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Yoshida T, Yagi N, Ogawa T, Nakanome A, Ohkoshi A, Katori Y, Oku Y. Breathing-Swallowing discoordination after definitive chemoradiotherapy for head and neck cancers is associated with aspiration pneumonia. PLoS One 2024; 19:e0305560. [PMID: 38990865 PMCID: PMC11238977 DOI: 10.1371/journal.pone.0305560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 05/31/2024] [Indexed: 07/13/2024] Open
Abstract
PURPOSE Swallowing dysfunction and the risk of aspiration pneumonia are frequent clinical problems in the treatment of head and neck squamous cell carcinomas (HNSCCs). Breathing-swallowing coordination is an important factor in evaluating the risk of aspiration pneumonia. To investigate breathing-swallowing discoordination after chemoradiotherapy (CRT), we monitored respiration and swallowing activity before and after CRT in patients with HNSCCs. METHODS Non-invasive swallowing monitoring was prospectively performed in 25 patients with HNSCCs treated with CRT and grade 1 or lower radiation-induced dermatitis. Videoendoscopy, videofluoroscopy, Food Intake LEVEL Scale, and patient-reported swallowing difficulties were assessed. RESULTS Of the 25 patients selected for this study, four dropped out due to radiation-induced dermatitis. The remaining 21 patients were analyzed using a monitoring system before and after CRT. For each of the 21 patients, 405 swallows were analyzed. Swallowing latency and pause duration after the CRT were significantly extended compared to those before the CRT. In the analysis of each swallowing pattern, swallowing immediately followed by inspiration (SW-I pattern), reflecting breathing-swallowing discoordination, was observed more frequently after CRT (p = 0.0001). In 11 patients, the SW-I pattern was observed more frequently compared to that before the CRT (p = 0.00139). One patient developed aspiration pneumonia at 12 and 23 months after the CRT. CONCLUSION The results of this preliminary study indicate that breathing-swallowing discoordination tends to increase after CRT and could be involved in aspiration pneumonia. This non-invasive method may be useful for screening swallowing dysfunction and its potential risks.
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Affiliation(s)
- Takuya Yoshida
- Department of Otolaryngology, Iwate Prefectural Iwai Hospital, Ichinoseki, Iwate, Japan
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Naomi Yagi
- Advanced Medical Engineering Research Institute, University of Hyogo, Himeji, Hyogo, Japan
| | - Takenori Ogawa
- Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Ayako Nakanome
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Akira Ohkoshi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yoshitaka Oku
- Department of Physiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Yang QL, Chen Y, Wang XJ, Qiu HY, Chen MT, Zhou XH, Jian CY, Zhao SF. Correlation between lesion location and dysphagia characteristics in post-stroke patients. J Stroke Cerebrovasc Dis 2024; 33:107682. [PMID: 38522758 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/28/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVE To assess the correlation between lesion location and swallowing function characteristics in post-stroke dysphagia (PSD) patients. MATERIALS AND METHODS We enrolled 133 PSD. The patients were divided into supratentorial and infratentorial stroke groups. We compared the measurements in the videofluoroscopic swallowing study (VFSS) with 3ml and 5 ml of diluted and thickened barium liquid data between supratentorial and brainstem stroke groups. We further compared the difference of VFSS measurements between patients with left hemispheric or right hemispheric lesions (further divided into unilateral hemispheric cortical and subcortical subgroups) and brianstem leison stroke group.To explore the lesion location's effect on different bolus volume, the VFSS measurements of 3ml and 5ml in each subgroups were compared respectively. The measurements of VFSS included the oral transit time, soft palate elevation duration, hyoid bone movement duration (HMD), UES opening duration, pharyngeal transit duration (PTD), stage of ansition duration, and laryngeal closure duration (LCD), the upper esophageal sphincter opening (UESO), hyoid bone superior horizontal displacement, and hyoid bone anterior horizontal displacement. General swallowing function was assessed using the Penetration Aspiration Scale (PAS) and Functional Oral Intake Scale (FOIS). We performed the paired t-test, Spearman's correlation, and Kruskal-Wallis test analysis to characterize the parameters among the groups. RESULTS Fifty-eight patients were assessed in the final analysis. The HMD (p = 0.019), PTD (p = 0.048) and LCD (p = 0.013) were significantly different between the supratentorial and brainstem lesion groups in 5ml volume. The HMD was significantly different (p = 0.045) between the left cortical and brainstem lesion groups. Significant differences in the HMD (p = 0.037) and LCD (p = 0.032) between the left subcortical and brainstem lesion groups were found in 5ml volume bolus. There was no group different when taking the 3ml volume bolus. Regarding the relationship between food bolus volume and swallowing functions, only the UESO demonstrated a significant difference in the subcortical lesion of the right hemisphere (p = 0.0032) compared the 3 ml and 5 ml volume bolus. The PTD demonstrated a moderate correlation with the PAS scores (r = 0.38, p = 0.0044). The HMD (r = 0.32, p = 0.018) and LCD (r = 0.29, p = 0.039) demonstrated weak correlations with the PAS scores. We did not identify any correlation between the VFSS parameters and FOIS scores in each subgroup level. CONCLUSION The PSD with brainstem lesion shows more sever dysfunction in the pharyngeal phases. The left hemisphere was engaged in both the oral and pharyngeal phases. Lesions in the bilateral cortical, subcortical, and brainstem regions may impair sensory input.
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Affiliation(s)
- Qing-Lu Yang
- Department of Rehabilitation Medicine, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Yang Chen
- Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Xue-Jie Wang
- Department of Rehabilitation Medicine, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Hui-Ying Qiu
- Department of Rehabilitation Medicine, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Meng-Ting Chen
- Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Xu-Hui Zhou
- Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Chu-Yao Jian
- Department of Rehabilitation Medicine, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Shao-Feng Zhao
- Department of Rehabilitation Medicine, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.
