Application of Ultrasound Biofeedback to the Learning of the Mendelsohn Maneuver in Non-dysphagic Adults: A Pilot Study

Kwong, Elizabeth; Ng, Ka Wing Katrina; Leung, Mkh; Zheng, Yongping

doi:10.1007/s00455-020-10179-y

Cited by 15 publications

(11 citation statements)

References 25 publications

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“…The ultrasound transducer was placed on the mid-sagittal plane in the submental area of subjects. Readers may refer to figures of a previous study [ 24 ] for the placement and fixation of gel pads and the transducer. All ultrasound images were acquired by two final-year Master of Speech Therapy students who were trained to manage dysphagia (one of them is the second author P.S.).…”

Section: Methodsmentioning

confidence: 99%

Temporal measures of oropharyngeal swallowing events identified using ultrasound imaging in healthy young adults

Kwong

Shek²,

Leung³

et al. 2022

PLoS ONE

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Swallowing is a complex process that involves precise coordination among oral and pharyngeal structures, which is essential to smooth transition of bolus and adequate airway protection. Tongue base retraction and hyolaryngeal excursion are two significant swallowing movements, and their related events can be examined using ultrasound imaging, which is physically and radioactively non-invasive. The present study aimed to 1) establish the temporal sequences and timing of swallowing events identified using ultrasound imaging, and 2) investigate the variability of the above temporal sequences and 3) investigate the effect of bolus type on the variability of temporal sequences in non-dysphagic individuals. Forty-one non-dysphagic young adults of both genders (19 males and 22 females) participated in the study. Ultrasound images were acquired mid-saggitally at their submental region during swallowing of boluses with different volume (i.e. 5mL or 10mL) and consistencies (i.e. IDDSI Levels 0 and 4). Timing and sequence of six events 1) displacement onset (TBOn), 2) maximum displacement (TBMax) and 3) displacement offset of tongue base retraction (TBOff); and, 4) displacement onset (HBOn), 5) maximum displacement (HBMax) and 6) displacement offset of the hyoid bone excursion (HBOff) were extracted from the ultrasound images. Out of the 161 swallows, 85.7% follow a general sequence of HBOn < TBOn < HBMax < TBMax < HBOff < TBOff. Percentage adherence to six anticipated paired-event sequences was studied. Results suggested the presence of individual variability as adherence ranged from 75.8% to 98.1% in four of the anticipated sequences, leaving only two sequences (HBOn < TBMax and TBMax < HBOff) obligatory (i.e. 100% adherence). For non-obligatory sequences, it was found that bolus type may have an effect on the level of adherence. Findings of the present study lay the groundwork for future studies on swallowing using ultrasound imaging and also the clinical application of ultrasonography.

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Section: Methodsmentioning

confidence: 99%

Temporal measures of oropharyngeal swallowing events identified using ultrasound imaging in healthy young adults

Kwong

Shek²,

Leung³

et al. 2022

PLoS ONE

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“…This will support the development of clinically realistic and achievable protocols (items 6 & 7). Implementation of US as a swallowing or laryngeal biofeedback (therapy) tool may mitigate the requirement for diagnostic values [ 80 ]. This alternative use may also enable US to be transitioned into clinical practice sooner, while primary research continues.…”

Section: Discussionmentioning

confidence: 99%

Translating Ultrasound into Clinical Practice for the Assessment of Swallowing and Laryngeal Function: A Speech and Language Pathology-Led Consensus Study

et al. 2022

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Ultrasound (US) has an emerging evidence base for the assessment of swallowing and laryngeal function. Accessibility and technological advances support the use of US as a clinical assessment tool; however, there is insufficient evidence to support its translation into clinical practice. This study aimed to establish consensus on the priorities for translation of US into clinical practice for the assessment of swallowing and laryngeal function. Nominal Group Technique (NGT) was used as a formal method of consensus development. Clinicians and academics, all members of an international US working group, were invited to participate in the study. Two NGT meetings were held, where participants silently generated and then shared ideas. Participants anonymously ranked items. Rankings were aggregated before participants re-ranked items in order of priority. Discussions regarding rankings were recorded and transcribed to inform analysis. Member-checking with participants informed the final analysis. Participants (n = 15) were speech and language pathologists, physiotherapists and sonographers representing six countries. Fifteen items were identified and prioritised 1–13 (including two equally ranked items). Reliability, validity and normative data emerged as key areas for research while development of training protocols and engagement with stakeholders were considered vital to progressing US into practice. Analysis revealed common themes that might be addressed together in research, in addition to the ranked priority. A measured approach to the translation of US into clinical practice will enable effective implementation of this tool. Priorities may evolve as clinical and professional contexts shift, but this study provides a framework to advance research and clinical practice in this field.

