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Vander Cruyssen E, van de Ven J, Dik E, Knuijt S. The feasibility of visualizing and quantifying muscle changes in postoperative oral cancer patients using Quantitative Muscle Ultrasound (QMUS). J Ultrasound 2024:10.1007/s40477-024-00910-y. [PMID: 38896395 DOI: 10.1007/s40477-024-00910-y] [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: 03/06/2024] [Accepted: 04/24/2024] [Indexed: 06/21/2024] Open
Abstract
PURPOSE Quantitative muscle ultrasound (QMUS) is a patient friendly tool for examining orofacial muscles. Resection of tissue can have an effect on the architecture and function of these muscles. The aim of this study is to investigate the feasibility of visualizing and quantifying muscle changes in postoperative oral cancer patients and to relate the findings to tumor and patient characteristics. METHODS Adult patients with a resected first primary pT1 or T2 oral squamous cell carcinoma, at least one year post operatively, where included. Ultrasound data were collected of the geniohyoid muscle, digastric muscles, masseter muscle, transverse muscle and genioglossus muscle. Ultrasound images were labeled as clearly visible, questionable or unclear. Of the clear muscles, echogenicity and muscle thickness were measured. RESULTS 37 patients were included. The masseter muscle was clearly visible in all ultrasound images, both intrinsic tongue muscles had the lowest visibility (45.9%). There was a significant correlation between visibility and tumor localization for the genioglossus (p = 0.029). Age correlated with the visibility of the genioglossus muscle, BMI with the genioglossus and transverse muscles. Echogenicity and muscle thickness of the clearly identified muscles did not differ from normative values. CONCLUSION QMUS of orofacial muscles is feasible in postoperative oral cancer patients with relatively small tumor sizes. Tongue resections negatively affected the visibility of the two intrinsic tongue muscles. These preliminary results for particular muscles indicate that the use of ultrasound might be promising in oral cancer patients to help determine targeted goals in post-operative rehabilitation.
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Affiliation(s)
- Emily Vander Cruyssen
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Rehabilitation, Regional Hospital Tienen (RZ Tienen), Tienen, Belgium
| | - Jelmer van de Ven
- Faculty of Medical Sciences, Radboud University, Nijmegen, The Netherlands
| | - Eric Dik
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Simone Knuijt
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
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Mialland A, Atallah I, Bonvilain A. Toward a robust swallowing detection for an implantable active artificial larynx: a survey. Med Biol Eng Comput 2023; 61:1299-1327. [PMID: 36792845 DOI: 10.1007/s11517-023-02772-8] [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: 02/17/2022] [Accepted: 01/04/2023] [Indexed: 02/17/2023]
Abstract
Total laryngectomy consists in the removal of the larynx and is intended as a curative treatment for laryngeal cancer, but it leaves the patient with no possibility to breathe, talk, and swallow normally anymore. A tracheostomy is created to restore breathing through the throat, but the aero-digestive tracts are permanently separated and the air no longer passes through the nasal tracts, which allowed filtration, warming, humidification, olfaction, and acceleration of the air for better tissue oxygenation. As for phonation restoration, various techniques allow the patient to talk again. The main one consists of a tracheo-esophageal valve prosthesis that makes the air passes from the esophagus to the pharynx, and makes the air vibrate to allow speech through articulation. Finally, swallowing is possible through the original tract as it is now isolated from the trachea. Yet, many methods exist to detect and assess a swallowing, but none is intended as a definitive restoration technique of the natural airway, which would permanently close the tracheostomy and avoid its adverse effects. In addition, these methods are non-invasive and lack detection accuracy. The feasibility of an effective early detection of swallowing would allow to further develop an implantable active artificial larynx and therefore restore the aero-digestive tracts. A previous attempt has been made on an artificial larynx implanted in 2012, but no active detection was included and the system was completely mechanic. This led to residues in the airway because of the imperfect sealing of the mechanism. An active swallowing detection coupled with indwelling measurements would thus likely add a significant reliability on such a system as it would allow to actively close an artificial larynx. So, after a brief explanation of the swallowing mechanism, this survey intends to first provide a detailed consideration of the anatomical region involved in swallowing, with a detection perspective. Second, the swallowing mechanism following total laryngectomy surgery is detailed. Third, the current non-invasive swallowing detection technique and their limitations are discussed. Finally, the previous points are explored with regard to the inherent requirements for the feasibility of an effective swallowing detection for an artificial larynx. Graphical Abstract.
