Straw Drinking Research Articles

Effect of inter-swallow interval on striated esophagus peristalsis; a comparative study with smooth muscle esophagus.

Effect of inter-swallow interval on the contractility of smooth muscle esophagus is well-documented. However, the effects on peristalsis of the striated esophagus have not been systematically studied. A better understanding of striated esophagus motor function in health and disease may enhance the interpretation of manometric studies and inform clinical care. The aim of this study was to assess the effect of inter-swallow interval on striated esophagus compared to findings with that of the smooth muscle esophagus. We performed two sets of studies to (1) determine the effect of various inter-swallow interval in 20 healthy volunteers and (2) assess the effect of ultra-short swallow intervals facilitated by straw drinking in 28 volunteers. We analyzed variables using ANOVA with Tukey's pairwise comparison and paired t-test. Unlike smooth muscle esophagus, the striated esophagus contractile integral did not change significantly for swallow intervals ranging from 30 to 5 s. On the contrary, striated esophagus demonstrated absent or reduced peristalsis in response to ultra-short (<2 s) intervals during straw-facilitated multiple rapid swallows. Striated esophagus peristalsis is subject to manometrically observed inhibition during swallows with ultra-short intervals. Inter-swallow intervals as short as 5 s that inhibit smooth muscle esophagus peristalsis do not inhibit striated muscle peristalsis. The mechanisms of these observations are unknown but may relate to central or myenteric nervous system influences or the effects of pharyngeal biomechanics.

Cortical Activation of Swallowing Using fNIRS: A Proof of Concept Study with Healthy Adults.

The purpose of this study was to determine whether functional near-infrared spectroscopy (fNIRS) could reliably identify cortical activation patterns as healthy adults engaged in single sip and continuous swallowing tasks. Thirty-three right-handed adults completed two functional swallowing tasks, one control jaw movement task, and one rest task while being imaged with fNIRS. Swallowing tasks included a single sip of 5mL of water via syringe and continuous straw drinking. fNIRS patches for acquisition of neuroimaging data were placed parallel over left and right hemispheres. Stimuli presentation was controlled with set time intervals and audio instructions. Using a series of linear mixed effect models, results demonstrated clear cortical activation patterns during swallowing. The continuous swallowing task demonstrated significant differences in blood oxygenation and deoxygenation concentration values across nearly all regions examined, but most notably M1 in both hemispheres. Of note is that there were areas of greater activation, particularly on the right hemisphere, when comparing the single sip swallow to the jaw movement control and rest tasks. Results from the current study support the use of fNIRS during investigation of swallowing. The utilization of healthy adults as a method for acquiring normative data is vital for comparison purposes when investigating individuals with disorders, but also in the development of rehabilitation techniques. Identifying activation areas that pertain to swallowing will have important implications for individuals requiring dysphagia therapy.

Tongue and Palate Contact during Cup and Straw Drinking

Tongue and Palate Contact during Cup and Straw Drinking

Classification of sequential swallowing types using videoendoscopy with high reproducibility and reliability.

This study aimed to classify sequential swallowing types using videoendoscopy (VE) avoiding radiation exposure and compare the results using videofluoroscopy (VF). Twenty-one healthy adults simultaneously underwent VF and VE during sequential straw drinking. Each discrete swallow was classified into an L-segmental type (laryngeal vestibule opens after swallow) or L-continuous type (laryngeal vestibule closure continues after swallow) using VF and a V-segmental type (velopharynx opens after swallow) or V-continuous type (velopharynx closure continues after swallow) using VE. Test-retest reproducibility and interrater and intrarater reliability were evaluated in ten healthy adults. Of 128 swallows, 94 were L-segmental and 34 were L-continuous types as per VF, whereas 95 were V-segmental and 33 were V-continuous types as per VE. The leading edge of the bolus at swallow onset was significantly deeper in L-continuous types (P = 0.001). Laryngeal vestibule closure on VF images corresponded to velopharyngeal closure on VE images for 127 of 128 swallows (κ = 0.98, P < 0.001). All subjects showed the same types of swallows in the first and the second studies. Both interrater and intrarater reliability were high. VE showed high reproducibility and reliability in the classification of sequential swallowing types.

