Oropharyngeal Swallowing Function Research Articles

Effects of effortful swallowing against kinesiology taping resistance on the swallowing function in patients with poststroke dysphagia: A randomized controlled trial.

A dysphagia rehabilitation method using kinesiology taping (KT) was recently introduced, and its potential for clinical efficacy was demonstrated by evaluating muscle activity and thickness. However, its effect on the swallowing function in patients with dysphagia remains unclear. This study aimed to investigate the effects of effortful swallowing against KT resistance on the swallowing function in patients with post stroke dysphagia. Thirty patients with poststroke dysphagia were recruited and randomly assigned to the experimental and placebo groups. In the experimental group, the KT was attached to the front of the neck (the hyoid bone between the sternum) with a tension of approximately 70% to 80%, and effortful swallowing was performed against the KT tension. In contrast, the placebo group performed effortful swallowing with KT applied at the same location without tension. The intervention was performed 30 times/day, 5 days/week for 6 weeks. The videofluoroscopic dysphagia scale (VDS) and penetration-aspiration scale (PAS) based on a videofluoroscopic swallowing study were used to analyze oropharyngeal swallowing function. The experimental group showed statistically significant improvements in the oral and pharyngeal phases of the VDS (P = .029 and .007, respectively) and PAS (P = .034) compared with the placebo group. Effect sizes were observed for the oral (0.3) and pharyngeal phases (0.5) of the VDS and PAS (1.1). This study demonstrated that effortful swallowing against resistance to KT is an effective therapeutic exercise for improving the swallowing function in patients with poststroke dysphagia.

Efficacy of High-Intensity Training in Patients with Moderate to Severe Dysphagia after Glossectomy.

Dysphagia is the main impairment arising from glossectomy for tongue cancer treatment. The study aimed to determine if an eight-week training protocol paired with accuracy tasks and swallowing exercises is effective and can improve tongue strength and swallowing in patients after tongue resection. Maximum isometric pressures, tongue endurance, swallowing pressures, mealtime duration, and oropharyngeal swallow function were studied in patients with moderate to severe dysphagia after glossectomy. Twenty-five (25) patients and thirty-one (31) healthy participants were enrolled in the study. The therapy group (TG) consisted of seventeen (17) patients who followed an 8-week treatment protocol and had multiple measurements. The follow-up control group (FUG) consisted of eight non-treated patients who had a baseline and an 8-week follow-up examination. Healthy participants served as the reference group (RF). Maximum isometric pressures, endurance, and swallowing pressures increased significantly in the TG versus the FUG. Significant improvement was documented in the TG regarding the EAT-10 questionnaire, the Penetration-Aspiration Scale scores at thickened and solid boluses, and post-swallow residues at thickened and solid boluses. The treatment protocol with tongue strength exercises combined with accuracy tasks and swallowing exercises improves the post-operative swallowing function in patients after glossectomy. Patients in the TG had more significant and quicker improvement in pressures and endurance compared to FUG.

The Influence of Side-Lying Position on Oropharyngeal Swallow Function in At-Risk Infants: An Exploratory Study.

This investigation assessed the effect of side-lying position on infant oropharyngeal swallow physiology. Infant modified barium swallow studies (MBS) recordings were retrospectively examined in matched-pairs comparing at-risk infants swallowing in both an upright/cradled position and a side-lying position. Swallow parameters were measured independently and through a consensus coding approach. Infants fed in side-lying position showed a decrease in airway invasion severity as compared with when those same infants were fed in an upright/cradled position (P = .009). Bolus location at the time of swallow initiation was higher when infants were fed in side-lying position as compared with cradle position (P = .024), representing decreased risk of airway invasion. Infants fed in side-lying position demonstrated fewer swallows per breaths (P = .032). This pilot study validates the need for additional research to further define the mechanisms related to this improvement, and to determine how diagnosis and medical stability moderate these findings.

