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Variation in temporal measures of swallowing: sex and volume effects

Molfenter, Sonja Melanie; Steele, Catriona M
Temporal measures of healthy swallowing appear to be variably sensitive to bolus and participant factors based on a recent meta-analysis of studies in the deglutition literature. In this carefully controlled study of healthy young volunteers, balanced for sex and height, we sought to understand the influence of bolus volume and participant sex on the three durations and three intervals most frequently reported in the deglutition literature. Three boluses per target volume (5, 10, and 20 ml) were repeated for each participant (n = 20, 10 male) using a spontaneous swallow paradigm in lateral view videofluoroscopy. None of the temporal durations or intervals was found to be correlated with participant height above an a priori cutoff point of r >/= 0.3. Further, none of the temporal durations or intervals varied significantly by participant sex. Bolus volume significantly impacted upper esophageal sphincter (UES) opening duration, laryngeal closure duration, the laryngeal closure-to-UES opening interval, and the pharyngeal transit time interval, but not hyoid movement duration or the stage transition duration interval. When participants are sampled in such a manner as to represent the range of height reported to be typical for both sexes in the population, sex does not significantly influence temporal measures of swallowing.
PMID: 23271165
ISSN: 1432-0460
CID: 2263082

Temporal variability in the deglutition literature

Molfenter, Sonja M; Steele, Catriona M
A literature review was conducted on temporal measures of swallowing in healthy individuals with the purpose of determining the degree of variability present in such measures within the literature. A total of 46 studies that met inclusion criteria were reviewed. The definitions and descriptive statistics for all reported temporal parameters were compiled for meta-analysis. In total, 119 different temporal parameters were found in the literature. The three most-frequently occurring durational measures were upper esophageal sphincter opening, laryngeal closure, and hyoid movement. The three most-frequently occurring interval measures were stage transition duration, pharyngeal transit time, and duration from laryngeal closure-to-UES opening. Subtle variations in operational definitions across studies were noted, making the comparison of data challenging. Analysis of forest plots compiling descriptive statistical data (means and 95% confidence intervals) across studies revealed differing degrees of variability across durations and intervals. Two parameters (UES opening duration and the laryngeal closure-to-UES opening interval) demonstrated the least variability, reflected by small ranges for mean values and tight confidence intervals. Trends emerged for factors of bolus size and participant age for some variables. Other potential sources of variability are discussed.
PMCID:3775714
PMID: 22366761
ISSN: 0179-051x
CID: 1047042

Electromyography as a Biofeedback Tool for Rehabilitating Swallowing Muscle Function

Chapter by: Steele, Catriona M; Bennett, Janice W; Chapman-Jay, Sarah; Polacco, Rebecca Cliffe; Molfenter, Sonja M; Oshalla, Mohammed
in: Applications of EMG in Clinical and Sports Medicine by
Rijeka, Crotia : InTech, 2012
pp. 311-328
ISBN: 9789533077987
CID: 2261162

Exploration of the utility of a brief swallow screening protocol with comparison to concurrent videofluoroscopy = Exploration de l'utilite d'un bref protocole de depistage des troubles de deglutition en comparaison avec une videofluoroscopie simultanee

Steele, Catriona M.; Molfenter, Sonja M.; Bailey, Gemma L.; Polacco, Rebecca Cliffe; Waito, Ashley A.; Zoratto, Dana C.B.H.; Chau, Tom
This study involved a direct blinded comparison between the results of a brief, standardized swallowing screening protocol and videofluoroscopy of exactly the same swallows. Forty adults participated. Each participant completed a brief swallow screening protocol involving tongue lateralization, voluntary cough, a voice task, and 2 swallowing tasks (3 swallows of 5cc thin liquid barium suspension and a cup-drinking task). We collected time-linked radiographic data and a high-definition movie of the participant's face, head and neck. The movie data were rated by 7 blinded clinicians (nurses and speech-language pathologists) for evidence of clinical signs associated with dysphagia. The videofluoroscopy data were rated by a separate panel of blinded speech-language pathologists for evidence of penetration-aspiration and post-swallow pharyngeal residues. Predictive statistics were calculated for the movie rating results, compared to the videofluoroscopy results. The results showed that none of the screening questions met our criteria for adequate predictive power: sensitivity, specificity and negative predictive values > 0.6, a false negative rate < 0.2 and a positive likelihood ratio > 1.0. We conclude that swallow screening decisions based on a series of 3-4 thin liquid swallows do not have good clinical utility for detecting dysphagia or penetration-aspiration. We discuss a number of issues in swallow screening research that may have contributed to the difference in these results compared to other studies.
SCOPUS:80052977923
ISSN: 1913-200x
CID: 2853482