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Seifelnasr A, Ding P, Si X, Biondi A, Xi J. Oropharyngeal swallowing hydrodynamics of thin and mildly thick liquids in an anatomically accurate throat-epiglottis model. Sci Rep 2024; 14:11945. [PMID: 38789468 PMCID: PMC11126673 DOI: 10.1038/s41598-024-60422-x] [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: 10/28/2023] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
Understanding the mechanisms underlying dysphagia is crucial in devising effective, etiology-centered interventions. However, current clinical assessment and treatment of dysphagia are still more symptom-focused due to our limited understanding of the sophisticated symptom-etiology associations causing swallowing disorders. This study aimed to elucidate the mechanisms giving rise to penetration flows into the laryngeal vestibule that results in aspirations with varying symptoms. Methods: Anatomically accurate, transparent throat models were prepared with a 45° down flapped epiglottis to simulate the instant of laryngeal closure during swallowing. Fluid bolus dynamics were visualized with fluorescent dye from lateral, rear, front, and endoscopic directions to capture key hydrodynamic features leading to aspiration. Three influencing factors, fluid consistency, liquid dispensing site, and dispensing speed, were systemically evaluated on their roles in liquid aspirations. Results: Three aspiration mechanisms were identified, with liquid bolus entering the airway through (a) the interarytenoid notch (notch overflow), (b) cuneiform tubercle recesses (recess overflow), and (c) off-edge flow underneath the epiglottis (off-edge capillary flow). Of the three factors considered, liquid viscosity has the most significant impact on aspiration rate, followed by the liquid dispensing site and the dispensing speed. Water had one order of magnitude higher aspiration risks than 1% w/v methyl cellulose solution, a mildly thick liquid. Anterior dispensing had higher chances for aspiration than posterior oropharyngeal dispensing for both liquids and dispensing speeds considered. The effects of dispending speed varied. A lower speed increased aspiration for anterior-dispensed liquids due to increased off-edge capillary flows, while it significantly reduced aspiration for posterior-dispensed liquids due to reduced notch overflows. Visualizing swallowing hydrodynamics from multiple orientations facilitates detailed site-specific inspections of aspiration mechanisms.
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Affiliation(s)
- Amr Seifelnasr
- Department of Biomedical Engineering, University of Massachusetts, 1 University Ave., Falmouth Hall 302I, Lowell, MA, 01854, USA
| | - Peng Ding
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Lerner College of Medicine, 9501 Euclid Ave, Cleveland, OH, 44195, USA
| | - Xiuhua Si
- Department of Mechanical Engineering, California Baptist University, 8432 Magnolia Ave, Riverside, CA, 92504, USA
| | - Andres Biondi
- Department of Electrical and Computer Engineering, University of Massachusetts, 1 University Ave., Lowell, MA, 01854, USA
| | - Jinxiang Xi
- Department of Biomedical Engineering, University of Massachusetts, 1 University Ave., Falmouth Hall 302I, Lowell, MA, 01854, USA.
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Kimura S, Emoto T, Suzuki Y, Shinkai M, Shibagaki A, Shichijo F. Novel Approach Combining Shallow Learning and Ensemble Learning for the Automated Detection of Swallowing Sounds in a Clinical Database. SENSORS (BASEL, SWITZERLAND) 2024; 24:3057. [PMID: 38793908 PMCID: PMC11124773 DOI: 10.3390/s24103057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024]
Abstract
Cervical auscultation is a simple, noninvasive method for diagnosing dysphagia, although the reliability of the method largely depends on the subjectivity and experience of the evaluator. Recently developed methods for the automatic detection of swallowing sounds facilitate a rough automatic diagnosis of dysphagia, although a reliable method of detection specialized in the peculiar feature patterns of swallowing sounds in actual clinical conditions has not been established. We investigated a novel approach for automatically detecting swallowing sounds by a method wherein basic statistics and dynamic features were extracted based on acoustic features: Mel Frequency Cepstral Coefficients and Mel Frequency Magnitude Coefficients, and an ensemble learning model combining Support Vector Machine and Multi-Layer Perceptron were applied. The evaluation of the effectiveness of the proposed method, based on a swallowing-sounds database synchronized to a video fluorographic swallowing study compiled from 74 advanced-age patients with dysphagia, demonstrated an outstanding performance. It achieved an F1-micro average of approximately 0.92 and an accuracy of 95.20%. The method, proven effective in the current clinical recording database, suggests a significant advancement in the objectivity of cervical auscultation. However, validating its efficacy in other databases is crucial for confirming its broad applicability and potential impact.
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Affiliation(s)
- Satoru Kimura
- Division of Science and Technology, Graduate School of Sciences and Technology for Innovations, Tokushima University, Tokushima 770-8506, Japan;
| | - Takahiro Emoto
- Division of Science and Technology, Industrial and Social Science, Graduate School of Technology, Tokushima University, Tokushima 770-8506, Japan
| | - Yoshitaka Suzuki
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8504, Japan; (Y.S.); (M.S.); (A.S.)
| | - Mizuki Shinkai
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8504, Japan; (Y.S.); (M.S.); (A.S.)
| | - Akari Shibagaki
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8504, Japan; (Y.S.); (M.S.); (A.S.)
| | - Fumio Shichijo
- Department of Neurosurgery, Suzue Hospital, Tokushima 770-0028, Japan;
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Xia Y, Sun C, Liu W, Wang X, Wen K, Feng Z, Zhang G, Fan E, He Q, Lin Z, Gou Y, Wu Y, Yang J. Ultra-Broadband Flexible Thin-Film Sensor for Sound Monitoring and Ultrasonic Diagnosis. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2305678. [PMID: 37875729 DOI: 10.1002/smll.202305678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/07/2023] [Indexed: 10/26/2023]
Abstract
Small-scale and flexible acoustic probes are more desirable for exquisite objects like human bodies and complex-shaped components than conventional rigid ones. Herein, a thin-film flexible acoustic sensor (FA-TES) that can detect ultra-broadband acoustic signals in multiple applications is proposed. The device consists of two thin copper-coated polyvinyl chloride films, which are stimulated by acoustic waves and contact each other to generate the triboelectric signal. Interlocking nanocolumn arrays fabricated on the friction surfaces are regarded as a highly adaptive spacer enabling this device to respond to ultra-broadband acoustic signals (100 Hz-4 MHz) and enhance sensor sensitivity for film weak vibration. Benefiting from the characteristics of high shape adaptability and ultrawide response range, the FA-TES can precisely sense human physiological sounds and voice (≤10 kHz) for laryngeal health monitoring and interaction in real-time. Moreover, the FA-TES flexibly arranged on a 3D-printed vertebra model can effectively and accurately diagnose the inner defect by ultrasonic testing (≥1 MHz). It envisions that this work can provide new ideas for flexible acoustic sensor designs and optimize real-time acoustic detections of human bodies and complex components.
