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Lim J, Hyun SE, Kim H, Ryu JS. Residual effect of sequential 4-channel neuromuscular electrical stimulation evaluated by high-resolution manometry. Biomed Eng Online 2024; 23:70. [PMID: 39049019 PMCID: PMC11270850 DOI: 10.1186/s12938-024-01269-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/16/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND High-resolution manometry (HRM) can quantify swallowing pathophysiology to evaluate the status of the pharynx. Sequential 4-channel neuromuscular electrical stimulation (NMES) was recently developed based on the normal contractile sequences of swallowing-related muscles. This study aimed to examine the effects of sequential 4-channel NMES for compensatory application during swallowing and to observe the residual effects after the application of NMES using HRM. RESULTS Sequential 4-channel NMES significantly improved the HRM parameters, with respect to the maximal pressure and area of the velopharynx (VP), maximal pressure and area of the mesopharynx (MP), and upper esophageal sphincter (UES) activation and nadir duration. Furthermore, the improvement in the pressure and area variables of the VP and MP showed a tendency to maintain even when measured after NMES, but there are no significant differences. CONCLUSIONS The present study suggests that the sequential 4-channel NMES application of the suprahyoid and infrahyoid muscles during swallowing improves the pressure, area, and time variables of the oropharynx, as measured by HRM, and it is likely that the effects may persist even after stimulation. Trial Registration Clinicaltrials.gov, registration number: NCT02718963 (initial release: 03/20/2016, actual study completion date: 06/24/2016, last release: 10/20/2020).
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Affiliation(s)
- Jiwoon Lim
- Department of Rehabilitation Medicine, Korea University Ansan Hospital, Ansan-Si, South Korea
| | - Sung Eun Hyun
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hayoung Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, 82 Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 463-707, South Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, 82 Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 463-707, South Korea.
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea.
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Cullins MJ, Connor NP. Differential impact of unilateral stroke on the bihemispheric motor cortex representation of the jaw and tongue muscles in young and aged rats. Front Neurol 2024; 15:1332916. [PMID: 38572491 PMCID: PMC10987714 DOI: 10.3389/fneur.2024.1332916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction Dysphagia commonly occurs after stroke, yet the mechanisms of post-stroke corticobulbar plasticity are not well understood. While cortical activity associated with swallowing actions is bihemispheric, prior research has suggested that plasticity of the intact cortex may drive recovery of swallowing after unilateral stroke. Age may be an important factor as it is an independent predictor of dysphagia after stroke and neuroplasticity may be reduced with age. Based on previous clinical studies, we hypothesized that cranial muscle activating volumes may be expanded in the intact hemisphere and would contribute to swallowing function. We also hypothesized that older age would be associated with limited map expansion and reduced function. As such, our goal was to determine the impact of stroke and age on corticobulbar plasticity by examining the jaw and tongue muscle activating volumes within the bilateral sensorimotor cortices. Methods Using the middle cerebral artery occlusion rat stroke model, intracortical microstimulation (ICMS) was used to map regions of sensorimotor cortex that activate tongue and jaw muscles in both hemispheres. Young adult (7 months) and aged (30 months) male F344 × BN rats underwent a stroke or sham-control surgery, followed by ICMS mapping 8 weeks later. Videofluoroscopy was used to assess oral-motor functions. Results Increased activating volume of the sensorimotor cortex within the intact hemisphere was found only for jaw muscles, whereas significant stroke-related differences in tongue activating cortical volume were limited to the infarcted hemisphere. These stroke-related differences were correlated with infarct size, such that larger infarcts were associated with increased jaw representation in the intact hemisphere and decreased tongue representation in the infarcted hemisphere. We found that both age and stroke were independently associated with swallowing differences, weight loss, and increased corticomotor thresholds. Laterality of tongue and jaw representations in the sham-control group revealed variability between individuals and between muscles within individuals. Conclusion Our findings suggest the role of the intact and infarcted hemispheres in the recovery of oral motor function may differ between the tongue and jaw muscles, which may have important implications for rehabilitation, especially hemisphere-specific neuromodulatory approaches. This study addressed the natural course of recovery after stroke; future work should expand to focus on rehabilitation.
