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Purpose: The purpose of this study was to compare the biomechanics of the effortful pitch glide (EPG) with swallowing using dynamic mRi. The EPG is a combination of a pitch glide and a pharyngeal squeeze maneuver for targeting laryngeal and pharyngeal muscles. The authors hypothesized that the EPG would elicit significantly greater structural excursions of anterior hyoid, superior hyoid, hyolaryngeal approximation, laryngeal elevation, and lateral pharyngeal wall medialization compared with swallowing. Method: Eleven healthy, young subjects with a mean age of 25 were recruited. The EPG was first taught and verified via laryngoscopy. Then 2-planar (coronal and sagittal) dynamic MRI acquisitions captured 10 repeated swallows and 3 EPGs. Kinematic analyses of minimum and maximum excursion of anatomical landmarks were calculated. Results: Results showed a nonsignificant difference between the 2 tasks for range of excursion with all measured biomechanics except for superior hyoid, where the swallow showed significantly greater excursion. This indicated that swallowing and EPG biomechanics were comparable, lending support for the potential use of the EPG as another nonswallowing exercise. Conclusion: Findings suggest EPG may be an effective exercise to target several important swallowing muscles, especially the long pharyngeal muscles that elevate the larynx and shorten the pharynx in swallowing. Key Words: swallow, exercise, dynamic MRI, pitch glide, pharyngeal squeeze maneuver, Rehabilitation of the swallow using exercises is frequently implemented to improve deglutitive function. However, the underlying mechanics of many of these exercises have not been fully explored. Two examples of [...]

Purpose: This study explored the effects of highconcentration taste manipulation trials on swallow function in persons with sensory-based dysphagia. Method: Dysphagia researchers partnered with clinical providers to prospectively identify traumatically injured U.S. military service members (N = 18) with sensorybased dysphagia as evidenced by delayed initiation and/or decreased awareness of residue/penetration/aspiration. Under videofluoroscopy, participants swallowed trials of 3 custom-mixed taste stimuli: unflavored (40% weight/volume [wt/vol] barium sulfate in distilled water), sour (2.7%wt/vol citric acid in 40% wt/vol barium suspension), and sweet-sour (1.11% wt/vol citric acid plus 8% wt/vol sucrose in 40% wt/vol barium suspension). Trials were analyzed and compared via clinical rating tools (the Modified Barium Swallow Impairment Profile [Martin-Harris et al., 2008] and the Penetration-Aspiration Scale [Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996]). Additionally, a computational analysis of swallowing mechanics (CASM) was applied to a subset of 9 swallows representing all 3 tastants from 3 participants. Results: Friedman's tests for the 3 stimuli revealed significantly (p < .05) improved functional ratings for Penetration-Aspiration Scale and pharyngoesophageal opening. CASM indicated differences in pharyngeal swallowing mechanics across all tastant comparisons (p = .0001). Eigenvectors revealed increased tongue base retraction, hyoid elevation, and pharyngeal shortening for sweet-sour and, to a lesser extent, sour than for unflavored boluses. Conclusion: Advantageous changes in certain parameters of oropharyngeal swallowing physiology were noted with high-intensity tastants per both clinical ratings and subsequent CASM, suggesting potential therapeutic application for taste manipulation. [ABSTRACT FROM AUTHOR]

Purpose: Speech production is a complex 3-dimensional (3D) process, and yet most of what is known about it is derived from 2D midsagittal data. The relatively recent development of safe 3D imaging technologies (including magnetic resonance imaging and ultrasound) provide new opportunities to revisit and reformulate what is already known and to push the boundaries of current knowledge still further. A particularly useful imaging modality for this purpose is 3D/4D ultrasound, which until very recently was not well suited for studies in speech research. This technical report presents an overview of what 3D/4D ultrasound can contribute to speech research, with a focus on 2 demonstrations. Conclusion: The 1st demonstration illustrates how 3D/4D ultrasound makes it possible to image certain vocal tract anatomical structures and planes that conventional 2D ultrasound is not capable of imaging. The 2nd demonstration illustrates how 3D/4D ultrasound can be combined with static 3D magnetic resonance imaging to provide new insight into the temporal pervasiveness and spatial extensiveness of lateral contact between the tongue and palate--teeth during speech production. [ABSTRACT FROM AUTHOR]

