Premature infant swallowing: Patterns of tongue-soft palate coordination based upon videofluoroscopy

Abstract

Coordination between movements of individual tongue points, and between soft palate elevation and tongue movements, were examined in 12 prematurely born infants referred from hospital NICUs for videofluoroscopic swallow study (VFSS) due to poor oral feeding and suspicion of aspiration. Detailed post-evaluation kinematic analysis was conducted by digitizing images of a lateral view of digitally superimposed points on the tongue and soft palate. The primary measure of coordination was continuous relative phase of the time series created by movements of points on the tongue and soft palate over successive frames. Three points on the tongue (anterior, medial, and posterior) were organized around a stable in-phase pattern, with a phase lag that implied an anterior to posterior direction of motion. Coordination between a tongue point and a point on the soft palate during lowering and elevation was close to anti-phase at initiation of the pharyngeal swallow. These findings suggest that anti-phase coordination between tongue and soft palate may reflect the process by which the tongue is timed to pump liquid by moving it into an enclosed space, compressing it, and allowing it to leave by a specific route through the pharynx.

Preterm Infant Swallowing of Thin and Nectar-Thick Liquids: Changes in Lingual–Palatal Coordination and Relation to Bolus Transit

“…As in our previous report [18], tongue and soft palate coordination during preterm infant swallowing was organized around stable in-phase and antiphase patterns. There may be a functional basis for the organization of the oral anatomy into patterns of in-phase and antiphase.…”

“…In a previous study, for example, we [18] found that the timing of tongue and soft palate appears to be attracted to certain stable coordination patterns. Three tongue points (anterior, medial, and posterior) were organized around a stable in-phase pattern, with a phase lag that implied an anterior–posterior direction of motion.…”

“…Coordination between a tongue point and a point on the soft palate during lowering and elevation was close to antiphase at initiation of the pharyngeal swallow. In this study we extend the methodology of Goldfield et al [18] by measuring differences in tongue–soft palate coordination and bolus transit during a single videofluoroscopic evaluation. Each infant followed a standard clinical protocol of being reclined in a Tumble-form seat at a 60° angle, presented with a silicone nipple, and swallowing thin-consistency barium presented by bottle for a set number of swallows, or until the clinician was able to visually document swallowing difficulty and/or aspirated liquid in the airway.…”

Neonatal swallowing assessment using fiberoptic endoscopic evaluation of swallowing (FEES)

“…In adults and children such dysphagia are usually investigated using Videofluroscopic Swallow Study (VFSS), or the Fiberoptic Endoscopic Evaluation of Swallowing (FEES). FEES has been proved in several studies to be of equivalent diagnostic value as VFSS . FEES uses transnasal flexible fiberoptic laryngoscopy to view the pharynx and larynx during swallowing without interfering in the physiology of respiration.…”

Bio-Inspired Design of Soft Robotic Assistive Devices: The Interface of Physics, Biology, and Behavior

“…This intricate array of fibers, aligned at various angles orthogonal to the direction of deformation, may be the structural basis for what is called hydrostatic deformation. For example, during human swallowing, a series of deformations results in the transport of ingested food from the mouth to the esophagus (Goldfield et al, 2010;Miller, 1993). How do large numbers of fibers of varying alignments achieve the mechanical functions of swallowing, such as containing the bolus in a grooved depression in the middle portion of the tongue's dorsal surface, transferring the bolus to the posterior oral cavity, and propelling the bolus to the pharynx?…”