Relationship Between Resultant Force Vector Acting on Human Organs From Food Bolus and the Bolus Configuration During Swallowing Using Numerical Swallowing Simulation With Moving Particle Simulation Method.

This study investigates the forces exerted on organs during swallowing, specifically focusing on identifying forces other than those resulting from direct organ contact. Using a swallowing simulator based on the moving particle method, we simulated the swallowing process of healthy individuals upon the ingestion of thickened foods, which were simulated as shear-thinning flow without yield stress. We extracted the resultant force vectors acting on the organs and shape of the bolus at each time interval. The simulation results confirmed that the bolus originates from tongue movement and is transferred between the oral cavity and pharynx, with each organ's coordinated movements with the tongue occurring at their respective positions, as indicated by the balance of the resultant force vectors. Utilizing the information about the resultant force vectors obtained through simulations, we calculated the physical parameters of impulse, energy, and power. The variations in these physical parameters were aligned with the behaviors of both the biological system and the food bolus during swallowing. The force values calculated from the simulations closely approximate the theoretical values. Furthermore, the forces calculated from the simulations were relatively smaller than the force values derived from pressure information, such as that from high-resolution manometry and tongue pressure sensors. This difference can be attributed to the simulations extracting only the forces exerted on the organ by the food bolus. Force information on organs has the potential to provide a new interpretation of conventional mechanical indicators such as manometry and tongue pressure sensors.

Orthodontic treatment in patients with atypical swallowing and malocclusion: a systematic review.

This review aimed to analyze the correlation between atypical swallowing and malocclusions and how this dysfunction can be treated. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed to conduct this systematic review, and the protocol was registered at International Prospective Register of Systematic Reviews (PROSPERO) with the CRD42024499707. A thorough search was conducted on PubMed, Scopus and Web of Science to find papers that discussed myofunctional and orthodontic treatment for patients with atypical swallowing and malocclusion from 01 January 2003 to 27 November 2023. The search yielded 2554 articles, of which only 12 records were selected for qualitative analysis. The analysis of these articles revealed that orofacial myofunctional therapy, criab appliance, Habit corrector™, and soft tongue restrainers are potential therapies for treating atypical swallowing and malocclusions. The tongue's position affects muscle behavior, leading to malocclusions that can be treated with various therapies, resulting in effective clinical outcomes. However, more research is required to delve deeper into the topic.

Variability in quantitative outcomes of instrumental swallowing assessments in adults: a scoping review. / Variabilidade dos desfechos quantitativos nas avaliações instrumentais da deglutição em adultos: uma revisão de escopo.

PURPOSE: To map scientific evidence on the variability of quantitative parameters extracted by instrumental swallowing assessment tests in adults, using the coefficient of variation. RESEARCH STRATEGIES: The methodological procedures recommended by the Joanna Briggs Institute and the extension for scoping reviews of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA-ScR) were followed. SELECTION CRITERIA: The search was carried out in the Pubmed/Medline, Lilacs, Cochrane Library, Embase, Web of Science, Scopus and CINAHL databases, as well as in Google Scholar to consult the gray literature. DATA ANALYSIS: Two blind and independent reviewers screened the articles by title and abstract. Subsequently, the articles were read in full and selected according to the eligibility criteria. Data were extracted according to a standardized instrument. RESULTS: 363 studies were found, 13 of which were eligible. Most studies had a sample size of less than 30 participants and were made up of healthy individuals. The instrumental exams used were diverse: videofluoroscopy, electrical impedance tomography, laryngeal sensors, high-resolution manometry and surface electromyography. The studies searched for intra-individual variability and the coefficient of variation ranged from low to high variability, as the instruments, parameters and collection procedures were very heterogeneous and non-standardized. CONCLUSION: Intra-individual variability of the quantitative outcomes of instrumental swallowing assessments in adults ranged from low to high according to the exam, outcome, presence or absence of underlying disease, consistency and volume of the bolus.

