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Morishita M, Sota J, Kobayashi M. Effects of carbonated beverages on sustained swallowing behavior changes in older inpatients. Physiol Behav 2023; 265:114172. [PMID: 36965570 DOI: 10.1016/j.physbeh.2023.114172] [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: 08/31/2022] [Revised: 12/23/2022] [Accepted: 03/21/2023] [Indexed: 03/27/2023]
Abstract
Sensory stimulation, including stimulation with carbonated liquids, has been known to influence swallowing activity. The aim of this study is to determine the effect of sustained changes in the swallowing behavior of hospitalized patients without dysphagia using the cervical auscultatory recordings of swallowing sounds. The study participants were hospitalized older adults without dysphagia. The participants were asked to initially swallow water and then a carbonated beverage. The sustained effects of the carbonated beverage in relation to swallowing movements were evaluated by measuring the swallowing sounds at the following time periods: (1) immediately and (2) at 1 to 9 minutes with intervals of 2 minutes after swallowing the carbonated beverage. The swallowing sounds before and after swallowing the same volume of water were also measured and compared on a different day. Analysis was performed to calculate the time from a sound signal to the beginning of the swallowing sound. Significant shortening of the swallowing sound time of the late pharyngeal phase was observed up to 7 minutes after swallowing the carbonated beverage, except during the 3 minutes after swallowing. Shortening of the whole swallowing sound time was observed only immediately after swallowing the carbonated beverage. Regarding the shortening of the acoustic signal in the late pharyngeal period, the effect of cerebral excitability changes due to carbonic acid stimulation was considered.
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Affiliation(s)
- Motoyoshi Morishita
- Department of Physical Therapy, Kibi International University, 8, Iga-machi, Takahashi, Okayama 716-8508, Japan.
| | - Junya Sota
- Rehabilitation Center, Watanabe Hospital, Shiseikai Medical Corporation, 2278-1, Takao, Niimi, Okayama 718-0003, Japan
| | - Mariko Kobayashi
- Rehabilitation Center, Watanabe Hospital, Shiseikai Medical Corporation, 2278-1, Takao, Niimi, Okayama 718-0003, Japan
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2
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Mulheren R, Westemeyer RM, Dietsch AM. The effect of taste on swallowing: A scoping and systematic review. Crit Rev Food Sci Nutr 2022; 64:1256-1282. [PMID: 36036968 DOI: 10.1080/10408398.2022.2115003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Consuming foods and liquids for nutrition requires the coordination of several muscles. Swallowing is triggered and modified by sensory inputs from the aerodigestive tract. Taste has recently received attention as a potential modulator of swallowing physiology, function, and neural activation; additionally, taste impairment is a sequela of COVID-19. This review presents factors impacting taste and swallowing, systematically summarizes the existing literature, and assesses the quality of included studies. A search was conducted for original research including taste stimulation, deglutition-related measure(s), and human participants. Study design, independent and dependent variables, and participant characteristics were coded; included studies were assessed for quality and risk of bias. Forty-eight articles were included after abstract and full-text review. Synthesis was complicated by variable sensory components of stimuli (taste category and intensity, pure taste vs. flavor, chemesthesis, volume/amount, consistency, temperature), participant characteristics, confounding variables such as genetic taster status, and methods of measurement. Most studies had a high risk of at least one type of bias and were of fair or poor quality. Interpretation is limited by wide variability in methods, taste stimulation, confounding factors, and lower-quality evidence. Existing studies suggest that taste can modulate swallowing, but more rigorous and standardized research is needed.
