Comparison of sEMG activity of submental muscles between the head-lift exercise, tongue-press exercise and the head extension tongue-press exercise in healthy young adults.

BACKGROUND: Swallowing is a complex function that requires precise coordination between different muscles. Weakness in submental muscles can lead to complications such as pharyngeal residue and aspiration. Therefore, exercise interventions targeting these muscles, such as the Head-Lift Exercise (HLE), are clinically important but pose challenges. OBJECTIVE(S): This study aimed to compare the myoelectric activity of submental muscles during traditional Head-Lift Exercise (HLE), Tongue-Press Exercise (TPE) and Head Extension Tongue-Press Exercise (HETPE), providing potential alternatives to HLE. METHODS: Thirty healthy volunteers (22 females and 8 males, mean age 25.63 ± 5.27 years) participated in this cross-sectional study. Surface electromyography (sEMG) recorded activity of the submental muscles bilaterally during HLE, TPE and HETPE. Participants performed each manoeuvre for 14 s, repeated three times in a counterbalanced order. Statistical analyses assessed differences in mean, maximum and median frequency of the sEMG signals among manoeuvres using repeated-measures analysis of variance (RM-ANOVA). The experienced irritation levels by participants during manoeuvres were also compared by the Friedman test. RESULTS: HETPE exhibited significantly higher maximum sEMG activity compared to HLE and TPE (p < .05). Mean sEMG activity was significantly increased during HETPE compared to TPE. Median frequency was significantly lower during HETPE compared to the two other exercises, indicating greater muscle fatigue. Participants reported similar levels of irritation for HLE and HETPE, and significantly lower levels during TPE. CONCLUSION: These results indicate that HETPE is effective in activating and strengthening submental muscles, potentially serving as a viable alternative to HLE without added difficulty. Further research is recommended to assess the long-term impacts on swallowing physiology in patients with dysphagia.

A Scoping Review on the Effects of Kinesio Taping on Oropharyngeal Function Related to Swallowing and Feeding.

Following the expansion of interdisciplinary communication among rehabilitative service providers, new techniques have been introduced for treating swallowing disorders. Kinesio taping (KT) is one of the recently noticed techniques in the rehabilitation of swallowing and feeding disorders. Given the novelty of this technique in research and practice, the present scoping review aimed to summarize the available evidence on the effects of KT on the oropharyngeal function related to swallowing, and to identify current knowledge gaps to guide future studies. The initial comprehensive search was conducted in the six databases in November 2022 and then was updated in June 2023. Studies were independently reviewed by two authors to exclude all types of reviews and study protocols, studies published only in an abstract form and also studies that used KT for improving voice and dysarthria symptoms. The methodology of the included studies was also critically appraised using Joanna Briggs Institute (JBI) standard tools by two authors. The results of the studies were categorized and reported based on their overall objectives. In final analysis, 21 articles were described. Study designs ranged from randomized control trials (RCTs) to the case reports. The effects of KT had been investigated on drooling, oral feeding skills of infants, immediate activation of swallowing muscles, and management of dysphagia in patients with stroke or cerebral palsy (CP). Although innovative approaches to use KT as a therapeutic method in swallowing disorders have been investigated in the studies, there are many methodological limitations that affected validity of the results. In general, it seems there is not enough evidence to add KT to the usual management of feeding and swallowing disorders yet. Further studies, therefore, are required to achieve more accurate conclusions in each of the objectives summarized in this study.

Neuromuscular Electrical Stimulation in Conjunction with Conventional Swallowing Therapy in the Treatment of Dysphagia Caused by Multiple Sclerosis: A Single-Case Experimental Design.