Dysphagia and Methamphetamine Use: Considerations for Speech-Language Pathologists

Purpose: Methamphetamine use increases the risk of medical conditions that may cause oropharyngeal dysphagia. This tutorial describes what is known about methamphetamine's effects and draws connections to a speech-language pathologist's (SLP's) practice in dysphagia assessment and treatment with this population. Method: Methamphetamine's mechanism of action and prevalence of use are explored. Research in speech-language pathology and related fields such as dentistry, pharmacology, psychology, and public health provides insights into how this drug may impact oropharyngeal swallowing function and treatment participation. Conclusions: Methamphetamine can have a profound impact on the user's medical, cognitive, and psychosocial status. Although patients with a history of methamphetamine use are commonly seen by SLPs, there is a lack of direct research investigating potential implications of use on swallowing physiology and treatment progress. Future directions for research are discussed.

Effects of Oxygen via High-Flow Nasal Cannula on Adult Oropharyngeal Swallowing: A Literature Review

Purpose The use of high-flow oxygen via nasal cannula has become increasingly more common in various patient populations given the multiple benefits for treating respiratory distress and failure. There is emerging, though varying research on the impact high-flow oxygen delivery may have on adult oropharyngeal swallowing function. The purpose of this literature review is to outline available research and examine study design, populations investigated, findings, and clinical considerations of these findings. Method After an extensive online database search, we found five available peer-reviewed research articles specifically investigating oropharyngeal swallowing function in adults receiving high-flow nasal cannula (HFNC) therapy. Each article was reviewed and summarized in detail with close attention paid to results and clinical implications. Limitations, indirectness, and/or methodologic flaws are highlighted for the readers' consideration. Conclusions Four prospective design studies and one retrospective data analysis collection have been published evaluating the effects of high-flow oxygen therapy on adult oropharyngeal swallowing. Three of the prospective design studies evaluated healthy adults; one prospective design and the retrospective analysis data collection investigated acute care patients requiring HFNC. Study findings varied greatly likely due to variability of each study's subject population, design, and methods. Variability of results may make it challenging for speech pathologists attempting to use evidence-based decision making in clinical practice. Additional studies investigating nonhealthy subjects undergoing instrumental swallow studies while on HFNC are warranted.

Dysphagia Phenotypes in Spinal Muscular Atrophy: The Past, Present, and Promise for the Future.

PurposeThe aim of this study was to provide clinicians with an overview of literature relating to dysphagia in spinal muscular atrophy (SMA) to guide assessment and treatment.MethodIn this clinical focus article, we review literature published in Scopus and PubMed between 1990 and 2020 pertaining to dysphagia in SMA across the life span. Original research articles that were published in English were included. Searches were conducted within four themes of inquiry: (a) etiology and phenotypes, (b) respiratory systemic deficits and management, (c) characteristics of natural history dysphagia and its treatment, and (d) dysphagia outcomes with disease-modifying therapies. Articles for the first two themes were selected by content experts who identified the most salient articles that would provide clinicians foundational background knowledge about SMA. Articles for the third theme were identified using search terms, including spinal muscular atrophy, swallow, dysphagia, bulbar, nutrition, g-tube, alternative nutrition, jaw, mouth, palate, OR mandible. Search terms for the fourth theme included spinal muscular atrophy AND nusinersen OR AVXS-101/onasemnogene abeparvovec-xioi.Review of Pertinent LiteratureTwenty-nine articles were identified. Findings across identified articles support the fact that patients with SMA who do not receive disease-modifying therapy exhibit clinically significant deficits in oropharyngeal swallow function. Few investigations provided systematic information regarding the underlying physiological deficits responsible for this loss in function, the timing of the degradation, or how disease-modifying therapies change these outcomes.ConclusionFuture research outlining the physiological and functional oropharyngeal swallowing deficits among patients with SMA who receive disease-modifying therapy is critical in developing standards of dysphagia care to guide clinicians.

