Effects of Age and Lingual-Palatal Pressure Levels on Submental Surface Electromyography Measures.

Submental surface electromyography (sEMG) may provide information about the lingual-palatal pressure (LPP) during swallowing. However, the extent to which changes in age and LPP levels are reflected in different sEMG measures is unclear. This study aimed to understand the effects of age and different levels of submaximal LPPs on submental sEMG peak, average, and integrated values in healthy adults. Ninety community-dwelling healthy participants were categorized into three age groups (young: 20-39 years, middle age: 40-59 years, older: 60 ≥ years). sEMG and LPP measurements were collected concurrently. After placing the sEMG electrodes, the maximal isometric LPP was established using the Iowa oral performance instrument (IOPI) on the anterior tongue. sEMG recordings were conducted for three submaximal LPP levels, including 40%, 60%, and 80% of the maximum LPP. Two-way repeated measure ANOVAs were conducted to find the effects of age and varying LPP levels on mean sEMG peak, average, and integrated measures. A significant age by LPP level interaction was identified for sEMG peak [F (4, 172) = 4.116, p < 0.007, ηp2 = 0.087], sEMG average [F (4, 170) = 5.049, p < 0.001, ηp2 = 0.106], and sEMG integrated values [F (4, 170) = 4.179, p < 0.003, ηp2 = 0.090]. Post hoc testing demonstrated that, in general, sEMG values significantly increased with rising LPP levels, primarily for younger and middle-aged adults. Furthermore, at 80% of maximum LPP, older adults generated less sEMG average and integrated values than middle age (only significant for sEMG integrated value) and younger adults. Likewise, max LPP was lower in older adults compared with young and middle-aged groups. Submental sEMG has the potential to be incorporated into a skill-based lingual exercise paradigm to improve tongue function during swallowing. Moreover, submental sEMG can characterize some age-related subclinical changes in swallowing.

Transcutaneous electrical stimulation as a resistance force in lingual exercise: A preliminary proof-of-concept study.

BACKGROUND: Limited knowledge exists regarding whether transcutaneous electrical stimulation (TES)-based exercise can improve the lingual pressure generation. OBJECTIVES: To compare the effect of submental TES with two different pulse durations (PD) coupled with isometric lingual exercises on lingual pressure measures. METHODS: Twenty-eight healthy volunteers were divided into two submental TES groups: short PD (300 µs) and long PD (700 µs). The Iowa Oral Performance Instrument (IOPI) was used for lingual pressure measurements and exercise. In total, participants attended six exercise sessions 3 days per week for 2 consecutive weeks. Maximum and swallowing lingual pressures were measured 1 h following each exercise session and 3 days after the final session to assess any detraining effect. Data were analysed using repeated measure ANOVA. RESULTS: Mean maximum lingual pressure change was significantly greater in TES with short PD versus the long PD condition following the first week of exercise. Following the 2-week exercise, a significant increase was found in mean maximum lingual pressure for short and long PD conditions compared with the baseline. However, no significant difference was found between PD conditions for maximum lingual pressure. Likewise, no significant differences in swallowing lingual pressure were found compared with the baseline or across the two TES conditions. CONCLUSION: Although short PD induced greater gain in maximum lingual pressure than the long PD after week 1, the enhanced effect faded after week 2, leading to a comparable increase in maximum lingual pressure for both groups. However, increased gain in maximum lingual pressure was not transferred to lingual pressure during swallowing.

Change in Spontaneous Swallowing Frequency in HNC Patients Undergoing C/RT.