Voice-quality abnormalities as a sign of dysphagia: validation against acoustic and videofluoroscopic data

Waito, Ashley; Bailey, Gemma L; Molfenter, Sonja M; Zoratto, Dana C; Steele, Catriona M
In this study we explored the validity of clinician judgments of voice abnormalities as indicators of penetration-aspiration or other swallowing abnormalities. Voice samples were collected using a high-quality microphone from 40 adults during videofluoroscopy (VFSS), at baseline and following each of four thin liquid swallows. Blinded speech-language pathologists (SLPs) rated the audio recordings for voice quality using the GRBAS scale and the VFSS recordings for abnormal swallow onset, penetration-aspiration, airway closure, and pharyngeal residues. Acoustic measures of % jitter, % shimmer, and signal-to-noise ratio were calculated using two /a/ vowel segments spliced from each voice recording. Preswallow to postswallow measures of voice-quality change were derived and the data were compared to determine the correspondence between perceived voice abnormalities, acoustic voice parameters, and radiographically confirmed swallowing abnormalities. The sensitivity of perceived postswallow changes in voice quality to dysphagia and penetration-aspiration was poor, ranging from 8 to 29%. Specificity was stronger for both penetration-aspiration (75-94%) and dysphagia (59-86%). Acoustic measures of voice quality had moderate sensitivity and specificity for both dysphagia and penetration-aspiration. Overall, perceptual judgments of postswallow wet voice showed the strongest potential for detecting penetration-aspiration (relative risk = 3.24). We conclude that a clear postswallow voice quality provides reasonable evidence that penetration-aspiration and dysphagia are absent. However, observations of abnormal postswallow voice quality can be misleading and are not a valid indication that penetration-aspiration or dysphagia exists.
PMID: 20454806
ISSN: 0179-051x
CID: 1047052

Physiological variability in the deglutition literature: hyoid and laryngeal kinematics

Molfenter, Sonja M; Steele, Catriona M
A literature review was conducted on hyoid and/or laryngeal displacement during swallowing in healthy populations according to several inclusion criteria. Anterior and superior displacement measures of both structures from previously published studies were compiled for meta-analysis. Results showed a large degree of variability across studies for each structure and plane of movement. Potential sources of variation were identified, including statistical, methodological, stimulus-related, and participant-related sources.
PMCID:3756522
PMID: 20927634
ISSN: 0179-051x
CID: 1047062

The relationship between hyoid and laryngeal displacement and swallowing impairment

Steele, C M; Bailey, G L; Chau, T; Molfenter, S M; Oshalla, M; Waito, A A; Zoratto, D C B H
OBJECTIVES: Reduced range of hyoid and laryngeal movement is thought to contribute to aspiration risk and pharyngeal residues in dysphagia. Our aim was to determine the extent to which movements of the hyoid and larynx are correlated in the superior and anterior directions in swallowing, and whether movement range is predictive of penetration-aspiration or pharyngeal residue. DESIGN: Prospective, single-blind study of penetration-aspiration and pharyngeal residue with objective frame-by-frame measures of hyoid and laryngeal excursion from videofluoroscopy. SETTING: Tertiary hospital and rehabilitation teaching hospital. PARTICIPANTS: Twenty-eight participants referred for videofluoroscopy: 13 women, aged 57-77; 15 men, aged 54-70. Individuals with known neurodegenerative diseases or prior surgery to the neck were excluded. Each swallowed three boluses of 40% w/v thin liquid barium suspension. OUTCOMES: Two speech-language pathologists independently rated penetration-aspiration, vallecular and pyriform sinus residue. Cervical spine length, hyoid and laryngeal displacement were traced frame-by-frame. Predictive power was calculated. RESULTS: Cervical spine length was significantly greater in men. Hyoid displacement ranged from 34-63% of the C2-4 distance. Arytenoid displacement ranged from 18-66%, with significantly smaller anterior displacement in men. Positive hyoid-laryngeal movement correlations in both axes were the most common pattern observed. Participants with reduced displacement ranges (
PMCID:3757521
PMID: 21414151
ISSN: 1749-4478
CID: 1047112

