The effects of Bolus Flow on Vertical Pharyngeal Pressure Measurement in the Pharyngoesophageal Segment: Clinical Significance

McConnel, Fred M. S.; Guffin, Thomas N.; Cerenko, Danko; Ko, Andrew Shyh-Feng

doi:10.1177/019459989210600219

Cited by 21 publications

(7 citation statements)

References 9 publications

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“…At the time of this publication, there are over 9700 citations in Medline of human studies and measurement methods of normal swallowing and swallowing disorders from 1950 to 2007. These methods are directed toward gaining objective indexes of the timing [1–7], pressure [8–17], range [18–20], and strength [21–23] of structural movements, bolus flow patterns [1, 24–27], bolus clearance and efficiency [12, 28], airway protection [29, 30], and sensation [31–34]. These studies have established a strong theoretical framework of the nature of swallowing abnormalities and the clinical value of this work has been unprecedented.…”

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confidence: 99%

MBS Measurement Tool for Swallow Impairment—MBSImp: Establishing a Standard

et al. 2008

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The aim of this study was to test reliability, content, construct, and external validity of a new modified barium swallowing study (MBSS) tool (MBSImp) that is used to quantify swallowing impairment. Multiple regression, confirmatory factor, and correlation analyses were used to analyze 300 in- and outpatients with heterogeneous medical and surgical diagnoses who were sequentially referred for MBS exams at a university medical center and private tertiary care community hospital. Main outcome measures were the MBSImp and index scores of aspiration, health status, and quality of life. Inter- and intrarater concordance were 80% or greater for blinded scoring of MBSSs. Regression analysis revealed contributions of eight of nine swallow types to impressions of overall swallowing impairment (p ≤ 0.05). Factor analysis revealed 13 significant components (loadings ≥ 0.5) that formed two impairment groupings (oral and pharyngeal). Significant correlations were found between Oral and Pharyngeal Impairment scores and Penetration-Aspiration Scale scores, and indexes of intake status, nutrition, health status, and quality of life. The MBSImp demonstrated clinical practicality, favorable inter- and intrarater reliability following standardized training, content, and external validity. This study reflects potential for establishment of a new standard for quantification and comparison of oropharyngeal swallowing impairment across patient diagnoses as measured on MBSS.

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MBS Measurement Tool for Swallow Impairment—MBSImp: Establishing a Standard

et al. 2008

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“…While the upper airway is able to exert powerful force on the bolus, dysphagia is common among patients with disordered negative intra-thoracic pressure during swallow (McConnel, Mendelsohn et al 1986, McConnel 1988, McConnel, Hester et al 1988, Cerenko, McConnel et al 1989, Ku, Ma et al 1990, McConnel, Guffin et al 1991, McConnel, Guffin et al 1992. There is extensive literature on how cSCI affects breathing-related phrenic nerve and diaphragm recruitment from the groups of Goshgarian (Hadley, Walker et al 1999, Goshgarian 2009, Sieck and Mantilla (Mantilla and Sieck 2003, Mantilla and Sieck 2011, Mantilla, Bailey et al 2012, Mitchell and Fuller (Fuller, Johnson et al 2002, Reier and Lane (Lane, Fuller et al 2008, Lane, Lee et al 2009), Alilain and Silver (Alilain, Li et al 2008, Alilain and Silver 2009, Alilain, Horn et al 2011, Sharma, Alilain et al 2012, Awad, Warren et al 2013, and others (Ginsborg and Hirst 1972, Golder, Reier et al 2001, Golder, Fuller et al 2003, Polentes, Stamegna et al 2004, Baussart, Stamegna et al 2006, DiMarco 2009; however, we have little knowledge about the effects of cSCI on swallow.…”

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confidence: 99%

Laryngeal and swallow dysregulation following acute cervical spinal cord injury

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et al. 2022

Journal of Neurophysiology

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Laryngeal function is vital to airway protection. While swallow is mediated by the brainstem, mechanisms underlying increased risk of dysphagia after cervical spinal cord injury (SCI) are unknown. We hypothesized that loss of descending phrenic drive affects swallow and breathing differently, and loss of ascending spinal afferent information alters swallow regulation. We recorded electromyograms from upper airway and chest wall muscles in freely breathing pentobarbital-anesthetized cats and rats. Inspiratory laryngeal activity increased ~two-fold following C2 lateral-hemisection. Ipsilateral to the injury, crural diaphragm EMG amplitude was reduced during breathing (62 ± 25% change post-injury), but no animal had complete termination of activity; 75% of animals increased contralateral diaphragm recruitment, but this did not reach significance. During swallow, laryngeal adductor and pharyngeal constrictor muscles increased activity, and diaphragm activity was bilaterally suppressed. This was unexpected because of the ipsilateral-specific response during breathing. Swallow-breathing coordination was also disrupted and more swallows occurred during early expiration. Finally, to determine if the chest wall is a major source of feedback for laryngeal regulation, we performed T1 total transections in rats. As in the C2 lateral-hemisection, inspiratory laryngeal recruitment was the first feature noted. In contrast to the C2 lateral-hemisection, diaphragmatic drive increased after T1 transection. Overall, we found that SCI alters laryngeal drive during swallow and breathing, and reduced swallow-related diaphragm activity. Our results show behavior-specific effects, suggesting SCI affects swallow more than breathing, and emphasizes the need for additional studies on the effects of ascending afferents from the spinal cord on laryngeal function.

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“…Pharyngeal manometry alone objectively quantifies pressure and timing data, but it does not provide precise information about the position of the manometric sensors anatomically. The simultaneous combination of manometry and videofluoroscopy (manofluorography) allows both a functional and anatomical assessment of bolus transport and a quantitative manometric analysis of intrabolus and extrabolus pressures in the pharyngeal and pharyngoesophageal segment (PES) 7,8 …”

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confidence: 99%