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Dysphagia Apr 2021Dysphagia associated with radiotherapy for head and neck cancer is complex and can be difficult to treat. Videofluoroscopic swallow studies (VFSS) are the current...
Dysphagia associated with radiotherapy for head and neck cancer is complex and can be difficult to treat. Videofluoroscopic swallow studies (VFSS) are the current gold-standard instrumented swallow assessment. High-resolution manometry (HRM) is an additional approach that provides objective measurements of swallowing-related pressures in the pharynx and esophagus. This can provide functional information on the pressure gradients underlying bolus propulsion, and is relevant for this patient population, where radiation-related fibrosis can lead to weakness and impaired pressure generation. The purpose of this preliminary study was to describe pharyngeal swallowing pressures in patients with radiation-associated dysphagia (RAD) and late radiation-associated dysphagia (LRAD) using HRM. RAD occurs during and immediately following treatment, whereas LRAD is a more recently described phenomenon in which the patient experiences an onset of dysphagia at least 5 years post-treatment. We performed a retrospective analysis of pharyngeal swallowing pressures from 21 patients with RAD or LRAD and 21 healthy sex/age-matched controls. Patients with RAD or LRAD exhibited decreased swallowing pressure durations throughout the pharynx (p ≤ 0.002), as well as decreased hypopharynx maximum pressure (p = 0.003) and pharyngeal contractile integral ( p < 0.0001). Understanding how pharyngeal pressure generation is altered in patients with a history of radiotherapy can help clinicians form more precise treatment plans.
Topics: Deglutition; Deglutition Disorders; Humans; Manometry; Pharynx; Retrospective Studies
PubMed: 32415490
DOI: 10.1007/s00455-020-10128-9 -
Dysphagia Aug 2020Drinks and foods may be thickened to improve swallowing safety for dysphagia patients, but the resultant consistencies are not always palatable. Characterising...
Drinks and foods may be thickened to improve swallowing safety for dysphagia patients, but the resultant consistencies are not always palatable. Characterising alternative appetising foods is an important task. The study aims to characterise the in vitro swallowing behaviour of specifically formulated thickened dysphagia fluids containing xanthan gum and/or starch with standard jellies and yoghurt using a validated mechanical model, the "Cambridge Throat". Observing from the side, the model throat can follow an experimental oral transit time (in vitro-OTT) and a bolus length (BL) at the juncture of the pharynx and larynx, to assess the velocity and cohesion of bolus flow. Our results showed that higher thickener concentration produced longer in vitro-OTT and shorter BL. At high concentration (spoon-thick), fluids thickened with starch-based thickener showed significantly longer in vitro-OTT than when xanthan gum-based thickener was used (84.5 s ± 34.5 s and 5.5 s ± 1.6 s, respectively, p < 0.05). In contrast, at low concentration (nectar-like), fluids containing xanthan gum-based thickener demonstrated shorter BL than those of starch-based thickener (6.4 mm ± 0.5 mm and 8.2 mm ± 0.8 mm, respectively, p < 0.05). The jellies and yoghurt had comparable in vitro-OTT and BL to thickeners at high concentrations (honey-like and spoon-thick), indicating similar swallowing characteristics. The in vitro results showed correlation with published in vivo data though the limitations of applying the in vitro swallowing test for dysphagia studies were noted. These findings contribute useful information for designing new thickening agents and selecting alternative and palatable safe-to-swallow foods.
Topics: Deglutition; Esophageal Sphincter, Upper; Food Additives; Food, Formulated; Humans; Larynx; Models, Anatomic; Pharynx; Polysaccharides, Bacterial; Rheology; Starch; Viscosity; Yogurt
PubMed: 31707519
DOI: 10.1007/s00455-019-10074-1 -
Italian Journal of Pediatrics Jun 2024Early infant feeding and swallowing are complex motor processes involving numerous muscles in coordination, e.g. the orofacial muscles as well as the muscles of the... (Review)
Review
Early infant feeding and swallowing are complex motor processes involving numerous muscles in coordination, e.g. the orofacial muscles as well as the muscles of the pharynx, larynx and esophagus. The newborn's reflexive drinking develops into the ability to ingest pureed complementary food as infancy progresses. Finally, in the last part of the first year of life, a differentiated eating, chewing and swallowing process develops allowing the voluntary intake of different foods of the family diet. The dietary schedule for the first year of life, which describes the recommended nutrition of infants in Germany, corresponds to these milestones in eating development. Disturbances in gross motor development, sensory processing issues, and organic and behavioral problems are known to interfere with the development of eating skills. Swallowing disorders (dysphagia) in children can have a detrimental effect on food intake and pose a serious risk to growth and development. Their prevention treatment requires a multidisciplinary approach with the aim of enabling the child to eat independently in the long term.
Topics: Humans; Infant; Child, Preschool; Child Development; Feeding Behavior; Deglutition Disorders; Eating; Infant, Newborn; Deglutition; Female; Male
PubMed: 38831369
DOI: 10.1186/s13052-024-01683-0 -
BMC Research Notes Dec 2023Swallowing dysfunction (dysphagia) significantly impacts patient and medical outcomes. In Sweden, there is no comprehensive outcome measure for dysphagia that...
