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Dumican M, Harper K, Stankiewicz J. The Effect of Oropharyngeal Resting Tremor on Swallowing Function in a Clinical Cohort of People with Parkinson's Disease. Dysphagia 2024:10.1007/s00455-024-10688-0. [PMID: 38512437 DOI: 10.1007/s00455-024-10688-0] [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: 09/07/2023] [Accepted: 02/20/2024] [Indexed: 03/23/2024]
Abstract
Parkinson's Disease (PD) is a progressive neurodegenerative disease, with hallmark symptomology typically consisting of tremor, bradykinesia, and rigidity. Though the classic "pill-rolling" rest tremor in the hand or upper limb are often the most salient, it can occur throughout the body including the lower limbs, jaw, face, or tongue. There have been investigations into other motor related phenomena potentially affecting swallow function in PwPD previously. However, there have been no investigations of how oropharyngeal resting tremor in structures such as the tongue or larynx explicitly affects swallowing physiology. A retrospective analysis of previously conducted VFSS on 34 patients diagnosed with idiopathic PD (IPD) was performed to examine how individuals that displayed resting tremor during VFSS (Tremor +) and those who did not (Tremor-) differ in swallowing function. Measures of swallowing function including timing intervals of key swallow events, post-swallow residue, and penetration-aspiration scale (PAS) scores were recorded, and key demographic information including time since diagnosis and medication status were extracted from the medical records available. Multivariate models were used to identify differences between tremor groups for timing intervals and post-swallow residue, and chi-squares were computed for differences in PAS score distribution by group and bolus. Sixty-eight percent (23/34) of this sample displayed oropharyngeal resting tremor in at least one structure during VFSS. There were no instances of other tremor types observed in this sample. All participants were taking medication to manage PD symptomology. Significant effects of tremor group were observed for swallow timing intervals related to airway closure (p < 0.001), post-swallow residue (p < 0.05), and swallow safety at the bolus level in the Tremor + group (p < 0.001). These results suggest that PwPD who present with resting tremor in oropharyngeal structures may manifest with different variations in swallowing physiology, including altered timings of swallow events, increased pharyngeal residue, and greater associations of airway invasion with thinner and larger volume boluses. This study highlights the need for substantially more research into how motor fluctuations and phenotypes of PwPD contribute to alterations in swallowing function.
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Affiliation(s)
- Matthew Dumican
- Department of Speech, Language, and Hearing Sciences, College of Health and Human Services, Western Michigan University, 1200 Oakland Dr., Kalamazoo, MI, 49008, USA.
| | - Kaitlynn Harper
- Department of Speech, Language, and Hearing Sciences, College of Health and Human Services, Western Michigan University, 1200 Oakland Dr., Kalamazoo, MI, 49008, USA
| | - Julia Stankiewicz
- Department of Speech, Language, and Hearing Sciences, College of Health and Human Services, Western Michigan University, 1200 Oakland Dr., Kalamazoo, MI, 49008, USA
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da Costa Miranda Barbosa R, de Freitas AS, Cerqueira RBA, Mancopes R, Dias FL, Steele CM. Dysphagia in Open Partial Horizontal Laryngectomy Type IIa: Quantitative Analysis of Videofluoroscopy using the ASPEKT Method. Dysphagia 2024:10.1007/s00455-024-10677-3. [PMID: 38431893 DOI: 10.1007/s00455-024-10677-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024]
Abstract
Open Partial Horizontal Laryngectomy (OPHL) Type IIa surgery is a conservative surgical technique used in the treatment of laryngeal carcinomas. In this pilot study, we aimed to characterize swallowing function and physiology in a series of patients after OPHL Type IIa surgery through comparison to healthy reference values for quantitative measures for videofluoroscopy. We performed retrospective quantitative analysis of videofluoroscopy recordings of thin liquid swallows for a preliminary sample of 10 male patients. Each videofluoroscopy clip was rated in triplicate by trained blinded raters according to the ASPEKT Method (Analysis of Swallowing Physiology: Events, Kinematics and Timing). This preliminary sample of patients with previous OPHL surgery showed functional airway protection, with only 2 patients showing incomplete laryngeal vestibule closure (LVC) and associated airway invasion. However, the majority of patients (90%) showed prolonged latencies to LVC and upper esophageal sphincter (UES) opening. Prolonged durations of LVC and UES opening were also noted, but these were in the direction of compensation rather than impairment. Reduced pharyngeal area at rest was seen in 70% of the sample, and all patients showed poor pharyngeal constriction. Post-swallow residue was a prominent finding in ≥ 75% of these patients. In particular, reduced or absent constriction of the hypopharynx in the region of the pyriform sinuses was noted as a characteristic of swallowing in this sample. The data from these patients suggest that despite functional airway protection, severe swallowing dysfunction involving poor pharyngeal constriction and bolus clearance may be likely after OPHL surgery.
