Reliability of an Automated High-Resolution Manometry Analysis Program Across Expert Users, Novice Users, and Speech-Language Pathologists

Jones, Corinne A.; Hoffman, Matthew R.; Geng, Zhixian; Abdelhalim, Suzan M.; Jiang, Jack J.; McCulloch, Timothy M.

doi:10.1044/2014_jslhr-s-13-0101

Cited by 20 publications

(13 citation statements)

References 16 publications

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“…Pressure variability was measured in the following manner: 1) a zero time-point was assigned to the pressure peak on the most superior sensor in the velopharynx for each swallow; 2) pressure waveforms from each sensor were aligned across swallows according to the zero time-point; 3) a coefficient of variation (CV = mean/standard deviation) was calculated on each sensor from the onset to offset of swallowing-related pressure change; 4) CVs were averaged over each sensor in the following regions: velopharynx, mesopharynx, and upper esophageal sphincter; and 5) CVs averaged over each region were summed into a single, overall pressure variability parameter. Reliability analysis was not performed for this study, but we have shown that our methods for extracting HRM measures is reliable between expert users, speech-language pathologists, and undergraduate research assistants [48]. …”

Section: Methodsmentioning

confidence: 99%

Multimodal Swallowing Evaluation with High-Resolution Manometry Reveals Subtle Swallowing Changes in Early and Mid-Stage Parkinson Disease

Jones

Ciucci

2016

JPD

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Background Parkinson disease (PD) has detrimental effects on swallowing function. Treatment options are largely behavioral; thus, patients would benefit from an earlier start to therapy. Early swallowing changes in PD are not well-known, so patients do not typically receive swallowing treatment until later in the progression of PD. Objective We used predictive modeling to determine what quantitative swallowing variables best differentiate individuals with early to mid-stage PD from healthy controls. Methods Participants included twenty-six individuals with early to mid-stage PD and 26 healthy, age- and sex-matched controls. Swallowing was evaluated by simultaneous high-resolution manometry and videofluoroscopy as well as the Sydney Swallow Questionnaire (SSQ). Binomial logistic regression was performed on 4 sets of data: 1) high-resolution manometry only; 2) videofluoroscopy only; 3) SSQ only; and 4) all data combined. Results A model from a combined data set had the highest accuracy in differentiating individuals with PD from controls. The model included maximum pressure in the velopharynx (soft palate), pressure variability in the velopharynx, and the SSQ item concerning difficulty with saliva swallowing. No significant models could be generated using the videofluoroscopy data. Conclusions Individuals with PD show quantitative changes in pressure generation and are able to self-assess aspects of swallowing function in the early and mid-stages of PD, even in the absence of swallowing changes seen on videofluoroscopy. A multimodal approach for the assessment of swallowing may be more accurate for determining subtle swallowing changes that occur in the early stages of PD.

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Section: Methodsmentioning

confidence: 99%

Multimodal Swallowing Evaluation with High-Resolution Manometry Reveals Subtle Swallowing Changes in Early and Mid-Stage Parkinson Disease

Jones

Ciucci

2016

JPD

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“…Additionally, the process of identifying and distinguishing pressures in pharyngeal regions is subjective in nature and may be more difficult when evaluating swallowing pressures in individuals with dysphagia. Nonetheless, our research team has had success in obtaining reliability in evaluating swallowing pressures, both with clinicians knowledgeable about swallowing function and in undergraduate research assistants without prior clinical training [124].…”

Section: Discussionmentioning

confidence: 99%

Methods for Measuring Swallowing Pressure Variability Using High-Resolution Manometry

Jones

Meisner

Broadfoot

et al. 2018

Front. Appl. Math. Stat.