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Affiliation(s)
- Adrien Mialland
- Institute of Engineering and Management Univ. Grenoble Alpes, Univ. Grenoble Alpes, CNRS, Grenoble INP, Gipsa-lab, 38000, Grenoble, France.
| | - Ihab Atallah
- Institute of Engineering and Management Univ. Grenoble Alpes, Otorhinolaryngology, CHU Grenoble Alpes, 38700, La Tronche, France
| | - Agnès Bonvilain
- Institute of Engineering and Management Univ. Grenoble Alpes, Univ. Grenoble Alpes, CNRS, Grenoble INP, Gipsa-lab, 38000, Grenoble, France
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Krekeler BN, Davidson K, Kantarcigil C, Pearson W, Blair J, Martin-Harris B. Determining Swallowing Biomechanics Underlying Modified Barium Swallow Impairment Profile Scoring Using Computational Analysis of Swallowing Mechanics. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3798-3808. [PMID: 36075206 PMCID: PMC9927620 DOI: 10.1044/2022_jslhr-22-00047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/11/2022] [Accepted: 06/05/2022] [Indexed: 05/09/2023]
Abstract
PURPOSE The elements of impaired swallowing biomechanics are visually assessed and scored by clinicians using a standardized and validated tool for assessing type and severity of physiological impairments using the Modified Barium Swallow Impairment Profile (MBSImP). However, the functional anatomical correlates that underly noted impairments using MBSImP scoring have not been measured. The purpose of this study was to determine whether differences in MBSImP component scores represent differences in underlying swallowing mechanics as measured by computational analysis of swallowing mechanics (CASM) to better define underlying mechanisms of impairment. METHOD A retrospective analysis of modified barium swallow studies from physician-referred adult patients with dysphagia was scored using the MBSImP for laryngeal elevation, anterior hyoid excursion, epiglottic movement, pharyngoesophageal segment opening, and tongue base retraction. A canonical variate analysis (CVA) was performed to determine the movement of anatomical landmarks associated with MBSImP component scores using the CASM method. Mahalanobis distances (D) were then used to detect differences among MBSImP scores for each component assessed. RESULTS CVA showed significant differences (p < .0001) in Mahalanobis distance (D > 1) between MBSImP component scores of 0-1, 0-2, 0-3, or 0-4, as applicable, depending on the component. Discriminant function analyses revealed concomitant increase/worsening in MBSImP score with changes in anatomical positioning of structures. CONCLUSIONS Ratings of swallowing impairment and physiology using the MBSImP have distinct biomechanical correlates with anatomical movements of swallowing. These data further demonstrate how swallowing mechanics are highly interrelated. Understanding these linkages between anatomical and physiological movement within impaired swallowing biomechanics is essential in more specific characterization and treatment of dysphagia. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.20816788.
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Affiliation(s)
- Brittany N. Krekeler
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, OH
| | - Kate Davidson
- Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Cagla Kantarcigil
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL
| | - William Pearson
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University
- Department of Biomedical Sciences, College of Osteopathic Medicine, Auburn, AL
| | - Julie Blair
- Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston
| | - Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL
- Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston
- Department of Otolaryngology—Head and Neck Surgery and Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Tadavarthi Y, Hosseini P, Reyes SE, Focht Garand KL, Pisegna JM, Pearson WG. Pilot Study of Quantitative Methods for Differentiating Pharyngeal Swallowing Mechanics by Dysphagia Etiology. Dysphagia 2021; 36:231-241. [PMID: 32410203 PMCID: PMC7666098 DOI: 10.1007/s00455-020-10123-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
Quantitative analysis of modified barium swallow (MBS) imaging is useful to determine the impact of various disease states on pharyngeal swallowing mechanics. In this retrospective proof of concept study, kinematic analysis and computational analysis of swallowing mechanics (CASM) were used to demonstrate how these methods differentiate swallowing dysfunction by dysphagia etiology. Ten subjects were randomly selected from four cohorts of dysphagic patients including COPD, head and neck cancer (HNC), motor neuron disease, and stroke. Each subject was age- and gender-matched with healthy, non-dysphagic controls. MBS videos of 5 ml thin and 5 ml thick bolus trials from each subject were used. A MATLAB tracker tool was adapted and updated to collect and compile data for each video (n = 160). For kinematic measurements, a MANOVA was performed with post-hoc analyses to determine group differences. For CASM measurements, a morphometric canonical variate analysis with post hoc analysis was performed to determine group differences. Kinematic analyses indicated statistically significant differences between HNC cohort and controls in distance measurements for hyolaryngeal approximation (p = .001), laryngeal elevation (p = 0.0001), pharyngeal shortening (p = 0.0002), and stage transition duration timing (p = 0.002). Timing differences were noted between the stroke cohort and controls for pharyngeal transit time (p = 0.007). Multivariate morphometric canonical variate analysis showed significant differences between etiology groups (p < 0.0001) with eigenvectors indicating differing patterns of swallowing mechanics. This study demonstrated that swallowing mechanics among cohorts of dysphagic patients can be differentiated using kinematics and CASM, providing different but complementary quantitative methods for investigating the impact of various disease states on swallowing function.