OBJECTIVE: This study sought to evaluate the role and trajectory of spontaneous swallowing frequency (SFA) in patients with head and neck cancer (HNC) undergoing chemoradiotherapy (C/RT).Study Design. Prospective cohort. SETTING: University comprehensive cancer center. METHODS: A prospective cohort of 80 patients with HNC was followed from baseline to 3 months post-C/RT. Subjects were evaluated for performance on swallowing function, functional diet consumed, weight, swallowing frequency rate, perceived xerostomia, perceived pain, and mucositis. Relationships were evaluated using univariate correlations, t tests, and repeated-measures analysis of variance. The diagnostic accuracy of SFA to express dysphagia was calculated by area under the curve (AUROC) and displayed using receiver operator characteristic curves. RESULTS: In general, patients with HNC demonstrated a parabolic decline in most measures over the C/RT trajectory. SFA and perceived xerostomia did not show improved recovery by 3 months. SFA was related to swallow function, xerostomia, and functional diet consumed posttreatment and pain at 3 months. The ability of SFA to correctly identify clinical dysphagia (Mann Assessment of Swallowing-Cancer version [MASA-C]) and reduced oral intake (Functional Oral Intake Scale [FOIS]) at posttreatment was strong (AUROC MASA-C: 0.824 [95% CI, 0.63-1.00], P < .0018; AUROC FOIS: 0.96 [95% CI, 0.87-0.96], P < .0001). CONCLUSION: This exploratory study suggests SFA may provide a useful method to identify dysphagia after HNC treatment. Furthermore, SFA may offer a simple, objective measure of swallowing function change in HNC over the C/RT trajectory.

Spontaneous Swallowing Frequency, Dysphagia, and Drooling in Children With Cerebral Palsy.

OBJECTIVE: To evaluate relationships between spontaneous swallowing frequency, dysphagia, and drooling in children with cerebral palsy. Spontaneous swallowing frequency was predicted to be inversely related to both dysphagia and drooling among children with cerebral palsy. A secondary objective compared patterns among spontaneous swallowing frequency, drooling, and age in healthy children vs children presenting with cerebral palsy. DESIGN: Cross sectional study. SETTING: Children with cerebral palsy were tested at a Cerebral Palsy Reference Center in a university hospital. Healthy children were tested in their home setting. PARTICIPANTS: Twenty children with cerebral palsy were recruited from the local registry for cerebral palsy children and purposive sampling among parents. A group of 30 healthy children was recruited by purposive sampling among family, friends, and the local community. Children below 1 year of age up to 5 years of age were included in the healthy group. This age range was targeted to maximize the potential for drooling in this group. MAIN OUTCOME MEASURES: Both groups provided data on spontaneous swallowing frequency (swallows per minute, or SPM), dysphagia, and drooling. Motor impairment was documented in the children with cerebral palsy. RESULTS: SPM was significantly lower in children with cerebral palsy. Among children with cerebral palsy, SPM correlated significantly with dysphagia severity and trended toward a significant correlation with drooling at rest. In this subgroup, SPM was not correlated with age or degree of motor impairment. Dysphagia was significantly correlated with drooling at rest and both dysphagia and drooling at rest were correlated with degree of motor impairment. The 2 groups did not differ in the degree of drooling at rest. Among healthy children, age but not SPM demonstrated a significant inverse correlation with drooling quotient at rest. CONCLUSIONS: Spontaneous swallowing frequency is related to dysphagia and drooling in children with cerebral palsy. The pattern of relationships among spontaneous swallowing frequency and drooling is different between children with cerebral palsy and younger healthy children.

Clinical Swallowing Profile Change in HNC Patients Treated with C/RT.