BACKGROUND
Swallowing dysfunction (dysphagia) significantly impacts patient and medical outcomes. In Sweden, there is no comprehensive outcome measure for dysphagia that incorporates holistic assessment and dysphagia impact on a person's impairment, function and participation. The Dysphagia Outcome and Severity Scale (DOSS) was developed and validated (in English) and incorporates the World Health Organisation's (WHO) aforementioned, International Classification of Functioning (ICF) aspects. This study translated then evaluated the validity and reliability of the Swedish version, DOSS-S.
METHOD
Translation occurred based on WHO recommendations. The Content Validity Index (CVI) of the translated version (DOSS-S) was assessed twice by 11 (multi-professional) dysphagia experts. Criterion validity and rater reliability was calculated using 18 Speech Pathologists assessing patient cases from International Dysphagia Diet Standardization Initiative-Functional Diet Scale (IDDS-FDS) research.
RESULTS
Very high CVI values (0.96-0.99) for the linguistic correlation, and high CVI values (0.84-0.94) for applicability correlation were achieved. High criterion validity of DOSS-S with IDDSI-FDS was demonstrated (r = 0.89, p < 0.01), with very high inter and intra rater reliabilities (ICC > 0.90).
CONCLUSION
The DOSS-S demonstrated very high validity values, and very high inter and intra rater reliability. This research contributes to improved dysphagia management by providing interprofessional dysphagia clinicians with a validated scale to identify patient progression, communicate dysphagia status between regions and countries, and document patient outcomes using an ICF framework.
Topics: Humans; Deglutition Disorders; Sweden; Reproducibility of Results; Deglutition; Language
PubMed: 38098056
DOI: 10.1186/s13104-023-06637-z -
American Journal of Physiology.... Apr 2022In Parkinson's disease (PD), oropharyngeal dysphagia is common and clinically relevant. The neurophysiology of dysphagia in PD is complex and incompletely understood....
In Parkinson's disease (PD), oropharyngeal dysphagia is common and clinically relevant. The neurophysiology of dysphagia in PD is complex and incompletely understood. The aim of the study was to determine the changes in oropharyngeal deglutitive pressure dynamics in PD and to correlate these with clinical characteristics including dysphagia and PD severity. In prospective consecutive series of 64 patients with PD [mean age: 66.9 ± 8.3 (SD)], we evaluated dysphagia severity clinically as well as with Sydney Swallow Questionnaire (SSQ) and Swallow Quality-of-Life Questionnaire (SWAL-QOL). PD severity was assessed with Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). We used high-resolution pharyngeal impedance manometry (HRPIM) to objectively evaluate swallow function and compared data from 23 age-matched healthy controls [mean age 62.3 ± 9.1 (SD)]. Metrics assessed were upper esophageal sphincter (UES), integrated relaxation pressure (IRP), relaxation time (RT), maximum opening (MaxAdm), and pharyngeal intrabolus pressure (IBP) and pharyngeal contractility (PhCI). Mean MDS-UPDRS score was positively associated with dysphagia severity on SSQ and SWAL-QOL. HRPIM in PD compared with controls showed impaired UES relaxation parameters, with shorter RT, and elevated IRP and IBP. MaxAdm was not affected. The overall pharyngeal contractility was significantly higher in PD. Only the IBP and IRP were associated with PD severity and only IBP was significantly associated with dysphagia severity. UES dysfunction leading to increased flow resistance is common in patients with PD and correlates with dysphagia severity. Increased flow resistance may suggest impaired UES relaxation and/or impaired neuromodulation to bolus volume. In Parkinson's disease, objective assessment of swallow function with high-resolution impedance manometry identifies upper esophageal sphincter dysfunction leading to increased flow resistance.
Topics: Aged; Deglutition; Deglutition Disorders; Esophageal Sphincter, Upper; Humans; Manometry; Middle Aged; Parkinson Disease; Pressure; Prospective Studies; Quality of Life
PubMed: 35138164
DOI: 10.1152/ajpgi.00314.2021 -
International Journal of Environmental... Aug 2022Tongue pressure (TP) is used to assess tongue muscle strength and is related to function and frailty. While performing TP, it is necessary to elevate the tongue and oral...
Tongue pressure (TP) is used to assess tongue muscle strength and is related to function and frailty. While performing TP, it is necessary to elevate the tongue and oral floor by contracting the suprahyoid muscles. However, the association between TP and suprahyoid muscle strength remains unclear. Accordingly, this study investigated the relationship between TP and jaw-opening force (JOF), an indicator of suprahyoid muscle strength. This cross-sectional study included 88 independent community-dwelling participants aged ≥65 years. Age, sex, and the number of remaining teeth were recorded. Ultrasonography was used to evaluate the cross-sectional area of the tongue and geniohyoid muscle, as representatives of the suprahyoid muscles. Sarcopenia was diagnosed based on appendicular skeletal muscle mass index, handgrip strength, and gait speed. Multiple regression analysis was performed with TP as the dependent variable. TP was significantly associated with JOF (β = 0.371, = 0.003). This study revealed that decreased TP was associated with a decline in JOF and suprahyoid muscle mass in older adults. Thus, low TP may be associated with decreased JOF. Prevention of the weakness of the suprahyoid muscles and maintaining TP may also contribute to the prevention of frailty associated with TP.