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Affiliation(s)
| | - Pouria Hosseini
- Medical College of Georgia (MCG), Augusta University, Augusta, Georgia
| | - Stephanie E Reyes
- College of Allied Health Sciences, Augusta University, Augusta, Georgia
- Department of Otolaryngology, MCG, Augusta University, Augusta, Georgia
| | - Kendrea L Focht Garand
- Department of Speech Pathology and Audiology, University of South Alabama, Mobile, AL, USA
| | - Jessica M Pisegna
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, Boston, MA, USA
| | - William G Pearson
- Department of Cellular Biology and Anatomy, MCG, Augusta University, Augusta, Georgia.
- Department of Otolaryngology, MCG, Augusta University, Augusta, Georgia.
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Fukino K, Tsutsumi M, Nimura A, Miwa K, Ono T, Akita K. Anatomy of inferior end of palatopharyngeus: its contribution to upper esophageal sphincter opening. Eur Arch Otorhinolaryngol 2020; 278:749-754. [PMID: 33083866 PMCID: PMC7895782 DOI: 10.1007/s00405-020-06437-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/12/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE The palatopharyngeus is one of the longitudinal pharyngeal muscles which contributes to swallowing. It is reported that the palatopharyngeus has muscle bundles in various directions and with attachment sites, and each muscle bundle has a specific function. Although previous reports suggest that the palatopharyngeus is partly interlaced with some parts of the inferior constrictor, the precise relationship remains unclear. The purpose of this study was to examine the precise manner of the connection between the palatopharyngeus and inferior constrictor, and to examine the histological characteristics of this connection. METHODS We examined 15 halves of nine heads from Japanese cadavers (average age: 76.1 years); 12 halves, macroscopically, and three halves, histologically. RESULTS Our observation suggests that the palatopharyngeus spreads radially on the inner aspect of the pharyngeal wall. The most inferior portion of the palatopharyngeus extended to the inner surface of the cricopharyngeal part of the inferior constrictor. Histological analysis showed that the inferior end of the palatopharyngeus continued into the dense connective tissue located at the level of the cricoid cartilage. The dense connective tissue not only covered the inner surface of the inferior constrictor but also entered its muscle bundles and enveloped them. CONCLUSION Therefore, the palatopharyngeus interlaced the cricopharyngeal part of the inferior constrictor through the dense connective tissues. The findings of this study show that the palatopharyngeus may act on the upper esophageal sphincter directly and help in its opening with the aid of the pulling forces in the superolateral direction.
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Affiliation(s)
- Keiko Fukino
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Masahiro Tsutsumi
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koh Miwa
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takashi Ono
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
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Martin J, Ruthven M, Boubertakh R, Miquel ME. Realistic Dynamic Numerical Phantom for MRI of the Upper Vocal Tract. J Imaging 2020; 6:86. [PMID: 34460743 PMCID: PMC8320850 DOI: 10.3390/jimaging6090086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/08/2020] [Accepted: 08/24/2020] [Indexed: 11/16/2022] Open
Abstract
Dynamic and real-time MRI (rtMRI) of human speech is an active field of research, with interest from both the linguistics and clinical communities. At present, different research groups are investigating a range of rtMRI acquisition and reconstruction approaches to visualise the speech organs. Similar to other moving organs, it is difficult to create a physical phantom of the speech organs to optimise these approaches; therefore, the optimisation requires extensive scanner access and imaging of volunteers. As previously demonstrated in cardiac imaging, realistic numerical phantoms can be useful tools for optimising rtMRI approaches and reduce reliance on scanner access and imaging volunteers. However, currently, no such speech rtMRI phantom exists. In this work, a numerical phantom for optimising speech rtMRI approaches was developed and tested on different reconstruction schemes. The novel phantom comprised a dynamic image series and corresponding k-space data of a single mid-sagittal slice with a temporal resolution of 30 frames per second (fps). The phantom was developed based on images of a volunteer acquired at a frame rate of 10 fps. The creation of the numerical phantom involved the following steps: image acquisition, image enhancement, segmentation, mask optimisation, through-time and spatial interpolation and finally the derived k-space phantom. The phantom was used to: (1) test different k-space sampling schemes (Cartesian, radial and spiral); (2) create lower frame rate acquisitions by simulating segmented k-space acquisitions; (3) simulate parallel imaging reconstructions (SENSE and GRAPPA). This demonstrated how such a numerical phantom could be used to optimise images and test multiple sampling strategies without extensive scanner access.