OBJETIVO: Mapear as evidências científicas sobre a variabilidade dos parâmetros quantitativos extraídos por exames instrumentais de avaliação da deglutição em adultos, mediante o coeficiente de variação. ESTRATÉGIA DE PESQUISA: Foram seguidos os procedimentos metodológicos recomendados pelo Joanna Briggs Institute e a extensão para revisões de escopo do Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA-ScR). CRITÉRIOS DE SELEçÃO: A busca foi realizada nas bases de dados Pubmed/Medline, Lilacs, Cochrane Library, Embase, Web of Science, Scopus e CINAHL, assim como no Google Scholar para consultar a literatura cinzenta. ANÁLISE DOS DADOS: Dois revisores cegos e independentes fizeram o rastreamento dos artigos por título e resumo. Posteriormente, os artigos foram lidos na íntegra e selecionados de acordo com os critérios de elegibilidade. Os dados foram extraídos de acordo com um instrumento padronizado. RESULTADOS: Foram encontrados 363 estudos, sendo 13 elegíveis. A maioria dos estudos teve amostra menor que 30 participantes e foi composta por indivíduos saudáveis. Os exames instrumentais utilizados foram diversos: videofluoroscopia, tomografia de impedância elétrica, sensores laríngeos, manometria de alta resolução e eletromiografia de superfície. Os estudos investigaram principalmente a variabilidade intraindividual e os valores do coeficiente de variação oscilaram entre baixa e alta variabilidade, pois os instrumentos, parâmetros e procedimentos de coleta foram heterogêneos e não padronizados. CONCLUSÃO: A variabilidade intraindividual dos parâmetros quantitativos da deglutição obtidos por meio de exames instrumentais em adultos oscila entre baixa e alta conforme o exame, parâmetro testado, presença ou não de doença de base, consistência e volume do bolo alimentar.

Introducing the Framework for RigOr aNd Transparency In REseaRch on Swallowing (FRONTIERS): An Editorial.

This is an editorial introducing the Framework for RigOr aNd Transparency In REseaRch on Swallowing (FRONTIERS) forum.

Change of Cerebral Hemodynamic Signals during the Process of Swallowing Water, Acetic Acid Solution and Salt Solution in Healthy Adults: An fNIRS Study.

BACKGROUND: The aim of this preliminary study was to investigate the similarities and differences in cortical activation patterns during the swallowing of water, acetic acid solution and salt solution in healthy adults using functional near-infrared spectroscopy (fNIRS). METHODS: Eighteen right-handed healthy adults were recruited and fNIRS was used to measure changes in concentrations of oxygenated hemoglobin (HbO2) and deoxygenated hemoglobin (HbR) in 35 channels during the swallowing of water, acetic acid solution and salt solution. The task-based experiment used a block-design in which participants alternated between resting blocks of 30 s and task blocks (swallowing water, acetic acid solution, or salt solution) of 30 s, repeated six times. Participants remained still during the resting blocks and performed a swallowing action every 6 s during the task blocks. Data preprocessing was conducted using NirSpark software and statistical analyses were performed using either one-sample or paired t-tests to compare differences in cortical activation in healthy participants between swallowing a water and acetic acid solution, as well as swallowing a water and salt solution. RESULTS: Compared to the resting state, nine brain regions, including primary somatosensory cortex (S1), primary motor cortex (M1), dorsolateral prefrontal cortex (DLPFC), Wernicke's area, premotor cortex (PMC), supplementary motor area (SMA), inferior frontal cortex (IFC), orbitofrontal cortex (OFC) and frontopolar area, were commonly activated during the process of swallowing water, acetic acid solution, and salt solution. The DLPFC, Broca's area, PMC and SMA showed higher activation levels during the swallowing of acetic acid solution when compared to swallowing water, with statistically significant differences (p < 0.05). The frontopolar area and OFC exhibited higher activation during the swallowing of salt solution when compared to water, also with statistically significant differences (p < 0.05). CONCLUSIONS: Multiple brain regions were activated during the swallowing of water, acetic acid solution and salt solution in healthy adults. Moreover, swallowing acetic acid solution leads to stronger activation of DLPFC, Broca's area, PMC and SMA, while swallowing salt solution leads to stronger activation of the frontopolar area and OFC.

Coordination Between Respiration and Swallowing in Patients With Dysphagia After Cervical Spinal Cord Injury: An Observational Case-Control Study.

PURPOSE: The purpose of the present study was to characterize the differences between respiration and swallowing in patients with dysphagia after cervical spinal cord injury (CSCI) and to explore the underlying physiological changes. METHOD: A total of 95 participants were recruited for bedside swallowing evaluation followed by a flexible endoscopic evaluation of swallowing and surface electromyography with a thermocouple nasal airflow sensor examination: 32 with dysphagia, 33 without dysphagia, and 30 healthy controls. The differences in respiratory patterns, swallowing apnea duration (SAD), inspiratory-expiratory ratio, and swallowing efficiency were observed among healthy adults, CSCI patients with and without dysphagia after CSCI. RESULTS: Compared with those of healthy controls and patients without dysphagia after CSCI, the postswallow respiratory pattern of patients with dysphagia after CSCI was an inspiratory pattern, and the SAD was significantly shorter in patients with dysphagia after CSCI (p < .001). Additionally, the expiratory time in patients with dysphagia was significantly shorter than the inspiratory time, and the swallowing efficiency was reduced, requiring multiple swallows. Moreover, the index of SAD was statistically significant for predicting the development of dysphagia in patients with CSCI (p < .001). CONCLUSION: Patients with CSCI have an inspiratory pattern after swallowing, and the SAD is significantly reduced; SAD can be used as the predictor of dysphagia in patients after CSCI; the pattern of coordination between respiration and swallowing in patients with dysphagia after CSCI is different from that of healthy controls and patients without dysphagia after CSCI. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.26524717.

