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Wang K, Cheng Z, Qiao D, Xie F, Zhao S, Zhang B. Polysaccharide-dextrin thickened fluids for individuals with dysphagia: recent advances in flow behaviors and swallowing assessment methods. Crit Rev Food Sci Nutr 2024:1-25. [PMID: 38556920 DOI: 10.1080/10408398.2024.2330711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The global aging population has brought about a pressing health concern: dysphagia. To effectively address this issue, we must develop specialized diets, such as thickened fluids made with polysaccharide-dextrin (e.g., water, milk, juices, and soups), which are crucial for managing swallowing-related problems like aspiration and choking for people with dysphagia. Understanding the flow behaviors of these thickened fluids is paramount, and it enables us to establish methods for evaluating their suitability for individuals with dysphagia. This review focuses on the shear and extensional flow properties (e.g., viscosity, yield stress, and viscoelasticity) and tribology (e.g., coefficient of friction) of polysaccharide-dextrin-based thickened fluids and highlights how dextrin inclusion influences fluid flow behaviors considering molecular interactions and chain dynamics. The flow behaviors can be integrated into the development of diverse evaluation methods that assess aspects such as flow velocity, risk of aspiration, and remaining fluid volume. In this context, the key in-vivo (e.g., clinical examination and animal model), in-vitro (e.g., the Cambridge Throat), and in-silico (e.g., Hamiltonian moving particles semi-implicit) evaluation methods are summarized. In addition, we explore the potential for establishing realistic assessment methods to evaluate the swallowing performance of thickened fluids, offering promising prospects for the future.
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Affiliation(s)
- Kedu Wang
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
| | - Zihang Cheng
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
| | - Dongling Qiao
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
| | - Fengwei Xie
- Department of Chemical Engineering, University of Bath, Bath, UK
- School of Engineering, Newcastle University, Newcastle upon Tyne, UK
| | - Siming Zhao
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
| | - Binjia Zhang
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
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2
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Johnson ML, Steer KE, Edmonds CE, Adjerid K, German RZ, Mayerl CJ. Nipple properties affect sensorimotor integration during bottle feeding in an infant pig model. JOURNAL OF EXPERIMENTAL ZOOLOGY. PART A, ECOLOGICAL AND INTEGRATIVE PHYSIOLOGY 2023; 339:767-776. [PMID: 37438924 PMCID: PMC10528713 DOI: 10.1002/jez.2727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 07/14/2023]
Abstract
Infant feeding is a critical neurological milestone in development defined by the coordination of muscles, peripheral nerves, and brainstem nuclei. In infants, milk flow rate is often limited to improve feeding performance without treating the underlying deficiencies in the sucking and swallowing processes. Modification of the neuromotor response via sensory information from the nipple during bottle feeding is an unexplored avenue for physiology-based interventions. In this study, we assessed how differences in nipple hole size and nipple stiffness affect sucking muscle activation and subsequent movement. We fabricated four bottle nipples of varying hole size and stiffness to determine how variation in nipple properties affects the sucking behavior of infant pigs. Our results demonstrate that sensory information from the nipple affects sucking motor output. Nipple hole sizes and stiffnesses with a larger milk flow rate resulted in greater muscle activity and kinematic movement. Additionally, our results suggest that sensorimotor interventions are better directed toward modulating tongue function rather than the mandible movements due to a greater response to sensory information. Understanding how sensory information influences infant feeding is instrumental in promoting effective infant feeding.
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Affiliation(s)
- ML Johnson
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH
| | - KE Steer
- Department of Biological Sciences, Northern Arizona University, Flagstaff, AZ
| | - CE Edmonds
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH
| | - K Adjerid
- Department of Biomedical Engineering, Tulane University, New Orleans, LA
| | - RZ German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH
| | - CJ Mayerl
- Department of Biological Sciences, Northern Arizona University, Flagstaff, AZ
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3
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Mayerl CJ, Gould FDH, Adjerid K, Edmonds C, German RZ. The Pathway from Anatomy and Physiology to Diagnosis: A Developmental Perspective on Swallowing and Dysphagia. Dysphagia 2023; 38:33-41. [PMID: 35441265 PMCID: PMC9579268 DOI: 10.1007/s00455-022-10449-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 04/04/2022] [Indexed: 01/29/2023]
Abstract
Dysphagia results from diverse and distinct etiologies. The pathway from anatomy and physiology to clinical diagnosis is complex and hierarchical. Our approach in this paper is to show the linkages from the underlying anatomy and physiology to the clinical presentation. In particular, the terms performance, function, behavior, and physiology are often used interchangeably, which we argue is an obstacle to clear discussion of mechanism of pathophysiology. We use examples from pediatric populations to highlight the importance of understanding anatomy and physiology to inform clinical practice. We first discuss the importance of understanding anatomy in the context of physiology and performance. We then use preterm infants and swallow-breathe coordination as examples to explicate the hierarchical nature of physiology and its impact on performance. We also highlight where the holes in our knowledge lie, with the ultimate endpoint of providing a framework that could enhance our ability to design interventions to help patients. Clarifying these terms, and the roles they play in the biology of dysphagia will help both the researchers studying the problems as well as the clinicians applying the results of those studies.
