Piecemeal Deglutition Research Articles

Swallowing Problems in Spinal Muscular Atrophy Types 2 and 3: A Clinical, Videofluoroscopic and Ultrasound Study.

Spinal muscular atrophy (SMA) is a hereditary motor neuron disorder, characterized by the degeneration of motor neurons and progressive muscle weakness. There is a large variability of disease severity, reflected by the classification of SMA types 1-4. The aim of this cross-sectional study was to determine the nature of swallowing problems and underlying mechanisms in patients with SMA types 2 and 3, and the relationship between swallowing and mastication problems. We enrolled patients (aged 13-67 years) with self-reported swallowing and/or mastication problems. We used a questionnaire, the functional oral intake scale, clinical tests (dysphagia limit, and timed test swallowing, the test of mastication and swallowing solids), a videofluoroscopic swallowing study (VFSS), and muscle ultrasound of the bulbar muscles (i.e. digastric, geniohyoid and tongue muscles). Non-ambulant patients (n = 24) had a reduced dysphagia limit (median 13 ml (3-45), and a swallowing rate at the limit of normal (median 10 ml/sec (range 4-25 ml). VFSS revealed piecemeal deglutition and hypo-pharyngeal residue. We found pharyngo-oral regurgitation in fourteen patients (58%), i.e. they transported the residue from the hypopharynx back into the oral cavity and re-swallowed it. Six patients (25%) demonstrated impaired swallowing safety (i.e. PAS >3). Muscle ultrasound revealed an abnormal muscle structure of the submental and tongue muscles. Ambulant patients (n = 3), had a normal dysphagia limit and swallowing rate, but VFSS showed hypo-pharyngeal residue, and muscle ultrasound demonstrated an abnormal echogenicity of the tongue. Swallowing problems were associated with mastication problems (p = 0.001).

Swallowing evaluation in patients who underwent Partial CO2 LASER Epiglottectomy for Sleep Apnea treatment

ObjectiveTo evaluate swallowing in patients who underwent CO2 LASER Partial Epiglottectomy (CO2-LPE) for Obstructive Sleep Apnea Syndrome and to assess the risk of aspiration with this technique. Material & MethodsChart review of adult patients who underwent CO2-LPE between 2016 and 2020, in a secondary care hospital. Patients underwent surgery for OSAS, in accordance to Drug Induced Sleep Endoscopy findings and an objective swallowing evaluation was done at least 6 months after surgery. Eating Assessment Tool (EAT-10) questionnaire was applied and Volume-Viscosity Swallow Test (V-VST) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) were performed. Dysphagia was classified according to Dysphagia Outcome Severity Scale (DOSS). ResultsEight patients were included in the study. The mean time between surgery and the swallowing evaluation was 50 (±13,2) months. Only 3 patients presented ≥ 3 points on EAT-10 questionnaire. Two patients presented signs of decreased efficacy of swallowing (piecemeal deglutition) but none had a decrease in safety, according to V-VST. Although 50% of the patients presented some pharyngeal residue on FEES, it was classified as trace to mild in most of the cases. No evidence of penetration or aspiration was identified (DOSS ≥ 6 in all patients). ConclusionThe CO2-LPE is a potential treatment for OSAS patients with epiglottic collapse and no evidence of swallowing safety compromise was found.

The Therapeutic Effect of Swallow Training with a Xanthan Gum-Based Thickener in Addition to Classical Dysphagia Therapy in Chinese Patients with Post-Stroke Oropharyngeal Dysphagia: A Randomized Controlled Study.