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Affiliation(s)
- Yushu Xia
- Department of Optoelectronic Engineering, Key Laboratory of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing, 400044, China
| | - Chenchen Sun
- Department of Optoelectronic Engineering, Key Laboratory of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing, 400044, China
| | - Wencai Liu
- CNPC Research Institute of Safety & Environment Technology, Beijing, 100007, China
| | - Xue Wang
- Department of Optoelectronic Engineering, Key Laboratory of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing, 400044, China
| | - Ke Wen
- Natural Gas Purification Plant of PetroChina Southwest Oil & Gasfield Company, 401120, Chongqing, China
| | - Zhiping Feng
- Department of Optoelectronic Engineering, Key Laboratory of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing, 400044, China
| | - Gaoqiang Zhang
- Department of Optoelectronic Engineering, Key Laboratory of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing, 400044, China
| | - Endong Fan
- Department of Optoelectronic Engineering, Key Laboratory of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing, 400044, China
| | - Qiang He
- Department of Optoelectronic Engineering, Key Laboratory of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing, 400044, China
| | - Zhiwei Lin
- Department of Optoelectronic Engineering, Key Laboratory of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing, 400044, China
| | - Yunfeng Gou
- Department of Optoelectronic Engineering, Key Laboratory of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing, 400044, China
| | - Yufen Wu
- College of Physics and Electronic Engineering, Chongqing Normal University, Chongqing, 401331, China
| | - Jin Yang
- Department of Optoelectronic Engineering, Key Laboratory of Optoelectronic Technology and Systems, Ministry of Education, Chongqing University, Chongqing, 400044, China
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Rangwala R, Saadi R, Lee JJ, Reedy EL, Kantarcigil C, Roberts M, Martin-Harris B. Respiratory-Swallow Coordination in Individuals with Parkinson's Disease: A Systematic Review and Meta-Analysis. JOURNAL OF PARKINSON'S DISEASE 2023; 13:681-698. [PMID: 37393516 PMCID: PMC10473138 DOI: 10.3233/jpd-230057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Swallowing impairment, including altered physiology and aspiration, occur across the progression of Parkinson's disease (PD). The phase of respiration during which a swallow is initiated has been linked to swallowing impairment and aspiration in cohorts with dysphagia following stroke and head and neck cancer treatment, but has been understudied in PD. If similar findings are shown in individuals with PD, the implications for swallowing assessment and treatment are significant. OBJECTIVE The aim of this systematic review and meta-analysis of literature was to examine respiratory-swallow coordination measures and potential implications on swallowing physiology in individuals with PD. METHODS An extensive search of 7 databases (PubMed, EMBASE, Central, Web of Science, ProQuest Dissertations & Theses, Scopus, and CINAHL) with predetermined search terms was conducted. Inclusion criteria were individuals with PD and the use of objective evaluations of respiratory-swallow coordination. RESULTS Of the 13,760 articles identified, 11 met the inclusion criteria. This review supports the presence of atypical respiratory swallow patterning, respiratory pause duration and lung volume at swallow initiation in individuals with PD. The meta-analysis estimated an occurrence of 60% of non-expiration-expiration and 40% of expiration-expiration respiratory phase patterns surrounding swallowing. CONCLUSION Although this systematic review supports the occurrence of atypical respiratory-swallow coordination in individuals with PD, the evidence is limited by the variability in the methods of data acquisition, analysis, and reporting. Future research examining the impact of respiratory swallow coordination on swallowing impairment and airway protection using consistent, comparable, and reproducible methods and metrics in individuals with PD is warranted.
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Affiliation(s)
- Rabab Rangwala
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
| | - Raneh Saadi
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
| | - Jungwha Julia Lee
- Preventive Medicine (Biostatistics), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Erin L. Reedy
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
- Edward J. Hines, Jr. Veterans Affairs Medical Center, Hines, IL, USA
| | - Cagla Kantarcigil
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
| | - Megan Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
| | - Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
- Otolaryngology - Head & Neck Surgery, Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Edward J. Hines, Jr. Veterans Affairs Medical Center, Hines, IL, USA
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Qiao J, Jiang YT, Dai Y, Gong YB, Dai M, Liu YX, Dou ZL. Research on a real-time dynamic monitoring method for silent aspiration after stroke based on semisupervised deep learning: A protocol study. Digit Health 2023; 9:20552076231183548. [PMID: 37434729 PMCID: PMC10331777 DOI: 10.1177/20552076231183548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 06/05/2023] [Indexed: 07/13/2023] Open
Abstract
Objective This study aims to establish a real-time dynamic monitoring system for silent aspiration (SA) to provide evidence for the early diagnosis of and precise intervention for SA after stroke. Methods Multisource signals, including sound, nasal airflow, electromyographic, pressure and acceleration signals, will be obtained by multisource sensors during swallowing events. The extracted signals will be labeled according to videofluoroscopic swallowing studies (VFSSs) and input into a special dataset. Then, a real-time dynamic monitoring model for SA will be built and trained based on semisupervised deep learning. Model optimization will be performed based on the mapping relationship between multisource signals and insula-centered cerebral cortex-brainstem functional connectivity through resting-state functional magnetic resonance imaging. Finally, a real-time dynamic monitoring system for SA will be established, of which the sensitivity and specificity will be improved by clinical application. Results Multisource signals will be stably extracted by multisource sensors. Data from a total of 3200 swallows will be obtained from patients with SA, including 1200 labeled swallows from the nonaspiration category from VFSSs and 2000 unlabeled swallows. A significant difference in the multisource signals is expected to be found between the SA and nonaspiration groups. The features of labeled and pseudolabeled multisource signals will be extracted through semisupervised deep learning to establish a dynamic monitoring model for SA. Moreover, strong correlations are expected to be found between the Granger causality analysis (GCA) value (from the left middle frontal gyrus to the right anterior insula) and the laryngeal rise time (LRT). Finally, a dynamic monitoring system will be established based on the former model, by which SA can be identified precisely. Conclusion The study will establish a real-time dynamic monitoring system for SA with high sensitivity, specificity, accuracy and F1 score.