INTRODUCTION: Dysphagia as a consequence of multiple sclerosis (MS) puts individuals at higher risk of dehydration, malnutrition, and aspiration pneumonia. This study intended to investigate the effects of a combined program of neuromuscular electrical stimulation (NMES) and conventional swallowing therapy to improve swallow safety and efficiency, oral intake, and physical, emotional, and functional impacts of dysphagia in people with dysphagia and MS. METHODS: In this single-case experimental study with ABA design, two participants with dysphagia caused by MS underwent 12 sessions therapy during 6 weeks following a baseline of 4 evaluation sessions. They were evaluated 4 more times in the follow-up phase after therapy sessions. Scores of Mann Assessment of Swallowing Ability (MASA), DYsphagia in MUltiple Sclerosis (DYMUS), and timed test of swallowing capacity were obtained at baseline, during treatment, and in the follow-up phases. The Dysphagia Outcome and Severity Scale (DOSS) based on videofluoroscopic swallow studies, Persian-Dysphagia Handicap Index (Persian-DHI), and Functional Oral Intake Scale (FOIS) were also completed before and after treatment. Visual analysis and percentage of nonoverlapping data were calculated. RESULTS: MASA, DYMUS, FOIS, and DHI scores indicated significant improvement in both participants. Although the scores of the timed test of swallowing capacity in participant 1 (B.N.) and DOSS in participant 2 (M.A.) showed no changes, considerable improvements including reducing the amount of residue and the number of swallows required to clear bolus were seen in the posttreatment videofluoroscopic records of both participants. CONCLUSION: NMES in conjunction with conventional dysphagia therapy based on motor learning principles could improve the swallowing function and decrease disabling effects of dysphagia on different aspects of life in participants with dysphagia caused by MS.

Speech outcomes after palatal closure in 3-7-year-old children / Resultados da fala após o reparo de fenda palatina em crianças de 3 a 7 anos

Abstract Introduction: One of the main goals of the team approach in management of oro-facial clefts is to help the children with cleft palate have adequate speech development. Objective: The present study aimed to investigate the prevalence of articulation and resonance disorders following palate closure in children who were visited for routine examination by the Isfahan Cleft Care Team between 2011 and 2015, and to study the impact of cleft type and age at the time of palatoplasty on speech outcomes. Methods: Clinical records of 180 preschool children with repaired cleft palate were reviewed. The percentage of children demonstrating hypernasality, nasal emission, nasal turbulence, and compensatory misarticulations was calculated. The relationship between cleft type and age at the time of palatal surgery, as independent variables, and speech outcomes were examined. Results: 67.7 and 64.5 percent of the children demonstrated respectively moderate/severe hypernasality and nasal emission, and 71.1 percent produced compensatory misarticulations. Age at the time of palatal repair was significantly associated with compensatory misarticulations and also with moderate/severe hypernasality. The prevalence of compensatory misarticulations, significant hypernasality, nasal emission and also nasal turbulence was not significantly different in various types of cleft. Conclusions: We observed a high prevalence of different speech disorders in preschool children with repaired cleft palate compared to other studies. This can be partly due to late palatal repair in the studied population. Despite many advances in cleft palate management programs in Iran, there are still many children who do not access the interdisciplinary team cares in their early childhood. We should, therefore, try to increase accessibility of appropriate and timely management services to all Iranian children with cleft lip/palate.

Resumo Introdução: Um dos principais objetivos da abordagem em equipe no tratamento das fendas orofaciais é contribuir para que as crianças com fenda palatina tenham um desenvolvimento adequado da fala. Objetivo: Investigar a prevalência de distúrbios de articulação e ressonância após o reparo da fenda palatina em crianças acompanhadas no Isfahan Cleft Care Team entre 2011 e 2015; e avaliar o impacto do tipo de fenda e da idade na época da palatoplastia nos resultados da fala. Método: Os prontuários de 180 pré-escolares com fenda palatina reparada foram revisados para determinação da porcentagem de crianças com hipernasalidade, emissão nasal, turbulência nasal e distúrbios articulatórios compensatórios. A relação entre o tipo de fenda e a idade no momento da cirurgia de palato, como variáveis independentes, e os resultados de fala também foram avaliados. Resultados: Das crianças, 67,7% e 64,5% apresentavam hipernasalidade moderada/grave e emissão nasal, respectivamente, e 71,1% tinham distúrbios articulatórios compensatórios. A idade no momento do reparo do palato foi significantemente associada aos distúrbios articulatórios compensatórios e também à hipernasalidade moderada/grave. A prevalência de distúrbios articulatórios compensatórios, hipernasalidade significativa, emissão nasal, assim como da turbulência nasal, não foi significantemente diferente nos vários tipos de fenda. Conclusão: Observou-se maior prevalência de diferentes alterações de fala em pré-escolares com fenda palatina reparada em comparação a outros estudos. Isso pode ser parcialmente decorrente do reparo palatino tardio na população estudada. Apesar dos muitos avanços nos programas de tratamento de fenda palatina no Irã, ainda existem muitas crianças que não têm acesso aos cuidados de uma equipe interdisciplinar na primeira infância. Devemos, portanto, tentar aumentar a acessibilidade de serviços de tratamento apropriados e oportunos para todas as crianças iranianas com fenda labiopalatina.

