Swallowing Tasks Research Articles

Tongue control for speech and swallowing in healthy younger and older subjects

Current literature on oral motor control reports contradictory findings regarding physiological, functional and sensory changes that occur in the muscles of the tongue with normal aging. It has been suggested that the high level of activity required of tongue muscles in mastication and speech may play a role in preserving them when other skeletal muscles are more likely to show functional effects of such changes. To test whether indeed tongue movements remain unaltered in both speech and swallowing tasks as a function of aging, kinematic measures of tongue dorsum movements were taken as 21 healthy young (20-30) and older (65-74) adults performed repeated iterations of speech tasks and a sequential water swallowing task. Tongue motion was recorded using electromagnetic articulography and from these data information was extracted with respect to movement range, duration, and variability. The findings suggest that in general tongue movements for swallowing were slower and more variable than for speech, and most importantly, more variable among older than younger participants. As well, the findings show that aging does influence the nature of tongue motions, in particular by inducing a more extreme distinction in the variability of movements for speech (less variable) and swallowing (more variable) tasks.

Modulation of Activity in Swallowing Motor Cortex Following Esophageal Acidification: A Functional Magnetic Resonance Imaging Study

Esophageal acid exposure induces sensory and motility changes in the upper gastrointestinal tract; however, the mechanisms involved and the effects on activity in the brain regions that control swallowing are unknown. The aim of this study was to examine functional changes in the cortical swallowing network as a result of esophageal acidification using functional magnetic resonance imaging (fMRI). Seven healthy volunteers (3 female, age range=20-30 years) were randomized to receive either a 0.1 M hydrochloric acid or (control) saline infusion for 30 min into the distal esophagus. Postinfusion, subjects underwent four 8 min blocks of fMRI over 1 h. These alternated between 1 min swallowing water boluses and 1 min rest. Three-dimensional cluster analysis for group brain activation during swallowing was performed together with repeated-measures ANOVA for differences between acid and saline. After acid infusion, swallowing-induced activation was seen predominantly in postcentral gyrus (p<0.004). ANOVA comparison of acid with saline showed a significant relative reduction in activation during swallowing of the precentral gyrus (M1) BA 4 (p<0.008) in response to acid infusion. No areas of increased cortical activation were identified with acid vs. saline during swallowing. Esophageal acidification inhibits motor and association cortical areas during a swallowing task, probably via changes in vagal afferent or nociceptive input from the esophagus. This mechanism may play a protective role, facilitating acid clearance by reduced descending central motor inhibition of enteric/spinal reflexes, or by preventing further ingestion of injurious agents.

The Influence of Orolingual Pressure on the Timing of Pharyngeal Pressure Events

This study explored the influence of two methods of effortful swallow execution on the timing of pharyngeal pressure events. Participants were asked to either emphasize or minimize tongue-to-palate contact during performance of the maneuver. Twenty healthy participants were evaluated using concurrent submental surface electromyography (sEMG), orolingual manometry, and pharyngeal manometry. Each subject performed three repetitions of three counterbalanced tasks (noneffortful dry swallows, effortful dry swallows with tongue-to-palate emphasis, and effortful dry swallows with tongue-to-palate de-emphasis). Four variables were measured: Onset Lag vs. sEMG Peak, Peak Lag vs. sEMG Peak, Total Duration, and Percent Rise Time to Peak. Compared to noneffortful swallows, the effortful swallow task elicited significantly earlier onsets and peaks of pharyngeal pressures relative to the submental sEMG peak. Total pressure event durations were greater and rise times were significantly shorter. When comparing the two methods of effortful swallow execution, a longer latency to peak proximal pharyngeal pressure was found in the tongue-to-palate emphasis condition. These results support the interpretation that the effortful swallow maneuver involves generation of higher velocity bolus driving forces that propel the bolus into and through the pharynx with greater efficiency and that pressure is then sustained to facilitate more complete bolus clearance.

Perception of Muscle Strength With and Without Biofeedback During Swallowing and Fist-Clenching Tasks

Perception of Muscle Strength With and Without Biofeedback During Swallowing and Fist-Clenching Tasks

Cortical representation of swallowing in normal adults: functional implications.

Dysphagia of neurogenic or postsurgical origin presents management and therapeutic challenges to the otolaryngologist. Improvements in management and therapeutic approaches may be facilitated by understanding how the central nervous system controls swallowing. The purpose of this investigation was to utilize functional magnetic resonance imaging to determine patterns of cortical activity during swallowing in normal, healthy adult subjects. Functional magnetic resonance imaging (fMRI) was performed on eight healthy adult subjects using conventional BOLD (blood oxygenation level dependent) techniques. Subjects performed three different swallowing tasks including dry and bolus swallows, and performed a control finger movement task. Statistical maps of cortical activation were generated using a cross-correlation analysis. One-way and two-way ANOVA statistical analyses were performed to compare activated areas among the different tasks and to determine the effects of task sequence. Activation during the three swallowing tasks occurred in the primary motor cortex, primary somatosensory cortex, and other cortical and subcortical sites. Cortical representation of swallowing and finger movement followed somatotopic maps. Differential distribution of cortical activation was observed for the different swallowing tasks. Activation of the primary motor and somatosensory cortices, as well as other sensory-motor areas, occurs with swallowing in normal adults. Differential distribution of cortical activity with different swallowing tasks suggests differential functional organization for different swallowing tasks. Understanding these mechanisms may facilitate improved management and therapeutic intervention for neurogenic and postsurgical dysphagia.

Lingual action in normal sequential swallowing.

Current knowledge about the flexibility in lingual motor control and performance during swallowing is incomplete. The present study aimed at gaining a better understanding of the tongue's motor flexibility and at identifying variable versus invariant lingual motor program parameters in light of changing swallowing task demands (discrete vs. sequential). Specifically, the timing and patterns of tongue-palate contact and the associated changes in tongue shape and action were examined in 5 normal adults using simultaneous electropalatography and ultrasound. Tasks for discrete swallowing included 5 and 30 cc of water; tasks for sequential swallowing involved drinking 200 cc of water at normal and fast rates. Results showed little variation in propulsive contact pattern as a function of task or subject. However, the tongue demonstrated shorter movement duration and overlapping gestures during sequential swallowing. Thus, continuous drinking was performed without changes in motor strategies per se but with changes in the timing coordination of the "drink" and "swallow" action sequences. These findings support the theory that the deglutitive lingual motor program has both invariant and variant parameters, and that movement pattern and action sequence reflect fixed elements within the structure of the motor program, but movement timing can be modified according to the demands of the task at hand.

Laryngeal activity during swallow, phonation, and the Valsalva maneuver: an electromyographic analysis.

To better understand the mechanisms of airway protection during swallow, the authors of this study performed an electromyographic (EMG) analysis on the thyroarytenoid (TA) and interarytenoid (IA) muscles during a variety of tasks. The tasks included high, low, and comfortable pitch phonation, the Valsalva maneuver, saliva swallow, and 5- and 10-mL water swallows. Raw EMG signals were analyzed to obtain root mean square data, which correspond to a relative magnitude of muscle activation. The data show that both TA and IA muscles generate a similar level of relative activation, with the greatest electrical activity observed during swallow tasks followed by the Valsalva maneuver and phonation. The duration, onset, offset, and pattern of activity during the swallowing tasks also showed close synchronization between the two muscles. These data can be used in designing therapy for voice disorders and pharyngeal dysphagia.