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Affiliation(s)
- C J Mayerl
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA
| | - F D H Gould
- Department of Cell Biology and Neuroscience, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - K Adjerid
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA
| | - C Edmonds
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA
| | - R Z German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA.
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4
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Adjerid K, Johnson M, Edmonds C, Steer K, Gould F, German R, Mayerl C. The effect of stiffness and hole size on nipple compression in infant suckling. JOURNAL OF EXPERIMENTAL ZOOLOGY. PART A, ECOLOGICAL AND INTEGRATIVE PHYSIOLOGY 2023; 339:92-100. [PMID: 36121049 PMCID: PMC9771940 DOI: 10.1002/jez.2657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/04/2022] [Accepted: 08/24/2022] [Indexed: 12/24/2022]
Abstract
During infant feeding, the nipple is an important source of sensory information that affects motor outputs, including ones dealing with compression of the nipple, suction, milk bolus movement, and swallowing. Despite known differences in behavior across commercially available nipples, little is known about the in vivo effects of nipple property variation. Here we quantify the effect of differences in nipple stiffness and hole size on an easily measured metric representing infant feeding behavior: nipple compression. We bottle-fed 7-day old infant pigs (n = 6) on four custom fabricated silicone nipples. We recorded live X-ray fluoroscopic imaging data of feeding on nipples of two levels of hardness/stiffness and two hole sizes. We tested for differences in nipple compression at the nipple's maximum compression across different nipple types using a mixed model analysis of variance. Stiffer nipples and those with smaller holes were compressed less than compliant nipples and nipples with larger holes (p < 0.001). We also estimated the force applied on the nipple during feeding and found that more force was applied to the compliant nipple with disproportionately larger strains. Our results suggest that infant pigs' nipple compression depends on material type and hole size, which is likely detected by the infant pigs' initial assessment of compressibility and flow. By isolating nipple properties, we demonstrated a relationship between properties and suckling behavior. Our results suggest that sensory information affects feeding behaviors and may also inform clinical treatment of poor feeding performance.
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Affiliation(s)
- K. Adjerid
- Northeast Ohio Medical University, Rootstown, OH
| | - M.L. Johnson
- Northeast Ohio Medical University, Rootstown, OH
| | - C.E. Edmonds
- Northeast Ohio Medical University, Rootstown, OH
| | - K.E. Steer
- Northeast Ohio Medical University, Rootstown, OH
| | - F.D.H. Gould
- Rowan University School of Osteopathic Medicine, Glassboro, NJ
| | - R.Z. German
- Northeast Ohio Medical University, Rootstown, OH
| | - C.J. Mayerl
- Northeast Ohio Medical University, Rootstown, OH
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5
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Mayerl CJ, Steer KE, Chava AM, Bond LE, Edmonds CE, Gould FDH, Hieronymous TL, Vinyard CJ, German RZ. Anatomical and physiological variation of the hyoid musculature during swallowing in infant pigs. J Exp Biol 2021; 224:jeb243075. [PMID: 34734633 PMCID: PMC10659033 DOI: 10.1242/jeb.243075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/06/2021] [Indexed: 11/20/2022]
Abstract
The function of a muscle is impacted by its line of action, activity timing and contractile characteristics when active, all of which have the potential to vary within a behavior. One function of the hyoid musculature is to move the hyoid bone during swallowing, yet we have little insight into how their lines of action and contractile characteristics might change during a swallow. We used an infant pig model to quantify the contractile characteristics of four hyoid muscles during a swallow using synchronized electromyography, fluoromicrometry and high-speed biplanar videofluoroscopy. We also estimated muscle line of action during a swallow using contrast-enhanced CT-scanned muscles animated to move with the hyoid bone and found that as the hyoid elevated, the line of action of the muscles attached to it became greater in depression. We also found that muscles acted eccentrically and concentrically, which was correlated with hyoid movement. This work contributes to our understanding of how the musculature powering feeding functions during swallowing.