Effect of cognitive and motor dual‐task on oropharyngeal swallowing in Parkinson's disease

Dysphagia frequently occurs in patients with Parkinson's disease (PD) and is associated with severe complications. However, the underlying pathology is poorly understood at present. This study investigated the effect of cognitive and motor dual-task interference on oropharyngeal swallowing in PD. Thirty PD patients (23 men, mean age 65.90±9.32years, mean Hoehn and Yahr stage 2.62±0.81, mean UPDRS 18.00±7.18) were examined using flexible endoscopic evaluation of swallowing (FEES). FEES was performed during three paradigms: at baseline without interference, during a cognitive dual-task, and during a motor dual-task. Oropharyngeal swallowing function was rated using a score which was validated to detect changes in PD related dysphagia. The three paradigms were compared using a two-way-repetitive-measures-ANOVA and a post-hoc-analysis. Mean swallowing score in baseline FEES was 10.67±5.89. It significantly increased (worsened) to 15.97±7.62 (p<0.001) in the motor dual-task and to 14.55±7.49 (p<0.001) in the cognitive dual-task. Premature bolus spillage and pharyngeal residue both significantly increased during both of the dual-task conditions whereas penetration/aspiration events did not change. Oropharyngeal swallowing in patients with PD is not purely reflexive but requires mental capacity. Additional allocation of attentional resources in the central control of swallowing seems to be an effective compensatory mechanism in PD-related dysphagia: The proposed dual-task protocol may be useful to challenge swallowing functional reserve. Conversely, as a therapeutic strategy, it could be beneficial to focus attention on swallowing and to avoid dual-task situations.

Muscle Tension Dysphagia: Contributing Factors and Treatment Efficacy.

To determine factors contributing to disease etiology and treatment efficacy. Original Report. Tertiary academic center. IRB approved prospective study of 20 patients with reported dysphagia who exhibited normal oropharyngeal and esophageal swallowing function as evidenced by videofluoroscopic swallow study, esophagogastroduodenoscopy, high-resolution esophageal manometry with stationary impedance, and Bravo pH probe off proton pump inhibitor. Patients underwent speech-language pathology intervention. Atypical laryngeal muscle tension was present in 100% of patients. Forty percent of patients had diagnosed positive gastroesophageal reflux disease. Sixty-five percent of patients showed signs of non-specific laryngeal inflammation and laryngeal hyperresponsiveness during strobolaryngoscopy. All patients reported a mean of 90% recovery by the completion of voice therapy directed toward unloading muscle tension. The study results suggest an association between laryngeal muscle tension and these patients' dysphagia symptoms regardless of associated conditions. Speech-language pathology intervention showed high treatment efficacy. 2c- Outcomes research.

The effect of neuromuscular electrical stimulation with different electrode positions on swallowing in stroke patients with oropharyngeal dysphagia: A randomized trial.

To examine the effects of neuromuscular electrical stimulation (NMES) on oropharyngeal swallowing function according to 2 types of placement, acting as assistance and as resistance, in stroke patients with dysphagia. Thirty-eight stroke patients with dysphasia were randomly assigned to the suprahyoid group (SMG), or infrahyoid muscle group (IMG); 26 patients completed the intervention and were included in the analysis. In the SMG, the electrodes were placed on the region between the jaw and the hyoid bone, whereas in the IMG, the electrodes were placed on the region below the hyoid for the targeted infrahyoid muscles. Both groups received NMES for 30 min/d, 5 d/wk, for 4 weeks and conventional dysphagia therapy. Swallowing function was measured using the Videofluoroscopic Dysphagia Scale and Penetration-Aspiration Scale based on videofluoroscopic swallowing study. Oral dietary intake was measured using the Functional Oral Intake Scale. Both groups showed significant improvements in oropharyngeal function and level of functional oral intake, but there was no significant difference between the two groups. However, the SMG showed a more reduced penetration-aspiration, compared with the IMG. Altogether, these data demonstrate that 2 types of NMES placements have a similar effect on improving swallowing function and oral diet intake in patients with dysphagia.

Adaptations to Oral and Pharyngeal Swallowing Function Induced by Injury to the Mylohyoid Muscle.

