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Nilsson, Håkan. "Quantitative aspects of swallowing with particular reference to disturbances of swallowing in neurological disorders /." Malmö : Dept. of Neurology, Malmö University Hospital, 1998. http://books.google.com/books?id=5ORqAAAAMAAJ.
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Chester, Christopher John. "Electrical-Impedance Biofeedback Instrumentfor Swallowing Rehabilitation." Thesis, University of Canterbury. Electrical and Computer Engineering, 2014. http://hdl.handle.net/10092/8961.
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Biofeedback is an important tool in the rehabilitation of several dysphagic conditions. This thesis presents an investigation into using bio-impedance as a technique for providing biofeedback of the swallowing sequence, specifically sequencing in the pharynx. The motivation behind this project was to find an alternative rehabilitation tool for detecting pharyngeal sequencing, as the current tool of pharyngeal manometry is invasive and non-portable. This investigation included the design and creation of a bio-impedance measuring device named the Guided Utility for Latency in Pharyngeal Sequencing (GULPS). This system was continued from a previous unpublished investigation at the University of Canterbury, where an initial prototype was designed and created. It was found that this pre-existing system had numerous faults in both its hardware and software, limiting the use of the device.
Electrical impedance across the throat can be determined by applying a known constant amplitude current signal across the throat and recording the corresponding voltage. This impedance has been shown to change during a swallowing sequence due to a change in the structure of the throat. The principle used in this project was to investigate if two positions of impedance measurement could be used to determine the sequencing of the pharynx during a swallow. The design of the GULPS device was influenced by the pre-existing system and several prototypes were built to obtain a system capable of providing two channels of impedance measurement. Software was adapted from the pre-existing system to interface with this hardware to provide a system that could be attached to an external computer.
Various electrode positions for the final device were trialled aimed at measuring two similar, but temporally separated, impedance waveforms. It was found that positioning the electrodes close to the approximate position of the pharynx with a 40 mm gap between channels allowed for two temporally separated channels to be produced with three distinct features: two peaks and one trough in each of the GULPS waveforms. The GULPS device with these electrode positions was trialled on three `healthy' subjects and one dysphagic subject. The three features could be identified in both impedance waveforms in all four subjects.
To determine if the identified features related to the sequencing of the pharynx, the GULPS device was trialled alongside the current conventional method for detecting pharyngeal sequencing, pharyngeal manometry. The results from these trials revealed a potential relationship between the temporal separation of the second peaks found in the GULPS waveforms and the temporal separation of the pressure peaks from pharyngeal manometry. The GULPS device was trialled alongside pharyngeal manometry on one `healthy' and one dysphagic subject. A linear regression between peak-to-peak latencies between the two methods had an R squared value of 0.347 for the `healthy' subject and 0.241 for the dysphagic subject. However, these peaks were often difficult to detect, and could only be detected in 64% of swallows in the `healthy' subjects using the GULPS device in a standalone fashion and in 23% of swallows when used concurrently with manometry.
As the current GULPS device is unable to produce the desired results in a consistent manner, no definitive conclusions can be drawn on the ability of using bio-impedance to measure the pharyngeal sequence. Notwithstanding, substantial progress has been made towards a device for reliable measurement of pharyngeal sequencing and, together with the clinical benefits to be gained, more than justify further research and development into GULPS for dysphagia rehabilitation.
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Kennedy, Daniel Lloyd, and n/a. "Measurement of intraoral pressure during normal swallowing." University of Otago. School of Dentistry, 2008. http://adt.otago.ac.nz./public/adt-NZDU20081211.160044.
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Aim: The aim of this research was to measure functional intraoral pressures using a newly developed method; specifically, three areas were examined. Firstly, this new approach to measurement allowed the equilibrium theory of tooth position to be re-addressed. Secondly, it allowed investigation the patterns of pressure change in the palatal midline during water swallowing. Lastly, this approach allowed a preliminary investigation of the affect of the viscosity of the food ingested on the pressures generated in the mouth.
Methods: The participants were 6 healthy volunteers (4 males, 2 females) recruited from the post-graduate students at the University of Otago, School of Dentistry. The age range was 25 to 35 years. All had full permanent dentitions, Angle Class I occlusions (normal) with acceptable overbite and overjet relationship, and none of them had a history of previous orthodontic treatment. For each of the subjects a cast chrome-cobalt baseplate was constructed to house 8 miniature strain gauge pressure transducers (Precision Measurement Co. Michigan). The location of the sensors were standardised as follows: Three sensors were paired on the buccal and lingual surfaces of the central, canine and first molar. Two palatal vault sensors were placed in the midline of the palate, one at level of the distal of the first premolar, and the second slightly anterior to the junction of the hard and soft palate. Simultaneous recordings were taken during a set of tasks including water swallows, saliva swallows and food ingestion.
Results: The results showed that swallowing was a highly complex wellcoordinated event, and that each individual had their own unique signature pattern of swallowing, characterised by pressure changes of high frequency, in excess of �1000 kPa/s.
Conclusions: The analysis of the pressure acting on the teeth showed that although the pattern and magnitude of pressure generated varied among the group, the observation of waveforms would suggest a tendency for no inherent balance between the buccal and the palatal pressures on the teeth during swallowing for any of the individuals tested.
This investigation of the pressure in the midline revealed an aspect previously not fully explored; these experiments showed that there were large and persistent negative pressures generated during swallowing, that preceded the positive pressures and which appear important in bolus propulsion
The patterns of swallowing and the magnitudes of pressure generated, changed with the different consistency of the various substances ingested. There was a general trend for increased pressures during swallowing of substrates that are more viscous; water showed the lowest pressures, followed by saliva and finally jelly.
Keywords: Tongue pressure, Intraoral pressures, Tongue dynamics, Swallowing.
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Manning, Robert K. "The Relationship of Knowledge of the Physiology of Normal and Abnormal Swallowing to Accuracy Interpreting Instrumental Observation of Swallowing." Ohio University / OhioLINK, 2002. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1015595609.
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Sundstedt, Stina. "Swallowing and deep brain stimulation : swallowing function in Parkinson's disease after subthalamic nucleus and caudal zona incerta deep brain stimulation." Licentiate thesis, Umeå universitet, Öron- näs- och halssjukdomar, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-86133.
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Background Swallowing problems are common in Parkinson’s disease, and these affect morbidity and mortality largely due to aspiration-induced pneumonia. Even mild dysphagia affects patient Quality of Life. Deep Brain Stimulation (DBS), a surgical treatment for Parkinson’s disease, improves overall motor function, though the effect of DBS on swallowing function is not clear. The aim of the studies in this thesis was to improve our understanding of the effect from DBS of caudal zona incerta and subthalamic nucleus on pharyngeal swallowing function. Specific aims were to compare DBS effects over time postoperatively (6 & 12 months) for swallowing function, on and off stimulation, with a preoperative baseline assessment in order to identify possible negative swallowing effects of DBS. Methods Eight patients with DBS in caudal zona incerta and eleven patients with DBS in subthalamic nucleus were included in the two studies. The effect of DBS on swallowing function was evaluated by self-estimation on a visual analogue scale and fiberoptic endoscopic evaluation of swallowing function with a predefined swallowing protocol including Rosenbek’s Penetration/Aspiration Scale, Secretion Severity Scale,preswallow spillage, pharyngeal residue and pharyngeal clearance. The patients with caudal zona incerta DBS also answered questions regarding swallowing-related Quality of Life. All patients received L-dopa treatment during postoperative assessments. Results There was no clear effect of DBS on swallowing function in the two samples. The occurrence of aspiration, secretions, pharyngeal residue or clearance was not affected by the surgery or the stimulation. In the subthalamic nucleus DBS sample, self-estimations revealed an improvement with stimulation turned on. For the caudal zona incerta DBS patients, no effect of DBS was seen on the results from the swallowing-related QOL questions. Conclusion Subthalamic nucleus DBS and caudal zona incerta DBS did not appear to have a negative effect on swallowing function in this cohort. Patients with subthalamic nucleus DBS reported a self-perceived improvement in swallowing function after DBS. There appears to be no increased risk for aspiration or penetration due to surgery or stimulation regardless of stimulation site. Since the sample sizes in these cohorts are small, the findings need to be confirmed in larger studies.
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Ling, Cheuk-ki Cora, and 凌卓錡. "Predictors of swallowing outcome in patients with tracheostomy." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206607.
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It is known that the incidence of aspiration is high in patients with tracheostomy. However, it is unclear which patient population with tracheostomy has a higher chance to aspirate. This study aims to determine the predictors of swallowing outcome of patients with tracheostomy. Eighty- three patients with tracheostomies who underwent videofloroscopy for swallowing were recruited in the study. Analysis was done on the presence of aspiration as well as the feeding status with respect to medical conditions and duration of tracheostomy. The prevalence of aspiration and silent aspiration were found to be high in patients with tracheostomy. The incidence of tube feeding was also found to be high in this patient population. Vocal cord paralysis was found to be a significant predictor of aspiration and silent aspiration in patients with tracheostomy. Head and neck cancer and vocal cord paralysis were found to be associated with tube feeding in patients with tracheostomy.published_or_final_version
Surgery
Master
Master of Medical Sciences
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Ragland, Mary C. "The Velocity of Hyolaryngeal Excursion in Normal Swallowing." Ohio University Honors Tutorial College / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ouhonors1400521302.
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Rosendall, Brigette Marie. "Mathematical modeling of the pharyngeal phase of swallowing /." Thesis, Connect to this title online; UW restricted, 1996. http://hdl.handle.net/1773/9888.
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Musto, F. "STANDARDIZED ELECTROMYOGRAPHIC ANALYSIS OF SWALLOWING AND CLINICAL APPLICATIONS." Doctoral thesis, Università degli Studi di Milano, 2017. http://hdl.handle.net/2434/476195.