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Affiliation(s)
- Joe Martin
- MR Physics, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’s Hospital, London SE1 7EH, UK;
| | - Matthieu Ruthven
- Clinical Physics, Barts Health NHS Trust, St Bartholomew’s Hospital, London EC1A 7BE, UK;
| | - Redha Boubertakh
- Singapore Bioimaging Consortium (SBIC), Singapore 138667, Singapore;
| | - Marc E. Miquel
- Clinical Physics, Barts Health NHS Trust, St Bartholomew’s Hospital, London EC1A 7BE, UK;
- Centre for Advanced Cardiovascular Imaging, NIHR Barts Biomedical Research Centre (BRC), William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
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Pearson WG, Griffeth JV, Ennis AM. Functional Anatomy Underlying Pharyngeal Swallowing Mechanics and Swallowing Performance Goals. ACTA ACUST UNITED AC 2019. [DOI: 10.1044/2019_pers-sig13-2018-0014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose
Rehabilitation of pharyngeal swallowing dysfunction requires a thorough understanding of the functional anatomy underlying the performance goals of pharyngeal swallowing. These goals include the safe and efficient transfer of a bolus through the hypopharynx into the esophagus. Penetration or aspiration of a bolus threatens swallowing safety. Bolus residue indicates swallowing inefficiency. Several primary mechanics, or elements of the swallowing mechanism, underlie these performance goals, with some elements contributing to both goals. These primary mechanics include velopharyngeal port closure, hyoid movement, laryngeal elevation, pharyngeal shortening, tongue base retraction, and pharyngeal constriction. Each element of the swallowing mechanism is under neuromuscular control and is therefore, in principle, a potential target for rehabilitation. Secondary mechanics of pharyngeal swallowing, those movements dependent on primary mechanics, include opening the upper esophageal sphincter and epiglottic inversion.
Conclusion
Understanding the functional anatomy of pharyngeal swallowing underlying swallowing performance goals will facilitate anatomically informed critical thinking in the rehabilitation of pharyngeal swallowing dysfunction.
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Affiliation(s)
- William G. Pearson
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University
- Department of Otolaryngology, Medical College of Georgia,Augusta University
| | | | - Alexis M. Ennis
- Department of Academic Affairs, Medical College of Georgia, Augusta University
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Lenell C, Brates D, Pearson WG, Molfenter S. Variations in Healthy Swallowing Mechanics During Various Bolus Conditions Using Computational Analysis of Swallowing Mechanics (CASM). Dysphagia 2019; 35:272-280. [PMID: 31165260 DOI: 10.1007/s00455-019-10026-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/20/2019] [Accepted: 05/25/2019] [Indexed: 01/09/2023]
Abstract
Bolus properties such as volume, consistency, and density have been shown to influence swallowing through the analysis of kinematics and timing in both normal and disordered swallowing. However, inherent intra- and inter-person variability of swallowing cloud interpretation of group data. Computational analysis of swallow mechanics (CASM) is an established methodology that uses coordinate tracking to map structural movements during swallowing and yields statistically powerful analyses at both the group and individual levels. In this study, the CASM method was used to determine how different bolus properties (volume, consistency, and density) altered swallow mechanics in healthy young adults at the group and individual levels. Videofluoroscopic swallow studies of 10 (4 females) healthy young adults were analyzed using CASM. Five bolus types were administered in each study (3 × 5 ml 40% w/v nectar, 3 × 5 ml 22% w/v thin, 3 × 5 ml 40% w/v thin, 3 × 10 ml 22% w/v thin, and 3 × 20 ml 22% w/v thin). Canonical variate analyses demonstrated that bolus condition did not affect swallowing mechanics at the group level, but bolus condition did affect pharyngeal swallow mechanics at the individual level. Functional swallow adaptations (e.g., hyoid movement) to bolus conditions were not uniform across participants, consistent with the nonsignificant group finding. These results suggest that individual swallowing systems of healthy young individuals vary in how they respond to bolus different conditions, highlighting the intrinsic variability of the swallow mechanism and the importance of individually tailored evaluation and treatment of swallowing. Findings warrant further investigation with different bolus conditions and aging and disordered populations.
