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Folia Phoniatrica Et Logopaedica :... 2023In the past four to five decades, the field of swallowing science has made significant strides in the evaluation and treatment of swallowing disorders (dysphagia).... (Review)
Review
BACKGROUND
In the past four to five decades, the field of swallowing science has made significant strides in the evaluation and treatment of swallowing disorders (dysphagia). Despite these strides, several gaps in knowledge remain and optimal approaches for dysphagia management have yet to be established. Part of this hindrance stems from our relatively limited understanding of the complex underlying swallowing mechanisms which further limits our ability to examine how these mechanisms may be altered in patients with dysphagia and how to optimally target them in therapy. To overcome this hindrance, it is critical that we develop sensitive new tools and methods that will allow for the precise and personalized examination of patients' complex swallowing control and neurophysiological changes, and for the direct targeting of this control to improve treatment effectiveness.
SUMMARY
Herein, the advantages and limitations of current approaches in the study of swallowing biomechanics and central and peripheral swallowing control mechanisms are first summarized. Then, two examples of recent technological advances developed by the author's multidisciplinary team are described, including an integrative MRI sequence that allows for the simultaneous examination of oropharyngeal swallow and brain activity (SimulScan), and a novel wearable surface electromyography sensor technology (i-Phagia) designed for swallowing rehabilitation monitoring. The current state, limitations, and future applications of both technologies are discussed. Upon optimization and validation, such technological advancements can offer unprecedented opportunities to gain direct and precise insights on the swallowing mechanism. Information gained from these and similar new technologies can act as a catalyst for the future development of optimized personalized dysphagia care. By leveraging advances in current methods, multidisciplinary collaborations, and new digital age technologies, the field of dysphagia can take the next giant leap forward in improving clinical care and patient lives.
KEY MESSAGES
There is a critical need to develop sensitive new tools and methods that will allow for the precise and personalized examination of the complex swallowing mechanism and lead to the development of physiology-based and more effective interventions. The digital age is the ideal time to begin leveraging the technological advancements of fields such as imaging, electrophysiology, wearables, and machine learning to advance dysphagia research and practice. A new integrative MRI sequence and a novel wearable surface electromyography sensor technology developed by the author's team are presented, as examples of recent technological advances that can play an important role in the future of personalized dysphagia care.
Topics: Humans; Deglutition Disorders; Deglutition; Treatment Outcome
PubMed: 37247613
DOI: 10.1159/000531265 -
Dysphagia Aug 2023Muscle fatigue is the diminution of force required for a particular action over time. Fatigue may be particularly pronounced in aging muscles, including those used for... (Review)
Review
Muscle fatigue is the diminution of force required for a particular action over time. Fatigue may be particularly pronounced in aging muscles, including those used for swallowing actions. Because risk for swallowing impairment (dysphagia) increases with aging, the contribution of muscle fatigue to age-related dysphagia is an emerging area of interest. The use of animal models, such as mice and rats (murine models) allows experimental paradigms for studying the relationship between muscle fatigue and swallowing function with a high degree of biological precision that is not possible in human studies. The goal of this article is to review basic experimental approaches to the study of murine tongue muscle fatigue related to dysphagia. Traditionally, murine muscle fatigue has been studied in limb muscles through direct muscle stimulation and behavioral exercise paradigms. As such, physiological and bioenergetic markers of muscle fatigue that have been validated in limb muscles may be applicable in studies of cranial muscle fatigue with appropriate modifications to account for differences in muscle architecture, innervation ratio, and skeletal support. Murine exercise paradigms may be used to elicit acute fatigue in tongue muscles, thereby enabling study of putative muscular adaptations. Using these approaches, hypotheses can be developed and tested in mice and rats to allow for future focused studies in human subjects geared toward developing and optimizing treatments for age-related dysphagia.
Topics: Humans; Rats; Mice; Animals; Muscle Fatigue; Deglutition Disorders; Muscle, Skeletal; Tongue; Deglutition
PubMed: 36401630
DOI: 10.1007/s00455-022-10537-y -
Neurology Aug 2015
Topics: Deep Brain Stimulation; Deglutition; Female; Gait; Humans; Male; Parkinson Disease; Subthalamic Nucleus
PubMed: 26484368
DOI: No ID Found -
HNO Jul 2015As a highly differentiated physiological process, swallowing may be affected by a variety of confounding factors. Primarily described are swallowing disorders caused by... (Review)
Review
As a highly differentiated physiological process, swallowing may be affected by a variety of confounding factors. Primarily described are swallowing disorders caused by mechanical anatomic changes (e. g., alteration of the cervical spine, goiter), surgery for head and neck tumors, thyroid abnormalities, and neuromuscular disorders. Age-related cerebral neurological and blood vessel-associated changes can also cause dysphagia (so-called presbyphagia) or worsen the condition.Medication-associated dysphagia is recognized far less frequently, not paid due attention, or accepted in silence; particularly in older patients. Furthermore, pharmacological interference of different medications is frequently inadequately considered, particularly in the case of polypharmacy.Initial treatment of medication-induced dysphagia includes a critical review of medication status, with the aim of reducing/discontinuing the causative medication by giving precise instructions regarding its administration; as well as antacid medication, diet, and professional oral stimulation or swallowing training.To date, medication-induced dysphagia has not occupied the focus of physicians and therapists. This is despite the fact that many active agents can have a negative effect on swallowing and medication-induced dysphagia caused by polypharmacy is not uncommon, particularly in old age. This article presents an overview of the different classes of drugs in terms of their direct or indirect negative effects on the swallowing function.