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Affiliation(s)
| | | | | | | | | | - Catriona M Steele
- KITE Research Institute-UHN, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Canada Research Chair (Tier 1) in Swallowing and Food Oral Processing, Canada Research Chairs Secretariat, Ottawa, Canada
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Borders JC, Steele CM. The effect of liquid consistency on penetration-aspiration: a Bayesian analysis of two large datasets. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1337971. [PMID: 38463609 PMCID: PMC10920265 DOI: 10.3389/fresc.2024.1337971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024]
Abstract
Introduction Thickened liquids are commonly recommended to reduce the risk of penetration-aspiration. However, questions persist regarding the impact of bolus consistency on swallowing safety. The common practice of summarizing Penetration-Aspiration Scale (PAS) scores based on worst scores is a bias in prior analyses. The aim of this study was to examine the impact of liquid consistency on PAS scores using a Bayesian multilevel ordinal regression model approach, considering all scores across repeated bolus trials. A second aim was to determine whether PAS scores differed across thickener type within consistency. Methods We analyzed two prior datasets (D1; D2). D1 involved 678 adults with suspected dysphagia (289 female; mean age 69 years, range 20-100). D2 involved 177 adults (94 female; mean age 54 years, range 21-85), of whom 106 were nominally healthy and 71 had suspected dysphagia. All participants underwent videofluoroscopy involving ≥3 boluses of 20% w/v thin liquid barium and of xanthan-gum thickened barium in mildly, moderately and extremely thick consistencies. D2 participants also swallowed trials of slightly thick liquid barium, and starch-thickened stimuli for each thickened consistency. Duplicate blinded rating yielded PAS scores per bolus, with discrepancies resolved by consensus. PAS ratings for a total of 8,185 and 3,407 boluses were available from D1 and D2, respectively. Bayesian models examined PAS patterns across consistencies. We defined meaningful differences as non-overlapping 95% credible intervals (CIs). Results Across D1 and D2, penetration occurred on 10.87% of trials compared to sensate (0.68%) and silent aspiration (1.54%), with higher rates of penetration (13.47%) and aspiration (3.07%) on thin liquids. For D1, the probability of a PAS score > 2 was higher for thin liquids with weighted PAS scores of 1.57 (CI: 1.48, 1.66) versus mildly (1.26; CI: 1.2, 1.33), moderately (1.1; CI: 1.07, 1.13), and extremely thick liquids (1.04; CI: 1.02, 1.08). D2 results were similar. Weighted PAS scores did not meaningfully differ between thin and slightly thick liquids, or between starch and xanthan gum thickened liquids. Discussion These results confirm that the probability of penetration-aspiration is greatest on thin liquids compared to thick liquids, with significant reductions in PAS severity emerging with mildly thick liquids.