OBJECTIVES/HYPOTHESIS: To demonstrate utility of the Mann Assessment of Swallowing Ability-Cancer (MASA-C) to describe change in swallowing ability in a cohort of HNC patients from pre-C/RT to post-C/RT to follow up at 3 months post-C/RT. An exploratory analysis compared patients treated with radiotherapy (RT) only to patients treated with chemoradiation (CRT). STUDY DESIGN: Prospective Cohort. METHODS: The MASA-C and Functional Oral Intake Scale (FOIS) were completed on 85 HNC patients within the first 5 days of CRT initiation, at the completion of C/RT (6 weeks), and 3 months after completion of C/RT. MASA-C total scores and clinical profiles were used to describe change in swallowing performance at each time point. RESULTS: MASA-C and FOIS scores were significantly lower at 6 weeks and 3 months compared to baseline. Patients treated with CRT demonstrated more frequent and more severe dysphagia. Post C/RT items demonstrating the most deterioration included taste, diet level, oral mucosa, saliva, weight loss, and pharyngeal functions. Significant recovery was observed between 6 weeks and 3 months on both the MASA-C and FOIS. MASA-C items revealing the greatest recovery included taste, diet level, oral mucosa, tongue movement, weight loss, oral transit, voice, and pharyngeal phase. Few significant differences were noted between RT and CRT cases at 3 months. CONCLUSIONS: Swallowing functions deteriorate significantly following C/RT with incomplete recovery at 3 months. Few differences were noted between RT and CRT treated patients at 3 months. Clinical profiling with the MASA-C provides a standard, simple method to document swallow function change over time in these patients. LEVEL OF EVIDENCE: 2 Laryngoscope, 131:E1873-E1880, 2021.

Assessment Across the Life Span: The Clinical Swallow Evaluation.

Purpose This clinical focus article considers the roles of the clinical swallow examination (CSE) as a clinically meaningful assessment method used in both adult and pediatric populations. Method This clinical focus article explores the utility of the CSE across the life span. Specifically, components, reliability, standardized assessments, and limitations of the CSE within the adult and pediatric populations are highlighted. Conclusions The CSE remains a crucial assessment tool for the speech-language pathologist. The experienced clinician can make important judgments regarding patient safety and function. If the CSE is conducted mindfully and methodically, findings can help chart the course of care for individuals needing additional assessment and possibly intervention.

Transcutaneous Electrical Stimulation on the Submental Area: The Relations of Biopsychological Factors with Maximum Amplitude Tolerance and Perceived Discomfort Level.

Transcutaneous electrical stimulation (TES) is a frequently used adjunctive modality in dysphagia rehabilitation. Stimulating deeper swallowing muscles requires higher TES amplitude. However, TES amplitude is limited by maximum amplitude tolerance (MAT). Previous studies have reported high interindividual variability regarding MAT and perceived discomfort. This variability might be one of the potential reasons of conflicting outcomes in TES-based swallowing studies. MAT and perceived discomfort are influenced by a variety of biopsychological factors. The influence of these factors related to swallow applications is poorly understood. This study explored the relation of biopsychological factors with MAT and perceived discomfort related to TES in the submental area. A convenience sample of thirty community-dwelling older adults between 60 and 70 years of age provided data for this study. Gender, submental adipose tissue thickness, perceptual pain sensitivity, and pain-coping strategies were evaluated for each subject. Subsequently, MAT and perceived discomfort level were determined using TES on the submental area. Relation of different biopsychological variables with MAT and discomfort level was examined using Pearson and Spearman correlation, and Mann-Whitney U test. Results indicated that neither gender nor adipose thickness was related to MAT and perceived discomfort. Among studied pain-coping strategies, catastrophizing was significantly related to MAT(r = - 0.552, p < .002). Distraction was significantly related to perceived discomfort level (r = - 0.561, p < 0.002). Given the negative impact of pain catastrophizing on MAT and the positive impact of distraction on perceiving discomfort, these coping strategies should be considered as amplitude-limiting and discomfort-moderating factors in TES-based dysphagia rehabilitation.

Exercise-based swallowing intervention (McNeill Dysphagia Therapy) with adjunctive NMES to treat dysphagia post-stroke: A double-blind placebo-controlled trial.