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Affiliation(s)
- Christopher J. Mayerl
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
| | - Kendall E. Steer
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
| | - Almasi M. Chava
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
| | - Laura E. Bond
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
| | - Chloe E. Edmonds
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
| | - Francois D. H. Gould
- Department of Cell Biology and Neuroscience, Rowan School of Osteopathic Medicine, Stratford, NJ 08084, USA
| | - Tobin L. Hieronymous
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
| | - Christopher J. Vinyard
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
| | - Rebecca Z. German
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
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Stevens M, Schiedermayer B, Kendall KA, Ou Z, Presson AP, Barkmeier-Kraemer JM. Physiology of Dysphagia in Those with Unilateral Vocal Fold Immobility. Dysphagia 2021; 37:356-364. [PMID: 33791864 DOI: 10.1007/s00455-021-10286-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
Quantitative measures of swallowing function were extracted from modified barium swallowing studies (MBS) to characterize swallowing pathophysiology in patients with unilateral vocal fold immobility (UVFI). All individuals with UVFI completing a MBS during the prior 5 years were included. Demographic information, penetration-aspiration score, timing of aspiration and quantitative measures from the MBS were extracted from electronic medical records and compared across 1, 3, and 20 cc liquid bolus swallows. UVFI patient measures were compared to normal age-matched controls to identify swallowing pathophysiology associated with aspiration. The incidence of aspiration by UVFI etiology groups (i.e., central nervous system, idiopathic, iatrogenic, skull base tumor, or peripheral tumor) was also compared. Of the 61 patients who met inclusion criteria, aspiration was observed in 23%. Maximum pharyngeal constriction was abnormal in 79% of aspirators compared to 34% of non-aspirators (p = .003). Delay in airway closure was the most common swallowing abnormality identified in the study population (62%) but was not associated with aspiration. Among the 14 individuals who aspirated, the iatrogenic and skull base tumor etiology groups comprised the majority (i.e., 36% each). However, the incidence of aspiration for the iatrogenic group was 19% compared to 50% of the skull base tumor group. Aspiration in patients with UVFI was associated with abnormally reduced pharyngeal constriction. Delayed airway closure was common in both aspirators and non-aspirators.
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Affiliation(s)
- Maya Stevens
- Division of Otolaryngology, Department of Surgery, University of Utah, Salt Lake City, UT, USA. .,Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT, USA. .,Division of Otolaryngology, University of Utah, 50 N Medical Dr, Rm 3C120 SOM, Salt Lake City, UT, 84132, USA.
| | - Ben Schiedermayer
- Division of Otolaryngology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Katherine A Kendall
- Division of Otolaryngology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Zhining Ou
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Julie M Barkmeier-Kraemer
- Division of Otolaryngology, Department of Surgery, University of Utah, Salt Lake City, UT, USA.,Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT, USA
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Mayerl CJ, Steer KE, Chava AM, Bond LE, Edmonds CE, Gould FDH, Stricklen BM, Hieronymous TL, German RZ. The contractile patterns, anatomy and physiology of the hyoid musculature change longitudinally through infancy. Proc Biol Sci 2021; 288:20210052. [PMID: 33715426 DOI: 10.1098/rspb.2021.0052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
All mammalian infants suckle, a fundamentally different process than drinking in adults. Infant mammal oropharyngeal anatomy is also anteroposteriorly compressed and becomes more elongate postnatally. While suckling and drinking require different patterns of muscle use and kinematics, little insight exists into how the neuromotor and anatomical systems change through the time that infants suckle. We measured the orientation, activity and contractile patterns of five muscles active during infant feeding from early infancy until weaning using a pig model. Muscles not aligned with the long axis of the body became less mediolaterally orientated with age. However, the timing of activation and the contractile patterns of those muscles exhibited little change, although variation was larger in younger infants than older infants. At both ages, there were differences in contractile patterns within muscles active during both sucking and swallowing, as well as variation among muscles during swallowing. The changes in anatomy, coupled with less variation closer to weaning and little change in muscle firing and shortening patterns suggest that the neuromotor system may be optimized to transition to solid foods. The lesser consequences of aspiration during feeding on an all-liquid diet may not necessitate the evolution of variation in neuromotor function through infancy.