Drinking speed using a Pat Saunders valved straw, wide-bore straw and a narrow-bore straw in a normal adult population.

Straw drinking is often recommended as a strategy for managing swallowing difficulties in adult clinical populations. This study presents a range of normal adult straw drinking speeds and discusses clinical applications. Straw drinking speed in a normal healthy population of 70 adults from 18 to 95 years of age was measured. Three types of straws were used: a Pat Saunders valved straw (PSVS), a wide-bore straw and a narrow-bore straw (NBS). Participants drank 40 ml of water for each straw tested. All participants were asked to comment on the straws used. A mixed-method design was used wherein both quantitative and simple structured qualitative data were collected. Drinking speed was quickest for the wide-bore straw, followed by the NBS and slowest for the PSVS. This was supported by qualitative comments from the adults who reported that the PSVS was the most difficult straw to use. There were no significant differences between straw flow or straw type and sex of the participants. There were significant changes with aging and a decrease in flow speed with the NBS. Weight and height had some effect on straw drinking speeds. There was a slight correlation between age and sex and age and height, but not between age and weight. This article presents data for a normal range of straw drinking speeds in a healthy adult population. It can be used in the assessment and monitoring of straw drinking in acquired disorders of swallowing.

Effects of varying fixed lingual apex positions on tongue pressure during straw drinking

We investigated the impact of tongue-thrusting on lingual pressure during fluid intake with a straw. In this study, 12 healthy young dentate individuals (two women and 10 men; 19-33 years) were instructed to drink 15 mL of water with a regular drinking straw at 37 °C, when indicated by the investigator. Participants drank after adjusting tongue position to one of the following patterns: (i) Holding the tip of the straw between the lips (Normal Position: NP), (ii) Sticking out the tongue to the vermilion zone of the lower lip and inserting the straw 1 cm past the front teeth (Tongue-thrusting Position: TP). Five recordings were conducted for each participant in a randomised order. To measure tongue pressure during swallowing, a specially designed 0.1-mm thick sensor sheet (Nitta, Osaka, Japan) with a tactile system for measurement of pressure distribution (I-SCAN; Nitta) was used. Duration, maximal magnitude and integrated value of tongue pressure were analysed based on the wave of tongue pressure recorded while water was swallowed. Magnitude, duration and integrated value of tongue pressure were significantly lower in TP than in NP at the median line (Ch1-3). Magnitude and integrated value of tongue pressure at the lateral part of the tongue (Ch5) were significantly lower in TP than in NP. When duration, maximal magnitude and integrated values were compared by channel, no significant differences were observed in NP, but a significant difference was found between Ch3 and the lateral areas Ch4/Ch 5 in TP. When the tongue was thrust forward, movement dynamics of the entire tongue changed and influenced contact between the tongue and palate during liquid intake with a straw. The impact was noticeably weaker on the median line than in lateral areas.

Drinking speed using a valved Pat Saunders straw, wide bore straw and a narrow bore straw in school-age children

To understand the nature of straw drinking in relation to a group of children with specific eating and drinking difficulties, it is first necessary to ascertain the range of normal function. Straw drinking is often recommended as a method that can support children with eating and drinking difficulties. This study looked at straw drinking performance in a normal population of 125 children aged between 6 and 11 years of age. Three types of straws were used: a valved Pat Saunders straw, a wide bore straw and a narrow bore straw. Children drank 40 mL of water for each straw tested. Children increased their speed of intake significantly for all straw types as they matured. Drinking speed was quickest for the wide bore straw followed by the narrow bore and slowest for the valved Pat Saunders straw. This was supported by qualitative feedback from the children with most finding the wide bore straw the easiest one to use and the valved Pat Saunders straw the hardest. There were significant differences in speed of flow between the valved Pat Saunders straw and wide bore straw, between the valved Pat Saunders straw and the narrow bore straw and between the wide bore straw and the narrow bore straw. There were no significant differences between straw flow or straw type and gender. This normative data for straw drinking in a paediatric population can be used to develop baseline measures for clinical assessment.