BACKGROUND: Dysphagia following stroke is prevalent; however, dysphagia treatment is often applied haphazardly and outcomes unclear. Neuromuscular electrical stimulation (NMES) has received increased attention as a treatment for post-stroke dysphagia; but application data remain conflicted. OBJECTIVE: This study investigated effectiveness and safety of an exercise-based swallowing therapy (McNeill Dysphagia Therapy: MDTP) +NMES for dysphagia rehabilitation following stroke. METHODS: Stroke patients (n = 53, x̅ age: 66 [13.2], 47.2% male) with dysphagia admitted to sub-acute rehabilitation hospital were randomised to MDTP + NMES [NMES], MDTP + sham NMES [MDTP] or usual care [UC] swallowing therapy groups. Patients were treated for 1 hour per day for 3 weeks and monitored to 3 months by a blinded evaluator. Outcomes included clinical swallowing ability, oral intake, weight, patient perception of swallow and occurrence of dysphagia-related complications. RESULTS: Post-treatment dysphagia severity and treatment response were significantly different between groups (P ≤ .0001). MDTP demonstrated greater positive change than either NMES or UC arms, including increase in oral intake (χ2  = 5, P ≤ .022) and improved functional outcome by 3 months post-stroke (RR = 1.72, 1.04-2.84). Exploratory Cox regression revealed the MDTP group conferred the greatest benefit in time to "return to pre-stroke diet" of 4.317 [95% CI: 1.08- 17.2, P< .03]. CONCLUSION: Greater benefit (eg reduction in dysphagia severity, improved oral intake and earlier return to pre-stroke diet) resulted from a programme of MDTP alone vs NMES or UC.

The Effects of Electrical Stimulation Pulse Duration on Lingual Palatal Pressure Measures During Swallowing in Healthy Older Adults.

Limited research in swallowing physiology has suggested that the most common existing transcutaneous electrical stimulation (TES) protocol (VitalStim) may not penetrate to layers of tissue to affect deep swallowing muscles. TES amplitude is the primary parameter that determines the depth of electrical current penetration (DECP). Preliminary work suggests that replacing a long-pulse duration with a short-pulse duration can increase maximum amplitude tolerance (MAT) within subjects' comfort level. Increasing MAT may indicate a higher DECP. The current study evaluates this premise in reference to the effects of varying pulse duration on lingual-palatal pressure during swallowing. Thirty healthy older adults (60-70 years of age) participated in this study. Each subject swallowed three trials of 10 mL pudding under three TES conditions: no stimulation, short-pulse duration, and long-pulse duration. TES was delivered using two pairs of surface electrodes on the submental muscles. MAT and perceived discomfort levels were identified separately for short and long-pulse TES conditions. Lingual-palatal peak pressure, pressure integral, and pressure duration were measured under each condition. Two-way repeated measures ANOVAs were conducted to identify within subject effects of TES condition and tongue bulb location. Lingual-palatal pressure and pressure integral were significantly reduced in the short-pulse duration condition. MAT was significantly higher in the short-pulse duration versus the long-pulse duration condition. Furthermore, MAT was significantly correlated with lingual-palatal pressure. Changing pulse duration had no significant impact on tongue pressure duration. Results suggest that a short-pulse duration may penetrate deeper into muscles involved in swallowing. The specific impact is reflected in a reduced upward pressure of the tongue on the palate during swallowing. This 'restrictive' effect of TES on tongue pressure may have the potential to be used during a resistive exercise paradigm for tongue elevation during swallowing.

Associations Between Spontaneous Swallowing Frequency at Admission, Dysphagia, and Stroke-Related Outcomes in Acute Care.

