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Objective: To evaluate the activities of the submental muscles using surface electromyography (sEMG) in patients presenting with dysphagia secondary to middle cerebral artery (MCA) infarction, and to compare the results with those in healthy volunteers., Design: Retrospective study design., Setting: A dysphagia clinic at a tertiary care university hospital., Participants: Twenty-one patients presenting with dysphagia after unilateral MCA infarction were recruited into the study within 2 months of stroke onset. To serve as a control group, 13 healthy volunteers were enrolled., Main Outcome Measures: The primary sEMG parameters were swallowing onset, pretrigger duration, swallowing duration, and swallowing amplitude. Swallowing functional outcome was evaluated using the Videofluoroscopic Dysphagia Scale and the American Speech-Language-Hearing Association National Outcome Measurement System., Results: Patients with MCA infarction demonstrated significantly delayed swallowing onset (P < .001) and shorter swallowing duration (P = .003) compared with the controls. Duration from the start of sEMG activity and actual laryngeal elevation also was delayed in the patient group (P = .042). At a cut-off point of 0.13 seconds for swallowing onset, sensitivity was 85.7% and specificity was 69.2%. For swallowing duration, sensitivity was 84.6% and specificity was 66.7% with 1.05 seconds as the cut-off point., Conclusions: Patients with MCA infarction showed not only delayed swallowing onset and pretrigger duration, but also shorter duration of sEMG activity compared with those in healthy volunteers. Our results suggest that dysphagia after stroke might be further compromised by delayed laryngeal response especially after the start of suprahyoid muscle activity, which represents impaired laryngeal protection mechanism., (Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)

The purpose of the study was to investigate the influence of the chin-tuck maneuver on the movements of swallowing-related structures in healthy subjects and formulate standard instructions for the maneuver. A total of 40 healthy volunteers (20 men and 20 women) swallowed 10 mL of diluted barium solution in a "normal and comfortable" position (NEUT), a comfortable chin-down position (DOWN), and a strict chin-tuck position (TUCK). Resting state anatomy and kinematic changes were analyzed and compared between postures. Although angles of anterior cervical flexion were comparable between DOWN (46.65 ± 9.69 degrees) and TUCK (43.27 ± 12.20), the chin-to-spine distance was significantly shorter in TUCK than in other positions. Only TUCK showed a significantly shorter anteroposterior diameter of the laryngeal inlet (TUCK vs. NEUT, 14.0 ± 4.3 vs. 16.3 ± 5.0 mm) and the oropharynx (18.8 ± 3.1 vs. 20.5 ± 2.8 mm) at rest. The maximal horizontal displacement of the hyoid bone was significantly less in TUCK (9.6 ± 3.0 mm) than in NEUT (12.6 ± 2.6 mm; p < 0.01) or DOWN (12.1 ± 3.0 mm; p < 0.01). TUCK facilitated movement of the epiglottic base upward (TUCK vs. NEUT, 15.8 ± 4.7 vs. 13.3 ± 4.5 mm; p < 0.01). In contrast, DOWN increased the horizontal excursion of the epiglottic base and reduced movement of the vocal cords. These results quantitatively elucidated the biomechanical influences of the chin-tuck maneuver including reduced horizontal movement of the hyoid bone, facilitation of vertical movement of the epiglottic base, and narrowing of the airway entrance. Comparing DOWN and TUCK, only TUCK induced significant changes in the airway entrance, hyoid movement, and epiglottic base retraction.

Although coordination and timing of swallowing have often been investigated by using discrete timing events such as the onset, peak, and duration of specific motions, the sequence and duration of swallowing events cannot represent the coordination of the swallowing mechanism quantitatively. This study aimed to apply a cross-correlation analysis of the motions of the hyolaryngeal structures during swallowing as an objective method for measuring the coordination and timing of the motions. Forty healthy subjects swallowed 2 and 5 ml of diluted barium solution (35 %) and 5 ml of curd yogurt under videofluoroscopy. Hyolaryngeal motions in videofluoroscopic images were digitized using the motion analysis system. The time series of the horizontal and vertical hyoid motion, the laryngeal elevation, and the angle of the epiglottic tilt were analyzed using cross-correlation at each 1/60-s time lag. The results showed high and consistent cross-correlations between hyolaryngeal motions during swallowing in most of the subjects regardless of age and bolus type. The horizontal hyoid motion and laryngeal elevation were more strongly correlated with the epiglottic tilt than the vertical hyoid motion, which might suggest the mechanism of the epiglottic tilt during swallowing. The bolus volume and viscosity affected the correlation coefficients and time lags between the hyolaryngeal motions, particularly those related to the epiglottic tilt. The results suggest that cross-correlation analysis may be used for measuring the coordination and timing of swallowing. Further studies using cross-correlation analysis of additional physiological factors related to swallowing or pathological conditions are warranted.