Are We Testing a True Thin Liquid?

The purpose of this study was to examine the effects on a patient's swallowing of diluting E-Z-EM's Varibar((R)) Thin liquid barium product (which is often used in videofluoroscopic swallow studies) to achieve a consistency closer to water. Forty patients who were 18 years and older participated in this study. Their varied medical diagnoses included stroke, pneumonia, TBI, and cancer as well as diagnoses not usually associated with dysphagia such as abdominal pain and rhabdomyolysis. To screen for aspiration, E-Z-EM's Varibar Thin liquid was presented to patients to swallow as 2 cc, 5 cc, cup, and straw drinking trials. If no aspiration occurred, the patient was given the Varibar Thin liquid diluted by 50% using water (referred to as Ultrathin) to swallow in the same amounts. Then occurrence of aspiration with the Ultrathin liquid was compared to the occurrence of aspiration when the patient swallowed the Varibar Thin liquid. Fifty percent of patients aspirated on the Ultrathin liquid but not on the Varibar Thin liquid, across at least one of the test conditions. From these results we suggest that although E-Z-EM Varibar Thin liquid may have a low-viscosity range, it still may not be "thin enough" to identify all patients who aspirate or who are at risk for aspiration on thin liquids.

Assessment of feeding performance in patients with cerebral palsy

Patients with cerebral palsy (CP) frequently manifest oral-ingestive problems ranging from mild to severe. Drooling, rejection of solid foods, choking, coughing and spillage during eating may contribute to these problems. The aim of this study was to assess functional feeding skills of patients with CP, aged 4-25 years. They were assessed with the Modified Functional Feeding Assessment Scale (FFAm). Mothers had expressed concern regarding drooling and reluctance in accepting solid foods. None of the mothers thought that there was a major problem with adequate ingestion. However, the study revealed that patients had disabilities in spoon feeding, biting, chewing, cup drinking, straw drinking, swallowing and clearing.

Mechanism of Sequential Swallowing During Straw Drinking in Healthy Young and Older Adults

Recent research has revealed differences between isolated and sequential swallowing in healthy young adults; however, the influence of normal aging on sequential swallowing has not been studied. Thus, the purpose of this investigation was to examine the effects of normal aging on deglutition during sequential straw drinking. Videofluoroscopic samples of two 10-s straw drinking trials were obtained for 20 healthy young men (age 29 +/- 3 years) and 18 healthy older men (age 69 +/- 7 years). Hyolaryngeal complex (HLC) movement patterns, leading edge of the bolus location at swallow onset, and occurrences of airway invasion were determined. Two HLC patterns were identified: (a). HLC lowering with the epiglottis returned to upright between swallows and (b). partially maintained HLC elevation with the epiglottis inverted between swallows. The bolus was frequently in the hypopharynx at swallow onset. Strong associations were identified between age and HLC pattern, age and leading edge of the bolus location, and HLC pattern and leading edge location. Laryngeal penetration was uncommon overall; however, it occurred more frequently in the older adults than in the young adults. A significant relation was identified between age and the average Penetration-Aspiration Scale score. Laryngeal penetration was associated with both HLC movement patterns and hypopharyngeal bolus location, particularly in older adults. Results indicate that subtle age-related differences are evident in healthy young and older adults with sequential straw drinking. These data suggest that specific inherent swallowing patterns may increase the risk of laryngeal penetration with normal aging.

Gender, age, vessel size, cup vs. straw sipping, and sequence effects on sip volume.

Two experiments were performed to examine the effects of cup size, gender, age, and parameters of sipping (cup vs. straw and sequence) on sip volume. Increasing the size of the vessel from 150 to 600 ml increased the volume of a sip by about 15%. Males took larger sips and had significantly larger maximum oral capacities than females. However, in a second group of taller females and shorter males, the difference in sip size between genders was minimized. A second experiment examined sip size from a cup and straw drinking, the effects of sequential sipping (one to five sips), personal characteristics (height, weight), age, and gender on sip volume. Height was a good predictor of individual differences in sip volume. Cup drinking produced larger sip volumes than straw drinking, but only in a group of adults and not in an elderly group. Volume per sip decreased across sips. A reasonable guide for cup sipping is about 25 ml per sip for males and 20 ml for females. However, this rule should be modified as a function of cup size, straw sipping, and sequential sipping.