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Affiliation(s)
- C J Mayerl
- NEOMED Department of Anatomy and Neurobiology, 4209 State Route 44, PO Box 95, Rootstown OH 44272, USA
| | - K E Steer
- NEOMED Department of Anatomy and Neurobiology, 4209 State Route 44, PO Box 95, Rootstown OH 44272, USA
| | - A M Chava
- NEOMED Department of Anatomy and Neurobiology, 4209 State Route 44, PO Box 95, Rootstown OH 44272, USA
| | - L E Bond
- NEOMED Department of Anatomy and Neurobiology, 4209 State Route 44, PO Box 95, Rootstown OH 44272, USA
| | - C E Edmonds
- NEOMED Department of Anatomy and Neurobiology, 4209 State Route 44, PO Box 95, Rootstown OH 44272, USA
| | - F D H Gould
- Department of Cell Biology and Neuroscience, Rowan School of Osteopathic Medicine, Stratford, NJ, USA
| | - B M Stricklen
- NEOMED Department of Anatomy and Neurobiology, 4209 State Route 44, PO Box 95, Rootstown OH 44272, USA
| | - T L Hieronymous
- NEOMED Department of Anatomy and Neurobiology, 4209 State Route 44, PO Box 95, Rootstown OH 44272, USA
| | - R Z German
- NEOMED Department of Anatomy and Neurobiology, 4209 State Route 44, PO Box 95, Rootstown OH 44272, USA
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Adjerid K, Mayerl CJ, Gould FDH, Edmonds CE, Stricklen BM, Bond LE, German RZ. Does birth weight affect neonatal body weight, growth, and physiology in an animal model? PLoS One 2021; 16:e0246954. [PMID: 33592070 PMCID: PMC7886147 DOI: 10.1371/journal.pone.0246954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/28/2021] [Indexed: 02/03/2023] Open
Abstract
Infant birth weight affects neuromotor and biomechanical swallowing performance in infant pig models. Preterm infants are generally born low birth weight and suffer from delayed development and neuromotor deficits. These deficits include critical life skills such as swallowing and breathing. It is unclear whether these neuromotor and biomechanical deficits are a result of low birth weight or preterm birth. In this study we ask: are preterm infants simply low birth weight infants or do preterm infants differ from term infants in weight gain and swallowing behaviors independent of birth weight? We use a validated infant pig model to show that preterm and term infants gain weight differently and that birth weight is not a strong predictor of functional deficits in preterm infant swallowing. We found that preterm infants gained weight at a faster rate than term infants and with nearly three times the variation. Additionally, we found that the number of sucks per swallow, swallow duration, and the delay of the swallows relative to the suck cycles were not impacted by birth weight. These results suggest that any correlation of developmental or swallowing deficits with reduced birth weight are likely linked to underlying physiological immaturity of the preterm infant.
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Affiliation(s)
- Khaled Adjerid
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, Ohio, United States of America
- * E-mail:
| | - Christopher J. Mayerl
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, Ohio, United States of America
| | - Francois D. H. Gould
- Department of Cell Biology and Neuroscience, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, United States of America
| | - Chloe E. Edmonds
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, Ohio, United States of America
| | - Bethany M. Stricklen
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, Ohio, United States of America
| | - Laura E. Bond
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, Ohio, United States of America
| | - Rebecca Z. German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, Ohio, United States of America
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Lammers AR, Abid S, Ding P, German RZ. Effects of Superior Laryngeal Nerve Lesion on Kinematics of Swallowing and Airway Protection in an Infant Pig Model. Dysphagia 2020; 35:907-917. [PMID: 32140904 DOI: 10.1007/s00455-020-10100-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
The superior laryngeal nerve provides detailed sensory information from the mucosal surfaces of laryngeal structures superior to the vocal folds, including the valleculae. Injury to this nerve results in airway penetration and aspiration. Furthermore, such injuries might have an impact on the function of multiple structures involved in intraoral transport and swallowing due to connections within the brainstem. We sought to determine the effects of a surgical lesion of the superior laryngeal nerve on kinematics of the tongue, hyoid, and epiglottis during swallowing. We implanted radio-opaque markers into five infant pigs under anesthesia. Then we fed milk mixed with contrast agent to the pigs while they were recorded via video fluoroscopy, before and after a surgery to transect the superior laryngeal nerve. We digitized and rated airway protection in 177 swallows. We found that in most animals, swallow duration was shorter after nerve lesion. The hyoid also traveled a shorter distance after lesion. Frequently, individuals reacted differently to the same nerve lesion. We suggest that these differences are due to individual differences in neurological connections. When comparing hyoid kinematics between swallows with successful or failed airway protection, we found more consistency among individuals. This indicates that protecting the airway requires specific sets of kinematic events to occur, regardless of the neurological differences among individuals.
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Affiliation(s)
- Andrew R Lammers
- School of Health Sciences, Cleveland State University, 2121 Euclid Ave, Cleveland, OH, 44115, USA.
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA.
