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Aim This article aims to guide the nurse caring for a tracheostomy patient, following the main principles of nursing care. Background Tracheostomy is a surgical procedure to create an opening in the anterior wall of the trachea. Owing to improvement in technological support, the number of adult patients receiving a tracheostomy has increased. This requires the critical care nurse to have an understanding of the essential principles of care for a patient with a tracheostomy tube in situ. Design and method Literature search was conducted in Medline and Cinahl using the search terms tracheostomy OR tracheotomy AND procedure/nursing care/experience limited to English language and adult. Owing to the lack of empirical research on the care of patients with tracheostomy, evidence is limited and therefore expert consensus is utilized in much of the article. Results This article considers the indications for a tracheostomy, identifies the component parts of a tracheostomy tube, discusses 12 essential principles of care for a patient with a tracheostomy tube in situ, and finally briefly describes the nurse's role in an emergency and when discharging a patient with a tracheostomy tube to a ward. Conclusion Performing a tracheostomy has an enormous impact on patients and their care. Relevance to clinical practice Nurses caring for patients with tracheostomy require an appreciation of the breadth of knowledge needed to provide individual and safe care. It is also important to appreciate the lack of empirical evidence on which to base that care. [ABSTRACT FROM AUTHOR]

Objectives To investigate the relationship between dysphagia and mild cognitive impairment ( MCI) in older adults residing in an independent-living facility in Korea. Design Population-based, cross-sectional study. Setting Seongnam, Korea. Participants Korean men and women aged 65 and older living in a typical South Korean city (n = 415) were enrolled in the Korean Longitudinal Study on Health and Aging. Measurements Dysphagia was assessed using the Standardized Swallowing Assessment ( SSA). Cognitive function was evaluated using the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery, digit span test, and lexical fluency test. MCI was diagnosed using operational diagnostic criteria and further classified into amnestic and nonamnestic MCI. Results Men with nonanmestic MCI had a greater likelihood of having dysphagia (odds ratio ( OR) = 3.77, 95% confidence interval ( CI) = 1.12-12.72) than men without MCI. Men with nonanmestic MCI were almost six times as likely to have dysphagia ( OR = 5.78, 95% CI = 1.15-29.27) as men with no neurological disorder after adjusting for age, education level, current smoking and drinking, diabetes mellitus, and apolipoprotein E-4 carrier status. Conclusion Men with nonamnestic MCI were more likely to have dysphagia than were their counterparts without MCI, whereas this difference was not found in men with amnestic MCI and women. Assessment of executive functions that interfere with planning of motor activities may be useful in predicting dysphagia and in planning preventive and therapeutic strategies for older men. [ABSTRACT FROM AUTHOR]

Background Chronic poststroke oropharyngeal dysfunction ( OD) is a common condition, leading to severe complications, including death. Treatments for chronic poststroke OD are scarce. The aim of our study was to assess and compare the efficacy and safety of treatment with surface electrical stimulation (e-stim) at sensory and motor intensities in patients with chronic poststroke OD. Methods Twenty chronic poststroke patients with OD were randomly assigned to (i) sensory e-stim (treatment intensity: 75% of motor threshold) or (ii) motor e-stim (treatment intensity: motor threshold). Patients were treated during 10 days, 1 h/day. Videofluoroscopy was performed at the beginning and end of the study to assess signs of impaired efficacy and safety of swallow and timing of swallow response. Key Results Patients presented advanced age (74.95 ± 2.18), 75% were men. The mean days poststroke was 336.26 ± 89.6. After sensory stimulation, the number of unsafe swallows was reduced by 66.7% (p < 0.001), the laryngeal vestibule closure time by 22.94% (p = 0.027) and maximal vertical hyoid extension time by 18.6% (p = 0.036). After motor stimulation, the number of unsafe swallows was reduced by 62.5% (p = 0.002), the laryngeal vestibule closure time by 38.26% (p = 0.009) and maximal vertical hyoid extension time by 24.8% (p = 0.008). Moreover, the motor stimulus reduced the pharyngeal residue by 66.7% (p = 0.002), the upper esophageal sphincter opening time by 39.39% (p = 0.009), and increased bolus propulsion force by 211.1% (p = 0.008). No serious adverse events were detected during the treatment. Conclusions & Inferences Surface e-stim is a safe and effective treatment for chronic poststroke dysphagic patients. [ABSTRACT FROM AUTHOR]

The relationships between food structure, texture perception and bolus properties during bolus formation are poorly understood. This preliminary single-subject study on three biscuit recipes investigated the links between bolus macrostructure, perceived texture (using temporal dominance of sensations), and mechanical and rheological properties (using back extrusion and consecutive double compression) throughout mastication. The fracture properties of the biscuits dominated textural perception in the early stages of mastication. As mastication progressed, a sensory transition from dry to sticky was accompanied by an increase in 'cohesiveness' and decreases in the consistency coefficient, peak force and 'adhesiveness.' At the point of swallow, the boluses were shear thinning pastes and sticky dominated perception. Consistency coefficient and 'cohesiveness' indicated different swallowing thresholds for the different recipes. This study found back extrusion to be a suitable method for characterizing biscuit bolus rheology in the later stages of mastication as it is unaffected by bolus dimensions. Practical Applications Mastication of a solid food involves the breakdown of the food and reassembly with saliva into a deformable bolus that can be swallowed safely. The relationships between the perceived texture and structural, mechanical and rheological properties throughout mastication are not well understood. An understanding of these relationships could aid in the design of foods that can be swallowed safely by the elderly or those with dysphagia, or foods that follow a desired oral processing path and thus have a desired texture profile or flavor release. [ABSTRACT FROM AUTHOR]

Transesophageal echocardiography or TEE is widely established as an important diagnostic tool in the etiological workup of patients with ischaemic stroke. TEE is used for the etiologic workup of patients with presumed cardioembolic stroke. Patients were either randomized to three flexible endoscopic evaluations of swallowing (FEES) at three different time points (24 h before, immediately after and 24 h after TEE) or to three daily consecutive FEES with TEE on the fourth day. [Extracted from the article]

Keywords: brain swallowing function; metaplasticity; oropharyngeal dysphagia EN brain swallowing function metaplasticity oropharyngeal dysphagia 5003 5004 2 11/16/20 20201115 NES 201115 This issue of I The Journal of Physiology i publishes a "proof of concept" study with evidence on the metaplasticity of the human pharyngeal motor cortex induced by repetitive transcranial magnetic stimulation (rTMS) (Cheng I et al i . 2020). Post-stroke OD has been associated with neural damage to the dominant swallowing hemisphere leading to a global motor cortex hypoexcitability (Cabib I et al i . 2019) and lack of capacity to develop neuroplastic modifications in the unaffected hemisphere to restore the swallow function (Hamdy I et al i . 1998). [Extracted from the article]

The article presents abstracts of articles on neurogastroenterology topics including "Autoimmune autonomic ganglionopathy: complete resolution following rituximab based treatment," by S. Harris and colleagues, "Reproducibility of multiple rapid swallows during high resolution manometry (HRM)," by L. H. Price and colleagues, and "DPP IV levels are altered in obesity - possible effect on satiety signaling," by A. Stengel and colleagues.

