Swallowing Kinematic Differences Across Frozen, Mixed, and Ultrathin Liquid Boluses in Healthy Adults: Age, Sex, and Normal Variability

Humbert, Ianessa A.; Sunday, Kirstyn L.; Karagiorgos, Eleni; Vose, Alicia; Gould, François D. H.; Greene, Lindsey R.; Azola, Alba; Tolar, Ara; Rivet, Alycia

doi:10.1044/2018_jslhr-s-17-0417

Cited by 51 publications

(49 citation statements)

References 68 publications

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“…The data included swallows of non‐cued cup sips of thin and nectar bolus viscosities. Our goal was to target swallowing trials that were more natural (non‐cued, cup sips) and that tend to require better airway protection kinematics due to the speed of bolus rheology (thin and nectar bolus viscosities) . All dysphagic subjects had at least one swallow with a PAS score of 1 or 2, which is considered to be “safe” or “normal,” as well as a PAS score of 3 through 8, which is considered to be “less safe,” with penetration or aspiration …”

Section: Methodsmentioning

confidence: 99%

Validation of the Normalized Laryngeal Constriction Ratio in Normal and Disordered Swallowing

et al. 2019

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Purpose The timing of laryngeal vestibule closure (LVC) is important for airway protection during swallowing. However, it is unknown whether the extent of LVC contributes to airway protection. The goal of this study is to validate the extent of LVC via a measure called laryngeal constriction ratio (LCR). Methods A retrospective analysis of videofluoroscopic swallows was conducted on 38 stroke participants and 40 healthy controls. The LCR was calculated by deriving a size‐normalized area of airspace from a 1) maximum closed laryngeal vestibule and a 2) maximum open laryngeal airspace (at rest). Airway invasion severity was derived via the Penetration–Aspiration Scale score. Results Six hundred forty‐nine videofluoroscopic swallows were analyzed. A mixed model analysis revealed a statistically significant mean difference between the normalized laryngeal constriction ratios of healthy individuals (mean (m) = 0.003) versus older dysphagic patients (m = .026) (P = 0.001), quantifying less closure in older patients with dysphagia. Additionally, swallows with airway compromise had a statistically worse LCR when compared to swallows without airway compromise (P = 0.001). Conclusion The normalized LCR might be a valid fluoroscopic surrogate measure for LVC and, furthermore, airway compromise during swallowing. By investigating spatial measurements in the laryngeal vestibule during safe and unsafe swallows, the LCR provides a direction for further research to allow for critical examination of the physiology relating to closure degree in order to precisely detect and treat abnormalities during swallowing. Level of Evidence 4 Laryngoscope, 130:E190–E198, 2020

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Section: Methodsmentioning

confidence: 99%

Validation of the Normalized Laryngeal Constriction Ratio in Normal and Disordered Swallowing

et al. 2019

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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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“…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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Swallowing Kinematic Differences Across Frozen, Mixed, and Ultrathin Liquid Boluses in Healthy Adults: Age, Sex, and Normal Variability

Abstract: This study provides important contributions to the literature by clarifying normal variability within a wide range of swallowing behaviors and by providing normative data from which to compare disordered populations.

Cited by 51 publications

References 68 publications

Validation of the Normalized Laryngeal Constriction Ratio in Normal and Disordered Swallowing

Validation of the Normalized Laryngeal Constriction Ratio in Normal and Disordered Swallowing

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

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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