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BACKGROUND AND AIMS. Swallowing is a complex function which needs coordination between all the structures involved. To date a non-invasive method for the instrumental evaluation of oro-pharyngeal phase of swallowing is lacking. The aims of this study were: phase 1) to develop an electromyographical (EMG) protocol for the assessment of submental muscles (SM), to demonstrate its repeatability and to apply it to maximal voluntary clench (MVC), to quantify the relative contribution of SM; phase 2) to electromyographically analyse the oropharyngeal phase of swallowing finding a standardized and repeatable protocol, to find the physiological muscular pattern involved and to draw the standard model. MATERIALS AND METHODS. In 20 healthy subjects, aged 19-35 years, surface electromyography of SM, masseter (MM) and anterior temporalis (TA) muscles was performed; for phase 1, during maximal voluntary clenching (MVC) with and without cotton rolls and the pushing of the tongue against the palate, while for phase 2 during swallowing. Clenching on cotton rolls and pushing the tongue against the palate were used to standardise respectively MM and TA, and SM muscular potentials. Both phases were repeated in two appointments (T1-T2); submental muscles standardisation (during phase 1) and swallowing (during phase 2) were also repeated twice (A-B) in each session to assess repeatability. RESULTS. Phase 1: symmetry and activity were calculated for each couple of muscles. A two-way analysis of variance was computed for SM: no Factor 1 (T1 vs T2) or Factor 2 (A vs B) or F1 X F2 significant effects were found. SM recruitment was 31% of the maximal activity, with symmetry values larger than 80%. Phase 2: symmetry, activity and duration of activation for each couple of muscles were detected. In addition the duration of the whole exercise and the time of the maximal spike of activation for each muscle were evaluated. A two-way analysis of variance similar to the one of phase 1 was computed : no Factor 1 (T1 vs T2) or Factor 2 (A vs B) or F1 X F2 significant effects were found. Symmetry values were close to 80% for all the muscles, recruitment values were between 22 and 28% of the maximal activity for all the muscles with differences between all the muscles (the MM were the less recruited, while the TA were the most activated). Also the duration of activation of each couple of muscles resulted to be different between all the couples, the MM showed the shortest activation (an average value of approximately 1 s), while the submental muscles the longest one (an average value of more than 1.5 s). The duration of the whole swallowing was found to be between 1.5 and 2 s. Finally, the results showed that all the couples of muscles had their spike of activation between 35.87 and 42.65% of their total duration of activation. The sEMG graphic assessment of the position of the spike was reliable (two-way analysis of variance). CONCLUSIONS. The protocol demonstrated a high repeatability of the EMG indexes both intra and inter-appointment for MVC. Regarding swallowing it is reported that the protocol was repeatable for all the analysed indexes, although an high inter-individual variability. These results are probably due to the existence of different physiological models of swallowing among healthy population.
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Whitmore, Efthalia. "The human upper oesophageal sphincter : a comparative study of its structure and compliance." Thesis, Queen Mary, University of London, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.294846.
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Mazhari, Seyed Babak. "An assessment of lattice Boltzmann method for swallowing simulations." Thesis, University of British Columbia, 2016. http://hdl.handle.net/2429/58288.
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Lattice Boltzmann is a fixed grid particle based method originated from molecular dynamics which uses a kinetic-based approach to simulate fluid flows. The fixed grid nature and simplicity of lattice Boltzmann algorithm makes it an appealing approach for preliminary swallowing simulations. However, the issues of compressibility effect and boundary/initial condition implementation can be the source of instability and inaccuracy especially at high Reynolds simulations. The current work is an assessment of the lattice Boltzmann method with respect to high Reynolds number flow simulations, compressibility effect of the method, and the issue of boundary and initial condition implementation. Here we investigate the stability range of the lattice Boltzmann single relaxation and multi relaxation time models as well as the issue of consistent boundary/initial condition implementation. The superior stability of multi relaxation time (MRT) model is shown on the lid-driven cavity flow benchmark as a function of Reynolds number. The computational time required for the SRT model to simulate the li-driven cavity flow at Re=3200 is about 14 times higher than the MRT model and it’s shown that computational time is related to the third power of lattice resolution. It is suggested that single relaxation time model is inefficient for simulations with moderately high Reynolds number Re>1000 and the use of multi relaxation time model becomes necessary. Compressibility effect is the next topic of study where the incompressible lattice Boltzmann method is introduced. The compressibility error of the method surpasses the spatial discretization error and becomes the dominant source of error as the flow Reynolds number increases. It is shown on a 2D Womersley flow benchmark that the physical time step required for LBM is about 300 times larger than the physical time step of the finite volume implicit solver while generating results with the same order of accuracy at Re=2000. Due to the compressibility error inherent to the method, lattice Boltzmann is not recommended for preliminary swallowing simulations with high Reynolds number, since implicit time advancement methods can generate results with the same order of accuracy in noticeably less computational time.Applied Science, Faculty of
Mechanical Engineering, Department of
Graduate
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Ma, Pingping. "Quantitative manofluorography for the evaluation of normal pharyngeal swallowing." Thesis, Georgia Institute of Technology, 1989. http://hdl.handle.net/1853/16106.
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Abdul, Wahab Norsila. "Modulation of swallowing behaviour by olfactory and gustatory stimulation." Thesis, University of Canterbury. Department of Communication Disorders, 2012. http://hdl.handle.net/10092/6574.
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Swallowing impairment or dysphagia can be a consequence of several neurological and anatomical disorders such as stroke, Parkinson’s diseases, and head and neck cancer. Management of patients with dysphagia often involves diet modification, sensory stimulation, and exercise programme with the primary goal being safe swallowing to maintain nutrition.
The aim of this project was to evaluate the effects of lemon odour and tastant on swallowing behaviour in healthy young adults. Specifically, the neural excitability and biomechanical characteristics of swallowing were measured in two studies. Neural excitability was evaluated by measuring motor-evoked potentials (MEPs) from the submental muscles which were evoked by transcranial magnetic stimulation (TMS) of the motor cortex. Biomechanical characteristics were evaluated through measures of submental muscle contraction, pressure changes in the oral cavity and pharynx, and the dynamics of the upper oesophageal sphincter (UES).
Two groups of volunteers (16 in each group) participated in two separate studies. In the MEP study, 25% and 100% concentrations of lemon concentrate were presented separately as olfactory and gustatory stimuli. The four stimuli were randomly presented in four separate sessions. The olfactory stimulus was nebulized and presented via nasal cannula. Filter paper strips impregnated with the lemon concentrate placed on the tongue served as the gustatory stimulus. Tap water was used as control. TMS-evoked MEPs were measured at baseline, during control condition, during stimulation, immediately poststimulation, and at 30-, 60-, and 90-min poststimulation. Experiments were repeated using the combination of odour and tastant concentration that most significantly influenced the MEP.
The biomechanical study used (a) surface electromyography (sEMG) to record contraction of the submental muscles, (b) lingual array with pressure transducers to record glossopalatal pressures, and (c) pharyngeal manometry to record pressures in the pharynx and the UES. Similar methods of presenting the stimuli were used to randomly present the 25% and 100% concentrations of lemon odour and tastant. All data were recorded concurrently during stimulation. The concentration of odour and tastant that produced the largest submental sEMG amplitude was selected for presentation of combined stimulation. Data were then recorded during combined stimulation and at 30-, 60-, and 90-min poststimulation.
Results from the MEP study showed increased MEP amplitude at 30-, 60-, and 90-min poststimulation during swallowing compared to baseline, but only for the combined stimulation. Poststimulation results from the biomechanical study showed decreased middle glossopalatal pressure at 30 min and decreased anterior and middle glossopalatal contact duration at 60 min. No poststimulation changes were found in sEMG and pharyngeal manometry measures. During combined odour and tastant stimulation, there were increased pressure and contact duration at the anterior glossopalatal contact and decreased hypopharyngeal pressure. Generally, these changes correspond to increased efficiency of swallowing.
In conclusion, these are the first studies to have measured the effects of flavour on neural excitability and biomechanics of swallowing and the first to have shown changes in MEP and several biomechanical characteristics of swallowing following flavour stimulation. These changes were present poststimulation, suggesting mechanisms of neural plasticity that may underlie potential value in the rehabilitation of patients with dysphagia.
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Savilampi, Johanna. "Effects of remifentanil on esophageal sphincters and swallowing function." Doctoral thesis, Örebro universitet, Institutionen för hälsovetenskap och medicin, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-42216.
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Han, Hyeju. "Temporal Characteristics of Oropharyngeal Swallowing in Toddlers with Dysphagia." Ohio University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1584994990563623.
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Alsanei, Woroud A. S. "Tongue pressure : a key limiting aspect in bolus swallowing." Thesis, University of Leeds, 2015. http://etheses.whiterose.ac.uk/10031/.
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Food oral processing is very basic activity of human life, providing individuals with pleasure, enjoyment and serving their needs for social interaction. Dysphagia describes a disorder affecting the safety and/or efficiency of swallowing. To manage this reduced ability, dysphagic individuals are often prescribed a diet having specific ranges of mechanical properties. As a result, a number of sectors such as food, pharmaceutical and health care industries are eagerly searching for fundamental knowledge in order to design food for vulnerable population. This thesis addresses this gap and aims to investigate the relationship between the mechanical properties of bolus swallowing (e.g. rheology, bolus manipulations, perceived ease / difficult of initiation swallowing and perceived bolus flow behaviour) along with oral pressures (i.e. generated by the tongue) recorded in healthy subjects. This area of oral processing is researched mostly from a clinical point of view and thus knowledge in oral processing from sensory view point is currently limited as shown in the literature review. In this study, some of existing clinical researches were extended using relevant techniques (such as maximum isometric tongue pressure, oral volume and oral residence time). Findings from this thesis demonstrated a strong correlation between sensory perception of bolus (e.g. ease / difficult of swallowing, ease of break-swallow, bolus flow) and subjective measurement of tongue pressure in context of ready-to-swallow food bolus with different rheological properties. Further experiments were conducted to mechanically characterise a range of viscoelastic and pastry food systems and measure the intra-oral pressures applied when breaking these foods. Data analysis showed that a positive correlation existed between tongue strength and oral food handling. From our results, we can conclude that individual’s capacity in tongue pressure generation needs to exceed a certain limit in order to perceive ease in swallowing bolus and also to perceive a bolus flow behaviour. However, such correlation was not seen for individuals with reduced capability in generating MITP. These results support the aim that both the oral physiological conditions (MITP) and the rheological properties of the food (bolus) are important factors that influence the bolus manipulations and comfortable oral handling as well as perceived ease of initiating bolus flow.