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Any movement performed repeatedly will be executed with inter-trial variability. Oropharyngeal swallowing is a complex sensorimotor action, and swallow-to-swallow variability can have consequences that impact swallowing safety. Our aim was to determine an appropriate method to measure swallowing pressure waveform variability. An ideal variability metric must be sensitive to known deviations in waveform amplitude, duration, and overall shape, without being biased by waveforms that have both positive and sub-atmospheric pressure profiles. Through systematic analysis of model waveforms, we found a coefficient of variability (CV) parameter on waveforms adjusted such that the overall mean was 0 to be best suited for swallowing pressure variability analysis. We then investigated pharyngeal swallowing pressure variability using high-resolution manometry data from healthy individuals to assess impacts of waveform alignment, pharyngeal region, and number of swallows investigated. The alignment that resulted in the lowest overall swallowing pressure variability was when the superior-most sensor in the upper esophageal sphincter (UES) reached half its maximum pressure. Pressures in the tongue base region of the pharynx were least variable and pressures in the hypopharynx region were most variable. Sets of 3-10 consecutive swallows had no overall difference in variability, but sets of two swallows resulted in significantly less variability than the other dataset sizes. This study identified variability in swallowing pressure waveform shape throughout the pharynx in healthy adults; we discuss implications for swallowing motor control.

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“…The locations were selected due to reported ease in identification of each region: the UES has a clear band of pressure at rest, and the velopharynx can be identified by non-swallow speech tasks such as production of /kaka/ [77]. These anatomic definitions have been used for measurement in numerous subsequent publications [18,52,63,78,84], and this framework has been adapted in automated analysis programmes described in the literature [91]. …”

Section: Pharyngeal Manometrymentioning

confidence: 99%

“…Research applications of HRM rely heavily on software such as MATLAB to analyse pharyngeal swallowing with custom algorithms outside of commercial HRM devices [78,79,80,81,82,83,91], and reliability of pharyngeal HRM is limited to one study investigating a custom MATLAB programme. The reliability of a custom-designed software programme was evaluated after provision of a 20-min training session to 20 raters with varying experience (e.g., expert and novice speech-language pathologists) [91].…”

Section: Pharyngeal Manometrymentioning

confidence: 99%

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Expanding Instrumental Options for Dysphagia Diagnosis and Research: Ultrasound and Manometry

Huckabee

Macrae²,

Lamvik³

2015

Folia Phoniatr Logop

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Diagnostic assessment of swallowing in routine clinical practice relies heavily on the long-standing techniques of videofluoroscopic swallowing study (VFSS) and videoendoscopic evaluation of swallowing (VEES). These complementary and sophisticated techniques provide a real-time visualization of biomechanical movements of the structures involved in swallowing and consequent effects on bolus flow. Despite the sophistication of this instrumentation, interpretation relies heavily on subjective clinical judgement and temporal resolution is limited, limitations that may influence patient management. Adjunctive diagnostic assessments may be utilized to compensate for the limitations posed by VFSS and VEES. Ultrasound and pharyngeal manometry do not represent the latest in technological advances, with both emerging in swallowing research over 20 years ago. However, both have resisted integration into routine clinical practice, despite the fact that they offer quantitative metrics of swallowing that are not available using standard techniques. The aim of this review is to present recent research on these two less frequently used modalities in clinical swallowing assessment, discuss potential applications in clinical practice and review supportive data on test-retest reliability, rater reliability and validity. The paper will conclude with a case report that exemplifies the unique contribution of these modalities in executing and revising therapeutic approaches for a patient with neurogenic dysphagia.

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Reliability of an Automated High-Resolution Manometry Analysis Program Across Expert Users, Novice Users, and Speech-Language Pathologists

Cited by 20 publications

References 16 publications

Multimodal Swallowing Evaluation with High-Resolution Manometry Reveals Subtle Swallowing Changes in Early and Mid-Stage Parkinson Disease

Multimodal Swallowing Evaluation with High-Resolution Manometry Reveals Subtle Swallowing Changes in Early and Mid-Stage Parkinson Disease

Methods for Measuring Swallowing Pressure Variability Using High-Resolution Manometry

Expanding Instrumental Options for Dysphagia Diagnosis and Research: Ultrasound and Manometry

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