Perceived Professional and Institutional Factors Influencing Clinical Adoption of Pharyngeal High-Resolution Manometry

Rogus-Pulia, Nicole; Jones, Corinne A.; Forgues, Angela; Orne, Jason; Macdonald, Cameron Lynne; Connor, Nadine P.; McCulloch, Timothy M.

doi:10.1044/2020_ajslp-19-00134

Cited by 4 publications

(2 citation statements)

References 44 publications

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“…This is despite the fact there has been a recent shift towards proactive dysphagia management in PwMND to optimise physiological reserve. As PHRM is being adopted into clinical practice internationally [32] the use of PHRM to evaluate dysphagia in this clinical population is likely to increase in the future. Several important findings based on this limited data are highlighted in this review.…”

Section: Discussionmentioning

confidence: 99%

Use of Pharyngeal High-Resolution Manometry to Evaluate Dysphagia in Adults with Motor Neurone Disease: A Scoping Review

Diver

Regan

2022

Dysphagia

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There has been a recent shift towards proactive dysphagia intervention in motor neurone disease (MND) to maintain physiological reserve. Pharyngeal high-resolution manometry (PHRM) can quantify swallowing pathophysiology to inform and evaluate proactive dysphagia intervention. This study aims to explore the current use of PHRM as a dysphagia evaluation in adults with MND. A scoping review based on the Joanna Briggs Framework was completed. Four electronic databases (PubMed, EMBASE, CINAHL and Web of Science core) were searched (inception to March 2021) by two independent researchers. Data were analysed according to (i) PHRM protocol and analysis methods and the feasibility of same, (ii) swallow biomechanics data and (iii) dysphagia intervention effects as measured by PHRM. Six studies with 78 people with MND (PwMND) were included. There was considerable variation in PHRM protocol and analysis methods. Five studies reported a 100% completion rate and three studies reported no adverse events. Swallow biomechanics data were reported across all studies. The effects of sensory stimulation, increased bolus consistency, effortful swallow and cricopharyngeal myotomy were evaluated using PHRM with 20 PwMND across four studies with varying effects. Literature on the use of PHRM in PwMND is limited. Variability in PHRM methods restricts comparison of metrics. PHRM appears to be a feasible tool for PwMND. PHRM can provide novel swallow physiology data in PwMND and quantify discrete effects of compensatory and surgical dysphagia interventions not detectable by videofluoroscopy or FEES. Further research on the effects of proactive dysphagia intervention as measured by PHRM is required.

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Section: Discussionmentioning

confidence: 99%

Use of Pharyngeal High-Resolution Manometry to Evaluate Dysphagia in Adults with Motor Neurone Disease: A Scoping Review

Diver

Regan

2022

Dysphagia

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“…Pharyngeal high-resolution manometry (PHRM) is an evaluation tool which is emerging into clinical dysphagia practice (Rogus-Pulia et al, 2020). PHRM can provide quantitative measures of physiological events that occur during swallowing which complement videofluoroscopy (VFS) and Fibreoptic Endoscopic Evaluation of Swallowing (FEES) findings and inform dysphagia treatment (Knigge et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Effect of effortful swallow on pharyngeal pressures during swallowing in adults with dysphagia: A pharyngeal high-resolution manometry study

Heslin

Regan

2021

International Journal of Speech-Language Pathology

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Purpose: Evidence base to support use of the effortful swallow in clinical populations with dysphagia is currently lacking. This study aims to quantify the effects of effortful swallowing on pharyngeal swallowing biomechanics in adults with dysphagia using pharyngeal high-resolution manometry (PHRM).Method: ManoScan HRM equipment with a 4.2 mm pressure catheter was used.Participants completed duplicate 10ml baseline and 10ml effortful liquid (IDDSI Level 0) swallows in randomized order. PHRM data were analysed using a semiautomated online platform (www.swallowgateway.com).Result: Fifteen adults (8 males; range 45-86 years) with mixed aetiology dysphagia (Functional Oral Intake Scale Level 2-5) were included. Median pharyngeal contractile (156.81 mmHg cm s; IQR 80.62) increased significantly (213.50 mmHg cm s; IQR 117.2) during effortful swallowing (p = 0.002). Significant increases were also observed in velopharyngeal pressure (p = 0.001), mesopharyngeal pressure (p = 0.027), hypopharyngeal pressure (p = 0.003) and UOS relaxation duration (p = 0.002). UOS IRP was not significantly altered with effortful swallowing (p = 0.233). Conclusion:Effortful swallowing induced significant biomechanical changes to swallowing in adults with dysphagia. Increases in global pharyngeal rigor, tongue base pressure and UOS opening duration were captured by PHRM during effortful swallowing. Further investigation in larger homogeneous clinical populations is needed to verify the physiological effects of this frequently employed intervention.

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Post-stroke Dysphagia: Recent Insights and Unanswered Questions

Jones¹,

Colletti

Ding

2020

Curr Neurol Neurosci Rep

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Purpose of Review We explored themes in recent post-stroke dysphagia literature, focusing on the following questions: (1) What does post-stroke dysphagia look like?; (2) Who gets post-stroke dysphagia?; (3) What are the consequences of post-stroke dysphagia?; and (4) How can we improve treatment of post-stroke dysphagia? Recent Findings There have been several improvements in quantitative descriptions of swallowing physiology using standard and new evaluation techniques. These descriptions have been correlated with lesion locations, and several factors can predict development of post-stroke dysphagia and its sequelae. Novel treatment paradigms have leveraged post-stroke neuroplastic improvements using neurostimulation and biofeedback techniques. Despite recent findings, the field is limited by lack of standardization and unanswered questions on rehabilitation variables. Summary Our improved understanding of post-stroke dysphagia will enhance our ability to prevent, identify, and treat it. Future work should be grounded in swallowing physiology and continue refining treatments, particularly in the acute stage.

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Perceived Professional and Institutional Factors Influencing Clinical Adoption of Pharyngeal High-Resolution Manometry

Cited by 4 publications

References 44 publications

Use of Pharyngeal High-Resolution Manometry to Evaluate Dysphagia in Adults with Motor Neurone Disease: A Scoping Review

Use of Pharyngeal High-Resolution Manometry to Evaluate Dysphagia in Adults with Motor Neurone Disease: A Scoping Review

Effect of effortful swallow on pharyngeal pressures during swallowing in adults with dysphagia: A pharyngeal high-resolution manometry study

Post-stroke Dysphagia: Recent Insights and Unanswered Questions

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