Effects of inhomogeneous spatial aroma distribution in food gels were investigated for the enhancement of perceived intensity and the muscle activity during oral processing. A polysaccharide mixture was used as the gel matrix, in which small cubes from the same gelling agent were dispersed at 50% weight ratio. Degree of inhomogeneous spatial aroma distribution was arranged by its concentration in both the matrix and the dispersed gels although the overall aroma concentration within one gel sample was constant. There were no differences in mechanical properties between structured gel samples. A greater degree of inhomogeneous spatial aroma distribution increased perceived intensity, increased the duration of oral processing and the suprahyoid musculature activity, decreased the particle size of the expectorated bolus before swallowing, and increased the saliva content in the bolus using healthy adults as subjects. Importance of food structure design for enhanced perceived aroma intensity and human eating behavior was suggested. Practical Application Results from this study can contribute to the food structure design, particularly for foods for the elderly or people with chewing and swallowing difficulties, because the texturally soft gels used can serve as a model of these foods in that they do not necessarily require chewing for size reduction and are often easy to form a bolus before swallowing. Because of some heterogeneity of food structure (fabricated by bi-phase gel in this study), perceived aroma intensity is increased, and people eat proactively. Gel technology that stimulates the five human senses may be a key for food texture innovation, for which the manufacturers should manipulate gelling and thickening polysaccharides as a texture modifier. [ABSTRACT FROM AUTHOR]

Objectives A diagnosis of head and neck cancer (HNC) is a profound event for patients and family members who play a crucial role in their care. Eating and drinking difficulties affect patients' quality of life (QOL), but the impact on the carers' QOL has not been explored. This preliminary mixed method study reports on carer QOL over time and investigates the relationship with dysphagia. Methods Two hundred and eight HNC patients referred for (chemo)radiotherapy were asked to identify a carer and complete a health-related QOL and a swallowing QOL questionnaire at pre-treatment, 3 and 12 months post-treatment. Carers were given the Caregiver QOL-Cancer (CQOL-C) questionnaire at the same time points. A purposive sample of patient and carer dyads was observed over mealtimes and interviewed. Results Seventy per cent of carers returned a questionnaire at least once. There was no change in CQOL-C scores between pre-treatment and 3 months, but a significant improvement was found between 3 and 12 months post-treatment ( p = 0.012). Patient-reported outcomes accounted for 52% of variance in carer QOL measurements ( R2 = 0.52, p < 0.001). Four themes emerged from the qualitative data food provision, monitoring, motivation and changes to lifestyle. Conclusions Findings suggest a relationship between carer and patient QOL. Elsewhere, these two characteristics have been associated such that the greater the patients' physical care needs, the poorer the carers' and patients' QOL. Living with someone with dysphagia not only involves managing the physical swallowing difficulties but is also likely to impact on social activities such as participation in shared meals, leading to permanent lifestyle changes. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The cervical auscultation method was applied to investigate sounds generated while swallowing various foods with different consistencies, including water, yogurt, and konjac jelly. Dynamic viscoelasticity, viscosity, and compression or penetration force of yogurt and konjac jelly were measured. The yogurt was fractured by the tongue while swallowing, whereas konjac jelly was not. Significant differences were detected in the durations of the swallowing sound component, generated by food bolus flow through the pharynx. The root mean square amplitude of the component that was attributed to the water flow was significantly higher than that for the flow of other food samples. No significant differences were detected in the duration of sound components appearing before and after the bolus flow or in the total duration among the food samples. Scattered or heterogeneous food bolus flow appeared to significantly reflect the duration of swallowing sounds, generated by the food flow. Practical Applications Nursing-care foods are in much demand in the expanding elderly society. Ease in swallowing is an important factor for such foods and it is strongly correlated to food texture. Our results indicated significant differences in the duration and amplitude of swallowing sounds, generated by food bolus flow through the pharynx. Because the swallowing sounds depend on the food texture, monitoring such sounds can aid in designing and evaluating the foods to ease swallowing. The method used in this study is noninvasive and cost effective and is therefore practical for use in the food industry. The dependence of the swallowing sounds on human subjects can be analyzed if the data from a greater number of subjects are gathered. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to analyze the improvement in oral function and environment in high-risk elderly persons participating in a program to improve oral function organized by their local government. Methods: Participants comprised 36 high-risk elderly and the mean age was 77.11 ± 7.24 years. The program involved training sessions carried out five or six times every 2-3 weeks for 3 months. Oral function and environment was evaluated before and after the program. The research period extended from 2008 to 2010. Results: The effects of intervention were clearly observed in oral diadochokinesis score in the high-risk elderly. Persons with a lower repetitive saliva swallowing test (RSST) and oral diadochokinesis score before intervention showed a tendency toward even greater improvement. No significant changes were observed in saliva secretion or total amounts of Streptococcus mutans, Lactobacilli, Candida or total microorganisms. Conclusions: The effects of intervention were clearly recognized in regards to oral diadochokinesis. Improvement in RSST and oral diadochokinesis scores was marked in those persons showing a lower number of articulations before intervention. Geriatr Gerontol Int 2013; 13: 451-457. [ABSTRACT FROM AUTHOR]

Background We sought to find the therapeutic effect of 5Hz high-frequency repetitive transcranial magnetic stimulation (rTMS) over the unaffected pharyngeal motor cortex in post-stroke dysphagic patients. Methods Eighteen patients with unilateral hemispheric stroke oropharyngeal dysphagia that lasted more than 1 month were randomly divided into two groups. They all performed videofluoroscopic swallowing study (VFSS) before rTMS intervention. The experimental group (EG) received 5Hz rTMS over contra-lesional pharyngeal motor cortex for 10 min per day for 2 weeks. The control group (CG) received sham stimulation under the same condition. Videofluoroscopic swallowing study were performed again just after treatment cessation and 2 weeks afterward. The evaluation was performed using videofluoroscopic dysphagia scale (VDS) and penetration-aspiration scale (PAS). Key Results Mean baseline VDS and PAS of EG was 33.6 ± 12.1 and 3.41 ± 2.32 respectively and the scores were reduced to 25.3 ± 9.8 and 1.93 ± 1.52 just after 2 weeks intervention ( P < 0.05). This effect lasted for up to 2 weeks after treatment. However, there was no change in the CG. Baseline prevalence of aspiration, pharyngeal residue, delayed triggering of pharyngeal swallowing and abnormal pharyngeal transit time (PTT) in EG was 66.7%, 66.7%, 33.3%, and 44.4%, respectively. After rTMS, the prevalence of aspiration and pharyngeal residue was reduced to 33.3% and 33.3%, respectively. However, the prevalence of delayed triggering and abnormal PTT was not changed. Conclusions & Inferences A 5Hz high-frequency rTMS on contra-lesional pharyngeal motor cortex might be beneficial for post-stroke dysphagic patients. This intervention can be used as a new treatment method in post-stroke patients with dysphagia. [ABSTRACT FROM AUTHOR]