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Affiliation(s)
- Miranda J. Cullins
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, United States
| | - Nadine P. Connor
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, United States
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, United States
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3
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Wang Y, Xu L, Wang L, Jiang M, Zhao L. Effects of transcutaneous neuromuscular electrical stimulation on post-stroke dysphagia: a systematic review and meta-analysis. Front Neurol 2023; 14:1163045. [PMID: 37228409 PMCID: PMC10203701 DOI: 10.3389/fneur.2023.1163045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/05/2023] [Indexed: 05/27/2023] Open
Abstract
Background Dysphagia is one of the common complications after stroke. It is closely related to lung infection and malnutrition. Neuromuscular electrical stimulation (NMES) is widely used in the treatment of post-stroke dysphagia, but the evidence-based medical evidence of NMES is limited. Therefore, this study aimed to evaluate the clinical efficacy of NMES in patients with post-stroke dysphagia by systematic review and meta-analysis. Methods We searched the CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, Cochrane Library, and Web of Science databases for all randomized controlled trials (RCTs) of NMES in the treatment of post-stroke dysphagia from the establishment of the database to 9 June 2022. The risk of bias assessment tool recommended by Cochrane and the GRADE method was used to assess the risk of bias and the quality of evidence. RevMan 5.3 was used for statistical analysis. Sensitivity and subgroup analyses were performed to evaluate the intervention effect more specifically. Results A total of 46 RCTs and 3,346 patients with post-stroke dysphagia were included in this study. Our meta-analysis showed that NMES combined with routine swallowing therapy (ST) could effectively improve swallowing function in Penetration-Aspiration Scale (MD = -0.63, 95% CI [-1.15, -0.12], P = 0.01), Functional Oral Intake Scale (MD = 1.32, 95% CI [0.81, 1.83], P < 0.00001), Functional Dysphagia Scale (MD = - 8.81, 95% CI [-16.48, -1.15], P = 0.02), the Standardized Swallowing Assessment (MD = -6.39, 95% CI [-6.56, -6.22], P < 0.00001), the Videofluoroscopic Swallow Study (MD = 1.42, 95% CI [1.28, 1.57], P < 0.00001) and the Water swallow test (MD = -0.78, 95% CI [-0.84, -0.73], P < 0.00001). Furthermore, it could improve the quality of life (MD = 11.90, 95% CI [11.10, 12.70], P < 0.00001), increase the upward movement distance of hyoid bone (MD = 2.84, 95% CI [2.28, 3.40], P < 0.00001) and the forward movement distance of hyoid bone (MD = 4.28, 95% CI [3.93, 4.64], P < 0.00001), reduce the rate of complications (OR = 0.37, 95%CI [0.24, 0.57], P < 0.00001). Subgroup analyses showed that NMES+ST was more effective at 25 Hz, 7 mA or 0-15 mA, and at courses ( ≤ 4 weeks). Moreover, patients with an onset of fewer than 20 days and those older than 60 years appear to have more positive effects after treatment. Conclusion NMES combined with ST could effectively increase the forward and upward movement distance of the hyoid bone, improve the quality of life, reduce the rate of complications, and improve the swallowing function of patients with post-stroke dysphagia. However, its safety needs to be further confirmed. Systematic review registration https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42022368416.
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Affiliation(s)
- Yuhan Wang
- Acupuncture and Moxibustion College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Lu Xu
- Gastroenterology Department, Yongchuan Traditional Chinese Medicine Hospital Affiliated to Chongqing Medical University, Chongqing, China
| | - Linjia Wang
- Acupuncture and Moxibustion College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Minjiao Jiang
- Acupuncture and Moxibustion College, Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Ling Zhao
- Acupuncture and Moxibustion College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Bioenergetic Evaluation of Muscle Fatigue in Murine Tongue. Dysphagia 2022:10.1007/s00455-022-10537-y. [DOI: 10.1007/s00455-022-10537-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/26/2022] [Indexed: 11/21/2022]
Abstract
AbstractMuscle 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.
