Tongue Pressure Resistance Training for Post-Stroke Dysphagia: A Case Study.

PURPOSE: The purpose of this study was to explore the effect of a lingual resistance training protocol on the swallowing function of an individual presenting with dysphagia and reduced tongue pressures following a supratentorial ischemic stroke. METHODS: A study involving a lingual resistance training protocol with videofluoroscopy to measure outcomes comparing different parameters to ASPEKT normative reference values at three timepoints: baseline (VFSS A), following a 4-week lead-in period to control for spontaneous recovery (VFSS B), and at the 8-week endpoint of treatment (VFSS C). The study was interrupted due to the COVID-19 pandemic after 1 participant enrollment and is presented as single case study. RESULTS: Isometric tongue pressures: Following the 4-week lead-in, a decline in maximum isometric anterior tongue pressure (MAIP) and regular effort saliva swallow pressures (RESS) was noted, however there was no change in maximum posterior isometric tongue pressures (MPIP). Isometric tongue pressures improved post-treatment, with increases in MAIP, MPIP, and to a lesser degree RESS. Swallowing Function: Impairments in swallowing safety continued between the baseline VFSS A (Penetration-Aspiration Scale score [PAS]=8) and lead-in VFSS B (PAS=5). Swallowing safety improved following the intervention, with PAS scores = 1 at the endpoint VFSS C. Pixel-based measures of swallowing efficiency revealed a reduced frequency of post-swallow total pharyngeal reside following the treatment. Improvements were found in two other swallowing parameters, laryngeal vestibule closure integrity and pharyngeal area at maximum pharyngeal constriction, at the endpoint VFSS. CONCLUSION: These pilot data suggest improvements in some swallowing parameters as an outcome of intervention.

Familicide in Canada, 2010 to 2019.

Familicide is rare; however, the high victim counts in each incident and context surrounding these killings underscore the need for further research. The purpose of this study is to gain a better understanding of the circumstances surrounding familicide in Canada. Using univariate statistics, this study analyzed 26 incidents of familicide that occurred in Canada between 2010 and 2019. The results show that familicide is a gendered crime involving primarily male accused who often target female victims, have a history of domestic violence, and commit the killings using firearms. This research highlights the importance of developing risk assessment, risk management, and safety planning strategies to address warning signs and prevent future familicides.

A qualitative study of cognitive, behavioral, and environmental influences on Hispanic mothers' early childhood feeding practices.

Young children's lifestyle behaviors are largely shaped by their parents. There are socioeconomic risk factors particular to Hispanic populations that influence the way parents feed their children. As obesity continues to be a public health issue with substantial inequities across race and ethnicity, it is critical to understand Hispanic parents' food choices and feeding practices. The objective of this qualitative study is to identify the behavioral, environmental, and cognitive factors that influence the parental food choices and feeding behaviors of Hispanic mothers of children ages 0-5 years. Snowball sampling was used to recruit participants from the community (n = 30) who were 1) female; 2) Hispanic; 3) over the age of 18; and 4) a mother to child(ren) between the ages zero and five. Each interview consisted of a brief demographic survey and a set of open-ended questions based on Social Cognitive Theory constructs. A thematic analysis using a combined deductive and inductive approach was used to analyze transcriptions. Results indicated that mothers' attitudes around breastfeeding were connected with their challenges, while their attitudes around solid foods were expressed in their feeding strategies. Mothers used strategies of modeling, repeated exposure, and practices of "sneaking" in healthy foods and bribing to promote healthy eating. Mothers were most likely to seek out information from (1) pediatricians, (2) female family members, and (3) the internet. Hispanic mothers actively seek out information from many different sources that impact how they feed their young children. Understanding their trusted sources and how it influences the SCT constructs is an important step in preventing early childhood obesity.

The Effectiveness of Slightly Thick Liquids for Improving Swallowing in Bottle-Fed Children With Aerodigestive Concerns.

