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Palmer PM, Padilla AH, Murray SC, Rashidi M, Martinez-Fisher A, Winter T. The Impact of Videofluoroscopic Pulse Rate on Duration and Kinematic Measures in Infants and Adults with Feeding and Swallowing Disorders. Dysphagia 2024:10.1007/s00455-024-10709-y. [PMID: 38683399 DOI: 10.1007/s00455-024-10709-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: 09/03/2023] [Accepted: 04/11/2024] [Indexed: 05/01/2024]
Abstract
This investigation assessed the impact of temporal resolution during a videofluoroscopic evaluation of swallowing (VFSS) on measures of duration and kinematics. Thirty adult and ten infant swallow studies, all acquired at 30 frames and 30 pulses per second, were obtained from a New Mexico hospital. All swallow studies were altered to simulate 15 and 5 pulses per second. Duration measures included pharyngeal response time, duration of upper esophageal sphincter (UES) opening, velopharyngeal closure duration and total swallow duration. Kinematic measures were assessed in adults only and included peak hyoid position and extent of UES opening during the swallow. Analysis of outcome measures was performed and compared across the three temporal resolutions (30, 15, and 5 pulses per second). For data points where normative values are available, we evaluated the impact of temporal resolution on clinical determination (i.e., did a change in pulse rate alter the clinical classification). Kinematic and duration measures were altered with changes in pulse rate and these changes increased as temporal resolution decreased. For outcome measures where normative values are available, accuracy of clinical determination decreased with decreased pulse rate. Temporal resolution impacts duration and kinematic measures. However, the direction of these changes is unpredictable, indicating sensitivity and specificity are both affected. Without a predictable impact, the use of lower pulse rates may alter clinical impressions and treatment recommendations yielding inappropriate treatment goals and treatment duration.
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Affiliation(s)
| | | | - Shauna C Murray
- University of New Mexico Hospital, Albuquerque, NM, MSC01 1195, 87131-0001, USA
| | | | | | - Taite Winter
- University of New Mexico Hospital, Albuquerque, NM, MSC01 1195, 87131-0001, USA
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2
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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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3
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He Y, Chen J, Shi W, Shi J, Ma T, Wang X. Can nonvolatile tastants be smelled during food oral processing? Chem Senses 2023; 48:bjad028. [PMID: 37590987 PMCID: PMC10516591 DOI: 10.1093/chemse/bjad028] [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] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Indexed: 08/19/2023] Open
Abstract
While accumulating evidence implied the involvement of retro-nasal sensation in the consumption of nonvolatile taste compounds, it is still unclear whether it was caused by the taste compounds themselves, and if so, how can they migrate from the oral to nasal cavity. At first, we proposed aerosol particles as an alternative oral-nasal mass transfer mechanism. The high-speed camera approved that aerosol particles could be generated by the typical oral and pharynx actions during food oral processing; while the narrow-band imaging of nasal cleft and mass spectrometry of nostril-exhaled air approved the migration of aerosol within the oral-nasal route. Then, the "smelling" of taste compounds within the aerosol particles was testified. The four-alternative forced choices (4AFC) approved that the potential volatile residues or contaminants within the headspace air of pure taste solution cannot arouse significant smell, while the taste compounds embedded in the in vitro prepared aerosol particles can be "smelled" via the ortho route. The "smell" of sucrose is very different from its taste and the "smell" of quinine, implying its actual olfaction. The sweetness intensity of sucrose solution was also reduced when the volunteers' noses were clipped, indicating the involvement of retro-nasal sensation during its drinking. At last, the efficiency of aerosol as a mechanism of oral-nasal mass transfer was demonstrated to be comparable with the volatile molecules under the experimental condition, giving it the potential to be a substantial and unique source of retro-nasal sensation during food oral processing.
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Affiliation(s)
- Yue He
- Laboratory of Food Oral Processing, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Jianshe Chen
- Laboratory of Food Oral Processing, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Weiyao Shi
- EPC Natural Products Co., Ltd., Beijing, China
| | - Jingang Shi
- EPC Natural Products Co., Ltd., Beijing, China
| | - Tian Ma
- Laboratory of Food Oral Processing, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Xinmiao Wang
- Laboratory of Food Oral Processing, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
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So BPH, Chan TTC, Liu L, Yip CCK, Lim HJ, Lam WK, Wong DWC, Cheung DSK, Cheung JCW. Swallow Detection with Acoustics and Accelerometric-Based Wearable Technology: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:170. [PMID: 36612490 PMCID: PMC9819201 DOI: 10.3390/ijerph20010170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
Swallowing disorders, especially dysphagia, might lead to malnutrition and dehydration and could potentially lead to fatal aspiration. Benchmark swallowing assessments, such as videofluoroscopy or endoscopy, are expensive and invasive. Wearable technologies using acoustics and accelerometric sensors could offer opportunities for accessible and home-based long-term assessment. Identifying valid swallow events is the first step before enabling the technology for clinical applications. The objective of this review is to summarize the evidence of using acoustics-based and accelerometric-based wearable technology for swallow detection, in addition to their configurations, modeling, and assessment protocols. Two authors independently searched electronic databases, including PubMed, Web of Science, and CINAHL. Eleven (n = 11) articles were eligible for review. In addition to swallowing events, non-swallowing events were also recognized by dry (saliva) swallowing, reading, yawning, etc., while some attempted to classify the types of swallowed foods. Only about half of the studies reported that the device attained an accuracy level of >90%, while a few studies reported poor performance with an accuracy of <60%. The reviewed articles were at high risk of bias because of the small sample size and imbalanced class size problem. There was high heterogeneity in assessment protocol that calls for standardization for swallowing, dry-swallowing and non-swallowing tasks. There is a need to improve the current wearable technology and the credibility of relevant research for accurate swallowing detection before translating into clinical screening for dysphagia and other swallowing disorders.
