Caryn Easterling

Pharyngoglottal Closure Reflex: Characterization in Healthy Young, Elderly and Dysphagic Patients with Predeglutitive Aspiration

Background: Mechanism(s) of aspiration, a common complication of oropharyngeal dysphagia, is not completely elucidated. Since the pharyngoglottal closure reflex induces vocal cord adduction in healthy young humans, it may help prevent aspiration during premature spill of oral content. Objective: The objective of this study was to characterize this reflex in normal young and elderly humans and dysphagic patients with predeglutitive aspiration; a potential group for developing abnormalities of this reflex. Methods: We used a concurrent video endoscopic and manometric technique for recording of the vocal cords’ response to pharyngeal water stimulation. We first studied 9 young (26 ± 2 years) and 9 elderly (77 ± 14 years) healthy volunteers to characterize and determine the effect of aging on the pharyngoglottal closure reflex. Subsequently, we studied 8 patients (65 ± 16 years) with predeglutitive aspiration and 7 age-matched controls to characterize this reflex among patients with compromised airway safety during swallowing. Results: The threshold volume of water for triggering both glottal closure and reflexive pharyngeal swallow in the elderly volunteers for rapid pulse injection was significantly larger than that for the young (p < 0.05). Neither glottal closure reflex nor pharyngeal reflexive swallow could be induced in any of the dysphagic patients with volumes of injected water as large as 1 ml. In contrast, in all age-matched controls, both the pharyngoglottal reflex and reflexive pharyngeal swallow were stimulated with threshold volumes of 0.3 ± 0.07 and 0.6 ± 0.05 ml, respectively. Conclusions: Pharyngeal stimulation by water induces vocal cord adduction in humans; the pharyngoglottal closure reflex. Although preserved, a significantly larger volume of water is required to stimulate this reflex by rapid pulse injection in the elderly, suggesting some deterioration in this age group. The pharyngoglottal closure reflex induced by rapid pulse injection is absent in dysphagic patients with predeglutitive aspiration, suggesting its contribution to airway protection against aspiration.

Attaining and Maintaining Isometric and Isokinetic Goals of the Shaker Exercise

Previous studies have shown that the Shaker Exercise is effective in restoring oral intake in patients with deglutitive failure due to upper esophageal sphincter (UES) dysfunction. Our aim was to determine (1) exerciser compliance among healthy older adults, (2) number of days required to attain the isometric (IM) and isokinetic (IK) exercise goals, (3) rate and reason for dropout of exercisers, and (4) complaints associated with performance of the exercise. Twenty-six nondysphagic older adults were enrolled from an independent-living community (66–93 yr) to perform the Shaker Exercise. Each participant completed a questionnaire on exercise performance and its associated difficulties three times a day for six weeks. Four randomly chosen nondysphagic participants underwent pre- and postexercise videofluoroscopic swallow studies for biomechanical measurements. Maximum anterior hyoid and laryngeal excursions, as well as maximum anteroposterior UES opening increased (p < 0.05) following exercise. Duration to attain Shaker Exercise performance goals varied among participants. IK was more easily attained than IM. Only 50% and 70% of those enrolled initially were able to complete the exercise duration and attain its IK and IM goals, respectively. However, those who stayed in the program attained the IK and IM goals (100% and 74%, respectively). Most dropouts occurred in the first two weeks of exercise. Performance of the exercise was associated with mild muscle discomfort that resolved spontaneously after a couple of weeks. We concluded that although the Shaker Exercise can be performed independently, a structured and gradually progressive program is needed to attain the exercise goals completely.

Principles of deglutition: A multidisciplinary text for swallowing and its disorders

principles of deglutition a multidisciplinary text for principles of deglutition a multidisciplinary text for principles of deglutition a multidisciplinary text for download pdf deglutition and its disorders book principles of deglutition a multidisciplinary text for principles of deglutition springer coordination of deglutition 3 and respiration springer john c. rosenbek and michelle s. troche springer oral phase preparation 8 and propulsion: anatomy curriculum vitae stephanie k. daniels, ph.d., ccc, brs-s pinciples r of eglutitiond doccheck doc book 3 ton floor jack repair playingscience deglutition syncope: a case report and review of the despertar el alma estudio junguiano sobre la vita nuova the normal swallow researchgate mindy mccumber, mcd, ccc-slp fhsportsmed ct187 principles of maintaining stationery stock tci world history ancient egypt and the near east lesson the boeing 737 technical guide complete louduk the sociology of community connections 1st edition princesa de cleves la alongs conceptual physics c2009 problem solving exercises in getting to know brazil fbtest reinventing yourself how to become the person youve always the transactional model of developmenthow children and illustrated dictionary opalfs 92 toyota surf repair manual ebook | imadev honda insight 2010 user manual download ebook | imadev 1991 ford ranger engine diagram oururl same buffalo 130 tractor repair manual fbtest censorship the search for the obscene nolia zickzack neu 2 workbook solutions, 2002, harald seegar document1 dysphagia cafe the smell of leather case files edgar sullivan 1 principles of deglutition a multidisciplinary text for precision injection molding process materials and