Deep learning approach for dysphagia detection by syllable-based speech analysis with daily conversations.

Dysphagia, a disorder affecting the ability to swallow, has a high prevalence among the older adults and can lead to serious health complications. Therefore, early detection of dysphagia is important. This study evaluated the effectiveness of a newly developed deep learning model that analyzes syllable-segmented data for diagnosing dysphagia, an aspect not addressed in prior studies. The audio data of daily conversations were collected from 16 patients with dysphagia and 24 controls. The presence of dysphagia was determined by videofluoroscopic swallowing study. The data were segmented into syllables using a speech-to-text model and analyzed with a convolutional neural network to perform binary classification between the dysphagia patients and control group. The proposed model in this study was assessed in two different aspects. Firstly, with syllable-segmented analysis, it demonstrated a diagnostic accuracy of 0.794 for dysphagia, a sensitivity of 0.901, a specificity of 0.687, a positive predictive value of 0.742, and a negative predictive value of 0.874. Secondly, at the individual level, it achieved an overall accuracy of 0.900 and area under the curve of 0.953. This research highlights the potential of deep learning modal as an early, non-invasive, and simple method for detecting dysphagia in everyday environments.

Assessment of swallowing performance in patients with neurodegenerative disease: A hierarchical cluster analysis.

BACKGROUND: Swallowing is a complex process that alters with age and neurological diseases; swallowing disorders can be a consequence of both of them. As an advanced multivariate statistical method, hierarchical cluster analysis (HCA) was utilized to make the dendrograms, which was used to find the relationship between the variables. The purpose of this study is to ascertain the type of clustering exhibited by the variables using HCA and to evaluate the approach to major neurodegenerative diseases (MND) with swallowing disorders based on the results obtained. METHODS: Data were collected from a total of 173 patients from various neurological diagnoses, such as dementia, Parkinson's disease, stroke and polyneuropathy, aging between 42 and 104 (mean of age 72.85) by using the Montreal Cognitive Assessment, the Edinburgh Feeding Evaluation Scale (EdFED), the Eating Assessment Tool (EAT-10), and the Modified Mann Swallowing Ability test. From the collected data, dendrograms were formed by using HCA with Ward linkage method. RESULTS: Based on cluster analysis results, clusters demonstrate statistical significance. They center around EdFED, EAT-10, and age in each MND. In healthy individuals, variables are not clustered as in the patient group. This study holds importance as it can give clinicians a different perspective on determining and managing the elderly population's swallowing problems. CONCLUSIONS: The HCA method explicitly proposes which variables should be examined concurrently in the clinic for MND. This research is one of the pioneering studies conducted by using the HCA method.

The Effect of Oral Diet Training in Indwelling Nasogastric Tube Patients with Prolonged Dysphagia.

Background: Patients with severe dysphagia are usually fed using a nasogastric tube (NGT). Many patients who receive long-term NGT feeding are unable to obtain sufficient nutrients orally immediately after NGT removal. Thus, a transitional period involving oral diet training is required to transition from NGT feeding to exclusive oral feeding. We aimed to investigate the therapeutic effect of oral diet training in indwelling NGT patients with prolonged dysphagia. Methods: A total of 175 patients who were fed using an NGT for more than 4 weeks were enrolled. Their swallowing function was evaluated by a videofluoroscopic swallowing study (VFSS). During the VFSS, patients received thick and thin barium while the NGT was inserted. Then, the patients underwent a VFSS without an NGT thirty minutes after NGT removal. If a patient had no aspiration with NGT inserted during the VFSS, oral diet training combined with NGT feeding was recommended. Results: Of the 49 indwelling NGT patients who were recommended to receive oral diet training, 39 (79.6%) transitioned to exclusive oral feeding. A transition period of 2-8 weeks was required for them to achieve full oral feeding. Patients who were eligible for oral feeding trials showed no significant aspiration during the VFSS with an NGT inserted and had sufficient cough function. Patients who required prolonged NGT feeding and who could not complete oral trials showed significant aspiration during the VFSS when an NGT was inserted. Conclusions: This study demonstrated that oral diet training combined with NGT feeding is safe in patients with prolonged dysphagia who have sufficient cough function and no aspiration during VFSS. We suggest that if the patient is a proper candidate for NGT removal, direct oral feeding training with an NGT inserted could be a useful therapeutic strategy during the transitional period from long-term NGT feeding to successful oral feeding.

Hyoid displacement during swallowing function for completely edentulous subjects rehabilitated with mandibular implant retained overdenture.