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Affiliation(s)
- Rachel Mulheren
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ross M Westemeyer
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Angela M Dietsch
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
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3
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Michou E, Hamdy S. Reversal of the effects of focal suppression on pharyngeal corticobulbar tracts by chemesthesis coupled with repeated swallowing. Neurogastroenterol Motil 2022; 34:e14286. [PMID: 34729879 DOI: 10.1111/nmo.14286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/27/2021] [Accepted: 10/12/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Previous reports suggested the potential benefit of chemesthesis in the form of carbonated water (CW) integrated within dysphagia rehabilitation protocols. Here, we examined the effects of CW within a repeated swallowing protocol following focal suppression to pharyngeal cortical representation as a prelude to its application in dysphagic patients. METHODS Fourteen healthy volunteers participated in a 3-arm study. Each participant underwent baseline corticobulbar pharyngeal and thenar motor-evoked potential (MEP) measurements with Transcranial Magnetic Stimulation (TMS). Subjects were then conditioned with 1Hz repetitive (r)TMS to induce focal unilateral suppression of the corticopharyngeal hotspot before randomization to each of three arms with 40 swallows of CW, non-CW and saliva swallowing on separate days. Corticobulbar and thenar MEPs were collected for up to 1 h and analyzed using repeated measures (rm)ANOVA. RESULTS A 2-way rmANOVA for Intervention x Time showed a significant effect of Intervention (F(1,13) = 7.519, p = 0.017) in both ipsi- and contra-lesional corticopharyngeal projections. Carbonation showed superiority in facilitating change by increasing pharyngeal cortical MEPs compared to non-CW (z = -3.05, p = 0.002) and saliva swallowing (z = -2.6, p = 0.008). No change in thenar representation (control) was observed nor in MEP latencies from both pharyngeal and thenar musculature. CONCLUSIONS We conclude that interventional paradigms with CW have the capacity to reverse the effects of a focal suppression with 1Hz rTMS more strongly than non-CW or saliva swallowing alone, producing site specific bi-hemispheric changes in corticopharyngeal excitability. Our data suggest that carbonation produces the effects through a mainly cortical mechanism.
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Affiliation(s)
- Emilia Michou
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, Clinical Sciences Building, Salford Royal Hospital, University of Manchester, Salford, UK.,Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, Clinical Sciences Building, Salford Royal Hospital, University of Manchester, Salford, UK
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Nagano A, Maeda K, Shimizu A, Murotani K, Mori N. Effects of Carbonation on Swallowing: Systematic Review and Meta-Analysis. Laryngoscope 2022; 132:1924-1933. [PMID: 35038167 DOI: 10.1002/lary.30019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The effectiveness of the use of carbonation in preventing penetration/aspiration or enhancing swallowing function in adults remains unclear. This systematic review aimed to evaluate the effectiveness of carbonation on improving swallowing function in adult subjects. METHODS Literature published before March 2021 was inspected using MEDLINE, CINAHL, Web of Science Core Collection, The Cochrane Library, Cochrane Central Register of Controlled Trials, and Ichushi-web databases. We searched for intervention studies or randomized control trials considering the effects of carbonated liquids on swallowing function. The risk of bias was assessed using the Cochrane tool for assessing the risk of bias for randomized controlled trials and the Risk of Bias Assessment Tool for Nonrandomized Studies. RESULTS The systematic review identified 19 studies with a total of 586 participants. The effects of carbonation on swallowing function are diverse. Overall, most studies showed that carbonation promotes swallowing function compared to other liquids. Five studies were included in the quantitative synthesis. Meta-analysis showed that carbonated liquids prevent aspiration (risk difference [RD] -0.27%, 95% confidence interval [CI] -0.44 to -0.10; I2 = 0%; number needed to treat 3.8, 95% CI 2.2 to 15.0; moderate quality of evidence) when compared to noncarbonated thin liquids. Carbonated liquids also increased the duration of swallowing apnea than did noncarbonated liquids (standardized mean difference 0.25 (mean difference 0.36 seconds), 95% CI 0.03 to 0.47; I2 = 0%; low quality of evidence). CONCLUSIONS Carbonation had favorable effects on swallowing function. Further in-depth studies are needed to clarify the benefits of carbonation. LEVEL OF EVIDENCE NA Laryngoscope, 2022.
