Dysphagia incidence can be up to 90% of patients after CVA disease and most of the patients demonstrate speech problems as well as dysphagia. The term of swallowing includes the entire process of deglutition from the placement of food in the mouth until the food enters to the esophagus through the oral and pharyngeal cavities. Swallowing functions share common anatomic structures and characteristics of physiology with speech in many aspects. Therefore, speech-language pathologists can help people with swallowing disorders. Herein the approaches and rationales for improving speech and swallowing functions in patients with stroke need to be discussed depending on the lesion sites of the brain.
Brain ; Deglutition Disorders ; Deglutition* ; Esophagus ; Humans ; Incidence ; Mouth ; Physiology ; Stroke*

OBJECTIVETo study the surface electromyography (sEMG) changes of globus patients during swallowing and to discuss the cause of the globus.

METHODSThe sEMG during swallowing was recorded in 126 healthy volunteers (control group) and 34 globus patients (globus group).Swallow included dry swallow and 20 ml water swallow. The durations and amplitudes of muscle activities during every swallow were recorded. The durations and amplitudes of the sEMG in two groups were compared using t test.

RESULTSThe durations of sEMG at dry swallow and 20 ml water swallow were (1.128 ± 0.191)s and (1.091 ± 0.208)s, while the amplitudes were (0.313 ± 0.110) mV and (0.286 ± 0.106) mV in control group. The durations of sEMG at dry swallow and 20 ml water swallow were (1.178 ± 0.252)s and (1.127 ± 0.178)s, while the amplitudes were (0.341 ± 0.116) mV and (0.316 ± 0.094) mV in globus group. There were no significant differences between globus patients and healthy volunteers in the durations and amplitudes of sEMG at dry swallow and 20 ml water swallow (P > 0.05).Furthermore, there were also no significant differences in the durations and amplitudes of the sEMG between the two groups in the same gender (P > 0.05).

CONCLUSIONThe results of swallowing sEMG suggested that the swallowing function in globus patients has not been damaged and psychological intervention should be considered in the treatment.

Adult ; Deglutition ; physiology ; Deglutition Disorders ; physiopathology ; Electromyography ; Humans ; Mental Disorders

OBJECTIVETo investigate the tongue pressure (TP) produced by tongue-hard palate contact in the process of normally swallowing liquid in healthy adults.

METHODSThirteen adult male subjects were recruited to perform a single swallow of 5 ml water when sitting with upright position. The tongue pressure sensor sheet was used to monitor TP as a result of tongue-hard palate approximatation in the anteriomedian, midmedian, posteriomedian and circumferential parts, and the swallowing sound was recorded by microphone. The temporal sequence of TP at each measured part was obtained after setting the swallowing sound as the reference time. Also, the total duration, pre-peak duration, post-peak duration, maximum magnitude and integrated value of TP were recorded and compared among the measured parts.