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Affiliation(s)
- Bryan Pak-Hei So
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Tim Tin-Chun Chan
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Liangchao Liu
- Physical Education Department, University of International Business and Economics, Beijing 100029, China
| | | | - Hyo-Jung Lim
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Wing-Kai Lam
- Sports Information and External Affairs Centre, Hong Kong Sports Institute, Hong Kong
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Daphne Sze Ki Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
- Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
- Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong
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5
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Shen Z, Hou Y, Huerman A, Ma A. Patients with dysphagia: How to supply nutrition through non-tube feeding. Front Nutr 2022; 9:1060630. [PMID: 36532550 PMCID: PMC9757495 DOI: 10.3389/fnut.2022.1060630] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/17/2022] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVE Dysphagia has become one of the important factors that cause malnutrition in the whole age group. At present, tube feeding is still the mainstream means to solve the problem of dysphagia. However, tube feeding has physical and mental harm to people, and the ways of non-tube feeding are relatively diversified. The significance of the thickening mechanism described in some articles to solve the problem of dysphagia is not clear. SETTING AND PARTICIPANTS All patients with dysphagia worldwide, including oropharyngeal dysphagia (OD) and non-oropharyngeal dysphagia. METHODS We searched the literature in Pubmed, Web of Science and Cochrane Library and initially browsed the titles and abstracts. We reviewed the full text of the articles that met our topic, and the language of the article was limited to English. RESULTS We found that food thickening to a certain degree (350-1,750 cP) can reduce the complications of choking, aspiration, reflux, and other complications in patients with dysphagia, and reduce the social disorder, anxiety, and other psychological problems caused by catheterization and surgery. Significantly, food science engineers should invite clinicians to intervene in the development of specialty foods from different perspectives such as clinical pathophysiology and fluid mechanics. CONCLUSION AND IMPLICATIONS It is necessary to develop special foods for patients with dysphagia, which requires scientists from different disciplines to work together.
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Affiliation(s)
- Zhean Shen
- College of Food Science and Engineering, Xinjiang Institute of Technology, Aksu, China
- Nutritional Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
| | - Yingze Hou
- Sanquan College, Xinxiang Medical University, Xinxiang, China
| | - Ayideng Huerman
- College of Food Science and Engineering, Xinjiang Institute of Technology, Aksu, China
| | - Aiqin Ma
- Nutritional Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
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6
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Badia‐Olmos C, Laguna L, Rizo A, Tárrega A. Dysphagia thickeners in context of use. Changes in thickened drinks’ viscosity and thixotropy with temperature and time of consumption. J Texture Stud 2022; 53:383-395. [PMID: 35434781 PMCID: PMC9321890 DOI: 10.1111/jtxs.12685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/23/2022] [Accepted: 04/06/2022] [Indexed: 11/27/2022]
Abstract
Dysphagia patients might need to thicken drinks. The viscosity of these thickened drinks varies among commercial thickeners and drinks compromising the ingesta safety. The aim of this study was to investigate how temperature and resting time affect the rheological properties of thickened drinks. Four commercial thickeners were used to thicken water, coffee, orange juice, and milk at two concentration levels used in dysphagia drinks (nectar and pudding). To study the effect of temperature, flow curves of thickened drinks at 10°C and 50°C were obtained and to study the effect of resting time, flow curves of thickened drinks at 25°C were obtained at different times (0, 30, and 60 min). All samples displayed shear‐thinning and time‐dependent behavior (thixotropy or antithixotropy). The effect of temperature on viscosity values and relative thixotropic area (RTA) depended on the thickener and the drink. Overall, apparent viscosity showed higher values at 50°C than 10°C, especially in thickeners containing starch and in drinks with higher soluble solids (milk and orange juice). This was attributed to the water absorption of pregelatinized starch granules favored by temperature. Antithixotropy was mainly observed at pudding concentration for the starch‐containing thickeners, and decreased with temperature. The effect of resting time on apparent viscosity and RTA depended also on the drink and thickener. Mostly, apparent viscosity values increased with resting time and antithixotropic behavior decreased. Both effects, increase in viscosity and decrease of antithixotropy with time, indicated that thickening action was being developed over the resting time.
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Affiliation(s)
- Celia Badia‐Olmos
- Instituto de Agroquímica y Tecnología de los Alimentos (IATA, CSIC), Agustín Escardino Benlloch 7 Valencia Spain
| | - Laura Laguna
- Instituto de Agroquímica y Tecnología de los Alimentos (IATA, CSIC), Agustín Escardino Benlloch 7 Valencia Spain
| | - Arantxa Rizo
- Instituto de Agroquímica y Tecnología de los Alimentos (IATA, CSIC), Agustín Escardino Benlloch 7 Valencia Spain
| | - Amparo Tárrega
- Instituto de Agroquímica y Tecnología de los Alimentos (IATA, CSIC), Agustín Escardino Benlloch 7 Valencia Spain
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7
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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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8
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Himashree P, Sengar AS, Sunil CK. Food thickening agents: Sources, chemistry, properties and applications - A review. Int J Gastron Food Sci 2022. [DOI: 10.1016/j.ijgfs.2022.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Methacanon P, Gamonpilas C, Kongjaroen A, Buathongjan C. Food polysaccharides and roles of rheology and tribology in rational design of thickened liquids for oropharyngeal dysphagia: A review. Compr Rev Food Sci Food Saf 2021; 20:4101-4119. [PMID: 34146451 DOI: 10.1111/1541-4337.12791] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 01/02/2023]
Abstract
In today's market environment, an aging society is recognized as one of the megatrends in the world. The demographic change in the world population age structure has driven a huge demand in healthcare products as well as services that include the technological innovation for the health and wellness of the elderly. Dysphagia or swallowing difficulty is a common problem in the elderly as many changes in swallowing function come with aging. The presence of a strong relationship between swallowing ability, nutritional status, and health outcomes in the elderly leads to the importance of dysphagia management in the population group. Modification of solid food and/or liquid is a mainstay of compensatory intervention for dysphagia patients. In this regard, texture-modified foods are generally provided to reduce risks associated with choking, while thickened liquids are recommended for mitigating risks associated with aspiration. In this review, we discuss thickened liquids and other issues including the importance of their rheological and tribological properties for oropharyngeal dysphagia management in the elderly. The review focuses on both commercial thickeners that are either based on modified starch or xanthan gum and other potential polysaccharide alternatives, which have been documented in the literature in order to help researchers develop or improve the characteristic properties of thickened liquids required for safe swallowing. Furthermore, some research gaps and future perspectives, particularly from the nutrition aspect related to the interaction between thickeners and other food ingredients, are suggested as such interaction may considerably control the rate of nutrient absorption and release within our body.