| | - Saja Abid
- School of Health Sciences, Cleveland State University, 2121 Euclid Ave, Cleveland, OH, 44115, USA
| | - Peng Ding
- Johns Hopkins Medicine International, 601 N. Caroline Street Suite 1080, Baltimore, MD, 21287, USA
| | - Rebecca Z German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA
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10
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Gould FDH, Lammers AR, Mayerl C, Ohlemacher J, German RZ. Muscle activity and kinematics show different responses to recurrent laryngeal nerve lesion in mammal swallowing. J Neurophysiol 2020; 124:1743-1753. [PMID: 32966748 DOI: 10.1152/jn.00409.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Understanding the interactions between neural and musculoskeletal systems is key to identifying mechanisms of functional failure. Mammalian swallowing is a complex, poorly understood motor process. Lesion of the recurrent laryngeal nerve, a sensory and motor nerve of the upper airway, results in airway protection failure (liquid entry into the airway) during swallowing through an unknown mechanism. We examined how muscle and kinematic changes after recurrent laryngeal nerve lesion relate to airway protection in eight infant pigs. We tested two hypotheses: 1) kinematics and muscle function will both change in response to lesion in swallows with and without airway protection failure, and 2) differences in both kinematics and muscle function will predict whether airway protection failure occurs in lesion and intact pigs. We recorded swallowing with high-speed videofluoroscopy and simultaneous electromyography of oropharyngeal muscles pre- and postrecurrent laryngeal nerve lesion. Lesion changed the relationship between airway protection and timing of tongue and hyoid movements. Changes in onset and duration of hyolaryngeal muscles postlesion were less associated with airway protection outcomes. The tongue and hyoid kinematics all predicted airway protection outcomes differently pre- and postlesion. Onset and duration of activity in only one infrahyoid and one suprahyoid muscle showed a change in predictive relationship pre- and postlesion. Kinematics of the tongue and hyoid more directly reflect changes in airway protections pre- and postlesion than muscle activation patterns. Identifying mechanisms of airway protection failure requires specific functional hypotheses that link neural motor outputs to muscle activation to specific movements.NEW & NOTEWORTHY Kinematic and muscle activity patterns of oropharyngeal structures used in swallowing show different patterns of response to lesion of the recurrent laryngeal nerve. Understanding how muscles act on structures to produce behavior is necessary to understand neural control.
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Affiliation(s)
- François D H Gould
- Department of Cell Biology and Neuroscience, Rowan School of Osteopathic Medicine, Stratford, New Jersey
| | | | - Christopher Mayerl
- Department of Anatomy and Neuroscience, Northeast Ohio Medical University, Rootstown, Ohio
| | - Jocelyn Ohlemacher
- Department of Anatomy and Neuroscience, Northeast Ohio Medical University, Rootstown, Ohio
| | - Rebecca Z German
- Department of Anatomy and Neuroscience, Northeast Ohio Medical University, Rootstown, Ohio
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11
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Mayerl CJ, Myrla AM, Gould FDH, Bond LE, Stricklen BM, German RZ. Swallow Safety is Determined by Bolus Volume During Infant Feeding in an Animal Model. Dysphagia 2020; 36:120-129. [PMID: 32328794 DOI: 10.1007/s00455-020-10118-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/15/2020] [Indexed: 12/14/2022]
Abstract
Feeding difficulties are especially prevalent in preterm infants, although the mechanisms driving these difficulties are poorly understood due to a lack of data on healthy infants. One potential mechanism of dysphagia in adults is correlated with bolus volume. Yet, whether and how bolus volume impacts swallow safety in infant feeding is unknown. A further complication for safe infant swallowing is recurrent laryngeal nerve (RLN) injury due to patent ductus arteriosus surgery, which exacerbates the issues that preterm infants face and can increase the risk of dysphagia. Here, we used a validated animal model feeding freely to test the effect of preterm birth, postnatal maturation and RLN lesion and their interactions on swallow safety. We also tested whether bolus size differed with lesion or birth status, and the relationship between bolus size and swallow safety. We found very little effect of lesion on swallow safety, and preterm infants did not experience more penetration or aspiration than term infants. However, term infants swallowed larger boluses than preterm infants, even after correcting for body size. Bolus size was the primary predictor of penetration or aspiration, with larger boluses being more likely to result in greater degrees of dysphagia irrespective of age or lesion status. These results highlight that penetration and aspiration are likely normal occurrences in infant feeding. Further, when comorbidities, such as RLN lesion or preterm birth are present, limiting bolus size may be an effective means to reduce incidences of penetration and aspiration.
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Affiliation(s)
- Christopher J Mayerl
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, 44272, USA.