RESULTSTP was produced from anterior to posterior along the midline of hard palate during normal swallowing of water [Ch1: (-0.40 ± 0.22) s, Ch2: (-0.36 ± 0.21) s, Ch3: (-0.24 ± 0.18) s], with the circumferential TP [Ch4: (-0.38 ± 0.23) s, Ch5: (-0.40 ± 0.23) s] occurring nearly to the anteriomedian one (P > 0.05). Before the swallowing sound (P < 0.05), TP at each part reached a peak synchronously [Ch1: (-0.12 ± 0.24) s, Ch2: (-0.16 ± 0.22) s, Ch3: (-0.13 ± 0.21) s, Ch4: (-0.16 ± 0.23) s, Ch5: (-0.17 ± 0.23) s] in a rapid manner (P > 0.05), then decreased gradually until disappeared simultaneously [Ch1: (0.32 ± 0.23) s, Ch2: (0.27 ± 0.21) s, Ch3: (0.23 ± 0.16) s, Ch4: (0.33 ± 0.31) s, Ch5: (0.33 ± 0.29) s] (P > 0.05) after the swallowing sound (P < 0.05). The TP related parameters (the total duration of TP:Ch1: (0.72 ± 0.20) s, Ch2: (0.63 ± 0.16) s, Ch3: (0.47 ± 0.17) s, Ch4: (0.70 ± 0.35) s, Ch5: (0.73 ± 0.29) s; the pre-peak duration of TP: Ch1: (0.28 ± 0.21) s, Ch2: (0.20 ± 0.16) s, Ch3: (0.12 ± 0.10) s, Ch4: (0.21 ± 0.22) s, Ch5: (0.23 ± 0.21) s; the post-peak duration of TP: Ch1: (0.44 ± 0.23) s, Ch2: (0.43 ± 0.18) s, Ch3: (0.36 ± 0.18) s, Ch4: (0.49 ± 0.25) s, Ch5: (0.50 ± 0.23) s; the maximum magnitude of TP: Ch1: (13.80 ± 7.73) kPa, Ch2: (12.40 ± 6.51) kPa, Ch3: (10.26 ± 7.15) kPa, Ch4: (12.16 ± 5.38) kPa, Ch5: (13.08 ± 5.05) kPa; the integrated value of TP: Ch1: (4.99 ± 3.69) kPa×s, Ch2: (4.25 ± 2.13) kPa×s, Ch3: (2.88 ± 1.87) kPa×s, Ch4: (4.32 ± 3.47) kPa×s, Ch5: (4.63 ± 2.49) kPa×s were significantly smaller in the posteriomedian part among all the five parts measured. No laterality was found in TP produced at the circumferential parts of the hard palate (P > 0.05).

CONCLUSIONSThe TP at each part coordinates precisely during swallowing. The effective measurement of TP by tongue pressure sensor sheet will facilitate the evaluation of oral swallowing and the diagnosis of dysphagia simply and non-invasively.

Adult ; Deglutition ; physiology ; Deglutition Disorders ; diagnosis ; Drinking ; physiology ; Drinking Water ; Humans ; Male ; Palate, Hard ; Pressure ; Time Factors ; Tongue ; physiology

OBJECTIVE: To investigate the impact of tracheostomy tube capping on swallowing physiology in stroke patients with dysphagia via videofluoroscopic swallowing study (VFSS). METHODS: This study was conducted as a prospective study that involved 30 stroke patients. Then, 4 mL semisolid swallowing was conducted with capping of the tracheostomy tube or without capping of the tracheostomy tube. The following five parameters were measured: laryngeal elevation, pharyngeal transit time, post-swallow pharyngeal remnant, upper esophageal sphincter width (UES), and penetration-aspiration scale (PAS) score. RESULTS: On assessment of the differences in swallowing parameters during swallowing between ‘with capping’ and ‘without capping’ statuses, statistically significant differences were found in the post-swallow pharyngeal remnant (without capping, 48.19%±28.70%; with capping, 25.09%±19.23%; p<0.001), normalized residue ratio scale for the valleculae (without capping, 0.17±0.12; with capping, 0.09±0.12; p=0.013), normalized residue ratio scale for the piriform sinus (without capping, 0.16±0.12; with capping, 0.10±0.07; p=0.015), and UES width (without capping, 3.32±1.61 mm; with capping, 4.61±1.95 mm; p=0.003). However, there were no statistically significant differences in laryngeal elevation (x-axis without capping, 2.48±1.45 mm; with capping, 3.26±2.37 mm; y-axis without capping, 11.11±5.24 mm; with capping, 12.64±6.16 mm), pharyngeal transit time (without capping, 9.19± 10.14 s; with capping, 9.09±10.21 s), and PAS score (without capping, 4.94±2.83; with capping, 4.18±2.24). CONCLUSION: Tracheostomy tube capping is a useful way to reduce post-swallow remnants and it can be considered an alternative method for alleviating dysphagia in stroke patients who can tolerate tracheostomy tube capping when post-swallow remnants are observed.
Deglutition ; Deglutition Disorders* ; Esophageal Sphincter, Upper ; Fluoroscopy ; Humans ; Methods ; Physiology ; Prospective Studies ; Pyriform Sinus ; Stroke* ; Tracheostomy*

