Dysphagia occurs when food or liquid is prevented from moving from the mouth to the stomach. The normal aging process and age-related disease contribute to the prevalence of dysphagia as do acquired acute and chronic progressive diseases. This paper will define compensatory techniques and discuss research that has led to evidence-based rehabilitative approaches in the treatment of deglutitive disorders.

As deglutologists, we strive to use the best evidence available in the treatment of swallowing disorders. Evidence-based medicine is a bottom-up approach that thoughtfully combines the best external evidence with individual clinical expertise and the patients’ choice reflective of their clinical state and preferences for their specific care plan. Evidence-based medicine is not restricted to randomized clinical trials and meta-analyses; rather, evidence-based medicine includes our ability to discriminate the best external evidence with which to answer clinical questions and then skillfully and appropriately being able to apply this evidence in the care and treatment of our patients (Sackett et al. in BMJ 312:71–72, 1996). Translation of efficient and effective dysphagia rehabilitative clinical practice implies the need to use treatment that has proven therapeutic value, yields measurable physiologic results and most importantly allows appreciable qualitative outcomes for the patient.

In the last decade, fluoroscopy in the radiology department has been largely replaced by more modern imaging techniques; however, the visualization of oropharyngeal swallowing function is still one of the hallmarks of fluoroscopy. This article describes the technique and interpretation of swallowing videofluoroscopy.

Arata Abe Muhammad Abbas Abid Muhammad Bilal Abid Valerie Adams Robert Addington B. Adeleye Lee Akst Zeynep Alkan Jacqueline E. Allen Edmilton Pereira Almeida Sheila Tamanini Almeida Ana Alter-Rega Kenneth Altman Elaine Amella Andreas Anagiotos Liubiana Arantes Araujo Brenda Lima Araujo Sally Katherine Archer Joan Arvedson Joan C. Arvedson Jonathon E. Aviv Margareta Christina Bulow Arash Babaei Mary Bacon Laura W. J. Baijens Mark Baker Matina Balou Hideki Bando Philip G. Bardin Julie Barkmeier-Kraemer Julie Barkmeier-Kraemer Linda Bartoshuk Robert W. Bastian Eric D. Baum Patricia Bazemore Kareem Bedeir Peter Belafsky Luciana Rodrigues Belo Dawn M. Betts Debabrata Biswas Andrew Blitzer Joel H. Blumin Jonathan M. Bock Hans Bogaardt Elfriede Bollschweiler Donald Bolser Heather Shaw Bonilha Leonardo Bonilha Worth Boyce Daniel Brasnu James G. Brasseur Edmundo Brito-de la Fuente Martin B. Brodsky Michael Broniatowski Dina Brooks Valerie Julie Brousseau Charles Christopher Broz Karen Nancy Bryant Neil R. M. Buist Adam Burbidge James A. Burns Claire Louise Butler Susan G. Butler Vincent Byron Norman Capra Giselle Carnaby Donald Castell Chin-Wen Chang Joan Chen Sung-Lang Chen Robert Chun Julie Cichero Michelle Ciucci Heather M. Clark John O. Clarke Matthew Clary Pere Clave Elizabeth Page Clawson Nicola Ann Clayton Nadine P. Connor Ian Cook James L. Coyle MIchael Crary Cynthia J. Cress Lori Cunningham Daniella Curcio Leonardo da Silva Virginia Daggett Stephanie K. Daniels Lori Davis Jesse Dean Davide DeLorenzi Numan Demir

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease involving nerve cells that control voluntary muscle movement (Rowland LP, Shneider NA, N Engl J Med 344(22):1688–1700, 2001). The aim of this study were to determine the pattern of neurodegenerative change in (1) isometric tongue strength (ITS) and spontaneous saliva swallow (SSS) pressure, (2) saliva weight, and (3) forced vital capacity (FVC) in patients with ALS who present with primary spinal versus primary bulbar symptoms. Twenty-three consecutive patients (age = 48–80 years, mean = 59.5 years) were enrolled. Data were collected over three visits (12-week interval) for each group: 9 patients with bulbar symptoms and 14 with spinal symptoms. A significant difference was noted in SSS and ITS in the group with bulbar symptoms from Trial 1 to II and from Trial II to III. SSS and ITS showed a significant difference when comparing Trial I to III but not when comparing Trial I to II for the spinal symptom group, indicating that this group experienced a slower decline in SSS. Saliva production did not show a significant change in the bulbar symptom group but did in the spinal group. FVC was significantly different when comparing Trial I to III and Trial II to III for both groups. FVC, SSS, and ITS may be complimentary measures used as a gauge of an ALS patient’s ability to efficiently take oral nutrition and to support required alterations in diet consistency.