Objective: To evaluate the activities of the submental muscles using surface electromyography (sEMG) in patients presenting with dysphagia secondary to middle cerebral artery (MCA) infarction, and to compare the results with those in healthy volunteers.Design: Retrospective study design.Setting: A dysphagia clinic at a tertiary care university hospital.Participants: Twenty-one patients presenting with dysphagia after unilateral MCA infarction were recruited into the study within 2 months of stroke onset. To serve as a control group, 13 healthy volunteers were enrolled.Main Outcome Measures: The primary sEMG parameters were swallowing onset, pretrigger duration, swallowing duration, and swallowing amplitude. Swallowing functional outcome was evaluated using the Videofluoroscopic Dysphagia Scale and the American Speech-Language-Hearing Association National Outcome Measurement System.Results: Patients with MCA infarction demonstrated significantly delayed swallowing onset (P < .001) and shorter swallowing duration (P = .003) compared with the controls. Duration from the start of sEMG activity and actual laryngeal elevation also was delayed in the patient group (P = .042). At a cut-off point of 0.13 seconds for swallowing onset, sensitivity was 85.7% and specificity was 69.2%. For swallowing duration, sensitivity was 84.6% and specificity was 66.7% with 1.05 seconds as the cut-off point.Conclusions: Patients with MCA infarction showed not only delayed swallowing onset and pretrigger duration, but also shorter duration of sEMG activity compared with those in healthy volunteers. Our results suggest that dysphagia after stroke might be further compromised by delayed laryngeal response especially after the start of suprahyoid muscle activity, which represents impaired laryngeal protection mechanism. [ABSTRACT FROM AUTHOR]

Abstract Objectives To investigate the characteristics of oropharyngeal dysphagia in adults with dyskinetic cerebral palsy (DCP) and cervical dystonia (CD). Design Exploratory observational cross-sectional study. Setting University hospital. Participants Seventeen patients with DCP (8 men, 9 women; age, 45.7±6.3y) enrolled in a randomized controlled trial on the effects of botulinum toxin injection on CD. Interventions Not applicable. Main Outcome Measures Baseline clinical assessments and videofluoroscopic swallowing studies (VFSSs) were conducted. VFSS findings were evaluated using the videofluoroscopic dysphagia scale (VDS) and the penetration-aspiration scale (PAS). The Gross Motor Function Classification System (GMFCS) and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores were also assessed. Relationships between outcomes were evaluated using Spearman's rank correlation. Results The clinical assessment revealed abnormalities in chewing (n=10, 58.8%), tongue movement (n=10, 58.8%), and laryngeal elevation (n=8, 47.1%). The most common abnormality on the VDS was inadequate mastication (n=13, 76.5%), followed by premature bolus loss, vallecular residue, and penetration/aspiration (all: n=10, 58.8%). A maximum PAS score of 8 was observed in 8 of 17 patients (47.1%). Total and pharyngeal VDS scores were significantly correlated with TWSTRS scores (ρ=0.543, P =.024 and ρ=0.539, P =.026, respectively); the VDS oral score did not correlate with the TWSTRS score (ρ=0.446, P =.073). There was no significant correlation between VDS score and GMFCS level (ρ=0.212, P =.414). Conclusions This preliminary observational study presents the characteristics of oropharyngeal dysphagia in adults with DCP and CD. Pharyngeal stage difficulties were negatively correlated with severity of CD, but not with GMFCS level. Screening for dysphagia may be recommended in adults with DCP and severe CD. [ABSTRACT FROM AUTHOR]