| | - Alexis M Myrla
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, 44272, USA
| | - Francois D H Gould
- Department of Cell Biology and Neuroscience, Rowan School of Osteopathic Medicine, Stratford, NJ, USA
| | - Laura E Bond
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, 44272, USA
| | - Bethany M Stricklen
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, 44272, USA
| | - Rebecca Z German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, 44272, USA
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12
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Mayerl CJ, Catchpole EA, Edmonds CE, Gould FDH, McGrattan KE, Bond LE, Stricklen BM, German RZ. The effect of preterm birth, recurrent laryngeal nerve lesion, and postnatal maturation on hyoid and thyroid movements, and their coordination in infant feeding. J Biomech 2020; 105:109786. [PMID: 32307182 DOI: 10.1016/j.jbiomech.2020.109786] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 01/03/2023]
Abstract
Movements of the hyoid and thyroid are critical for feeding. These structures are often assumed to move in synchrony, despite evidence that neurologically compromised populations exhibit altered kinematics. Preterm infants are widely considered to be a neurologically compromised population and often experience feeding difficulties, yet measuring performance, and how performance matures in pediatric populations is challenging. Feeding problems are often compounded by complications arising from surgical procedures performed to ensure the survival of preterm infants, such as damage to the recurrent laryngeal nerve (RLN) during patent ductus arteriosus correction surgery. Here, we used a validated infant pig model for infant feeding to test how preterm birth, postnatal maturation, and RLN lesion interact to impact hyoid and thyroid excursion and their coordination. We filmed infant pigs when feeding using videofluorscopy at seven days old (1-2 months human equivalent) and 17 days old (6-9 months human equivalent) and tracked movements of the hyoid and thyroid on both days. We found that preterm birth impacted the coordination between hyoid and thyroid movements, but not their actual excursion. In contrast, excursion of the two structures increased with postnatal age in term and preterm pigs. RLN lesion decreased thyroid excursion, and primarily impacted hyoid movements by increasing variation in hyoid excursion. This work demonstrates that RLN lesion and preterm birth have distinct, but pervasive effects on feeding performance in infants, and suggest that interventions targeted towards reducing dysphagia should be prescribed based off the etiology driving dysphagia, rather than the prognosis of dysphagia.
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Affiliation(s)
- Christopher J Mayerl
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, 44272, United States.
| | - Emily A Catchpole
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, 44272, United States
| | - Chloe E Edmonds
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, 44272, United States
| | - Francois D H Gould
- Department of Cell Biology and Neuroscience, Rowan School of Osteopathic Medicine, Stratford, NJ, 08854, United States
| | - Katlyn E McGrattan
- Department of Speech-Language-Hearing Science, University of Minnesota, Minneapolis, MN, 55455, United States
| | - Laura E Bond
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, 44272, United States
| | - Bethany M Stricklen
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, 44272, United States
| | - Rebecca Z German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, 44272, United States
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Stricklen BM, Bond LE, Gould FDH, German RZ, Mayerl CJ. Swallow Safety in Infant Pigs With and Without Recurrent Laryngeal Nerve Lesion. Dysphagia 2020; 35:978-984. [PMID: 32112144 DOI: 10.1007/s00455-020-10099-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 02/17/2020] [Indexed: 01/22/2023]
Abstract
Aerodigestive coordination is critical for safe feeding in mammals, and failure to do so can result in aspiration. Using an infant pig model, we analyzed the impact of recurrent laryngeal nerve (RLN) lesion on aerodigestive coordination and swallow safety at two time points prior to weaning. We used high-speed videofluoroscopy to record 23 infant pigs longitudinally at two ages (7 days, 17 days) feeding on barium milk. We measured respiration with a plethysmograph and used the Infant Mammalian Penetration-Aspiration Scale (IMPAS) to identify unsafe swallows. We tested for changes in swallow safety longitudinally in control and lesion pigs, and whether there was any interaction between the four different groups. On postnatal day 7, lesioned pigs exhibited differences in the frequency distribution of IMPAS scores relative to control pigs on day 7, and 17 day old lesion and control pigs. There were longitudinal changes in performance following RLN lesion through time, suggesting that the impact of RLN lesion decreases with time, as older lesioned pigs performed similarly to older control pigs. We found minimal differences in the impact of aerodigestive coordination on swallow safety, with shorter delays of inspiration onset reflecting higher rates of penetration in young lesioned pigs. Healthy pigs aspirated at a similar rate to those with an RLN lesion indicating that the occasional occurrence of dysphagia in infants may be a normal behavior.
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Affiliation(s)
- Bethany M Stricklen
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, 44272, USA
| | - Laura E Bond
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, 44272, USA
| | - Francois D H Gould
- Department of Cell Biology and Neuroscience, Rowan School of Osteopathic Medicine, Stratford, NJ, USA
| | - Rebecca Z German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, 44272, USA
| | - Christopher J Mayerl
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, 44272, USA.