Purpose: Strategies for facilitating safe and functional bottle feeding in children with dysphagia include selecting nipples that reduce flow rate, pacing, altered positioning, and thickening liquid consistencies. We aimed to determine the impact of slightly thick liquids on swallowing through retrospective review of a convenience sample of clinical videofluoroscopic swallowing studies (VFSS) from 60 bottle-fed children (21 boys and 39 girls, mean age of 9.9 months) referred due to suspected aspiration. Method: Eligible VFSS exams were those in which the child swallowed both thin and slightly thick barium (40% w/v Varibar barium) using the same nipple. VFSS sequences (i.e., uninterrupted portions of the VFSS recording) were randomly assigned in duplicate for rating by trained raters; discrepancies were resolved by consensus. Parameters measured included number of swallows/sequence, sucks/swallow, swallow and sequence duration, number and timing of penetration or aspiration events, laryngeal vestibule closure integrity, and pharyngeal residue. Chi-square tests, linear mixed-model analyses of variance, and Wilcoxon signed-ranks tests identified consistency effects. Results: There were no aspiration events in these recordings. Slightly thick liquids resulted in significantly fewer penetration events (p < .05), increased sucks/swallow, fewer swallows/sequence, and longer swallow and sequence durations. The number of children with ≥ 1 sequence showing pyriform sinus residue was significantly higher with slightly thick liquids. Conclusions: Slightly thick liquids can be effective in reducing penetration in bottle-fed children with dysphagia. However, slightly thick liquids may also lead to a safety-efficiency trade-off, with increased risk of pyriform sinus residue. Thickening for children with dysphagia should be considered only when other approaches are not effective. Overthickening should be avoided to limit negative impact on swallowing efficiency.

Bolus Texture Testing as a Clinical Method for Evaluating Food Oral Processing and Choking Risk: A Pilot Study.

PURPOSE: Choking on food is a leading cause of accidental death in several populations, including children, people with intellectual/developmental disability, and older adults in residential care facilities. One contributor to choking risk is incomplete oral processing and failure to convert food to a cohesive, nonsticky bolus with a maximum particle size that will not block the airway. Clinical tests of mastication do not evaluate properties of chewed food boluses. We characterized expectorated boluses, after oral processing, using methods developed by the International Dysphagia Diet Standardisation Initiative (IDDSI). METHOD: Seventeen adults without dysphagia (seven women and 10 men), aged 23-55 years, chewed samples of a cracker, a raw baby carrot, and a circular, dome-shaped gummy candy. Chewing metrics were obtained up to the point when the person indicated that they were ready to swallow. The bolus was then either expectorated or swallowed; IDDSI tests were used to characterize the expectorated boluses. RESULTS: Measures of chewing did not differ between spit and swallow conditions. Expectorated cracker and carrot boluses had maximum particle size consistent with IDDSI Level SB6 Soft & Bite-Sized foods or lower. The gummy candy samples remained at IDDSI Level RG7 Regular food consistency. CONCLUSIONS: This study suggests that expectorated ready-to-swallow boluses are representative of boluses that are swallowed and that oral processing in adults without dysphagia typically results in boluses at IDDSI's Level SB6 or lower. IDDSI's testing methods provide a practical method for evaluating oral processing by characterizing expectorated ready-to-swallow boluses and may guide food texture recommendations for persons who have increased risk of choking.

Profiles of Swallowing Impairment in a Cohort of Patients With Reduced Tongue Strength Within 3 Months of Cerebral Ischemic Stroke.