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Affiliation(s)
- James C. Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
| | - Catriona M. Steele
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute—University Health Network, Toronto, ON, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Canada Research Chair (Tier 1) in Swallowing and Food Oral Processing, Canada Research Chairs Secretariat, Ottawa, ON, Canada
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Garand KL(F, Armeson K, Hill EG, Blair J, Pearson W, Martin-Harris B. Quantifying Oropharyngeal Swallowing Impairment in Response to Bolus Viscosity. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:460-467. [PMID: 37902448 PMCID: PMC11001168 DOI: 10.1044/2023_ajslp-23-00082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/28/2023] [Accepted: 09/10/2023] [Indexed: 10/31/2023]
Abstract
PURPOSE The purpose of this study was to test the feasibility for quantifying changes in oropharyngeal swallowing impairment in response to alteration in bolus viscosity using a reliable and valid method of observational measurement-the Modified Barium Swallow Impairment Profile (MBSImP). METHOD This retrospective analysis included a heterogeneous cohort of 119 patients with suspected dysphagia that underwent a videofluoroscopic swallowing study as part of clinical care. Using consensus scoring, two expert clinicians assigned MBSImP scores to components related to oropharyngeal swallowing function between two bolus viscosities (thin liquid and pudding): epiglottic movement, laryngeal elevation, anterior hyoid excursion, tongue base retraction, pharyngeal stripping wave, and pharyngoesophageal segment opening (PESO). Comparisons between the two bolus viscosities were investigated for each component. RESULTS Higher (worse) scores were observed in the thin-liquid trial compared with the pudding trial for the following MBSImP components: anterior hyoid excursion (p = .03), epiglottic movement (p < .001), pharyngeal stripping wave (p < .001), and PESO (p = .002). Lower (better) scores were observed in the liquid trial compared with the pudding trial for one component-tongue base retraction (Component 15) only (p < .001). CONCLUSION These findings provide further evidence for positive influences of viscosity on the swallow mechanism, including influences of sensory feedback on the sensorimotor swallow program.
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Affiliation(s)
| | - Kent Armeson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Elizabeth G. Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Julie Blair
- Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston
| | - William Pearson
- Department of Biomedical Sciences (Anatomy), Edward Via College of Osteopathic Medicine, Auburn, AL
| | - Bonnie Martin-Harris
- Department of Communication Sciences Disorders, Northwestern University, Evanston, IL
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Steele CM, Bayley MT, Bohn MK, Higgins V, Peladeau-Pigeon M, Kulasingam V. Reference Values for Videofluoroscopic Measures of Swallowing: An Update. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:3804-3824. [PMID: 37669617 PMCID: PMC10713020 DOI: 10.1044/2023_jslhr-23-00246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/03/2023] [Accepted: 06/27/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE It is essential that clinicians have evidence-based benchmarks to support accurate diagnosis and clinical decision making. Recent studies report poor reliability for diagnostic judgments and identifying mechanisms of impairment from videofluoroscopy (VFSS). Establishing VFSS reference values for healthy swallowing would help resolve such discrepancies. Steele et al. (2019) released preliminary reference data for quantitative VFSS measures in healthy adults aged < 60 years. Here, we extend that work to provide reference percentiles for VFSS measures across a larger age span. METHOD Data for 16 VFSS parameters were collected from 78 healthy adults aged 21-82 years (39 male). Participants swallowed three comfortable sips each of thin, slightly, mildly, moderately, and extremely thick barium (20% w/v). VFSS recordings were analyzed in duplicate by trained raters, blind to participant and task, using the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) Method. Reference percentiles (p2.5, 5, 25, 50, 75, 95, and 97.5) were determined as per Clinical and Laboratory Standards Institute EP28-A3c guidelines. RESULTS We present VFSS reference percentile tables, by consistency, for (a) timing parameters (swallow reaction time; the hyoid burst-to-upper esophageal sphincter (UES)-opening interval; UES opening duration; time-to-laryngeal vestibule closure (LVC); and LVC duration) and (b) anatomically scaled pixel-based measures of maximum UES diameter, pharyngeal area at maximum pharyngeal constriction and rest, residue (vallecular, pyriform, other pharyngeal locations, total), and hyoid kinematics (X, Y, XY coordinates of peak position; speed). Clinical decision limits are proposed to demarcate atypical values of potential clinical concern. CONCLUSION These updated reference percentiles and proposed clinical decision limits are intended to support interpretation and reliability for VFSS assessment data. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24043041.