We tested the effects of cranio-cervical flexion ( CCF) on activation of swallowing-related muscles while swallowing liquid in a sample of 45 healthy volunteers. Activation following CCF movement was examined across two positions (supine and sitting) and, three pressure levels and two different postures were examined in each condition, respectively. When CCF was applied, activation of swallowing-related muscles was significantly increased compared to the neutral neck position, and such findings were found across both the supine and sitting positions. Also in the supine position, when the pressure level of the stabilizer was escalated, there was a significant difference in the activity of the swallowing-related muscles compared to the baseline level. In conclusion, our results suggest that CCF may be a viable method to enhance the effectiveness of swallowing-related muscles by changing neck position. When CCF is applied, the stability of the deep flexor muscles must be secured first after which superficially located muscles may better assist swallowing with less effort. [ABSTRACT FROM AUTHOR]

Background The purpose of this study was to report the risk of pharyngoesophageal stricture after treatment for head and neck cancer. Methods Human studies on radiation therapy with or without chemotherapy for head and neck cancer published in peer-reviewed journals with assessment of pharyngoesophageal stricture with barium swallow or endoscopy were included. Results A total of 4727 patients from 26 studies treated between 1989 and 2008 were eligible for analysis. The reported overall risk of stricture was 7.2%. The risks of pharyngoesophageal stricture in both conventional and intensity-modulated radiation therapy (IMRT) studies were 5.7% and 16.7%, respectively ( p < .001). Use of concurrent ( p < .001) and taxane ( p = .01) chemotherapy was associated with the IMRT technique. Prospective studies reported a 3.3-fold increased risk of stricture compared with that of retrospective studies (odds ratio: 3.3; 95% confidence interval: 2.3-4.8; p < .001). Conclusions Pharyngoesophageal stricture after IMRT and chemotherapy treatment for head and neck cancer is not uncommon. Videofluoroscopic swallow study should be performed prospectively to evaluate swallowing function. © 2011 Wiley Periodicals, Inc. Head Neck, 2012 [ABSTRACT FROM AUTHOR]

Background The purpose of this investigation was to present 5-years of quality-of-life (QOL) results of a multicenter randomized phase III trial, assessing intra-arterial (IA) versus standard intravenous (IV) chemoradiation for inoperable stage IV head and neck cancer. Methods Evaluation of 71 patients through European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core Module (EORTC QLQ-C30) and Head and Neck Module (QLQ-H&N35), and trial-specific questionnaires. Treatment consisted of standard radiotherapy with 4 weekly IA or 3 weekly IV cisplatin infusions. Results No significant differences in treatment-related QOL problems between 1 and 5 years posttreatment were observed, except for 'dry mouth' (gradually improving; p = .004). Survivors have lower fatigue levels ( p = .04), better voice ( p = 0.3), and swallowing ( p = .03) than patients who could not complete all subsequent follow-up questionnaires. Conclusions Most treatment-related QOL issues deteriorate during treatment, improve in the first year, and then remain stable, except xerostomia, improving up to the 5-year assessment point. Survivors show more positive scores for fatigue, voice, and swallowing. QOL issues at 1 year, thus, for most already represent those after 5-year follow-up. © 2011 Wiley Periodicals, Inc. Head Neck, 2012 [ABSTRACT FROM AUTHOR]

Background: Voice and swallowing symptoms following thyroidectomy in the absence of any demonstration of laryngeal nerves injury are usually considered a functional outcome of uncomplicated operations, mainly related to scar formation and emotional reaction. They could be related to unapparent laryngeal nerve or cricothyroid (CT) muscle injuries detectable only by laryngeal electromyography (LEMG). We correlated such symptoms with LEMG patterns. Methods: A total of 33 consenting patients undergoing total thyroidectomy (TT) were enrolled. Video-strobolaryngoscopy (VSL), acoustic voice analysis (AVA), and maximum phonation time (MPT) were performed preoperatively and 3 months postoperatively. Subjective evaluation of voice (Voice Impairment Score, or VIS) and swallowing (Swallowing Impairment Score, or SIS) were obtained preoperatively and 1 and 3 months postoperatively. At 1 month postoperatively LEMG was performed examining thyroarytenoid (TA) and CT muscles to evaluate the inferior laryngeal nerve (ILN) and the external branch of the superior laryngeal nerve (EBSLN), respectively. Results: One patient experienced transient vocal cord palsy and was excluded. The remaining 32 patients completed the postoperative evaluation. No significant difference was found between preoperative and postoperative AVA and MPT parameters. Mean VIS was significantly worse than preoperatively 1 and 3 months after TT. No significant difference was found between preoperative and postoperative SIS. LEMG evaluation of TA muscle showed decreased voluntary activity and spontaneous fibrillation potentials in one patient. LEMG of the CT muscle did not reveal any sign of EBSLN injury. Conclusions: Patients frequently complain of subjective symptoms early after TT. LEMG demonstrated the absence of subclinical laryngeal nerve injury in all but one patient, confirming their functional nature. [ABSTRACT FROM AUTHOR]

doi: 10.1111/j.1741-2358.2011.00536.x Effect of ill-fitting dentures on the swallowing duration in patients using polygraphy Background: Surface electromyography (SEMG) has been widely used in the recent years to study swallowing physiology, offering a valid and reliable tool for identifying normal swallowing. The goal of our study was to assess the contribution of denture fitness in the age-related increase of swallowing duration. Methods: Twenty denture wearers and 20 dentate individuals were analysed using SEMG and a computerised kinesiography of mandibular movement. Three spontaneous saliva swallowings were recorded for each patient with both their old and new prostheses. Three spontaneous saliva swallowings were recorded for each dentate person in two different recording sessions. Results: Old prosthesis mean swallowing time was 1.84 (SD ± 0.85) seconds while the new well-fitting prostheses needed a 1.28 (SD ± 0.55) ( p = 0.0009) swallowing time. The difference in swallowing time was significant ( p = 0.01) between dentate subjects and individuals wearing an old prosthesis. No significant difference was found between dentate subjects and the same prosthesis wearers when a new well-fitting prosthesis was worn. Conclusion: Data presented in this work suggest that part of the increased duration of swallowing showed by elderly and healthy people is because of incorrect an dental prosthesis. Prolongation of swallowing duration in the elderly population could be reconsidered in the light of the quality of dental device worn by the aged population. [ABSTRACT FROM AUTHOR]