BACKGROUND: Hyoid bone is attached to the mandible, tongue, larynx, temporal bone, and cervical spine via different types of muscles or ligaments. The tongue, mandible, and hyoid system play a crucial role in swallowing function. This within subject study aimed to evaluate the impact of mandibular implant overdentures on the displacement of the hyoid bones during the swallowing process. METHODS: Twenty five healthy edentulous subjects were selected for participating in the study. New complete dentures were constructed for all the participants. Subsequently two dental implants were inserted in the canine regions of the participant's mandibular arch. In order to retain the mandibular prosthesis in place, ball attachments were incorporated into the mandibular dentures to convert them into implant overdentures. Using 10 ml of thin liquid bolus, videofluoroscopy swallowing examination was performed in three different oral conditions: without complete dentures (WCD), with complete denture (CDs), and with a mandibular implant overdenture (IODs). ANOVA with Bonferroni test was used to analyze the data in order to determine how the hyoid displacement varied throughout different oral conditions. RESULTS: Compared to complete dentures, mandibular implant overdentures showed a significant decrease (P < 0.05) in both anterior hyoid displacement and duration of hyoid maximum anterior excursion (DOHMAE). However, there was a non-significant difference (P > 0.05) between the two oral circumstances in terms of superior hyoid displacement or duration for hyoid maximum elevation (DOHME). There is no penetration or aspiration for both complete denture and implant overdenture oral conditions. CONCLUSION: Implant retained overdentures have a positive effect on hyoid displacement during swallowing of thin liquid bolus consistency relative to conventional complete dentures. TRIAL REGISTRATION: Retrospectively registered (NCT06187181) 02/1/2024.

Relationship between oral status, swallowing function, and nutritional risk in older people with and without Parkinson's disease. / Relação entre estado oral, função de deglutição e risco nutricional entre idosos com e sem doença de Parkinson.

PURPOSE: To compare oral status, swallowing function (through instrumental and SLH assessment), and nutritional risk between dysphagic individuals with and without Parkinson's disease. METHOD: This is a cross-sectional retrospective study based on data collected from medical records. It included 54 dysphagic older adults, divided into two groups according to the diagnosis of Parkinson's disease. The study collected data on the speech-language-hearing assessment of postural control, tongue mobility and strength, maximum phonation time (MPT), and cough efficiency. Oral status was assessed using the number of teeth and the Eichner Index. The level of oral intake and pharyngeal signs of dysphagia were analyzed with four food consistencies, according to the International Dysphagia Diet Standardization Initiative classification, using fiberoptic endoscopic evaluation of swallowing, for comparison between groups. The severity of pharyngeal residues was analyzed and classified with the Yale Pharyngeal Residue Severity Rating Scale, and the nutritional risk was screened with the Malnutrition Screening Tool. RESULTS: The group of older adults with Parkinson's disease was significantly different from the other group in that they had fewer teeth, unstable postural control, reduced tongue strength, reduced MPT, weak spontaneous coughing, pharyngeal signs, less oral intake, and nutritional risk. CONCLUSION: Dysphagic older people with Parkinson's disease had different oral status, swallowing function, and nutritional risk from those without the diagnosis.

OBJETIVO: Comparar o estado oral, a função de deglutição por meio da avaliação instrumental, fonoaudiológica e do risco nutricional entre indivíduos disfágicos com e sem doença de Parkinson. MÉTODO: Trata-se de um estudo transversal e retrospectivo com base na coleta de dados dos prontuários. Foram incluídos 54 idosos disfágicos divididos em dois grupos, de acordo com a presença do diagnóstico de doença de Parkinson. Foram coletados dados com relação à avaliação fonoaudiológica de controle postural, mobilidade e força de língua, Tempo Máximo de Fonação (TMF) e eficiência da tosse. O estado oral foi avaliado por meio do número de dentes e o Índice de Eichner. Foram analisados o nível de ingestão oral e os sinais faríngeos de disfagia em quatro consistências alimentares, de acordo com a classificação International Dysphagia Diet Standardisation Initiative (IDDSI), por meio da videoendoscopia da deglutição, para comparação entre os grupos. Para análise e classificação da gravidade dos resíduos faríngeos, foi utilizado o Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), enquanto que, para rastrear o risco nutricional foi utilizado o Malnutrition Screening Tool (MST). RESULTADOS: O grupo de idosos com doença de Parkinson apresentou diferença significativa em menor número de dentes, controle postural instável, força de língua reduzida, TMF reduzido, tosse espontânea fraca, sinais faríngeos, nível de ingestão oral menor e em risco nutricional, em comparação ao outro grupo. CONCLUSÃO: Os idosos disfágicos com doença de Parkinson apresentaram diferenças no estado oral, na função de deglutição e no risco nutricional em comparação àqueles sem o diagnóstico.