PURPOSE: Patients with poststroke dysphagia may experience inefficient bolus clearance or inadequate airway protection. Following a stroke, impairments in lingual pressure generation capacity are thought to contribute to oropharyngeal dysphagia. The goal of our study was to determine whether similar profiles of swallowing impairment would be seen across a cohort of patients with reduced tongue strength within 3 months after cerebral ischemic stroke. METHOD: The sample comprised six adults with reduced tongue strength (i.e., maximum anterior isometric pressure < 40 kPa). Participants underwent a videofluoroscopy according to a standard protocol. Post hoc blinded ratings were completed using the Analysis of Swallowing Physiology: Events, Kinematics and Timing Method and coded as "typical" versus "atypical" (i.e., within vs. outside the healthy interquartile range) in comparison to published reference values. RESULTS: The videofluoroscopies suggested that having reduced tongue strength did not translate into a common profile. Of the six participants, two showed Penetration-Aspiration Scale (PAS) scores of ≥ 3 on thin liquids, associated with incomplete laryngeal vestibule closure (LVC). Another two participants displayed PAS scores of 2 (transient penetration), but these were not associated with incomplete LVC. Pharyngeal residue, above the healthy 75th percentile, was seen for three participants. Five participants presented with atypical reductions in hyoid XY peak position. CONCLUSIONS: In this cohort of adults within 3 months of cerebral ischemic stroke, reductions in tongue strength presented alongside a variety of changes in swallowing physiology. There was no straightforward relationship linking reduced tongue strength to particular patterns of impairment on videofluoroscopy.

Differentiating Characteristics of Intimate Partner Violence: Do Relationship Status, State, and Duration Matter?

A growing body of literature has been devoted to analyzing the relationship status and state between victim and perpetrator to understand the dynamics of intimate partner violence (IPV). Prior research revealed that IPV was more frequent and severe in cohabiting and estranged relationships relative to marital/dating and intact relationships, respectively. Violence in cohabiting unions, however, has declined in recent years potentially due to the increasing popularity of such unions and their growing similarity to legal marriages. The use of relationship duration as a focal variable in analyzing the characteristics of IPV incidents, however, has received inadequate attention within the field. This study addresses this gap and builds upon existing research by exploring whether characteristics of IPV differ depending on the status, state, and duration of relationship by examining IPV cases documented in Crown Attorney files in one Ontario jurisdiction between 2003 and 2009. Through bivariate and multivariate analyses, current findings reveal that IPV involving marital, compared with dating, unions is more severe because of weapon use. Contradictory to previous research, IPV occurring among estranged intimate partners, compared with those in intact unions, is less likely to involve physical injury or weapon use. Finally, situational, in comparison with demographic, characteristics are affected less by the relationship duration between the perpetrator and victim. Several explanations for these findings are discussed along with study limitations and practical implications in terms of preventive measures, and it concludes with areas for future research.

The Frequency of Atypical and Extreme Values for Pharyngeal Phase Swallowing Measures in Mild Parkinson Disease Compared to Healthy Aging.

Purpose Dysphagia is thought to be prevalent and a leading cause of morbidity and mortality in people with Parkinson disease (PwPD). The aim of this study was to compare the frequencies of atypical and extreme values for measures of swallowing physiology in PwPD and in an age- and sex-matched cohort of healthy adults. Atypical and extreme values were defined, respectively, as values falling in the 25% and 5% tails of the reference distribution for healthy adults under age 60 years. Method A standard videofluoroscopy (VF) protocol was performed in 17 adults with mild PD and 17 age- and sex-matched healthy adults using 20% w/v liquid barium ranging from thin to extremely thick consistency. Blinded VF analysis was performed according to the Analysis of Swallowing Physiology: Events, Kinematics and Timing Method. Frequencies for atypical and extreme values were tabulated by cohort and compared using odds ratios. Results Increased frequencies of atypical values (> 25%) were seen in the PwPD for prolonged swallow reaction time, prolonged time-to-laryngeal-vestibule-closure (LVC), and poor pharyngeal constriction. However, these findings were also observed in the healthy controls. The PwPD showed significantly higher odds of atypical values for narrow upper esophageal sphincter (UES) diameter on thin liquids, a short hyoid-burst-to-UES-opening interval on extremely thick liquids, and prolonged time-to-LVC, LVC duration, and UES opening duration on multiple consistencies. The frequencies of extreme values failed to show any significant cohort differences for any parameter. Conclusions In this study, a group of people with mild PD did not show clear evidence of swallowing impairments distinct from the changes seen in a healthy age-matched control group when odds ratios were used to compare the frequencies of atypical values between PwPD and the control group; only a few parameters showed significant differences. These were findings of significantly higher frequencies in PwPD of prolonged LVC and UES opening duration. Supplemental Material https://doi.org/10.23641/asha.15032241.