In patients with post-stroke oropharyngeal dysphagia (PSOD), classical dysphagia therapy (CDT) continues to provide unsatisfactory outcomes and makes it challenging for them to remove the nasal feeding tube. Increasing bolus viscosity helps prevent aspiration in PSOD. However, conventional starch thickeners enhance post-digestion residue. This study aims to evaluate the efficacy of swallow training with xanthan gum-based thickener (XGT) (Softia G, NUTRI Co., Ltd., Yokkaichi, Japan) additional to CDT in Chinese PSOD patients with a nasogastric tube when compared to CDT alone. Patients with PSOD who had a nasogastric tube were randomly assigned to either the experimental group (E-group) or the control group (C-group) in this randomized controlled, single-blind, parallel-group study. Both groups received CDT for 4 weeks. The E-group cases received additional swallow training with a Softia G-prepared hydrogel training material. The Functional Oral Intake Scale (FOIS) and modified volume-viscosity swallow test (M-VVST) for swallowing safety and efficacy according to adjusted Chinese dietary habits were administered before and after treatment. Post-training, both groups' nasogastric tube removal rates were calculated. One hundred sixty-seven participants (E-group: 82 and C-group: 85) completed the study. The E-group's median score of FOIS improved significantly than the C-group after training (median = 5 vs. 3, P < 0.001). The incidence of coughing, voice changes, oxygen desaturation of 3% or more, pharyngeal residue and piecemeal deglutition in the E-group was significantly lower than that in the C-group (P < 0.05). The E-group had 100% nasogastric tube removal, while the C-group had 28.24% (P < 0.001). Swallow training with XGT Softia G in addition to CDT can promote swallowing safety and efficacy in Chinese patients with PSOD more effectively than CDT alone.

Effects of the GABA(B) agonist baclofen on volitional swallowing in normal subjects.

The GABA(B) receptor agonist baclofen is known to suppress the rate of spontaneous swallowing but not pharyngeal muscle contraction. The extent to which baclofen may alter volitional swallowing is not currently known. We investigated the effects of baclofen in healthy subjects, hypothesizing that baclofen exposure would alter volume-regulation and/or piecemeal deglutition behaviors during volitional swallowing attempts. Pharyngeal high-resolution manometry impedance (P-HRM-I) protocol was used to assess swallowing function of 22 healthy adult volunteers (median 29 years) who were investigated on two occasions, receiving 40 mg baclofen (oral) 1 h before study, or placebo (randomized). Standard swallow function variables recommended by the pharyngeal HRM Working Group were derived for 5ml, 10ml, and 20 ml volumes of thin and extremely thick liquid challenges. Multiple swallow behaviors, comprising two swallows <5s apart, were characterized. The spontaneous swallow rate was also determined. Baclofen exposure had no overall significant effect on swallow variables. Upper esophageal sphincter pressure was weaker during exposure to baclofen, during both the pre-deglutitive and post-deglutitive phases of the swallow (p < 0.05 during thick liquid swallows). Piecemeal swallows, where the bolus is separated in two potions, were significantly more common during 20 ml boluses (p=0.002). Baclofen decreased the frequency of piecemeal deglutition overall. Baclofen has limited to no effect on volitional swallowing measures, however, does reduce the likelihood of initiation of piecemeal deglutition to large volume challenges.

The sensitivity and specificity of the modified volume-viscosity swallow test for dysphagia screening among neurological patients.

Oropharyngeal dysphagia (OD) is a highly prevalent condition after stroke and other neurological diseases. The volume-viscosity swallow test (V-VST) is a screening tool for OD. Considering that the recommendations of volume and thickeners in the original V-VST limited the popularization and application of the test in the Chinese population, we provide the modified V-VST to detect OD among neurological patients. In addition, the accuracy of the modified V-VST to screen OD needs to be verified. We included 101 patients with neurological diseases. OD was evaluated by a modified V-VST and a videofluoroscopy swallowing study (VFSS) using 3 volumes (i.e., 3, 5, and 10 ml) and 4 viscosities (i.e., water, mildly thick, moderately thick, and extremely thick). In this study, to compare with the original V-VST results, a volume of 20 ml was also included. The discriminating ability of modified V-VST in detecting OD was assessed by the sensitivity and specificity values of clinical signs of impaired efficiency (impaired labial seal, piecemeal deglutition, and residue) and impaired safety of swallowing (cough, voice changes, and oxygen desaturation ≥3%) in comparison to the results of VFSS. The modified V-VST showed 96.6% sensitivity and 83.3% specificity for OD, 85.2% sensitivity and 70% specificity for impaired safety, and 90.9% sensitivity and 76.9% specificity for impaired efficacy. Our study suggests that the modified V-VST offers a high discriminating ability in detecting OD among neurological patients.

