Measures of test emotions other than test anxiety are lacking. In a series of six studies, we developed a multi scale questionnaire assessing test related joy, hope, pride, relief, anger, anxiety, shame, and hopelessness (Test Emotions Questionnaire, TEQ). Consisting of subscales measuring affective, cognitive, physiological, and motivational emotion components, the scales can be used to identify both trait and state test emotions, and are available in German and English language versions. Using a rational empirical strategy of test construction, we first developed theoretical models of the component structures, antecedents, and effects of different test emotions. We then conducted two exploratory, qualitative studies on the occurrence and structures of these emotions. Finally, based on theory and our exploratory data, we constructed, analyzed, and revised the scales of the TEQ in four quantitative studies. Findings of correlational and confirmatory factor analysis indicate that the scales are reliable, structurally valid in terms of representing different test emotions and components within emotions, and externally valid in terms of correlating significantly with personality, learning, academic achievement, and perceived health problems. Many of these correlations proved to be stronger for test emotions other than anxiety, implying that test anxiety is neither the only relevant test emotion, nor necessarily the most important one.

Objectives Reduced range of hyoid and laryngeal movement is thought to contribute to aspiration risk and pharyngeal residues in dysphagia. Our aim was to determine the extent to which movements of the hyoid and larynx are correlated in the superior and anterior directions in swallowing, and whether movement range is predictive of penetration-aspiration or pharyngeal residue. Design Prospective, single-blind study of penetration-aspiration and pharyngeal residue with objective frame-by-frame measures of hyoid and laryngeal excursion from videofluoroscopy. Setting Tertiary hospital and rehabilitation teaching hospital. Participants 28 participants referred for videofluoroscopy: 13 females, aged 57-77; 15 males aged 54-70. Individuals with known neurodegenerative diseases or prior surgery to the neck were excluded. Each swallowed three boluses of 40% w/v thin liquid barium suspension. Outcomes Two speech-language pathologists independently rated penetration-aspiration, vallecular and pyriform sinus residue. Cervical spine length, hyoid and laryngeal displacement were traced frame-by-frame. Predictive power was calculated. Results Cervical spine length was significantly greater in males. Hyoid displacement ranged from 34-63% of the C2-4 distance. Arytenoid displacement ranged from 18-66%, with significantly smaller anterior displacement in males. Positive hyoid-laryngeal movement correlations in both axes were the most common pattern observed. Participants with reduced displacement ranges (≤ first quartile) and with abnormal correlation patterns were more likely to display penetration-aspiration. Those with reduced anterior hyoid displacement and abnormal correlation patterns had a greater risk of post-swallow pharyngeal residues. Conclusions It is difficult for clinicians to make on-line appraisals of the extent to which hyoid and laryngeal movement may be contributing to functional swallowing consequences during videofluoroscopy. This study suggests that it is most important for clinicians to discern whether reduced anterior displacement of these structures is contributing to a patient's swallowing impairment. Measures of structural displacement in thin liquid swallowing should be corrected for variations in participant height. Reductions in anterior hyoid and laryngeal movement below the first quartile boundaries are statistically associated with increased risk for penetration-aspiration and post-swallow residues.

The purpose of this study was to measure treatment outcomes in a group of six adults with chronic dysphagia following acquired brain injury, who each completed 24 sessions of tongue-pressure resistance training, over a total of 11–12 weeks. The treatment protocol emphasized both strength and accuracy. Biofeedback was provided using the Iowa Oral Performance Instrument. Amplitude accuracy targets were set between 20–90% of the patient's maximum isometric pressure capacity. Single subject methods were used to track changes in tongue strength (maximum isometric pressures), with functional swallowing outcomes measured using blinded ratings of a standard pre- and post-treatment videofluoroscopy protocol. Improvements were seen in post-treatment measures of tongue pressure and penetration–aspiration. No improvements were seen in pharyngeal residues, indeed worsening residue was seen in some patients.

Post-swallow residue is considered a sign of swallowing impairment. Existing methods for capturing post-swallow residue (perceptual and quantitative) have inherent limitations. We employed several different perceptual and quantitative (ratio) methods for measuring post-swallow residue on the same 40 swallows and addressed the following questions: (1) Do perceptual and quantitative methods demonstrate good agreement? (2) What differences in precision are apparent by measurement method (one-dimensional, two-dimensional, and circumscribed area ratios)? (3) Do residue ratios agree strongly with residue area measures that are anatomically normalized? Based on the findings of this series of questions, a new method for capturing residue is proposed: the Normalized Residue Ratio Scale (NRRS). The NRRS is a continuous measurement that incorporates both the ratio of residue relative to the available pharyngeal space and the residue proportionate to the size of the individual. A demonstration of this method is presented to illustrate the added precision of the NRRS measurement in comparison to other approaches for measuring residue severity.