Swallowing physiology of sequential straw drinking.

The goal of this study was to examine deglutitive physiology during sequential straw drinking in healthy young adults (n = 15) to learn how sequential swallowing differs from single swallows. The physiology of single swallows has been studied extensively in healthy adults and in adults with a variety of debilitating conditions, but the physiology of sequential swallows has not been studied adequately. Videofluoroscopic analysis revealed three distinct patterns of hyolaryngeal complex (HLC) movement during sequential straw swallows: opening of the laryngeal vestibule after each swallow (Type I, 53%), continued vestibule closure after each swallow (Type II, 27%), and interchangeable vestibule opening and closing during the swallow sequence (Mixed, 20%). Unlike discrete swallowing, the onset of the pharyngeal swallow occurred when the bolus was inferior to the valleculae in the majority of subjects and was significantly associated with HLC movement pattern. The leading bolus edge was inferior to the valleculae at swallow onset for Type II movement patterns. For Type I movement patterns, bolus position at swallow onset was randomly distributed between three anatomical positions: superior to the valleculae, at the level of the valleculae, and inferior to the valleculae. Preswallow pharyngeal bolus accumulation, which is common during mastication, was evident and significantly associated with the HLC pattern of opened laryngeal vestibule after each swallow. These data suggest that in healthy young adults, sequential swallows differ physiologically from discrete swallows and indicate substantial variability in deglutitive biomechanics.

Oral-motor skills following sensorimotor therapy in two groups of moderately dysphagic children with cerebral palsy: aspiration vs nonaspiration.

The purpose of this study was to determine the effect of oral sensorimotor treatment on oral-motor skills and measures of growth in moderately eating impaired children with cerebral palsy who were stratified by state of aspiration/nonaspiration. Twenty-seven children aged 2.5-10.0 years participated in this study (aspiration: n = 7, nonaspiration: n = 20). Weight and skinfold measures were taken. Children were observed at lunch time and six domains of feeding were examined: spoon feeding, biting, chewing, cup drinking, straw drinking, swallowing, and drooling. Children underwent 10 weeks of control and 10 weeks of sensorimotor treatment, 5-7 minutes/day, 5 days/week. Treatment compliance for the entire group was 67%. Children who aspirated had significantly poorer oral-motor skills in spoon feeding, biting, chewing, and swallowing than children who did not aspirate. There was significant improvement in eating: spoon feeding (fewer abnormal behaviors, p < 0.03), chewing (more normal behaviors, p < 0.003), and swallowing (more normal behaviors, p < 0.008). There were no significant changes in drinking skills. Children as a group maintained their pretreatment weight-age percentile but did not show any catch-up growth. Children showed adequate energy reserves as measured by skinfold thicknesses. Improvement in oral-motor skills may help these children to ingest food more competently (i.e., less spillage). However, their weight remains at the lowest level of age norms.

Oral-motor skills following sensorimotor intervention in the moderately eating-impaired child with cerebral palsy.

The purpose of this study was to determine the efficacy of oral sensorimotor treatment in moderately eating-impaired children with cerebral palsy and to examine the effects of treatment on measures of growth. Six domains of feeding were examined in 35 children 4.3-13.3 years of age. Weight and skinfold measures were taken. Children were observed at lunch time, and spoon-feeding, biting, chewing, cup drinking, straw drinking, swallowing, and drooling were examined. Children underwent 20 weeks of sensorimotor treatment, 5-7 min/day, 5 days/week. Limited improvement was observed in the following eating domains: spoon-feeding, biting, and chewing, but not in drinking. Children as a group maintained the pretreatment weight-age percentile. To meet the increasing growth demands of the teenage years, oral-motor therapy may need to be combined with oral caloric supplementation.