Background: The assessment of adequate upper oesophageal sphincter (UOS) opening during swallowing is an integral component of dysphagia evaluation. Aims: To ascertain speech and language therapists' (SLTs) satisfaction with current methods for assessing UOS function in people with dysphagia and to identify challenges encountered by SLTs with UOS evaluation. Methods & Procedures: A survey was disseminated to 82 SLT managers in Ireland; to two dysphagia Special Interest Groups in the UK; and to the Royal College of Speech & Language Therapists' Bulletin periodical. A survey link was also posted on the American Speech and Hearing Association (ASHA) Division 13 (Dysphagia) web forum. Outcomes & Results: Surveys from 224 SLTs with active dysphagia caseloads were included in data analysis. Only 17.9% (40/224) of SLTs were satisfied with the accuracy and reliability of UOS evaluations currently being employed in dysphagia practice. Satisfaction with current UOS evaluation was not associated with the level of clinical experience ( r= 0.078; p= 0.246). Eighty-seven per cent (195/224) of SLTs working with dysphagia experience challenges in UOS evaluation. Challenges reported include lack of resources/equipment (55.9%), limited quantitative information (45.6%), lack of training (41%) and knowledge (39%) in UOS function, and limited multidisciplinary team involvement (34%). Conclusions & Implications: SLTs across all levels of clinical experience are not satisfied with current UOS evaluation in dysphagia practice. Based on the specific challenges identified, recommendations to progress SLT evaluation of UOS function in people with dysphagia are proposed. [ABSTRACT FROM AUTHOR]

It was hypothesized that tongue-palate pressure generation might directly facilitate hyoid movement in swallowing through the anatomical connections of the extrinsic tongue muscles. If true, non-invasive measures of tongue-palate pressure timing might serve as a proxy measure of hyoid excursion. The timing relationships between events in the tongue-palate pressure and hyoid movement profiles during water and nectar-thick liquid swallowing in healthy adults were explored. Concurrent intra-oral manometry and submental B-mode midsagittal ultrasound were recorded. It was determined that there is no obligate sequence in the onsets, or offsets, of tongue-palate pressures and hyoid excursion. Timing lags (either of hyoid movement lagging tongue-palate pressures or vice versa) fell within 0.5 s, on average. It is concluded that tongue-palate pressure generation and hyoid movement are separate phenomena in the swallowing sequence and that non-invasive measures of tongue-pressure timing cannot be used reliably as proxy measures of hyoid movement timing. [ABSTRACT FROM AUTHOR]

We treated the liquid refusal of a 15-month-old girl using 2 antecedent manipulations: flipped spoon and chin prompt. Use of the chin prompt in the absence of the flipped spoon failed to produce increases in mouth clean (a product measure of swallowing). By contrast, modest increases in mouth clean resulted from the implementation of the flipped spoon alone. The greatest increases in mouth clean resulted from the combination of the 2 manipulations. [ABSTRACT FROM AUTHOR]

The article identifies the neural activation sites of different components of deglutition in healthy elders and investigates age differences in the neural control of swallowing. The researchers concluded that swallowing requires larger and more widespread areas for neural control than the combination of the component tasks examined, such as planning, tongue tap, and throat clearing tasks. The study also showed decreased activations in older adults as compared to their younger counterparts.

To evaluate the efficacy of botulinum neurotoxin type A (BoNT/A) for severe oro-pharyngeal dysphagia associated with multiple sclerosis (MS). BoNT/A was injected percutaneously into the hyperactive cricopharyngeal muscle of 14 dysphagic MS patients under electromyographic control. Patients were evaluated by videofluoroscopic and electromyographic examinations and by the Penetration/Aspiration Scale (PAS), at week 1, 4, 12, 16, 18, and 24 after BoNT/A injection. All patients showed a significant improvement in all the swallowing outcome measures. No specific treatment for oro-pharyngeal dysphagia related to MS has been described to date. Our preliminary findings suggest a potential benefit from BoNT/A treatment in MS patients with dysphagia associated with upper esophageal sphincter hyperactivity. [ABSTRACT FROM AUTHOR]

Background Coordination of breathing and swallowing is essential for airway protection and dyscoordination may cause morbidity and mortality. Methods Using a recently developed technique for high accuracy respiratory measurements of airflow during swallowing, we investigated the effects of body position (upright vs left lateral), bolus type (spontaneously swallowed saliva vs water), and respiratory drive (normo- vs hypercapnia) on coordination of breathing and swallowing in 32 healthy volunteers. Key Results Swallows were in all cases (100%) proceded by expiration and 98% were also followed by expiration, regardless of body position, bolus type, or respiratory drive. While the endpoint of postswallow apnea correlated well to the endpoint of pharyngeal swallowing, duration of preswallow apnea was highly variable. In a small fraction of swallows followed by inspiration (3%), the expiratory phase before swallowing and duration of postswallow apnea was significantly longer. Body position and respiratory drive affected the increase in upper esophageal sphincter tone during inspiration. Increased respiratory drive also reduced swallowing frequency and shortened duration of preswallow apnea. Water swallows had longer duration of preswallow apnea. Conclusions & Inferences Swallowing occurs during the expiratory phase of respiration, and the fraction of swallows preceded and followed by expiration approach 100% in healthy humans. This integration between breathing and swallowing remains unchanged regardless of body position, bolus characteristics, or respiratory drive. Our results provide a platform for future studies aiming at understanding how this integration is changed by aging, diseases, and drugs. [ABSTRACT FROM AUTHOR]

Aim The aim of this unregistered evidence-based systematic review was to determine the state and quality of evidence on the effects of oral motor exercises (OME) on swallowing physiology, pulmonary health, functional swallowing outcomes, and drooling management in children with swallowing disorders. Method A systematic search of 20 electronic databases was completed to identify relevant peer-reviewed literature published in English between 1960 and 2007. Experimental or quasi-experimental design studies examining OME as a treatment for children with swallowing disorders were appraised for methodological quality by two assessors and reviewed by a third. Results Sixteen studies of varying methodological quality were included. No study examining the effects of OME on pulmonary health in children was identified. The included studies incorporated a wide variety of OME, and mixed findings were noted across all of the outcomes targeted in this review. Interpretation Based on the results of this evidence-based systematic review, there is insufficient evidence to determine the effects of OME on children with oral sensorimotor deficits and swallowing problems. Well-designed studies are needed to provide clinicians with evidence that can be incorporated into the preferences of the client and the clinicians' knowledge of anatomy, physiology, and neurodevelopment in the management of this group of children. [ABSTRACT FROM AUTHOR]