OBJECTIVE: To expand the scope of prior spontaneous swallowing frequency analysis (SFA) studies, by evaluating the role of SFA in dysphagia-and stroke-related outcomes at acute stroke discharge. DESIGN: Period prevalence study. SETTING: Tertiary care university hospital. PARTICIPANTS: Patients with acute stroke (N=96). INTERVENTIONS: Subjects were screened for dysphagia using SFA. Mode of screening was 24 hours from identified stroke onset. All patients completed dysphagia- and stroke-related assessments. Patients were followed to discharge from acute care, and admission SFA was compared with status at discharge. RESULTS: Lower SFA rates at admission were significantly associated with presence of dysphagia. Lower SFA rates were also associated with persistent dysphagia and restricted diet at discharge. The SFA rates were lower for patients with identified aspiration on fluoroscopic swallowing study. Negative stroke-related outcomes from acute care were associated with lower SFA rates including disability at admission, disability and handicap at discharge, and institutionalization at discharge. Regression analysis identified SFA as an independent predictor of the negative composite outcome of death-disability-institutionalization. CONCLUSIONS: Swallowing frequency analysis not only has a high accuracy of dysphagia identification in acute stroke and relates to dysphagia severity, but it is also associated with multiple dysphagia- and stoke-related outcomes from acute care. Early poststroke dysphagia identification with SFA may lead to earlier and more effective interventions targeted at identified negative stroke outcomes.

Derivation and measurement consistency of a novel biofluid dynamics measure of deglutitive bolus-driving function-pharyngeal swallowing power.

BACKGROUND: The primary function of the pharyngeal swallowing mechanism is to drive ingested materials into the esophagus. Currently, a definitive measure of pharyngeal bolus-driving function that accounts for bolus movement remains lacking. The primary objectives of this study were to describe the derivation of a novel biofluid dynamics measure of deglutition-that is, pharyngeal swallowing power (PSP)-and to demonstrate the consistency of PSP in normal swallowing. METHODS: The pharyngeal swallowing mechanism was conceptualized as a hydraulic power system with the upper esophageal sphincter (UES) as a conduit. PSP was calculated as the product of bolus pressure and flow across the UES. Thirty-four young healthy subjects swallowed materials consisting of two bolus volumes (10, 20 mL) and four bolus viscosities (thin liquid, nectar-thick liquid, honey-thick liquid, pudding). High-resolution impedance manometry was used for data collection. The consistency of PSP across specific bolus conditions was evaluated using standardized Cronbach's coefficient alpha. KEY RESULTS: Standardized Cronbach's coefficient alphas in specific bolus conditions ranged between 0.85 and 0.93. Fisher weighted mean Cronbach's coefficient alphas for swallow trials across bolus volumes and across bolus viscosities ranged from 0.86 to 0.90. Fisher weighted mean Cronbach's coefficient alpha for overall consistency of PSP across all swallow trials was 0.88. CONCLUSIONS AND INFERENCES: PSP estimates the output power of the pharyngeal bolus-driving mechanism during deglutition. PSP's high consistency indicates that it can be a useful biofluid dynamics measure of pharyngeal bolus-driving function. Current results also demonstrate that consistency in pharyngeal bolus propulsion is an important physiological target for the pharyngeal swallowing mechanism.

Longitudinal Kinematic Evaluation of Pharyngeal Swallowing Impairment in Thyroidectomy Patients.

The aim of this study was to assess pharyngeal swallowing impairments in thyroidectomy patients and to delineate the contributory kinematic components. Forty consecutive patients (mean age = 47.33 years) and fourteen age- and sex-matched heathy adult volunteers (mean age = 42.64 years) participated in this study. A videofluoroscopic swallowing study (VFSS) was performed 1 day prior to surgery, and at 1 week and 3 months post-surgery. VFSS images were evaluated using the Modified Barium Swallowing Impairment Profile (MBSImp). Kinematic and temporal aspects of swallowing were characterized by measurement of maximum hyoid and laryngeal excursion, pharyngeal transit duration, laryngeal response duration (LRD), and laryngeal closure duration at each three time-points. At 1 week post-surgery, only pharyngeal impairment was significantly deteriorated than pre-surgery (p = 0.001). However, at 3 months, a significant improvement was observed to pre-surgery level (p = 0.01). Post-surgery, maximum hyoid excursion was significantly reduced in patients compared controls (p = 0.001). Although the maximal distance of the hyoid and the laryngeal excursion was shorter than before surgery, laryngeal excursion at all three time-points was similar to that of controls. At all three time-points, LRD was significantly longer in patients than in controls (p = 0.01). Following thyroidectomy, pharyngeal aspects of swallowing as measured by the MBSImp and kinematic aspects of swallowing were reduced with incomplete recovery at 3 months. These exploratory data may guide decision regarding management of pharyngeal swallowing impairment with patients undergoing total thyroidectomy.

