Diagnostic value of “dysphagia limit” for neurogenic dysphagia: 17years of experience in 1278 adults

Aydoğdu, İbrahim; Kıylıoğlu, Nefati; Tarlacı, Sultan; Tanrıverdi, Zeynep; Alpaydın, Sezin; Acarer, Ahmet; Baysal-Kıraç, Leyla; Arpaci, Esra; Yüceyar, Nur; Seçıl, Yaprak; Özdemirkıran, T.; Ertekin, Çumhur

doi:10.1016/j.clinph.2014.06.035

Cited by 40 publications

(46 citation statements)

References 74 publications

(110 reference statements)

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“…A previous study showed that sEMG can be well used to assess swallowing performance in breathing–swallowing interactions before and after tracheostomy in patients with DMD . In support of this statement, another study of adult patients showed significant correlation with sEMG and improvement or worsening of the dysphagia for patients with NMD . VFSS showed good validity and should be reserved for diagnosis or when aspiration status is unclear with the non‐invasive approaches.…”

Section: Discussionmentioning

confidence: 84%

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Screening and evaluation tools of dysphagia in children with neuromuscular diseases: a systematic review

Audag

Goubau

Toussaint³

et al. 2016

Develop Med Child Neuro

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Section: Discussionmentioning

confidence: 84%

“…Early symptoms of dysphagia such as changes in voice (‘wet voice’), dyspnea following a meal, or weight loss are often discrete and insidious . Aspirations can cause inflammation within the lungs, leading to airway obstruction and to worsening restrictive lung disease.…”

mentioning

confidence: 99%

Screening and evaluation tools of dysphagia in children with neuromuscular diseases: a systematic review

Audag

Goubau

Toussaint³

et al. 2016

Develop Med Child Neuro

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“…Because the dysphagia assessment method is non‐invasive, it can be used in clinical practice at the patient's bedside. The method may be used to monitor the dysphagia limit, time swallowing capacity, and speed in stroke or patients with neurological dysphagia . Additionally, continuous swallowing monitoring for eating behavior during meal times is important for stroke patients.…”

Section: Discussionmentioning

confidence: 99%

Integrated non‐invasive measurements reveal swallowing and respiration coordination recovery after unilateral stroke

Wang

Chen

2015

Neurogastroenterology Motil

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Key Messages• Oropharyngeal dysphagia (OD) is common after a stroke, and OD is a potential cause of aspiration, dehydration, malnutrition, increased length of hospital stay.• The fine coordination between oropharyngeal swallowing and respiration is essential to ensure the safety of swallowing without aspiration, and stroke insults affect swallowing and respiration coordination, but no longitudinal follow-up study of this coordination after unilateral stroke was demonstrated in a literature review.• A non-invasive swallowing assessment method was used to detect oropharyngeal swallowing parameters and respiration coordination simultaneously during the swallowing process.• Results show that oropharyngeal swallowing and respiration coordination in unilateral stroke patients deviate from normal controls after stroke insult and improved during the subacute phase poststroke. AbstractBackground Oropharyngeal dysphagia is common after a stroke. Understanding the physiology of swallowing and its coordination with respiration in stroke recovery is crucially important. Methods A noninvasive swallowing assessment method was used to detect oropharyngeal swallowing and respiration coordination simultaneously during the swallowing process. This system detected movement of the larynx, submental muscle activity, and nasal airflow. Six different sizes of water boluses (maximum of 20 mL) were swallowed and assessed for each subject. Key ResultsWe recruited 59 healthy participants and 38 first ever unilateral stroke patients completed baseline and follow-up assessments at 3, 6, and 9 months poststroke. The results showed that oropharyngeal swallowing parameters in unilateral stroke deviate from normal patterns. For respiration coordination, the unilateral stroke group had longer swallowing apnea duration but similar frequencies of preand postswallowing respiratory phase patterns compared with the healthy controls. The probability of piece-meal deglutition was higher in the stroke group than in the control group. Additionally, there were gradually decreasing piece-meal deglutition probabilities among the stroke patients at follow-up, and none differed statistically from those of the controls at 6 months poststroke. Conclusions & Inferences The non-invasive swallowing and respiration assessment method applied in this study detected the changes manifested in swallowing and respiration during the subacute phase of recovery in 6 months after a unilateral stroke. The study results serve as a baseline for

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“…The concept of a "dysphagia limit", the volume above which swallowing occurs in a piecemeal fashion, had been previously described by Ertekin et al [18,19]. Their data suggested the dysphagia limit in most subjects is at a volume above 20ml.…”

mentioning

confidence: 95%

“…The inability of integrative functions to appropriately modulate the individual components; UES relaxation, opening and hyolaryngeal elevation, may have clinical implications for patients with oropharyngeal dysphagia. In particular, for determining the "dysphagia limit" beyond which multiple swallows are needed to clear a bolus effectively through the UES [18,19].…”

mentioning

confidence: 99%

Modulation of Upper Esophageal Sphincter (UES) Relaxation and Opening During Volume Swallowing

et al. 2016

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Background: UES opening occurs following cricopharyngeus deactivation and submental muscle contraction causing hyolaryngeal elevation and UES distraction. During impedance manometry, the inverse of impedance (admittance) can be used to measure bolus presence and infer UES opening. We hypothesized that the temporal relationship between UES relaxation, opening and hyolaryngeal elevation would change with increasing bolus volume. Methods: Simultaneous intramuscular cricopharyngeal (CP) electromyography (EMG), surface submental EMG (SM-EMG) and high-resolution impedance manometry (HRIM)were recorded in eight (aged 27±7 yrs, 5M) healthy volunteers while swallowing 0.9% Saline boluses of 2,5,10 and 20ml. Data were exported and analyzed via Matlab. Statistical analysis comprised of repeated measured one-way ANOVA and Pearson correlation. A P-value of < 0.05 was considered significant Results: Duration of CP deactivation increased at 20ml volume (P < 0.001). UES relaxation and opening increased with increasing bolus volume (P < 0.001), however overall duration of SM activation did not change. As UES opening occurs progressively earlier with increasing volumes, peak SM-EMG activity occurs relatively later (P < 0.001) and shifts from occurring before to following peak UES distention. Conclusions

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Diagnostic value of “dysphagia limit” for neurogenic dysphagia: 17years of experience in 1278 adults

Cited by 40 publications

References 74 publications

Screening and evaluation tools of dysphagia in children with neuromuscular diseases: a systematic review

Screening and evaluation tools of dysphagia in children with neuromuscular diseases: a systematic review

Integrated non‐invasive measurements reveal swallowing and respiration coordination recovery after unilateral stroke

Modulation of Upper Esophageal Sphincter (UES) Relaxation and Opening During Volume Swallowing

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