Activity patterns of the swallowing-related muscles were examined in normal subjects at different four body positions during swallowing of foods with different textural properties. Surface electromyograms were recorded from two muscle groups, the anterior tongue and suprahyoid muscles. The TP technique we developed was applied to the electromyograms for quantitative analysis of the activity patterns. Three test foods were prepared by dissolving 2·0% (low), 5·7% (middle) and 9·1% (high concentration) of a thickening agent into distilled water. Each subject was delivered randomly, one of the test foods to swallow at one of the four body positions i.e. horizontal supine, 30° inclined, 60° inclined and upright. In this study, T50 values were calculated in activity data of the two muscle groups, and the T50 values were statistically examined analysis of variance with a linear model including four fixed effects of ‘concentrations’, ‘body positions’, ‘subjects’ and ‘sessions’. Three major findings obtained were that (i) the activity pattern of the anterior tongue was altered from a decrementing discharge pattern to an incrementing discharge pattern by shifting from the upright to the horizontal supine position, (ii) the activity pattern of the suprahyoid muscles was altered from a decrementing discharge pattern to an incrementing discharge pattern by shifting from the low concentration food to the higher ones and (iii) two subgroups were detected in subjects with the significant effects of ‘concentrations’ and ‘body positions’. These findings lead a conclusion that activity patterns of the swallowing-related muscles are affected by food properties and body positions. [ABSTRACT FROM AUTHOR]

Understanding of eating behaviors associated with obesity requires objective and accurate monitoring of food intake patterns. Accurate methods are available for measuring total energy expenditure and its components in free-living populations, but methods for measuring food intake in free-living people are far less accurate and involve self-reporting or subjective monitoring. We suggest that chews and swallows can be used for objective monitoring of ingestive behavior. This hypothesis was verified in a human study involving 20 subjects. Chews and swallows were captured during periods of quiet resting, talking, and meals of varying size. The counts of chews and swallows along with other derived metrics were used to build prediction models for detection of food intake, differentiation between liquids and solids, and for estimation of the mass of ingested food. The proposed prediction models were able to detect periods of food intake with >95% accuracy and a fine time resolution of 30 s, differentiate solid foods from liquids with >91% accuracy, and predict mass of ingested food with >91% accuracy for solids and >83% accuracy for liquids. In earlier publications, we have shown that chews and swallows can be captured by noninvasive sensors that could be developed into a wearable device. Thus, the proposed methodology could lead to the development of an innovative new way of assessing human eating behavior in free-living conditions. [ABSTRACT FROM AUTHOR]

This study investigated the effects of a prosthetic appliance on the chewing function, evaluating the electrical activity of masseter and temporal muscles to characterize the chewing process using an artificial test material. Moreover, the chewing behavior with foods of different textures (chewing gum, raw carrot, cheese, banana and industrialized toast) was evaluated. Twenty-three partially edentulous children (12 girls and 11 boys, 7.10 ± 0.74 year-old) participated. Electromyography and chewing behavior were determined before and 6 months after the appliance placement. During habitual chewing, the muscle activity values after the 6 months were higher (P < 0.001). Electromyographic recording (EMG) values were not correlated with body variables. At the two evaluations, significant differences occurred in the number of cycles, swallowing threshold and amount of food ingested for soft and hard foods. The increase in EMG values and the improvement in chewing natural foods were able to demonstrate the influence possibility of the partial removable denture on the muscles and masticatory functions in children. PRACTICAL APPLICATIONS Masticatory muscles respond to the stimulus received. Chewing is a complex neuromuscular task, in which an extrinsic stimulus, such as food, provokes an intrinsic response involving the oral structures. Apart from the subject-related variables, food consistency, texture and volume seem to be particularly significant in determining the characteristics of chewing in oral partial or total denture wearers to enable the outcome on the masticatory system function to be verified. In children, these considerations are important, since the oral sensorimotor pathway matures throughout childhood in concert with the continued acquisition of complex motor skills. Thus, it is expected that partial removable denture with good occlusal relations and good retention can not only restore mastication, but also help to maintain the health of the masticatory system since the motor system could be exercised properly. [ABSTRACT FROM AUTHOR]

Background Dysphagia has rarely been investigated in adults with intellectual disabilities (ID) despite being a serious condition affecting health and quality of life. Method This study collected information about 101 adults with ID, living in community settings, referred for an assessment of their eating and drinking. Ninety-nine people were classified as having dysphagia from clinical and videofluoroscopic assessments. This information was used to give an indication of the prevalence of dysphagia in adults with ID and identify the co-occurrence of physiological and anatomical indicators and associated negative health conditions. Results Details of the characteristics and conditions associated with dysphagia are provided. These include cerebral palsy, increased physical disability and cognitive impairment. A tentative indication of the current prevalence of dysphagia was found (8.15%). Conclusion Findings indicate that dysphagia is a significant issue for people with ID warranting further investigation. Practice implications detailed include increasing awareness of ‘at risk’ groups, changes in dysphagia with ageing, medication use and illness, and how findings can inform assessment and training. [ABSTRACT FROM AUTHOR]

Background and purpose: Transient lower oesophageal sphincter relaxations (TLESRs) are the main mechanism underlying gastro-oesophageal reflux and are a potential pharmacological treatment target. We evaluated the effect of the CB1/CB2 receptor agonist Δ9-tetrahydrocannabinol (Δ9-THC) on TLESRs in dogs. Based on these findings, the effect of Δ9-THC was studied in healthy volunteers. Experimental approach: In dogs, manometry was used to evaluate the effect of Δ9-THC in the presence and absence of the CB1 receptor antagonist SR141716A on TLESRs induced by gastric distension. Secondly, the effect of 10 and 20 mg Δ9-THC was studied in 18 healthy volunteers in a placebo-controlled study. Manometry was performed before and for 3 h after meal ingestion on three occasions. Key results: In dogs, Δ9-THC dose-dependently inhibited TLESRs and reduced acid reflux rate. SR141716A significantly reversed the effects of Δ9-THC on TLESRs. Similarly, in healthy volunteers, Δ9-THC significantly reduced the number of TLESRs and caused a non-significant reduction of acid reflux episodes in the first postprandial hour. In addition, lower oesophageal sphincter pressure and swallowing were significantly reduced by Δ9-THC. After intake of 20 mg, half of the subjects experienced nausea and vomiting leading to premature termination of the study. Other side-effects were hypotension, tachycardia and central effects. Conclusions and implications: Δ9-THC significantly inhibited the increase in meal-induced TLESRs and reduced spontaneous swallowing in both dogs and humans. In humans, Δ9-THC significantly reduced basal lower oesophageal sphincter pressure. These findings confirm previous observations in dogs and indicate that cannabinoid receptors are also involved in the triggering of TLESRs in humans. Mandarin translation of abstract [ABSTRACT FROM AUTHOR]