Pharyngeal phase of swallowing in post-stroke dysphagia: videoendoscopy and speech-language-hearing assessment. / Fase faríngea da deglutição na disfagia pós-AVE: achados videoendoscópios e da avaliação fonoaudiológica.

PURPOSE: To investigate the outcomes of fiberoptic endoscopic evaluation of pharyngeal swallowing phase and clinical evaluation of swallowing among dysphagic individuals with and without chronic stroke in different food consistencies. METHODS: This is a cross-sectional and retrospective study based on data collection from medical records. 134 swallowing video endoscopy exams of dysphagic patients were analyzed, in which they were divided into two groups according to the diagnosis of stroke, in which data were collected regarding mobility and strength of the tongue, phonation and cough efficiency, and the pharyngeal signs of dysphagia with four food consistencies from the International Dysphagia Diet Standardization Initiative (IDDSI), for comparison between groups. To analyze and classify the severity of pharyngeal residues, the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) was used by two independent professionals. RESULTS: There was a significant difference in the presence of pharyngeal residue, laryngeal penetration and laryngotracheal aspiration in all consistencies evaluated (level 0, 2, 4 and 7) (p= <0.001), in addition to the association with multiple swallowing in thin liquid, slightly thickened liquid and solid (level 0, 2 and 7) (p= 0.026). CONCLUSION: Dysphagic individuals diagnosed with stroke showed differences in videoendoscope signs of pharyngeal residue, laryngeal penetration and laryngotracheal aspiration, regardless of the food consistency assessed, compared to dysphagic individuals without the diagnosis. Just as there was a difference in the finding of multiple swallowing only in the consistencies of thin liquid, extremely thickened liquid and solid.

OBJETIVO: Investigar os achados videoendoscópios da fase faríngea da deglutição e da avaliação clínica da deglutição, entre indivíduos disfágicos com e sem AVE crônico em diferentes consistências alimentares. MÉTODO: Trata-se de um estudo transversal e retrospectivo com base na coleta de dados dos prontuários. Foram analisados 134 exames da videoendoscopia da deglutição de pacientes disfágicos, em que foram divididos em dois grupos de acordo com o diagnóstico de AVE, na qual, foram coletados dados com relação à mobilidade e força de língua, fonação e eficiência da tosse, e os sinais faríngeos de disfagia com quatro consistências alimentares do International Dysphagia Diet Standartisation Initiative (IDDSI), para comparação entre os grupos. Para análise e classificação da gravidade dos resíduos faríngeos, foi utilizado o Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) por dois profissionais independentes. RESULTADOS: Houve diferença significativa com a presença de resíduos faríngeos, penetração laríngea e aspiração laringotraqueal em todas as consistências avaliadas (nível 0, 2, 4 e 7) (p= <0,001), além da associação com deglutições múltiplas em líquido ralo, líquido levemente espessado e sólido (nível 0, 2 e 7) (p= 0,026). CONCLUSÃO: Os indivíduos disfágicos com diagnóstico de acidente vascular encefálico apresentaram diferença nos sinais videoendoscópios de resíduos faríngeos, penetração laríngea e aspiração laringotraqueal independentemente da consistência alimentar avaliada, em comparação aos indivíduos disfágicos sem o diagnóstico. Assim como houve diferença no achado da deglutição múltipla apenas nas consistências de líquido ralo, líquido extremamente espessado e sólido.

Effectiveness of orofacial myofunctional intervention to mitigate facial aging signs: a clinical trial. / Efetividade da intervenção miofuncional orofacial para atenuar sinais do envelhecimento facial: ensaio clínico.

PURPOSE: Propose and verify the efficiency of myofunctional intervention program to attenuate facial aging signs and balance the orofacial functions. METHODS: Thirty women, aged 50 to 60 years, randomly divided into: therapy group (TG) submitted to Orofacial Myofunctional Therapy and electromyographic biofeedback group (EBG), submitted to the same program associated with electromyographic biofeedback for chewing, swallowing, and smiling functions training. Aesthetic and oromyofunctional aspects were assessed from photographs, videos, MBGR Protocol and scales for assessing facial aging signs, described in the literature. 50-minute sessions were held weekly for nine weeks and monthly for six months after washout period. Three assessments, identical to the initial one, were performed in the tenth week, eighth week after washout and conclusion of the research. The participants responded to the Satisfaction Questionnaire on the tenth week. RESULTS: The statistical analysis using the ANOVA, Tukey and Mann Whitney tests, for inter and intragroup comparison, showed that: intervention promoted attenuation of facial aging signs mainly in TG group, balance of chewing and swallowing functions in both groups; there was an impact of electromyographic biofeedback on the degree of participants' satisfaction, greater for EBG; interruption of the program for eight weeks resulted in aesthetic losses, mainly in TG, yet not functional losses, in both groups; the six monthly sessions had a limited impact on overcoming the esthetic losses that occurred after washout. CONCLUSION: The proposed program resulted in attenuation of aging signs, mainly in the TG group and improvement in orofacial functions, in both groups.