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Affiliation(s)
- Ayano Nagano
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Keisuke Maeda
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Akio Shimizu
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | | | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
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Cheng I, Sasegbon A, Hamdy S. A systematic review and meta-analysis of the effects of intraoral treatments for neurogenic oropharyngeal dysphagia. J Oral Rehabil 2021; 49:92-102. [PMID: 34800341 DOI: 10.1111/joor.13274] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/01/2021] [Accepted: 10/25/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rehabilitative treatments for oropharyngeal dysphagia, including oromotor exercises and sensory stimulation, have been widely adopted into clinical practice. However, the effects of these treatments are mainly supported by exploratory studies. As such, their clinical efficacy remains uncertain. OBJECTIVE Our systematic review and meta-analysis aimed to evaluate the efficacy of intraoral treatments for neurogenic oropharyngeal dysphagia based on evidence from randomised controlled trials (RCTs). METHODS Six electronic databases were systematically searched between January 1970 and July 2021. Data were extracted and analysed by two independent reviewers. The outcome measure was changes in (any) relevant clinical swallowing-related characteristics. RESULTS Data from 285 dysphagic patients were collected from 8 RCT studies across a range of intraoral dysphagia treatments. The pooled effect size of all intraoral dysphagia treatments was non-significant compared to control comparators (SMD [95%CI] = 0.23 [-0.22, 0.69], p = .31; I2 = 73%). Subgroup analysis revealed that the pooled effect sizes were also non-significant for oromotor exercises (device-facilitated lip resistance exercises and tongue exercises) (SMD [95%CI] = 0.11 [-0.76, 0.97]; p = .81; I2 = 88%) and sensory stimulation (thermal-tactile, thermo-chemical and electrical stimulation) (SMD [95%CI] = 0.35 [-0.03, 0.72]; p = .07; I2 = 0%). CONCLUSIONS Our results showed that overall, intraoral dysphagia treatments, including oromotor exercises and sensory stimulation, do not show beneficial effects for neurogenic oropharyngeal dysphagia. The evidence for these treatments remains weak and currently inadequate to support clinical use. Large-scale, multi-centre RCTs are warranted to fully explore their clinical efficacy.
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Affiliation(s)
- Ivy Cheng
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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6
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Metaplasticity in the human swallowing system: clinical implications for dysphagia rehabilitation. Neurol Sci 2021; 43:199-209. [PMID: 34654983 PMCID: PMC8724108 DOI: 10.1007/s10072-021-05654-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 10/05/2021] [Indexed: 02/03/2023]
Abstract
Dysphagia is a common and devastating complication following brain damage. Over the last 2 decades, dysphagia treatments have shifted from compensatory to rehabilitative strategies that facilitate neuroplasticity, which is the reorganization of neural networks that is essential for functional recovery. Moreover, there is growing interest in the application of cortical and peripheral neurostimulation to promote such neuroplasticity. Despite some preliminary positive findings, the variability in responsiveness toward these treatments remains substantial. The purpose of this review is to summarize findings on the effects of neurostimulation in promoting neuroplasticity for dysphagia rehabilitation and highlight the need to develop more effective treatment strategies. We then discuss the role of metaplasticity, a homeostatic mechanism of the brain to regulate plasticity changes, in helping to drive neurorehabilitation. Finally, a hypothesis on how metaplasticity could be applied in dysphagia rehabilitation to enhance treatment outcomes is proposed.
