Radiographic techniques and interpretation of abnormal swallowing in adult and elderly patients

Feinberg, Michael J.

doi:10.1007/bf01321779

Cited by 33 publications

(22 citation statements)

References 6 publications

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“…These impairments may occur singly or in combination with a prolonged oral phase due to loss of voluntary control [22]. This placebo-controlled, double-blind study has shown that treatment with nifedipine results in a significant and measurable improvement in both the pharyngeal transit time and swallow delay in patients with persistent dysphagia after stroke.…”

Section: Discussionmentioning

confidence: 90%

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Pharmacological Treatment of Dysphagia in Stroke

et al. 1998

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The pharynx is important for a normal swallow and it has been suggested that pharmacological agents may play a role in the management of pharyngeal dysphagia, but none have been formally evaluated. A pilot double-blind, placebo-controlled study was undertaken in 17 hospitalized patients with persistent dysphagia 2 weeks after stroke. Patients were randomized to treatment with slow-release nifedipine 30 mg orally (n = 8) or placebo (n = 9) following specialist swallowing assessment and videofluoroscopy to exclude severe dysphagia. Videofluoroscopy was repeated after 4 weeks of treatment. Fourteen patients (active 6, placebo 8) completed the study. Two patients died (active 1, placebo 1) and 1 patient in the active group had to be withdrawn because of progressive heart failure. Initial assessment showed impairment in the pharyngeal phase with delayed triggering of swallow, poor laryngeal elevation, and prolonged pharyngeal transit times in all patients. Silent aspiration was seen in 4 patients (active 2, placebo 2). Improvement in swallowing was seen in 8 patients (active 5, placebo 3) at the end of 4 weeks. There were significant changes in the pharyngeal transit time (mean -1.34 second; 95% C.I. -2.56, -0.11) and swallow delay (mean -1.91 seconds; 95% C.I. -3.58, -0.24) in the active group suggesting improvement in the initiation of pharyngeal contractions and reduction in the time taken for the bolus to transverse the pharynx. A similar change was not seen in the placebo group. It is suggested that pharmacological agents such as nifedipine may have a role in the management of stroke-related dysphagia and merit further investigation.

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Section: Discussionmentioning

confidence: 90%

“…The pharyngeal phase of swallowing is commonly affected following stroke and is seen as prolongation of pharyngeal phase or delayed swallow reflex on videofluoroscopy [22]. These impairments may occur singly or in combination with a prolonged oral phase due to loss of voluntary control [22].…”

Section: Discussionmentioning

confidence: 99%

Pharmacological Treatment of Dysphagia in Stroke

et al. 1998

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“…Two models of swallowing are widely recognized in drinking and eating in humans. The first is the four-stage sequence model that corresponds to command, or discrete swallowing of liquids (Linden et al 1989;Dodds et al 1990;Feinberg 1993) and the second is the process model that accounts for the chewing and swallowing of solid food (Palmer et al 1992Palmer 1998;Hiiemae and Palmer 1999). In both of these swallowing models, the pharyngeal swallow occurs after the oral stage, i.e., using propulsion by the tongue, the bolus is transported from the oral cavity through the pharynx into the esophagus.…”

Section: Introductionmentioning

confidence: 99%

Isolated Pharyngeal Swallow Exists during Normal Human Feeding

Kagaya

Yokoyama

Saitoh

et al. 2015

Tohoku J. Exp. Med.