Topics: Administration, Oral; Deglutition; Deglutition Disorders; Humans
PubMed: 26148562
DOI: 10.1007/s00106-015-0015-8 -
Otolaryngologic Clinics of North America Aug 2024Dysphagia is a common manifestation of endocrine and metabolic diseases. Swallowing is a complex neuromuscular process, with an interplay of sensory and motor function,... (Review)
Review
Dysphagia is a common manifestation of endocrine and metabolic diseases. Swallowing is a complex neuromuscular process, with an interplay of sensory and motor function, that has voluntary and involuntary control. Disruptions in any of these processes can cause significant dysphagia. Endocrine disorders and metabolic derangements are systemic conditions that affect multiple organ systems. They contribute to the development of neuropathies, myopathies, and motility disorders that lead to swallowing difficulty. Malnutrition and critical illness can lead to deconditioning and atrophy which can cause dysphagia, which in turn can lead to further malnutrition and deconditioning.
Topics: Humans; Deglutition Disorders; Endocrine System Diseases; Metabolic Diseases; Malnutrition; Deglutition
PubMed: 38575488
DOI: 10.1016/j.otc.2024.02.024 -
Current Opinion in Otolaryngology &... Jun 2018This review examines the recent literature concerning the development of VFSS analysts. (Review)
Review
PURPOSE OF REVIEW
This review examines the recent literature concerning the development of VFSS analysts.
RECENT FINDINGS
Face-to-face and blended methods of training improve reliability and accuracy of VFSS analysis. However, with the exception of the literature describing the MBSImP training, most studies investigate relatively brief training for specific VFSS rating tools. The influence of training mode and trainee factors has received limited attention.
SUMMARY
There is a lack of controlled studies investigating the influences of training methods for VFSS analysis. Pilot data is emerging concerning VFSS analysis training 'packages' but without information about the relative influence of training mode, it is difficult to determine the most efficient and cost-effective way of training VFSS analysts. Future research should investigate the contribution of trainee-related factors to succeed in VFSS analysis training, and the relative benefits and disadvantages of online, peer, independent, and blended modes of training.
Topics: Deglutition; Deglutition Disorders; Fluoroscopy; Humans; Reproducibility of Results; Video Recording
PubMed: 29461287
DOI: 10.1097/MOO.0000000000000449 -
Dysphagia Dec 2019Sleep is associated with stages of relative cortical quiescence, enabling evaluation of swallowing under periods of reduced consciousness and, hence, absent volition....
Sleep is associated with stages of relative cortical quiescence, enabling evaluation of swallowing under periods of reduced consciousness and, hence, absent volition. The aim of this study was to measure and characterize changes in the characteristics of pharyngeal swallows during sleep and wake using high-resolution manometry (HRM). Pharyngeal swallows were recorded with a ManoScan™ HRM in wake-upright, wake-supine, and sleep conditions in 20 healthy participants (mean 27 years; range 21-52). Velopharyngeal and hypopharyngeal segments were analysed separately. Contractile integral, mean peak pressure, inverse velocity of superior-to-inferior pharyngeal pressure, and time to first maximum pressure were analysed with custom-designed software. The supine-wake condition was compared to both upright-wake and sleep conditions using linear mixed effects models. No significant differences were found between supine-wake and upright-wake conditions on any measures. The mean peak pharyngeal pressure was lower during sleep than during the supine-wake condition for both the velopharynx (- 60 mmHg, standard error [SE] = 11, p < 0.001) and hypopharynx (- 59 mmHg, SE = 9, p = 0.001), as was the pharyngeal inverse velocity (- 12 ms/cm, SE = 4, p = 0.012) for the hypopharyngeal segment and the pharyngeal contractile integral (- 32 mmHg s cm, SE = 6, p < 0.001). No significant differences were found in time to the first pharyngeal maximum pressure. This study used HRM to characterize and compare pharyngeal pressures during swallowing in both wake and sleep conditions. No differences were found between upright and supine awake conditions, a finding important to pharyngeal manometric measures made during supine positioning, such as in fMRI. Higher pressures and longer time-related measures of volitional pharyngeal swallowing when awake indicate that cortical input plays an important role in modulation of pharyngeal swallowing.