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7
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Shapira-Galitz Y, Levy A, Madgar O, Shpunt D, Zhang Y, Wang B, Wolf M, Drendel M. Effects of carbonation of liquids on penetration-aspiration and residue management. Eur Arch Otorhinolaryngol 2021; 278:4871-4881. [PMID: 34292401 PMCID: PMC8297430 DOI: 10.1007/s00405-021-06987-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/06/2021] [Indexed: 12/23/2022]
Abstract
Objective Carbonation as a sensory enhancement strategy for prevention of aspiration of thin liquids has not been thoroughly studied. The aim of our study was to examine the effect of carbonation on penetration–aspiration and pharyngeal residue in dysphagia patients using Fiber-Optic Endoscopic Evaluation of Swallowing (FEES) and to identify parameters associated with a response to carbonation. Methods A cross-sectional study of patients undergoing FEES in a dysphagia clinic. Patients were offered 100 cc of dyed water. Penetration–aspiration was scored using the penetration–aspiration scale (PAS). Residue was scored using the Yale Pharyngeal Residue Severity Rating Scale (YPR-SRS). Patients with a PAS ≥ 2 for water were subsequently offered 100 cc of carbonated water. PAS, YPR-SRS and residue clearance were compared between thin and carbonated liquids. Multivariate logistic regression analysis was used to identify predictors for good response to carbonation. Results 84 patients were enrolled, 77.4% males, with diverse dysphagia etiologies (58.3% neurogenic, 11.9% radiation-induced, 23.8% deconditioning-induced, and 6% neck surgery induced). Median PAS was 7 (IQR 4–8) for thin liquids and 4.5 (IQR 2–8) for carbonated liquids (P = 0.0001). YPR-SRS was reduced for carbonated compared to thin liquids in the vallecula (1.58 ± 0.83 vs 1.76 ± 0.93, P = 0.001) and piriform sinuses (1.5 ± 0.87 vs 1.67 ± 0.9, P = 0.002). 31 patients had improvement in PAS with carbonation. Deconditioning as a dysphagia etiology was found to predict good response to carbonation on multivariate logistic regression analysis. Conclusion Carbonation may prevent aspiration and improve residue management for some patients with dysphagia for liquids. Level of evidence IV.
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Affiliation(s)
- Yael Shapira-Galitz
- Otolaryngology-Head and Neck Surgery Department, Kaplan Medical Center, #1 Pasternak St., Rehovot, Israel. .,Hadassah School of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Audrey Levy
- The Hearing, Speech and Language Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Ory Madgar
- Otorhinolaryngology-Head and Neck Surgery Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dina Shpunt
- The Hearing, Speech and Language Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yan Zhang
- Division of Statistics, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Binhuan Wang
- Division of Statistics, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Michael Wolf
- Otorhinolaryngology-Head and Neck Surgery Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Drendel
- Otorhinolaryngology-Head and Neck Surgery Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hossain MZ, Ando H, Unno S, Kitagawa J. Targeting Chemosensory Ion Channels in Peripheral Swallowing-Related Regions for the Management of Oropharyngeal Dysphagia. Int J Mol Sci 2020; 21:E6214. [PMID: 32867366 PMCID: PMC7503421 DOI: 10.3390/ijms21176214] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/22/2022] Open
Abstract
Oropharyngeal dysphagia, or difficulty in swallowing, is a major health problem that can lead to serious complications, such as pulmonary aspiration, malnutrition, dehydration, and pneumonia. The current clinical management of oropharyngeal dysphagia mainly focuses on compensatory strategies and swallowing exercises/maneuvers; however, studies have suggested their limited effectiveness for recovering swallowing physiology and for promoting neuroplasticity in swallowing-related neuronal networks. Several new and innovative strategies based on neurostimulation in peripheral and cortical swallowing-related regions have been investigated, and appear promising for the management of oropharyngeal dysphagia. The peripheral chemical neurostimulation strategy is one of the innovative strategies, and targets chemosensory ion channels expressed in peripheral swallowing-related regions. A considerable number of animal and human studies, including randomized clinical trials in patients with oropharyngeal dysphagia, have reported improvements in the efficacy, safety, and physiology of swallowing using this strategy. There is also evidence that neuroplasticity is promoted in swallowing-related neuronal networks with this strategy. The targeting of chemosensory ion channels in peripheral swallowing-related regions may therefore be a promising pharmacological treatment strategy for the management of oropharyngeal dysphagia. In this review, we focus on this strategy, including its possible neurophysiological and molecular mechanisms.