Preliminary Temporal Measurement Analysis of Normal Oropharyngeal Swallowing in Infants and Young Children

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

Pharyngeal dysphagia in postesophagectomy patients: correlation with deglutitive biomechanics

BACKGROUND Because of the transient nature of pharyngeal phase dysphagia, posttranshiatal esophagectomy patients provide a model for studying the correlation of dysphagic symptoms and aspiration with deglutitive biomechanics. METHODS We studied 8 transhiatal esophagectomy patients (age range, 51 to 78 years) and 8 normal age-matched controls in upright position using lateral and anteroposterior (AP) projection videofluoroscopy during three 5 mL barium swallows. RESULTS The maximum upper esophageal sphincter (UES) AP diameter and maximum anterior excursion of the hyoid bone in patients with transhiatal esophagectomy who experienced aspiration (6.2+/-0.6 and 9.0+/-2.0 mm, respectively) were significantly smaller than those of age-matched normal controls (9.4+/-0.7 and 17.0+/-1.0 mm, respectively). Resolution of aspiration was associated with a significant increase in AP diameter of the UES as well as anterior and superior excursion of the hyoid bone (p<0.05). CONCLUSIONS Dysphagic symptoms and aspiration in posttranshiatal esophagectomy patients are associated with significant abnormalities of deglutitive biomechanics. Improvement in deglutitive biomechanics is associated with resolution of dysphagic symptoms as well as postdeglutitive aspiration in these patients.

Oropharyngeal dysphagia assessment and treatment efficacy: setting the record straight (response to Campbell-Taylor)

In September 2008, an article was published in the Journal of the American Medical Directors Association criticizing current dysphagia assessment and management practices performed by speech-language pathologists in Long-Term Care (LTC) settings. In the same issue, an editorial invited dialogue on the points raised by Campbell-Taylor. We are responding to this call for dialogue. We find Campbell-Taylors interpretation of the literature to be incomplete and one-sided, leading to misleading and pessimistic conclusions. We offer a complementary perspective to balance this discussion on the 4 specific questions raised: (1) Is the use of videofluoroscopy warranted for evaluating dysphagia in the LTC population? (2) How effective are thickened liquids and other interventions for preventing aspiration and do they contribute to reduction of morbidity? (3) Can aspiration be prevented and is its prevention important? and (4) Is there sufficient evidence to justify dysphagia intervention by speech language pathologists?

Fatigue Analysis Before and After Shaker Exercise: Physiologic Tool for Exercise Design

Recent studies suggest that the Shaker exercise induces fatigue in the upper esophageal sphincter (UES) opening muscles and sternocleidomastoid (SCM), with the SCMs fatiguing earliest. The aim of this study was to measure fatigue induced by the isometric portion of the Shaker exercise by measuring the rate of change in the median frequency (MF rate) of the power spectral density (PSD) function, which is interpreted as proportional to the rate of fatigue, from surface electromyography (EMG) of suprahyoid (SHM), infrahyoid (IHM), and SCM. EMG data compared fatigue-related changes from 20-, 40-, and 60-s isometric hold durations of the Shaker exercise. We found that fatigue-related changes were manifested during the 20-s hold. The findings confirm that the SCM fatigues initially and as fast as or faster than the SHM and IHM. In addition, upon completion of the exercise protocol, the SCM had a decreased MF rate, implying improved fatigue resistance, while the SHM and IHM showed increased MF rates, implying that these muscles increased their fatiguing effort. We conclude that the Shaker exercise initially leads to increased fatigue resistance of the SCM, after which the exercise loads the less fatigue-resistant SHM and IHM, potentiating the therapeutic effect of the Shaker exercise regimen with continued exercise performance.