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Affiliation(s)
- Catriona M. Steele
- KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Canada Research Chair in Swallowing and Food Oral Processing, Canada Research Chairs Secretariat, Ottawa, Ontario
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Mark T. Bayley
- KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Mary Kathryn Bohn
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
| | - Victoria Higgins
- DynaLIFE Medical Labs, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | | | - Vathany Kulasingam
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
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Wong MKL, Ku PKM, Tong MCF, Lee KYS, Fong R. Endoscopic and observational findings of swallowing of traditional and molded puree in healthy individuals. Dysphagia 2023; 38:1363-1370. [PMID: 36869928 DOI: 10.1007/s00455-023-10565-2] [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: 09/23/2022] [Accepted: 02/14/2023] [Indexed: 03/05/2023]
Abstract
Puree is commonly prescribed for patients with mastication and bolus formation difficulties, but its appearance might negatively impact appetite and intake. Molded puree is marketed to be an alternative to traditional puree, but the process of molding puree could alter the properties of the food significantly and lead to different swallowing physiology as compared to puree. The current study investigated the differences between traditional and molded puree in terms of swallowing physiology and perception in healthy individuals. Thirty two participants were included. Two outcomes were used to quantify the oral preparatory and oral phase. Fibreoptic endoscopic evaluation of swallowing was used to assess the pharyngeal phase as it could retain the purees in their original form. Six outcomes were collected. Perceptual rating of the purees were provided by participants in six domains. Molded puree required significantly more masticatory cycles (p < 0.001) and longer time for ingestion (p < 0.001). Molded puree had longer swallow reaction time (p = 0.001) and more inferior site of swallow initiation (p = 0.007) compared with traditional puree. Participants' satisfaction with the appearance, texture and overall of molded puree was significantly greater. Molded puree was perceived to be more difficult to chew and swallow. This study established that the two types of puree were different in various aspects. The study also provided important clinical implications regarding the use of molded puree as a form of texture modified diet (TMD) in patients with dysphagia. The results could serve as the foundation of larger cohort studies on the effect of various TMDs on patients with dysphagia.
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Affiliation(s)
- Meko Ka Lam Wong
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter Ka Ming Ku
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ear, Nose & Throat, United Christian Hospital, Hong Kong, China
| | - Michael Chi Fai Tong
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong, China
| | - Kathy Yuet Sheung Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong, China
| | - Raymond Fong
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
- Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong, China.
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Gandhi P, Peladeau-Pigeon M, Simmons M, Steele CM. Exploring the Efficacy of the Effortful Swallow Maneuver for Improving Swallowing in People With Parkinson Disease-A Pilot Study. Arch Rehabil Res Clin Transl 2023; 5:100276. [PMID: 37744193 PMCID: PMC10517353 DOI: 10.1016/j.arrct.2023.100276] [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] [Indexed: 09/26/2023] Open
Abstract
Objectives To determine the immediate (compensatory) and longer term (rehabilitative) effect of the effortful swallow (ES) maneuver on physiological swallowing parameters in Parkinson disease. Design Virtual intervention protocol via Microsoft Teams with pre- and post-videofluoroscopic swallowing studies. Setting Outpatient hospital setting, with intervention performed virtually. Participants Eight participants (median age 74 years [63-82])with Parkinson disease (years post onset 3-20) with a Hoehn and Yahr scale score between 2 and 4 (N=8). Interventions ES maneuver, initiated using a maximum effort isometric tongue-to-palate press, with biofeedback provided using the Iowa Oral Performance Instrument. The protocol included 30 minute sessions twice daily, 5 days/week for 4 weeks. Main Outcome Measures Penetration-Aspiration Scale scores, time-to-laryngeal-vestibule-closure, total pharyngeal residue, and pharyngeal area at maximum constriction as seen on lateral view videofluoroscopy. Results No consistent, systematic trends were identified in the direction of improvement or deterioration across Penetration-Aspiration Scale scores, time-to-laryngeal-vestibule-closure, pharyngeal area at maximum constriction, or total pharyngeal residue. Conclusions Heterogeneous response to the ES as both a compensatory and rehabilitative technique. Positive response on the compensatory probe was predictive of positive response after rehabilitation.