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Affiliation(s)
- Mohammad Zakir Hossain
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan;
| | - Hiroshi Ando
- Department of Biology, School of Dentistry, Matsumoto Dental University, 1780 Gobara, Hirooka, Shiojiri, Nagano 399-0781, Japan;
| | - Shumpei Unno
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan;
| | - Junichi Kitagawa
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan;
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Dafiah PM, Swapna N. Variations in the amplitude and duration of hyolaryngeal elevation during swallow: Effect of sour and carbonated liquid bolus. Physiol Behav 2020; 224:113028. [PMID: 32590092 DOI: 10.1016/j.physbeh.2020.113028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Altering sensory properties of food is relevant to the management of swallowing disorders. The current investigation aimed to examine the influence of sour and carbonated stimuli on measures of hyolaryngeal elevation. METHOD Sixty healthy adults in the age range of 18 to 35 years were assessed using Digital Accelerometry Swallowing Imaging (DASI) while swallowing 5 ml of neutral, sour and carbonated liquid bolus. RESULTS Sour stimulus was significantly different with higher amplitude and longer durational measures of hyolaryngeal elevation compared to the two other stimuli. CONCLUSION Sour stimulus facilitates better hyolaryngeal elevation, which implicates its usage in dysphagia management.
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Affiliation(s)
- P M Dafiah
- All India Institute of Speech and Hearing, Manasagangothri, Mysore-570006, Karnataka, India.
| | - N Swapna
- Department of Speech-Language Pathology, All India Institute of Speech and Hearing, Manasagangothri, Mysore-570006, Karnataka, India
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Saliva Secretion and Swallowing-The Impact of Different Types of Food and Drink on Subsequent Intake. Nutrients 2020; 12:nu12010256. [PMID: 31963804 PMCID: PMC7019672 DOI: 10.3390/nu12010256] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/07/2020] [Accepted: 01/16/2020] [Indexed: 12/28/2022] Open
Abstract
The oral processing of food is important for eating and digestion in order to gain energy and nutrients. Due to disease, injury, or aging, individuals may experience difficulties in this process. These difficulties often lead to dysphagia, which is associated with malnutrition. Thus, it is of importance to find solutions and strategies to enable food intake. It is well known that sour and/or carbonated foods and drinks increase saliva secretion and trigger the swallowing reflex. However, knowledge regarding how subsequent food intake is impacted is lacking. The aim of this study was to clarify whether sour and/or carbonated foods and drinks had subsequent impacts on swallowing function. Twelve healthy participants evaluated eleven foods and drinks in terms of their ability to increase saliva production and ease the swallowing of subsequent food. Results showed that sourness and carbonation had positive impacts on saliva secretion and swallowing. No correlation was found between the pH/sourness of the foods and the ease of swallowing them. It was concluded that the ingestion of cherry tomatoes, natural yoghurt, and, in particular, citrus juice made swallowing of a neutral cracker easier. These results may be used to increase food intake among dysphagia patients.
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Turkington L, Ward EC, Farrell A, Porter L, Wall LR. Impact of carbonation on neurogenic dysphagia and an exploration of the clinical predictors of a response to carbonation. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:499-513. [PMID: 30729616 DOI: 10.1111/1460-6984.12458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/19/2018] [Accepted: 01/16/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The need for effective compensatory strategies in neurogenic dysphagia management has led to the exploration of sensory enhancement strategies (SES), such as carbonated liquids. Despite some positive findings, evidence related to the efficacy of carbonation as an SES is limited. AIMS To determine if carbonated thin liquids reduced dysphagia symptoms and to explore clinical factors associated with response to carbonation. METHODS & PROCEDURES Participants (n = 29) with neurogenic dysphagia demonstrating deep penetration or aspiration on thin liquids during videofluoroscopic swallow studies (VFSS) completed a set protocol: discrete sips of non-carbonated thin fluids (DS-NC) followed by discrete sips of carbonated thin fluids (DS-C) and then consecutive sips of carbonated fluids (CS-C). The impact of carbonation was identified through changes to swallow physiology (videofluoroscopy dysphagia scale-VDS) and depth of airway compromise (penetration-aspiration scale-PAS). Demographic variables including genetic taste type, cranial nerve function and key results from the VDS were examined for association with carbonation response using both individual parameter analysis and exploratory cluster analysis. OUTCOMES & RESULTS Significant (p < 0.05) improvements in PAS scores were noted in DS-C and CS-C conditions compared with DS-NC. Total VDS score was also significantly (p < 0.05) reduced (i.e., improved function) in the DS-NC condition. Individual variability in response to carbonation was noted and no clear clinical factors associated with carbonation response in the current set of parameters were identified. CONCLUSION & IMPLICATIONS Findings support that carbonated thin fluids sometimes result in neurogenic dysphagia symptom reduction. However, identifying the clinical characteristics of patients who may benefit from trials of carbonation needs further investigation.