Topics: Aged; Cross-Sectional Studies; Deglutition; Frailty; Hand Strength; Humans; Muscle Strength; Pressure; Tongue
PubMed: 36011461
DOI: 10.3390/ijerph19169825 -
Arquivos de Neuro-psiquiatria Dec 2019
Topics: Deglutition; Deglutition Disorders; Humans; Mutation; Prevalence; Spastic Paraplegia, Hereditary
PubMed: 31939579
DOI: 10.1590/0004-282X20190153 -
Respiratory Care Aug 2020
Topics: Amyotrophic Lateral Sclerosis; Deglutition; Deglutition Disorders; Humans; Respiration; Saliva
PubMed: 32712585
DOI: 10.4187/respcare.08298 -
Journal of Otolaryngology - Head & Neck... Dec 2021There has been increasing interest in the management of oropharyngeal swallowing dysfunction (SwD). Its prevalence, particularly in otherwise healthy infants and... (Review)
Review
OBJECTIVES
There has been increasing interest in the management of oropharyngeal swallowing dysfunction (SwD). Its prevalence, particularly in otherwise healthy infants and toddlers (OHITs), is underappreciated. As the standard diagnostic tests are either invasive or scarce, valid parent-reported outcome (PRO) questionnaires could play a pivotal role in the understanding and managing SwD in this group. This article reviewed the literature on PRO questionnaires pertaining to SwD in OHITs.
DATA SOURCE
A librarian searched Prospero, Cochrane Library, Embase, Medline, PsycINFO, HaPI, CINAHL, and SCOPUS until February 2021 using the MeSH terms for deglutition and screening methods.
REVIEW METHOD
Questionnaires that examined disease-specific or eating and feeding concerns or difficulties were excluded. Two reviewers independently identified PRO questionnaires for SwD that were used in OHITs and extracted the author names, publication year, questionnaire name, the studied population, and the reported psychometric assessments. A quality assessment was performed based on consensus-based standards for the selection of health measurement instruments (COSMIN) and updated criteria for good measurement properties.
RESULTS
Of the 3488 screened articles, we identified only two questionnaires, the pediatric version of the Eating Assessment Tool (PEDI-EAT-10) and the PRO questionnaire for Swallowing Dysfunction in OHITs. The PEDI-EAT-10 authors assessed the validity and reliability on children with cerebral palsy. However, concerns were identified regarding the developmental process and the internal structure validity. The PRO questionnaire for SwD in OHITs meets criteria but has not yet been validated in the population of interest nor its psychometric properties assessed.
CONCLUSION
Two instruments were identified. The PED-EAT-10 exhibits methodological flaws, while Edmonton PRO questionnaire for SwD in OHITs awaits construct validation and could fill the current knowledge gap.
Topics: Child; Child, Preschool; Deglutition; Humans; Infant; Parents; Psychometrics; Reproducibility of Results; Surveys and Questionnaires
PubMed: 34863293
DOI: 10.1186/s40463-021-00549-3 -
Journal of Speech, Language, and... Jan 2021Purpose Judgments regarding hyoid movement are frequently included in evaluations of swallowing. However, the literature lacks reference values for measures of hyoid...
Purpose Judgments regarding hyoid movement are frequently included in evaluations of swallowing. However, the literature lacks reference values for measures of hyoid kinematics in healthy swallowing. This study explores hyoid movement across the continuum from thin to extremely thick liquids. Method Participants were 39 healthy adults under the age of 60 years (19 men) who underwent videofluoroscopy involving three sips each of 20% w/v thin barium and six sips each of slightly, mildly, moderately, and extremely thick barium. Half of the thickened stimuli were prepared using xanthan gum; and half, with a starch-based thickener. Sip volume was derived from pre- and post-sip cup weights. Hyoid position was tracked frame-by-frame relative to the anterior-inferior corner of C4. Measures of peak hyoid position (along the axis) were normalized to a C2-C4 scalar, and measures of time-to-peak position, speed, and time-to-peak speed were derived. As a first step, Spearman's correlations confirmed the influence of sip volume on these hyoid measures. Linear mixed-effects models then explored the effects of stimulus, sip volume, and task repetition on the dependent variables. Results The data set comprised 975 swallows with available hyoid tracking data. Sip volume was correlated with peak hyoid position ( = .15, < .01), time-to-peak position ( = -.15, < .05), and speed ( = .13, < .01). No significant differences in hyoid kinematics were found across stimuli. Conclusion Measures of hyoid movement in healthy swallowing remain stable across the range from thin to extremely thick liquids with no systematic alterations in hyoid position or kinematics.
Topics: Adult; Biomechanical Phenomena; Cineradiography; Deglutition; Deglutition Disorders; Humans; Hyoid Bone; Male; Middle Aged
PubMed: 33270468
DOI: 10.1044/2020_JSLHR-20-00508