Shinichi Abe Muhammad Bilal Abid B Adeleye Joan Arvedson James Barthel Peter Belafsky Mark Bianchi Joel Blumin Leonardo Bonilha Heather Bonilha Worth Boyce S Brady Daniel Brasnu James G. Brasseur Deanna Britton Martin Brodsky Margareta Bulow Margareta Bülow Adam Burbidge Susan Butler Giselle Carnaby Danielle Carneiro Chin-wen Chang Ratanapat Chanubol Julie Cichero Naomi Cocks Ian Cook James Coyle MIchael Crary Marinos C. Dalakas Stephanie K. Daniels Paul Davenport Tom R. DeMeester Numan Demir Pamela Dodrill Kulwinder Dua Caryn Easterling Olle Ekberg Cumhur Ertekin Louise Gallagher Rebecca German Marion Boyd Gillespie Michael Groher Roxann Gross Lucinda Halstead Shaheen Hamdy Kozo Hanayama Gady Har-El Dana Hartl Bas Heijnen Maggie-Lee Huckabee Ianessa Humbert Kate Hutcheson Sudarshan Jadcherla Peter Kahrilas Jun Kayashita Mark Kern HyangHee Kim Youngsun Kim Motoi Kobashi Gintas Krisciunas Hitoshi Kurabayashi Ivan Lang Patricia Langdon Susan Langmore Chantal Lau Cathy Lazarus Steven B. Leder Christian Ledl Maureen Lefton-Greif Rebecca Leonard Norman A. Leopold Jeri Logemann Fernanda Loureiro Donna Lundy Ruth E. Martin Rosemary Martino Benson Massey Timothy McCulloch Gary H. McCullough David McFarland Betty McMicken Albert Merati Ray Merrill Krisztina Mészáros Arthur Miller Robert M. Miller Lori Morgan Joseph Murray Elizabeth Musto Lisa Newman Mark A. Nicosia Sonoko Nozaki

Principles of Deglutition: E-Book , Principles of Deglutition: E-Book , کتابخانه دیجیتال جندی شاپور اهواز

Our professional American Speech-Language-Hearing Association (ASHA) guidelines state, if a speech-language pathologist suspects on the basis of the clinical history that there may be an esophageal disorder contributing to the patient's dysphagia, then “An esophageal screening can be incorporated into most [videofluoroscopic swallowing studies, or] VFSS” (ASHA, 2004). However, the esophageal screen has not been defined by ASHA or by the American College of Radiology. This “Food for Thought” column suggests deglutologists work together to determine the procedure and expected outcome for the esophageal screen so that there is acceptance and consensus among the multidisciplinary team members who evaluate patients with dysphagia.

Temporal measures of normal pediatric oropharyngeal deglutition have not been studied. Knowledge of range and variation of normative temporal measures could define abnormal deglutition and assist in design of appropriate compensatory and rehabilitative treatment techniques. The purpose of this retrospective study was to determine temporal measurements for oral filling, oral transit, onset of laryngeal closure, time of bolus arrival at the valleculae, pharyngeal delay, pharyngeal transit, and UES opening. Videofluoroscopic swallow studies of 15 normally swallowing pediatric subjects were divided into three age groups and method of liquid delivery. Mean, standard deviation, percentages, and extension of the median were utilized to determine relationships of temporal measures. Mean temporal duration increased with age for oral filling, oral transit time, time of laryngeal closure, UES opening, and pharyngeal delay time. However, no significant differences were found between age groups indicating a deglutitive biomechanical adaptation to growth of the oral and pharyngeal cavity. Feeding method for bottle versus cup mean duration increased for oral transit time, laryngeal closure time, UES opening, and pharyngeal delay time. Bolus head location relative to onset of laryngeal vestibule closure changed with increased age and method of feeding. Temporal measures were not significantly different for age groups or feeding methods. Bolus location was at or fully contained in the valleculae at the onset of laryngeal closure and appeared to be a normal finding in functional pediatric swallows and is not indicative of a delay or disorder.

Seven institutions participated in this small clinical trial that included 19 patients who exhibited oropharyngeal dysphagia on videofluorography (VFG) involving the upper esophageal sphincter (UES) and who had a 3-month history of aspiration. All patients were randomized to either traditional swallowing therapy or the Shaker exercise for 6 weeks. Each patient received a modified barium swallow pre- and post-therapy, including two swallows each of 3 ml and 5 ml liquid barium and 3 ml barium pudding. Each videofluorographic study was sent to a central laboratory and digitized in order to measure hyoid and larynx movement as well as UES opening. Fourteen patients received both pre-and post-therapy VFG studies. There was significantly less aspiration post-therapy in patients in the Shaker group. Residue in the various oral and pharyngeal locations did not differ between the groups. With traditional therapy, there were several significant increases from pre- to post-therapy, including superior laryngeal movement and superior hyoid movement on 3-ml pudding swallows and anterior laryngeal movement on 3-ml liquid boluses, indicating significant improvement in swallowing physiology. After both types of therapy there is a significant increase in UES opening width on 3-ml paste swallows.