Bolus volume and viscosity effects on pharyngeal swallowing power-How physiological bolus accommodation affects bolus dynamics.

BACKGROUND: Pharyngeal swallowing power (PSP) is a novel measure of pharyngeal bolus-driving function derived from fluid dynamics principles. This study examined the impact of bolus volume and viscosity on PSP to determine bolus effects on pharyngeal bolus dynamics. The impact of bolus accommodation and physical characteristics of boluses were also explored. METHODS: Thirty-four healthy subjects swallowed materials consisting of two bolus volumes (10 and 20 mL) and four bolus viscosities (thin liquid, nectar-thick liquid, honey-thick liquid and pudding). High-resolution impedance manometry was used for data collection. The pharyngeal swallowing mechanism was conceptualized as a hydraulic power system with the UES as a conduit, and PSP was calculated as the product of bolus pressure and flow across the UES. The impact of bolus characteristics on PSP was evaluated using a mixed model approach. KEY RESULTS: Both bolus volume (F1,32.8  = 412.73, P < 0.0001) and viscosity (F3,84.7  = 28.94, P < 0.0001) were significant predictors of PSP. PSP for 20 mL bolus volume was greater than for 10 mL bolus volume. PSP was lowest in the thin liquid bolus condition and highest in the pudding bolus. All pairwise comparisons among bolus viscosities were significant except between thin liquid and nectar-thick liquid bolus viscosities. Test of linear trend across bolus viscosities was significant (F1,97.2  = 77.25, P < 0.0001). CONCLUSIONS & INFERENCES: Pharyngeal swallowing power variation across bolus conditions illustrates bolus-related changes in bolus dynamics. Bolus effects on PSP likely result from physiological bolus accommodation combined with physical characteristics of boluses.

Dysphagia and Oral Morbidities in Chemoradiation-Treated Head and Neck Cancer Patients.

This study prospectively evaluated relationships between oral morbidities and swallowing ability in head/neck cancer patients following chemoradiation therapy (CRT) and at 3 months following CRT. Thirty patients with confirmed head/neck cancer undergoing chemoradiation were assessed with a battery of swallowing measures and measures of oral morbidities related to chemoradiation (xerostomia, mucositis, pain, taste/smell, oral moisture). All measures were completed at baseline (within the first week of CRT), at 6 weeks (end of treatment), and at 3 months following chemoradiation. Descriptive and univariate statistics were used to depict change over time in swallowing and each oral morbidity. Correlation analyses evaluated relationships between swallowing function and oral morbidities at each time point. Most measures demonstrated significant negative change at 6 weeks with incomplete recovery at 3 months. At 6 weeks, mucositis ratings, xerostomia, and retronasal smell intensity demonstrated significant inverse relationships with swallowing function. In addition, oral moisture levels demonstrated significant positive relationships with swallowing function. At 3 months, mucositis ratings maintained a significant, inverse relationship with swallow function. Taste and both orthonasal and retronasal smell intensity ratings demonstrated inverse relationships with measures of swallow function. Swallow functions and oral morbidities deteriorate significantly following CRT with incomplete recovery at 3 months post treatment. Furthermore, different patterns of relationships between swallow function measures and oral morbidities were obtained at the 6-week versus the 3-month assessment point suggesting that different mechanisms may contribute to the development versus the maintenance of dysphagia over the trajectory of treatment in these patients.