Optimizing Delivery of Breast Milk for Premature Infants: Comparison of Current Enteral Feeding Systems.

BACKGROUND: Incomplete delivery of fat from expressed breast milk (EBM) during enteral feeding to premature neonates remains a significant problem. Feeding system manufacturers have introduced changes to the enteral syringe design to improve fat delivery that have not yet been evaluated in the literature. METHODS: This study compares percentage delivery of fat from EBM using 2 major enteral feeding systems in various configurations with silicone and polyurethane tubing material and ENFit and Legacy connection systems at 3 clinically relevant infusion rates. RESULTS: The percent of fat delivery from EBM was significantly higher for the eccentric syringe system than the concentric system (P = 0.036) but did not vary significantly across infusion rates (P = 0.081). Silicone tubing had a significantly higher percent of fat delivery than polyurethane tubing within the eccentric syringe system (P = 0.039) but did not vary significantly across infusion rates (P = 0.105). There was no significant difference between ENFit and Legacy connectors using eccentric syringes with silicone tubing (P = 0.360). CONCLUSION: We demonstrate that changes to syringe design and tubing material are effective and improve fat delivery from EBM, which may result in improved growth and outcomes in premature infants. The eccentric syringe marginally improves fat delivery in comparison with the concentric syringe, and silicone tubing significantly improves fat delivery compared with polyurethane tubing.

Cut umbilical cord milking: an ineffective method of placental transfusion in preterm infants?

Objective: To determine if umbilical cord milking performed on a cut umbilical cord segment increased the hemoglobin/hematocrit, with a reduction in the incidence of intraventricular hemorrhage, need for blood transfusions, and pressor requirement in infants with <35-weeks gestation.Study design: This was a single center, observational study in the NICU. One-hundred-six neonates received cut umbilical cord milking and two hundred ninety seven served as historical controls.Result: There were no statistically significant differences between the two groups in hemoglobin/hematocrit, peak bilirubin values, the incidence of intraventricular hemorrhage, need for blood transfusions, and the use of pressors.Conclusion: This is the first study using the cut umbilical cord milking technique that includes neonates with <35-weeks gestation. The procedure is safe but did not result in an increase in hemoglobin/hematocrit, nor did it reduce the incidence of intraventricular hemorrhage, need for blood transfusions, and pressor use.

Peripheral biomarkers in Autism: secreted amyloid precursor protein-alpha as a probable key player in early diagnosis.

Autism is a pervasive developmental disorder characterized by impairments in socialization and communication. There is currently no single molecular marker or laboratory tool capable of diagnosing autism at an early age. The purpose of this study is to explore the plausible use of peripheral biomarkers in the early diagnosis of autism via a sensitive ELISA. Here, we measured plasma secreted amyloid precursor protein alpha (sAPP-alpha) levels in autistic and aged-matched control blood samples and found a significantly increased level of sAPP-alpha in 60% of the known autistic children. We then tested 150 human umbilical cord blood (HUCB) samples and found significantly elevated levels of plasma sAPP-alpha in 10 of 150 samples. As an additional confirmatory measure, we performed Western blot analysis on these samples which consistently showed increased sAPP-alpha levels in autistic children and 10 of 150 HUCB samples; suggesting a group of autistic patients which could be identified in early childhood by levels of sAPP-alpha. While there is need for further studies of this concept, the measurement of sAPP-alpha levels in serum and human umbilical cord blood by ELISA is a potential tool for early diagnosis of autism.