Speech outcomes after palatal closure in 3-7-year-old children.

INTRODUCTION: One of the main goals of the team approach in management of oro-facial clefts is to help the children with cleft palate have adequate speech development. OBJECTIVE: The present study aimed to investigate the prevalence of articulation and resonance disorders following palate closure in children who were visited for routine examination by the Isfahan Cleft Care Team between 2011 and 2015, and to study the impact of cleft type and age at the time of palatoplasty on speech outcomes. METHODS: Clinical records of 180 preschool children with repaired cleft palate were reviewed. The percentage of children demonstrating hypernasality, nasal emission, nasal turbulence, and compensatory misarticulations was calculated. The relationship between cleft type and age at the time of palatal surgery, as independent variables, and speech outcomes were examined. RESULTS: 67.7 and 64.5 percent of the children demonstrated respectively moderate/severe hypernasality and nasal emission, and 71.1 percent produced compensatory misarticulations. Age at the time of palatal repair was significantly associated with compensatory misarticulations and also with moderate/severe hypernasality. The prevalence of compensatory misarticulations, significant hypernasality, nasal emission and also nasal turbulence was not significantly different in various types of cleft. CONCLUSIONS: We observed a high prevalence of different speech disorders in preschool children with repaired cleft palate compared to other studies. This can be partly due to late palatal repair in the studied population. Despite many advances in cleft palate management programs in Iran, there are still many children who do not access the interdisciplinary team cares in their early childhood. We should, therefore, try to increase accessibility of appropriate and timely management services to all Iranian children with cleft lip/palate.

The effects of swallowing exercise and non-nutritive sucking exercise on oral feeding readiness in preterm infants: A randomized controlled trial.

INTRODUCTION: Preterm infants demonstrate problems with pharyngeal swallowing in addition to sucking problems. Oral motor intervention and nonnutritive sucking (NNS) were introduced for promoting oral feeding skills in preterm infants. NNS cannot cover all the components of oral feeding. In another hand, the swallowing exercise (SE) can accelerate the attainment of independent oral feeding in the preterm infants. The current study sought to examine if a combined program of NNS and SE compared with a program that only involves NNS would be more effective on oral feeding readiness of premature infants. MATERIAL AND METHODS: This randomized controlled trial was conducted in a neonatal intensive care unit (NICU). 45 preterm infants were recruited in three groups. In the group I, infants were provided with NNS twice a day. The group II received a program that involved 15 min of NNS and 15 min of SE, daily. Both interventions were provided 10 days during two consecutive weeks. The group III, control group, just received the routine NICU care. All infants were assessed by functional oral feeding outcome measures including postmenstrual age (PMA) at the start of oral feeding, PMA at full oral feeding, transition time (days from start to full oral feeding), PMA at discharge time and also the infant's dependency on tube-feeding at discharge time after interventions. Also, all infants were assessed via Preterm Oral Feeding Readiness Scale (POFRAS) before and after intervention. RESULTS: No significant differences were observed in the PMA mean at start of oral-feeding (P = 0.29), full oral-feeding (P = 0.13), discharge time (P = 0.45) and the mean of transition time (P = 0.14). Compared to the control group, more infants in the group II were discharged without tube-feeding (P = 0.01). The mean of POFRAS was significantly higher in both groups I and II compared to the group III (P = 0.02 and P = 0.01, respectively). This score was, however, not statistically different between the groups I and II (P = 0.98). CONCLUSIONS: Both studied interventions were superior to routine NICU care in enhancing the oral feeding readiness of preterm infants based on the POFRAS score. The studied combined program of NNS and SE, and not NNS program, could significantly increase the number of discharged infants without tube-feeding compared to control group.