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Affiliation(s)
- Jia Qiao
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-Sen University
| | - Yuan-tong Jiang
- School of Software Engineering, South China University of Technology
| | - Yong Dai
- Clinical Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine
| | - Yan-bin Gong
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology
| | - Meng Dai
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-Sen University
| | - Yan-xia Liu
- School of Software Engineering, South China University of Technology
| | - Zu-lin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-Sen University
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Qiao J, Wu ZM, Ye QP, Dai M, Dai Y, He ZT, Dou ZL. Characteristics of dysphagia among different lesion sites of stroke: A retrospective study. Front Neurosci 2022; 16:944688. [PMID: 36090270 PMCID: PMC9449127 DOI: 10.3389/fnins.2022.944688] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/01/2022] [Indexed: 02/05/2023] Open
Abstract
Objective This study aims to compare the characteristics of dysphagia among different lesion sites and explore the possible risk factors that are relevant to penetration and aspiration after stroke. Materials and methods Data on patients with post-stroke dysphagia were collected. Major measures of the videofluoroscopic swallowing study included pharyngeal transit duration (PTD), pharyngeal response duration (PRD), soft palate elevation duration (SED), stage transition duration (STD), hyoid bone anterior-horizontal displacement (HAD), hyoid bone superior-horizontal displacement (HSD), upper esophageal sphincter opening (UESO), Pharyngeal Residual Grade (PRG), and Penetration Aspiration Scale (PAS). Included patients were divided into supratentorial (deep or lobar intracerebral) and infratentorial stroke groups. The Kruskal–Wallis test, Spearman’s correlation analysis, and multivariate logistic regression analyses were used to test the difference and the correlation between those measures. Time-to-event endpoints (oral feeding) were analyzed by the Kaplan–Meier method. Results A total of 75 patients were included in this study. Significant differences were demonstrated in PTD, PRD, SED, STD, HAD, HSD, UESO, PAS, and PRG between supratentorial and infratentorial stroke groups (p < 0.05). The PRG score of the lobar intracerebral subgroup was significantly higher (p < 0.05) than that of the deep intracerebral and lobar + deep intracerebral stroke subgroups, while HSD was significantly shorter (p < 0.01). Spearman’s correlation analysis revealed that PAS was related to PTD, PRG, HAD, and UESO (p < 0.05). Multivariate logistic regression analysis demonstrated that HAD and PRG may be risk factors for penetration and aspiration (p < 0.05). Kaplan–Meier survival plot showed that there was a significant difference in time to oral feeding between supratentorial and infratentorial stroke groups (p < 0.01). Conclusion Infratentorial stroke may lead to worse swallowing function as compared with supratentorial stroke, and lobar intracerebral stroke may be worse than deep intracerebral stroke. Suitable preventive measures may be considered for patients with higher PRG scores and shorter HSD to avoid penetration and aspiration.
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Affiliation(s)
- Jia Qiao
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhi-min Wu
- Department of Neurosurgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiu-ping Ye
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Meng Dai
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yong Dai
- Clinical Medical College of Acupuncture, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zi-tong He
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zu-lin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- *Correspondence: Zu-lin Dou,
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Shahmoon R, Tamir Y, Beiderman Y, Agdarov S, Beiderman Y, Zalevsky Z. Analysis of swallowing in infants and adults using speckle pattern analysis. Sci Rep 2022; 12:3847. [PMID: 35264633 PMCID: PMC8907278 DOI: 10.1038/s41598-022-07895-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/23/2022] [Indexed: 11/09/2022] Open
Abstract
The ability to detect and evaluate ingestion is especially important in toddlers. The development of new methods for detecting and accurately measuring ingestion is therefore extremely important. One of the methods allowing such measurements is speckle pattern analyses, a well-known phenomenon in coherent imaging. The method allows extraction of various medical parameters, such as blood pulse pressure, temporal signature of heartbeats and breath. The current work contains further development and application of the speckle tracking technique for remote detection and quantification of swallowing and distinguishing between sucking and swallowing to identify feeding disorders in infants and elderly individuals.
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10
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Singing Experience Influences RSST Scores. Healthcare (Basel) 2022; 10:healthcare10020377. [PMID: 35206991 PMCID: PMC8871987 DOI: 10.3390/healthcare10020377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/06/2022] [Accepted: 02/12/2022] [Indexed: 02/01/2023] Open
Abstract
It has recently been shown that the aging population is refractory to the maintenance of swallowing function, which can seriously affect quality of life. Singing and vocal training contribute to mastication, swallowing and respiratory function. Previous studies have shown that singers have better vocal cord health. No consensus has been reached as to how vocal training affects swallowing ability. Our study was designed to establish evidence that singers are statistically superior at inducing the swallowing reflex. To test our hypothesis, we undertook a clinical trial on 55 singers and 141 non-singers (mean age: 60.1 ± 11.7 years). This cross-sectional study with propensity score matching resulted in significant differences in a repetitive saliva swallowing test among singers: 7.1 ± 2.4, n = 53 vs. non-singers: 5.9 ± 1.9, n = 53, p < 0.05. We conclude that singing can serve an important role in stabilizing the impact of voluntary swallowing on speech.
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11
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Feng C, Volkman K, Wagoner C, Siu KC. Effects of different viscous liquids and solid foods on swallowing speeds and sounds among healthy adults. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:78-89. [PMID: 34637189 DOI: 10.1111/1460-6984.12675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/09/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Digital cervical auscultation (CA) has been proposed since the 1950s for screening aspiration among patients with dysphagia. Researchers have investigated the 'external' effects such as bolus viscosity, volume, and head and neck positions. However, the influences of standardized liquid viscosity and food texture on swallowing sounds have not been fully understood due to lacking uniform standardization of bolus preparation. Furthermore, a paucity of the literature recommends proper viscous liquids and foods to start swallowing training or monitor the swallowing progress during the continuum of disease based on acoustic signals. AIMS To investigate the effects of eight-level liquids and foods on swallowing sound features based on the International Dysphagia Diet Standardisation Initiative (IDDSI). METHODS & PROCEDURES We collected swallowing sounds from 30 healthy participants ranging in age from 19 to 60 years and who were self-reporting no history of swallowing disorders. Each participant swallowed liquids and foods regarding different consistency or texture with their head-trunk in a neutral position. OUTCOMES & RESULTS Features of swallowing acoustic signals and the IDDSI flow test as well as food test confirmed the level 3 moderately thick (MO3) was more suitable to categorize into liquids and the level 4 extremely thick (EX4) was more corresponded to the properties of food bolus. We found significant differences in duration of acoustic signals across different liquids and foods except between swallowing level 0 thin liquid and level 1 slightly thick liquid, as well as EX4 and level 5 minced and moist. Our results also demonstrated liquid viscosity significantly impacted the peak intensity of swallowing sounds. CONCLUSIONS & IMPLICATIONS As an initial exploration of digital CA across eight levels of different liquids and foods according to the IDDSI, we established the baseline findings for future comparisons with other study populations or other various consistent liquids/foods. Although both MO3 and EX4 can be considered as liquid or food boluses with high thickness, MO3 might be suitable as the 'start liquid' for patients with dysphagia; however, the decision still needs to be confirmed by the healthcare provider based on patients' safety and the area of deficit. We also concluded there are influences of varied fluid consistency and food texture on swallowing sounds. Furthermore, future investigations should explore whether changing viscosity levels could either continuously or discretely disturb the swallowing acoustic signals. WHAT THIS PAPER ADDS What is already known on the subject Previous studies have found that the 'external' effects such as bolus viscosity, volume, and head and neck positions. Due to lacking uniform standardization of bolus preparation, there is limited information about the influences of standardized liquid viscosity and food texture on swallowing sounds. What this paper adds to the existing knowledge As an initial exploration, we utilized digital CA with a large sample of viscous liquids and different textures of foods based on the IDDSI to investigate the swallowing sounds. What are the potential or actual clinical implications of this work? This study confirms that the effects of various fluid consistency and food texture on swallowing acoustic signals. However, the findings of this study support the need for further research relating to changing viscosity could either continuously or discretely disturb the swallowing acoustic signals.