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Affiliation(s)
- Charles Lenell
- Department of Communicative Sciences and Disorders, New York University, 665 Broadway, New York, NY, 10012, USA
| | - Danielle Brates
- Department of Communicative Sciences and Disorders, New York University, 665 Broadway, New York, NY, 10012, USA
| | - William G Pearson
- Department of Cellular Biology and Anatomy, Augusta University, 1120 15th Street, Augusta, GA, 30912, USA
| | - Sonja Molfenter
- Department of Communicative Sciences and Disorders, New York University, 665 Broadway, New York, NY, 10012, USA.
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Hosseini P, Tadavarthi Y, Martin‐Harris B, Pearson WG. Functional Modules of Pharyngeal Swallowing Mechanics. Laryngoscope Investig Otolaryngol 2019; 4:341-346. [PMID: 31236469 PMCID: PMC6580054 DOI: 10.1002/lio2.273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/05/2019] [Accepted: 04/30/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The present retrospective cohort study aims to test the hypothesis that elements of swallowing mechanics including hyoid movement, laryngeal elevation, tongue base retraction, pharyngeal shortening, pharyngeal constriction, and head and neck extension can be grouped into functional modules, and that these modules are predictably altered in disease states. METHODS Modified barium swallow video clips of a thick and a thin liquid swallow from 40 normal patients and 10 dysphagic post-treatment oropharyngeal head-and-neck cancer (HNC) patients were used in this study. Coordinate locations of 12 anatomical landmarks mapping pharyngeal swallowing mechanics were tracked on every frame during the pharyngeal phase of each swallow using a custom-made MATLAB tool. Morphometric modularity hypothesis testing was performed on these coordinate data to characterize the modular elements of swallowing function in each cohort using MorphoJ software. RESULTS The elements of normal swallowing can be grouped into four functional modules including bolus propulsion, pharyngeal shortening, airway protection, and head and neck posture. Modularity in HNC patient showed an intact airway protection module but altered bolus propulsion and pharyngeal shortening modules. To cross-validate the alteration in modules, a post hoc analysis was performed, which showed significantly increased vallecular (P < .04) and piriform (P < .05) residue but no significant change in aspiration status in the HNC cohort versus controls. CONCLUSIONS This study suggests that while pharyngeal swallowing mechanics is highly complex, the system is organized into functional modules, and that changes in modularity impacts swallowing performance. This approach to understanding swallowing function may help the patient care team better address swallowing difficulties. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Pouria Hosseini
- Medical College of Georgia (MCG)Augusta UniversityAugustaGeorgiaU.S.A.
| | | | - Bonnie Martin‐Harris
- Department of Communication Sciences and DisordersSchool of Communication, Northwestern UniversityEvanstonIllinoisU.S.A.
- Department of Otolaryngology—Head and Neck SurgeryFeinberg School of Medicine, Northwestern UniversityChicagoIllinoisU.S.A.
- Department of Radiation OncologyFeinberg School of Medicine, Northwestern UniversityChicagoIllinoisU.S.A.
| | - William G. Pearson
- Department of Cellular Biology and AnatomyMCG, Augusta UniversityAugustaGeorgiaU.S.A.
- Department of OtolaryngologyMCG, Augusta UniversityAugustaGeorgiaU.S.A.
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Kletzien H, Cullins MJ, Connor NP. Age-related alterations in swallowing biomechanics. Exp Gerontol 2019; 118:45-50. [PMID: 30633957 DOI: 10.1016/j.exger.2019.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/14/2018] [Accepted: 01/06/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aging rodent models allow for the discovery of underlying mechanisms of cranial muscle dysfunction. Methods are needed to allow quantification of complex, multivariate biomechanical movements during swallowing. Videofluoroscopic swallow studies (VSS) are the standard of care in assessment of swallowing disorders in patients and validated quantitative, kinematic, and morphometric analysis methods have been developed. Our purpose was to adapt validated morphometric techniques to the rodent to computationally analyze swallowing dysfunction in the aging rodent. METHODS VSS, quantitative analyses (bolus area, bolus velocity, mastication rate) and a rodent specific multivariate, morphometric computational analysis of swallowing biomechanics were performed on 20 swallows from 5 young adult and 5 old Fischer 344/Brown Norway rats. Eight anatomical landmarks were used to track the relative change in position of skeletal levers (cranial base, vertebral column, mandible) and soft tissue landmarks (upper esophageal sphincter, base of tongue). RESULTS Bolus area significantly increased and mastication rate significantly decreased with age. Aging accounted for 77.1% of the variance in swallow biomechanics, and 18.7% of the variance was associated with swallow phase (oral vs pharyngeal). Post hoc analyses identified age-related alterations in tongue base retraction, mastication, and head posture during the swallow. CONCLUSION Geometric morphometric analysis of rodent swallows suggests that swallow biomechanics are altered with age. When used in combination with biological assays of age-related adaptations in neuromuscular systems, this multivariate analysis may increase our understanding of underlying musculoskeletal dysfunction that contributes to swallowing disorders with aging.