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Li WY, Jin H, Zou Y, Huang H, Wei Z, Kang J, Xue Y, Wang W. The Different Effect of Tongue Motor Task Training (TTT) and Strength Training (ST) on the Modulation of Genioglossus Corticomotor Excitability and upper airway stability in Rats. Sleep 2022; 45:6648555. [PMID: 35867628 DOI: 10.1093/sleep/zsac170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES the mechanical efficiency of upper airway (UA) muscles are pivotal in maintaining UA stability. We aimed to investigate if different tongue training approaches could differently induce signs of neuroplastic in the corticomotor pathways and upper airway stability changes. METHODS 36 Sprague-Dawley rats were trained daily for eight weeks to lick an isotonic force-sensing disc at targeting forces using 30-50% of maximal achieved lick force (MALF) for tongue task training (TTT) or targeting force set above 50%, 60% and 70% of MALF progressively for tongue strength training (TST). Corticomotor excitability was dynamically assessed by GG response to transcortical magnetic stimulation (TMS) at different sessions. GG EMG activity, GG ultrastructure and myosin heavy chain (MHC), UA dynamics were assessed after eight weeks. RESULTS After 4 weeks, GG TMS latencies decreased in both tongue training groups when compared with the control group (p<0.05) and this excitability was more stable in TTT group. After 8 weeks, both GG TMS response and EMG activity revealed increased excitability in TTT and TST groups. The apoptotic pathological morphology changes of GG ultrastructure were observed in TST group, but not TTT. Percentage of GG MHC type I fibers in TST group was higher than the control and TTT groups (p<0.05). The UA Pcrit decreased significantly in TTT group (p<0.05) and tend to decrease in TST group (p=0.09). CONCLUSION TTT could improve the UA stability and induce the neuroplastic changes more efficiently without training-induced muscle injury, while TST revealed a fatigue-resistance change in GG.
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Affiliation(s)
- Wen-Yang Li
- Respiratory and critical care department, the First Hospital of China Medical University, Shenyang, China
| | - Hongyu Jin
- Respiratory and critical care department, the First Hospital of China Medical University, Shenyang, China
| | - Ying Zou
- Respiratory and critical care department, the First Hospital of China Medical University, Shenyang, China
| | - Hong Huang
- Respiratory and critical care department, the First Hospital of China Medical University, Shenyang, China
| | - Zhijing Wei
- Respiratory and critical care department, the First Hospital of China Medical University, Shenyang, China
| | - Jian Kang
- Respiratory and critical care department, the First Hospital of China Medical University, Shenyang, China
| | - Yixue Xue
- Neurobiology department, College of Life Science, China Medical University, Shenyang, China
| | - Wei Wang
- Respiratory and critical care department, the First Hospital of China Medical University, Shenyang, China
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Glass TJ, Figueroa JE, Russell JA, Krekeler BN, Connor NP. Progressive Protrusive Tongue Exercise Does Not Alter Aging Effects in Retrusive Tongue Muscles. Front Physiol 2021; 12:740876. [PMID: 34744782 PMCID: PMC8567011 DOI: 10.3389/fphys.2021.740876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/27/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose: Exercise-based treatment approaches for dysphagia may improve swallow function in part by inducing adaptive changes to muscles involved in swallowing and deglutition. We have previously shown that both aging and progressive resistance tongue exercise, in a rat model, can induce biological changes in the genioglossus (GG); a muscle that elevates and protrudes the tongue. However, the impacts of progressive resistance tongue exercise on the retrusive muscles (styloglossus, SG; hyoglossus, HG) of the tongue are unknown. The purpose of this study was to examine the impact of a progressive resistance tongue exercise regimen on the retrusive tongue musculature in the context of aging. Given that aging alters retrusive tongue muscles to more slowly contracting fiber types, we hypothesized that these biological changes may be mitigated by tongue exercise. Methods: Hyoglossus (HG) and styloglossus (SG) muscles of male Fischer 344/Brown Norway rats were assayed in age groups of young (9 months old, n = 24), middle-aged (24 months old, n = 23), and old (32 months old, n = 26), after receiving an 8-week period of either progressive resistance protrusive tongue exercise, or sham exercise conditions. Following exercise, HG and SG tongue muscle contractile properties were assessed in vivo. HG and SG muscles were then isolated and assayed to determine myosin heavy chain isoform (MyHC) composition. Results: Both retrusive tongue muscle contractile properties and MyHC profiles of the HG and SG muscles were significantly impacted by age, but were not significantly impacted by tongue exercise. Old rats had significantly longer retrusive tongue contraction times and longer decay times than young rats. Additionally, HG and SG muscles showed significant MyHC profile changes with age, in that old groups had slower MyHC profiles as compared to young groups. However, the exercise condition did not induce significant effects in any of the biological outcome measures. Conclusion: In a rat model of protrusive tongue exercise, aging induced significant changes in retrusive tongue muscles, and these age-induced changes were unaffected by the tongue exercise regimen. Collectively, results are compatible with the interpretation that protrusive tongue exercise does not induce changes to retrusive tongue muscle function.