The Volume-Viscosity Swallowing Test – Portuguese Version: Validation and prevalence of safety and efficacy clinical signs in acute stroke patients

PurposeThe early identification of oropharyngeal dysphagia (OD) in patients after an acute stroke using non-invasive and easily administered instruments can minimize its consequences and reduce comorbidity and mortality. The Volume-Viscosity Swallow Test (V-VST) is a screening test that makes it possible. The goal of this study is to contribute to the validation of the V-VST European Portuguese (V-VST: EP) version and study the prevalence of safety and efficacy signs in acute stroke patients. MethodThe V-VST: EP, its instructions manual and algorithm, was presented to a panel of experts, to assess its content validity. It was applied to 33 acute stroke patients, with signs of OD, to analyze its psychometric properties. Finally, the prevalence of impaired signs of safety and efficacy was analyzed. ResultsThe V-VST: EP and its instruction manual (content) demonstrate very good agreement values. Most of the results for inter and intra-evaluator reliability presented Cohen's kappa values higher than 0.60 or 0.80 (75.0%). The concurrent validity (against the 3 OZ wst) presented a sensitivity of 100% and a specificity of 57.1%. For evaluator 1, the results presented are for the nectar, liquid and pudding consistencies, the prevalence values for the 5 ml, 10 ml and 20 ml volume capacity was: impaired lip closure (36%, 39%, 18%), piecemeal deglutition (50%, 50%, 50%), oral residue (7%, 0%, 9%), pharyngeal residue (25%, 17%, 9%) and safe swallowing (89%, 33%, 94%), respectively.

Fiberoptic Endoscopic Evaluation of Swallowing in Resistant Hypertensive Patients With and Without Sleep Obstructive Apnea.

Resistant arterial hypertension (RAH) is strongly associated with obstructive sleep apnea (OSA). Individuals with OSA may have subclinical swallow impairment, diagnosed by instrumental assessments, such as videofluoroscopy and fiberoptic endoscopic evaluation of swallowing (FEES). However, few studies have evaluated this population and included a control group of individuals without OSA. To evaluate, through FEES, the swallowing characteristics of resistant hypertensive patients with and without OSA and to investigate the association between the signs of swallow impairment and OSA. This was an observational study in which individuals with RAH underwent baseline polysomnography and were diagnosed with and without OSA. All participants underwent an initial assessment with the collection of demographic characteristics and FEES. Individuals were divided into 2 groups based on the presence or absence of OSA. Seventy-nine resistant hypertensive patients were evaluated: 60 with OSA (19 with mild OSA, 21 with moderate OSA, and 20 with severe OSA) and 19 without OSA. The most prevalent swallowing differences between groups with and without OSA were piecemeal deglutition, in 61.7% and 31.6%, respectively (p = 0.022); spillage, in 58.3% and 21.1% (p = 0.005); penetration/aspiration, in 55% and 47.4% (p = 0.561); and pharyngeal residue, in 51.5% and 26.3% (p = 0.053). The prevalence of swallow impairment among the participants in this study was 58.3% and 47.4% in the groups with OSA and without OSA, respectively (p = 0.402). This study shows a high prevalence of swallow impairment both in hypertensive patients with OSA and without OSA. The characteristics of swallowing associated with hypertensive patients with OSA are spillage, piecemeal deglutition, and the onset of the pharyngeal phase in the hypopharynx.

Endoscopic Characteristics of Dysphagia in Multiple System Atrophy Compared to Parkinson's Disease.