Purpose Traditional methods for measuring hyoid excursion from dynamic videofluoroscopy recordings involve calculating changes in position in absolute units (mm). This method shows a high degree of variability across studies but agreement that greater hyoid excursion occurs in men than women. Given that men are typically taller than women, we hypothesized that controlling for participant size might neutralize apparent sex-based differences in hyoid excursion. Methods We measured hyoid excursion in 20 young (<45) healthy volunteers (10 male), stratified by height, in a tightly controlled videofluoroscopic protocol. Results We identified an anatomical scalar (C2-4 length), visible on the videofluoroscopic image, correlated with participant height. This scalar differed significantly between men and women. By incorporating the anatomical scalar as a continuous covariate in repeated measures mixed model ANOVAs of hyoid excursion, apparent sex-based differences were neutralized. Transforming measures of hyoid excursion into anatomically scaled units, achieved the same result, reducing variation attributable to sex-based differences in participant size. Conclusions Hyoid excursion during swallowing is dependent on a person’s size. If measurements do not control for this source of variation, apparent sex differences in hyoid excursion are seen.

Dysphagia, or diffi culty swallowing, often occurs secondary to conditions such as stroke, head injury or progressive disease, many of which increase in frequency with advancing age. Sarcopenia, the gradual loss of muscle bulk and strength, can place older individuals at greater risk for dysphagia. Data are reported for three older participants in a pilot trial of a tongue-pressure training therapy. During the experimental therapy protocol, participants performed isometric strength exercises for the tongue as well as tongue pressure accuracy tasks. Biofeedback was provided using the Iowa Oral Performance Instrument (IOPI), an instrument that measures tongue pressure. Treatment outcome measures show increased isometric tongue strength, improved tongue pressure generation accuracy, improved bolus control on videofl uoroscopy, and improved functional dietary intake by mouth. These preliminary results indicate that, for these three adults with dysphagia, tongue-pressure training was benefi cial for improving both instrumental and functional aspects of swallowing. The experimental treatment protocol holds promise as a rehabilitative tool for various dysphagia populations.

The tongue plays a key role in the generation of pressures for transporting liquids and foods through the mouth in swallowing. Recent studies suggest that there is an age-related decline in tongue strength in healthy adults. However, whether age-related changes occur in tongue pressures generated for the purpose of swallowing remains unclear. Prior literature in this regard does not clearly explore the influence of task on apparent age-related differences in tongue pressure amplitudes. Furthermore, differences attributable to variations across individuals in strength, independent of age, have not clearly been elucidated. In this study, our goal was to clarify whether older adults have reduced tongue-palate pressures during maximum isometric, saliva swallowing, and water swallowing tasks, while controlling for individual variations in strength. Data were collected from 40 healthy younger adults (under age 40) and 38 healthy mature adults (over age 60). As a group, the mature participants had significantly lower maximum isometric pressures (MIPs). Swallowing pressures differed significantly by task, with higher pressures seen in saliva swallows than in water swallows. Age-group differences were not seen in swallowing pressures. Consideration of MIP as a covariate in the analysis of swallowing pressures revealed significant correlations between strength and swallowing pressures in the older participant group. Age-group differences were evident only when strength was considered in the model, suggesting that apparent age-related differences are, in fact, explained by differences in strength, which tends to be lower in healthy older adults. Our results show no evidence of independent differences in swallowing pressures attributable to age.

In this study, we undertook careful analysis of 13 quantitative physiological variables related to oropharyngeal swallowing from a sample of 42 subacute patients referred for dysphagia assessment. Each patient underwent videofluoroscopic swallowing examination in which they swallowed up to 5 boluses of 22% w/v ultra-thin liquid barium suspension administered by teaspoon. Our goal was to determine whether scores on thirteen kinematic or temporal parameters of interest were independently associated with the presence of penetration-aspiration in the final compiled dataset of 178 swallows. Participants were classified as aspirators, based on the presence of at least one swallow demonstrating a penetration-aspiration scale score ≥ 3. The parameters of interest included: six kinematic parameters for capturing hyoid position; three swallow durations (laryngeal closure duration; hyoid movement duration; upper esophageal sphincter (UES) opening duration); and four swallow intervals (laryngeal closure to UES opening; bolus dwell time in the pharynx prior to laryngeal closure; stage transition duration; and pharyngeal transit time). Mixed model repeated measures ANOVAs were conducted to determine the association between each parameter and aspiration status. Only one of the 13 parameters tested distinguished aspirators from non-aspirators: aspirators demonstrated significantly shorter UES opening duration. Additionally, a trend towards reduced maximum superior position of the hyoid was seen in aspirators. Limitations and future considerations are discussed.