Effects of the head lift exercise and neuromuscular electrical stimulation on swallowing muscles activity in healthy older adults: a randomized pilot study.

PURPOSE: Swallowing physiology exhibits several changes in advanced ages. The present study aimed to investigate and compare effects of a period of the head lift exercise (HLE) and neuromuscular electrical stimulation (NMES) on swallowing muscles activity in healthy elderly. PATIENTS AND METHODS: A total of 23 older adults were randomized to either the HLE or NMES group for ten therapy sessions. They received pre- and post-therapy surface electromyography (sEMG) during water swallowing. RESULTS: For the HLE group, duration of suprahyoid muscles activity was significantly reduced at post-intervention compared to pre-intervention (p=0.036). Moreover after treatments, duration and latency between onset and peak amplitude of suprahyoid muscles activity was significantly shorter in the HLE group compare to the NMES group (respectively, p=0.007 and p=0.003). CONCLUSION: Our findings suggest that the HLE, against the NMES, may be effective in reducing some aging effects on the suprahyoid muscles activity, especially in elders who demonstrate prolonged duration and latency between onset and peak of the suprahyoid muscles activity during swallowing.

Narrative discourse in Persian-speaking patients with mild Alzheimer's disease.

Despite the significance of discourse impairments, they have not been thoroughly investigated in Persian-speaking patients with Alzheimer's disease (AD). OBJECTIVE: the aim of this study was to perform a multi-level analysis of narrative discourse in Persian-speaking patients with mild AD and to compare them with healthy elderly. METHODS: the study included 14 older adults with mild AD and a matched group of 14 healthy elderly. Using a storytelling task based on serial pictures, both macro- and micro-linguistic aspects of narrative discourse were assessed. Cohesion ratio and coherence were investigated as macrolinguistic dimensions of discourse. The studied microlinguistic features included syntactic complexity and verbal errors (mostly involving phonological and semantic paraphasias and mazes). Severity of AD was determined using the Cognitive Dementia Rating (CDR). RESULTS: there were significant differences between the groups regarding cohesion ratio (0.9 ± 0.34 vs. 1.29 ± 0.45, p = 0.02) and coherence scores (2.43 ± 0.41 vs. 3.02 ± 0.81, p = 0.03). Verbal errors and syntactic complexity did not differ significantly between the groups. CONCLUSION: Persian-speaking patients with mild AD show macrolinguistic impairments in producing discourses based on picture description. Therefore, intervention protocols should focus on the ability to organize information on a specific subject and also to connect sentences produced using appropriate cohesive ties.

Apesar da significância das deficiências discursivas, elas não foram completamente investigadas em pacientes de fala persa com doença de Alzheimer (DA). OBJETIVO: o objetivo deste estudo foi desenvolver uma análise multinível do discurso narrativo em pacientes de língua persa com DA leve e compará-los com idosos saudáveis. MÉTODOS: o estudo incluiu 14 idosos com DA leve e um grupo pareado de 14 idosos saudáveis. Usando uma tarefa narrativa baseada em imagens seriais, os aspectos macro e microlinguísticos do discurso narrativo foram avaliados. Coesão e coesão foram investigadas como dimensões macrolinguísticas do discurso. As características microlinguísticas estudadas incluíram complexidade sintática e erros verbais (incluindo principalmente parafasias e labirintos fonológicos e semânticos). A gravidade da DA foi avaliada por meio do Cognitive Dementia Rating (CDR). RESULTADOS: houve diferenças significativas entre os grupos quanto ao coeficiente de correlação (0,9 ± 0,34 vs. 1,29 ± 0,45, p = 0,02) e escores de coerência (2,43 ± 0,41 vs. 3,02 ± 0,81, p = 0,03). Erros verbais e complexidade sintática não foram significativamente diferentes entre os grupos. CONCLUSÃO: pacientes de língua persa com DA leve apresentam comprometimento macrolinguístico em produzir discursos baseados na descrição de figuras. Portanto, os protocolos de intervenção devem enfocar sua capacidade de organizar informações sobre um assunto específico e também conectar suas sentenças produzidas por laços coesos apropriados.