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Affiliation(s)
- Chun Feng
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Rehabilitation Hospital Affiliated to Tongji University, Shanghai, China
| | - Kathleen Volkman
- Department of Health and Rehabilitation Sciences, 984420 Nebraska Medical Center, Omaha, NE, USA
| | - Cheryl Wagoner
- Madonna Rehabilitation Hospital Lincoln Campus, Lincoln, NE, USA
| | - Ka-Chun Siu
- Department of Health and Rehabilitation Sciences, 984420 Nebraska Medical Center, Omaha, NE, USA
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12
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Jo S, Yeo MS, Shin YK, Shin KH, Kim SH, Kim HR, Kim SJ, Cho SR. Therapeutic Singing as a Swallowing Intervention in Head and Neck Cancer Patients With Dysphagia. Integr Cancer Ther 2021; 20:15347354211065040. [PMID: 34903088 PMCID: PMC8679067 DOI: 10.1177/15347354211065040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Head and neck cancer patients often suffer from dysphagia after surgery and
radiotherapy. A singing-enhanced swallowing protocol was established to
improve their swallowing function. This study aimed to evaluate the
beneficial effects of therapeutic singing on dysphagia in head and neck
cancer (HNC) patients. Methods: Patients who participated in this study were allocated to the intervention
group (15 patients) and the control group (13 patients). Patients assigned
to the intervention group received therapeutic singing 3 times per week for
4 weeks. Each group was divided into 2 subgroups, including the oral cavity
cancer group and the pharyngeal cancer group. The patients’ vocal functions
were evaluated in maximum phonation time, pitch, intensity, jitter, shimmer,
harmonics to noise ratio, and laryngeal diadochokinesis (L-DDK). To evaluate
swallowing function, videofluoroscopic swallowing study was done, and the
results were analyzed by videofluoroscopic dysphagia scale (VDS) and dynamic
imaging grade of swallowing toxicity (DIGEST). Results: Among the voice parameters, L-DDK of the intervention group significantly
increased compared to that of the control group. Swallowing functions of the
intervention group were significantly improved in VDS and DIGEST after the
intervention. Detailed items of VDS and DIGEST showed improvements
especially in the pharyngeal phase score of VDS, such as laryngeal
elevation, pharyngeal transit time, and aspiration. In addition, the
pharyngeal cancer group showed significant improvements in VDS and DIGEST
scores after the intervention. Conclusions: Our outcomes highlight the beneficial effects of singing for HNC patients
with dysphagia. The notable improvements in the pharyngeal phase suggest
that therapeutic singing would be more appropriate for HNC patients who need
to improve their intrinsic muscle movements of vocal fold and laryngeal
elevation.
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Affiliation(s)
- Seongmoon Jo
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Sun Yeo
- Department of Music Therapy, Graduate School, Ewha Womans University, Seoul, Korea.,Music Therapy Education, Graduate School of Education, Ewha Womans University, Seoul, Korea
| | - Yoon-Kyum Shin
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Hun Shin
- Yonsei University College of Medicine, Seoul, Korea
| | - Se-Heon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Ryun Kim
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Ji Kim
- Department of Music Therapy, Graduate School, Ewha Womans University, Seoul, Korea.,Music Therapy Education, Graduate School of Education, Ewha Womans University, Seoul, Korea
| | - Sung-Rae Cho
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.,Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
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13
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Mootassim‐Billah S, Van Nuffelen G, Schoentgen J, De Bodt M, Dragan T, Digonnet A, Roper N, Van Gestel D. Assessment of cough in head and neck cancer patients at risk for dysphagia-An overview. Cancer Rep (Hoboken) 2021; 4:e1395. [PMID: 33932152 PMCID: PMC8551981 DOI: 10.1002/cnr2.1395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/22/2021] [Accepted: 03/26/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This literature review explores the terminology, the neurophysiology, and the assessment of cough in general, in the framework of dysphagia and regarding head and neck cancer patients at risk for dysphagia. In the dysphagic population, cough is currently assessed perceptually during a clinical swallowing evaluation or aerodynamically. RECENT FINDINGS Recent findings have shown intra and inter-rater disagreements regarding perceptual scoring of cough. Also, aerodynamic measurements are impractical in a routine bedside assessment. Coughing, however, is considered to be a clinically relevant sign of aspiration and dysphagia in head and cancer patients treated with concurrent chemoradiotherapy. CONCLUSION This article surveys the literature regarding the established cough assessment and stresses the need to implement innovative methods for assessing cough in head and neck cancer patients treated with concurrent chemoradiotherapy at risk for dysphagia.