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“…The addition of a 20 mm deep gel acoustic standoff (SONOKIT soft 200 × 100 × 20 mm; Sonogel Vertriebs GmbH, Bad Camberg, Germany) between the probe and the submental surface reduced these blackouts but did not remediate the problem in all cases. Although a specially contoured layer of standoff material or water‐filled balloon (Chen et al., 2020; Kwong et al., 2020) might provide a better solution, this was not available at the time of recording. As a result, the 60 mm radius probe was set aside in favour of a smaller 20 mm radius 2–4 MHz probe.…”

Section: Methodsmentioning

confidence: 99%

Automated assessment of hyoid movement during normal swallow using ultrasound

K-Y

Wrench

2022

Intl J Lang & Comm Disor

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Background The potential for using ultrasound by speech and language therapists (SLTs) as an adjunct clinical tool to assess swallowing function has received increased attention during the COVID‐19 pandemic, with a recent review highlighting the need for further research on normative data, objective measurement, elicitation protocol and training. The dynamic movement of the hyoid, visible in ultrasound, is crucial in facilitating bolus transition and protection of the airway during a swallow and has shown promise as a biomarker of swallowing function. Aims To examine the kinematics of the hyoid during a swallow using ultrasound imaging and to relate the patterns to the different stages of a normal swallow. To evaluate the accuracy and robustness of two different automatic hyoid tracking methods relative to manual hyoid position estimation. Methods & Procedures Ultrasound data recorded from 15 healthy participants swallowing a 10 ml water bolus delivered by cup or spoon were analysed. The movement of the hyoid was tracked using manually marked frame‐to‐frame positions, automated hyoid shadow tracking and deep neural net (DNN) tracking. Hyoid displacement along the horizontal image axis (HxD) was charted throughout a swallow, and the maximum horizontal displacement (HxD max) and maximum hyoid velocity (HxV max) along the same axis were automatically calculated. Outcomes & Results The HxD and HxV of 10 ml swallows are similar to values reported in the literature. The trajectory of the hyoid movement and its location at significant swallow event time points showed increased hyoid displacement towards the peak of the swallow. Using an interclass correlation coefficient, HxD max and HxV max values derived from the DNN tracker and shadow tracker are shown to be in high agreement and moderate agreement, respectively, when compared with values derived from manual tracking. Conclusions & Implications The similarity of the hyoid tracking results using ultrasound to previous reports based on different instrumental tools supports the possibility of using hyoid movement as a measure of swallowing function in ultrasound. The use of machine learning to automatically track the hyoid movement potentially provides a reliable and efficient way to quantify swallowing function. These findings contribute towards improving the clinical utility of ultrasound as a swallowing assessment tool. Further research on both normative and clinical populations is needed to validate hyoid movement metrics as a means of differentiating normal and abnormal swallows and to verify the reliability of automatic tracking. WHAT THIS PAPER ADDS What is already known on this subject There is growing interest in the use of ultrasound as an adjunct tool for assessing swallowing function. However, there is currently insufficient knowledge about the patterning and timing of lingual and hyoid movement in a typical swallow. We know that movement of the hyoid plays an essential role in bolus transition and airway protection. However, manual tracking of hyoi...

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Application of Ultrasound Biofeedback to the Learning of the Mendelsohn Maneuver in Non-dysphagic Adults: A Pilot Study

Cited by 15 publications

References 25 publications

Temporal measures of oropharyngeal swallowing events identified using ultrasound imaging in healthy young adults

Temporal measures of oropharyngeal swallowing events identified using ultrasound imaging in healthy young adults

Translating Ultrasound into Clinical Practice for the Assessment of Swallowing and Laryngeal Function: A Speech and Language Pathology-Led Consensus Study

Automated assessment of hyoid movement during normal swallow using ultrasound

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