Narrative discourse in Persian-speaking patients with mild Alzheimer's disease / Discurso narrativo em pacientes de fala persa com doença de Alzheimer leve

ABSTRACT. Despite the significance of discourse impairments, they have not been thoroughly investigated in Persian-speaking patients with Alzheimer's disease (AD). Objective: the aim of this study was to perform a multi-level analysis of narrative discourse in Persian-speaking patients with mild AD and to compare them with healthy elderly. Methods: the study included 14 older adults with mild AD and a matched group of 14 healthy elderly. Using a storytelling task based on serial pictures, both macro- and micro-linguistic aspects of narrative discourse were assessed. Cohesion ratio and coherence were investigated as macrolinguistic dimensions of discourse. The studied microlinguistic features included syntactic complexity and verbal errors (mostly involving phonological and semantic paraphasias and mazes). Severity of AD was determined using the Cognitive Dementia Rating (CDR). Results: there were significant differences between the groups regarding cohesion ratio (0.9 ± 0.34 vs. 1.29 ± 0.45, p = 0.02) and coherence scores (2.43 ± 0.41 vs. 3.02 ± 0.81, p = 0.03). Verbal errors and syntactic complexity did not differ significantly between the groups. Conclusion: Persian-speaking patients with mild AD show macrolinguistic impairments in producing discourses based on picture description. Therefore, intervention protocols should focus on the ability to organize information on a specific subject and also to connect sentences produced using appropriate cohesive ties.

RESUMO. Apesar da significância das deficiências discursivas, elas não foram completamente investigadas em pacientes de fala persa com doença de Alzheimer (DA). Objetivo: o objetivo deste estudo foi desenvolver uma análise multinível do discurso narrativo em pacientes de língua persa com DA leve e compará-los com idosos saudáveis. Métodos: o estudo incluiu 14 idosos com DA leve e um grupo pareado de 14 idosos saudáveis. Usando uma tarefa narrativa baseada em imagens seriais, os aspectos macro e microlinguísticos do discurso narrativo foram avaliados. Coesão e coesão foram investigadas como dimensões macrolinguísticas do discurso. As características microlinguísticas estudadas incluíram complexidade sintática e erros verbais (incluindo principalmente parafasias e labirintos fonológicos e semânticos). A gravidade da DA foi avaliada por meio do Cognitive Dementia Rating (CDR). Resultados: houve diferenças significativas entre os grupos quanto ao coeficiente de correlação (0,9 ± 0,34 vs. 1,29 ± 0,45, p = 0,02) e escores de coerência (2,43 ± 0,41 vs. 3,02 ± 0,81, p = 0,03). Erros verbais e complexidade sintática não foram significativamente diferentes entre os grupos. Conclusão: pacientes de língua persa com DA leve apresentam comprometimento macrolinguístico em produzir discursos baseados na descrição de figuras. Portanto, os protocolos de intervenção devem enfocar sua capacidade de organizar informações sobre um assunto específico e também conectar suas sentenças produzidas por laços coesos apropriados.

Surface Electromyographic Assessment of Swallowing Function.

The reliability of surface electromyographic (sEMG) variables during swallowing determines the potential usefulness of these measures in swallowing assessment and treatment. This study aimed to establish the reliability of the sEMG measures of the swallowing function of muscles during different swallowing conditions in healthy young and old volunteers. Two groups of volunteers (24 older adults, 10 younger adults) participated in this cross-sectional study during 2014. The activity of masseter, submental, and infrahyoid groups were measured using sEMG during three repetitions of different swallowing tasks. Both the relative and absolute reliability (characterized respectively by ICC, SEM%, and SRD%) were calculated for the sEMG indices of muscle activity during swallowing events. Statistical analyses were performed by the SPSS 19.0 and Microsoft Excel 2007 software packages. Statistical significance was set at P≤0.05. The relative reliability calculations showed significant agreements between repetitions for the mean and peak amplitude and the average of median frequency (MDF) of the studied muscles function during most swallowing types in both groups. However, the duration and particularly the time to peak of muscle activity showed significant agreements during fewer swallowing conditions. Excluding MDF, we found high SEM% and SRD% for the studied measures (particularly timing measures) of muscles function during most swallowing types in both groups. The reliability of sEMG measures was influenced by the age and swallowing types. Our findings suggest that the MDF of muscle function during almost all studied swallowing types can be a reliable measure for the sEMG assessment of swallowing function in both younger and older adults.

