics.

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“…It was found that the average volume of a single mouthful for healthy swallowing of an adult is 21 mL (Adnerhill et al, 1989), however, during natural drinking situations the bolus volume is approximately 10 -12 mL (Macrae et al, 2011). At higher fluid temperatures, the volume that is consumed is approximately 5 -15 mL (Longman and Pearson, 1987).…”

Section: Volume Of the Bolusmentioning

confidence: 99%

Understanding the Rheological Parameters of Thickened Fluids for Dysphagia Sufferers

Hadde¹

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An abnormality of swallowing food or fluid, known as dysphagia is a major issue throughout the world. Thickened fluids are commonly used in the medical management of individuals who suffer dysphagia, allowing for better oral and pharyngeal coordination and increasing the cohesiveness of the fluid. This reduces the risk of aspiration associated with bolus fracture while swallowing. Thickened fluids have been used for many years in healthcare centres and at home to provide nutrition and hydration to individuals with dysphagia. However, it is not always easy to obtain the correct consistency of thickened fluids. Fluids that are too thin may result in pneumonia, while over-thickened fluids may result in aspiration due to residue possibly inhaled from pharyngeal stasis. Variabilities in the consistency of thick fluids can be due to type of thickeners, solid content, serving temperature and differences in dispersing media.In Australia the consistency of thickened fluids is routinely assessed by evaluating their flow characteristics through a fork. This method is subjective. Although, several more reliable measuring devices are available to measure the thickness of the fluid, these devices are not suitable for the application of dysphagia management. For example, a rheometer can be used to accurately measure the viscosity of the fluid, but this device is not affordable for the healthcare industry. In contrast, the Line Spread Test is an affordable device to measure the thickness of the fluid, but the current investigation found it was potentially unreliable as many factors may influence the results of the measurement.A study of the rheological and material property characteristics of thickened fluids is needed to understand the behaviour of these fluids to allow patients to receive a consistent level of thickened fluids. The development of objective measurement guidelines for the three levels of thickened fluids for the Australian National Standards and a suitable measuring technique is also needed. This project therefore had three main objectives: (a) to rheologically characterise the behaviour of thickened fluids, considering a wide range of thickeners, fluids and serving conditions, (b) to determine which rheological parameter(s) are important for the application of dysphagia management, and (c) to obtain design guidelines for a reliable, inexpensive measuring device to accurately measure the relevant rheological parameter(s) of thickened fluids for the application of dysphagia management.The rheological properties of thickened fluids were examined in shear deformation to observe the effect of temperature, pH, fluid components (e.g. protein, fat and minerals) and type of thickener on the rheological parameters of thickened fluids. The rheological properties of thickened fluids across four available commercial thickener products and a range of types of fluids were iii | P a g e characterised and compared. Studies confirmed significant variabilities in rheological parameters between thickener products and disp...

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Pharyngeal Pressures During Swallowing Within and Across Three Sessions: Within-Subject Variance and Order Effects

Cited by 9 publications

References 24 publications

Studies of the Oral Capabilities in Relation to Bolus Manipulations and the Ease of Initiating Bolus Flow

Studies of the Oral Capabilities in Relation to Bolus Manipulations and the Ease of Initiating Bolus Flow

Normative data for pharyngeal pressure generation during saliva, bolus, and effortful saliva swallowing across age and gender

Understanding the Rheological Parameters of Thickened Fluids for Dysphagia Sufferers

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