Dysphagia is a major clinical concern in multiple system atrophy (MSA). A detailed evaluation of its major endoscopic features compared with Parkinson's disease (PD) is lacking. This study systematically assessed dysphagia in MSA compared with PD and correlated subjective dysphagia to objective endoscopic findings. Fifty-seven patients with MSA (median, 64 [interquartile range (IQR): 59-71] years; 35 women) underwent flexible endoscopic evaluation of swallowing using a specific MSA-flexible endoscopic evaluation of swallowing task protocol. Findings were compared with an age-matched cohort of 57 patients with PD (median, 67 [interquartile range: 60-73] years; 28 women). In a subcohort, subjective dysphagia was assessed using the Swallowing Disturbance Questionnaire and correlated to endoscopy findings. Patients with MSA predominantly showed symptoms suggestive of oral-phase disturbance (premature spillage, 75.4%, piecemeal deglutition, 75.4%). Pharyngeal-phase symptoms occurred less often (pharyngeal residues, 50.9%; penetration/aspiration, 28.1%). In contrast, pharyngeal symptoms were the most common finding in PD (pharyngeal residues, 47.4%). Oral symptoms occurred less frequently in PD (premature spillage, 15.8%, P< 0.001; piecemeal deglutition, 1.8%, P< 0.01). Patients with MSA had a greater risk for oral-phase disturbances with increased disease severity (P < 0.05; odds ratio,3.15). Patients with MSA showed a significantly higher intraindividual interswallow variability compared with PD. When correlating Swallowing Disturbance Questionnaire scores with endoscopy results, its cutoff, validated for PD, was not sensitive enough to identify patients with MSA with dysphagia. We developed a subscore for identifying dysphagia in MSA and calculated a new cutoff (sensitivity 85%, specificity 100%). In contrast with patients with PD, patients with dysphagic MSA more frequently present with oral-phase symptoms and a significantly higher intraindividual interswallow variability. A novel Swallowing Disturbance Questionnaire MSA subscore may be a valuable tool to identify patients with MSA with early oropharyngeal dysphagia. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Videofluoroscopic Study of Swallowing Disorders in Patients with Parkinsonism

Background: Dysphagia in Parkinsonism is often reported, and diagnosed, late. This can be a contributor to morbidity and mortality. Hence, a screening tool is essential as part of routine workup of these patients. The gold standard diagnostic modality for dysphagia is Videofluoroscopic Swallowing Study (VFSS). However, being an interventional imaging procedure, it cannot be made routine for every case. Aim: To study swallowing problems in patients with Parkinsonism using a screening questionnaire and to objectively observe the findings at VFSS in these patients. Materials and Methods: Fifteen patients (nine males and six females) attending the Parkinsonism clinic over a period of 1 year, and meeting the inclusion criteria, were included in the study. After standard neurological evaluation, they were administered our screening tool, the Amrita Dysphagia Screening Questionnaire (ADSQ). Next, they underwent VFSS. The scores and findings from these were documented, and the results were tabulated. Results: The average Hoehn and Yahr scale and ADSQ scores were 0.488 and 0.799, respectively. Mean age was 68.9 years. In VFSS, all the patients showed features of oropharyngeal swallowing disorders characteristic of Parkinsonism. These included features of bradykinesia such as tongue pumping, smaller tongue movements and piecemeal deglutition in the oral preparatory stage of swallowing, and reduced pharyngeal constriction, premature spillage, vallecular and pyriform sinuses residue, reduced hyoid movement, prolonged transit time, delayed laryngeal closure, aspiration/penetration, and repetitive or multiple swallow in the pharyngeal stage of swallowing. Conclusion: The present study has documented the objective findings of swallowing disorders, especially of the oral phase, in patients with Parkinsonism. This, along with our screening tool, must be considered essential in the management protocol for this debilitating neurological condition.

