A planar finite element model of bolus containment in the oral cavity

Polysaccharide-dextrin thickened fluids for individuals with dysphagia: recent advances in flow behaviors and swallowing assessment methods

The global aging population has brought about a pressing health concern: dysphagia. To effectively address this issue, we must develop specialized diets, such as thickened fluids made with polysaccharide-dextrin (e.g., water, milk, juices, and soups), which are crucial for managing swallowing-related problems like aspiration and choking for people with dysphagia. Understanding the flow behaviors of these thickened fluids is paramount, and it enables us to establish methods for evaluating their suitability for individuals with dysphagia. This review focuses on the shear and extensional flow properties (e.g., viscosity, yield stress, and viscoelasticity) and tribology (e.g., coefficient of friction) of polysaccharide-dextrin-based thickened fluids and highlights how dextrin inclusion influences fluid flow behaviors considering molecular interactions and chain dynamics. The flow behaviors can be integrated into the development of diverse evaluation methods that assess aspects such as flow velocity, risk of aspiration, and remaining fluid volume. In this context, the key in-vivo (e.g., clinical examination and animal model), in-vitro (e.g., the Cambridge Throat), and in-silico (e.g., Hamiltonian moving particles semi-implicit) evaluation methods are summarized. In addition, we explore the potential for establishing realistic assessment methods to evaluate the swallowing performance of thickened fluids, offering promising prospects for the future.

Two dimensional computational model coupling myoarchitecture-based lingual tissue mechanics with liquid bolus flow during oropharyngeal swallowing

Biomechanical relationships involving lingual myoanatomy, contractility, and bolus movement are fundamental properties of human swallowing. To portray the relationship between lingual deformation and bolus flow during swallowing, a weakly one-way solid-fluid finite element model (FEM) was derived employing an elemental mesh aligned to magnetic resonance diffusional tractography (Q-space MRI, QSI) of the human tongue, an arbitrary Lagrangian-Eulerian (ALE) formulation with remeshing to account for the effects of lingual surface (boundary) deformation, an implementation of patterned fiber shortening, and a computational visualization of liquid bolus flow. Representing lingual tissue deformation in terms of its 2D principal Lagrangian strain in the mid-sagittal plane, we demonstrated that the swallow sequence was characterized by initial superior-anterior expansion directed towards the hard palate, followed by sequential, radially directed, contractions of the genioglossus and verticalis to promote lingual rotation (lateral perspective) and propulsive displacement. We specifically assessed local bolus velocity as a function of viscosity (perfect slip conditions) and observed that a low viscosity bolus (5 cP) exhibited maximal displacement, surface spreading and local velocity compared to medium (110 cP, 300 cP) and high (525 cP) viscosity boluses. Analysis of local nodal velocity revealed that all bolus viscosities exhibited a bi-phasic progression, with the low viscosity bolus being the most heterogeneous and fragmented and the high viscosity bolus being the most homogenous and cohesive. Intraoral bolus cohesion was depicted in terms of the distributed velocity gradient, with higher gradients being associated with increased shear rate and bolus fragmentation. Lastly, we made a sensitivity analysis on tongue stiffness and contractility by varying the degree of extracellular matrix (ECM) stiffness through effects on the Mooney-Rivlin derived passive matrix and by varying maximum tetanized isometric stress, and observed that a graded increase of ECM stiffness was associated with reduced bolus spreading, posterior displacement, and surface velocity gradients, whereas a reduction of global contractility resulted in a graded reduction of obtainable accommodation volume, absent bolus spreading, and loss of posterior displacement. We portray a unidirectionally coupled solid-liquid FEM which associates myoarchitecture-based lingual deformation with intra-oral bolus flow, and deduce that local elevation of the velocity gradient correlates with bolus fragmentation, a precondition believed to be associated with aspiration vulnerability during oropharyngeal swallowing.

sEMG-assisted inverse modelling of 3D lip movement: a feasibility study towards person-specific modelling

We propose a surface-electromyographic (sEMG) assisted inverse-modelling (IM) approach for a biomechanical model of the face to obtain realistic person-specific muscle activations (MA) by tracking movements as well as innervation trajectories. We obtained sEMG data of facial muscles and 3D positions of lip markers in six volunteers and, using a generic finite element (FE) face model in ArtiSynth, performed inverse static optimisation with and without sEMG tracking on both simulation data and experimental data. IM with simulated data and experimental data without sEMG data showed good correlations of tracked positions (0.93 and 0.67) and poor correlations of MA (0.27 and 0.20). When utilising the sEMG-assisted IM approach, MA correlations increased drastically (0.83 and 0.59) without sacrificing performance in position correlations (0.92 and 0.70). RMS errors show similar trends with an error of 0.15 in MA and of 1.10 mm in position. Therefore, we conclude that we were able to demonstrate the feasibility of an sEMG-assisted inverse modelling algorithm for the perioral region. This approach may help to solve the ambiguity problem in inverse modelling and may be useful, for instance, in future applications for preoperatively predicting treatment-related function loss.

"A Day in the Life of the Fluid Bolus": An Introduction to Fluid Mechanics of the Oropharyngeal Phase of Swallowing with Particular Focus on Dysphagia

By following the path of a liquid bolus, from the oral preparatory phase to the esophagus, we show that a few fundamental concepts of fluid mechanics can be used to better understand and assess the importance of bolus viscosity during human swallowing, especially when considering dysfunctional swallowing (dysphagia) and how it can be mitigated. In particular, we highlight the important distinction between different flow regimes (i.e. viscosity controlled versus. inertia controlled flow). We also illustrate the difference between understanding bolus movements controlled by a constant force (or pressure) and those controlled by a constant displacement (or velocity). We limit our discussion to simple, Newtonian liquids where the viscosity does not depend on the speed of flow. Consideration of non-Newtonian effects (such as shear thinning or viscoelasticity), which we believe play an important part in human swallowing, requires a sound grasp of the fundamentals discussed here and warrants further consideration in its own right.