Dysphagia Grand Rounds 10

DGR 10 reviews a research study discussing how the coordination patterns observed in preterm infant swallowing change during feeding with nectar-thick-consistency compared to thin-consistency liquids. Read the open-access paper in the link below to review this article. Then watch the Dysphagia Grand Rounds 10 webinar to learn about the clinical implications. 

Article: Preterm infant swallowing of thin and nectar-thick liquids: Changes in lingual-palatal coordination and relation to bolus transit.
Authors: 
Eugene C. Goldfield, PhD; Vincent Smith, MD, MPH; Carlo Buonomo, MD; Jennifer Perez, MS, CCC-SLP; and Kara Larson, MS, CCC-SLP.
Journal: Dysphagia. 2013;28(2), 234–244.

Read DGR 10 article here: https://www.ncbi.nlm.nih.gov/pubmed/23274694

Watch DGR webinar here: https://dysphagiagrandrounds.yondo.com/playlist/dgr-10-october-2017/505

Abstract:
Tongue-soft palate coordination and bolus head pharyngeal transit were studied by means of postacquisition kinematic analysis of videofluoroscopic swallowing images of ten preterm infants referred from hospital NICUs due to poor oral feeding and suspicion of aspiration. Sequences of coordinated tongue-soft palate movements and bolus transits during swallows of thin-consistency and nectar-thick-consistency barium were digitized, and time series data were used to calculate continuous relative phase, a measure of coordination. During swallows of nectar-thick compared to thin barium, tongue-soft palate coordination was more likely to be antiphase, bolus head pharyngeal transit time was longer, and coordination was significantly correlated with bolus head pharyngeal transit. Analysis of successive swallows indicated that tongue-soft palate coordination variability decreased with nectar-thick but not with thin-consistency barium. Together, the results suggest that slower-moving bolus transits may promote greater opportunity for available sensory information to be used to modulate timing of tongue-soft palate movements so that they are more effective for pumping liquids.

 

Dysphagia Grand Rounds 9

Can respiratory-swallowing coordination be trained and sustained? Does it have a beneficial impact on swallowing physiology and airway protection? What effects does it have in the head and neck cancer population with chronic dysphagia? Read the open-access paper in the link below to learn more. Then watch the Dysphagia Grand Rounds 9 webinar to learn about the clinical implications of this research.   

Article: Respiratory-Swallow Training in Patients with Head and Neck Cancer
Authors: Bonnie Martin-Harris, David McFarland, Elizabeth G. Hill, Charlton B. Strange, Kendrea L. Focht, Zhuang Wan, Julie Blair, and Katlyn McGrattan
Journal: Archives of physical medicine and rehabilitation. 2015;96(5):885-893

Read DGR 9 article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410058/

Watch DGR 9 webinar: http://dysphagiagrandrounds.yondo.com/playlist/dgr-9-september-2017/454

Abstract: 
Objective

To test a novel intervention to train swallowing to occur in the mid-to-low expiratory phase of quiet breathing to improve swallowing safety and efficiency.

Design
Safety and efficacy non-randomized clinical trial with one-month follow-up.

Setting
Head and neck cancer (HNC) ambulatory clinics.

Participants
Thirty patients with HNC and chronic dysphagia completed the intervention. Fifteen of these patients participated in a one-month follow-up visit.

Interventions
Training protocol based on hierarchy of motor skill acquisition to encourage autonomous and optimal respiratory-swallowing coordination. Visual feedback of respiratory phase and volume for swallowing initiation was provided by nasal airflow and rib cage/abdomen signals.

Main Outcome Measures
Respiratory-swallow phase pattern, Modified Barium Swallow Impairment Profile™© (MBSImP) scores, Penetration Aspiration Scale (PAS) scores, M.D. Anderson Dysphagia Inventory scores

Results
Using visual feedback, patients were trained to initiate swallows during the mid-expiratory phase of quiet breathing and to continue to expire after swallowing. This optimal phase patterning increased significantly after treatment (p <0.0001). Changes in respiratory-swallowing coordination were associated with improvements in three MBSImP component scores: laryngeal vestibular closure (p = 0.0004), tongue base retraction (p <0.0001), and pharyngeal residue (p = 0.01). Significant improvements were also seen in PAS scores (p <0.0001). Relative to pre-treatment values, patients participating in one-month follow-up had increased optimal phase patterning (p <0.0001), improved laryngeal vestibular closure (p = 0.01), tongue base retraction (p = 0.003), and pharyngeal residue (p = 0.006) MBSImP scores, and improved PAS scores (p <0.0001).

Conclusions
Improvements in respiratory-swallowing coordination can be trained using a systematic protocol and respiratory phase-lung volume related biofeedback in patients with HNC and chronic dysphagia, with favorable effects on airway protection and bolus clearance.