Multiple swallow behaviour during high resolution pharyngeal manometry: prevalence and sub-typing in healthy adults

ABSTRACT Background: Typical voluntary bolus swallowing consists of a single discrete oropharyngeal swallow. Multiple Swallow Behaviour, such as piecemeal deglutition, is also known to occur in health. We hypothesized that Multiple Swallow Behaviour can be detected and sub-typed utilizing high resolution pharyngeal manometry (HRPM) with impedance. Methods: Prevalence of Multiple Swallow Behaviour was examined in 50 healthy subjects (29 females, mean age 47years, range 19.8–79.5years). HRPM was performed using the Medical Measurement Systems motility system and 8-French pressure-impedance solid state catheter (32 × 1 cm spaced uni-directional pressure sensors, 16 × 2 cm impedance segments). Triplicate boluses of 3, 5, 10 and 20 ml of thin, mildly thick and extremely thick consistencies were tested. Multiple Swallow Behaviour was defined by a sequence of two or more swallows on the pressure topography tracing, occurring after oral bolus administration, with an inter-swallow interval of ≤5 sec. Results: Single swallows were the most common behaviour observed. However, 28 of 50 participants exhibited at least one Multiple Swallow Behaviour event. Larger bolus volumes elicited more Multiple Swallow events. Using impedance, Multiple Swallow Behaviour was further sub-typed as Secondary Dry Swallows (70%, considered normal), Preceding Dry Swallows (1%, considered abnormal), Piecemeal Swallows (25%, considered abnormal for volumes <20 ml) or Clearing Swallows (4%, considered abnormal). Conclusion: HRPM with impedance enables the detection and characterization of Multiple Swallow Behaviour and potentially improves our ability to distinguish manifestations of swallowing disorders. Further studies are required to investigate Multiple Swallow Behaviour sub-types in patients with dysphagia.

Swallow-related quality of life and oropharyngeal dysphagia in myotonic dystrophy

PurposeThis study describes swallow-related quality of life (SWAL-QOL) in patients with myotonic dystrophy type 1 (DM1) and investigates its association with swallowing function and disease severity.MethodsA SWAL-QOL questionnaire was completed by 75 DM1 patients and 25 healthy control subjects. The severity of the disease was evaluated using the muscular impairment rating scale (MIRS). Twenty-eight DM1 patients underwent a videofluroscopic swallowing examination (VFS). Spearman’s correlation coefficient was used to measure the direction and strength of associations.ResultsThe SWAL-QOL median scores were significantly lower for the DM1 group than for the healthy control group. The scores for the majority of the SWAL-QOL domains were lower in patients with proximal muscular weakness (MIRS 4 and 5). Postswallow vallecular pooling and piecemeal deglutition were the most impaired VFS outcome variables.ConclusionOur results suggest that a multidimensional swallowing assessment is recommended for DM1 patients as SWAL-QOL and VFS measure different aspects of the swallowing function, thus providing complementary information.

Prospective Analysis of the Swallowing Reflex After Sagittal Split Osteotomy: Comparison with Normal Volunteers

The aim of this study was electromyographic description of changes in swallowing before and after bilateral sagittal split ramus osteotomy. In this prospective study, twenty-eight patients were divided into 3 groups according to the occlusion pattern: Group I (Angle Class III), Group II (Angle Class II), and Control (Class I). Serial cone-beam computed tomography analyses and electromyographic data were collected preoperatively, 1st and 6th months after setback surgery in Group I, and advancement surgery in Group II. Swallowing reflex with 3-20ml water bolus were studied. Patients were further divided into two subgroups according to the magnitude of relapse. The mean setback of the mandible was 4.62 ± 1.92mm in Group I, and the mean advancement was 4.19 ± 2.00mm in Group II. Mandibular relapse rate was 17.40%. Oral preparation phase shortened after surgery in both study groups. Two subjects in Group II and one in Group I had piecemeal deglutition, and two of them became normal postoperatively. Most of the swallowing durations of the relapsed cases were longer than those of stabilized patients. Important clinical considerations are as follows: the oral preparation period becomes shorter after surgery; piecemeal deglutition may disappear after treatment; and individuals with a longer oral period and piecemeal deglutition may have increased tendency to skeletal relapse. This multidisciplinary study enhances our understanding of the adaptive response to the swallowing reflex after orthognathic surgery and provides novel insight into the association between the submental muscle activity and relapse in orthognathic patients.