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Affiliation(s)
- Pooja Gandhi
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute—University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Melanie Peladeau-Pigeon
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute—University Health Network, Toronto, Canada
| | - Michelle Simmons
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute—University Health Network, Toronto, Canada
| | - Catriona M. Steele
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute—University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
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Robison RD, DiBiase L, Anderson A, Wymer JP, Plowman EK. Maximum lingual pressure impacts both swallowing safety and efficiency in individuals with amyotrophic lateral sclerosis. Neurogastroenterol Motil 2023; 35:e14521. [PMID: 36573040 PMCID: PMC10033350 DOI: 10.1111/nmo.14521] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 12/05/2022] [Accepted: 12/10/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although reduced lingual strength is a confirmed early manifestation of amyotrophic lateral sclerosis (ALS), its functional impact on swallowing remains unclear. We therefore sought to examine relationships between maximum anterior isometric lingual pressure (MAIP) with swallowing safety, swallowing efficiency, and swallowing timing metrics in a large cohort of individuals with ALS. METHODS Ninety-seven participants with ALS completed a standardized videofluoroscopic swallowing examination (VF) and lingual pressure testing (Iowa Oral Performance Instrument). Duplicate and blinded ratings of the Penetration-Aspiration Scale (PAS) and Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) percent efficiency (%C2-C42 ) and timing (laryngeal vestibule closure (LVC) duration: amount of time (milliseconds, msec) between LVC onset and laryngeal vestibule opening; time-to-LVC: hyoid burst to onset of LVC (msec); and swallow reaction time: interval between bolus passing ramus of mandible and onset of LVC (msec)) were performed across bolus trials. Swallowing safety (safe PAS: 1, 2, 4; unsafe PAS: 3, 5, 6, 7, and 8) and efficiency (inefficient: ≥3% worst total residue) were derived. Statistical analyses including descriptives, binary logistic regressions, and Spearman's rho correlations were performed (α = 0.05). KEY RESULTS Mean MAIP was 36.3 kPa (SD: 18.7). Mean MAIP was higher in those with safe swallowing as compared to those who penetrated (mean difference: 12 kPa) or aspirated (mean difference: 18 kPa). Individuals with efficient swallowing demonstrated higher MAIP than those with inefficient swallowing (mean difference: 11 kPa). Binary logistic regression analyses revealed increasing MAIP was significantly associated with a 1.06 (95% CI: 1.03-1.09) and 1.04 (95% CI: 1.01-1.06) greater odds of safe and efficient swallowing, respectively. No relationships were observed between MAIP and swallow reaction time across all bolus trials. Longer time-to-LVC (5 ml thin liquid: rs = -0.35, p = 0.002; cup sip thin liquid: rs = -0.26, p = 0.02; moderately thick liquid: rs = -0.28, p = 0.01) and prolonged LVC duration (cup sip thin liquid, rs = -0.34, p = 0.003) were associated with lower MAIP. CONCLUSIONS AND INFERENCES Reduced lingual strength was confirmed in this group of 97 individuals with ALS that was associated with a diminished ability to effectively transport boluses and aide in laryngeal vestibule closure to prevent entry of material into the airway.