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Affiliation(s)
- Sofiana Mootassim‐Billah
- Department of Radiation Oncology, Speech Therapy, Institut Jules BordetUniversité Libre de BruxellesBrusselsBelgium
| | - Gwen Van Nuffelen
- Department of Otolaryngology and Head and Neck Surgery, University Rehabilitation Center for Communication DisordersAntwerp University HospitalAntwerpBelgium
- Department of Translational Neurosciences, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
- Department of Logopaedics and Audiological Sciences, Faculty of Medicine and Health SciencesUniversity of GhentGhentBelgium
| | - Jean Schoentgen
- BEAMS (Bio‐, Electro‐ And Mechanical Systems)Université Libre de BruxellesBrusselsBelgium
| | - Marc De Bodt
- Department of Otolaryngology and Head and Neck Surgery, University Rehabilitation Center for Communication DisordersAntwerp University HospitalAntwerpBelgium
- Department of Translational Neurosciences, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
- Department of Logopaedics and Audiological Sciences, Faculty of Medicine and Health SciencesUniversity of GhentGhentBelgium
| | - Tatiana Dragan
- Department of Radiation Oncology, Head and Neck Unit, Institut Jules BordetUniversité Libre de BruxellesBrusselsBelgium
| | - Antoine Digonnet
- Department of Surgical Oncology, Head and Neck Surgery Unit, Institut Jules BordetUniversité Libre de BruxellesBrusselsBelgium
| | - Nicolas Roper
- Department of Oto‐Rhino‐Laryngology and Head & Neck Surgery, Erasme HospitalUniversité Libre de BruxellesBrusselsBelgium
| | - Dirk Van Gestel
- Department of Radiation Oncology, Head and Neck Unit, Institut Jules BordetUniversité Libre de BruxellesBrusselsBelgium
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14
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Natta L, Guido F, Algieri L, Mastronardi VM, Rizzi F, Scarpa E, Qualtieri A, Todaro MT, Sallustio V, De Vittorio M. Conformable AlN Piezoelectric Sensors as a Non-invasive Approach for Swallowing Disorder Assessment. ACS Sens 2021; 6:1761-1769. [PMID: 34010558 PMCID: PMC8294609 DOI: 10.1021/acssensors.0c02339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Deglutition disorders (dysphagia) are common symptoms of a large number of diseases and can lead to severe deterioration of the patient's quality of life. The clinical evaluation of this problem involves an invasive screening, whose results are subjective and do not provide a precise and quantitative assessment. To overcome these issues, alternative possibilities based on wearable technologies have been proposed. We explore the use of ultrathin, compliant, and flexible piezoelectric patches that are able to convert the laryngeal movement into a well-defined electrical signal, with extremely low anatomical obstruction and high strain resolution. The sensor is based on an aluminum nitride thin film, grown on a soft Kapton substrate, integrated with an electrical charge amplifier and low-power, wireless connection to a smartphone. An ad-hoc designed laryngeal motion simulator (LMS), which is able to mimic the motions of the laryngeal prominence, was used to evaluate its performances. The physiological deglutition waveforms were then extrapolated on a healthy volunteer and compared with the sEMG (surface electromyography) of the submental muscles. Finally, different tests were conducted to assess the ability of the sensor to provide clinically relevant information. The reliability of these features permits an unbiased evaluation of the swallowing ability, paving the way to the creation of a system that is able to provide a point-of-care automatic, unobtrusive, and real-time extrapolation of the patient's swallowing quality even during normal behavior.
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Affiliation(s)
- Lara Natta
- Istituto Italiano di Tecnologia, Center for Biomolecular Nanotechnologies, Arnesano 73010, Italy
| | - Francesco Guido
- Istituto Italiano di Tecnologia, Center for Biomolecular Nanotechnologies, Arnesano 73010, Italy
- Piezoskin S.r.l., Lecce 73100, Italy
| | - Luciana Algieri
- Istituto Italiano di Tecnologia, Center for Biomolecular Nanotechnologies, Arnesano 73010, Italy
- Piezoskin S.r.l., Lecce 73100, Italy
| | - Vincenzo M. Mastronardi
- Istituto Italiano di Tecnologia, Center for Biomolecular Nanotechnologies, Arnesano 73010, Italy
| | - Francesco Rizzi
- Istituto Italiano di Tecnologia, Center for Biomolecular Nanotechnologies, Arnesano 73010, Italy
| | - Elisa Scarpa
- Istituto Italiano di Tecnologia, Center for Biomolecular Nanotechnologies, Arnesano 73010, Italy
| | - Antonio Qualtieri
- Istituto Italiano di Tecnologia, Center for Biomolecular Nanotechnologies, Arnesano 73010, Italy
| | - Maria T. Todaro
- Consiglio Nazionale delle Ricerche, c/o Campus Ecotekne, Istituto di Nanotecnologia Via Monteroni, Lecce 73100, Italy
| | - Vincenzo Sallustio
- Hospital Unit Phoniatrics and Communication Disorders, Rehabilitation Department, ASL Lecce, Lecce 73100, Italy
| | - Massimo De Vittorio
- Istituto Italiano di Tecnologia, Center for Biomolecular Nanotechnologies, Arnesano 73010, Italy
- Università del Salento, Lecce 73100, Italy
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15
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Endo H, Ohmori N, Chikai M, Miwa H, Ino S. Effects of age and gender on swallowing activity assessed by electromyography and laryngeal elevation. J Oral Rehabil 2020; 47:1358-1367. [PMID: 32895952 DOI: 10.1111/joor.13089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Quantitative assessment of swallowing function is necessary to prevent swallowing impairment due to ageing. Though surface electromyography (EMG) has been widely used to measure swallowing activity, the relationship between EMG results and swallowing function is unclear. OBJECTIVE This study examined the relationship between the temporal characteristics of muscle activity and laryngeal elevation (LE) during swallowing. METHODS This study analysed 60 healthy volunteers in two age groups (young, between 20 and 38 years; old, between 65 and 75 years), each containing the same number of male and female participants. Surface EMG signals were recorded from the suprahyoid and infrahyoid muscle groups (SH-EMG and IH-EMG, respectively). LE was measured using an array of pressure sensors. The participants swallowed 3 mL of water under three swallowing speed conditions: fast, normal and slow swallowing. The EMG duration, EMG time intervals before and after the onset of LE (pre-LE and post-LE intervals, respectively), and the LE velocity were analysed. RESULTS Both EMG duration and the post-LE interval of IH-EMG were significantly longer in the older group. As for the gender effect, the pre-LE interval of SH-EMG was significantly longer and the LE velocity was significantly higher in men than in women. Furthermore, there was a negative correlation between pre-LE interval and LE velocity in the fast swallowing condition. CONCLUSION Though ageing slightly prolonged the muscle activity time, gender influenced swallowing activity in a more complex manner. Therefore, it is important to take gender into account when examining swallowing function with increasing age.
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Affiliation(s)
- Hiroshi Endo
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Nobuyuki Ohmori
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan.,Material Technology Department, Nagano Prefecture General Industrial Technology Nagano, Japan
| | - Manabu Chikai
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Hiroyasu Miwa
- Human Augmentation Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Kashiwa, Japan
| | - Shuichi Ino
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
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16
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Lagarde MLJ, van Alfen N, de Groot SAF, Geurts ACH, van den Engel-Hoek L. Adaptive capacity of 2- to 5-month-old infants to the flow, shape, and flexibility of different teats during bottle feeding: a cross-sectional study. BMC Pediatr 2019; 19:477. [PMID: 31805974 PMCID: PMC6894202 DOI: 10.1186/s12887-019-1859-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 11/28/2019] [Indexed: 02/02/2023] Open
Abstract
Background Nutritive sucking is a complex activity, the biomechanical components of which may vary in relation to respiratory phase, swallow-rate per minute, suck-swallow ratio, and swallow non-inspiratory flow (SNIF). Quantitative measurement of these components during nutritive sucking in healthy infants could help us to understand the complex development of sucking, swallowing, and breathing. This is important because the coordination between these components is often disturbed in infants with feeding difficulties. The aims of this study were to describe the biomechanical components of sucking and swallowing in healthy 2- to 5-month-old infants during bottle feeding, to assess whether infants adapt to the characteristics of two different teats, and to determine which independent variables influence the occurrence of SNIF. Methods Submental muscle activity, nasal airflow, and cervical auscultation were evaluated during bottle-feeding with two different teats. Results Sixteen term-born infants (6 boys) aged 2–5 months were included. All infants showed variable inhalation and exhalation after swallowing. The swallow rate per minute was significantly higher when infants fed with a higher flow teat (Philips Avent Natural 2.0™). Infants had suck:swallow ratios ranging from 1:1 to 4:1. A suck:swallow ratio of 1:1 occurred significantly more often when infants fed with a higher flow teat, whereas a suck:swallow ratio of 2:1 occurred significantly more often when infants fed with a low-flow teat (Philips Avent Classic+™). A suck:swallow ratio of 1:1 was negatively correlated with SNIF, whereas a suck:swallow ratio of 2:1 was positively correlated with SNIF. Conclusion Healthy infants aged 2–5 months can adapt to the flow, shape, and flexibility of different teats, showing a wide range of biomechanical and motor adaptations.