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Affiliation(s)
- Heidi Kletzien
- Division of Otolaryngology-Head and Neck Cancer, Department of Surgery, University of Wisconsin School of Medicine and Public Health, United States of America; Department of Biomedical Engineering, University of Wisconsin-Madison, United States of America.
| | - Miranda J Cullins
- Division of Otolaryngology-Head and Neck Cancer, Department of Surgery, University of Wisconsin School of Medicine and Public Health, United States of America
| | - Nadine P Connor
- Division of Otolaryngology-Head and Neck Cancer, Department of Surgery, University of Wisconsin School of Medicine and Public Health, United States of America; Department of Biomedical Engineering, University of Wisconsin-Madison, United States of America; Department of Communication Sciences and Disorders, University of Wisconsin-Madison, United States of America
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Natarajan R, Stavness I, Pearson W. Semi-automatic tracking of hyolaryngeal coordinates in videofluoroscopic swallowing studies. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2017. [DOI: 10.1080/21681163.2015.1046190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rajkiran Natarajan
- Department of Computer Science, University of Saskatchewan, 176 Thorvaldson Building, 110 Science Place, Saskatoon, SK S7N 5C9, Canada
| | - Ian Stavness
- Department of Computer Science, University of Saskatchewan, 176 Thorvaldson Building, 110 Science Place, Saskatoon, SK S7N 5C9, Canada
| | - William Pearson
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA
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12
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Computational Analysis of Pharyngeal Swallowing Mechanics in Patients with Motor Neuron Disease: A Pilot Investigation. Dysphagia 2017; 33:243-250. [DOI: 10.1007/s00455-017-9853-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/03/2017] [Indexed: 12/13/2022]
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May NH, Pisegna JM, Marchina S, Langmore SE, Kumar S, Pearson WG. Pharyngeal Swallowing Mechanics Secondary to Hemispheric Stroke. J Stroke Cerebrovasc Dis 2017; 26:952-961. [PMID: 27913200 PMCID: PMC5409864 DOI: 10.1016/j.jstrokecerebrovasdis.2016.11.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/21/2016] [Accepted: 11/02/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Computational analysis of swallowing mechanics (CASM) is a method that utilizes multivariate shape change analysis to uncover covariant elements of pharyngeal swallowing mechanics associated with impairment using videofluoroscopic swallowing studies. The goals of this preliminary study were to (1) characterize swallowing mechanics underlying stroke-related dysphagia, (2) decipher the impact of left and right hemispheric strokes on pharyngeal swallowing mechanics, and (3) determine pharyngeal swallowing mechanics associated with penetration-aspiration status. METHODS Videofluoroscopic swallowing studies of 18 dysphagic patients with hemispheric infarcts and age- and gender-matched controls were selected from well-controlled data sets. Patient data including laterality and penetration-aspiration status were collected. Coordinates mapping muscle group action during swallowing were collected from videos. Multivariate morphometric analyses of coordinates associated with stroke, affected hemisphere, and penetration-aspiration status were performed. RESULTS Pharyngeal swallowing mechanics differed significantly in the following comparisons: stroke versus controls (D = 2.19, P < .0001), right hemispheric stroke versus controls (D = 3.64, P < .0001), left hemispheric stroke versus controls (D = 2.06, P < .0001), right hemispheric stroke versus left hemispheric stroke (D = 2.89, P < .0001), and penetration-aspiration versus within normal limits (D = 2.25, P < .0001). Differences in pharyngeal swallowing mechanics associated with each comparison were visualized using eigenvectors. CONCLUSIONS Whereas current literature focuses on timing changes in stroke-related dysphagia, these data suggest that mechanical changes are also functionally important. Pharyngeal swallowing mechanics differed by the affected hemisphere and the penetration-aspiration status. CASM can be used to identify patient-specific swallowing impairment associated with stroke injury that could help guide rehabilitation strategies to improve swallowing outcomes.
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Affiliation(s)
- Nelson H May
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Jessica M Pisegna
- Department of Speech, Language and Hearing Sciences, Boston University, Boston, Massachusetts
| | - Sarah Marchina
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Susan E Langmore
- Department of Speech, Language and Hearing Sciences, Boston University, Boston, Massachusetts
| | - Sandeep Kumar
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - William G Pearson
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, Georgia.