Objective: To determine if fibreoptic endoscopic evaluation of swallowing adds information to the clinical assessment of swallowing in tracheostomised patients. Design: A prospective, observational study. Setting: Addenbrooke’s Hospital, Cambridge, UK. Participants: Twenty-five consecutive, adult, tracheostomised patients were recruited over a 3-month period. They were referred to speech and language therapy for a swallowing assessment and were ready to trial cuff deflation. Main outcome measures: In current practice the clinical assessment is invariably a precursor to fibreoptic endoscopic evaluation of swallowing and a test would be considered positive when penetration or aspiration are detected. We considered the value of fibreoptic endoscopic evaluation of swallowing following both positive and negative outcomes of the clinical assessment. Results: The positive predictive value of aspiration or penetration was 91% i.e. when a clinical assessment is failed, there is a very high probability the patient would also be failed on fibreoptic endoscopic evaluation of swallowing. However, the negative predictive value was only 64% i.e. over one-third of patients who pass a clinical assessment would later fail a fibreoptic endoscopic evaluation of swallowing. Conclusions: Despite a small cohort, our data suggest that the assessment of swallowing to aid weaning in tracheostomised patients is currently performed incorrectly; we estimate that over a third of all tracheostomised patients that ‘pass’ the clinical assessment of swallowing are, in reality, at risk from penetration, aspiration or failed decannulation. This finding supports the use of fibreoptic endoscopic evaluation of swallowing and a change in clinical practice. [ABSTRACT FROM AUTHOR]

Voice and swallowing symptoms are frequently reported after thyroidectomy even in absence of objective voice alterations. We evaluated the influence of the video-assisted approach on voice and swallowing outcome of thyroidectomy. Sixty-five patients undergoing total thyroidectomy (TT) were recruited. Eligibility criteria were: nodule size ≤30 mm, thyroid volume ≤30 ml, no previous neck surgery. Exclusion criteria were: younger than aged 18 years and older than aged 75 years, vocal fold paralysis, history of voice, laryngeal or pulmonary diseases, malignancy other than papillary thyroid carcinoma. Patients were randomized for video-assisted (VAT) or conventional (CT) thyroidectomy. Videostrobolaryngoscopy (VSL), acoustic voice analysis (AVA), and maximum phonation time (MPT) evaluation were performed preoperatively and 3 months after TT. Subjective evaluation of voice (voice impairment score = VIS) and swallowing (swallowing impairment score = SIS) were obtained preoperatively, 1 week, 1 month, and 3 months after TT. Fifty-three patients completed the postoperative evaluation: 29 in the VAT group, and 24 in the CT group. No laryngeal nerves injury was shown at postoperative VSL. Mean postoperative MPT, F 0, F low, F high, and the number of semitones were significantly reduced in the CT group but not in the VAT group. Mean VIS 3 months after surgery was significantly higher than preoperatively in CT group but not in the VAT group. Mean SIS was significantly decreased 1 and 3 months after VAT but not after CT. The incidence and the severity of early voice and swallowing postthyroidectomy symptoms are significantly reduced in patients who undergo VAT compared with conventional surgery. [ABSTRACT FROM AUTHOR]

We examined the clinical manifestations and computed tomography findings of patients with leakage after gastrectomy for cancer and determined the sensitivity of the contrast swallow for the leakage diagnosis. The medical records of 331 consecutive patients undergoing gastrectomy between January 1992 and December 2003 were reviewed. Routine contrast swallow was performed in all patients before oral intake. Once leakage was suspected, an emergency contrast swallow was performed and its diagnostic sensitivity determined. In total, leakage was diagnosed 9 of 17 times by the contrast swallow, for a diagnostic sensitivity of 53%. The clinical signs or another imaging modality often corrected the misdiagnosis. The diagnostic sensitivity of contrast swallow for leakage after gastrectomy was low. Therefore, if we employ the contrast swallow technique, we should keep in mind its low sensitivity. [ABSTRACT FROM AUTHOR]

Individual rhythms of suck, swallow, and respiration are disrupted in preterm infants with bronchopulmonary dysplasia (BPD). Integration of respiration into suck–swallow efforts is critical for establishing coordinated suckle feeding. This study quantitatively assessed the coordination of respiration and swallow in infants with and without BPD. Thirty-four preterm infants of 26 to 33 weeks' gestational age were included: 14 participants with BPD (eight males, six females)and 20 comparison participants without BDP (10 males, 10 females). Participants were studied at postmenstrual age 32 to 40 weeks and postnatal age 2 to 12 weeks using digital recordings of pharyngeal pressure, nasal thermistor flow, and thoraco-abdominal plethysmography. The coefficients of variation (COV; standard deviation/mean) of the swallow–breath (SW–BR) and breath–breath (BR–BR) intervals during swallow runs, the percentage of ‘apneic swallows’ (runs of 3 swallows without interposed breaths), and phase relationships of respiration and swallow were used to quantify rhythmic coordination and integration of respiration into feeding episodes. Apneic swallows were significantly increased after 35 weeks in infants with BPD (mean 13.4% [SE 2.4]) compared with non-BDP infants (6.7% [SE 1.8] p<0.05), as were SW–BR phase relationships involving apnea. The BPD cohort also had significantly higher SW–BR COV and BR–BR COV than non-BPD infants, indicating less rhythmic coordination of swallowing and respiration during feeding. Results emphasize the need for frequent rests and closer monitoring when feeding infants with respiratory compromise. Quantitative assessment of the underlying rhythms involved in feeding may be predictive of longer-term feeding and neurological problems. [ABSTRACT FROM AUTHOR]

This study was carried out to clarify the distribution and individual variation of the number of chewing strokes before last swallowing (NCS), as well as to assess the factors that affect NCS, when dentulous adults masticate the same type of food. NCS was measured in 75 dentulous adults using gummy candies. Measurements were repeated five times to obtain the average and variation. Moreover, the correlation of NCS with various physiological factors (lateral width and vertical distance of chewing loop, angle of opening and closing path, opening and closing time, occlusal time, masticatory performance, number of occlusal contact points, occlusal contact area, occlusal force, flow rate of whole saliva and viscosity of whole saliva) and 28 personality factors were analysed by both of the single variate analysis and the multivariate analysis. The results showed that the average NCS was 41·0 ± 16·0, and the coefficient of variation was 0·090 ± 0·040. Additionally, the correlation between NCS and each factor was investigated, and found that any of these factors did not function as a single determinant for NCS. Following, determinant factors were further examined by the stepwise method of linear multiple regression analysis. From these analysis we found that when opening and closing time and four personality factors were combined, they were significantly involved in determining NCS ( P < 0·01). Therefore, we conclude that individual NCS until last swallowing is not determined by a sole, specific physiological factor but is affected by multiple factors including personality. [ABSTRACT FROM AUTHOR]

