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Critical Reviews in Food Science and... 2015The effect of food consistency on swallowing function has been widely studied, and it is well recognized that by delaying the flow of the food bolus, thickened liquids... (Review)
Review
The effect of food consistency on swallowing function has been widely studied, and it is well recognized that by delaying the flow of the food bolus, thickened liquids can help in the management of swallowing dysfunction. However, fewer studies have been carried out on the impact of food sensory properties and related liking on swallowing function. This paper reviews the role of taste, olfaction, and trigeminal perceptions on swallowing function and highlights the need for a deeper investigation of this aspect of patient diet modification.
Topics: Deglutition; Deglutition Disorders; Food; Humans; Sensation
PubMed: 24915399
DOI: 10.1080/10408398.2011.649810 -
Dysphagia Aug 2022The upper esophageal sphincter (UES) plays a central role in safe swallowing. Impaired UES opening is commonly observed in individuals presenting with impaired... (Review)
Review
The upper esophageal sphincter (UES) plays a central role in safe swallowing. Impaired UES opening is commonly observed in individuals presenting with impaired swallowing and various interventions are available aiming to improve bolus passage across the UES during swallowing. This scoping review addressed the following question: Which behavioral interventions are available to improve UES opening for deglutition? We searched MEDLINE, CINAHL, Ovid Emcare, Web of Science, SCOPUS and ProQuest for studies that met the following criteria: i. behavioral interventions targeting UES opening ii. performed over a period of time, which iii. were assessed using UES specific outcome measures. Study quality was assessed using the Joanna Briggs Institute and GRADE frameworks. Data were extracted and synthesized into dominant themes. Of the 357 studies originally identified, 15 met inclusion criteria and reported interventions that were grouped into four intervention types: (1) floor of mouth exercises that were sub-categorized into the Shaker exercise and other strengthening exercises, (2) Mendelsohn maneuver, (3) lingual exercises and (4) mixed exercise paradigms. Across the included studies, varying levels of success in improving various aspects of UES opening metrics were reported. Nine of 15 studies evaluated patients with demonstrated swallowing impairment, whereas six studies evaluated healthy adults. Quality assessment revealed significant variability in study quality, unclear reporting of participant training and treatment fidelity, as well as training dosage. The evidence base for the four behavioral intervention approaches targeting deglutitive UES opening is limited. The translation of existing evidence to clinical practice is hindered by small sample sizes and methodological limitations. Further research in this space is warranted.
Topics: Adult; Deglutition; Deglutition Disorders; Esophageal Sphincter, Upper; Exercise Therapy; Humans; Manometry; Tongue
PubMed: 34448028
DOI: 10.1007/s00455-021-10349-6 -
Journal of Applied Physiology... Nov 2005
Topics: Animals; Deglutition; Humans; Respiratory Mechanics; Sleep; Time Factors
PubMed: 16227455
DOI: 10.1152/japplphysiol.00715.2005 -
Journal of Texture Studies Feb 2021Thickened fluids and texture-modified foods are commonly used in the medical management of individuals who suffer from swallowing difficulty (known as dysphagia).... (Review)
Review
Thickened fluids and texture-modified foods are commonly used in the medical management of individuals who suffer from swallowing difficulty (known as dysphagia). However, how to reliably assess texture properties of such food systems is still a big challenge both to industry and to academic researchers. This article aims to identify key physical parameters that are important for objective assessment of such properties by reviewing the significance of rheological or textural properties of thickened fluids and texture-modified foods for swallowing. Literature reviews have identified that dominating textural properties in relation to swallowing could be very different for thickened fluids and for texture-modified foods. Important parameters of thickened fluids are generally related with the flow of the bolus in the pharyngeal stage, while important parameters of texture-modified foods are generally related with the bolus preparation in the oral stage as well as the bolus flow in the pharyngeal stage. This review helps to identify key textural parameters of thickened fluids and texture-modified foods in relation to eating and swallowing and to develop objective measuring techniques for quality control of thickened fluids and texture-modified foods for dysphagia management.