Muscle injury is a frequent side effect of radiation treatment for head and neck cancer. To understand the pathophysiology of injury-related dysfunction, we investigated the effects of a single muscle injury to the mylohyoid on oropharyngeal swallowing function in the rat. The mylohyoid protects the airway from food/liquid via hyolaryngeal elevation and plays an active role during both oral and pharyngeal swallowing. We hypothesized (1) that fibrosis to the mylohyoid alters swallowing bolus flow and licking patterns and (2) that injury to the mylohyoid changes normal activity of submental, laryngeal, and pharyngeal muscles during swallowing. A chilled cryoprobe was applied to the rat mylohyoid muscle to create a localized injury. One and two weeks after injury, swallowing bolus transit was assessed via videofluoroscopy and licking behavior via an electrical lick sensor. The motor activity of five swallow-related muscles was analyzed immediately after injury using electromyography (EMG). Comparisons were made pre- and post-injury. Fibrosis was confirmed in the mylohyoid at 2 weeks after injury by measuring collagen content. One week after injury, bolus size decreased, swallowing rate reduced, and licking patterns were altered. Immediately post-injury, there was a significant depression in mylohyoid and thyropharyngeus EMG amplitudes during swallowing. Our results demonstrated that injury to the mylohyoid is sufficient to cause changes in deglutition. These disruptions in oral and pharyngeal swallowing were detected prior to long-term fibrotic changes, including delays in tongue movement, alterations in bolus flow, and changes in sensorimotor function. Therefore, injuring a single important swallowing muscle can have dramatic clinical effects.

Effects of Neuromuscular Electrical Stimulation for Masseter Muscle on Oral Dysfunction After Stroke.

ObjectiveTo determine positive effect of neuromuscular electrical stimulation (NMES) in conventional dysphagia therapy on masseter muscle oral dysfunction of patients after subacute stroke.MethodsAmong subacute stroke patients who were diagnosed as oropharyngeal dysphagia by videofluoroscopy swallowing study (VFSS), those with oral dysfunction were enrolled. They were randomly assigned to a study group or a control group. The study group received NMES on masseter muscle and suprahyoid muscle simultaneously, while the control group received NMES only on suprahyoid muscle. NMES therapy session as applied 30 minutes each time, two times per day for a total of 20 sessions. Both groups received conventional dysphagia therapy for 2 weeks. All enrolled patients were evaluated by VFSS after 2 weeks. Oropharyngeal swallowing function was evaluated by Penetration-Aspiration Scale, Functional Dysphagia Scale (FDS), and American Speech-Language-Hearing Association National Outcome Measurement System swallowing scale based on results of VFSS.ResultsPatients were randomly assigned to the study group (n=20) or the control group (n=20). There were no significant differences in baseline characteristics or initial values between the two groups. After 2 weeks of NMES, both groups showed improvement in scores of total FDS and pharyngeal phase FDS. Additionally, the study group showed improvement in oral phase FDS. Changes in all measurements were similar between the two groups.ConclusionIn this preliminary study, NMES for masseter muscle has a therapeutic effect on oral dysfunction of patients after subacute stroke.

Effect of effortful swallowing training on tongue strength and oropharyngeal swallowing function in stroke patients with dysphagia: a double-blind, randomized controlled trial.

Effortful swallowing training (EST) is a remedial method for the training of swallowing-related muscles in the oropharyngeal phase. However, clinical evidence of its effectiveness is insufficient. To investigate the effects of EST on tongue strength and swallowing function in patients with stroke. Stroke patients with dysphagia were randomly assigned to one of two groups: an experimental group (n = 12) and a control group (n = 12). The experimental group underwent EST, while the control group performed saliva swallowing. Training was conducted 5 days per week for 4 weeks. Both groups underwent conventional dysphagia treatment for 30 min/day, 5 days/week for 4 weeks. Tongue strength was assessed using the Iowa Oral Performance Instrument. The Videofluoroscopic Dysphagia Scale (VDS), based on a videofluoroscopic swallowing study, was used to analyze oropharyngeal swallowing function. The experimental group showed greater improvements in anterior and posterior tongue strength compared with the control group (p = 0.046 and 0.042, respectively), and greater improvement in the oral phases of the VDS (p = 0.017). We recommend EST as a remedial strategy for improving tongue strength and oral swallowing function in patients with stroke.

Oropharyngeal swallow physiology and swallowing-related quality of life in underweight patients with concomitant advanced chronic obstructive pulmonary disease.