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Affiliation(s)
- Tiffany J Glass
- Department of Surgery-Otolaryngology, University of Wisconsin-Madison, Madison, WI, United States
| | | | - John A Russell
- Department of Surgery-Otolaryngology, University of Wisconsin-Madison, Madison, WI, United States
| | - Brittany N Krekeler
- Department of Surgery-Otolaryngology, University of Wisconsin-Madison, Madison, WI, United States.,Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Nadine P Connor
- Department of Surgery-Otolaryngology, University of Wisconsin-Madison, Madison, WI, United States.,Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, United States
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7
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Mo H, Zhao J, Wu X, Liu W, Hu K. The combination of intermittent electrical stimulation with acute intermittent hypoxia strengthens genioglossus muscle discharge in chronic intermittent hypoxia-pretreated rats. Respir Physiol Neurobiol 2021; 291:103680. [PMID: 33971311 DOI: 10.1016/j.resp.2021.103680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/24/2021] [Accepted: 04/30/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Exploring whether the genioglossus discharge in chronic intermittent hypoxia(CIH) - pretreated rats could be enhanced by intermittent electrical stimulation combined with acute intermittent hypoxia(AIH). METHODS Rats were pretreated with CIH for 4 weeks and then were randomly divided into 6 groups: time control, intermittent electric stimulation, AIH, intermittent electric stimulation + AIH, continuous electric stimulation and continuous hypoxia exposure. The genioglossus discharges were recorded and compared before and after stimulation. Normoxic-treated rats were grouped and treated with the same stimulation protocols. RESULTS Intermittent electrical stimulation or AIH temporarily increased the activity of the genioglossus discharge, in which the degree of the increase was significantly higher in CIH-pretreated rats than in normoxic rats.After intermittent electrical stimulation, AIH evoked a sustained elevation of genioglossus discharge activities in CIH-pretreated rats, in which the degree of the increase was significantly higher than in rats induced by a single intermittent electric stimulation. CONCLUSION Intermittent electrical stimulation combined with AIH strengthens the genioglossus plasticity in CIH-pretreated rats.
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Affiliation(s)
- Huaheng Mo
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China.
| | - JingJing Zhao
- Department of Respiratory and Critical Care Medicine, Zhumadian Central Hospital, Zhumadian 463000, China.
| | - Xiaofeng Wu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China.
| | - Wei Liu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China.
| | - Ke Hu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China.
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8
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Zhang Q, Wu S. Effects of Synchronized Neuromuscular Electrical Stimulation (NMES) on the Submental Muscles During Ingestion of a Specified Volume of Soft Food in Patients with Mild-to-Moderate Dysphagia Following Stroke. Med Sci Monit 2021; 27:e928988. [PMID: 33780432 PMCID: PMC8018178 DOI: 10.12659/msm.928988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background Neuromuscular electrical stimulation (NMES) is a method for producing regular contractions of muscles that have been paralyzed. This study aimed to evaluate the effects of synchronized NMES on the submental muscles during ingestion of a specified volume of soft food in patients with mild-to-moderate dysphagia following stroke. Material/Methods Eighty-three patients with mild-to-moderate dysphagia following stroke were enrolled and randomly divided into 3 groups: conventional training (CT) (n=28), eating training (ET) (n=28), and intensive swallowing training (IST) (n=27). The CT group received conventional swallow training, the ET group was given additional individual feedings with a specified volume of soft food, and the IST group received intensive swallowing training with synchronized NEMS. All of the patients were evaluated before and after the treatment with a modified barium swallow, and the Dysphagia Outcome and Severity Scale (DOSS); the numbers of patients with Stroke-Associated Pneumonia (SAP) and wet voice also were assessed. Results After 6 weeks, DOSS scores improved in patients in all 3 groups, and there were significant differences among the groups in their scores (P<0.001 for both measures). In the CT and ET groups, there was a statistically significant difference in the number of patients with SAP before and after treatment (P=0.010 and P<0.001, respectively). There also were fewer cases in the IST group than in the CT (P=0.042) and ET groups (P=0.011). After completion of treatment, compared with the first treatment, there were significantly fewer patients with wet voices in the CT (P<0.001) and IST groups (P<0.001). Conclusions Feeding a specified volume of soft food plus synchronized NMES of the submental muscles can improve the swallowing function of patients with mild-to-moderate dysphagia following stroke and it reduces their risk of food aspiration.