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Affiliation(s)
- Pawadee Methacanon
- Advanced Polymer Technology Research Group, National Metal and Materials Technology Center (MTEC), NSTDA, Klong Luang, Pathumthani, Thailand
| | - Chaiwut Gamonpilas
- Advanced Polymer Technology Research Group, National Metal and Materials Technology Center (MTEC), NSTDA, Klong Luang, Pathumthani, Thailand
| | - Akapong Kongjaroen
- Advanced Polymer Technology Research Group, National Metal and Materials Technology Center (MTEC), NSTDA, Klong Luang, Pathumthani, Thailand
| | - Chonchanok Buathongjan
- Advanced Polymer Technology Research Group, National Metal and Materials Technology Center (MTEC), NSTDA, Klong Luang, Pathumthani, Thailand
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Raheem D, Carrascosa C, Ramos F, Saraiva A, Raposo A. Texture-Modified Food for Dysphagic Patients: A Comprehensive Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5125. [PMID: 34066024 PMCID: PMC8150365 DOI: 10.3390/ijerph18105125] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/30/2021] [Accepted: 05/08/2021] [Indexed: 12/16/2022]
Abstract
Food texture is a major food quality parameter. The physicochemical properties of food changes when processed in households or industries, resulting in modified textures. A better understanding of these properties is important for the sensory and textural characteristics of foods that target consumers of all ages, from children to the elderly, especially when food product development is considered for dysphagia. Texture modifications in foods suitable for dysphagic patients will grow as the numbers of elderly citizens increase. Dysphagia management should ensure that texture-modified (TM) food is nutritious and easy to swallow. This review addresses how texture and rheology can be assessed in the food industry by placing particular emphasis on dysphagia. It also discusses how the structure of TM food depends not only on food ingredients, such as hydrocolloids, emulsifiers, and thickening and gelling agents, but also on the applied processing methods, including microencapsulation, microgels as delivery systems, and 3D printing. In addition, we address how to modify texture for individuals with dysphagia in all age groups, and highlight different strategies to develop appropriate food products for dysphagic patients.
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Affiliation(s)
- Dele Raheem
- Northern Institute for Environmental and Minority Law (NIEM), Arctic Centre, University of Lapland, 96101 Rovaniemi, Finland;
| | - Conrado Carrascosa
- Department of Animal Pathology and Production, Bromatology and Food Technology, Faculty of Veterinary, Universidad de Las Palmas de Gran Canaria, Trasmontaña s/n, 35413 Arucas, Spain;
| | - Fernando Ramos
- Pharmacy Faculty, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal;
- REQUIMTE/LAQV, R. D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
| | - Ariana Saraiva
- Department of Animal Pathology and Production, Bromatology and Food Technology, Faculty of Veterinary, Universidad de Las Palmas de Gran Canaria, Trasmontaña s/n, 35413 Arucas, Spain;
| | - António Raposo
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal
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Hadde EK, Chen J. Texture and texture assessment of thickened fluids and texture-modified food for dysphagia management. J Texture Stud 2020; 52:4-15. [PMID: 33155674 DOI: 10.1111/jtxs.12567] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 12/19/2022]
Abstract
Thickened fluids and texture-modified foods are commonly used in the medical management of individuals who suffer from swallowing difficulty (known as dysphagia). However, how to reliably assess texture properties of such food systems is still a big challenge both to industry and to academic researchers. This article aims to identify key physical parameters that are important for objective assessment of such properties by reviewing the significance of rheological or textural properties of thickened fluids and texture-modified foods for swallowing. Literature reviews have identified that dominating textural properties in relation to swallowing could be very different for thickened fluids and for texture-modified foods. Important parameters of thickened fluids are generally related with the flow of the bolus in the pharyngeal stage, while important parameters of texture-modified foods are generally related with the bolus preparation in the oral stage as well as the bolus flow in the pharyngeal stage. This review helps to identify key textural parameters of thickened fluids and texture-modified foods in relation to eating and swallowing and to develop objective measuring techniques for quality control of thickened fluids and texture-modified foods for dysphagia management.