Validation of a brief swallow screening protocol against concurrent videofluoroscopy

Steele, CM; Molfenter, Sonja M; Bailey, GL; Cliffe Polacco, R; Waito, AA; Zoratto, DCBH; Chau, T
ORIGINAL:0011572
ISSN: 1913-200x
CID: 2263152

Anthropometric and demographic correlates of dual-axis swallowing accelerometry signal characteristics: a canonical correlation analysis

Hanna, Fady; Molfenter, Sonja M; Cliffe, Rebecca E; Chau, Tom; Steele, Catriona M
Swallowing accelerometry has been proposed as a potential minimally invasive tool for collecting assessment information about swallowing. The first step toward using sounds and signals for dysphagia detection involves characterizing the healthy swallow. The purpose of this article is to explore systematic variations in swallowing accelerometry signals that can be attributed to demographic factors (such as participant gender and age) and anthropometric factors (such as weight and height). Data from 50 healthy participants (25 women and 25 men), ranging in age from 18 to 80 years and with approximately equal distribution across four age groups (18-35, 36-50, 51-65, 66 and older) were analyzed. Anthropometric and demographic variables of interest included participant age, gender, weight, height, body fat percent, neck circumference, and mandibular length. Dual-axis (superior-inferior and anterior-posterior) swallowing accelerometry signals were obtained for five saliva and five water swallows per participant. Several swallowing signal characteristics were derived for each swallowing task, including variance, amplitude distribution skewness, amplitude distribution kurtosis, signal memory, total signal energy, peak energy scale, and peak amplitude. Canonical correlation analysis was performed between the anthropometric/demographic variables and swallowing signal characteristics. No significant linear relationships were identified for saliva swallows or for superior-inferior axis accelerometry signals on water swallows. In the anterior-posterior axis, signal amplitude distribution kurtosis and signal memory were significantly correlated with age (r = 0.52, P = 0.047). These findings suggest that swallowing accelerometry signals may have task-specific associations with demographic (but not anthropometric) factors. Given the limited sample size, our results should be interpreted with caution and replication studies with larger sample sizes are warranted.
PMID: 19495874
ISSN: 0179-051x
CID: 1047072

Tongue pressure modulation during swallowing: water versus nectar-thick liquids

Steele, Catriona M; Bailey, Gemma L; Molfenter, Sonja M
PURPOSE: Evidence of tongue-palate pressure modulation during swallowing between thin and nectar-thick liquids stimuli has been equivocal. This mirrors a lack of clear evidence in the literature of tongue and hyoid movement modulation between nectar-thick and thin liquid swallows. In the current investigation, the authors sought to confirm whether tongue-palate pressures are modulated between discrete swallows of water and nectar-thick juice. METHOD: Tongue-palate pressures were measured at 3 sites (anterior, medial, and posterior palate) using an adhered 3-bulb pressure strip in 20 healthy, young adults during discrete swallows of water and nectar-thick apple juice. RESULTS: Pressure modulation was not noted with respect to pressure amplitudes (in mm Hg), but was identified both in the pressure patterns observed (the sites and number of bulbs activated) and temporal aspects of pressure duration. CONCLUSION: Tongue-palate pressure amplitude modulation does not occur for nectar-thick swallows compared to thin liquid swallows. Modulation does, however, occur with respect to the tongue-palate contact surface area and pressure durations. The authors introduce the concept of pressure slope as a meaningful way to examine tongue-palate pressure application in swallowing.
PMID: 20008678
ISSN: 1092-4388
CID: 1047082