Effects of cognitive and motor dual-tasks on oropharyngeal swallowing assessed with FEES in healthy individuals

Muhle, Paul; Claus, Inga; Labeit, Bendix; Ogawa, Mitsuhiro; Dziewas, Rainer; Suntrup‐Krueger, Sonja; Warnecke, Tobias

doi:10.1038/s41598-020-77421-3

Cited by 17 publications

(14 citation statements)

References 63 publications

(70 reference statements)

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“…In a previous study with healthy participants from our group, motor dual‐task interference with oropharyngeal swallowing and deterioration of premature spillage and pharyngeal residue were similar to the results of this study. However, in contrast to the results in this study, there was no cognitive dual‐task interference in healthy individuals [37]. This suggests, that the neural correlates of the motor task might overlap more strongly with those of swallowing compared to the cognitive task and thus share more mental capacity.…”

Section: Discussioncontrasting

confidence: 99%

Effect of cognitive and motor dual‐task on oropharyngeal swallowing in Parkinson's disease

Labeit

Claus²,

Muhle

et al. 2020

Euro J of Neurology

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Background Dysphagia frequently occurs in patients with Parkinson’s disease (PD) and is associated with severe complications. However, the underlying pathology is poorly understood at present. This study investigated the effect of cognitive and motor dual‐task interference on oropharyngeal swallowing in PD. Methods Thirty PD patients (23 men, mean age 65.90 ± 9.32 years, mean Hoehn and Yahr stage 2.62 ± 0.81, mean UPDRS 18.00 ± 7.18) were examined using flexible endoscopic evaluation of swallowing (FEES). FEES was performed during three paradigms: at baseline without interference, during a cognitive dual‐task, and during a motor dual‐task. Oropharyngeal swallowing function was rated using a score which was validated to detect changes in PD related dysphagia. The three paradigms were compared using a two‐way‐repetitive‐measures‐ANOVA and a post‐hoc‐analysis. Results Mean swallowing score in baseline FEES was 10.67 ± 5.89. It significantly increased (worsened) to 15.97 ± 7.62 (p < 0.001) in the motor dual‐task and to 14.55 ± 7.49 (p < 0.001) in the cognitive dual‐task. Premature bolus spillage and pharyngeal residue both significantly increased during both of the dual‐task conditions whereas penetration/aspiration events did not change. Conclusion Oropharyngeal swallowing in patients with PD is not purely reflexive but requires mental capacity. Additional allocation of attentional resources in the central control of swallowing seems to be an effective compensatory mechanism in PD‐related dysphagia: The proposed dual‐task protocol may be useful to challenge swallowing functional reserve. Conversely, as a therapeutic strategy, it could be beneficial to focus attention on swallowing and to avoid dual‐task situations.

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Section: Discussioncontrasting

confidence: 99%

Effect of cognitive and motor dual‐task on oropharyngeal swallowing in Parkinson's disease

Labeit

Claus²,

Muhle

et al. 2020

Euro J of Neurology

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“…Small amounts of pharyngeal residue have been frequently observed in research examining healthy adult swallows during FEES (31)(32)(33)(34)(35)(36). The findings from the present study support these previous research findings.…”

Section: Pharyngeal Residuesupporting

confidence: 90%

“…There is a relatively large body of literature examining the presence of penetration and/or aspiration in healthy adults during FEES (27,(31)(32)(33)(34)(35)(36)(38)(39)(40)(41)(42)(43). The most comprehensive of these studies was published by Butler and colleagues in 2018 (43).…”

Section: Penetration-aspirationmentioning

confidence: 99%

Normative Reference Values for FEES and VASES: A Prospective, Observational Study of Non-Dysphagic, Community-Dwelling Adults

