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Duanmu Z, Ali SJV, Allen J, Cheng LK, Stommel M, Xu W. A Review of In Vitro and In Silico Swallowing Simulators: Design and Applications. IEEE Trans Biomed Eng 2024; 71:2042-2057. [PMID: 38294923 DOI: 10.1109/tbme.2024.3360893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Swallowing is a primary and complex behaviour that transports food and drink from the oral cavity, through the pharynx and oesophagus, into the stomach at an appropriate rate and speed. To understand this sophisticated behaviour, a tremendous amount of research has been carried out by utilising the in vivo approach, which is often challenging to perform, poses a risk to the subjects if interventions are undertaken and are seldom able to control for confounding factors. In contrast, in silico (computational) and in vitro (instrumental) methods offer an alternate insight into the process of the human swallowing system. However, the appropriateness of the design and application of these methods have not been formally evaluated. The purpose of this review is to investigate and evaluate the state of the art of in vitro and in silico swallowing simulators, focusing on the evaluation of their mechanical or computational designs in comparison to the corresponding swallowing mechanisms during various phases of swallowing (oral phase, pharyngeal phase and esophageal phase). Additionally, the potential of the simulators is also discussed in various areas of applications, including the study of swallowing impairments, swallowing medications, food process design and dysphagia management. We also address current limitations and recommendations for the future development of existing simulators.
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Leichter DM, Stark NE, Leary OP, Brodsky MB, Gilbert RJ, Nicosia MA. Two dimensional computational model coupling myoarchitecture-based lingual tissue mechanics with liquid bolus flow during oropharyngeal swallowing. Comput Biol Med 2022; 145:105446. [PMID: 35390748 DOI: 10.1016/j.compbiomed.2022.105446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/13/2022] [Accepted: 03/21/2022] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Dana M Leichter
- Center for Biomedical Engineering, Brown University, Providence, RI, 02912, USA; Research Service, Providence VA Medical Center, Providence, RI, 02908, USA
| | - Nicole E Stark
- Department of Mechanical Engineering, Widener University, Chester, PA, 19013, USA
| | - Owen P Leary
- Research Service, Providence VA Medical Center, Providence, RI, 02908, USA; Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Martin B Brodsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, USA
| | - Richard J Gilbert
- Research Service, Providence VA Medical Center, Providence, RI, 02908, USA; Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Mark A Nicosia
- Department of Mechanical Engineering, Widener University, Chester, PA, 19013, USA.
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Abstract
Food oral processing (FOP) is a fast-emerging research area in the food science discipline. Since its first introduction about a decade ago, a large amount of literature has been published in this area, forming new frontiers and leading to new research opportunities. This review aims to summarize FOP research progress from current perspectives. Food texture, food flavor (aroma and taste), bolus swallowing, and eating behavior are covered in this review. The discussion of each topic is organized into three parts: a short background introduction, reflections on current research findings and achievements, and future directions and implications on food design. Physical, physiological, and psychological principles are the main concerns of discussion for each topic. The last part of the review shares views on the research challenges and outlooks of future FOP research. It is hoped that the review not only helps readers comprehend what has been achieved in the past decade but also, more importantly, identify where the knowledge gaps are and in which direction the FOP research will go.
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Affiliation(s)
- Yue He
- Laboratory of Food Oral Processing, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, Zhejiang, China;
| | - Xinmiao Wang
- Laboratory of Food Oral Processing, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, Zhejiang, China;
| | - Jianshe Chen
- Laboratory of Food Oral Processing, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, Zhejiang, China;
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