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Khlaifi, Hajer. "Preliminary study for detection and classification of swallowing sound." Thesis, Compiègne, 2019. http://www.theses.fr/2019COMP2485/document.
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Les maladies altérant le processus de la déglutition sont multiples, affectant la qualité de vie du patient et sa capacité de fonctionner en société. La nature exacte et la gravité des changements post/pré-traitement dépendent de la localisation de l’anomalie. Une réadaptation efficace de la déglutition, cliniquement parlant, dépend généralement de l’inclusion d’une évaluation vidéo-fluoroscopique de la déglutition du patient dans l’évaluation post-traitement des patients en risque de fausse route. La restriction de cette utilisation est due au fait qu’elle est très invasive, comme d’autres moyens disponibles, tels que la fibre optique endoscopique. Ces méthodes permettent d’observer le déroulement de la déglutition et d’identifier les lieux de dysfonctionnement, durant ce processus, avec une précision élevée. "Mieux vaut prévenir que guérir" est le principe de base de la médecine en général. C’est dans ce contexte que se situe ce travail de thèse pour la télésurveillance des malades et plus spécifiquement pour suivre l’évolution fonctionnelle du processus de la déglutition chez des personnes à risques dysphagiques, que ce soit à domicile ou bien en institution, en utilisant le minimum de capteurs non-invasifs. C’est pourquoi le principal signal traité dans ce travail est le son. La principale problématique du traitement du signal sonore est la détection automatique du signal utile du son, étape cruciale pour la classification automatique de sons durant la prise alimentaire, en vue de la surveillance automatique. L’étape de la détection du signal utile permet de réduire la complexité du système d’analyse sonore. Les algorithmes issus de l’état de l’art traitant la détection du son de la déglutition dans le bruit environnemental n’ont pas montré une bonne performance. D’où l’idée d’utiliser un seuil adaptatif sur le signal, résultant de la décomposition en ondelettes. Les problématiques liées à la classification des sons en général et des sons de la déglutition en particulier sont abordées dans ce travail avec une analyse hiérarchique, qui vise à identifier dans un premier temps les segments de sons de la déglutition, puis à le décomposer en trois sons caractéristiques, ce qui correspond parfaitement à la physiologie du processus. Le couplage est également abordé dans ce travail. L’implémentation en temps réel de l’algorithme de détection a été réalisée. Cependant, celle de l’algorithme de classification reste en perspective. Son utilisation en clinique est prévueThe diseases affecting and altering the swallowing process are multi-faceted, affecting the patient’s quality of life and ability to perform well in society. The exact nature and severity of the pre/post-treatment changes depend on the location of the anomaly. Effective swallowing rehabilitation, clinically depends on the inclusion of a video-fluoroscopic evaluation of the patient’s swallowing in the post-treatment evaluation. There are other available means such as endoscopic optical fibre. The drawback of these evaluation approaches is that they are very invasive. However, these methods make it possible to observe the swallowing process and identify areas of dysfunction during the process with high accuracy. "Prevention is better than cure" is the fundamental principle of medicine in general. In this context, this thesis focuses on remote monitoring of patients and more specifically monitoring the functional evolution of the swallowing process of people at risk of dysphagia, whether at home or in medical institutions, using the minimum number of non-invasive sensors. This has motivated the monitoring of the swallowing process based on the capturing only the acoustic signature of the process and modeling the process as a sequence of acoustic events occuring within a specific time frame. The main problem of such acoustic signal processing is the automatic detection of the relevent sound signals, a crucial step in the automatic classification of sounds during food intake for automatic monitoring. The detection of relevant signal reduces the complexity of the subsequent analysis and characterisation of a particular swallowing process. The-state-of-the-art algorithms processing the detection of the swallowing sounds as distinguished from environmental noise were not sufficiently accurate. Hence, the idea occured of using an adaptive threshold on the signal resulting from wavelet decomposition. The issues related to the classification of sounds in general and swallowing sounds in particular are addressed in this work with a hierarchical analysis that aims to first identify the swallowing sound segments and then to decompose them into three characteristic sounds, consistent with the physiology of the process. The coupling between detection and classification is also addressed in this work. The real-time implementation of the detection algorithm has been carried out. However, clinical use of the classification is discussed with a plan for its staged deployment subject to normal processes of clinical approval
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Wong, Yew Mun. "Improving recognition and management of swallowing difficulties with medicines." Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/203193/1/Yew%20Mun_Wong_Thesis.pdf.
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This thesis looked at improving the screening and management of people who dislike swallowing solid oral medicines e.g. tablets and capsules. A novel screening tool was developed and validated to assist healthcare professionals in quickly identifying people who dislike swallowing tablets and capsules. A clinical trial was run to look at whether pill-swallowing aids made it easier for people to swallow tablets. The findings from the thesis may provide useful information with regards to managing people who dislike swallowing solid oral medicines, and information about pill-swallowing aids that aim to make solid oral medicines easier to swallow.
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PIZZORNI, NICOLE. "DYSPHAGIA IN NEURODEGENERATIVE DISEASES: SWALLOWING PROFILES AND NUTRITIONAL RISK." Doctoral thesis, Università degli Studi di Milano, 2020. http://hdl.handle.net/2434/697889.
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The PhD dissertation focuses on the topic of dysphagia in neurodegenerative diseases. The first aim was to investigate the frequency of dysphagia in 55 patients with different stages of Huntington’s disease through an instrumental assessment of swallowing. Dysphagia was found in 30% of the patients in the early stage, in 90% of patients in the moderate stage, and in all patients in the advanced stage. Diagnostic accuracy of a neurological clinical scale was investigated and a cut-off was identified to guide the neurologists in the referral to the swallowing team. A second study analyzed the association between maximum tongue pressure and signs of dysphagia during fiberoptic endoscopic evaluation of swallowing in patients with Amyotrophic Lateral Sclerosis. Results showed that patients with residue in the pyriform sinus had lower maximum tongue pressure. Measuring maximum tongue pressure in patients with Amyotrophic Lateral Sclerosis may provide additional information on swallowing function and may potentially represent a marker for eating-related fatigue. Chapter 4 describes the development and validation of the Mealtime Assessment Scale (MAS), a clinical protocol to assess swallowing safety and efficacy during meal. Finally, the association between dysphagia and risk of malnutrition was investigated in 162 patients with neurodegenerative diseases (Huntington’s disease, Parkinson’s disease, and Amyotrophic Lateral Sclerosis). Age, type of oral intake, residue in the valleculae with semisolids, penetration with liquids, swallowing safety during meal, number of masticatory cycles, and oral phase duration were significantly associated with risk of malnutrition in three neurodegenerative diseases, but only age and swallowing safety during the meal were independent predictors of malnutrition risk. Clinical implications of the studies are discussed.
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McKee, Gary John. "Pressure change in the pharynx during swallowing in normal subjects." Thesis, Queen's University Belfast, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.337045.
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Kulneff, Linda, Stina Sundstedt, Katarina Olofsson, Doorn Jan van, Jan Linder, Erik Nordh, and Patric Blomstedt. "Deep brain stimulation : effects on swallowing function in Parkinson's disease." Umeå universitet, Logopedi, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-61453.
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Objective: In patients with Parkinson’s disease (PD), deep brainstimulation of the subthalamic nucleus (STN DBS) is well recognizedin improving limb function, but the outcome on swallowing functionhas rarely been studied. The aim of this work was to evaluate theeffect of STN DBS on pharyngeal swallowing function in patientswith PD using self-estimation and fiberoptic endoscopic evaluation ofswallowing. Methods: Eleven patients (aged 41–72, median 61 years)were evaluated preoperatively and at 6 and 12 months after STN DBSsurgery. All patients were evaluated with self-estimation on a visualanalogue scale, and eight of them with a fiberoptic endoscopicexamination with a predefined swallowing protocol includingRosenbek’s Penetration-Aspiration Scale, Secretion Severity Scale,preswallow spillage, pharyngeal residue, and pharyngeal clearance. Results: The self-assessments of swallowing function revealed asubjective improvement with STN DBS stimulation, whereas the datafrom the swallowing protocol did not show any significant effect ofthe STN DBS treatment itself. The prevalence of aspiration was notaffected by the surgery. Conclusions: The results show thatswallowing function was not negatively affected by STN DBS and therisk of aspiration did not increase. Self-estimation of swallowingfunction showed a subjective improvement due to stimulationSpeech, voice and swallowing outcomes after deep brain stimulation (DBS)
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Athukorala, Ruvini Piyadarshika. "Skill training for swallowing rehabilitation in individuals with Parkinson's disease." Thesis, University of Canterbury. Communication Disorders, 2012. http://hdl.handle.net/10092/6936.
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The primary aim of this pilot study was to evaluate the effects of a novel dysphagia rehabilitation approach: skill training on swallowing in individuals who have dysphagia secondary to Parkinson’s disease. The secondary objective was to assess skill retention following treatment termination. This within-subject study involved 10 patients with Parkinson’s disease who met the inclusionary criteria.