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Affiliation(s)
- Leisa Turkington
- Speech Pathology Department, Royal Brisbane & Women's Hospital, Queensland Health, Herston, QLD, Australia
- The University of Queensland, School of Health & Rehabilitation Sciences, St Lucia, QLD, Australia
| | - Elizabeth C Ward
- The University of Queensland, School of Health & Rehabilitation Sciences, St Lucia, QLD, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland Health, Buranda, Brisbane, QLD, Australia
| | - Anna Farrell
- Speech Pathology Department, Royal Brisbane & Women's Hospital, Queensland Health, Herston, QLD, Australia
- The University of Queensland, School of Health & Rehabilitation Sciences, St Lucia, QLD, Australia
| | - Linda Porter
- Medical Imaging Department, Royal Brisbane & Women's Hospital, Queensland Health, Herston, QLD, Australia
| | - Laurelie R Wall
- The University of Queensland, School of Health & Rehabilitation Sciences, St Lucia, QLD, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland Health, Buranda, Brisbane, QLD, Australia
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Yamamura K, Kurose M, Okamoto K. Guide to Enhancing Swallowing Initiation: Insights from Findings in Healthy Subjects and Dysphagic Patients. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018; 6:178-185. [PMID: 30147997 PMCID: PMC6096907 DOI: 10.1007/s40141-018-0192-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Difficulty in initiating swallowing is one of the main symptoms of oropharyngeal dysphagia. Therefore, enhancing swallowing initiation is an important approach for the treatment of oropharyngeal dysphagia. This review aims to introduce recent approaches to enhancing swallowing and to discuss their therapeutic potential. RECENT FINDINGS Both central interventions such as non-invasive brain stimulation and peripheral interventions such as electrical stimulation to peripheral tissues are conducted to enhance swallowing. Recent studies have paid more attention to generating neuroplasticity to produce long-lasting facilitative effect on swallowing. SUMMARY Transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), pharyngeal electrical stimulation (PES), transcutaneous electrical stimulation, and somatic and chemical stimulation were introduced. Considerable evidence supports the therapeutic potential of TMS and PES. Other approaches need further studies to verify their efficacy (e.g., duration of the effect and a limit of effectiveness) and/or possible risk of adverse effects.