1. To minimize study-area artefacts in a study of natal dispersal distances in tree swallows, we intensively banded nestlings and adults in nest-boxes in upstate New York and recruited and trained 70 volunteer banders within a 400 km radius of Ithaca. We banded 26 567 nestlings in the years 1985 through 1998, and captured 4774 adults at the nest, 630 of which had been banded as nestlings and were recaptured the year after fledging. 2. To correct for spatial variation in capture intensity, we resampled the distribution of all boxes where an adult capture was made under uniform, exponential and Cauchy null hypotheses. Compared to the null distributions, the frequency of observed dispersal events was significantly higher at 0–10 km and lower for all larger dispersal distances. The Cauchy distribution came closest to approximating the observed dispersal distance distribution. 3. Dispersal distances were sensitive to the distribution of nesting sites, and all measurements of dispersal distance distributions must be seen as being habitat-specific. We could detect no effect of dispersal distance on the subsequent timing of breeding and no effect of the timing of fledging on dispersal distance. The sexual differences in raw mean dispersal distances (8·38 km for females, 2·44 km for males) are similar to those reported for other species. 4. While it is tempting to conclude that studies in smaller areas have not missed a great deal, even a study area of 10 km extent (substantially larger than most) would have missed 11% of the dispersing birds detected and 95% of the range of distances recorded. Despite this sizeable component that would have been missed with a smaller study area, the relatively low frequencies of long-distance dispersal overall reinforce the conclusion that tree swallows, and probably most other migratory passerines, generally disperse much less far from their natal sites than the distances of their annual migrations might lead one to expect. [ABSTRACT FROM AUTHOR]

Objectives: To examine the association between the speech and swallowing aspect of health-related quality of life (HRQOL) and selected clinical parameters, and particularly to determine those that are predictive of good outcomes at 1 year after surgery. Design: Prospective questionnaire and clinical study. Setting: Regional Maxillofacial Unit. Participants: A total of 278 consecutive patients undergoing primary surgery for squamous cell carcinoma between 1995 and 1999. HRQOL was assessed using the University of Washington Quality of Life questionnaire (UW-QOL) pre-surgery, and post-surgery at 6 months, 1 year and later (median 39 months). Main outcome measures: Presentation of results was mainly descriptive, involving percentages and mean scores. Association of clinico-demographic factors with tumour site, and with UW-QOL swallowing and speech after 12 months, was tested with Fisher's exact or chi-squared tests as appropriate and modelled using logistic regression methods. Results: Univariate relationships were seen between speech and swallowing scores and with tumour size, T staging, radiotherapy, type of surgery (primary closure or free tissue transfer), tumour site, extent of resection of posterior tongue and soft palate, and UW-QOL taste and saliva scores. Multiple logistic regression showed that no radiotherapy ( P < 0.001) and primary surgical closure/laser surgery ( P = 0.003) were the main predictors of good swallowing, and primary surgical closure/laser surgery was the main predictor of good speech ( P < 0.001) at 1 year. Conclusions: A number of clinical parameters can influence the speech and swallowing aspect of quality of life in these patients and when feasible, primary closure results in a better outcome than free flap reconstruction. [ABSTRACT FROM AUTHOR]

With each swallow a certain amount of air is transported to the stomach. The stomach protects itself against excessive distention by swallowed air through belching (gas reflux). The mechanism of belching (transient lower oesophageal sphincter relaxation) is also one of the mechanisms underlying gastro-oesophageal reflux.To investigate whether swallowing of air leads to an increase in size of the intragastric air bubble and to gastro-oesophageal reflux.Multichannel intraluminal impedance mea-surement was used to quantify the incidence of swallowing of air in 20 healthy volunteers before and after a meal. Radiography was used to measure the size of the intragastric air bubble. Gastro-oesophageal reflux was assessed by concurrent impedance and pH measurement.The rate of air swallowing was correlated to the size of the intragastric air bubble postprandially and to the rate of gaseous gastro-oesophageal reflux. The number of air swallows and the size of the intragastric air bubble did not correlate with the number of liquid acid and non-acid reflux episodes.In healthy subjects, air swallowing promotes belching but does not facilitate acid reflux. [ABSTRACT FROM AUTHOR]

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BSTRACT The oral processing of most semisolid and solid foods can be summarized in terms of two opposing mechanical influences: forces that fracture food particles versus those that make them adhere to each other. During either the ingestion of food into the mouth or the early stages of mastication, the aim of processing solid food particles is usually to fracture them. However, later on towards swallowing, adhesion is desirable in order to try to form a sticky food bolus that could clear the mouth of isolated food fragments. Neither of these tendencies is actually a function of any particular force (or stress) or displacement (or strain) on food particles, but is instead controlled by energy. Food particles can adhere not only to each other but to the mouth's surfaces. This produces friction. While this is essential for the tongue to grip food particles and move them around the mouth, it also adds to the work that mouthparts must do during processing and may affect sensory perception of food quality. Successful processing of foods in the mouth requires a considerable amount of neural feedback from sensory receptors. We focus here on recent evidence about these sensory receptors with an attempt to reinterpret their role in terms of textural perception. [ABSTRACT FROM AUTHOR]

BSTRACT i [ABSTRACT FROM AUTHOR]

BSTRACT i [ABSTRACT FROM AUTHOR]

lin l.c., wang s.c., chen s.h., wang t.g., chen m.y. & wu s.c. (2003) Journal of Advanced Nursing 44(5), 469–478 Efficacy of swallowing training for residents following stroke The presence of dysphagia is associated with an increased risk of mortality, malnutrition, dehydration, compromised pulmonary function, and disability. Appropriate swallowing training can establish optimal nutritional status and eliminate or reduce the risk of developing medical complications associated with swallowing impairment. The aim of this study was to examine the functional swallowing and nutritional outcomes of swallowing training in institutionalized stroke residents with dysphagia. A quasi-experimental parallel cluster design was used. Seven institutions with similar bed sizes were selected. All subjects in the experimental group received a structured swallowing training programme. The subjects in the experimental group ( n = 40) received 30 minutes of swallowing training each day for 6 days per week for 8 weeks. The control group ( n = 21) did not receive any training. After swallowing training, mean differences in volume per second, volume per swallow, mid-arm circumference and body weight between pre- and post-training of the experimental group were significantly higher than for the control group, while mean differences in neurological examination and choking frequency during meals for the experimental group were significantly lower than in the control group. This study used objective timed swallowing tests, a swallowing questionnaire, and a neurological examination to evaluate the effects of swallowing training. However, videofluroscopy is generally considered the best method for evaluating the pharyngeal and esophageal stages of swallowing, and introducing this technique is recommended for future studies. Furthermore, it is recommended that nursing professionals should conduct swallowing training protocols in stroke patients to help prevent aspiration from dysphagia. [ABSTRACT FROM AUTHOR]