Topics: Deglutition; Deglutition Disorders; Diet; Food; Humans; Rheology; Viscosity
PubMed: 33155674
DOI: 10.1111/jtxs.12567 -
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 -
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 1990
Topics: Cineradiography; Deglutition; Fluoroscopy; Humans; Video Recording
PubMed: 2249486
DOI: 10.1007/BF02412633 -
Dysphagia Dec 2022Despite rapid growth in the number of treatments to rehabilitate dysphagia, studies often demonstrate mixed results with non-significant changes to functional outcomes.... (Review)
Review
Despite rapid growth in the number of treatments to rehabilitate dysphagia, studies often demonstrate mixed results with non-significant changes to functional outcomes. Given that power analyses are infrequently reported in dysphagia research, it remains unclear whether studies are adequately powered to detect a range of treatment effects. Therefore, this review sought to examine the current landscape of statistical power in swallowing rehabilitation research. Databases were searched for swallowing treatments using instrumental evaluations of swallowing and the penetration-aspiration scale as an outcome. Sensitivity power analyses based on each study's statistical test and sample size were performed to determine the minimum effect size detectable with 80% power. Eighty-nine studies with 94 treatment comparisons were included. Sixty-seven percent of treatment comparisons were unable to detect effects smaller than d = 0.80. The smallest detectable effect size was d = 0.29 for electrical stimulation, d = 0.49 for postural maneuvers, d = 0.52 for non-invasive brain stimulation, d = 0.61 for combined treatments, d = 0.63 for respiratory-based interventions, d = 0.70 for lingual strengthening, and d = 0.79 for oral sensory stimulation. Dysphagia treatments examining changes in penetration-aspiration scale scores were generally powered to reliably detect larger effect sizes and not smaller (but potentially clinically meaningful) effects. These findings suggest that non-significant results may be related to low statistical power, highlighting the need for collaborative, well-powered intervention studies that can detect smaller, clinically meaningful changes in swallowing function. To facilitate implementation, a tutorial on simulation-based power analyses for ordinal outcomes is provided ( https://osf.io/e6usd/ ).
Topics: Humans; Deglutition; Deglutition Disorders; Rehabilitation Research; Combined Modality Therapy
PubMed: 35226185
DOI: 10.1007/s00455-022-10428-2 -
Experimental Brain Research Feb 2002The role of acetylcholine in the central mechanism of swallowing remains a matter of debate. The aim of this work, conducted in sheep, was to assess the effects of...
The role of acetylcholine in the central mechanism of swallowing remains a matter of debate. The aim of this work, conducted in sheep, was to assess the effects of anti-muscarinic drugs (mainly atropine) on the activity of peripheral muscles involved in the oropharyngeal and esophageal phases of swallowing, and on that of dorsal medulla interneurons which program swallow-induced esophageal contractions and therefore belong to the so-called central pattern generator. Our results were obtained in anesthetized animals by means of electromyographic and manometric recordings of peripheral muscle contractions associated with microelectrode recordings of medullary interneuron discharge. They show that both interneuron discharge and primary esophageal contractions that follow the oropharyngeal component of swallowing were suppressed under atropine (0.1--0.5 mg/kg). In contrast, atropine did not impede the swallowing oropharyngeal component, the secondary peristalsis and the "deglutitive inhibition," which affects the esophageal motility during the oropharyngeal phase of swallowing. In conclusion, muscarinic receptors (probably not those of M(1)type) appear to control the primary peristalsis, but neither the secondary peristalsis nor the deglutitive inhibition.
Topics: Anesthetics, Inhalation; Animals; Atropine; Deglutition; Esophagus; Interneurons; Peristalsis; Sheep
PubMed: 11845245
DOI: 10.1007/s00221-001-0958-8 -
Dysphagia Jun 2023Foods and liquids have properties that are often modified as part of clinical dysphagia management to promote safe and efficient swallowing. However, recent studies have... (Review)
Review
Foods and liquids have properties that are often modified as part of clinical dysphagia management to promote safe and efficient swallowing. However, recent studies have questioned whether this practice is supported by the evidence. To address this, a scoping review was conducted to answer the question: "Can properties of food and liquids modify swallowing physiology and function in adults?" Online search in six databases yielded a set of 4235 non-duplicate articles. Using COVIDENCE software, two independent reviewers screened the articles by title and abstract, and 229 full-text articles were selected for full-text review. One-hundred eleven studies met the inclusion criteria for qualitative synthesis and assessment of risk of bias. Three randomized controlled trials and 108 non-randomized studies were analyzed. Large amounts of variability in instrumental assessment, properties of food and liquids, and swallowing measures were found across studies. Sour, sweet, and salty taste, odor, carbonation, capsaicin, viscosity, hardness, adhesiveness, and cohesiveness were reported to modify the oral and pharyngeal phase of swallowing in both healthy participants and patients with dysphagia. Main swallow measures modified by properties of food and liquids were penetration/aspiration, oral transit time, lingual pressures, submental muscle contraction, oral and pharyngeal residue, hyoid and laryngeal movement, pharyngeal and upper esophageal sphincter pressures, and total swallow duration. The evidence pooled in this review supports the clinical practice of food texture and liquid consistency modification in the management of dysphagia with the caveat that all clinical endeavors must be undertaken with a clear rationale and patient-specific evidence that modifying food or liquid benefits swallow safety and efficiency while maintaining quality of life.
Topics: Humans; Adult; Deglutition; Deglutition Disorders; Quality of Life; Food; Pharynx
PubMed: 36266521
DOI: 10.1007/s00455-022-10525-2