Temporal measures of oropharyngeal swallowing events identified using ultrasound imaging in healthy young adults

Methodological Procedures to Acquire and Analyze Ultrasound Images of Swallowing: A Scoping Review

This scoping review aimed to identify methodological procedures for acquiring and analyzing ultrasound images related to swallowing in adults and older adults. The inclusion criteria were based on the PCC strategy (participants, concept, and context), as follows: population (adults and older adults), concept (ultrasound assessment), and context (swallowing assessment). The review included observational, experimental, descriptive, and analytical studies and excluded those that were not available in full, animal studies, in vitro studies, letters to the editor, errata, study protocols, and those that used ultrasound for purposes other than swallowing. There were no language and time restrictions. Two independent blinded professionals selected 81 articles that met the inclusion criteria from different databases. The most evaluated parameters included tongue morphology and movements, hyoid bone displacement, swallowing muscle area, and pharyngeal residue detection, such as pharyngeal wall mobility. They used convex and linear transducers (3 MHz to 8 MHz) positioned in the submental, laryngeal, and lateral regions of the neck. The subjects were seated and instructed to eat different food volumes and consistencies. The literature mapping showed that ultrasound is a promising diagnostic tool, helping clinicians understand swallowing disorders, as it provides static and dynamic images in different modes and positions. Also, patients receive real-time biofeedback of changes related to dysphagia.

Effect of Ankle-Foot Orthosis on Paretic Gastrocnemius and Tibialis Anterior Muscle Contraction of Stroke Survivors During Walking: A Pilot Study

Ankle-foot orthoses (AFOs) have been commonly prescribed for stroke survivors with foot drop, but their impact on the contractions of paretic tibialis anterior (TA) and medial gastrocnemius (MG) has remained inconclusive. This study thus investigated the effect of AFOs on these muscle contractions in stroke survivors. The contractions of paretic TA and MG muscles were assessed in twenty stroke patients and compared between walking with and without AFOs, using a novel wearable dynamic ultrasound imaging and sensing system. The study found an increase in TA muscle thickness throughout a gait cycle (p > 0.05) and a significant increase in TA muscle surface mechanomyography (sMMG) signals during the pre- and initial swing phases (p < 0.05) when using an AFO. MG muscle thickness generally decreased with the AFO (p > 0.05), aligning more closely with trends seen in healthy adults. The MG surface electromyography (sEMG) signal significantly decreased during the initial and mid-swing phases when wearing an AFO (p < 0.05). The TA-MG co-contraction index significantly decreased during initial and mid-swing phases with the AFO (p < 0.05). These results suggest that AFOs positively influenced the contraction patterns of paretic ankle muscles during walking in stroke patients, but further research is needed to understand their long-term effects.

Kinematic Measurements of Swallowing by Ultrasound: A Scoping Review

Ultrasound (US) is a non-invasive method used to study the kinematics of the swallowing function. Kinematic measurements are reported in studies evaluating swallowing using US, but there is no standardization. The aim of this scoping review was to identify and characterize the kinematic measurements of swallowing obtained by ultrasound. We followed the methodological recommendations of the Joanna Briggs Institute (JBI) and the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-extension for scoping reviews (PRISMA-ScR). The research question followed the acronym PCC (population, concept, and context). Seven databases and gray literature were searched. Studies were selected using a blind, paired, and independent method. Data were extracted using a standardized tool. There were 2591 studies and 42 were eligible. Most studies had samples of less than 30 participants and mostly included healthy young adults and older people. The swallowing tasks during the assessments were not standardized. The most commonly studied measures were hyoid displacement and tongue movement during swallowing. However, there is no consensus between studies on the definition of the measures and the procedures for ultrasound assessment, including image acquisition and analysis.

Hyoid Bone Movement During Swallowing in Female Thyroidectomy Patients: A Kinematic Ultrasound Study

The aim of this study was to investigate the measures of displacement, time and velocity of hyoid bone movement in female thyroidectomy patients. Fifty-eight ultrasound videos of 29 women during swallowing were analyzed. The sample was divided into experimental group (EG), composed of 12 women following total or partial thyroidectomy; and control group (CG) of 17 healthy women. The kinematic measures of displacement, time and velocity of hyoid bone displacement were tracked during swallowing of 10 ml of liquid (water) and 10 ml of thickened liquid (honey) in both groups for comparisons. Additional analysis included bolus consistency effect and relationship with clinical characteristics. Ultrasound videos were analyzed according to a standardized protocol using ImageJ software. Displacement, time and velocity of hyoid movement during swallowing of 10 ml of liquid or thickened liquid were not statistically different between female thyroidectomy patients and healthy women. There is no bolus consistency effect on kinematic measures in both groups, but among thyroidectomy patients, velocity of hyoid bone movement is significantly faster in those with swallowing complaints.