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Affiliation(s)
- Qian Zhang
- Department of Rehabilitation, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China (mainland).,Guizhou Medical University, Guiyang, Guizhou, China (mainland)
| | - Shuang Wu
- Department of Rehabilitation, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China (mainland).,Guizhou Medical University, Guiyang, Guizhou, China (mainland)
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Kletzien H, Kelm-Nelson CA, Wang S, Suzuki M, Connor NP. Myogenic marker expression as a function of age and exercise-based therapy in the tongue. Exp Gerontol 2020; 142:111104. [PMID: 33017670 PMCID: PMC7748063 DOI: 10.1016/j.exger.2020.111104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/29/2020] [Accepted: 09/24/2020] [Indexed: 12/30/2022]
Abstract
Degeneration of tongue muscles with aging may contribute to swallowing deficits observed in elderly people. However, the capacity for tongue muscle stem cells (SCs) to regenerate and repair the aged tongue and improve tongue strength following tongue exercise (a current clinical treatment) has never been examined. We found that the expression of regenerative, myogenic markers were impaired with age and may be related to increased expression of senescent marker p16INK4a. Tongue strength increased in young adult and old rats following exercise and was related to the expression of Pax7, MyoD, myogenin, and p16INK4a. Our study also suggests that strengthening of tongue muscles via clinical rehabilitation strategies also increased the expression of SC regenerative markers in the tongue throughout the exercise duration.
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Affiliation(s)
- Heidi Kletzien
- Department of Biomedical Engineering, University of Wisconsin-Madison, United States of America; Department of Surgery, University of Wisconsin School of Medicine and Public Health, United States of America; Department of Stem Cell and Regenerative Biology, Harvard University, United States of America.
| | - Cynthia A Kelm-Nelson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, United States of America
| | - Sabrina Wang
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, United States of America
| | - Masatoshi Suzuki
- Department of Biomedical Engineering, University of Wisconsin-Madison, United States of America; Department of Comparative Biosciences, University of Wisconsin-Madison, United States of America
| | - Nadine P Connor
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, United States of America; Department of Communication Sciences and Disorders, University of Wisconsin-Madison, United States of America
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Fogarty MJ, Mu EWH, Lavidis NA, Noakes PG, Bellingham MC. Size‐dependent dendritic maladaptations of hypoglossal motor neurons in SOD1
G93A
mice. Anat Rec (Hoboken) 2020; 304:1562-1581. [DOI: 10.1002/ar.24542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/14/2020] [Accepted: 09/22/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Matthew J. Fogarty
- School of Biomedical Sciences The University of Queensland St Lucia Australia
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester Minnesota USA
| | - Erica W. H. Mu
- School of Biomedical Sciences The University of Queensland St Lucia Australia
| | - Nickolas A. Lavidis
- School of Biomedical Sciences The University of Queensland St Lucia Australia
| | - Peter G. Noakes
- School of Biomedical Sciences The University of Queensland St Lucia Australia
- Queensland Brain Institute The University of Queensland St Lucia Australia
| | - Mark C. Bellingham
- School of Biomedical Sciences The University of Queensland St Lucia Australia
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Wirth M, Unterhuber D, von Meyer F, Hofauer B, Ott A, Edenharter G, Eckert DJ, Heiser C. Hypoglossal nerve stimulation therapy does not alter tongue protrusion strength and fatigability in obstructive sleep apnea. J Clin Sleep Med 2020; 16:285-292. [PMID: 31992396 DOI: 10.5664/jcsm.8184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
STUDY OBJECTIVES Hypoglossal nerve stimulation (HNS) is an effective surgical alternative for patients with obstructive sleep apnea (OSA). HNS therapy relies on the stimulation of the hypoglossal nerve to open the upper airways. This stimulation could lead to alterations in tongue strength and fatigability, which could alter treatment outcome over time. The aim of the study was to investigate whether HNS alters tongue strength and fatigability. METHODS Tongue protrusion strength (peak pressure in kPa) and fatigability (time to task failure during 50% of peak pressure contraction) were measured with a pressure transducer at least 2 months after HNS implantation (n = 30). These results were compared to a group of patients with OSA (n = 38) and a non-OSA control group (n = 35). RESULTS Median tongue protrusion strength was lower (54.7 [43.8, 63.0] versus 60.7 [53.7, 66.0] kPa, P = .013) and fatigue occurred more quickly (21.3 [17.4, 26.3] versus 26.0 [19.3, 31.3] seconds, P = .017) in the patients with OSA compared to the non-OSA control group. In multiple regression analysis, age was a significant factor for tongue strength and diagnosis of OSA for tongue fatigability. Tongue strength and fatigability did not differ between patients with OSA with conservative therapy or observation versus after HNS implantation (51.8 [41.3, 63.4] versus 56.3 [45.0, 62.3] kPa, P = .502; 20.8 [16.3, 26.2] versus 21.8 [18.3, 26.8] seconds, P = .418). CONCLUSIONS Tongue strength decreases with age. Tongue fatigability is more pronounced in people with OSA. However, approximately 1.5 years of HNS therapy on average does not alter tongue strength or fatigability compared to an OSA control group. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: Change in Tongue Strength and Fatigue After Upper Airway Stimulation Therapy; Identifier: NCT03980158.