Earlier studies of the effect of 6 weeks of the Shaker Exercise have shown significant increase in UES opening and anterior excursion of larynx and hyoid during swallowing in patients with upper esophageal sphincter (UES) dysfunction, resulting in elimination of aspiration and resumption of oral intake. This effect is attributed to strengthening of the suprahyoid muscles, as evidenced by comparison of electromyographic changes in muscle fatigue before and after completion of the exercise regime. The effect of this exercise on thyrohyoid muscle shortening is unknown. Therefore the aim of this study was to determine the effect of the exercise on thyrohyoid muscle shortening. We studied 11 dysphagic patients with UES dysfunction. Six were randomized to traditional swallowing therapy and five to the Shaker Exercise. Videofluoroscopy was used to measure deglutitive thyrohyoid shortening before and after completion of assigned therapy regimen. Maximum thyrohyoid muscle shortening occurred at close temporal proximity to the time of maximal thyroid cartilage excursion. The percent change in thyrohyoid distance from initiation of deglutition to maximal anterior/superior hyoid excursion showed no statistically significant difference between the two groups prior to either therapy ( p = 0.54). In contrast, after completion of therapy, the percent change in thyrohyoid distance in the Shaker Exercise group was significantly greater compared to the traditional therapy ( p = 0.034). The Shaker Exercise augments the thyrohyoid muscle shortening in addition to strengthening the suprahyoid muscles. The combination of increased thyrohyoid shortening and suprahyoid strengthening contributes to the Shaker Exercise outcome of deglutitive UES opening augmentation.

Age-related sarcopenia or muscle wasting contributes to changes in the ability to perform activities of daily living, changes in deglutition, and changes in vocal function. The Shaker Exercise, an isometric and isokinetic exercise, has been shown to strengthen suprahyoid muscles and increase deglutitive anteroposterior (AP) upper esophageal sphincter (UES) opening diameter. The aim of this study was to determine if this exercise has an effect on the age-related changes in vocal function and deglutition in healthy older adults. Eleven females and 10 males, aged 65-78 years (mean = 70 +/- 4 years) and with a negative history for dysphagia and voice disorders, participated by exercising three times per day for 6 weeks. Five age-matched controls did not perform the exercise. Acoustic analysis of voice and biomechanical analysis of deglutition were performed before and after 6 weeks of exercise. Controls participated in voice analysis only. Dysphonia Severity Index (DSI), a multivariate voice index, was used to compare voice production initially and after 6 weeks. Deglutitive biomechanical measures increased and DSI scores improved in 10 of 21 participants following 6 weeks of the exercise. DSI for controls did not change over the 6-week period. Ten of 21 exercise participants experienced improved deglutitive biomechanics and DSI scores. Accuracy of exercise performance, compliance, and/or disclosed alterations in health status may contribute to the lack of deglutitive and DSI change in the participants who did not experience change in function. A large randomized control study, including periodic monitoring of health status, exercise performance accuracy, and compliance, is warranted to evaluate the affect of this exercise on deglutition as well as voice. The Shaker Exercise could be recommended as a preventative measure to diminish the effect of sarcopenia on the muscles used in deglutition and voice and alter the progression of the characteristic senescent voice and swallow changes.

In 2004, more than 12% of the population in the United States was aged 65 years or older. This percentage is expected to increase to 20% of the population by 2030. The prevalence of swallowing disorders, or dysphagia, in older individuals ranges from 7% to 22% and dramatically increases to 40% to 50% in older individuals who reside in long-term care facilities. For older individuals, those with neurologic disease, or those with dementia, the consequence of dysphagia may be dehydration, malnutrition, weight loss, and aspiration pneumonia. Dysphagia can be a result of behavioral, sensory, or motor problems (or a combination of these) and is common in individuals with neurologic disease and dementia. Although there are few studies of the incidence and prevalence of dysphagia in individuals with dementia, it is estimated that 45% of institutionalized dementia patients have dysphagia. The high prevalence of dysphagia in individuals with dementia likely is the result of age-related changes in sensory and motor function in addition to those produced by neuropathology. The following article describes evidence based practices in caring for those individuals with dementia and dysphagia with guidelines for evaluation and management.