Home-Based Orolingual Exercise Improves the Coordination of Swallowing and Respiration in Early Parkinson Disease: A Quasi-Experimental Before-and-After Exercise Program Study.

Introduction: The coordination of swallowing and respiration is important for safety swallowing without aspiration. This coordination was affected in Parkinson disease (PD). A noninvasive assessment tool was used to investigate the effect of an easy-to-perform and device-free home-based orolingual exercise (OLE) program on swallowing and respiration coordination in patients with early-stage PD.Materials and Methods: This study had a quasi-experimental before-and-after exercise program design. Twenty six patients with early-stage PD who were aged 62.12 ± 8.52 years completed a 12-week home-based OLE program. A noninvasive assessment tool was used to evaluate swallowing and respiration. For each patient, we recorded and analyzed 15 swallows (3 repeats of 5 water boluses: 1, 3, 5, 10, and 20 mL) before and after the home-based OLE program. Oropharyngeal swallowing and its coordination with respiration were the outcome measures. The frequency of piecemeal deglutition, pre- and post-swallowing respiratory phase patterns, and parameters of oropharyngeal swallowing and respiratory signals (swallowing respiratory pause [SRP], onset latency [OL], total excursion time [TET], excursion time [ET], second deflexion, amplitude, and duration of submental sEMG activity, and amplitude of laryngeal excursion) were examined.Results: The rate of piecemeal deglutition decreased significantly when swallowing 10- and 20-mL water boluses after the program. In the 1-mL water bolus swallowing trial, the rate of protective pre- and post-swallowing respiratory phase patterns was significantly higher after the program. For the parameters of oropharyngeal swallowing and respiratory signals, only the amplitude of laryngeal excursion was significantly lower after the program. Moreover, the volume of the water bolus significantly affected the SRP and duration of submental sEMG when patients swallowed three small water bolus volumes (1, 3, and 5 mL).Conclusion: The home-based OLE program improved swallowing and its coordination with respiration in patients with early-stage PD, as revealed using a noninvasive method. This OLE program can serve as a home-based program to improve swallowing and respiration coordination in patients with early-stage PD.

Medically Unexplained Oropharyngeal Dysphagia at the University Hospital ENT Outpatient Clinic for Dysphagia: A Cross-Sectional Cohort Study

Medically unexplained oropharyngeal dysphagia (MUNOD) is a rare condition. It presents without demonstrable abnormalities in the anatomy of the upper aero-digestive tract and/or swallowing physiology. This study investigates whether MUNOD is related to affective or other psychiatric conditions. The study included patients with dysphagic complaints who had no detectible structural or physiological abnormalities upon swallowing examination. Patients with any underlying disease or disorder that could explain the oropharyngeal dysphagia were excluded. All patients underwent a standardized examination protocol, with FEES examination, the Hospital Anxiety and Depression Scale (HADS), and the Dysphagia Severity Scale (DSS). Two blinded judges scored five different FEES variables. None of the 14 patients included in this study showed any structural or physiological abnormalities during FEES examination. However, the majority did show abnormal piecemeal deglutition, which could be a symptom of MUNOD. Six patients (42.8%) had clinically relevant symptoms of anxiety and/or depression. The DSS scores did not differ significantly between patients with and without affective symptoms. Affective symptoms are common in patients with MUNOD, and their psychiatric conditions could possibly be related to their swallowing problems.