Purpose: Rehabilitation of pharyngeal swallowing dysfunction requires a thorough understanding of the functional anatomy underlying the performance goals of pharyngeal swallowing. These goals include the safe and efficient transfer of a bolus through the hypopharynx into the esophagus. Penetration or aspiration of a bolus threatens swallowing safety. Bolus residue indicates swallowing inefficiency. Several primary mechanics, or elements of the swallowing mechanism, underlie these performance goals, with some elements contributing to both goals. These primary mechanics include velopharyngeal port closure, hyoid movement, laryngeal elevation, pharyngeal shortening, tongue base retraction, and pharyngeal constriction. Each element of the swallowing mechanism is under neuromuscular control and is therefore, in principle, a potential target for rehabilitation. Secondary mechanics of pharyngeal swallowing, those movements dependent on primary mechanics, include opening the upper esophageal sphincter and epiglottic inversion. Conclusion: Understanding the functional anatomy of pharyngeal swallowing underlying swallowing performance goals will facilitate anatomically informed critical thinking in the rehabilitation of pharyngeal swallowing dysfunction. [ABSTRACT FROM AUTHOR]

Purpose: This study predicts and simulates the function and relative contributions of the intravelar and extravelar portions of the levator veli palatini (LVP) and palatoglossus (PG) muscles in velic constrictions. Method: A finite element-based model of the 3-dimensional upper airway structures (palate, pharynx, tongue, jaw, maxilla) was implemented, with LVP and PG divided into intravelar and extravelar portions. Simulations were run to investigate the contributions of these muscles in velopharyngeal port (VPP) closure and constriction of the oropharyngeal isthmus (OPI). Results: Simulations reveal that the extravelar portion of LVP, though crucial for lifting the palate, is not sufficient to effect VPP closure. Specifically, the characteristic "bulge" appearing in the posterior soft palate during VPP closure (Pigott, 1969; Serrurier & Badin, 2008) is found to result from activation of the intravelar portion of LVP. Likewise, the intravelar portion of posterior PG is crucial in bending the "veil" or "traverse" (Gick, Francis, Klenin, Mizrahi, & Tom, 2013) of the velum anteriorly to produce uvular constrictions of the OPI (Gick et al., 2014). Conclusions: Simulations support the view that intravelar LVP and PG play significant roles in VPP and OPI constrictions. [ABSTRACT FROM AUTHOR]

Multilevel upper airway surgery for obstructive sleep apnea (OSA) has been shown to cause clinically significant dysphagia in some patients. We describe the cases of 2 adults with OSA who developed persistent dysphagia after multilevel upper airway surgery. Patient-specific computational analysis of swallowing mechanics (CASM) revealed absent pharyngeal shortening and aberrant tongue base retraction in both patients. These findings are consistent with the OSA surgical goal of enlarging the hypopharyngeal airway but likely contributed to our patients' dysphagia. Patient-specific CASM allows for sensitive identification of swallowing mechanical dysfunction that might otherwise be overlooked, and it may be utilized in future head and neck surgery patients to analyze swallowing dysfunction associated with treatment. [ABSTRACT FROM AUTHOR]