BackgroundSwallowing impairment (dysphagia) has been associated with COPD and may contribute to exacerbations of this chronic and progressive disease. Further, risk of mortality increases with concomitant presence of cachexia in the COPD population. The purpose of this prospective study was to depict oropharyngeal swallowing physiology in underweight patients with stable but advanced-stage COPD.Patients and methodsTen underweight patients with stable but advanced COPD underwent a modified barium swallow study. Analysis of oropharyngeal swallowing function was completed using the standardized Modified Barium Swallow Impairment Profile and the Penetration–Aspiration Scale. Scores from the Dysphagia Handicap Index and 10-item Eating Assessment Tool were collected to assess patient perception of swallowing difficulty. Findings were compared to age- and sex-matched healthy controls.ResultsSignificantly higher MBSImP oral total scores (P=0.007) were observed in COPD patients compared to matched controls, but no difference was observed in pharyngeal total scores (P=0.105). Patients with COPD had significantly higher maximum PAS scores compared with controls (P=0.030). There was no significant difference in EAT-10 or DHI scores between patients with COPD and controls (P=0.41 and P=0.08, respectively).ConclusionUnderweight patients with severe but stable COPD present with dysphagia that may not be recognized by the patient. Further investigation is needed to elucidate the interaction between the respiratory–swallowing systems, how muscular weakness may contribute to swallowing impairment, and responsiveness to swallowing treatment.

Relationship Between Swallowing Function and Maximum Phonation Time in Patients With Parkinsonism.

ObjectiveTo identify the relationship between maximum phonation time (MPT) and swallowing function, as well as the elements of swallowing, in order to provide a rationale for speech therapy in patients with Parkinsonism manifesting dysphagia.MethodsThirty patients with Parkinsonism who underwent speech evaluation and videofluoroscopic swallowing study (VFSS) were recruited. The MPT, the longest periods of sustained pronunciation of /aa/, was evaluated. The VFSS was evaluated using Penetration Aspiration Scale (PAS), National Institutes of Health-Swallowing Safety Scale (NIH-SSS), and Videofluoroscopic Dysphagia Scale (VDS). The relationship between dysphagia scales and MPT was analyzed using Pearson correlation. The difference in VDS variables between subgroups (Parkinson disease or Parkinsonian syndrome, independent or dependent ambulation, and normal or abnormal MPT) and the difference in MPT between subgroups based on the VDS variables were analyzed using the independent t-test.ResultsBolus formation and laryngeal elevation functions were significantly higher in the normal MPT group compared with the impaired group. In the VDS variables, patients with intact bolus formation, oral transit time, pharyngeal swallow triggering, and laryngeal elevation showed significantly longer MPTs compared with the impaired groups. In addition, MPT was significantly correlated with the VDS and modestly correlated with the NIH-SSS, but not the PAS, suggesting that phonatory function is related to the oropharyngeal swallowing function, but not directly to the aspiration itself.ConclusionThe correlation between MPT and several swallowing-related elements was identified, indicating an interactive correlation between swallowing and phonation. This result justifies voice therapy as a treatment for dysphagia in patients with Parkinsonism.

Dysphagia in Children

Speech-Language Pathologists (SLP) play an integral role in evaluating and treating pediatric patients with dysphagia related to aerodigestive disorders. Non-supportive anatomy, cardio-respiratory and medical status, state control, neurologic functioning, postural stability and control, gastrointestinal functioning, hunger and satiation, developmental abilities, oral-motor skills, oral/pharyngeal reflexes, airway protection and secretion management can create barriers to successful oral feeding. Swallowing is broken down into four phases and difficulties can occur during any phase or in combination with another phase of swallowing. Dysphagia is diagnosed by both clinical and instrumental evaluation. Objective evaluations of swallowing include the Video Fluoroscopic Swallow Study (VFSS) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES). A Video Fluoroscopic Swallow Study (VFSS) is a radiographic study assessing oropharyngeal swallow function. The Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is conducted by passing a laryngoscope through the nose to just below the soft palate for a "bird's eye view" of laryngeal anatomy and swallow function. Following a diagnosis of dysphagia from either a clinical or instrumental assessment, there are a variety of avenues that can be pursued including diet modifications, compensatory strategies, and use of specialized equipment to ensure a safe feeding plan and reduce the risk of aspiration. In conclusion, through numerous evaluation and intervention approaches, the contributions of SLPs helps provide input for well-rounded, multi-disciplinary plans supporting successful oral feeding.