OBJETIVO: Propor e verificar a eficiência de um programa de intervenção miofuncional para atenuar sinais do envelhecimento facial e equilibrar as funções orofaciais. MÉTODO: 30 mulheres, entre 50 e 60 anos, divididas aleatoriamente em: grupo terapia (GT), submetido ao programa de terapia miofuncional orofacial e grupo biofeedback eletromiográfico (GBE), submetido ao mesmo programa associado ao biofeedback eletromiográfico para treinamento da mastigação, deglutição e sorriso. Aspectos estéticos e oromiofuncionais foram avaliados a partir da documentação das fotografias e vídeos, do Protocolo de avaliação miofuncional orofacial MBGR e escalas de avaliação dos sinais de envelhecimento facial descritas na literatura. Sessões de 50 minutos foram realizadas semanalmente, durante nove semanas e mensalmente, durante seis meses, após washout. Três avaliações, idênticas à inicial, foram realizadas na décima semana, oitava semana após washout e conclusão da pesquisa. As participantes responderam ao Questionário de Satisfação na décima semana. RESULTADOS: A análise estatística realizada, por meio dos testes ANOVA, Tukey e Mann Whitney, para comparação inter e intragrupos, demonstrou que: houve atenuação dos sinais do envelhecimento facial, principalmente no GT e equilíbrio das funções mastigação e deglutição nos dois grupos; houve impacto do biofeedback eletromiográfico sobre o grau de satisfação das participantes, sendo maior no GBE; a interrupção do programa durante oito semanas resultou em perdas estéticas, principalmente no GT, mas não em perdas funcionais, nos dois grupos; as seis sessões realizadas mensalmente tiveram impacto limitado para superação das perdas estéticas ocorridas após washout. CONCLUSÃO: O programa proposto resultou em atenuação dos sinais de envelhecimento, principalmente no grupo GT e melhoria nas funções orofaciais, nos dois grupos.

Motion reconstruction and finite element analysis of the temporomandibular joint during swallowing in healthy adults.

There is a close physiological connection between swallowing and the temporomandibular joint (TMJ). However, a shortage of quantitative research on the biomechanical behavior of the TMJ during swallowing exists. The purpose of this study was to reconstruct the movement of the temporomandibular joint (TMJ) based on in vivo experiment and analyze the biomechanical responses during swallowing in healthy adults to investigate the role of the TMJ in swallowing. Motion capture of swallowing, computed tomography (CT), and magnet resonance images (MRI) were performed on six healthy subjects. The movements of the TMJ during swallowing were reconstructed from the motion capture data. The three-dimensional finite element model was constructed. The dynamic finite element analysis of the swallowing process was performed based on the motion data. The range of condylar displacement was within 1 mm in all subjects. The left and right condyle movements were asymmetrical in two-thirds of the subjects. The peak stresses of the discs were relatively low, with a maximum of 0.11 MPa. During swallowing, the condylar displacement showed two trends: slow retraction and slow extension. The tendency to extend could lead to a gradual increase in stress on the disc.

Habitual intake of carbonated drinks is associated with subjective difficulty in swallowing in community-dwelling older adults: a survey-based cross-sectional study.

Carbonated drinks have been reported to increase muscle activity during swallowing compared with water. Older adults who habitually consume carbonated drinks may use their swallowing-related muscles to a greater extent, thereby preserving their swallowing function. This study investigated the relationship between habitual carbonated drink intake, amount of carbonated drink consumed, and subjective difficulty in swallowing in community-dwelling older adults. We administered a questionnaire to determine subjective difficulty in swallowing, nutritional status, presence of sarcopenia, and habitual intake of carbonated drinks. Statistical analysis of the subjective difficulty in swallowing was performed using logistic regression analysis with the presence or absence of suspected dysphagia, using the Eating Assessment Tool-10 as the dependent variable. The results showed that older age (odds ratio [OR]: 1.077; p = 0.011), nutritional status (OR: 0.807; p = 0.040), systemic sarcopenia (OR: 1.753, p < 0.001), and habitual intake of carbonated drinks (OR: 0.455; p = 0.039) were associated with subjective difficulty in swallowing. In conclusion, the daily habits of community-dwelling older adults impact their swallowing function.

Analyzing effects on anterior open bite in twins by PLS-SEM and sobel test.