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Affiliation(s)
- Kensuke Yamamura
- Division of Oral Physiology, Department of Oral Biological Sciences, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514 Japan
| | - Masayuki Kurose
- Division of Oral Physiology, Department of Oral Biological Sciences, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514 Japan
| | - Keiichiro Okamoto
- Division of Oral Physiology, Department of Oral Biological Sciences, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514 Japan
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14
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Larsson V, Torisson G, Bülow M, Londos E. Effects of carbonated liquid on swallowing dysfunction in dementia with Lewy bodies and Parkinson's disease dementia. Clin Interv Aging 2017; 12:1215-1222. [PMID: 28848329 PMCID: PMC5557100 DOI: 10.2147/cia.s140389] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Swallowing dysfunction is an increasingly recognized problem in patients with dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD), which can result in aspiration pneumonia and death. Few studies have examined potential ways of improving swallowing function in this fragile patient group. The aim of this study was to evaluate swallowing dysfunction and carbonated liquid using videofluoroscopy in DLB and PDD patients. Methods A total of 48 patients with DLB and PDD were referred for a clinical examination with videofluoroscopy. Descriptive overall assessments were provided at the time of the examination regarding swallowing function and the effects of different modifications, including carbonated thin liquid (CTL). Additionally, a repeated measures quantitative retrospective analysis has been performed comparing 1) thin liquids; 2) thickened liquids and 3) CTLs, with regard to the quantitative variables 1) pharyngeal transit time (PTT); 2) pharyngeal retention and 3) tracheal penetration. Results In all, 40/48 (83%) of the patients had a swallowing dysfunction, which was confirmed on videofluoroscopy, with 34/40 (85%) patients having a pharyngeal-type dysfunction. A total of 14/40 (35%) patients with an objective swallowing impairment did not have any subjective swallowing symptoms. Out of the patients with swallowing dysfunction, 87% had an overall improved swallowing function with carbonated liquid. PTT for carbonated liquid (median 633 ms, interquartile range [IQR] 516–786 ms) was quicker than for thin liquid (760 ms, IQR 613–940 ms, P=0.014) and thickened liquid (880.0 ms, IQR 600–1,500 ms, P<0.001). No significant effect was seen in residue or penetration. Conclusion The majority of patients with DLB or PDD had a swallowing dysfunction, sometimes without subjective swallowing symptoms, which improved with carbonated liquid. This highlights the importance of investigating patients with videofluoroscopy and to carry out a prospective interventional study to further evaluate carbonated liquid, also addressing the effects on quality of life, aspiration and mortality.
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Affiliation(s)
- Victoria Larsson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University
| | - Gustav Torisson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University.,Department of Infectious Diseases
| | - Margareta Bülow
- Diagnostic Centre of Imaging and Functional Medicine, Skåne University Hospital, Malmö, Sweden
| | - Elisabet Londos
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University
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15
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Abstract
Changes to swallowing affect most people with Parkinson's disease (PD). Changes may not initially exercise a decisive impact, but can later pose significant threats to nutritional, hydration and respiratory health and psychosocial quality of life. This review, from a largely clinical viewpoint, outlines the nature of changes in PD and considers the issue of how many people are affected and in what ways. It outlines main approaches to assessment and management, with an emphasis on aspects relevant to PD. Dysphagia contributes to drooling in PD. The review therefore also touches on the nature and management of this condition that has its own set of health and psychosocial quality-of-life issues.
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Affiliation(s)
- Nick Miller
- Newcastle University Institute for Ageing, Speech & Language Sciences, George VI Building, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
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16
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Lazarus CL. History of the Use and Impact of Compensatory Strategies in Management of Swallowing Disorders. Dysphagia 2017; 32:3-10. [PMID: 28130600 DOI: 10.1007/s00455-016-9779-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/30/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Cathy L Lazarus
- Department of Otolaryngology Head and Neck Surgery, Mount Sinai Beth Israel, New York, NY, 10003, USA. .,Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA. .,THANC Foundation, 10 Union Square East, New York, NY, 10003, USA.