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Affiliation(s)
- M L J Lagarde
- Radboud University Medical Center, Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands.
| | - N van Alfen
- Radboud University Medical Center, Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - S A F de Groot
- Radboud University Medical Center, Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands
| | - A C H Geurts
- Radboud University Medical Center, Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands
| | - L van den Engel-Hoek
- Radboud University Medical Center, Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands
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17
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Hori R, Ishida R, Isaka M, Nakamura T, Oku Y. Effects of noninvasive ventilation on the coordination between breathing and swallowing in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2019; 14:1485-1494. [PMID: 31371935 PMCID: PMC6627177 DOI: 10.2147/copd.s205543] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/14/2019] [Indexed: 01/13/2023] Open
Abstract
Purpose As shown in our previous study, inspiration after swallowing (SW-I) increases during the bi-level positive airway pressure ventilation (BiPAP) in healthy subjects because swallowing-associated non-inspiratory flow (SNIF) triggers inspiratory support, while SW-I during continuous positive pressure ventilation (CPAP) is rare. In the present study, we evaluated the coordination between breathing and swallowing during spontaneous breathing, BiPAP, and CPAP in patients with chronic obstructive pulmonary disease (COPD). Patients and methods This study is a prospective intervention study at the Hoshigaoka Medical Center (November 01, 2015–April 30, 2018). We simultaneously recorded the respiratory flow, laryngeal motion, and swallowing sounds during saliva swallowing in patients with COPD. We estimated the respiratory phase after swallowing, frequency of SNIF, the duration of the respiratory pause during swallowing, and timing of swallowing in the respiratory cycle and compared these parameters among control, CPAP, and BiPAP conditions. Results The expiration after swallowing (SW-E) frequency was associated with the occurrence of SNIF (p<0.01), pause duration ≤0.8 s (p<0.01), and timing of swallowing at the intermediate respiratory phase (50–80% of the respiratory cycle from the onset of inspiration) (p<0.01). In particular, the occurrence of SNIF most substantially affected the SW-E frequency. The SW-I frequencies under the control, CPAP, and BiPAP conditions were 35.0%, 3.0%, and 37.7%, respectively. The pause durations were shorter during CPAP and BiPAP than under the control condition (p<0.01). During CPAP, the occurrence rates of SW-E. Residual denotes the percentage difference between observed and expected values (residual =10.8: p<0.01) and SNIF (residual =9.1: p<0.01) were significantly increased, and timing of swallowing shifted toward the intermediate respiratory phase (residual=3.5: p<0.01). Conclusion CPAP decreases the SW-I frequency, increases the SNIF occurrence, and normalizes the timing of swallowing, all of which suggest that CPAP alleviates the risk of aspiration in patients with COPD.
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Affiliation(s)
- Ryuji Hori
- Department of Physical Therapy, Morinomiya University of Medical Science, Suminoe-ku, Osaka 559-8611, Japan.,Department of Rehabilitation, Hoshigaoka Medical Center, Hirakata, Osaka 573-8511, Japan
| | - Rika Ishida
- Department of Physical Therapy, Morinomiya University of Medical Science, Suminoe-ku, Osaka 559-8611, Japan
| | - Masaaki Isaka
- Department of Physical Therapy, Osaka Yukioka College of Health Science, Ibaraki, Osaka 567-0801, Japan
| | - Takahito Nakamura
- Center of Respiratory Disease, Hoshigaoka Medical Center, Hirakata, Osaka 573-8511, Japan
| | - Yoshitaka Oku
- Department of Physiology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
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18
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Hopkins-Rossabi T, Curtis P, Temenak M, Miller C, Martin-Harris B. Respiratory Phase and Lung Volume Patterns During Swallowing in Healthy Adults: A Systematic Review and Meta-Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:868-882. [PMID: 30964715 PMCID: PMC6802879 DOI: 10.1044/2018_jslhr-s-18-0323] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/24/2018] [Accepted: 11/20/2018] [Indexed: 05/22/2023]
Abstract
Purpose The coordination of respiration with swallowing is critical for facilitation of airway protection and the efficiency of movements that propel ingested material through the upper aerodigestive tract. Confirmation of a predominant pattern in healthy adults provides a platform for comparison to aberrant patterns observed in the population with swallowing impairment (dysphagia). Method A comprehensive search of published research in MEDLINE via PubMed 1946-2018, Embase 1947-2018, and Proquest Dissertations & Theses Global 1861-2018 was completed. Results Thirty-seven articles meeting inclusion criteria were selected for data extraction, and the findings were reviewed. In addition, a meta-analysis of the data was completed. A significantly higher occurrence ( p < .001) of expiration prior to and following the swallow was found when compared to 3 other patterns. The predominance of the pattern was influenced by increases in bolus volume when controlling for participant sample size. Conclusion Determination of this predominant pattern provides a normative framework for evaluating respiratory-swallow coordination in adults across the age span and highlights the relevance for assessing and incorporating respiratory swallowing coordination during assessment and interventions.