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Gould FDH, Lammers AR, Mayerl CJ, German RZ. Specific Vagus Nerve Lesion Have Distinctive Physiologic Mechanisms of Dysphagia. Front Neurol 2019; 10:1301. [PMID: 31920925 PMCID: PMC6920241 DOI: 10.3389/fneur.2019.01301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/26/2019] [Indexed: 01/17/2023] Open
Abstract
Swallowing is complex at anatomical, functional, and neurological levels. The connections among these levels are poorly understood, yet they underpin mechanisms of swallowing pathology. The complexity of swallowing physiology means that multiple failure points may exist that lead to the same clinical diagnosis (e.g., aspiration). The superior laryngeal nerve (SLN) and the recurrent laryngeal nerve (RLN) are branches of the vagus that innervate different structures involved in swallowing. Although they have distinct sensory fields, lesion of either nerve is associated clinically with increased aspiration. We tested the hypothesis that despite increased aspiration in both case, oropharyngeal kinematic changes and their relationship to aspiration would be different in RLN and SLN lesioned infant pigs. We compared movements of the tongue and epiglottis in swallows before and after either RLN or SLN lesion. We rated swallows for airway protection. Posterior tongue ratio of safe swallows changed in RLN (p = 0.01) but not SLN lesioned animals. Unsafe swallows post lesion had different posterior tongue ratios in RLN and SLN lesioned animals. Duration of epiglottal inversion shortened after lesion in SLN animals (p = 0.02) but remained unchanged in RLN animals. Thus, although SLN and RLN lesion lead to the same clinical outcome (increased aspiration), the mechanisms of failure of airway protection are different, which suggests that effective therapies may be different with each injury. Understanding the specific pathophysiology of swallowing associated with specific neural insults will help develop targeted, disease appropriate treatments.
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Affiliation(s)
- François D H Gould
- Department of Cell Biology and Neuroscience, Rowan University School of Osteopathic Medicine, Stratford, NJ, United States
| | - Andrew R Lammers
- School of Health Sciences, Cleveland State University, Cleveland, OH, United States
| | | | - Rebecca Z German
- Department of Anatomy and Neurobiology, NEOMED, Rootstown, OH, United States
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Schiedermayer B, Kendall KA, Stevens M, Ou Z, Presson AP, Barkmeier-Kraemer JM. Prevalence, incidence, and characteristics of dysphagia in those with unilateral vocal fold paralysis. Laryngoscope 2019; 130:2397-2404. [PMID: 31763701 DOI: 10.1002/lary.28401] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/05/2019] [Accepted: 10/23/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study was to investigate the impact of dysphagia definition on the incidence and overall prevalence of dysphagia in patients with unilateral vocal fold paralysis (UVP) stratified by etiology. STUDY DESIGN Retrospective medical chart review. METHODS Data was collected from the records of individuals diagnosed with UVP from 2013 to 2018, including patient demographics, dysphagia questionnaire total scores, clinical evaluation dysphagia symptoms, and instrumental swallow assessment outcomes. The annual incidence and overall prevalence of dysphagia were calculated by etiology as counts and percentages across five operational definitions of dysphagia. RESULTS A total of 415 individuals met inclusion criteria for the study. Annual prevalence estimates ranged from 19% to 55%, depending on the definition of dysphagia used. The highest prevalence of dysphagia occurred when defined by symptoms or signs identified by the clinician (55%). The lowest prevalence of dysphagia occurred using a definition of abnormal swallowing function documented during instrumental assessment (19%). Dysphagia questionnaire scores were more frequently abnormal in those with iatrogenic than idiopathic etiology of UVP (adjusted P = 0.014). Rate of instrumental assessment and documentation of aspiration was highest for central UVP etiology (33%). On average, pneumonia was rare (6%) irrespective of UVP etiology. CONCLUSION Up to 55% of patients diagnosed with UVP complained of dysphagia, but only 21% had dysphagia symptoms severe enough to prompt instrumental assessment. Incidence and severity of dysphagia varied depending on UVP etiologic category as well as dysphagia definition. The etiology of UVP may impact dysphagia risk and severity in this population and warrants further investigation. LEVEL OF EVIDENCE IV Laryngoscope, 130:2397-2404, 2020.