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Affiliation(s)
- Raele Donetha Robison
- Aerodigestive Research Core, University of Florida, Gainesville, Florida, USA
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Center for Health Disparities Research, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Lauren DiBiase
- Aerodigestive Research Core, University of Florida, Gainesville, Florida, USA
| | - Amber Anderson
- Aerodigestive Research Core, University of Florida, Gainesville, Florida, USA
| | - James P. Wymer
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Emily K. Plowman
- Aerodigestive Research Core, University of Florida, Gainesville, Florida, USA
- Department of Neurology, University of Florida, Gainesville, Florida, USA
- Speech, Language and Hearing Science Department, University of Florida, Gainesville, Florida, USA
- Department of Surgery, University of Florida, Gainesville, Florida, USA
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Valenzano TJ, Smaoui S, Peladeau-Pigeon M, Barbon CEA, Craven BC, Steele CM. Using Reference Values to Identify Profiles of Swallowing Impairment in a Case Series of Individuals With Traumatic Spinal Cord Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:688-700. [PMID: 36812476 PMCID: PMC10171848 DOI: 10.1044/2022_ajslp-22-00298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/28/2022] [Accepted: 12/09/2022] [Indexed: 05/12/2023]
Abstract
PURPOSE In this article, we illustrate use of a systematic approach to rating videofluoroscopic swallowing studies (VFSS), the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) method. The method is applied to a clinical case series of individuals with a history of traumatic spinal cord injury (tSCI) requiring surgical intervention using a posterior approach. Previous studies suggest that swallowing is highly variable in this population given heterogeneity in mechanisms, location and extent of injury, and in surgical management approaches. METHOD The case series involved 6 individuals who were at least 1 month postsurgery for management of tSCI. Participants completed a VFSS using a standardized bolus protocol. Each VFSS was blindly rated in duplicate using the ASPEKT method and compared with published reference values. RESULTS The analysis revealed considerable heterogeneity across this clinical sample. Penetration-aspiration scale scores of 3 or higher were not observed in this cohort. Of note, patterns of impairment did emerge, suggesting there are some commonalities across profiles in this population, including the presence of residue associated with poor pharyngeal constriction, reduced upper esophageal opening diameter, and short upper esophageal sphincter opening duration. CONCLUSIONS Although the participants in this clinical sample shared a history of tSCI requiring surgical intervention using a posterior approach, there was great heterogeneity in swallowing profile. Using a systematic method to identify atypical swallowing parameters can guide clinical decision making for determining rehabilitative targets and measuring swallowing outcomes.
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Affiliation(s)
- Teresa J. Valenzano
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Sana Smaoui
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada
| | - Melanie Peladeau-Pigeon
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
| | - Carly E. A. Barbon
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - B. Cathy Craven
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
- Division of Physiatry, Department of Medicine, University of Toronto, Ontario, Canada
| | - Catriona M. Steele
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada
- Canada Research Chair (Tier 1) in Swallowing and Food Oral Processing
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Gandhi P, Plowman EK, Steele CM. Differences in pharyngeal swallow event timing: Healthy aging, Parkinson disease, and amyotrophic lateral sclerosis. Laryngoscope Investig Otolaryngol 2023; 8:466-477. [PMID: 37090868 PMCID: PMC10116960 DOI: 10.1002/lio2.1019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/01/2022] [Accepted: 12/29/2022] [Indexed: 02/05/2023] Open
Abstract
Objective The pharyngeal phase of swallowing involves a coordinated sequence of events. Event durations may be prolonged in people with Parkinson disease (PwPD), and amyotrophic lateral sclerosis (PwALS); however, the cumulative effect of these changes is unexplored. We compared event latencies relative to hyoid burst (HYB) (time zero) to understand differences in deglutatory event timing. We hypothesized PwPD and PwALS would display similarly prolonged cumulative pharyngeal phase durations compared to healthy controls, with greater prolongations with increasing bolus viscosity. Method We retrospectively evaluated videofluoroscopic data of healthy adults (n = 78), PwPD (n = 17), and PwALS (n = 20). Participants swallowed 15 boluses of 20% (w/v) barium across five liquid consistencies. Paired raters evaluated nine deglutitive events using the ASPEKT method. Latencies were plotted by consistency relative to HYB and compared across cohorts using Mann-Whitney U tests (p ≤ .05). Cohen's d was calculated for all statistically significant results to determine effect size. Results In PwPD, significantly prolonged latencies were observed on thin liquid boluses compared to healthy controls. Latencies to all post-HYB events were significantly prolonged except for maximum upper esophageal sphincter distension. In PwALS, significantly prolonged latencies for events preceding and following HYB were noted on all consistencies compared to healthy controls and PwPD. Conclusion In PwPD, event latencies for multiple components of the swallowing sequence were prolonged culminating in overall prolongation of the pharyngeal phase on thin liquid. A similar pattern, but with significantly greater prolongation, was seen in the PwALS, and extended to swallows of all liquid consistencies.