Cervical accelerometry with digital signal processing (DSP) can identify signals that are consistently associated with swallowing during feeding of infants. It is shown that these signals, called initial discrete sounds (IDSs), become more uniform with advancing postmenstrual age (PMA) in healthy preterm infants. The objectives of this study were to determine if cervical accelerometry and DSP at a higher sample rate than previously used (22kHz versus 16kHz), in conjunction with a DSP software package that allows manipulation of the sound files, would improve the accuracy of the previously developed variance index (VI) method of analyzing accelerometric information. The modified VI method was then used to measure developmental differences in the IDS morphology of infants with and without bronchopulmonary dysplasia (BPD). VIs were calculated for 24 feeding studies of infants of between 32 and 39 weeks PMA: 12 studies on healthy preterm infants (n=10: three males, seven females; mean gestational age [GA] 28.6 weeks, SD 0.4; mean birthweight [BW] 1080g, SD 82; PMA mean 35.2 weeks, SD 0.6) and 12 studies on infants with BPD (n=7: five males, two females; GA 27.1 weeks, SD 0.4; BW 911g, SD 71; PMA 36.2 weeks, SD 0.6). There was a significant inverse correlation between VI and PMA for the healthy preterm group (r=0.66, m=–2.31/week, p=0.02). There was no significant correlation between VI and PMA for the BPD cohort. The VI of infants with BPD was significantly different from that of infants without BPD (p<0.007, multiple regression analysis, interaction PMA×Group). Additionally, using our modified VI technique, 100% of swallows were found to have the expected IDS signals. [ABSTRACT FROM AUTHOR]

Summary A computer simulation of the time course of flavour release from foods in the mouth is presented which takes into account individual differences in mastication behaviour. Pearson type IV distributions of chewing and swallowing times, sphericity and mass loss changes determined by electromyography and spit-out experiments for each panellist are used to simulate mastication runs which are combined with the mass transfer kinetics to predict the time course of flavour concentration in the headspace for each panellist. These predictions are compared with the corresponding sensory time-intensity measurements. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To investigate the prevalence of impaired swallowing in residents at long-term care facilities (LTCFs) in Taiwan. DESIGN: A chart review, a structured questionnaire completed at interview, a neurological examination, and a timed swallowing test were used to assess impairment and to gather demographic data. SETTING: Nine skilled nursing facilities and nine intermediate-care facilities in metropolitan Taipei. PARTICIPANTS: One thousand two hundred twenty-one conscious and unconscious residents with a mean age of 77.07. MEASUREMENTS: Impaired swallowing was defined when a subject met two or more of the following criteria: self-report of swallowing difficulty, a score of 2 or more derived from a swallowing questionnaire combined with a neurological examination investigating symptoms and signs of impairment, and coughing/choking during a timed swallowing test or a measured swallowing rate (volume swallowed per second) below the 10th percentile as derived from a gender-based study of an older community in Taipei. RESULTS: Of the 1,221 subjects, 356 (29.2%) were fed by tube. The prevalence rates for impaired swallowing as estimated were 97.5% and 31.9% for tube-fed and non-tube-fed subjects respectively, whereas the overall prevalence for tube-fed and non-tube-fed subjects altogether was 51.0%. CONCLUSIONS: The findings may serve to increase awareness of this problem among healthcare professionals in LTCFs. Further research is contemplated to investigate whether early identification makes a difference in treatment choices and outcomes. [ABSTRACT FROM AUTHOR]

The aim was to measure the angle of elevation of the soft palate during the separate conditions of swallowing of pudding, swallowing of liquid and during production of 'may/pay', using videofluoroscopy and innovative computer software. We then determined whether soft palate elevation (as reflected in measures of an angle) differed in those separate conditions. Twelve female participants were studied, aged 40-70 years. The trends observed were that the highest soft palate elevation was displayed in the liquid-swallowing condition and the lowest soft palate elevation was displayed in the speech conditions. The results did not reach statistical significance, but the findings support the suggestions of Rubesin et al. (1987) and Fritzell (1969) that soft palate elevation is higher during swallowing than during speech. This same method was then used to measure soft palate elevation under the same three conditions in nine females, all aged >40 years, who had motor neuron disease. Again, the highest soft palate elevation was displayed when swallowing liquid, but this time the lowest elevation occurred when swallowing pudding. Owing to small numbers, results did not reach statistical significance, but the trends may be important to replicate in a larger study. This pilot study developed a comprehensive and accurate method of measuring the soft palate elevation using digitization and computer software. [ABSTRACT FROM AUTHOR]

The activity of the anterior and posterior portions of the temporal muscle and in the upper and lower lips were studied electromyographically in 50 girls, aged 9-13 years with normal occlusion. The recordings were made during swallowing of water, saliva, apple and peanuts as well as during chewing of apple and peanuts. The maximal mean voltage amplitudes during swallowing varied notably with the test medium and were larger for solid than for fluid media. The amplitudes were the same for both portions of the temporal muscle, but always greater for the lower lip than for the upper. Many girls swallowed fluid media without demonstrable activity of the anterior portion of the temporal muscle, while absence of demonstrable activity in the lips was rare. No correlation was found between the degree of activity of the lips during swallowing of fluid and solid substances. The amplitudes during chewing were the same for both portions of the temporal muscle, but larger for the lower lip than for the upper. The amplitudes found for the two portions of the temporal muscle and for the upper and lower lips were intercorrelated both during swallowing and chewing. No correlation was found between the amplitudes from the lower lip and from the temporal muscle during swallowing. The amplitude from the upper lip during swallowing was correlated only with that from the posterior portion of the temporal muscle. Palpation of muscular activity of the temporal muscle during swallowing is of little or no value for estimating the degree of activity of the lip during swallowing. [ABSTRACT FROM AUTHOR]

Normal speech and swallow depend on the integrity of the oral motor system and the underlying processes of respiration, phonation, sensation, resonance and articulation. A variety of age-related changes occur in the oral peripheral mechanism, some of which affect speech and swallow. Nonpathologic changes in the thoracic and laryngeal structures that serve to reduce the vital capacity of the lungs and produce perturbations in the acoustic signal alter the quality of the aging voice. As one ages, the oral mucosa reportedly thins, salivary flow may be decreased, and the sensory and motor integrity of the tongue musculature is altered. The effect of such changes on speech articulation and voice production in the elderly is discussed. Although not dependent on one another, speech and swallowing use many of the same oral structures and underlying physiologic mechanisms. The anatomic and physiologic changes in the aging pharyngeal area and oral tract that can affect swallowing are reviewed and studies of these changes are discussed. Viewing the oral area and vocal tract has required invasive, cumbersome or dangerous radiographic procedures, thereby limiting the quantity of research in this field. Recent work on the use of real-time ultrasound imaging to view the oral soft tissues and dynamic lingual gestures in vivo during speech and swallow are reviewed and ongoing studies of speech and swallowing performance in normal aging persons using this technique are presented. [ABSTRACT FROM AUTHOR]

The effect of varying amount and concentration of a sucrose solution on swallowing and sucking activity of newborns was studied. Swallowing activity increased relative to the number of sucks, and sucking rate slowed as amount and concentration of sucrose was increased. Sucking interresponse times associated with swallowing were approximately 200 msec longer than interresponse times not associated with swallows. The results are discussed in relation to previous studies of sucking in the newborn. [ABSTRACT FROM AUTHOR]