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Affiliation(s)
- Enrico K Hadde
- Lab of Food Oral Processing, School of Food Science and Biotechnology, Zhejiang Gongshang University, Zhejiang, Hangzhou, China
| | - Jianshe Chen
- Lab of Food Oral Processing, School of Food Science and Biotechnology, Zhejiang Gongshang University, Zhejiang, Hangzhou, China
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12
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Álvarez G, Dias FJ, Lezcano F, Arias A, Navarro P, Fuentes R. Description of tongue movements on swallowing patterns. Arch Oral Biol 2020; 113:104706. [PMID: 32199154 DOI: 10.1016/j.archoralbio.2020.104706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/25/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the different swallowing patterns regarding tongue movement during saliva swallowing in healthy participants. DESIGN Seventeen participants (23.0 ± 3.6 years old) were included in this cross-sectional study. The movement of the tongue (anterior, middle and posterior portions) on the three axes of space (inferior-superior, anterior-posterior and medial-lateral) was recorded using a 3D electromagnetic articulograph. The tongue movement patterns registered during saliva swallowing were classified according to Bourdiol et al. (2014) into Type I, II or III. RESULTS Three swallowing patterns were identified (Type I, 64.7 %; Type II, 5.9 %; and Type III, 29.4 %). On the anterior-posterior axis, the displacement of the three portions of the tongue was significantly higher in Type III pattern compared with the Type I pattern. Furthermore, on the superior-inferior axis, the displacement of the anterior portion was significantly higher in Type III pattern compared with Type I pattern. In Type I pattern, on the inferior-superior axis, the smallest range of displacement occurred in the anterior portion of the tongue, followed by the middle and, finally, the posterior portion. In the analysis of Type III swallowing pattern, no significant differences were found on the range of displacement of the tongue portions on the three axes. CONCLUSION Statistical differences were found between swallowing patterns Type I and III regarding tongue movement. The frequency of pattern II found in the participants of this study was not high enough to compare the three patterns. However, the results obtained indicate that the methodology applied could be used to identify the patterns based on quantitative data.
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Affiliation(s)
- Giannina Álvarez
- Research Centre in Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile
| | - Fernando José Dias
- Research Centre in Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile; Department of Integral Adults Dentistry, Dental School, Universidad de La Frontera, Temuco, Chile
| | - Florencia Lezcano
- Research Centre in Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile; Department of Integral Adults Dentistry, Dental School, Universidad de La Frontera, Temuco, Chile
| | - Alain Arias
- Research Centre in Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile; Department of Integral Adults Dentistry, Dental School, Universidad de La Frontera, Temuco, Chile; Research Group of Health Sciences, Faculty of Health Sciences, Universidad Adventista de Chile, Chillán, Chile
| | - Pablo Navarro
- Research Centre in Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile; Universidad Autónoma de Chile, Chile
| | - Ramón Fuentes
- Research Centre in Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile; Department of Integral Adults Dentistry, Dental School, Universidad de La Frontera, Temuco, Chile.
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13
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Qazi WM, Ekberg O, Wiklund J, Mansoor R, Stading M. Simultaneous X-ray Video-Fluoroscopy and Pulsed Ultrasound Velocimetry Analyses of the Pharyngeal Phase of Swallowing of Boluses with Different Rheological Properties. Dysphagia 2020; 35:898-906. [PMID: 32048021 PMCID: PMC7669789 DOI: 10.1007/s00455-020-10092-4] [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: 04/06/2019] [Accepted: 01/30/2020] [Indexed: 12/02/2022]
Abstract
The Ultrasound Velocity Profiling (UVP) technique allows real-time, non-invasive flow mapping of a fluid along a 1D-measuring line. This study explores the possibility of using the UVP technique and X-ray video-fluoroscopy (XVF) to elucidate the deglutition process with the focus on bolus rheology. By positioning the UVP probe so that the pulsed ultrasonic beam passes behind the air-filled trachea, the bolus flow in the pharynx can be measured. Healthy subjects in a clinical study swallowed fluids with different rheological properties: Newtonian (constant shear viscosity and non-elastic); Boger (constant shear viscosity and elastic); and shear thinning (shear rate-dependent shear viscosity and elastic). The results from both the UVP and XVF reveal higher velocities for the shear thinning fluid, followed by the Boger and the Newtonian fluids, demonstrating that the UVP method has equivalent sensitivities for detecting the velocities of fluids with different rheological properties. The velocity of the contraction wave that clears the pharynx was measured in the UVP and found to be independent of bolus rheology. The results show that UVP not only assesses accurately the fluid velocity in a bolus flow, but it can also monitor the structural changes that take place in response to a bolus flow, with the added advantage of being a completely non-invasive technique that does not require the introduction of contrast media.
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Affiliation(s)
- Waqas M Qazi
- Agrifood and Bioscience, Product Design and Perception, RISE, Research Institutes of Sweden AB, Göteborg, Sweden. .,Department of Industrial and Material Sciences, Chalmers University of Technology, Göteborg, Sweden.