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Schwertner RW, Garand KL, Pearson WG. A Novel Imaging Analysis Method for Capturing Pharyngeal Constriction During Swallowing. JOURNAL OF IMAGING SCIENCE 2016; 1:http://www.ommegaonline.org/admin/journalassistance/publishimages/A-Novel-Imaging-Analysis-Method-for-Capturing-Pharyngeal-Constriction-During-Swallowing.pdf. [PMID: 28239682 PMCID: PMC5321622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Videofluoroscopic imaging of swallowing known as the Modified Barium Study (MBS) is the standard of care for assessing swallowing difficulty. While the clinical purpose of this radiographic imaging is to primarily assess aspiration risk, valuable biomechanical data is embedded in these studies. Computational analysis of swallowing mechanics (CASM) is an established research methodology for assessing multiple interactions of swallowing mechanics based on coordinates mapping muscle function including hyolaryngeal movement, pharyngeal shortening, tongue base retraction, and extension of the head and neck, however coordinates characterizing pharyngeal constriction is undeveloped. The aim of this study was to establish a method for locating the superior and middle pharyngeal constrictors using hard landmarks as guides on MBS videofluoroscopic imaging, and to test the reliability of this new method. Twenty de-identified, normal, MBS videos were randomly selected from a database. Two raters annotated landmarks for the superior and middle pharyngeal constrictors frame-by-frame using a semi-automated MATLAB tracker tool at two time points. Intraclass correlation coefficients were used to assess test-retest reliability between two raters with an ICC = 0.99 or greater for all coordinates for the retest measurement. MorphoJ integrated software was used to perform a discriminate function analysis to visualize how all 12 coordinates interact with each other in normal swallowing. The addition of the superior and middle pharyngeal constrictor coordinates to CASM allows for a robust analysis of the multiple components of swallowing mechanics interacting with a wide range of variables in both patient specific and cohort studies derived from common use imaging data.
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Affiliation(s)
- Ryan W. Schwertner
- Department of Cellular Biology & Anatomy, Medical College of Georgia, Augusta University, Augusta, GA
| | - Kendrea L. Garand
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - William G. Pearson
- Department of Cellular Biology & Anatomy, Medical College of Georgia, Augusta University, Augusta, GA
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15
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Pearson WG, Taylor BK, Blair J, Martin-Harris B. Computational analysis of swallowing mechanics underlying impaired epiglottic inversion. Laryngoscope 2016; 126:1854-8. [PMID: 27426940 PMCID: PMC4955610 DOI: 10.1002/lary.25788] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/22/2015] [Accepted: 10/27/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVES/HYPOTHESIS Determine swallowing mechanics associated with the first and second epiglottic movements, that is, movement to horizontal and full inversion, respectively, to provide a clinical interpretation of impaired epiglottic function. STUDY DESIGN Retrospective cohort study. METHODS A heterogeneous cohort of patients with swallowing difficulties was identified (n = 92). Two speech-language pathologists reviewed 5-mL thin and 5-mL pudding videofluoroscopic swallow studies per subject, and assigned epiglottic component scores of 0 = complete inversion, 1 = partial inversion, and 2 = no inversion, forming three groups of videos for comparison. Coordinates mapping minimum and maximum excursion of the hyoid, pharynx, larynx, and tongue base during pharyngeal swallowing were recorded using ImageJ software. A canonical variate analysis with post hoc discriminant function analysis of coordinates was performed using MorphoJ software to evaluate mechanical differences between groups. Eigenvectors characterizing swallowing mechanics underlying impaired epiglottic movements were visualized. RESULTS Nineteen of 184 video swallows were rejected for poor quality (n = 165). A Goodman-Kruskal index of predictive association showed no correlation between epiglottic component scores and etiologies of dysphagia (λ = .04). A two-way analysis of variance by epiglottic component scores showed no significant interaction effects between sex and age (f = 1.4, P = .25). Discriminant function analysis demonstrated statistically significant mechanical differences between epiglottic component scores: 1 and 2, representing the first epiglottic movement (Mahalanobis distance = 1.13, P = .0007); and 0 and 1, representing the second epiglottic movement (Mahalanobis distance = 0.83, P = .003). Eigenvectors indicate that laryngeal elevation and tongue base retraction underlie both epiglottic movements. CONCLUSIONS Results suggest that reduced tongue base retraction and laryngeal elevation underlie impaired first and second epiglottic movements. The styloglossus, hyoglossus, and long pharyngeal muscles are implicated as targets for rehabilitation in dysphagic patients with impaired epiglottic inversion. LEVEL OF EVIDENCE 2b Laryngoscope, 126:1854-1858, 2016.