All participants underwent two baseline data collection sessions, conducted two weeks apart. Data collected included the water swallow test, Test of Mastication and Swallowing Solids (TOMASS), ultrasound measurement of hyoid movement and cross-sectional area of submental muscles, surface electromyography (sEMG) of submental muscles, and swallowing-related quality of life questionnaire (SWAL-QOL). Patients then underwent 10 sessions over two weeks of skill training therapy using custom-designed sEMG software. The focus of the treatment was producing swallowing tasks with defined and adjustable temporal and amplitude precision. The skill training treatment phase was followed by an immediate post-intervention assessment session and two weeks later by a retention assessment session. All outcome measures were administered at each data collection point. The study consisted of a total of 14 laboratory sessions, conducted over a six-week period per subject.
Results revealed significant improvements in swallowing efficiency for liquids, reduced durational parameters on sEMG, such as pre-motor time (PMT), pre-swallow time (PST), and duration of submental muscle contraction. There was a functional carry-over effect seen from dry swallows, which were the focus of training, to water swallows, which were not directly trained. Additionally, improvements in swallowing-related quality of life were demonstrated.
In conclusion, the skill training approach evaluated in this research is able to produce functional, biomechanical, and swallowing-related quality of life improvements in patients with Parkinson’s disease. This indicates the potential effectiveness of this novel approach for dysphagia rehabilitation in this population. However, replication with a larger number of patients with Parkinson’s disease is needed before findings can be generalised to the larger population
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Sarraf, Shirazi Samaneh. "Acoustical analysis of the swallowing mechanism for diagnosis of dysphagia." Springer, 2011. http://hdl.handle.net/1993/23974.
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Swallowing dysfunction (dysphagia) is a common disorder in patients with neurological impairments, head/neck injuries or brain-stem stroke. The main objectives of this thesis were to use acoustical analysis of swallowing and breath sounds for 1) understanding the swallowing mechanism and the main cause of dysphagia, and 2) developing a noninvasive diagnostic technology to detect swallowing aspiration (the entry of bolus into airway); thus, identifying individuals at high risk of severe dysphagia.
As the first objective of the study, swallowing mechanism modeling in two groups of healthy individuals and dysphagic patients (due to cerebral palsy or stroke) was approached by using two different assumptions to relate the swallowing sounds either to the pharyngeal response or to the neural activities that initiate the swallow. The results showed that the model with the assumption of neural activities as the cause of dysphagia was a better fit to the available data.
As the second main objective of the study, we analyzed breathing and swallowing sounds of 50 dysphagic individuals during the fiberoptic endoscopic evaluation of swallowing (FEES) or the videofluoroscopic swallowing study (VFS). The results showed 91% sensitivity and 85% specificity in identifying patients with severe aspirations. Also, the algorithm was able to detect the silent aspiration among the swallows of each patient.
The proposed methods led to development of a non-invasive and reliable diagnostic/screening tool as an aid to the clinical examination of swallowing. The proposed acoustic method can be performed at the patients’ bedside to determine the appropriate further assessment or a dietetic treatment; thus, reducing the health care cost by prioritizing the patients’ referrals to the VFS/FEES tests.
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Zeidler, Stephanie J. "ULTRASONIC NORMATIVE SWALLOWING DATA IN THREE/FOUR YEAR OLD CHILDREN." Miami University / OhioLINK, 2007. http://rave.ohiolink.edu/etdc/view?acc_num=miami1177036048.
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Erol, Rosalind A. "An investigation of the use of electrical impedance tomography to measure the transport of food and gastric contents between the human stomach and oesophagus." Thesis, University of Sheffield, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.388704.
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Patterson, Joanne Margaret. "Swallowing in head and neck cancer patients treated by (chemo) radiotherapy." Thesis, University of Newcastle Upon Tyne, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.545765.
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Sella, Oshrat. "Skill versus Strength in Swallowing Training: Neurophysiological, Biomechanical, and Structural Assessments." Thesis, University of Canterbury. Communication Disorders, 2012. http://hdl.handle.net/10092/7767.
Full textAbstract:
Swallowing is a complex sensorimotor behaviour that includes precisely-timed bilateral activation and relaxation of muscles of the face, lips, tongue, cheeks, palate, larynx, pharynx and oesophagus. These events of activation and inhibition are controlled by many structures of the brain and are executed by cranial nerves that carry motor and sensory information to and from the swallowing muscles.
Swallowing disorders are common sequelae of many neurological and structural disorders, including stroke, Parkinson’s disease, and head and neck cancer. Changes to swallowing physiology are also prevalent in older individuals, but these changes do not necessarily translate to dysphagia. Decreased muscle strength, changes to motor unit properties, and hypotrophic changes in skeletal muscles can result in age-related changes in swallowing physiology. In addition to muscular changes, neural changes might also change swallowing function in older subjects.
The motor-learning literature presents a clear distinction between the differential applications and effects of skill- and strength-training approaches for rehabilitation of limb movement. In contrast to limb-movement rehabilitation, swallowing rehabilitation approaches consist mainly of strength training, although the pathophysiological basis for dysphagia is not always weakness. Therefore, this Phase I clinical-trial critically evaluated a unique swallowing skill training protocol in which the goal of intervention is to increase precision of motor control during swallowing. A Phase I clinical-trial was necessary to identify the appropriate protocol for inducing neurophysiological, biomechanical, and structural adaptations, to estimate effect sizes, and to identify adverse effects.
The first and primary question addressed in this thesis was whether swallowing skill training would produce greater physiological effects in healthy subjects than a traditional swallowing strength training approach. In order to answer this question, three levels of assessment were included. Neurophysiological assessment consisted of delivering single-pulse transcranial magnetic stimulation (TMS) over the M1 area that sends efferent projections to the submental muscle group during a functional task of volitional saliva swallowing, and during a non-functional task of submental muscle group contraction. Biomechanical assessments consisted of pharyngeal and upper esophageal sphincter (UES) pressure measurements using pharyngeal manometry during effortful and non-effortful swallowing tasks, submental muscle activation measurements using surface electromyography (sEMG) during effortful and non-effortful swallowing tasks, and hyoid displacement using ultrasonography. Structural assessment consisted of measuring the cross sectional area of the submental muscle group. Finally, motor performance during training, and subjective ratings of the training protocols were assessed. Two skill training protocols were developed to assess the use of immediate versus delayed visual feedback in swallowing skill training. In addition, a pilot study aimed at examining the effects of increased dosage of training sessions was conducted.
Forty healthy subjects (20 young, and 20 old; 20 females and 20 males) were allocated to skill and strength training groups in a counterbalanced manner. Strength training consisted of execution of the effortful swallowing technique targeting increased demand for strength. Skill training targeted precise timing and force execution during swallowing execution. Several motor-learning principles were considered in devising the training protocols, including the principles of task specificity and high intensity of training. Biofeedback was included to promote motor learning. Since the submental muscle group plays an important role in hyolaryngeal excursion, the current study utilized submental sEMG biofeedback using custom-made training software. The training protocols consisted of 1000 repetition of swallowing over a 2-week period. Subjects trained for an hour, five days a week, for 2 weeks (i.e., 10 training sessions). The extended dosage protocol included 10 subjects and comprised an additional eight sessions.
The results indicated that there was a significant difference in submental activation following training, with strength training having an increase in sEMG peak amplitude in comparison to skill training. There were no other differences between groups at the 5% error level. Patterns of change were revealed when marginally significant results (0.05 < p ≤ 0.10) were investigated as well. Strength training resulted in a trend towards increased neural drive for volitional effortful-type tasks (i.e., effortful saliva swallowing, effortful water swallowing, and submental muscle contraction) as indicated by increased MEP magnitude (p = 0.07) which was consistent with significantly increased peak amplitude of submental activity measures (p < 0.001). This finding supports the task specificity principle of motor learning. Skill training resulted in no changes in MEP magnitude. There was a trend (p = 0.06) towards increased submental muscles activity during functional swallowing tasks (i.e., non-effortful swallowing) in young subjects,. Males in skill training had decreased duration of UES opening in 10 mL water effortful swallowing task (p = 0.02), a trend towards increased UES pressure in non-effortful saliva swallowing task (p = 0.07), and reduced hyoid displacement following training (p < 0.001). Changes in pharyngeal pressures were detected for skill training with delayed visual feedback that resulted in decreased pressure at mid-pharynx in effortful and non-effortful tasks (p < 0.05). No difference in submental CSA changes was detected in either training group. Both groups improved motor performance measured by data collected during the session (target hit-rate and muscle activity).
The results of the pilot study that examined the effects of an extended dosage of training were difficult to interpret due to the small sample size. However, there were significant and marginally significant effects of skill training on mid-pharyngeal and UES pressure duration events.
Dysphagia is common in patients with Parkinson’s disease, but no specific training programme exists for these patients, leading to the second question addressed through this research. Since movement planning is compromised due to dysfunction of the basal ganglia, providing external information for planning and executing swallowing was hypothesized to alleviate dysphagic symptoms. Ten subjects were recruited. Swallowing skill training with immediate feedback was administered for one hour every day, five days a week, for 2 weeks, similar to the training dosage and frequency in the healthy group. Biomechanical and structural changes were assessed. Swallowing skill training with immediate feedback led to an increase in submental activity in effortful swallowing tasks but not non-effortful tasks. In addition, it was found that individuals with dysphagia secondary to Parkinson’s disease have deceased submental muscle reserve relative to healthy subjects.
Preliminary analysis of MEP data led to exploration of submental MEP measures between younger and older subjects. This ‘discovery’ research shed light on the third topic addressed in this thesis. There are contradicting results in the literature regarding age-related brain activity during swallowing. Since submental MEPs were included as an outcome measure in the main study, it was important to evaluate them at baseline in order to understand and interpret changes in this measure. Unlike other measures, such as pharyngeal pressure and hyoid displacement that have been documented in the literature to change with age, no similar study has been conducted to assess for differences in swallowing-related MEPs. Baseline data from the main study were analysed. Older subjects produced larger MEP magnitude in comparison to young in volitional saliva swallowing and volitional submental contraction. This finding raised some questions regarding the use of MEPs as an outcome measure, since it is not clear what constitutes a ‘positive’ change.