| | - Olle Ekberg
- Diagnostic Centre of Imaging and Functional Medicine, Skåne University Hospital, Lund, Sweden
| | - Johan Wiklund
- Incipientus Ultrasound Flow Technologies AB, Frans Perssons Väg 6, 412 76, Göteborg, Sweden
| | - Rashid Mansoor
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Mats Stading
- Agrifood and Bioscience, Product Design and Perception, RISE, Research Institutes of Sweden AB, Göteborg, Sweden.,Department of Industrial and Material Sciences, Chalmers University of Technology, Göteborg, Sweden
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14
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Munialo CD, Kontogiorgos V, Euston SR, Nyambayo I. Rheological, tribological and sensory attributes of texture‐modified foods for dysphagia patients and the elderly: A review. Int J Food Sci Technol 2020. [DOI: 10.1111/ijfs.14483] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | - Vassilis Kontogiorgos
- Department of Biological Sciences School of Applied Sciences University of Huddersfield UK
| | - Stephen R. Euston
- Institute of Mechanical, Process & Energy Engineering School of Engineering & Physical Sciences Heriot‐Watt University Edinburgh UK
| | - Isabella Nyambayo
- School of Life Sciences Coventry University Priory Street Coventry CV1 5FB UK
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15
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Hadde EK, Cichero JAY, Zhao S, Chen W, Chen J. The Importance of Extensional Rheology in Bolus Control during Swallowing. Sci Rep 2019; 9:16106. [PMID: 31695062 PMCID: PMC6834566 DOI: 10.1038/s41598-019-52269-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/10/2019] [Indexed: 11/16/2022] Open
Abstract
Thickened fluids are commonly used in the medical management of individuals who suffer swallowing difficulty (known as dysphagia). Previous studies have shown that the rheological properties of a liquid affect the flow behavior of the bolus in swallowing, such as pharyngeal transit time. While there is no doubt that shear rheology is a highly important factor for bolus flow, it is suspected that extensional properties of a liquid bolus also plays an important role in swallowing, due to elongation of the bolus as it flows through the oropharynx. Our aim in this work was to observe the effect of extensional viscosity on pharyngeal transit time and elongation of the bolus during swallowing. Eight samples of thickened liquid barium that were shear-controlled, but varied in extensional viscosity and two samples that were extensional-controlled, but varied in shear viscosity were swallowed by eight healthy individuals. Data were collected under lateral view of videofluoroscopy swallow study (VFSS); measures of pharyngeal transit time and the ratio of the length to the width of the bolus on the frame of Upper Esophageal Sphincter (UES) opening were taken from the VFSS recordings. It was observed that the pharyngeal transit time generally increases when the fluids are thickened to higher IDDSI consistency. Additionally, higher extensional viscosity fluids reduced the elongation of the bolus during swallowing, thus potentially reducing the risk of post-swallow residue due to bolus breakage. This study confirmed the relevance of the extensional viscosity of the bolus in swallowing.
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Affiliation(s)
- Enrico Karsten Hadde
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China.
| | | | - Shaofeng Zhao
- The 1st Affiliated Hospital of Soochow University, Suzhou, China.,The Eight Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Wei Chen
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Jianshe Chen
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
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16
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Marim GC, Machado BCZ, Trawitzki LVV, de Felício CM. Tongue strength, masticatory and swallowing dysfunction in patients with chronic temporomandibular disorder. Physiol Behav 2019; 210:112616. [DOI: 10.1016/j.physbeh.2019.112616] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/03/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
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17
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Biting force and tongue muscle strength as useful indicators for eating and swallowing capability assessment among elderly patients. FOOD SCIENCE AND HUMAN WELLNESS 2019. [DOI: 10.1016/j.fshw.2019.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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18
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A review of the approaches to predict the ease of swallowing and post-swallow residues. Trends Food Sci Technol 2019. [DOI: 10.1016/j.tifs.2019.02.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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19
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Stading M, Waqas MQ, Holmberg F, Wiklund J, Kotze R, Ekberg O. A Device that Models Human Swallowing. Dysphagia 2019; 34:615-626. [PMID: 30673839 PMCID: PMC6717600 DOI: 10.1007/s00455-018-09969-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 12/31/2018] [Indexed: 11/02/2022]
Abstract
The pharynx is critical for correct swallowing, facilitating the transport of both air and food transport in a highly coordinated manner, and aberrant co-ordination causes swallowing disorders (dysphagia). In this work, an in vitro model of swallowing was designed to investigate the role of rheology in swallowing and for use as a pre-clinical tool for simulation of different routes to dysphagia. The model is based on the geometry of the human pharynx. Manometry is used for pressure measurements and ultrasonic analysis is performed to analyze the flow profiles and determine shear rate in the bolus, the latter being vital information largely missing in literature. In the fully automated model, bolus injection, epiglottis/nasopharynx movement, and ultrasound transducer positioning can be controlled. Simulation of closing of the airways and nasal cavity is modulated by the software, as is a clamping valve that simulates the upper esophageal sphincter. The actions can be timed and valves opened to different degrees, resembling pathologic swallowing conditions. To validate measurements of the velocity profile and manometry, continuous and bolus flow was performed. The respective velocity profiles demonstrated the accuracy and validity of the flow characterization necessary for determining bolus flow. A maximum bolus shear rate of 80 s-1 was noted for syrup-consistency fluids. Similarly, the manometry data acquired compared very well with clinical studies.
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Affiliation(s)
- M Stading
- Agrifood and Bioscience Product Design and Perception, RISE Research Institutes of Sweden AB, Göteborg, Sweden. .,Department of Industrial and Material Sciences, Chalmers University of Technology, Göteborg, Sweden.