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17
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Turkington LG, Ward EC, Farrell AM. Carbonation as a sensory enhancement strategy: a narrative synthesis of existing evidence. Disabil Rehabil 2016; 39:1958-1967. [PMID: 27646052 DOI: 10.1080/09638288.2016.1213894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE Sensory enhancement techniques, like other compensatory strategies, aim to reduce dysphagia symptoms. The use of carbonated liquids has been proposed as a possible sensory technique, however to date, there is limited information of its efficacy or guidance for clinical implementation. A narrative synthesis was completed to determine the quality and strength of the evidence base for use of carbonation as a compensatory strategy in dysphagia rehabilitation. METHODS From 101 articles initially identified, 14 articles met the study criteria. Eleven papers described the effects of carbonation on swallowing in healthy participants whereas three described the impact of carbonation in dysphagic populations. A narrative synthesis of papers was undertaken given the diversity of identified studies. RESULTS Synthesis of findings was challenging given the exploratory phase of most research activity with diverse populations described and extensive differences in research methodologies. There is currently weak, but potentially positive evidence to support using carbonation as a compensatory technique in dysphagia rehabilitation. CONCLUSION Despite future potential, existing evidence fails to provide clear direction for the clinical implementation of carbonation. Validation of carbonation use with the dysphagic population requires further research with consistent, controlled methodologies, and larger cohorts of participants to inform potential for dysphagia rehabilitation. Implications for Rehabilitation The use of carbonated liquids has been proposed as a possible sensory enhancement technique which may facilitate changes to swallow physiology. However to date, there is limited information to direct clinical implementation. This paper provides a narrative synthesis of existing knowledge and highlights possible limitations of findings reported. Research to date has used disparate research methodologies in varied populations making synthesis of current findings challenging.
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Affiliation(s)
- Leisa G Turkington
- a Speech Pathology Department , Royal Brisbane & Women's Hospital, Queensland Health , Herston , Queensland , Australia.,b School of Health & Rehabilitation Sciences , The University of Queensland , St Lucia , Queensland , Australia
| | - Elizabeth C Ward
- b School of Health & Rehabilitation Sciences , The University of Queensland , St Lucia , Queensland , Australia.,c Centre for Functioning and Health Research , Queensland Health , Buranda, Brisbane , Queensland , Australia
| | - Anna M Farrell
- a Speech Pathology Department , Royal Brisbane & Women's Hospital, Queensland Health , Herston , Queensland , Australia
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18
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Magara J, Michou E, Raginis-Zborowska A, Inoue M, Hamdy S. Exploring the effects of synchronous pharyngeal electrical stimulation with swallowing carbonated water on cortical excitability in the human pharyngeal motor system. Neurogastroenterol Motil 2016; 28:1391-400. [PMID: 27061591 DOI: 10.1111/nmo.12839] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/17/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Previous reports have revealed that excitation of human pharyngeal motor cortex can be induced by pharyngeal electrical stimulation (PES) and swallowing carbonated water (CW). This study investigated whether combining PES with swallowing (of still water, SW or CW) can potentiate this excitation in either cortical and/or brain stem areas assessed with transcranial and transcutaneous magnetic stimulation (TMS). METHODS Fourteen healthy volunteers participated and were intubated with an intraluminal catheter to record pharyngeal electromyography and deliver PES. Each participant underwent baseline corticopharyngeal, hand and craniobulbar motor-evoked potential (MEP) measurements. Subjects were then randomized to receive each of four 10-min interventions (PES only, ShamPES+CW, PES+CW, and PES+SW). Corticobulbar, craniobulbar and hand MEPs were then remeasured for up to 60 min and data analyzed using anova and post hoc t-tests. KEY RESULTS A two-way rmanova for Interventions × Time-point showed a significant corticopharyngeal interaction (p = 0.010). One-way anova with post hoc t-tests indicated significant cortical changes with PES only at 45 (p = 0.038) and 60 min (p = 0.023) and ShamPES+CW immediately (p = 0.008) but not with PES+CW or PES+SW. By contrast, there were immediate craniobulbar amplitude changes only with PES+CW (p = 0.020) which were not sustained. CONCLUSIONS & INFERENCES We conclude that only PES produced long-term changes in corticopharyngeal excitability whereas combination stimuli were less effective. Our data suggest that PES alone rather than in combination, may be better for the patients who have difficulty in performing voluntary swallows.
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Affiliation(s)
- J Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.,Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Salford, UK
| | - E Michou
- Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Salford, UK
| | - A Raginis-Zborowska
- Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Salford, UK
| | - M Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - S Hamdy
- Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Salford, UK
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