This study documented, for the first time, the application of skill training in swallowing in a healthy and dysphagic population. Positive effects of treatment were found in the dysphagic group; an indication of negative effects was identified in the healthy group. In addition, this is the first study to compare skill to strength training in swallowing. The only significant difference between the two was significantly greater submental activation in effortful swallowing tasks following strength training in comparison to skill training; although there were some significant interactions between age and training type and gender and training type. This project represents the first Phase I clinical-trial of an innovative approach for addressing swallowing impairments. Achieving the ultimate aim of finding the most appropriate training protocol for treating individuals with a specific pathophysiological basis of dysphagia, requires the implementation of a long-term on-going research programme characterized by a staged process. This research programme sets an initial reference framework from which further projects can estimate the sample size required to answer specific questions, control for effects of age and gender and their interaction with training, increase precision in choosing assessment tools, and test new specific questions.
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Sundstedt, Stina. "Swallowing function in patients with Parkinson’s disease and Deep Brain Stimulation." Doctoral thesis, Umeå universitet, Öron- näs- och halssjukdomar, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-127116.
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Background Parkinson’s disease (PD) is one of the most common neurodegenerative diseases in Europe. Besides motor dysfunction, PD is characterized by several non-motor and secondary motor features, such as weight change, sialorrhea, constipation and swallowing problems. Of these, swallowing is one of the most critical, as it is associated with aspiration pneumonia and consequently is the comorbidity with the highest mortality rate. Swallowing problems affect four of every five patients with PD, and even mild swallowing problems have notable psychosocial effects for patients and their caregivers. Consequently, it is essential to find treatment strategies for PD that may alleviate symptoms for patients with swallowing problems and their potential consequences. Deep Brain Stimulation (DBS) is a surgical treatment option for PD, which improves overall motor function and quality of life, but its effect on swallowing function is not clear. The purpose of this thesis was to contribute to the understanding of the effect of deep brain stimulation in the subthalamic nucleus (STN DBS) and the caudal zona incerta (cZI DBS) on pharyngeal swallowing function and on swallow-specific quality of life in patients with PD. The specific aims were to assess longitudinally the effect of STN DBS and cZI DBS on swallowing at 6 and 12 months postoperatively, in order to identify possible effects of the DBS on swallowing function. In addition, the effects of cZI DBS on ratings of swallowing-related non-motor and secondary motor features such as body weight changes, sialorrhea and speech problems were to be assessed. Methods Eleven PD patients with STN DBS (Paper I) and seventeen patients with cZI DBS (Paper II-IV) were included in this thesis. All patients were evaluated preoperatively and 6 and 12 months postoperatively. The effect of STN DBS and cZI DBS on swallowing was assessed with Fibreoptic-Endoscopic Evaluation of Swallowing (FEES) according to a predefined protocol including Penetration-Aspiration scale, Secretion Severity scale, preswallow spillage, pharyngeal residue, and pharyngeal clearance. Self-assessments were addressed using a visual analogue scale. The cZI DBS patients also completed the Swallowing Quality of Life (SWAL-QOL) questionnaire. Weight changes measured by Body Mass Index, and specific items from the Unified Parkinson’s Disease Rating Scale were also examined. Nine controls without PD were included in Paper IV, by answering the SWAL-QOL questionnaire. Results No clear effect of DBS on swallowing function or swallow-specific quality of life could be observed. There was no effect of DBS on the occurrence of aspiration, secretion, pharyngeal residue or clearance in the study groups with STN DBS or cZI DBS. Patients with STN DBS reported a subjective improvement in swallowing function with DBS stimulation turned on at 6 and 12 months after surgery. In patients with cZI DBS, the median body mass index was postoperatively increased with 1.1kg/m2 and the median increase in weight were +3.0 kg after 12 months with cZI DBS. The scores from the SWAL-QOL questionnaire were high overall in the group with cZI DBS, and the scores were unaffected by the cZI DBS surgery and stimulation. The SWAL-QOL total score was not significantly different between the PD patients and the controls, but the scores from the ‘burden’ and the ‘symptom’ subscales were worse in PD patients. Conclusions STN DBS or cZI DBS did not have a negative effect on swallowing function or ratings of swallow-specific ‘quality of life’ aspects in this cohort. Patients with STN DBS reported a self-perceived improvement in swallowing function when DBS was turned on. With regard to swallowing, patients with cZI DBS had an overall good quality of life throughout the conduct of the study and their swallow-specific quality of life was not negatively affected by cZI DBS. There seems to be no increased risk for aspiration or penetration due to surgery or stimulation for either the STN DBS or the cZI DBS groups. cZI DBS caused weight gain postoperatively. Since the sample sizes in these cohorts are small, the findings need to be confirmed in larger studies.
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Dasari, Ganeshram. "Entropy and Fractal Dimension of the Surface Electromyographic Signals During Swallowing." University of Akron / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=akron1302246036.
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SCARBOROUGH, DONNA RUSSELL. "CONSEQUENCES OF INTERRUPTING NORMAL NEUROPHYSIOLOGIC DEVELOPMENT: IMPACT ON PRE-SWALLOWING SKILLS." University of Cincinnati / OhioLINK, 2002. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1014663977.
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Scarborough, Donna Russell. "Consequences of interrupting normal neurophysiologic development impact on pre-swallowing skills /." Cincinnati, Ohio : University of Cincinnati, 2002. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=ucin1014663977.
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Nagaya, Masahiro, Teruhiko Kachi, Takako Yamada, and Yasunori Sumi. "Videofluorographic observations on swallowing in patients with dysphagia due to neurodegenerative diseases." Nagoya University School of Medicine, 2004. http://hdl.handle.net/2237/5400.
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Masilamoney, Mehrusha. "Medicine use in swallowing-impaired patients: Pharmacists’ knowledge, practice and information needs." Thesis, Rhodes University, 2018. http://hdl.handle.net/10962/61940.
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Dysphagia, or swallowing impairment, is a growing problem that affects 13.5% of the general population. The ability to swallow is essential for patients taking oral medicines, so this presents a challenge for swallowing-impaired (SI) patients as tablets and capsules will usually require modification prior to ingestion. Pharmacists should play a central role in advising SI patients about their medicine use, as well as problems that may impact on safety, adherence and therapeutic outcome. However, little is known about pharmacists’ level of knowledge, their practice and their information needs when dealing with SI patients and their use of medicines. The aim of this study was to investigate pharmacist knowledge, practice and information needs relating to the support of SI patients and their medicine-related needs. The study design included both quantitative and qualitative methods. A quantitative questionnaire was developed to collect data on the knowledge, practice and information needs of pharmacists and was piloted in 10 pharmacists, which resulted in minor modifications. The questionnaire was converted to a web-based survey and emailed to all pharmacists registered with the South African Pharmacy Council. Two knowledge scores were generated by summating correct responses: knowledge of dysphagia (KOD) and knowledge of medicine use (KOMU) in SI patients. Correlation analysis was used to investigate the strength of the relationship between specific variables with KOD and KOMU using the Pearson correlation coefficient. Qualitative semi-structured interviews were conducted with pharmacists from community, hospital and primary healthcare clinics in both a small town and a major metropole. The aim was to gain deeper understanding of issues arising from the survey, and to explore preferences for topic-specific information materials. All interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyse the data. A total of 439 pharmacists responded to the survey, with 67% being females.The mean KOD score out of a maximum score of 10 was 6.1 ± 1.8. KOD was inadequate (<5) in just over one-third (37.8%) of pharmacists. The mean KOMU score achieved (maximum score 17) was 9.4 ± 2.0, with inadequate knowledge (<10) being established in just over two-thirds of pharmacists (70.8%). Age, length of registration as a pharmacist, and years of practice in a setting with direct patient interaction were significantly but weakly correlated with KOMU, whereas KOD showed no significant association with these variables. Qualification significantly influenced both KOD and KOMU; the highest group with adequate knowledge had either a Masters or a PharmD degree. Fewer than half the pharmacists (44%) never ask patients about their swallowing ability, and most (86%) reported no knowledge of locally available viscosity enhancers. Almost all pharmacists were interested in receiving information materials on assisting SI patients with their medicine use. Three major themes emerged from the semi-structured interviews. Pharmacists recognised their knowledge deficit and felt that lack of both undergraduate training and formal training during practice, as well as limited exposure to SI patients, were contributing factors. Barriers to their practice with SI patients included lack of time, lack of institutional support and lack of easily accessible references on the pharmacists’ role in supporting medicine use in SI patients. Lastly, most pharmacists were not prepared to take ownership of medicine-related problems in SI patients and had conflicting opinions of the pharmacists’ role, usually shifting the responsibility of medicine use in SI patients to nurses. This is the first study to investigate pharmacist knowledge of medicine use in SI patients. The findings indicate that pharmacists do not have the requisite knowledge when dealing with SI patients and their medicine-taking issues despite being the most highly trained healthcare professionals in this field. Lack of undergraduate training, in-house training and limited exposure to SI patients were reported to contribute to poor knowledge. Current practice revealed that there appears to be poor communication among different healthcare professionals, pharmacists were reluctant to work with and/or train nurses on appropriate medicine use in SI patients, and there appeared to be ambiguity surrounding the role of a pharmacist. This research identified that pharmacists regard this topic to be highly relevant to their everyday practice and are keen to receive more information and training relating to this area of study. Information materials were designed and will be made accessible to all pharmacists registered in South Africa.
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Thanos, Akrivi Viki. "Effects of lateral sensorimotor cortex lesions on the temporal organization of swallowing." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0001/MQ42214.pdf.
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Wong, Oi-chi, and 王藹慈. "Evidence-based bedside swallowing assessment by nurses for the patients with stroke." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48339301.