| | - M Q Waqas
- Agrifood and Bioscience Product Design and Perception, RISE Research Institutes of Sweden AB, Göteborg, Sweden.,Department of Industrial and Material Sciences, Chalmers University of Technology, Göteborg, Sweden
| | - F Holmberg
- Animato Konstruktions AB, Domsjö, Sweden
| | - J Wiklund
- Agrifood and Bioscience Product Design and Perception, RISE Research Institutes of Sweden AB, Göteborg, Sweden
| | - R Kotze
- Agrifood and Bioscience Product Design and Perception, RISE Research Institutes of Sweden AB, Göteborg, Sweden
| | - O Ekberg
- Diagnostic Centre of Imaging and Functional Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
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20
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Perry BJ, Martino R, Yunusova Y, Plowman EK, Green JR. Lingual and Jaw Kinematic Abnormalities Precede Speech and Swallowing Impairments in ALS. Dysphagia 2018; 33:840-847. [PMID: 29774424 PMCID: PMC6244810 DOI: 10.1007/s00455-018-9909-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 05/10/2018] [Indexed: 11/18/2022]
Abstract
Early identification of bulbar involvement in persons with ALS is critical for improving diagnosis and prognosis; however, efficacious diagnostic markers have not yet been identified. The purpose of this study was to determine whether kinematic changes of the tongue and jaw during swallowing, measured using 3D electromagnetic articulography (EMA), predate clinically identifiable symptoms of speech and swallowing impairment in persons diagnosed with ALS. Data were collected from 16 adults diagnosed with ALS and 18 neurotypical controls. Groups were aged matched. Eligible participants with ALS were tolerating an unrestricted diet (FOIS = 7), produced intelligible speech (> 97%), and had a speaking rate greater than 150 words per minute. Participants completed a 3-mL water swallow task, during which EMA recorded kinematic measures of the anterior and posterior regions of tongue including lingual speed, range of motion, duration, coordination, and efficiency. Jaw speed and range of motion were also recorded. Persons diagnosed with ALS demonstrated reduced posterior lingual range of motion (11.40 mm ± 4.01 vs. 16.07 mm ± 5.27), slower posterior lingual speeds (83.67 mm/s ± 47.96 vs. 141.35 mm/s ± 66.54), increased lingual movement duration (13.46 s ± 6.75 vs. 9.21 s ± 3.28), and reduced lingual coordination (0.04 s ± 0.11 vs. 17 s ± 0.19) during the 3-oz water swallow task compared to controls. Persons diagnosed with ALS demonstrated increased range of motion (9.86 mm ± 5.38 vs. 6 mm ± 3.78) and increased jaw speed (68.62 mm/s ± 50.13 vs. 34.72 mm/s ± 17.75) during swallowing compared to controls. The current findings suggest that changes in lingual and jaw motor performance during a simple water swallow task are present in persons with ALS who are pre-symptomatic of clinically detectable bulbar impairment.
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Affiliation(s)
- Bridget J Perry
- MGH Institute of Health Professions, 79/96 13th Street, Charlestown, MA, 02109, USA
| | - Rosemary Martino
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- University Health Network - Toronto Rehabilitation Institute, Toronto, Canada
- Biological Sciences, Sunnybrook Research Institute, 160-500 University Ave, Toronto, ON, M5G1V7, Canada
| | - Emily K Plowman
- Swallowing Systems Core, University of Florida, Gainesville, FL, USA
- Department of Speech-Language Hearing Sciences and Neurology, University of Florida, Gainesville, FL, 32610, USA
| | - Jordan R Green
- MGH Institute of Health Professions, 79/96 13th Street, Charlestown, MA, 02109, USA.
- Program in Speech and Hearing Bioscience and Technology, Harvard University, 260 Longwood Avenue, Boston, MA, 02115, USA.
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21
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Fassicollo CE, Machado BCZ, Garcia DM, de Felício CM. Swallowing changes related to chronic temporomandibular disorders. Clin Oral Investig 2018; 23:3287-3296. [PMID: 30488118 DOI: 10.1007/s00784-018-2760-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/22/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate whether chronic temporomandibular disorder (TMD) patients showed any changes in swallowing compared to a control group. Moreover, it was examined whether swallowing variables and a valid clinic measure of orofacial myofunctional status were associated. MATERIAL AND METHODS Twenty-three patients with chronic TMD, diagnosed with disc displacement with reduction (DDR) and pain, according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), and 27 healthy volunteers (control group) were compared. Surface electromyography (EMG) of the temporalis, masseter, sternocleidomastoid, and suprahyoid muscles was performed during swallowing tasks of thin liquid (10 and 15 mL) and spontaneous saliva. Data were normalized. RESULTS Compared to the control group, TMD patients showed a prolonged duration of swallowing for liquid and saliva and required a longer time to reach the activity peak and half the integral. While the overall mean value of the relative peaks was similar for the groups, the suprahyoid peak was significantly lower in the TMD group during swallowing of liquid. Moreover, TMD patients recruited the jaw elevator muscles proportionally more than controls. The orofacial myofunctional status was moderately correlated with EMG parameters. CONCLUSION Patients with chronic TMD showed temporal prolongation and changes in the relative activity of the muscles during the swallowing tasks. CLINICAL RELEVANCE The present results contribute additional evidence regarding the reorganization of muscle activity in patients with chronic TMD.
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Affiliation(s)
- Carlos Eduardo Fassicollo
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery School of Medicine of Ribeirão Preto, University of São Paulo - USP, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | | | - Denny Marcos Garcia
- Craniofacial Research Support Center, University of São Paulo - USP, Ribeirão Preto, SP, Brazil
| | - Cláudia Maria de Felício
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery School of Medicine of Ribeirão Preto, University of São Paulo - USP, Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil.
- Craniofacial Research Support Center, University of São Paulo - USP, Ribeirão Preto, SP, Brazil.
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22
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Álvarez G, Dias FJ, Lezcano MF, Arias A, Fuentes R. A Novel Three-Dimensional Analysis of Tongue Movement During Water and Saliva Deglutition: A Preliminary Study on Swallowing Patterns. Dysphagia 2018; 34:397-406. [PMID: 30382383 PMCID: PMC6548866 DOI: 10.1007/s00455-018-9953-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/20/2018] [Indexed: 10/31/2022]
Abstract
Deglutition is a complex oral function, and the study of the whole process requires a precise analysis of the elements involved, especially of the tongue biomechanics. We described a three-dimensional analysis of tongue movements during both saliva and water deglutition in participants with normal occlusion. Fourteen participants (25.36 ± 4.85 years) were evaluated, and the movements of anterior, middle, and posterior portions of the tongue were recorded using AG501 3D-electromagnetic articulograph. An average volume (AVS) for water deglutition was determined for each participant. Saliva deglutition was classified according to Bourdiol et al. 35.71% was type I, 14.29% type II, and 50% type III. The greatest displacement on the inferior-superior axis was in the posterior portion, followed by the middle and anterior portions. In the posterior-anterior axis, smallest movement was in the anterior portion. During water deglutition, on the inferior-superior axis, there were statistical differences for 1-AVS between the anterior/middle and anterior/posterior portions of the tongue. There were statistical differences for both ½-AVS and ¼-AVS between the anterior/posterior portions of the tongue. On the posterior-anterior axis, there were no statistical differences among any volume-portion relations. On the medial-lateral axis, there was statistical difference for the ½-AVS between middle and posterior portions. The movement of the tongue portions was influenced by the volume and the element to be swallowed. The amplitude of the movement was directly proportional to the volume of water swallowed.