Correlation Within the Piece-Meal Deglutition, MDADI and UPDRS in Early Stage of Parkinson’s Disease

To identify the Correlation within the piece-meal deglutition, MDADI and UPDRS in early stage of Parkinson’s disease.

P267 Swallowing and brainstem reflexes before and after mandibular sagittal split osteotomy

Objectives To study the electrophysiological parameters of swallowing and related brainstem reflexes before and after bilateral mandibular sagittal split osteotomy in patients with mandibular dentoskeletal deformities. Methods The patients were divided into 3 groups based on the occlusion pattern, Group I (Angle Class III malocclusion, 7 patients), Group II (Angle Class II malocclusion, 4 patients) and Controls (Class I occlusion, 12 healthy subjects). Swallowing reflex with 3–20 ml water bolus, blink reflexes (BR) with supraorbital and mental nerve stimulation, and masseter inhibitory reflex (MIR) during maximal intercuspidation were studied. Electrophysiological tests were repeated postoperatively in 2nd and 7th months. Results Oral preparation and triggering the pharyngeal phase of swallowing was shorter in Group II (especially with 15–20 ml water) and longer in Group I, as compared to the controls. Oral period shortened after surgery in Group I. In Group II, 2 patients had piecemeal deglutition during swallowing of 10–20 ml water, and one of them became normal after surgery. At the postoperative 2nd month examination, BR with mental nerve stimulation was suppressed bilaterally (with a unilaterally absent MIR) in one patient in Group I and unilaterally in one patient in Group II, with subsequent recovery. Discussion and conclusion Oral phase of swallowing is shorter in Group II, possibly due to the low volume capacity of the oral cavity. BR and MIR abnormalities substantiates the reversible inferior alveolar nerve damage. Significance This study combines the electrophysiological swallowing tests and brainstem reflexes in patients with mandibular malocclusion both before and after surgery.

BEYOND THE ISOLATED SWALLOW: DYSPHAGIA IN THE CONTEXT OF PERFORMANCE DURING A MEAL

Dysphagia (difficulty in swallowing) makes the socially and culturally important meal situation problematic in elderly people, and may lead to decreased health, well-being and quality of life. Since eating, drinking and swallowing are complex and integrated neuromuscular processes, it is proposed that assessment of dysphagia should be based on a multi-stage process of ingestion: pre-oral (anticipatory), oral, pharyngeal, and esophageal. However, there is limited literature regarding the influences of the individual ingestion stages on the swallowing safety in dysphagic elders during a meal. As a part of a comprehensive needs assessment for developing and enhance dysphagia rehabilitation, this study aimed to provide insights into which specific ingestive skill impairments influences unsafe swallowing in elderly (65+) people with dysphagia. A cross-sectional study with 328 Danish elderly people (mean age: 77.7 ± 11.6 years) referred to occupational therapy for swallowing evaluation was carried out, and data on mealtime performance was collected using the McGill Ingestive Skills Assessment. Multiple logistic regression models showed that unsafe swallowing during a meal was significantly associated with: 1) inability to maintain a seating position, 2) inability to self-feed, impaired judgment and energy and 3) reduced labial seal, inability to bite and chew food items, piecemeal deglutition, inability to coordinate respiratory pattern during ingestion and inability to clear the airway in case of aspiration. Since impairments in all stages of ingestion tend to occur concurrently in elders with dysphagia, the goal of rehabilitation should not only address the swallowing impairment, but also eating as an activity of daily living.