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Affiliation(s)
| | - Philip Curtis
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Mark Temenak
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Corinne Miller
- Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Bonnie Martin-Harris
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
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19
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Non-invasive quantification of human swallowing using a simple motion tracking system. Sci Rep 2018; 8:5095. [PMID: 29572522 PMCID: PMC5865167 DOI: 10.1038/s41598-018-23486-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/06/2018] [Indexed: 11/21/2022] Open
Abstract
The number of patients with dysphagia is rapidly increasing due to the ageing of the population. Therefore, the importance of objectively assessing swallowing function has received increasing attention. Videofluoroscopy and videoendoscopy are the standard clinical examinations for dysphagia, but these techniques are not suitable for daily use because of their invasiveness. Here, we aimed to develop a novel, non-invasive method for measuring swallowing function using a motion tracking system, the Kinect v2 sensor. Five males and five females with normal swallowing function participated in this study. We defined three mouth-related parameters and two larynx-related parameters and recorded data from 2.5 seconds before to 2.5 seconds after swallowing onset. Changes in mouth-related parameters were observed before swallowing and reached peak values at the time of swallowing. In contrast, larynx-related parameters showed little change before swallowing and reached peak values immediately after swallowing. This simple swallow tracking system (SSTS) successfully quantified the swallowing process from the oral phase to the laryngeal phase. This SSTS is non-invasive, wireless, easy to set up, and simultaneously measures the dynamics of swallowing from the mouth to the larynx. We propose the SSTS for use as a novel and non-invasive swallowing assessment tool in the clinic.
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20
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Yagi N, Oku Y, Nagami S, Yamagata Y, Kayashita J, Ishikawa A, Domen K, Takahashi R. Inappropriate Timing of Swallow in the Respiratory Cycle Causes Breathing-Swallowing Discoordination. Front Physiol 2017; 8:676. [PMID: 28970804 PMCID: PMC5609438 DOI: 10.3389/fphys.2017.00676] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/24/2017] [Indexed: 01/13/2023] Open
Abstract
Rationale: Swallowing during inspiration and swallowing immediately followed by inspiration increase the chances of aspiration and may cause disease exacerbation. However, the mechanisms by which such breathing–swallowing discoordination occurs are not well-understood. Objectives: We hypothesized that breathing–swallowing discoordination occurs when the timing of the swallow in the respiratory cycle is inappropriate. To test this hypothesis, we monitored respiration and swallowing activity in healthy subjects and in patients with dysphagia using a non-invasive swallowing monitoring system. Measurements and Main Results: The parameters measured included the timing of swallow in the respiratory cycle, swallowing latency (interval between the onset of respiratory pause and the onset of swallow), pause duration (duration of respiratory pause for swallowing), and the breathing–swallowing coordination pattern. We classified swallows that closely follow inspiration (I) as I-SW, whereas those that precede I as SW-I pattern. Patients with dysphagia had prolonged swallowing latency and pause duration, and tended to have I-SW or SW-I patterns reflecting breathing–swallows discoordination. Conclusions: We conclude that swallows at inappropriate timing in the respiratory cycle cause breathing–swallowing discoordination, and the prolongation of swallowing latency leads to delayed timing of the swallow, and results in an increase in the SW-I pattern in patients with dysphagia.
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Affiliation(s)
- Naomi Yagi
- Department of Swallowing Physiology, Hyogo College of MedicineNishinomiya, Japan.,Department of Neurology, Graduate School of Medicine, Kyoto UniversityKyoto, Japan.,Clinical Research Center for Medical Equipment Development, Kyoto University HospitalKyoto, Japan
| | - Yoshitaka Oku
- Department of Swallowing Physiology, Hyogo College of MedicineNishinomiya, Japan.,Department of Physiology, Hyogo College of MedicineNishinomiya, Japan
| | - Shinsuke Nagami
- Department of Neurology, Graduate School of Medicine, Kyoto UniversityKyoto, Japan.,Clinical Research Center for Medical Equipment Development, Kyoto University HospitalKyoto, Japan.,Department of Physiology, Hyogo College of MedicineNishinomiya, Japan
| | - Yoshie Yamagata
- Department of Health Sciences, Prefectural University of HiroshimaHiroshima, Japan
| | - Jun Kayashita
- Department of Health Sciences, Prefectural University of HiroshimaHiroshima, Japan
| | - Akira Ishikawa
- Graduate School of Health Sciences, Kobe UniversityKobe, Japan
| | - Kazuhisa Domen
- Department of Physical Medicine & Rehabilitation, Hyogo College of MedicineNishinomiya, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Graduate School of Medicine, Kyoto UniversityKyoto, Japan
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Nagami S, Oku Y, Yagi N, Sato S, Uozumi R, Morita S, Yamagata Y, Kayashita J, Tanimura K, Sato A, Takahashi R, Muro S. Breathing-swallowing discoordination is associated with frequent exacerbations of COPD. BMJ Open Respir Res 2017; 4:e000202. [PMID: 28883930 PMCID: PMC5531308 DOI: 10.1136/bmjresp-2017-000202] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 05/01/2017] [Accepted: 05/02/2017] [Indexed: 12/05/2022] Open
Abstract
Introduction Impaired coordination between breathing and swallowing (breathing–swallowing discoordination) may be a significant risk factor for the exacerbation of chronic obstructive pulmonary disease (COPD). We examined breathing–swallowing discoordination in patients with COPD using a non-invasive and quantitative technique and determined its association with COPD exacerbation. Methods We recruited 65 stable outpatients with COPD who were enrolled in our prospective observational cohort study and did not manifest an apparent swallowing disorder. COPD exacerbation was monitored for 1 year before and 1 year after recruitment. Swallowing during inspiration (the I-SW pattern) and swallowing immediately followed by inspiration (the SW-I pattern) were identified. Results The mean frequency of the I-SW and/or SW-I patterns (I-SW/SW-I rate) was 21.5%±25.5%. During the 2-year observation period, 48 exacerbation incidents (25 patients) were identified. The I-SW/SW-I rate was significantly associated with the frequency of exacerbation. During the year following recruitment, patients with a higher I-SW/SW-I frequency using thicker test foods exhibited a significantly higher probability of future exacerbations (p=0.002, log-rank test). Conclusions Breathing–swallowing discoordination is strongly associated with frequent exacerbations of COPD. Strategies that identify and improve breathing–swallowing coordination may be a new therapeutic treatment for patients with COPD.
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Affiliation(s)
- Shinsuke Nagami
- Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Physiology, Hyogo College of Medicine, Nishinomiya, Japan.,Clinical Research Center for Medical Equipment Development (CRCMeD), Kyoto University Hospital, Kyoto, Japan
| | - Yoshitaka Oku
- Department of Physiology, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Swallowing Physiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Naomi Yagi
- Clinical Research Center for Medical Equipment Development (CRCMeD), Kyoto University Hospital, Kyoto, Japan.,Department of Swallowing Physiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Susumu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryuji Uozumi
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshie Yamagata
- Department of Health Sciences, Prefectural University Hiroshima, Hiroshima, Japan
| | - Jun Kayashita
- Department of Health Sciences, Prefectural University Hiroshima, Hiroshima, Japan
| | - Kazuya Tanimura
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Respiratory Medicine, Chest Disease Clinical and Research Institute, Kishiwada City Hospital, Kishiwada, Japan
| | - Atsuyasu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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