OBJECTIVE: This study aimed to assess the different pathways between predictor factors such as zygosity, atypical swallowing, mouth breathing, breastfeeding and bottle feeding related to anterior open bite (AOB) in twins. METHODS: The study was conducted in monozygotic (MZ) and dizygotic (DZ) twin children aged 3-15 years. AOB, atypical swallowing, mouth breathing, feeding type, duration of bottle use, and mouth opening status during sleep were recorded during oral examination. Partial least squares structural equation model (PLS-SEM) and sobel tests were performed to assess the total and indirect effects among the variables on AOB. RESULTS: A total of 404 children (29.2% MZ;70.8% DZ) participated in this study. The effect of zygosity on mouth breathing in the PLS-SEM model was statistically significant. Conversely, it was determined that mouth breathing effected that atypical swallowing (p = 0.001). Atypical swallowing triggered AOB (p = 0.001). The atypical swallowing has a mediation effect between AOB and mouth breathing (p = 0.020). Mouth breathing causes atypical swallowing and therefore indirectly increases the likelihood of AOB. While breastfeeding decreases AOB incidence (p = 0.023), bottle feeding increases AOB incidence (p = 0.046). The sobel tests show that the fully mediator variable feature of mouth breathing is statistically significant in the negative relation between zygosity and atypical swallowing. CONCLUSION: The PLS-SEM model showed that mouth breathing triggers atypical swallowing and atypical swallowing triggers AOB. As a result of this chain of relationships, an indirect effect of zygosity on AOB was observed. According to sobel tests, zygosity has an indirect effect on atypical swallowing through mouth breathing, while mouth breathing has a positive indirect effect on AOB through atypical swallowing. CLINICAL RELEVANCE: This study identified the relationships between different factors and the presence of AOB. The findings of this study demonstrate in detail the relationships between AOB and zygosity, atypical swallowing, mouth breathing, breastfeeding and bottle feeding. Brestfeeding has a reducing effect on the frequency of AOB. Among the nutritional forms, breastfeeding ensures the proper development of the stomatognathic system by working the oro-facial muscles.

Videofluoroscopic Swallowing Studies: A Proposed Checklist.

PURPOSE: The videofluoroscopic swallowing study (VFSS) is used widely in dysphagia research. However, variations exist in the conduct and interpretation of VFSS, including differences in contrast agents, food and fluid consistencies tested, patient positioning, intervention strategies trialed, fluoroscopy settings, resolution, and image storage solutions. It cannot be assumed that VFSS exams yield directly comparable results across different studies. It is essential that relevant elements of VFSS be clearly reported in research. The goal of this article is to outline optimal VFSS reporting as part of the Framework for RigOr aNd Transparency In REseaRch on Swallowing (FRONTIERS), a critical appraisal tool intended to promote rigor and transparency in dysphagia research. METHOD: We developed a set of 27 questions regarding the rigor and transparency of VFSS reporting, based on review of previous research articles. These were reviewed by all members of the FRONTIERS Framework collaborative, to determine which questions were mandatory, unnecessary, or needed revision, prior to inclusion in the final critical appraisal tool. RESULTS: The final FRONTIERS Framework tool contains 20 questions and seven subquestions regarding VFSS. These are grouped into four themes: patient/participant positioning, equipment and recording settings, contrast agents, and rating methods, including operational definitions and reliability. CONCLUSIONS: The VFSS section of the FRONTIERS Framework tool is intended to facilitate and promote rigorous and transparent reporting of all elements that may influence the interpretation of VFSS in research. This critical appraisal tool can also be used to guide research design and the evaluation of study outcomes contributing to best practices in the field of dysphagia research.

To Compare the Effect of Swallowing and Non-Swallowing Exercises on Dysphagia in Post Operative Oral Cancer Individuals: A Comparative Study.

PRIMARY OBJECTIVE: To find out the effect of Swallowing and Non-Swallowing Exercises on Dysphagia in Post-Operative Oral Cancer individuals. SECONDARY OBJECTIVE: To compare the effect of Swallowing and Non-Swallowing Exercises on Dysphagia on Quality of Life in Post-Operative Oral Cancer individuals. METHODS: The study was conducted in Krishna Hospital Karad where 66 participants with post-operative oral cancer were selected according to the inclusion criteria. Simple random sampling was used to allocate the subjects into Group A (n=33) (non-swallowing exercises) & Group B (n=33) (swallowing exercises). The subjects performed respective exercises for 5 weeks. Pre & post assessment was performed by the outcome measures. RESULTS: Using paired t test both the Groups demonstrated significant results with all the outcome measures MWST with p<0.0001, MDADI with p<0.0001 and FACT H&N with p<0.0001 respectively concluding extremely significant results. Unpaired t test analysis for MWST, MDADI & FACT H&N of group A showed extremely significant mean difference as compare to group B with p<0.0001. CONCLUSION: This study concluded that both swallowing and non-swallowing exercises are beneficial for dysphagia in post-operative oral cancer individuals, but the Non-Swallowing Exercises were more effective.