PURPOSE: To determine the effect of a 45degrees reclining sitting posture on swallowing in patients with dysphagia. MATERIALS AND METHODS: Thirty-four patients with dysphagia were evaluated. Videofluoroscopic swallowing study was performed for each patient in 90degrees upright and in 45degrees reclining sitting posture. Patients swallowed 5 types of boluses twice: sequentially 2 mL thin liquid, 5 mL thin liquid, thick liquid, yogurt, and cooked rice. Data such as the penetration-aspiration scale (PAS), oral transit time (OTT), pharyngeal delay time (PDT), pharyngeal transit time (PTT), residue in valleculae and pyriform sinuses, premature bolus loss, and nasal penetration were obtained. RESULTS: The mean PAS on the 2 mL thin liquid decreased significantly in the 45degrees reclining sitting posture (p=0.007). The mean PAS on 5 mL thin liquid in the 45degrees reclining sitting posture showed decreasing tendency. The residue in valleculae decreased significantly for all boluses in the 45degrees reclining sitting posture (p<0.001, p=0.002, p=0.003, p<0.001, p=0.020, respectively). The residue in pyriform sinuses increased significantly on 5 mL thin liquid, thick liquid, and yogurt (p=0.031, p=0.020, p=0.002, respectively). There were no significant differences in OTT, PDT, PTT, premature bolus loss, and nasal penetration between both postures. CONCLUSION: PAS on 2 mL thin liquid and residue in valleculae on all types of boluses were decreased in a 45degrees reclining sitting posture. Therefore, we believe that the 45degrees reclining sitting posture on swallowing is beneficial for the patients with penetration or aspiration on small amounts of thin liquid and large amounts of residue in valleculae.
Adult ; Deglutition/*physiology ; Deglutition Disorders/*physiopathology ; Female ; Fluoroscopy ; Humans ; Male ; Middle Aged ; Patient Positioning ; *Posture

OBJECTIVETo investigate a reliable and easy assessment method for swallowing function by evaluating objectively the recovery process of swallowing function in patients six months after supracricoid partial laryngectomy.

METHODSThe swallowing function of patients who underwent supracricoid partial laryngectomy was evaluated six months after operation in Nanfang Hospital of Southern Medical University between January 2013 and February 2014 with two methods, the modified barium swallow (MBS) and fiberoptic endoscopic evaluation of swallowing (FEES), combined with modified penetration aspiration scale (MPAS). Furthermore, the feasibility, reliability and accuracy of these two methods were compared.

RESULTSEleven patients were enrolled. MPAS equals score 1 for solid food, semiliquid food, and liquid food was defined as a criteria of normal swallowing function. By MBS evaluation, the numbers of patients with normal swallowing function were two cases at day 16-30 postoperation, two cases at day 31-45 postoperation, five cases at day 46-90 postoperation, and six cases at day 91-180 postoperation, respectively. By FEES evaluation, the above numbers were three cases, four cases, six cases and eight cases, respectively. When the aspiration was minimal and ejected completely and MPAS was less than or equal to score 4 for solid food, semiliquid food, and liquid food, the gastric tube could be removed. According to this standard, the gastric tube was removed in all cases, and the mean time was (21.7 ± 9.8) days. A good correlation was obtained between these two methods when evaluating solid and semiliquid food, and the Kappa values were 0.802 and 0.844, respectively. However, a little agreement was obtained between these two methods when evaluating liquid food, and the Kappa value was 0.529.

CONCLUSIONSPatients who underwent supracricoid partial laryngectomy could restore good swallowing function in six months after the operation. Both the MBS and FEES are valuable procedures for evaluating objectively the swallowing function in patients after supracricoid partial laryngectomy. The FEES is much better than MBS, because FEES is a simple operation performed alone by otolaryngologists with no radiation.

