Purpose Dysphagia is thought to be prevalent and a leading cause of morbidity and mortality in people with Parkinson disease (PwPD). The aim of this study was to compare the frequencies of atypical and extreme values for measures of swallowing physiology in PwPD and in an age- and sex-matched cohort of healthy adults. Atypical and extreme values were defined, respectively, as values falling in the 25% and 5% tails of the reference distribution for healthy adults under age 60 years. Method A standard videofluoroscopy (VF) protocol was performed in 17 adults with mild PD and 17 age- and sex-matched healthy adults using 20% w/v liquid barium ranging from thin to extremely thick consistency. Blinded VF analysis was performed according to the Analysis of Swallowing Physiology: Events, Kinematics and Timing Method. Frequencies for atypical and extreme values were tabulated by cohort and compared using odds ratios. Results Increased frequencies of atypical values (> 25%) were seen in the PwPD for prolonged swallow reaction time, prolonged time-to-laryngeal-vestibule-closure (LVC), and poor pharyngeal constriction. However, these findings were also observed in the healthy controls. The PwPD showed significantly higher odds of atypical values for narrow upper esophageal sphincter (UES) diameter on thin liquids, a short hyoid-burst-to-UES-opening interval on extremely thick liquids, and prolonged time-to-LVC, LVC duration, and UES opening duration on multiple consistencies. The frequencies of extreme values failed to show any significant cohort differences for any parameter. Conclusions In this study, a group of people with mild PD did not show clear evidence of swallowing impairments distinct from the changes seen in a healthy age-matched control group when odds ratios were used to compare the frequencies of atypical values between PwPD and the control group; only a few parameters showed significant differences. These were findings of significantly higher frequencies in PwPD of prolonged LVC and UES opening duration. Supplemental Material https://doi.org/10.23641/asha.15032241
Purpose: Patients with poststroke dysphagia may experience inefficient bolus clearance or inadequate airway protection. Following a stroke, impairments in lingual pressure generation capacity are thought to contribute to oropharyngeal dysphagia. The goal of our study was to determine whether similar profiles of swallowing impairment would be seen across a cohort of patients with reduced tongue strength within 3 months after cerebral ischemic stroke. Method: The sample comprised six adults with reduced tongue strength (i.e., maximum anterior isometric pressure < 40 kPa). Participants underwent a videofluoroscopy according to a standard protocol. Post hoc blinded ratings were completed using the Analysis of Swallowing Physiology: Events, Kinematics and Timing Method and coded as “typical” versus “atypical” (i.e., within vs. outside the healthy interquartile range) in comparison to published reference values. Results: The videofluoroscopies suggested that having reduced tongue strength did not translate into a common profile. Of the six participants, two showed Penetration–Aspiration Scale (PAS) scores of ≥ 3 on thin liquids, associated with incomplete laryngeal vestibule closure (LVC). Another two participants displayed PAS scores of 2 (transient penetration), but these were not associated with incomplete LVC. Pharyngeal residue, above the healthy 75th percentile, was seen for three participants. Five participants presented with atypical reductions in hyoid XY peak position. Conclusions: In this cohort of adults within 3 months of cerebral ischemic stroke, reductions in tongue strength presented alongside a variety of changes in swallowing physiology. There was no straightforward relationship linking reduced tongue strength to particular patterns of impairment on videofluoroscopy.
Purpose: Choking on food is a leading cause of accidental death in several populations, including children, people with intellectual/developmental disability, and older adults in residential care facilities. One contributor to choking risk is incomplete oral processing and failure to convert food to a cohesive, nonsticky bolus with a maximum particle size that will not block the airway. Clinical tests of mastication do not evaluate properties of chewed food boluses. We characterized expectorated boluses, after oral processing, using methods developed by the International Dysphagia Diet Standardisation Initiative (IDDSI). Method: Seventeen adults without dysphagia (seven women and 10 men), aged 23–55 years, chewed samples of a cracker, a raw baby carrot, and a circular, dome-shaped gummy candy. Chewing metrics were obtained up to the point when the person indicated that they were ready to swallow. The bolus was then either expectorated or swallowed; IDDSI tests were used to characterize the expectorated boluses. Results: Measures of chewing did not differ between spit and swallow conditions. Expectorated cracker and carrot boluses had maximum particle size consistent with IDDSI Level SB6 Soft & Bite-Sized foods or lower. The gummy candy samples remained at IDDSI Level RG7 Regular food consistency. Conclusions: This study suggests that expectorated ready-to-swallow boluses are representative of boluses that are swallowed and that oral processing in adults without dysphagia typically results in boluses at IDDSI's Level SB6 or lower. IDDSI's testing methods provide a practical method for evaluating oral processing by characterizing expectorated ready-to-swallow boluses and may guide food texture recommendations for persons who have increased risk of choking.
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