Temporal recovery and prognostic factors for dysphagia following cardiovascular surgery: Retrospective analysis and development of predictive score.

OBJECTIVE: Dysphagia is a common complication associated with cardiovascular surgery (CVS). This study sought to better understand recovery timelines, identify risk factors, and create a prognostic model for oral intake restoration. METHODS: This retrospective study included 134 patients who had CVS between April 2022 and March 2024. We assessed swallowing ability through fiberoptic endoscopic evaluation of swallowing (FEES). We randomly divided the patients' data into a training dataset and a test dataset in a ratio of 70/30 and Kaplan-Meier analyses and Cox regression were used to assess predictors of total oral intake. We also created a scoring system using the estimated regression coefficients. RESULTS: Most patients with CVS achieved total oral intake in 7-11 days after extubation. Over 168 h of intubation, the presence of penetration or aspiration, a poor FEES score (score > 6), and perioperative complications were significant risk factors for delayed total oral intake. The predicting score was calculated by adding the scores for each individual factor, including FEES score, penetration/aspiration, and preoperative complications. Scores ranged 0-8, categorizing patients into 0-2, 3-5, and 6-8 groups, clearly demonstrating that the higher the predicting score, the longer the time to total oral intake in both the training and the test dataset. CONCLUSIONS: All risk factors for unsuccessful or delayed total oral intake were intubation for more than a week, poor swallowing ability, and the presence of perioperative complications. The scoring system accurately predicts the restoration of oral intake following CVS.

Apraisal of the diagnostic value of the gag reflex in patients with neurogenic oropharyngeal dysphagia / Evaluación del valor clínico del reflejo nauseoso en la disfagia orofaríngea neurogénica.

Introduction: The gag reflex is a protection mechanism that prevents food and unwanted agents from entering the lower airways. It is usually part of the physical examination of swallowing to detect oropharyngeal dysphagia, but it is a potentially ambiguous sign. Objective: To evaluate the diagnostic value of the gag reflex in patients with neurogenic oropharyngeal dysphagia and adults without it. Materials and methods: We conducted an analytical observational study in patients with neurogenic oropharyngeal dysphagia (cases) and patients without dysphagia (controls). We evaluated the absence or presence of the reflex bilaterally, by direct visualization, and adjusted it according to sex, age, and other interaction variables. Results: We included 86 patients with neurogenic oropharyngeal dysphagia and 80 control subjects. The gag reflex on swallowing physical examination showed a positive relationship with the patients (right side: OR = 3.97; 95 % CI: 2.01-7.84; left side: OR = 4.84; 95 % CI: 2.41-9.72), but a negative association with the control group. In both groups, neither sex, nor age, nor other interaction variables modified the gag reflex. Conclusions: The gag reflex absence or presence does not confirm or exclude the existence of oropharyngeal dysphagia due to neurological and neuromuscular causes. Therefore, health professionals must not rely on this reflex. Clinicians must go beyond a simple reflex revision, even in neurological patients where it is supposed to be absent.

Introducción. El reflejo nauseoso es un mecanismo de protección que impide que alimentos y agentes no deseados penetren en la vía aérea inferior. Usualmente, hace parte del examen físico de la deglución para detectar la disfagia orofaríngea, pero es un signo potencialmente ambiguo. Objetivo. Evaluar el valor diagnóstico del reflejo nauseoso en pacientes con disfagia orofaríngea neurogénica y en pacientes sin ella. Materiales y métodos. Se trata de un estudio observacional, analítico, en pacientes con disfagia orofaríngea neurogénica (casos) y en personas sin disfagia (controles), en el cual se evaluó por visualización directa la ausencia o la presencia del reflejo nauseoso de forma bilateral. Este resultado se ajustó por sexo, edad y otras variables de interacción. Resultados. Se evaluaron 86 pacientes con disfagia orofaríngea neurogénica y 80 personas sin ella. En el examen físico de la deglución, la presencia del reflejo mostró una relación positiva con los pacientes (lado derecho: OR = 3,97; IC95%: 2,01-7,84; lado izquierdo: OR = 4,84; IC95%: 2,41-9,72), pero una asociación negativa con los controles. En ambos grupos, ni el sexo ni la edad, ni otras variables de interacción modificaron el reflejo nauseoso. Conclusiones. La ausencia o la presencia del reflejo nauseoso no confirma ni excluye la existencia de una disfagia orofaríngea por causas neurológicas o neuromusculares; por lo tanto, no es recomendable que los profesionales de la salud se fíen del resultado de este reflejo. Los médicos tratantes deben ir más allá de una simple revisión del reflejo nauseoso, incluso en pacientes neurológicos en quienes se supone que debería estar ausente.