Systemic review on highly qualified screening tests for swallowing disorders following stroke: Validity and reliability issues.

BACKGROUND: Oropharyngeal dysphagia following stroke enhances the risk of dehydration, malnutrition, aspiration pneumonia, persistent disablement, and even death. Screening of dysphagia has been shown to positively change health outcomes. The aim of the present study was to systematically introduce the published swallowing screening methods in patients with stroke and their appropriateness for detecting swallowing disorders following stroke with an emphasis on the methodological quality of their research studies. MATERIALS AND METHODS: A computerized search through the Medline (PubMed), Embase, Scopus, and Google Scholar; databases from 1990 through 20 July 2013 was performed. In addition, the related citations and reference lists of the selected articles were considered. RESULTS: A total of 264 papers were retrieved and 19 articles finally met inclusion criteria. Sixty-eight percent of included papers did not have a sufficient quality and only six articles were scored as having evidence level 'I' and were reported descriptively. The most prevalent bias in the included studies was probably a kind of spectrum bias that could lead to select just a subgroup of admitted stroke patients. The screening tests' sensitivities ranged from 47 to 100%, while their specificities ranged from about 63 to 100%. Strengths and limitations of each test have been discussed. CONCLUSION: We ultimately found four simple, valid, reliable, sensitive, and specific tests for screening swallowing disorders in the almost all acute alert stroke patients. Further validation and reliability assessing of screening tests need to follow a very accurate and well-established method in a large sample of the almost all acute alert stroke patients admitted to the hospitals.

Surface electrical stimulation for treating swallowing disorders after stroke: a review of the stimulation intensity levels and the electrode placements.

Neuromuscular electrical stimulation (NMES) for treating dysphagia is a relatively new therapeutic method. There is a paucity of evidence about the use of NMES in patients with dysphagia caused by stroke. The present review aimed to introduce and discuss studies that have evaluated the efficacy of this method amongst dysphagic patients following stroke with emphasis on the intensity of stimulation (sensory or motor level) and the method of electrode placement on the neck. The majority of the reviewed studies describe some positive effects of the NMES on the neck musculature in the swallowing performance of poststroke dysphagic patients, especially when the intensity of the stimulus is adjusted at the sensory level or when the motor electrical stimulation is applied on the infrahyoid muscles during swallowing.

Oropharyngeal dysphagia in multiple sclerosis.

Swallowing disorders are commonly observed in multiple sclerosis (MS) patients. The complications of dysphagia are common causes of morbidity and death in late stages of MS. However, dysphagia in MS usually receives limited attention. The purpose of this study was to determine the prevalence of different kinds of swallowing disorders in MS patients with mild to moderate disability; and to identify possible associations between clinical and demographic features of patients and the presence of dysphagia. The swallowing functions of 101 consecutive MS patients were screened by the Northwestern Dysphagia Patient Check Sheet. This is a screening test which identifies patients with pharyngeal stage disorders, aspiration, oral stage disorders and/or pharyngeal delay. 'Dysphagia' was defined as having at least one of the above mentioned four disorders. Among 101 MS patients, 32 (31.7%) were classified as having dysphagia. Pharyngeal stage disorders were the most common observed impairment (28.7%) and aspiration, oral stage disorders, and pharyngeal delay were observed in 6.9%, 5%, and 1% of patients, respectively. Dysphagic patients had a significantly longer disease duration (p = 0.031) and more neurological impairment in cerebellar functional system (p = 0.04) when compared with non-dysphagic patients. Moreover, dysphagia was significantly more prevalent in patients with more neurological disability as measured by Expanded Disability Status Scale (EDSS) scores (p = 0.04). These results emphasize the importance of assessment and management of swallowing function in MS patients, particularly in patients with a high EDSS score; more severe cerebellar dysfunction, and long disease duration.