Curtis¹,

Borders²,

Dakin³

et al. 2023

Preprint

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Purpose: The aim of this study was to establish preliminary reference values for the Visual Analysis of Swallowing Efficiency and Safety (VASES) – a standardized rating methodology used to evaluate swallowing safety and efficiency for flexible endoscopic evaluations of swallowing (FEES). Method: FEES were completed in non-dysphagic, community-dwelling adults using a standardized protocol of 15 swallowing trials which varied by bolus size, consistency, contrast agent, and swallowing instructions. FEES were blindly analyzed using VASES. Primary outcome measures included bolus location at swallow onset, Penetration-Aspiration Scale (PAS) scores, and percentage-based residue ratings for six anatomic landmarks. Secondary outcome measures included sip size, bite size, and number of swallows.Results: Thirty-nine healthy adults completed the study, yielding an analysis of 584 swallows. Swallows were initiated with the bolus in the pharynx for 41.8% of trials. PAS 1 was the most common score, accounting for 75.3% of trials, followed by PAS 3, which accounted for 18.8% of trials. When residue was present (>0%), the amount was relatively small across all anatomic landmarks, with median residue ratings of 2.0% (oropharynx), 1.5% (hypopharynx), 3.0% (epiglottis), 3.0% (laryngeal vestibule), and 3.5% (vocal folds). Five events of aspiration were observed, which were characterized by subglottic residue ratings of 1%, 3%, 10%, 24%, and 90%. The average sip size of self-selected volume cup sips of water was 19.8 mL and the average bite size of a 3.0-gram saltine cracker was 1.33 grams. Seventy-eight percent of the trials in this study protocol (except 90 mL trials) were completed in a single swallow.Discussions: The results from this study provide preliminary reference values for VASES in healthy adults across a range of bolus volumes, consistencies, colorants, and swallowing instructions. These normative data provide useful insight into typical swallowing function during FEES with a standardized rating methodology. An open dataset is provided to aide in the diagnosis of normal and abnormal swallowing function in clinical and research practices (https://osf.io/4anzm/).

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“…Intranasal catheter placement for HRM requires simultaneous patient deglutition to prevent entry of the catheter into the trachea. Elderly patients develop age-related changes such as decrease in strength and amplitude of swallows, sarcopenia of the oropharyngeal structures, and prolonged reaction time with swallowing to cognitive stimuli ( 17 , 18 ). Thus, the elderly population may be less able to either perform synchronized swallows with catheter insertion or suppress excessive swallows during measurements, leading to early termination of the HRM study.…”

Section: Discussionmentioning

confidence: 99%

Safety and Tolerability of High-Resolution Esophageal Manometry in Children and Adults

Huang²,

Takakura

et al. 2023

Clin Transl Gastroenterol

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INTRODUCTION: While high-resolution manometry (HRM) is widely accepted as a safe procedure, no study has assessed the safety profile of HRM in clinical practice. This study aimed to determine the safety and tolerability of HRM and to investigate potential determinants of intolerability. METHODS: We obtained HRM procedure reports, demographics, and clinical data (2005–2022) at a tertiary center using electronic chart review. Our primary outcome was HRM tolerability. Multivariable regression was performed to identify associations between the outcome and covariates including age, sex, race, and comorbidities. RESULTS: A total of 5,107 patients (60.3% female) were included. Of them, 5,050 patients (98.9%) tolerated HRM well and 57 patients (1.1%) did not. Age had a statistically significant effect on tolerance: those younger than 18 years had more than a 5-fold increase in not tolerating HRM compared with those aged 18–79 years (5.77% vs 0.99%; odds ratio [OR] = 5.44, 95% confidence interval [CI] 1.60–18.45; P = 0.007), and those aged 80 years or older were also more likely to terminate HRM (2.43% vs 0.99%; OR = 2.56, 95% CI 1.13–5.76; P = 0.024). While prior foregut surgery had a significant effect on tolerance (OR = 8.06, 95% CI 2.29–28.39; P = 0.001), other factors of race, sex, body mass index, and psychological or cognitive disorders had no significant impact. No serious complications were identified. DISCUSSION: HRM is safe and well-tolerated with approximately 1 in every 100 patients being unable to tolerate HRM. Intolerance was more commonly seen in children and seniors due to minor symptoms of discomfort without serious complications. These data points are crucial to counsel patients in whom HRM is being considered.

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Effects of cognitive and motor dual-tasks on oropharyngeal swallowing assessed with FEES in healthy individuals

Cited by 17 publications

References 63 publications

Effect of cognitive and motor dual‐task on oropharyngeal swallowing in Parkinson's disease

Effect of cognitive and motor dual‐task on oropharyngeal swallowing in Parkinson's disease

Normative Reference Values for FEES and VASES: A Prospective, Observational Study of Non-Dysphagic, Community-Dwelling Adults

Safety and Tolerability of High-Resolution Esophageal Manometry in Children and Adults

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