Purpose: Artificial airway procedures such as intubation and tracheotomy are common in the treatment of traumatic injuries, and bolus modifications may be implemented to help manage swallowing disorders. This study assessed artificial airway status, bolus properties (volume and viscosity), and the occurrence of laryngeal penetration and/or aspiration in relation to mechanical features of swallowing. Method: Coordinates of anatomical landmarks were extracted at minimum and maximum hyolaryngeal excursion from 228 videofluoroscopic swallowing studies representing 69 traumatically injured U.S. military service members with dysphagia. Morphometric canonical variate and regression analyses examined associations between swallowing mechanics and bolus properties based on artificial airway and penetration-aspiration status. Results: Significant differences in swallowing mechanics were detected between extubated versus tracheotomized (D = 1.32, p < .0001), extubated versus decannulated (D = 1.74, p < .0001), and decannulated versus tracheotomized (D = 1.24, p < .0001) groups per post hoc discriminant function analysis. Tracheotomy-in-situ and decannulated subgroups exhibited increased head/neck extension and posterior relocation of the larynx. Swallowing mechanics associated with (a) penetration-aspiration status and (b) bolus properties were moderately related for extubated and decannulated subgroups, but not the tracheotomized subgroup, per morphometric regression analysis. Conclusion: Specific differences in swallowing mechanics associated with artificial airway status and certain bolus properties may guide therapeutic intervention in traumabased dysphagia. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare the biomechanics of the effortful pitch glide (EPG) with swallowing using dynamic MRI. The EPG is a combination of a pitch glide and a pharyngeal squeeze maneuver for targeting laryngeal and pharyngeal muscles. The authors hypothesized that the EPG would elicit significantly greater structural excursions of anterior hyoid, superior hyoid, hyolaryngeal approximation, laryngeal elevation, and lateral pharyngeal wall medialization compared with swallowing. Method: Eleven healthy, young subjects with a mean age of 25 were recruited. The EPG was first taught and verified via laryngoscopy. Then 2-planar (coronal and sagittal) dynamic MRI acquisitions captured 10 repeated swallows and 3 EPGs. Kinematic analyses of minimum and maximum excursion of anatomical landmarks were calculated. Results: Results showed a nonsignificant difference between the 2 tasks for range of excursion with all measured biomechanics except for superior hyoid, where the swallow showed significantly greater excursion. This indicated that swallowing and EPG biomechanics were comparable, lending support for the potential use of the EPG as another nonswallowing exercise. Conclusion: Findings suggest EPG may be an effective exercise to target several important swallowing muscles, especially the long pharyngeal muscles that elevate the larynx and shorten the pharynx in swallowing. [ABSTRACT FROM AUTHOR]

By design or default, anatomy educators are often responsible for introducing students to medical professionalism. Although much has been said about the role of anatomical education, there are no published reports suggesting how to measure change. This study investigated what professionalism attitudes, if any, change during a gross anatomy course. Additionally, the influence of four dichotomous variables related to student identity and preparation for medical school were analyzed for their effect on professionalism attitudes. A cross-sectional time-one (T1; beginning of the course), time-two (T2; end of the course) study using the Penn State College of Medicine Survey of Professionalism was conducted. A multivariate analysis of variance identified the main effects and interaction effects of categorical variables. A Mann Whitney U test verified significant differences. This study found a reprioritization of professionalism attitudes in favor of altruism (P = 0.04 with a Cohen's d = 0.26) at T2. Female students (P = 0.03, Cohen's d = 0.38) and students from a science background (P = 0.04, Cohen's d = 0.36) changed the most in favor of altruism. Interestingly, though several factors correlated with dissimilarities in professionalism values at T1, gender was the only factor to show a significant difference in professionalism attitudes at T2. This cohort of students reported a statistically significant increase in altruism and no significant decreases in other professionalism attitudes concurrent with the gross anatomy course. Anat Sci Educ 3:12-16, 2010. © 2009 American Association of Anatomists [ABSTRACT FROM AUTHOR]

Objective: The primary aim of this review is to evaluate the effects of non-invasive brain stimulation on post-stroke dysphagia. Methods: Thirteen databases were systematically searched through July 2014. Studies had to meet pre-specified inclusion and exclusion criteria. Each study's methodological quality was examined. Effect sizes were calculated from extracted data and combined for an overall summary statistic. Results: Eight randomized controlled trials were included. These trials revealed a significant, moderate pooled effect size (0.55; 95% CI = 0.17, 0.93; p = 0.004). Studies stimulating the affected hemisphere had a combined effect size of 0.46 (95% CI = 0.18, 1.11; p = 0.16); studies stimulating the unaffected hemisphere had a combined effect size of 0.65 (95% CI = 0.14, 1.16; p = 0.01). At long-term follow up, three studies demonstrated a large but non-significant pooled effect size (0.81, p = 0.11). Conclusions: This review found evidence for the efficacy of non-invasive brain stimulation on post-stroke dysphagia. A significant effect size resulted when stimulating the unaffected rather than the affected hemisphere. This finding is in agreement with previous studies implicating the plasticity of cortical neurons in the unaffected hemisphere. [ABSTRACT FROM AUTHOR]