Manual of diagnostic and therapeutic techniques for disorders of deglutition

Part I: General Consideration in Evaluation of Dysphagic Patients 1. Establishing a comprehensive Center for diagnosis and therapy of swallowing disorders - Bronwyn Jones and William Ravich 2. Clinical Evaluation of Patients with Dysphagia: Importance of History Taking and Physical Exam - Gary H. McCullough and Rosemary Martino Part II: Commonly Used Tests for Evaluation of Deglutitive Disorders 3. Radiographic Evaluation of the Oral/preparatory and Pharyngeal Phases of swallowing including the UES: Comprehensive Modified Barium Swallow Studies - Jeri A. Logemann 4. Radiographic Evaluation of the Esophageal Phase of swallowing - Marc Levine 5. Flexible Endoscopic Evaluation of Swallowing (FEES) - Susan Langmore and Joseph T. Murray 6. Laryngopharyngeal Sensory Testing - Jonathan Aviv 7. Un-sedated Transnasal esophagoscopy: Endoscopic evaluation of esophageal phase of deglutition - Gregory Postma and Kia Saeian 8. Manometry of the UES including High Resolution Manometry - Benson Massey 9. Manometric Assessment of the Esophagus - Jeff Conklin 10. Esophageal pH and impedance monitoring - Eytan Bardan 11. Pharyngeal pH and impedance monitoring - Robert T. Kavitt and Michael F. Vaezi Part III: Management of Oral Pharyngeal Dysphagia in Adults 12. Oropharyngeal Strengthening and Rehabilitation of Deglutitive Disorders - Jacqueline Hind and JoAnne Robbins 13. Shaker Exercise - Caryn Easterling 14. Mendelson Maneuver and Masako Maneuver - Cathy L. Lazarus 15. Effortful Swallow - Maggie Lee Huckabee and Phoebe Macrae 16. Compensatory Strategies and Techniques - Susan Butler, Cathy Pelletier, Catriona M. Steele Part IV: Management of Oral Pharyngeal Dysphagia in Pediatrics 17. Rehabilitative Maneuvers and Exercise - Joan Justine Sheppard 18. Compensatory Strategies and Techniques - Claire Miller and Paul Willging 19. Special Consideration in the Evaluation of Infants and Children with Deglutitive Disorders - Neelesh Tipnis

Performance and Optimal Technique for Pharyngeal Impedance Recording: A Simulated Pharyngeal Reflux Study

BACKGROUND AND AIMS:Detection rate, influence of recording site, and subject posture for impedance monitoring of pharyngeal reflux of gastric contents remain unknown. We evaluated the ability of the impedance sensor for detection of various volumes of intrapharyngeal infusate at two sites and in two subject positions.METHODS:Nineteen healthy subjects were studied using concurrent videoendoscopic, manometric, impedance, and pH recording.RESULTS:Detection rate of simulated pharyngeal reflux events ranged between 87% and 100% for 1–4 mL. Detection rate for 0.1–1 mL volumes in the upright position was significantly higher (78–85%) when the impedance sensor was located at the proximal margin of the upper esophageal sphincter (UES) compared to 2 cm proximally (38–68%) (P < 0.001). With the sensor at 2 cm above the UES, the average detection rate for all volumes in the upright position was significantly less (P < 0.001) compared to the supine position (48% vs 84%). There was substantial variability in the magnitude of impedance changes induced by different infusates.CONCLUSIONS:Impedance sensors can detect as small a volume as 0.1 mL and combined with a pH sensor can detect acidic and nonacidic liquid and mist reflux events. Sensor placement at the proximal margin of the UES yields the highest detection rate irrespective of subject posture compared to placement 2 cm proximally. Depending on the volume of refluxate and location of the impedance sensor, a substantial minority of simulated reflux events can be missed.

UES Opening Muscle Dysfunction

The upper esophageal sphincter (UES) is composed of the cricopharyngeus (CP), the inferior pharyngeal constrictor (IPC), and the most proximal segment of the esophagus and maintains a high pressure zone between pharynx and esophagus. UES opening mechanism during deglutition is multifactorial and includes the combination of neural relaxation of tonically contracted crycopharyngeus muscle, traction forces imparted by the suprahyoid (SH) UES opening muscles, intrabolus pressure generated by the oncoming bolus, and distensibility of the UES musculature [1, 2]. Each of the aforementioned factors involved in UES opening can potentially be modified to compensate for deficiency of others in a compensated state allowing complete pharyngeal clearance; failing to do so results in an uncompensated state, diminished deglutitive UES opening resulting in incomplete pharyngeal clearance, and postdeglutitive residue and potentially postdeglutitive aspiration.