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Background and Purpose
Stroke is the loss of brain’s function caused by hypoxia of brain cells depending on the severity and the location of the stroke. In Hong Kong, strokes are the 4th leading cause of death and morbidity in the year of 2010. Dysphagia is a common morbidity related to stroke. Approximately, 50% of stroke patients with dysphagia are suffered with aspiration and aspiration pneumonia which may lead to increased length of stay in hospitals, mortality rate and medical costs. An early nursing dysphagic screening and assessment protocol can help in early detect of dysphagia and therefore help to reduce incidence of aspiration and pneumonia. In order to understand the effectiveness of the nursing dysphagic screening and assessment protocol for the acute stroke patients, a number of studies have been reviewed to gather evidences for the translational research. A bedside nursing swallowing screening and assessment for patients with stroke is developed by incorporating findings from the literature review.
Review Question
In comparison to the routine care, is the nursing dysphagia assessment intended for the acute stroke patients more effective in reducing (1) the waiting time for having swallow assessment and the (2) the incidence of aspiration and pneumonia?
Methods
A systematic review of literatures from Ovid Medline (from 1946 to 2012), Pubmed (all dates), CINAHL Plus (from 1971 to 2012) and China Journal Net (from 1912 to 2012) was conducted. Five studies of bedside swallow screening and assessment that can be performed by nurses were selected and critically appraised using the recognized assessment criteria.
Results
The key components identified from the reviewed studies including swallowing assessment should be performed by trained nurses and acute stroke patients should be alert and able and can keep the sit up position during the swallowing assessment. Moreover, water swallowing test must be included as a part of the swallow assessment and assessment should best be performed in daily basic. Patients should be keeping nil of mouth when they failed the screening and referred for further assessment and management. Implementation potential in terms of transferability, feasibility and the cost benefit ratio of the proposed innovation were assessed. A communication plan was developed for the integration of the proposed innovation into the clinical setting. Outcome measures such as positive predictive value of detecting dysphagia, mean waiting time of waiting the initial swallow screening, occurrence of pneumonia, staff knowledge and compliance were identified to evaluate the effectiveness of the proposed innovation and guideline.
Conclusion
The findings of this systematic review showed that the nursing dysphagic swallow screening and assessment is effective in detecting the dysphagia of the acute stroke patients. Further development of the proposed innovation will be conducted in the clinical setting in order to satisfy the needs of the acute stroke patients.published_or_final_version
Nursing Studies
Master
Master of Nursing
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Lippitt, Alex. "Development of a bioimpedance-based swallowing biofeedback device with smart device integration." Thesis, University of Canterbury. Electrical and Computer Engineering, 2015. http://hdl.handle.net/10092/10975.
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Low resolution pharyngeal manometry is an invasive diagnostic method that has recently been used as a biofeedback device for swallowing rehabilitation. The University of Canterbury Rose Centre uses pharyngeal manometry to diagnose and rehabilitate subjects who suffer from pharyngeal mis-sequencing. Pharyngeal mis-sequencing occurs when pressure is applied simultaneously throughout the pharynx rather than sequentially. Rehabilitation can only be performed in clinic due to the need for specialized equipment and trained staff, and the invasiveness of the test limits the time that can be spent training.
As an alternative method to measure the pharyngeal pressure sequence, bioimpedance has been investigated by a previous University of Canterbury Master’s student. A prototype was developed that measured bioimpedance in two locations as a proxy for pharyngeal pressure sequence. The prototype device named GULPS (Guided Utility for Latency in Pharyngeal Swallowing), measured a change in impedance during swallowing. However, the features of this waveform were inconsistent and were not present during every swallow.
The frequency of the current that passes through tissue affects its path through the tissue, therefore impacting the measured impedance. To improve the consistency of the impedance measurement, the effect of current injection frequency was investigated. A modular-hardware system was created from the original design to allow testing of different injection frequencies. The hardware was further developed by replacing the method of generating the constant amplitude current injection signal.
The improvement to the design resulted in a differently-shaped waveform to that of the previous prototype, including a new feature. This feature is a single peak that occurred in both channels and was reproduced in every swallow. Experimentation showed that the features were not obviously frequency dependent. The separation between the peaks of the two impedance channels was compared with the separation between the two pressure peaks recorded during simultaneous pharyngeal manometry but there was no significant correlation between the two measures of peak-peak separations.
Two alternative hardware/signal conditioning changes were trialled: electrical isolation of each channel and a subtraction method, which aims to remove the effect of the changing impedance between the two electrode channels. Electrical isolation of the two channels had no effect on the impedance waveforms. However, the subtraction method produced a different output and requires further investigation as the output was inconsistent.
Bluetooth communication was integrated into the GULPS hardware, and a corresponding Android Application (App) was written. The developed App was successful in displaying the impedance measurement output and adds greater user flexibility, allowing the user to interface with the bioimpedance measurement hardware from their tablet or phone.
With no measured significant correlation between GULPS and pharyngeal manometry, further research needs to be performed to better relate the features measured by GULPS to those seen during pharyngeal manometry. Until this can be achieved, the GULPS device cannot replace pharyngeal manometry for biofeedback-based rehabilitation of pharyngeal mis-sequencing.
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Alhussain, Kholoud Mohammed A. "Swallowing changes in people with Parkinson's in Saudi Arabia : perceptions and practices." Thesis, University of Newcastle upon Tyne, 2017. http://hdl.handle.net/10443/3732.
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The aim of this research was to explore the experience of swallowing changes in people with Parkinson’s (PwP) in Saudi Arabia and their impact on both PwP and their families. The impact of eating and drinking changes in neurological conditions has not been thoroughly studied and the influence of culture on how people deal and cope with swallowing changes also has been neglected. There are very few studies on Parkinson’s carried out in Saudi Arabia and none have looked at the impact of these changes on both the PwP and their families. This is a qualitative study, using semi-structured interviews with 39 participants PwP and their carers and a focus group with three speech and language therapists. The interviews and focus group were transcribed verbatim, translated into English and were analysed using thematic analysis. The main themes categories that emerged are ‘the whole meal is awkward’, ‘we all have Parkinson’s’ and ‘I leave it all to Allah’. There was a close link between cultural context and how eating and drinking changes manifested and impacted on individuals and families. The role of the older person in Saudi culture during meals as well as gender roles within a Saudi family strongly influenced how PwP felt about their restricted eating abilities. The influence of Islamic beliefs was apparent in both the PwP and the caregivers’ interviews. It shaped how they dealt with Parkinson’s, how they interpreted symptoms and change, their views on rehabilitation and their willingness to discuss the impact of changes with the interviewer. This study highlights how Saudi Arabian society has traditional mealtime customs for families and for older people in particular. Eating and drinking changes due to Parkinson’s challenge and restrict these customs. An understanding of these socio-cultural factors is necessary to appreciate how the impact of eating and drinking changes in Saudi Arabia differs from impacts reported for European and North American populations and the different implications this holds for rehabilitation of PwP. Speech and language therapists as well as other healthcare workers need to be aware of the cultural background of the person with Parkinson’s when assessing their eating and drinking abilities. Considerations have to be made when recommending treatment plans or eating modifications.
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Elshukri, Omsaad. "The effects of carbonated fluids on the human cortical swallowing motor system." Thesis, University of Manchester, 2013. https://www.research.manchester.ac.uk/portal/en/theses/the-effects-of-carbonated-fluids-on-the-human-cortical-swallowing-motor-system(770f0e3e-795c-4e5c-b1d0-8a8ae1ba06bb).html.
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Swallowing is a complex neurophysiological process involving the activation of several components of the central nervous system with bilateral but asymmetric representations of swallowing musculature in the motor cortex. Difficulty in swallowing (dysphagia) in stroke patients has been reported by up to 50% of victims, and can increase morbidity and mortality in this population due to the development of aspiration pneumonia and malnutrition. One of the common factors that predispose patients to dysphagia after a stroke is believed to be the reduced sensory awareness in the oropharyngeal area, which affects the swallowing process. The uses of diet modification to reduce thin liquid aspiration have gained interest but are often unpalatable or have limited success. Carbonated liquid have shown some beneficial effects in swallowing behaviour. However, there is very little evidence to support this intervention. Therefore, the aim of this thesis is to investigate the neurophysiological and behavioural effects of carbonated liquids on swallowing in healthy volunteers.The effects of carbonated solutions on swallowing performance compared to non-carbonated solutions (still water) was investigated in a pilot study and (still water and citric acid) in the main study using reaction time task (chapter 2). Carbonation appears to alter swallowing performance compared to other liquids by improving complex tasks. In addition, beneficial neurophysiological effects of carbonated liquids were evident after 10 minutes of carbonated liquid swallowing compared to still water and citric acid solution in healthy volunteers (chapter 3).In chapter 4, the response of the healthy swallowing motor cortex to carbonated liquids following application of a virtual lesion compared to still water and saliva swallowing, was investigated. Carbonated liquids were able to reverse the inhibitory effect induced by 1 Hz rTMS to the dominant pharyngeal motor representation. Moreover, the beneficial effects of carbonated liquids on swallowing performance, measured with a swallowing reaction times task after application of a virtual lesion was observed in a pilot investigation in healthy volunteers (chapter 5). These data demonstrate that carbonated liquids have beneficial neurophysiological and swallowing performance effects and support notion that the chemical properties of carbonated liquids may provide the required peripheral sensory information that alter the brain swallowing function, which leads to an improvement in the swallowing performance of stroke dysphagic patients. These data lay the foundation for considering the use of carbonation as facilitating stimuli in dysphagic patients.
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Raginis-Zborowska, Alicja Iwona. "Unravelling the genetic basis for cortical plasticity in the human swallowing motor system." Thesis, University of Manchester, 2016. https://www.research.manchester.ac.uk/portal/en/theses/unravelling-the-genetic-basis-for-cortical-plasticity-in-the-human-swallowing-motor-system(6734efa3-1872-44bf-9642-1cb28a5b404e).html.