Topics: Adult; Deglutition; Female; Humans; Male; Manometry; Middle Aged; Pharynx; Sleep; Wakefulness; Young Adult
PubMed: 30806776
DOI: 10.1007/s00455-019-09989-6 -
Dysphagia Dec 2023Impaired pharyngo-laryngeal sensory function is a critical mechanism for oropharyngeal dysphagia (OD). Discovery of the TRP family in sensory nerves opens a window for... (Review)
Review
Impaired pharyngo-laryngeal sensory function is a critical mechanism for oropharyngeal dysphagia (OD). Discovery of the TRP family in sensory nerves opens a window for new active treatments for OD. To summarize our experience of the action mechanism and therapeutic effects of pharyngeal sensory stimulation by TRPV1, TRPA1 and TRPM8 agonists in older patients with OD. Summary of our studies on location and expression of TRP in the human oropharynx and larynx, and clinical trials with acute and after 2 weeks of treatment with TRP agonists in older patients with OD. (1) TRP receptors are widely expressed in the human oropharynx and larynx: TRPV1 was localized in epithelial cells and TRPV1, TRPA1 and TRPM8 in sensory fibers mainly below the basal lamina. (2) Older people present a decline in pharyngeal sensory function, more severe in patients with OD associated with delayed swallow response, impaired airway protection and reduced spontaneous swallowing frequency. (3) Acute stimulation with TRP agonists improved the biomechanics and neurophysiology of swallowing in older patients with OD TRPV1 = TRPA1 > TRPM8. (4) After 2 weeks of treatment, TRPV1 agonists induced cortical changes that correlated with improvements in swallowing biomechanics. TRP agonists are well tolerated and do not induce any major adverse events. TRP receptors are widely expressed in the human oropharynx and larynx with specific patterns. Acute oropharyngeal sensory stimulation with TRP agonists improved neurophysiology, biomechanics of swallow response, and safety of swallowing. Subacute stimulation promotes brain plasticity further improving swallow function in older people with OD.
Topics: Humans; Aged; Deglutition Disorders; Pharynx; Deglutition; Oropharynx; Brain
PubMed: 37145201
DOI: 10.1007/s00455-023-10578-x -
Dysphagia Feb 2023Dysphagia results from diverse and distinct etiologies. The pathway from anatomy and physiology to clinical diagnosis is complex and hierarchical. Our approach in this... (Review)
Review
Dysphagia results from diverse and distinct etiologies. The pathway from anatomy and physiology to clinical diagnosis is complex and hierarchical. Our approach in this paper is to show the linkages from the underlying anatomy and physiology to the clinical presentation. In particular, the terms performance, function, behavior, and physiology are often used interchangeably, which we argue is an obstacle to clear discussion of mechanism of pathophysiology. We use examples from pediatric populations to highlight the importance of understanding anatomy and physiology to inform clinical practice. We first discuss the importance of understanding anatomy in the context of physiology and performance. We then use preterm infants and swallow-breathe coordination as examples to explicate the hierarchical nature of physiology and its impact on performance. We also highlight where the holes in our knowledge lie, with the ultimate endpoint of providing a framework that could enhance our ability to design interventions to help patients. Clarifying these terms, and the roles they play in the biology of dysphagia will help both the researchers studying the problems as well as the clinicians applying the results of those studies.
Topics: Infant; Child; Humans; Infant, Newborn; Deglutition Disorders; Deglutition; Infant, Premature
PubMed: 35441265
DOI: 10.1007/s00455-022-10449-x -
The Journal of Pharmacy and Pharmacology Apr 2017The aim of this review was to map the currently available evidence on acceptability of oral paediatric medicines to aid in the selection of suitable platform... (Review)
Review
OBJECTIVES
The aim of this review was to map the currently available evidence on acceptability of oral paediatric medicines to aid in the selection of suitable platform formulations for the development of new acceptable paediatric products.
METHODS
This process used a defined search strategy of indexed publications and included methods to assess the quality of the evidence retrieved.
KEY FINDINGS
Taste/palatability was the most extensively studied area of paediatric medicine acceptability yet standard methods or criteria that define what is classed as acceptable to children is still to be defined. There have been many reports on the acceptability of medicines to paediatric populations yet major gaps in the acceptability knowledge base exist including the shape and dimensions of tablets, minitablets and capsules swallowed whole in infants and children; size and overall volume of multiparticulates; volume of liquids completely swallowed in infants and children; duration of retention within the oral cavity, size and taste of orodispersible tablets, lozenges and chewable tablets and the number of solid units dosed at each time point.
CONCLUSIONS
The review highlights where further information is required to support knowledge around acceptability of age-appropriate medicines. An algorithm to aid in selection of a formulation that is likely to be acceptable based on the age range to be treated by the medicine is presented as a result of this review.
Topics: Administration, Oral; Child; Child, Preschool; Deglutition; Dosage Forms; Drug Compounding; Humans; Infant; Pharmaceutical Preparations; Tablets; Taste
PubMed: 27524471
DOI: 10.1111/jphp.12610