Non-invasive assessment determine the swallowing and respiration dysfunction in early Parkinson's disease

IntroductionDysphagia is common among patients with Parkinson's disease. Swallowing and its coordination with respiration is extremely important to achieve safety swallowing. Different tools have been used to assess this coordination, however the results have been inconsistent. We aimed to investigate this coordination in patients with Parkinson's disease using a non-invasive method. MethodsSignals of submental muscle activity, thyroid cartilage excursion, and nasal airflow during swallowing were recorded simultaneously. Five different water boluses were swallowed three times, and the data were recorded and analyzed. ResultsThirty-seven controls and 42 patients with early-stage Parkinson's disease were included. The rates of non-expiratory/expiratory pre- and post-swallowing respiratory phase patterns were higher in the patients than in the controls (P < 0.001). The rates of piecemeal deglutition when swallowing 10-ml and 20-ml water boluses and overall were also significantly higher in the patients (all P < 0.001). There were differences in oropharyngeal swallowing parameters between the patients and controls, including a pharyngeal phase delay with longer total excursion duration and excursion time in the patients swallowing small water boluses (1 ml, 3 ml and 5 ml), but no difference in the length of swallowing respiratory pause. ConclusionOropharyngeal swallowing and its coordination with respiration are affected in patients with early-stage Parkinson's disease, and safety compensation mechanisms were used more than efficiency during swallowing. The results of this study may serve as a baseline for further research into new treatment regimens and to improve the management of swallowing in patients with Parkinson's disease.

Non-invasive Assessment of Swallowing and Respiration Coordination for the OSA Patient.

The objectives of this study are to investigate swallowing and its coordination with respiration in patients with obstructive sleep apnea (OSA). This is a prospective cohort study conducted in a tertiary referred Medical Center. A non-invasive method of assessing swallowing was used to detect the oropharyngeal swallowing parameters and the coordination with respiration during swallowing. The system used to assess swallowing detected: (1) movement of the larynx using a force-sensing resistor; (2) submental muscle activity using surface electromyography; and (3) coordination with respiration by measuring nasal airflow. Five sizes of water boluses (maximum 20 mL) were swallowed three times, and the data recorded and analyzed for each participant. Thirty-nine normal controls and 35 patients with OSA who fulfilled the inclusion criteria were recruited. The oropharyngeal swallowing parameters of the patients differed from the controls, including longer total excursion duration and shorter duration of submental muscles contraction. A longer swallowing respiratory pause (SRP), temporary coordination with respiration during swallowing, was demonstrated in the patients compared with the controls. The frequency of non-expiratory/expiratory pre- and postswallowing respiratory phase patterns of the patients was similar with the controls. There was significantly more piecemeal deglutition in OSA patients when clumping 10- and 20-mL water boluses swallowing together (p = 0.048). Oropharyngeal swallowing and coordination with respiration affected patients with OSA, and it could be detected using a non-invasive method. The results of this study may serve as a baseline for further research and help advance research methods in obstructive sleep apnea swallowing studies.

The interaction between breathing and swallowing in amyotrophic lateral sclerosis.

The aim of the study is to determine the association between respiratoryswallow patterns in amyotrophic lateral sclerosis (ALS) patients. Furthermore, it aims to clarify the role of the dysphagia limit in defining the relationship between swallowing disorders and respiratory disorders. Functional rating scales were used to describe swallowing and respiratory function. Swallowing was observed using the dysphagia limit. Dysphagia limit is the volume at which a second or more swallows are required to swallow the whole bolus. Laryngeal and chest movement sensors, pulmonary function tests, submental, and diaphragm electromyography activity were used to evaluate the relationship between swallowing and respiratory phase. Of the 27 patients included in the study, 14 were dysphagic and 13 were non-dysphagic. Tests showed normal respiratory function in 11 of the non-dysphagic patients and 3 of the dysphagic patients. There was a high correlation between the dysphagia limit and Amyotrophic Lateral Sclerosis Functional Rating Scale swallowing parameters. Non-dysphagic patients were able to swallow during inspiration but only six patients in the dysphagic group were able to swallow during inspiration. The occurrence of dysphagia in ALS is related to piecemeal deglutition and respiration consistency during swallowing. Detecting the timingof disturbances in the relationship betweenswallowing and respirationmay be a way of identifying dysphagia. Dysphagia limit may be a useful, complementary test for assessing swallowing disturbances in amyotrophic lateral sclerosis.