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Affiliation(s)
- William G Pearson
- Department of Cellular Biology and Anatomy, Augusta, Georgia
- Department of Otolaryngology, Augusta, Georgia
| | - Brandon K Taylor
- Medical College of Georgia at Georgia Regents University, Augusta, Georgia, U.S.A
| | - Julie Blair
- Department of Otolaryngology Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Bonnie Martin-Harris
- Department of Otolaryngology Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Tran TTA, Harris BM, Pearson WG. Improvements resulting from respiratory-swallow phase training visualized in patient-specific computational analysis of swallowing mechanics. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING-IMAGING AND VISUALIZATION 2016; 6:532-538. [PMID: 30581689 DOI: 10.1080/21681163.2016.1152567] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aim of this study was to visualize improved swallowing mechanics resulting from respiratory-swallow phase training using patient specific computational analysis of Modified Barium Swallow (MBS) videofluoroscopic images. Imaging from a single subject showing improved MBSImP™© scores in 17 of 18 pre- to post-treatment swallows was selected for analysis. Using a semi-automated MATLAB tracker tool, a frame-by-frame annotation of 10 coordinates mapping muscle functional groups was performed during oropharyngeal swallowing. Computational analysis of coordinate shape change was executed using MorphoJ software to determine differences in swallowing mechanics associated with multiple independent variables. Canonical variant analysis indicated significant differences in mechanics associated with respiratory-swallow phase training (D=1.92,p<.0001). Vectors allowed for visualization of changes in swallowing mechanics associated with respiratory-swallow phase training. A regression of shape associated with laryngeal vestibular closure on respiratory-swallow phase training was highly significant (p<.0001) and accounted for 94.1% of the variance.
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Affiliation(s)
- Thi Tu Anh Tran
- Medical College of Georgia, Georgia Regents University, Augusta, GA, USA
| | - Bonnie Martin Harris
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - William G Pearson
- Department of Cellular Biology and Anatomy; Department of Otolaryngology, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA
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Pearson Jr WG, Davidoff AA, Smith ZM, Adams DE, Langmore SE. Impaired swallowing mechanics of post radiation therapy head and neck cancer patients: A retrospective videofluoroscopic study. World J Radiol 2016; 8:192-199. [PMID: 26981228 PMCID: PMC4770181 DOI: 10.4329/wjr.v8.i2.192] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/24/2015] [Accepted: 12/20/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine swallowing outcomes and hyolaryngeal mechanics associated with post radiation therapy head and neck cancer (rtHNC) patients using videofluoroscopic swallow studies.
METHODS: In this retrospective cohort study, videofluoroscopic images of rtHNC patients (n = 21) were compared with age and gender matched controls (n = 21). Penetration-aspiration of the bolus and bolus residue were measured as swallowing outcome variables. Timing and displacement measurements of the anterior and posterior muscular slings elevating the hyolaryngeal complex were acquired. Coordinate data of anatomical landmarks mapping the action of the anterior muscles (suprahyoid muscles) and posterior muscles (long pharyngeal muscles) were used to calculate the distance measurements, and slice numbers were used to calculate time intervals. Canonical variate analysis with post-hoc discriminant function analysis was performed on coordinate data to determine multivariate mechanics of swallowing associated with treatment. Pharyngeal constriction ratio (PCR) was also measured to determine if weak pharyngeal constriction is associated with post radiation therapy.
RESULTS: The rtHNC group was characterized by poor swallowing outcomes compared to the control group in regards to: Penetration-aspiration scale (P < 0.0001), normalized residue ratio scale (NRRS) for the valleculae (P = 0.002) and NRRS for the piriform sinuses (P = 0.003). Timing and distance measurements of the anterior muscular sling were not significantly different in the two groups, whereas for the PMS time of displacement was abbreviated (P = 0.002) and distance of excursion was reduced (P = 0.02) in the rtHNC group. A canonical variate analysis shows a significant reduction in pharyngeal mechanics in the rtHNC group (P < 0.0001). The PCR was significantly higher in the test group than the control group (P = 0.0001) indicating reduced efficiency in pharyngeal clearance.
CONCLUSION: Using videofluoroscopy, this study shows rtHNC patients have worse swallowing outcomes associated with reduced hyolaryngeal mechanics and pharyngeal constriction compared with controls.
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