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Affiliation(s)
- Markus Wirth
- Department of Otolaryngology - Head and Neck Surgery, Technical University of Munich, Munich, Germany
| | - Daniel Unterhuber
- Department of Otolaryngology - Head and Neck Surgery, Technical University of Munich, Munich, Germany
| | - Franziska von Meyer
- Department of Otolaryngology - Head and Neck Surgery, Technical University of Munich, Munich, Germany
| | - Benedikt Hofauer
- Department of Otolaryngology - Head and Neck Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Armin Ott
- Institute of Medical Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | | | - Danny J Eckert
- Adelaide Institute for Sleep Health, A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Clemens Heiser
- Department of Otolaryngology - Head and Neck Surgery, Technical University of Munich, Munich, Germany
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12
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Kletzien H, Cullins MJ, Connor NP. Age-related alterations in swallowing biomechanics. Exp Gerontol 2019; 118:45-50. [PMID: 30633957 DOI: 10.1016/j.exger.2019.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/14/2018] [Accepted: 01/06/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aging rodent models allow for the discovery of underlying mechanisms of cranial muscle dysfunction. Methods are needed to allow quantification of complex, multivariate biomechanical movements during swallowing. Videofluoroscopic swallow studies (VSS) are the standard of care in assessment of swallowing disorders in patients and validated quantitative, kinematic, and morphometric analysis methods have been developed. Our purpose was to adapt validated morphometric techniques to the rodent to computationally analyze swallowing dysfunction in the aging rodent. METHODS VSS, quantitative analyses (bolus area, bolus velocity, mastication rate) and a rodent specific multivariate, morphometric computational analysis of swallowing biomechanics were performed on 20 swallows from 5 young adult and 5 old Fischer 344/Brown Norway rats. Eight anatomical landmarks were used to track the relative change in position of skeletal levers (cranial base, vertebral column, mandible) and soft tissue landmarks (upper esophageal sphincter, base of tongue). RESULTS Bolus area significantly increased and mastication rate significantly decreased with age. Aging accounted for 77.1% of the variance in swallow biomechanics, and 18.7% of the variance was associated with swallow phase (oral vs pharyngeal). Post hoc analyses identified age-related alterations in tongue base retraction, mastication, and head posture during the swallow. CONCLUSION Geometric morphometric analysis of rodent swallows suggests that swallow biomechanics are altered with age. When used in combination with biological assays of age-related adaptations in neuromuscular systems, this multivariate analysis may increase our understanding of underlying musculoskeletal dysfunction that contributes to swallowing disorders with aging.
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Affiliation(s)
- Heidi Kletzien
- Division of Otolaryngology-Head and Neck Cancer, Department of Surgery, University of Wisconsin School of Medicine and Public Health, United States of America; Department of Biomedical Engineering, University of Wisconsin-Madison, United States of America.
| | - Miranda J Cullins
- Division of Otolaryngology-Head and Neck Cancer, Department of Surgery, University of Wisconsin School of Medicine and Public Health, United States of America
| | - Nadine P Connor
- Division of Otolaryngology-Head and Neck Cancer, Department of Surgery, University of Wisconsin School of Medicine and Public Health, United States of America; Department of Biomedical Engineering, University of Wisconsin-Madison, United States of America; Department of Communication Sciences and Disorders, University of Wisconsin-Madison, United States of America
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