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Swallowing is an important physiological function leading to nourishment of the organism, controlled by complicated interactions between the muscles, the cranial nerves and multiple brain structures. Swallowing impairments, also called dysphagia, are a major health burden for patients with neurological diseases such as stroke, Parkinson’s disease as well as community dwelling elderly individuals. It has been shown that activation of undamaged swallowing motor cortex compensates for the initial lost swallowing function in stroke patients. Non-invasive brain stimulation provides a tool to explore excitability within the areas of the motor cortex responsible for swallowing muscles. Repetitive transcranial magnetic stimulation (rTMS) is one such technique, with defined frequency parameters, however the underlying reasons for the heterogeneity is responses to low (1Hz) and high (5Hz) frequencies is unclear. These physiological interactions affecting the neurological control of swallowing may be influenced by multiple genes and proteins. Insights into the molecular basis of swallowing through genetic interactions could provide a source of information which can be further used in understanding and treating swallowing impairments. Existing evidence is limited in terms of candidate proteins, genes and pathways which might drive the neural control of swallowing. The aim of my doctoral research was to explore genes which might be involved in swallowing neurophysiology and pathophysiology. My hypothesis is that swallowing due to its complicated physiology is most likely affected by multiple genes and interactions between genes and proteins. To study this hypothesis I used two experimentally distinct study designs. Firstly I explored a number of single nucleotide polymorphisms (SNPs) and potential candidate genes presented in the existing literature. Then, I performed a SNP- and gene-based Genome-Wide Association Study (GWAS) of self-reported swallowing impairments compared with over 500,000 single nucleotide changes. For GWAS I used a group of 555 community dwelling individuals from the Dyne Steel Cohort from the areas of Manchester and Newcastle. Further research involved replication of selected genes and SNPs from literature screening and GWAS using two rTMS paradigms on the largest to date cohort of healthy young volunteers. Forty one volunteers (were assessed for corticobulbar excitability after single-pulse TMS. Repeated measurements of motor evoked potentials from the pharynx and the hand were recorded after the interventions of 1Hz and 5Hz rTMS. The subjects’ individual responses were grouped according to multiple criteria and then associated with factors such as gender, ethnicity, time of day of the stimulation and individual genetic information. GWAS analysis for association with swallowing impairment identified one SNP rs17601696 which achieved genome-wide significance (P-value=5×10(-8)) within a non-coding region of chromosome 10. Gene-based analysis did not result in any genome-wide significant association. In replication of these findings and following a priori selected genes from the literature (BDNF, COMT, TRKB, APOE, DRD2, GRIN2B and GRIN1) from neurophysiological studies applying TMS, two main conclusions were formed. Firstly, rTMS paradigms showed high variability in responses which made the phenotype more complicated. Secondly the result from GWAS could not be confirmed. By contrast, SNP rs6269 from the COMT gene was associated with responsiveness of the pharyngeal MEPs after delivering 1Hz paradigm and rs1800497 from the DRD2 gene with responsiveness after 5Hz rTMS.Lack of replication of the findings between two experiments might be caused by high variability in responsiveness with complex molecular networks of swallowing control where multiple genes with small genetic effects are involved. Although our findings support the hypothesis that molecular markers can be associated with swallowing, more studies are needed to understand the individual factors that determine responsiveness and effectiveness of treatment therapies of swallowing impairments.
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Shune, Samantha Eve. "The effects of age and sensation on the anticipatory motor patterns activated during deglutition." Diss., University of Iowa, 2014. https://ir.uiowa.edu/etd/4752.
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Swallowing problems, and the often-associated sequelae including pneumonia, malnutrition, and dehydration are common, potentially life-threatening conditions suffered by many elderly individuals. The combination of cognitive, physical, and sensory impairments commonly seen in individuals with dementia and following stroke often results in eating needs going unmet, leading to increased morbidity and premature mortality. The functional limitations of many of these individuals frequently result in decreased mealtime independence and necessitate extensive or total assistance (i.e., dependence) with consuming food and liquids. Despite the implication of increased safety associated with feeding assistance, the influence and potential risk of absent pre-oral cues are unclear, especially in an already taxed system. This study investigated the cooperative relationships between the sequential sensorimotor acts involved in eating and swallowing, focusing on the anticipatory stage, under various sensory-loss conditions.
Kinematic data from the lips, jaw, and hand were obtained from 24 healthy younger adults (ages 18-30) and 24 healthy older adults (ages 70-85) under four different conditions: typical self-feeding, typical assisted feeding (i.e., loss of proprioceptive cues), sensory loss self-feeding (i.e., loss of visual cues and degradation of auditory cues), and sensory loss assisted feeding (i.e., loss/degradation of auditory, proprioceptive, and visual cues). During typical self-feeding, all participants began the mouth opening gesture shortly after the onset of hand movement toward the mouth and prior to the onset of oral sensation. However, differences in the timing of anticipatory onset and offset lip movements were observed between older and younger adults and also on the basis of the presence/absence of feeding dependency and sensory loss. Older adults initiated lowering movement earlier than younger adults given the availability of proprioceptive and/or visual cues. In addition to demonstrating earlier lip lowering, during both self-feeding conditions older adults more consistently attended to the timing between lip lowering onset and hand movement onset as compared to both the younger adults and other relative timing pairs. Given the absence of proprioceptive cues (i.e., during assisted feeding), the onset of anticipatory lip movement was delayed. Sensory loss (i.e., loss of visual cues, reduction in auditory cues) alone did not negatively impact the onset of lip movement for either group as compared to typical self-feeding. Conversely, the presence of sensory loss more negatively impacted the offset of lip movement as compared to the absence of proprioception (e.g., the offset of lip movement was later given only visual/auditory loss as compared to assisted feeding). The presence of both feeding dependence and sensory loss had the greatest negative impact on the timing of both the onset and offset of anticipatory lip movement.
These findings suggest that deglutition should be considered as beginning prior to the onset of oral sensation and highlight the necessity of better understanding the role that pre-oral, or anticipatory, sensorimotor information may play in the overall eating and deglutitory process. As older adults consistently demonstrated a "compensatory advantage" via earlier and less variable movement onset given the availability of proprioceptive and/or visual cues, continued investigation into these age-related differences is important. This study provides a first step in clarifying the relationship between these pre-oral cues and anticipatory oral posturing during eating and swallowing, allowing for a better understanding of the potential for increased risk assisted feeding recommendations may elicit. However, the differences observed between older and younger adults, particularly under conditions of sensory loss, may be further exacerbated in a taxed system, potentially increasing risk for various patient populations.
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Anerfält, Jessica, and Bladh Anna Maria Eriksdotter. "Vattensväljtest som screening för dysfagi hos vuxna : Normer som funktion av ålder, kön och vattenmängd." Thesis, Uppsala universitet, Logopedi, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-193072.
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Sväljkapacitet kan skilja sig åt mellan olika åldrar och kön. Detta kan inverka på prestationen på så kallade vattensväljtest. Ingen uttömmande studie har gjorts angående effekt av ålder, kön och vattenmängd på sväljförmåga hos friska vuxna i Sverige. Syftet med föreliggande studie var att presentera normdata för tre olika mått på sväljförmåga: sväljtid, sväljkapacitet och antal klunkar vid 1 respektive 2 dl vatten hos friska vuxna, samt att undersöka effekter av vattenmängd och ålder respektive kön på sväljförmågan. 239 vuxna deltagare stratifierades utifrån ålder och kön. Under testförfarandet noterades sväljtid, antal klunkar samt övriga observanda. Resultatet visade signifikant längre sväljtid, lägre sväljkapacitet och fler klunkar såväl hos individer över 70 år som hos kvinnor. Tydligare skillnader kunde ses med den större vattenmängden. Dessutom framkom att 1 dl vatten inte mäter sekventiell sväljning hos samtliga individer.Swallowing may differ between different age groups and genders. This may affect performance on water swallow tests. So far there have been no comprehensive studies on the effect of age, gender and water volume on the swallowing performance of healthy adults in Sweden. The aim of this study was to present normative data for three different measures of swallowing: swallowing time, swallowing capacity and number of swallows at 100 ml and 200 ml of water in healthy adults, and to examine possible effects on swallowing of age and gender. The 239 adult participants were stratified according to age and gender. During testing, time, number of swallows and a number of deviations were noted. Results showed significantly longer swallowing times, lower swallowing capacity and more swallows both in individuals older than 70 and in women. These differences were greater when using the larger volume of water. Furthermore, results showed that 100 ml of water was insufficient for measuring sequential swallowing in some individuals.
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Wong, Wai-ming. "The swallowing compliance of post-discharge geriatric patients with dysphagia in Hong Kong." Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B31972329.
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Stenger, Mary Jennifer. "The impact of observational learning on preschoolers' cooperation in an ultrasound swallowing study." Oxford, Ohio : Miami University, 2007. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=miami1177018753.
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Wong, Wai-ming, and 王維明. "The swallowing compliance of post-discharge geriatric patients with dysphagia in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B31972329.
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GROVES, WRIGHT KATHY J. "ACOUSTICS AND PERCEPTION OF WET VOCAL QUALITY IN IDENTIFYING PENETRATION/ASPIRATION DURING SWALLOWING." University of Cincinnati / OhioLINK, 2007. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1176987749.
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Lai, Sin-yi Sindy. "Laryngeal muscle activities during phonation and swallowing in non-dysphonic and dysphonic subjects." Click to view the E-thesis via HKU Scholars Hub, 2007. http://lookup.lib.hku.hk/lookup/bib/B42005346.
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Thesis (B.Sc)--University of Hong Kong, 2007."A dissertation submitted in partial fulfilment of the requirements for the Bachelor of Science (Speech and Hearing Sciences), The University of Hong Kong, June 30, 2007." Includes bibliographical references (p. 30-34). Also available in print.
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Hardenbergh, Loren Ito. "Swallowing health ideology: Vitamin consumption among university students in the contemporary United States." Thesis, The University of Arizona, 2001. http://hdl.handle.net/10150/278764.