Deglutition ; physiology ; Deglutition Disorders ; surgery ; Endoscopy ; Female ; Humans ; Laryngectomy ; Postoperative Period ; Reproducibility of Results

Deglutition ; physiology ; Deglutition Disorders ; physiopathology ; Humans ; Muscles ; physiopathology ; Stroke ; physiopathology ; Viscosity

The main purpose of this paper was to review the role of the hyoid movement in the swallowing process and the effect of swallowing posture, age, gender, bolus properties on the hyoid movement. The displacement of the hyoid bone was divided into vertical and forward displacement. The vertical displacement of the hyoid bone contributes primarily to epiglottic and laryngeal closure, while the anterior displacement contributes primarily to opening of the UES. The dysphagia patients often experienced a reduction in hyoid bone displacement. Therefore, further research on the movement of the hyoid bone in the deglutition, especially the relationship between anterior displacement and UES opening is necessary.
Age Factors ; Deglutition ; physiology ; Deglutition Disorders ; physiopathology ; Epiglottis ; physiology ; Female ; Humans ; Hyoid Bone ; physiology ; Larynx ; physiology ; Male ; Movement ; physiology ; Sex Factors

OBJECTIVETo examine the esophageal function of neonates by high resolution manometry (HRM), and to provide preliminary data for research on the esophageal function of neonates.

METHODSEsophageal HRM was performed on neonates using a solid-state pressure measurement system with 36 circumference sensors arranged at intervals of 0.75 cm, and ManoView software was used to analyze esophageal peristalsis pattern.

RESULTSEsophageal HRM was performed successfully in 11 neonates, and 126 occurrences of complete esophageal peristalsis were recorded. Complete esophageal peristalsis with pressure increase was recorded in some neonates but most neonates showed a different esophageal peristalsis pattern compared with adults. Some neonates had no relaxation of the upper esophageal sphincter (UES) when pharyngeal muscles contracted in swallowing, some neonates had multiple swallowing without esophageal peristalsis and some neonates had relatively low pressure of esophageal peristalsis. Full-term infants could have relatively low UES pressure and esophageal sphincter (LES) pressure but some preterm infants showed relatively high UES pressure and LES pressure. Longitudinal contraction of the whole esophagus and elevation of LES after swallowing were recorded in some neonates.

CONCLUSIONSEsophageal HRM is safe and tolerable for neonates. HRM shows that esophageal peristalsis after swallowing may not occur or may be incomplete in neonates. The esophageal function of neonates has not yet been developed completely, with large individual differences in esophageal peristalsis. Large sample data are needed for further analysis and research on the esophageal function of neonates.

Deglutition ; physiology ; Esophageal Sphincter, Lower ; physiology ; Esophageal Sphincter, Upper ; physiology ; Esophagus ; physiology ; Female ; Humans ; Infant, Newborn ; Male ; Manometry ; methods ; Peristalsis

OBJECTIVETo evaluate the effects of the application of tongue pressure sensor sheet on the signal waveform of laryngeal movement produced by the bend sensor during deglutition.

METHODSTwelve adult male subjects were recruited to perform a single swallow of 5 ml water when sitting on the dental chair with upright position. The data recorded by bend sensor was obtained with attaching tongue pressure sensor sheet simultaneously or not. Then the measured parameters by bend sensor with or without concurrent application of tongue pressure sensor sheet were compared.

RESULTSThere were no significant differences between the same time point on the signal waveform produced by bend sensor whether concurrently attaching tongue pressure sensor sheet or not (P > 0.05). Additionally, we found no statistical significances between matched phases on the signal waveform recorded by bend sensor with or without application of tongue pressure sensor sheet (P > 0.05).

CONCLUSIONThe findings in this study suggest us that the usage of tongue pressure sensor sheet exerted no influences on the waveform of the laryngeal movement produced by bend sensor during deglutition, facilitating us to further apply tongue pressure sensor sheet and bend sensor simultaneously to record tongue pressure production and hyoid activity during deglutition.

Adult ; Biosensing Techniques ; instrumentation ; Deglutition ; physiology ; Humans ; Hyoid Bone ; physiology ; Larynx ; physiology ; Male ; Middle Aged ; Pressure ; Tongue ; physiology