Using Sequence Analyses to Quantitatively Measure Oropharyngeal Swallowing Temporality in Point-of-Care Ultrasound Examinations: A Pilot Study

(1) Background: Swallowing is a complex process that comprises well-timed control of oropharyngeal and laryngeal structures to achieve airway protection and swallowing efficiency. To understand its temporality, previous research adopted adherence measures and revealed obligatory pairs in healthy swallows and the effect of aging and bolus type on the variability of event timing and order. This study aimed to (i) propose a systemic conceptualization of swallowing physiology, (ii) apply sequence analyses, a set of information-theoretic and bioinformatic methods, to quantify and characterize swallowing temporality, and (iii) investigate the effect of aging and dysphagia on the quantified variables using sequence analyses measures. (2) Method: Forty-three participants (17 young adults, 15 older adults, and 11 dysphagic adults) underwent B-mode ultrasound swallowing examinations at the mid-sagittal plane of the submental region. The onset, maximum, and offset states of hyoid bone displacement, geniohyoid muscle contraction, and tongue base retraction were identified and sorted to form sequences which were analyzed using an inventory of sequence analytic techniques; namely, overlap coefficients, Shannon entropy, and longest common subsequence algorithms. (3) Results: The concurrency of movement sequence was found to be significantly impacted by aging and dysphagia. Swallowing sequence variability was also found to be reduced with age and the presence of dysphagia (H(2) = 52.253, p < 0.001, η2 = 0.260). Four obligatory sequences were identified, and high adherence was also indicated in two previously reported pairs. These results provided preliminary support for the validity of sequence analyses for quantifying swallowing sequence temporality. (4) Conclusions: A systemic conceptualization of human deglutition permits a multi-level quantitative analysis of swallowing physiology. Sequence analyses are a set of promising quantitative measurement techniques for point-of-care ultrasound (POCUS) swallowing examinations and outcome measures for swallowing rehabilitation and evaluation of associated physiological conditions, such as sarcopenia. Findings in the current study revealed physiological differences among healthy young, healthy older, and dysphagic adults. They also helped lay the groundwork for future AI-assisted dysphagia assessment and outcome measures using POCUSs. Arguably, the proposed conceptualization and analyses are also modality-independent measures that can potentially be generalized for other instrumental swallowing assessment modalities.

Assessing Swallowing Dysfunction Aggravation in Chronic Obstructive Pulmonary Disease Patients Using Ultrasonic Measurements With Swallowing Movement Parameters

OBJECTIVE

To investigate the correlation between ultrasonic measurements of swallowing movement parameters and aggravation of swallowing dysfunction in patients with chronic obstructive pulmonary disease (COPD).

METHODS

COPD patients with swallowing dysfunction (n = 120) and COPD patients with normal swallowing function (n = 100) treated in our hospital between January 2020 and January 2023 were included in observation and control groups, respectively. The correlation between ultrasonic measurements of swallowing movement parameters and COPD with swallowing dysfunction was analyzed. The observation group was divided into mild and severe groups according to their Gugging Swallowing Screen (GUSS) scores. The correlation between ultrasonic measurements of swallowing movement parameters and COPD exacerbation combined with swallowing dysfunction was analyzed.

RESULTS

In the observation group, Hyoid muscle thickness, hyoid bone displacement, geniohyoid muscle movement distance, HLAS, and CSR were lower compared to the control group, negatively associated with COPD-related swallowing issues. Conversely, geniohyoid muscle movement time and minimum hyohyoid distance (NHLA) were higher in the observation group, positively correlated with COPD-related swallowing dysfunction. In COPD patients with swallowing problems, the severe group exhibited lower values for lingual muscle thickness, hyoid bone displacement, geniohyoid muscle movement distance, HLAS, and CSR compared to the mild group, while geniohyoid muscle movement time and NHLA were higher in the severe group. Receiver operating characteristic (ROC) curves were created, indicating the promising diagnostic utility of these parameters for assessing the presence and severity of swallowing dysfunction in COPD patients.

CONCLUSION

The ultrasonic measurement of swallowing motion parameters can effectively assess swallowing dysfunction in COPD patients.