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Affiliation(s)
- Benjamin Schiedermayer
- Department of Surgery, Division of Otolaryngology, University of Utah, Salt Lake City, Utah
| | - Katherine A Kendall
- Department of Surgery, Division of Otolaryngology, University of Utah, Salt Lake City, Utah
| | - Maya Stevens
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, Utah
| | - Zhining Ou
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, Utah
| | - Angela P Presson
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, Utah
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Mok A, Allen J, Haney MM, Deninger I, Ballenger B, Caywood V, Osman KL, Zitsch B, Hopewell BL, Thiessen A, Szewczyk M, Ohlhausen D, Newberry CI, Leary E, Lever TE. A Surgical Mouse Model for Advancing Laryngeal Nerve Regeneration Strategies. Dysphagia 2019; 35:419-437. [PMID: 31388736 DOI: 10.1007/s00455-019-10045-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/06/2019] [Accepted: 07/31/2019] [Indexed: 01/16/2023]
Abstract
Iatrogenic recurrent laryngeal nerve (RLN) injury is a morbid complication of anterior neck surgical procedures. Existing treatments are predominantly symptomatic, ranging from behavioral therapy to a variety of surgical approaches. Though laryngeal reinnervation strategies often provide muscle tone to the paralyzed vocal fold (VF), which may improve outcomes, there is no clinical intervention that reliably restores true physiologic VF movement. Moreover, existing interventions neglect the full cascade of molecular events that affect the entire neuromuscular pathway after RLN injury, including the intrinsic laryngeal muscles, synaptic connections within the central nervous system, and laryngeal nerve anastomoses. Systematic investigations of this pathway are essential to develop better RLN regenerative strategies. Our aim was to develop a translational mouse model for this purpose, which will permit longitudinal investigations of the pathophysiology of iatrogenic RLN injury and potential therapeutic interventions. C57BL/6J mice were divided into four surgical transection groups (unilateral RLN, n = 10; bilateral RLN, n = 2; unilateral SLN, n = 10; bilateral SLN, n = 10) and a sham surgical group (n = 10). Miniaturized transoral laryngoscopy was used to assess VF mobility over time, and swallowing was assessed using serial videofluoroscopy. Histological assays were conducted 3 months post-surgery for anatomical investigation of the larynx and laryngeal nerves. Eight additional mice underwent unilateral RLN crush injury, half of which received intraoperative vagal nerve stimulation (iVNS). These 8 mice underwent weekly transoral laryngoscopy to investigate VF recovery patterns. Unilateral RLN injury resulted in chronic VF immobility but only acute dysphagia. Bilateral RLN injury caused intraoperative asphyxiation and death. VF mobility was unaffected by SLN transection (unilateral or bilateral), and dysphagia (transient) was evident only after bilateral SLN transection. The sham surgery group retained normal VF mobility and swallow function. Mice that underwent RLN crush injury and iVNS treatment demonstrated accelerated and improved VF recovery. We successfully developed a mouse model of iatrogenic RLN injury with impaired VF mobility and swallowing function that can serve as a clinically relevant platform to develop translational neuroregenerative strategies for RLN injury.
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Affiliation(s)
- Alexis Mok
- Department of Communication Science and Disorders, University of Missouri School of Health Professions, Columbia, MO, USA
| | - Jakob Allen
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Megan M Haney
- Department of Veterinary Pathobiology, University of Missouri College of Veterinary Medicine, Columbia, MO, USA
| | - Ian Deninger
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Brayton Ballenger
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Victoria Caywood
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Kate L Osman
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Bradford Zitsch
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Bridget L Hopewell
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Aaron Thiessen
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Marlena Szewczyk
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Daniel Ohlhausen
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | | | - Emily Leary
- Department of Orthopedic Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Teresa E Lever
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA. .,One Hospital Dr. MA314, Columbia, MO, 65212, USA.
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Catchpole E, Bond L, German R, Mayerl C, Stricklen B, Gould FDH. Reduced Coordination of Hyolaryngeal Elevation and Bolus Movement in a Pig Model of Preterm Infant Swallowing. Dysphagia 2019; 35:334-342. [PMID: 31297599 DOI: 10.1007/s00455-019-10033-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/30/2019] [Accepted: 07/02/2019] [Indexed: 01/13/2023]
Abstract
Preterm infants often have dysphagia. Because reducing lifetime cumulative exposure to radiation in the context of diagnosis and treatment is a continuing goal of all medical fields which use X-ray imaging, efforts exist to reduce reliance on the gold standard diagnostic tool for dysphagia, VFSS. Alternatives, such as video of external hyolaryngeal movement using video recordings of the anterior surface of the neck, must be evaluated and validated against videofluoroscopy, a task for which non-human animal models are appropriate. In this study, we tested the hypotheses that (1) swallows could be identified equally well from video of external hyolaryngeal movement and bolus movement in videofluoroscopy, and that (2) the two measures would be tightly temporally linked in both term and preterm infant pigs. We recorded 222 swallows in simultaneous and precisely synchronized high-speed videofluoroscopy and high-speed camera films of 4 preterm and 3 term infant pigs drinking milk from a bottle. In term pigs, the two measures consistently identified the same swallows in each image stream. However, in preterm pigs there was a high rate of false positives (~ 10% per feeding sequence) and false negatives (~ 27% per feeding sequence). The timing of hyolaryngeal elevation (external video) and bolus movement (videofluoroscopy) was correlated and consistent in terms pigs, but not in preterm pigs. Magnitude of hyolaryngeal elevation was less in preterm pig swallows than term pig swallows. Absence of epiglottal inversion in preterm pigs was not linked to variation in the timing of the two swallow events. Video of external hyolaryngeal movement, though a reliable swallow indicator in term infant pigs, was unreliable in preterm infant pigs. The coordination of swallowing events differs in preterm and term infant pigs. More research is needed into the distinctive biomechanics of preterm infant pigs.
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Affiliation(s)
| | | | | | | | | | - François D H Gould
- Department of Cell Biology and Neuroscience, Rowan University School of Osteopathic Medicine, 42 East Laurel road, Stratford, NJ, 08084, USA.
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