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Affiliation(s)
- Pooja Gandhi
- Swallowing Rehabilitation Research Laboratory KITE Research Institute—University Health Network Toronto Ontario Canada
- Rehabilitation Sciences Institute University of Toronto Toronto Ontario Canada
| | - Emily K. Plowman
- Aerodigestive Research Core—University of Florida Gainesville Florida United States
| | - Catriona M. Steele
- Swallowing Rehabilitation Research Laboratory KITE Research Institute—University Health Network Toronto Ontario Canada
- Rehabilitation Sciences Institute University of Toronto Toronto Ontario Canada
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Dumican M, Watts C, Drulia T, Zhang Y. Dysphagia Presentation, Airway Invasion, and Gender Differences in a Clinically Based Sample of People with Parkinson's Disease. Dysphagia 2023; 38:353-366. [PMID: 35809095 DOI: 10.1007/s00455-022-10472-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/28/2022] [Indexed: 01/27/2023]
Abstract
Dysphagia in People with Parkinson's Disease (PWPD) is expected to occur in most individuals. The manifestation of dysphagia and its salient swallow dysfunction characteristics leading to decreased airway safety are not well understood. The aim of this study was to quantify dysphagia presentation and severity, examine contributors to airway invasion, and explore gender differences in dysphagia manifestation in PWPD. 60 PWPD in clinical, healthcare settings underwent a Videofluoroscopic Swallow Study (VFSS) after referral for complaints of dysphagia. VFSS records and videos were analyzed to obtain dysphagia diagnosis, Videofluoroscopic Dysphagia Scale (VDS) scores, laryngeal vestibule kinematic timings, and Penetration-Aspiration Scale scores. Frequencies of VDS component and PAS scores were examined. MANOVA and logistic regression analyses were used to identify predictors of penetration and aspiration. Pharyngeal stage dysphagia was prevalent throughout PWPD and presented more frequently than oral stage dysphagia. Pharyngeal residue was a significant predictor for aspiration events. Laryngeal vestibule closure reaction time (LVCrt) and duration time (LVCd) were significant predictors of airway invasion, as were bolus consistency and volume. LVCrt, LVCd, and pharyngeal stage VDS scores were significantly altered in men compared to women in PWPD. A broad clinical sample of PWPD displayed atypical frequencies of airway invasion and frequent atypical scores of oral and pharyngeal stage physiologies. Thicker and smaller bolus consistencies significantly reduced the odds of airway invasion. Men and women presented with significantly different swallow physiology including prolonged LVCrt, LVCd, and more frequent atypical scores of pharyngeal residue and laryngeal elevation.Journal instruction requires a country for affiliations; however, these are missing in affiliation [1, 2]. Please verify if the provided country are correct and amend if necessary.Yes, USA is correct as the provided country.