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Swallowing is one of the basic activities in humans. The pharynx functions as an airway and a food channel, and a pharyngeal swallow usually occurs after bolus transport from the oral cavity. However, direct fluid infusion through a catheter into the hypopharynx produces a pharyngeal swallow without the oral stage in experimental situations. The purpose of this study was to examine whether a pharyngeal swallow, which is not accompanied by bolus transport, can occur during normal human feeding. Fifty-three healthy volunteers (25-89 years) were recorded, via videofluoroscopic examination of swallowing, during 3 different swallowing trials: command swallow of 10 ml liquid barium, chew-swallow of corned beef, and chew-swallow of a mixture of corned beef and liquid barium. Subsequently each swallow was classified as being either a consecutive pharyngeal swallow (CPS), following transport, or an isolated pharyngeal swallow (IPS), without immediately prior transport. The location of the bolus at swallow initiation was also noted. Of 307 trials, 681 swallows were identified, which included 43 IPS and 638 CPS. IPS only occurred as the first swallow of a trial, but the frequency of IPS did not differ between 28 younger (< 60 years) and 25 older (≥ 60 years) people. Of the three food types, IPS occurred more frequently with the mixed food than with liquid. These results suggest that IPS may represent an airway protective mechanism. In conclusion, IPS occurs in normal swallowing during a daily eating situation. Swallowing is more complex than a simple reflex.

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“…[2][3][4][5][6] However, dentures are often avoided in the elderly especially with dysphagia due to their ill-fitting dentures and disadvantages such as the uncomfortable sensation caused by the palate covering. Therefore, to elucidate the relationship between the palate covering and swallowing function is an most important issue.…”

Section: Introductionmentioning

confidence: 99%

“…The importance of appropriate contact between the tongue and the palate was pronounced, and tongue dynamics have been studied using ultrasonography 9 and contact pressure sensors 10 with advanced ME technology. A palate-covering prosthesis may have a structural and physical influence on swallowing func-tion due to a reduction in the oral cavity volume or sensory deprivation, and may particularly affect tongue function 6,11,12 in the oral preparatory stage and oral stage of swallowing. However, the detailed effects on swallowing function caused by covering a palate with dentures are unknown.…”

Section: Introductionmentioning

confidence: 99%

Temporal Changes in Swallowing Function Caused by a Palate Covering

Furuya

Suzuki

et al. 2008

Prosthodont Res. Pract.

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Use of prostheses such as complete dentures is often avoided in dysphagia rehabilitation for the elderly due to the effects of the palate covering. However, the influence of the palate covering is relieved over a short time (approximately 7 days), suggesting that the commonly used approach should be reconsidered. AbstractPurpose: The purpose of this study was to elucidate the temporal relationship between habituation to a palate covered by a prosthesis and swallowing function. Materials and methods: Ten healthy adults were selected as subjects. Tongue pressure on an experimental palatal plate with four pressure sensors was recorded simultaneously with surface electromyography measurements of suprahyoid muscles during swallowing of 3 ml of water. Measurements were performed 6 times: immediately after placement of the experimental palatal plate (Day 0), and on Day 1, Day 3, Day 7, Day 10, and Day 14. Temporal changes were analyzed in terms of the order of EMG activity and tongue pressure, and the duration for total swallowing (DTS), oral preparatory stage (DOPS), oral stage (DOS), and pharyngeal stage (DPS). Results: Onset of activity of the suprahyoid muscles was observed significantly earlier in all regions compared to onset of tongue pressure. Onset of tongue pressure in the posterior region was significantly delayed compared to onset of tongue pressure in another region. These results remained constant over the measurement period. DTS and DOS were significantly shortened on and after Days 3 and 7, respectively, compared to the respective values on Day 0. DOPS was significantly shortened on Day 7, compared to Day 0 and 1. DPS showed no significant change over time. Conclusion:The time required for swallowing shows a tendency to decrease over time as a subject becomes accustomed to a palate covering. This was mainly due to shortening of the oral stage.

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Radiographic techniques and interpretation of abnormal swallowing in adult and elderly patients

Cited by 33 publications

References 6 publications

Pharmacological Treatment of Dysphagia in Stroke

Pharmacological Treatment of Dysphagia in Stroke

Isolated Pharyngeal Swallow Exists during Normal Human Feeding

Temporal Changes in Swallowing Function Caused by a Palate Covering

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