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Affiliation(s)
- Giannina Álvarez
- Master's Program in Dentistry, Dental School, Universidad de La Frontera, Temuco, Chile
| | - Fernando José Dias
- Department of Integral Adults Dentistry, Research Centre for Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile
| | - María Florencia Lezcano
- Department of Integral Adults Dentistry, Research Centre for Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile
| | - Alain Arias
- Department of Integral Adults Dentistry, Research Centre for Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile
- Universidad Adventista de Chile, Chillán, Chile
| | - Ramón Fuentes
- Department of Integral Adults Dentistry, Research Centre for Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile.
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23
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Sukkar SG, Maggi N, Travalca Cupillo B, Ruggiero C. Optimizing Texture Modified Foods for Oro-pharyngeal Dysphagia: A Difficult but Possible Target? Front Nutr 2018; 5:68. [PMID: 30131962 PMCID: PMC6090051 DOI: 10.3389/fnut.2018.00068] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/17/2018] [Indexed: 11/21/2022] Open
Abstract
Dysphagia is a swallowing disorder characterized by the difficulty in transferring solid foods and/or liquids from the oral cavity to the stomach, imparing autonomous, and safe oral feeding. The main problems deriving from dysphagia are tracheo-bronchial aspiration, aspiration pneumonia, malnutrition and dehydration. In order to overcome dysphagia-induced problems, over the years water and food thickening has been used, focusing specifically on viscosity increase, but limited results have been obtained. Elastic components and their effects on the cohesiveness on the bolus should be taken into account in the first place. We provide an analysis of dysphagia and suggest possible corrections to the protocols which are being used at present, taking into account rheological properties of food and the effect of saliva on the bolus. We reckon that considering such aspects in the dysphagia management market and healthcare catering would result in significant clinical risk reduction.
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Affiliation(s)
- Samir G Sukkar
- Clinical Nutrition Unit, IRCCS Ospedale Policlinico San Martino di Genova, Genova, Italy
| | - Norbert Maggi
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genova, Genova, Italy
| | | | - Carmelina Ruggiero
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genova, Genova, Italy
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24
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A review of diet standardization and bolus rheology in the management of dysphagia. Curr Opin Otolaryngol Head Neck Surg 2018; 24:183-90. [PMID: 26900822 DOI: 10.1097/moo.0000000000000251] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Texture modification is a widespread practice as a strategy for the management of dysphagia and can be very effective in individual cases. However, it is often performed in a qualitative, subjective manner and practices vary internationally according to multiple sets of national guidelines. This article aims to identify best practice by reviewing the theory and practice of texture modification, focussing on recent advances. RECENT FINDINGS Instrumental assessment of texture modification in vivo is challenging, and studies including rheology and perception have indicated that fluid viscosity is only one of many factors affecting texture modification in practice. Systematic reviews have identified a historical lack of high-quality clinical evidence, but recent controlled studies are beginning to identify positive and negative aspects of thickened fluids. Research and practice to date have been limited by the lack of control and standardization of foods and drinks. However in 2015 a not-for-profit organization, the International Dysphagia Diet Standardisation Initiative, has published a framework for texture modification from thin liquids to solid foods based on all the existing documentation and guidance, and the - limited - available clinical evidence. SUMMARY Rheology exists in the lab; however, normal practice is often subjective or lacking control and standardization. In the near future, cohesion of practice and the availability of practical standardization tools may increase awareness and use of rheology.
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25
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Chambers E, Jenkins A, Mertz Garcia J. Sensory texture analysis of thickened liquids during ingestion. J Texture Stud 2017; 48:518-529. [DOI: 10.1111/jtxs.12265] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/22/2016] [Accepted: 12/03/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Edgar Chambers
- Center for Sensory Analysis and Consumer Behavior; Kansas State University; Manhattan Kansas
| | | | - Jane Mertz Garcia
- Communication Sciences and Disorders; Kansas State University; Manhattan Kansas
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26
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Waqas MQ, Wiklund J, Altskär A, Ekberg O, Stading M. Shear and extensional rheology of commercial thickeners used for dysphagia management. J Texture Stud 2017; 48:507-517. [PMID: 28464563 DOI: 10.1111/jtxs.12264] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/24/2017] [Accepted: 02/23/2017] [Indexed: 11/28/2022]
Abstract
People who suffer from swallowing disorders, commonly referred to as dysphagia, are often restricted to a texture-modified diet. In such a diet, the texture of the fluid is modified mainly by the addition of gum or starch-based thickeners. For optimal modification of the texture, tunable rheological parameters are shear viscosity, yield stress, and elasticity. In this work, the flow properties of commercial thickeners obtained from major commercial suppliers were measured both in shear and extensional flow using a laboratory viscometer and a newly developed tube viscometry technique, termed Pulsed Ultrasound Velocimetry plus Pressure Drop (PUV + PD). The two methods gave similar results, demonstrating that the PUV + PD technique can be applied to study flow during the swallowing process in geometry similar to that of the swallowing tract. The thickeners were characterized in relation to extensional viscosity using the Hyperbolic Contraction Flow method, with microscopy used as a complementary method for visualization of the fluid structure. The gum-based thickeners had significantly higher extensional viscosities than the starch-based thickeners. The rheological behavior was manifested in the microstructure as a hydrocolloid network with dimensions in the nanometer range for the gum-based thickeners. The starch-based thickeners displayed a granular structure in the micrometer range. In addition, the commercial thickeners were compared to model fluids (Boger, Newtonian, and Shear-thinning) set to equal shear viscosity at 50/s and it was demonstrated that their rheological behavior could be tuned between highly elastic, extension-thickening to Newtonian. PRACTICAL APPLICATIONS Thickeners available for dysphagia management were characterized for extensional viscosity to improve the understanding of these thickeners in large scale deformation. Extensional deformation behavior was further explained by using microcopy as corresponding technique for better understanding of structure/rheology relationship. Moreover, the major challenge in capturing human swallowing process is the short transit times of the bolus flow (<1 s). Therefore, the ultrasound-based rheometry method; PUV+PD which measures the real-time flow curve in ∼50 ms was used in addition to classical shear rheometry. The two methods complimented each other indicating that the PUV+PD method can be applied to study the transient swallowing process which is part of our future research, where we are studying the flow properties of fluids in an in vitro swallowing tract.