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Affiliation(s)
- Matthew Dumican
- Western Michigan University, 1903 W Michigan Ave, Kalamazoo, MI, 46008, USA.
| | - Christopher Watts
- Texas Christian University, 2900 S University Dr, Fort Worth, TX, 76129, USA
| | - Teresa Drulia
- Texas Christian University, 2900 S University Dr, Fort Worth, TX, 76129, USA
| | - Yan Zhang
- Texas Christian University, 2900 S University Dr, Fort Worth, TX, 76129, USA
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Do N, Mitchell S, Sturgill L, Khemani P, Sin MK. Speech and Swallowing Problems in Parkinson’s Disease. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dumican M, Watts C. Swallow Safety and Laryngeal Kinematics: A Comparison of Dysphagia Between Parkinson's Disease and Cerebrovascular Accident. JOURNAL OF PARKINSON'S DISEASE 2022:JPD222372. [PMID: 35964202 DOI: 10.3233/jpd-222372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cerebrovascular accident (CVA) and Parkinson's disease (PD) are well established etiologies of dysphagia. However, differing physiological mechanisms underlying dysphagia may exist between these two causes. There have been limited investigations specifically comparing dysphagia between these two groups. Comparing dysphagia presentation in two different populations may improve clinical expectations, guide treatment approaches, and inform future research. OBJECTIVE This study examined the differences in presentation of dysphagia between PD and CVA. Dysphagia presentation, swallow safety, and laryngeal kinematics were compared between two clinical cohorts. What factors best predicted airway invasion in each group were explored. METHODS 110 swallow studies of individuals with PD and CVA who were referred for swallowing evaluation were obtained. Each video was analyzed for quantitative dysphagia presentation using the Videofluoroscopic Dysphagia Scale (VDS), swallow safety using the Penetration-Aspiration scale, and kinematic timings of the laryngeal vestibule (time-to-laryngeal vestibule closure [LVC] and closure duration [LVCd]). RESULTS Frequencies of penetration or aspiration were similar between groups. The PD group displayed significantly greater pharyngeal stage swallow impairment than CVA, with more frequent reduced laryngeal elevation and increased vallecular residue. The CVA group displayed significantly greater oral stage impairment, with prolonged oral transit times. Time-to-LVC was significantly prolonged and was the strongest predictor of airway invasion in the PD group, but not for CVA. CONCLUSION Similar airway invasion rates for PD and CVA indicate the importance of screening for dysphagia in PD. Laryngeal kinematics as significant contributors to airway invasion in PD but not for CVA highlight the need for further research into these mechanisms and for targeted treatment approaches to dysphagia.
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Dumican M, Watts C. Swallow Safety and Laryngeal Kinematics: A Comparison of Dysphagia Between Parkinson's Disease and Cerebrovascular Accident. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2147-2159. [PMID: 36120789 PMCID: PMC9661323 DOI: 10.3233/jpd-223272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cerebrovascular accident (CVA) and Parkinson's disease (PD) are well established etiologies of dysphagia. However, differing physiological mechanisms underlying dysphagia may exist between these two causes. There have been limited investigations specifically comparing dysphagia between these two groups. Comparing dysphagia presentation in two different populations may improve clinical expectations, guide treatment approaches, and inform future research. OBJECTIVE This study examined the differences in presentation of dysphagia between PD and CVA. Dysphagia presentation, swallow safety, and laryngeal kinematics were compared between two clinical cohorts. What factors best predicted airway invasion in each group were explored. METHODS 110 swallow studies of individuals with PD and CVA who were referred for swallowing evaluation were obtained. Each video was analyzed for quantitative dysphagia presentation using the Videofluoroscopic Dysphagia Scale (VDS), swallow safety using the Penetration-Aspiration scale, and kinematic timings of the laryngeal vestibule (time-to-laryngeal vestibule closure [LVC] and closure duration [LVCd]). RESULTS Frequencies of penetration or aspiration were similar between groups. The PD group displayed significantly greater pharyngeal stage swallow impairment than CVA, with more frequent reduced laryngeal elevation and increased vallecular residue. The CVA group displayed significantly greater oral stage impairment, with prolonged oral transit times. Time-to-LVC was significantly prolonged and was the strongest predictor of airway invasion in the PD group, but not for CVA. CONCLUSION Similar airway invasion rates for PD and CVA indicate the importance of screening for dysphagia in PD. Laryngeal kinematics as significant contributors to airway invasion in PD but not for CVA highlight the need for further research into these mechanisms and for targeted treatment approaches to dysphagia.
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