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The moral coloring of eating behavior in the contemporary U.S. reflects the value placed on taking charge of one's health through diet, exercise, and self-control. At the same moment that health promotion efforts focus on individual responsibility, the population is experiencing time famine, or a chronic shortage of time that does not allow people to live as they think they should. In this context, health behaviors such as exercise and a health-balanced diet may be compromised. Vitamin consumption is one way that individuals maintain a moral identity in the face of time pressure. Drawing on twenty open-ended interviews, this paper explores the multiple meanings vitamins have in the lives of vitamin users, including their role as food substitutes and productivity enhancers. Issues related to efficacy and the tension between biomedical sources of health information and localized "embodied" knowledge also receive attention.
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Pearson, William Gordon Jr. "A two-sling mechanism of hyolaryngeal elevation in the pharyngeal phase of swallowing." Thesis, Boston University, 2012. https://hdl.handle.net/2144/12585.
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Thesis (Ph.D.)--Boston UniversityThe pharyngeal phase of swallowing is a complex function that transfers a bolus from the oral cavity through the hypopharynx into the esophagus. A critical event in this process is the elevation of the hyolaryngeal complex, which opens the upper esophageal sphincter and relocates the airway away from an oncoming bolus. The suprahyoid group of muscles (mylohyoid, geniohyoid, digastric, and stylohyoid) and thyrohyoid are thought to underlie this function. The role of a deeper posterior sling of muscles that is comprised of stylopharyngeus, salpingopharyngeus and palatopharyngeus has not been determined. This project aims to investigate a hypothesized two-sling mechanism for hyolaryngeal elevation in the pharyngeal phase of swallowing. The thesis begins with background information of the functional anatomy thought to underlie hyolaryngeal elevation followed by an outline of studies that validate the structure, function, and clinical relevance of the two-sling mechanism. A cadaver model is first used to calculate potential force vectors of the muscular slings. The function of the two-sling apparatus is then investigated in vivo by using muscle functional MRI to evaluate muscles active in swallowing and dynamic MRI to perform kinematic analysis on key anatomical landmarks that represent attachment sites of the two-sling mechanism. Finally, the clinical significance of the two-sling mechanism is demonstrated by comparing spatial and temporal measurements collected from fluoroscopic imaging studies of patients with normal swallowing ability and swallowing difficulty.
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BEGNONI, GIACOMO. "ELECTROMYOGRAPHIC EVALUATION OF THE EFFICACY OF MYOFUNCTIONAL THERAPY IN PATIENTS WITH ATYPICAL SWALLOWING." Doctoral thesis, Università degli Studi di Milano, 2018. http://hdl.handle.net/2434/618978.
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ABSTRACT
Objectives:
Swallowing is a complex physiologic function developing mostly in the first years of life. After 6 years old, if a complete maturation is not achieved, swallowing persists as “atypical swallowing” (AS). The therapy provided to re-educate this dysfunction is based on the myofunctional treatment (MFT). The aim of this study was to detect functional (electromyographical) and clinical (orofacial muscular evaluation with score (OMEs) protocol) effects of MFT in a group of patients with AS so to highlight any differences in the muscular activation pattern and muscular orofacial behavior.
Materials and Methods:
20 adolescents and young adults (4 males and 16 females, mean age 17.85 years, SD 4.80) with AS were selected for this study. Standardized surface electromyographic (ssEMG) analysis was performed by the same operator to detect the activity of masseter (MM), temporalis (TA) and submental (SM) muscles before (T1) and after (T2) the logopedic treatment. The MFT was performed by the same speech therapist according to the Garliner method for a period of 10 weeks. The speech therapist completed the OMEs protocol at T1 and T2. A Student-t test for paired data was carried out to detect differences between T1 and T2 for both ssEMG and OMEs data. Then, a 1-way ANOVA variance test was performed to detect any differences between the different couples of muscles at T1 and T2. In addition, ssEMG data at T1 and T2 were compared with ssEMG obtained in a control (C) group of 18 adolescents and young adult patients (8 males and 10 females, mean age 17.28 years, SD 2.56) with bimolar class 1 and without AS.
Results:
From the starting group of 20 patients, 15 patients completed the MFT (4 males and 11 females, mean age 17.72 years, SD 5.21). At T2, AS patients showed a significantly shorter duration of activation for each couple of muscles and for the whole duration act of swallowing (p<.0001) as well as higher intensity of the SM activity (p<.01) than at T1. Within the AS group, at T1 the masticatory muscles (MM and TA) showed lower duration of activation (p<.05) and lower intensity of the spike (p<.0001) than SM. At T2, masticatory muscles also showed lower values for the activation index (IMPACT) (p<.0001) and for the spike position (p<.01) than SM. At T2. The OMEs protocol showed a significant increase for the total evaluation (p<.01) and specifically for appearance and posture (p<.01) and functions (p<.0001). If compared to C group, the AS group at T1 showed significantly longer duration of activation for each couple of muscles and for the whole duration act of swallowing (p<.0001) as well as lower intensity of the SM activity (p<.05) than controls. At T2 all the ssEMG data detected in AS patients showed a general improvement and moved toward the control values. The differences between AS and C groups about the duration of activation of each couple of muscles and the whole duration act of swallowing were lower at T2 than at T1 even if still significantly different from C ones (p<.0001).
Conclusion:
MFT confirms itself as an effective method in the treatment of AS dysfunction permitting a shortening of the muscular activation pattern, an increase in SM activity and a general improvement in the orofacial muscular behavior making them closer to the data obtained in controls. ssEMG and OMEs protocol represent valid and useful methods in the analysis of the swallowing function and in establishing the effects of the MFT.
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SANTOS, Valéria Alves dos. "Caracterização da atividade eletromiográfica dos músculos da deglutição nos pacientes portadores de esclerose múltipla." Universidade Federal de Pernambuco, 2016. https://repositorio.ufpe.br/handle/123456789/17715.
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A esclerose múltipla (EM) é uma desordem neurológica progressiva e crônica que pode levar a severas incapacidades incluindo as alterações das funções do sistema estomatognático, como por exemplo a deglutição. As pesquisas atuais relatam a presença dessas alterações na EM entretanto, há poucos estudos que utilizem instrumentos que auxiliem no diagnóstico das alterações da deglutição. Assim surgiu o interesse de desenvolver uma pesquisa utilizando a Eletromiografia de Superfície (EMGs) que é uma técnica segura e não invasiva e bastante utilizada no monitoramento da atividade elétrica muscular. O objetivo principal desse estudo foi caracterizar a atividade eletromiográfica dos músculos da deglutição na EM. Método: o projeto foi desenvolvido no ambulatório de reabilitação do Hospital da Restauração Governador Paulo Guerra (HR) e teve como população 30 indivíduos oriundos do setor de Neurologia, com diagnóstico definitivo de EM, de ambos os sexos e com média de idade 37,57 anos. Também foram avaliados 30 indivíduos sem nenhuma patologia neurológica como grupo de comparação. Foi realizada uma entrevista para coleta dos dados pessoais dos voluntários com EM e dos voluntários que serviram como grupo de comparação selecionados entre os funcionários do referido hospital. Foi realizada também análise do prontuário para coleta dos dados clínicos dos indivíduos com EM. Em seguida foi aplicado o questionário DYMUS que é utilizado para detectar os sinais da disfagia na EM e também foi utilizado o Protocolo de Avaliação Eletromiográfica da Deglutição para obter os sinais da atividade elétrica da musculatura avaliada. Conclusão: Quanto pior o estado clínico do paciente com EM menor será a atividade elétrica da musculatura suprahioidea e que o aumento da atividade elétrica do músculo masseter está relacionado com o aumento da dificuldade de deglutição. O aumento da atividade elétrica de masseter parece ter relação com mecanismos compensatórios que buscam o melhor sinergismo muscular possível durante a deglutição de saliva e líquido. Estudos futuros devem avançar na busca da relação da atividade elétrica dessa musculatura com outros dados clínicos e instrumentais relacionados à deglutição na EM na medida em que nossos achados ressaltaram diferenças no comportamento da musculatura relacionada à deglutição dos pacientes em relação a uma população saudável.
The multiple sclerosis (MS) is a chronic progressive neurological disorder which can lead to severe disabilities including changes in Stomatognathic system functions such as swallowing. The current research report the presence of these changes on in however, there are few studies that use instruments to aid in the diagnosis of the changes of swallowing. Thus arose the interest of developing a research using surface electromyography (SEMG) which is a safe and noninvasive technique widely used in muscle electrical activity monitoring. The main objective of this study was to characterize the electromyographic activity of the swallowing muscles in on. Method: the project was developed in the Rehabilitation Clinic of the Hospital da Restauração Governor Paulo Guerra (HR) and 30 individuals from the population sector of Neurology, with definitive diagnosis, of both sexes and averaging 37.57 age years. 30 individuals were also evaluated with no neurological pathology as the comparison group. An interview was held to collect the personal data of the volunteers with MS and of the volunteers who served as a comparison group selected from the staff of that hospital. Chart analysis also was held for collection of clinical data of individuals with in. Then we applied the questionnaire DYMUS which is used to detect the signs of dysphagia and was also used in the Electromyographic Assessment of swallowing Protocol for signs of electrical activity of the muscles evaluated. Conclusion: it is concluded that the worse the clinical state of the patient with lesser will be the electrical activity of the muscles suprahioidea and that the increase in electrical activity of the masseter muscle is related to the increased difficulty swallowing. The increase in electrical activity of masseter seems to have relationship with compensatory mechanisms that seek the best synergy possible muscle during swallowing of saliva and fluid. Future studies should go forward in search of the relationship between the electrical activity of this muscle with other clinical and instrumental data related to swallowing in on to the extent that our findings underscored differences in behavior related to swallowing muscles of patients with respect to a healthy population.