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Affiliation(s)
- Muhammad Qazi Waqas
- SP - Food and Biosciences, Soft Materials Science, Gothenburg, Sweden.,Department of Materials and Manufacturing Technology, Chalmers University of Technology, Gothenburg, Sweden
| | - Johan Wiklund
- SP - Food and Biosciences, Soft Materials Science, Gothenburg, Sweden.,Department of Materials and Manufacturing Technology, Chalmers University of Technology, Gothenburg, Sweden
| | - Annika Altskär
- SP - Food and Biosciences, Soft Materials Science, Gothenburg, Sweden
| | - Olle Ekberg
- Diagnostic Centre of Imaging and Functional Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Mats Stading
- SP - Food and Biosciences, Soft Materials Science, Gothenburg, Sweden.,Department of Materials and Manufacturing Technology, Chalmers University of Technology, Gothenburg, Sweden
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27
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Nishinari K, Takemasa M, Brenner T, Su L, Fang Y, Hirashima M, Yoshimura M, Nitta Y, Moritaka H, Tomczynska-Mleko M, Mleko S, Michiwaki Y. The Food Colloid Principle in the Design of Elderly Food. J Texture Stud 2016. [DOI: 10.1111/jtxs.12201] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Katsuyoshi Nishinari
- Department of Food and Pharmaceutical Engineering, Glyn O Phillips Hydrocolloids Research Centre; Hubei University of Technology; Wuhan 430068 China
- Hubei Collaborative Innovation Centre for Industrial Fermentation; Hubei University of Technology; Wuhan 430068 China
| | - Makoto Takemasa
- School of Creative Science and Engineering; Waseda University; Tokyo 169-8555 Japan
| | - Tom Brenner
- Department of Materials and Life Sciences; Sophia University; Chiyoda-ku, Kioimachi 7-1 Tokyo 102-8554 Japan
| | - Lei Su
- Institute of Chemistry, Chinese Academy of Sciences; Zhongguancun North First Street 2 100190 Beijing China
| | - Yapeng Fang
- Department of Food and Pharmaceutical Engineering, Glyn O Phillips Hydrocolloids Research Centre; Hubei University of Technology; Wuhan 430068 China
- Hubei Collaborative Innovation Centre for Industrial Fermentation; Hubei University of Technology; Wuhan 430068 China
| | - Madoka Hirashima
- Faculty of Education; Mie University; 1577 Kurima-machiya-cho Tsu Mie 514-8507 Japan
| | - Miki Yoshimura
- School of Human Science and Environment; University of Hyogo; 1-1-12 Shinzaike-Honcho Himeji, Hyogo 670-0092 Hyogo Japan
| | - Yoko Nitta
- Graduate School of Health and Welfare Science; Okayama Prefectural University; 111 Kuboki Soja-shi Okayama 719-1197 Japan
| | - Hatsue Moritaka
- Graduate School of Human Life Science; Showa Women's University; 1-7 Taishido Setagaya-ku Tokyo 154-8533 Japan
| | - Marta Tomczynska-Mleko
- Institute of Plant Genetics, Breeding and Biotechnology; University of Life Sciences in Lublin; 15 Akademicka Street 20-950 Lublin Poland
| | - Stanisław Mleko
- Department of Milk Technology and Hydrocolloids; University of Life Sciences in Lublin; 8 Skromna Street 20-704 Lublin Poland
| | - Yukihiro Michiwaki
- Oral Surgery Division, Japanese Red Cross Musashino Hospital; Musashino-shi, Kyonancho, 1-26-1 Tokyo 180-8610 Japan
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Brossard N, Cai H, Osorio F, Bordeu E, Chen J. “Oral” Tribological Study on the Astringency Sensation of Red Wines. J Texture Stud 2016. [DOI: 10.1111/jtxs.12184] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Natalia Brossard
- School of Food Science and Biotechnology; Zhejiang Gongshang University; Hangzhou 310018 P.R. China
- Facultad de Agronomía e Ingeniería Forestal, Pontificia Universidad Católica de Chile; Chile
| | - Huifang Cai
- School of Food Science and Biotechnology; Zhejiang Gongshang University; Hangzhou 310018 P.R. China
| | - Fernando Osorio
- Department of Food Science and Technology; Universidad de Santiago de Chile; Chile
| | - Edmundo Bordeu
- Facultad de Agronomía e Ingeniería Forestal, Pontificia Universidad Católica de Chile; Chile
| | - Jianshe Chen
- School of Food Science and Biotechnology; Zhejiang Gongshang University; Hangzhou 310018 P.R. China
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