Oropharyngeal swallowing function in patients with presbyphagia.

[Purpose] This study investigated the characteristics of oropharyngeal swallowing function in patients with presbyphagia. [Participants and Methods] Data for 25 patients with presbyphagia were retrospectively analyzed. The oropharyngeal swallowing function was evaluated using VDS based on videofluoroscopic swallowing study. [Results] Lip closure, mastication, laryngeal elevation, and aspiration showed a relative decrease in function. [Conclusion] This study showed a reduction in oropharyngeal swallowing in patients with presbyphagia. Our results may help in the diagnosis and treatment of presbyphagia.

662 - Strength Training Using a Novel Swallow Resistance Exercise Device (SRED) Improves Oropharyngeal Swallow Function, Deglutitive UES Opening and Biomechanics in a Heterogeneous Group of Dysphagic Patients

662 - Strength Training Using a Novel Swallow Resistance Exercise Device (SRED) Improves Oropharyngeal Swallow Function, Deglutitive UES Opening and Biomechanics in a Heterogeneous Group of Dysphagic Patients

Continued Relevance of Videofluoroscopy in the Evaluation of Oropharyngeal Dysphagia

In the last decade, fluoroscopy in the radiology department has been largely replaced by more modern imaging techniques; however, the visualization of oropharyngeal swallowing function is still one of the hallmarks of fluoroscopy. This article describes the technique and interpretation of swallowing videofluoroscopy. As the evaluation of swallowing is a dynamic study with important, discrete events occurring rapidly, the fluoroscopic acquisition rate must be continuous or no less than 30 pulses per second. If the acquisition rate is less, important clinical information will be missed. Other swallowing evaluation techniques such as endoscopy, magnetic resonance imaging, and manometry are available. While each offers some advantages, their limitations preclude them from being the best evaluation tool for oropharyngeal swallowing. The videofluoroscopic swallowing study remains a relevant and efficient instrumental evaluation for the management and rehabilitation of oropharyngeal swallowing.

Effects of bedside self-exercise on oropharyngeal swallowing function in stroke patients with dysphagia: a pilot study.

[Purpose] The purpose of this study was to investigate the effect of self-exercise on oropharyngeal swallowing function in patients with dysphagia. [Subjects and Methods] Nine patients with dysphagia after stroke were recruited. Self-exercise including effortful swallowing, tongue strengthening, and shaker exercise was performed 5 times a week for 4 weeks. Swallowing function was evaluated using the videofluoroscopic dysphagia scale (VDS) based on a videofluoroscopic swallowing study. [Results] There were significant differences in both the oral and pharyngeal phases of the VDS before and after the intervention. [Conclusion] This study demonstrated that bedside self-exercise is a positive method to improve oropharyngeal swallowing function in patients with dysphagia after stroke.

Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia.

Tongue function can affect both the oral and pharyngeal stages of the swallowing process, and proper tongue strength is vital for safe oropharyngeal swallowing. This trial investigated the effect of tongue-to-palate resistance training (TPRT) on tongue strength and oropharyngeal swallowing function in stroke with dysphagia patients. This trial was performed using a 4-week, two-group, pre-post-design. Participants were allocated to the experimental group (n=18) or the control group (n=17). The experimental group performed TPRT for 4weeks (5days per week) and traditional dysphagia therapy, whereas the control group performed traditional dysphagia therapy on the same schedule. Tongue strength was measured using the Iowa Oral Performance Instrument. Swallowing function was measured using the videofluoroscopic dysphagia scale (VDS) and penetration-aspiration scale (PAS) based on a videofluoroscopic swallowing study. Experimental group showed more improved in the tongue strength (both anterior and posterior regions, P=0·009, 0·015). In addition, the experimental group showed more improved scores on the oral and pharyngeal phase of VDS (P=0·029, 0·007), but not on the PAS (P=0·471), compared with the control group. This study demonstrated the effectiveness of TPRT in increasing tongue muscle strength and improving swallowing function in patients with post-stroke dysphagia. Therefore, we recommend TPRT as an easy and simple rehabilitation strategy for improving swallowing in patients with dysphagia.