Bolus Transit and Airway Protection Coordination in Older Dysphagic Patients

Kendall, Katherine A.; Leonard, Rebecca J.

doi:10.1097/00005537-200111000-00028

Cited by 41 publications

(44 citation statements)

References 8 publications

(7 reference statements)

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“…While decreases in swallow durations have been considered desirable for overall functionality and swallow safety, researchers have recently revised their notion on swallow durations and now consider that faster swallowing is not necessarily more functional or safe. 18,21,32 Rather, it may be reasonable to propose that there exists a minimum time requirement for coordination of airway protection and bolus propulsion and flow through the oropharynx and laryngopharynx.…”

Section: Discussionmentioning

confidence: 99%

“…15 Decreased elevation and excursion of the hyolaryngeal complex is considered one cause of penetration and aspiration. [18][19][20][21] Submental muscle contraction elevates the hyolaryngeal complex. EMST treatment produces significantly longer durations, higher peak amplitudes, and greater average amplitudes of the submental muscles' EMG signal when compared to dry and wet swallows.…”

mentioning

confidence: 99%

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Aspiration and swallowing in Parkinson disease and rehabilitation with EMST

Troche

Okun²,

Rosenbek³

et al. 2010

Neurology

337

323

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Objective: Dysphagia is the main cause of aspiration pneumonia and death in Parkinson disease (PD) with no established restorative behavioral treatment to date. Reduced swallow safety may be related to decreased elevation and excursion of the hyolaryngeal complex. Increased submental muscle force generation has been associated with expiratory muscle strength training (EMST) and subsequent increases in hyolaryngeal complex movement provide a strong rationale for its use as a dysphagia treatment. The current study's objective was to test the treatment outcome of a 4-week device-driven EMST program on swallow safety and define the physiologic mechanisms through measures of swallow timing and hyoid displacement. Methods:This was a randomized, blinded, sham-controlled EMST trial performed at an academic center. Sixty participants with PD completed EMST, 4 weeks, 5 days per week, for 20 minutes per day, using a calibrated or sham, handheld device. Measures of swallow function including judgments of swallow safety (penetration-aspiration [PA] scale scores), swallow timing, and hyoid movement were made from videofluoroscopic images.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Aspiration and swallowing in Parkinson disease and rehabilitation with EMST

Troche

Okun²,

Rosenbek³

et al. 2010

Neurology

337

323

View full text Add to dashboard Cite

show abstract

“…Previous investigations did not find loss on swallowing efficiency before 80 years, in the swallow index risk (19) and in esophageal contraction amplitude (8,20) . Bolus pharyngeal transit time in older subjects is longer with swallows of 20 mL volume of liquid bolus, but not with swallows of 1 mL bolus volume (15) , compared with younger subjects. Swallows of a non viscous bolus (water) cause an increase in the duration of pharyngeal transit and pharyngeal clearance in subjects older than 55 years (2) .…”

Section: Introductionmentioning

confidence: 73%

“…Most of the studies which evaluated the pharyngeal transit in the elderly showed that the transit is longer than in younger subjects (12,13,15,19,24) . Increased slowness in movement is a general characteristic in aging (16) ; however, these investigations had the participation of older subjects than we included in this.…”

Section: Discussionmentioning

confidence: 99%

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Influence of Age on Swallows of a Highly Viscous Liquid Bolus

Nascimento

Santos

Cassiani

et al. 2015

Arq. Gastroenterol.

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-Background -Swallow function has a decline with aging, mainly in those over 80 years old. In the population over 69 years, about 11% of subjects reported symptoms indicative of significant dysphagia. Objective -Our objective was to evaluate the hypothesis that older asymptomatic subjects before 80 years old have compensations to sustain a safe and efficient swallow, at least with swallows of liquid bolus. Method -We performed videofluoroscopic evaluation of swallows in 55 normal volunteers, a younger group with 33 subjects (16 men and 17 women) aged 19 to 55 years, mean 35.5±9.8 years, and an older group with 22 subjects (15 men and 7 women) aged 56 to 77 years, mean 64.8±6.8 years. The subjects swallowed in duplicate 5 mL and 10 mL of liquid barium with a pH of 7.9, density of 1.82 g/cm 3, and viscosity of 895 cp. Results -The mean duration of pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were longer in the younger group compared with the older group. The relation between pharyngeal clearance duration and hyoid movement duration was similar in younger and older subjects, for 5 mL and 10 mL bolus volumes. Conclusion -On average, a highly viscous liquid bolus crosses the pharynx faster in older subjects (56-77 years old) than in younger subjects (19-55 years old), which suggested an adaptation to the aging process to maintain a safe swallow.

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Comparison of timing abnormalities leading to penetration versus aspiration during the oropharyngeal swallow

2013

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Objectives/Hypothesis: Penetration and aspiration during the oropharyngeal swallow have different clinical implications. This study examined temporal measures made from modified barium swallow examinations that might differentiate the two events.Study Design: Retrospective cohort study. Methods: Temporal measures of swallows of male patients with penetration only on the modified barium swallow study, those who showed aspiration (during the swallow), and normal control subjects were compared.Results: Significantly longer durations of temporal measures (glossopalatal junction opening until laryngeal vestibule closure and laryngeal lifting onset until laryngeal vestibule closure) were found for the penetration and aspiration groups compared to the normal group. No significant differences were found between the penetration and aspiration groups for any temporal measure.Conclusions: Both aspiration and penetration cases showed abnormal timing measures compared to normal. However, aspiration during the swallow was not associated with a more extreme abnormality of temporal measures than penetration. Therefore, in the aspiration cases, there may be an additional neuromuscular disorder at the vocal fold level, allowing for deeper invasion of material into the airway. In addition, findings point to slow laryngeal elevation, and not a delayed onset of laryngeal elevation, as the dominant cause for the prolonged intervals seen with aspiration during the swallow.

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Bolus Transit and Airway Protection Coordination in Older Dysphagic Patients

Cited by 41 publications

References 8 publications

Aspiration and swallowing in Parkinson disease and rehabilitation with EMST

Aspiration and swallowing in Parkinson disease and rehabilitation with EMST

Influence of Age on Swallows of a Highly Viscous Liquid Bolus

Comparison of timing abnormalities leading to penetration versus aspiration during the oropharyngeal swallow

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