Transcutaneous electrical stimulation on the anterior neck region: The impact of pulse duration and frequency on maximum amplitude tolerance and perceived discomfort.

Maximum amplitude tolerance (MAT) has been known as a primary factor determining the depth of electrical current penetration. However, the effect of varying transcutaneous electrical stimulation (TES) parameters on MAT and discomfort level is poorly understood. Furthermore, limited information exists regarding the biopsychological factors that may impact MAT and discomfort. The primary aims of this study were to compare the effects TES protocol with varying levels of pulse duration (300 µs vs 700 µs) and frequency (30 Hz vs 80 Hz) on the MAT and discomfort in healthy older adults. The exploratory aim of this study was to examine relationships between submental adipose tissue thickness, pain sensitivity and gender with MAT and discomfort. Twenty-four healthy older adults participated in this study. Transcutaneous electrical stimulation was delivered to the submental region. Maximum amplitude tolerance and discomfort were measured for each condition. Furthermore, submental adipose tissue thickness and pain sensitivity were measured for each subject. Maximum amplitude tolerance was significantly increased for the TES protocols with short-pulse duration [F (3, 69) = 38.695, P < .0001]. Discomfort was similar across different TES protocols. Submental adipose tissue thickness (r = .30, P < .003) and pain sensitivity (r = -.43, P < .0001) were related to MAT. Pain sensitivity rating was also related to discomfort (r = .45, P < .0001). In conclusion, using TES protocols with short-pulse duration may increase the MAT. Higher amplitude stimulation may increase the impact on deep swallowing muscles. In addition, submental adipose tissue thickness and pain sensitivity are potential biopsychological factors that may affect MAT and discomfort.

Preliminary Development of a Screening Tool for Pre-Clinical Dysphagia in Community Dwelling Older Adults.

Evidence suggests that community dwelling older adults (CDOA) are at risk for dysphagia (swallowing difficulties). Dysphagia is often unidentified until related morbidities like under nutrition or pneumonia occur. These cases of unidentified dysphagia, prior to any clinical intervention, may be termed 'pre-clinical dysphagia'. Identifying pre-clinical dysphagia is challenged by the lack of validated tools appropriate for CDOA. This study addresses preliminary development of a novel patient reported outcome (PRO) screening tool for pre-clinical dysphagia. Initially, 34 questions were developed from literature review and expert opinion. Following pilot testing (n = 53), the questionnaire was revised and tested on 335 additional CDOA. Face validity, content validity, item analysis, reliability (internal consistency), and construct validity (exploratory factor analysis) measures were completed. Psychometric validation resulted in a 17-question PRO tool. Construct analysis identified a three-factor model that explained 67.345% of the variance. Emergent factors represented swallowing effort, physical function, and cognitive function. The results revealed strong construct validity and internal consistency (Cronbach's α = 0.90). A novel, simple PRO incorporating multiple function domains associated with aging demonstrated strong preliminary psychometric properties. This tool is more comprehensive and aging-focused than existing dysphagia screening tools. Inclusion of multiple domains may be key in early identification of pre-clinical dysphagia.

Computational Modelling of Cough Function and Airway Penetrant Behavior in Patients with Disorders of Laryngeal Function.

OBJECTIVE/HYPOTHESIS: Patients with laryngeal disorders often exhibit changes to cough function contributing to aspiration episodes. Two primary cough variables (peak cough flow: PCF and compression phase duration: CPD) were examined within a biomechanical model to determine their impact on characteristics that impact airway compromise. STUDY DESIGN: Computational study. METHODS: A Computational Fluid Dynamics (CFD) technique was used to simulate fluid flow within an upper airway model reconstructed from patient CT images. The model utilized a finite-volume numerical scheme to simulate cough-induced airflow, allowing for turbulent particle interaction, collision, and break-up. Liquid penetrants at 8 anatomical release locations were tracked during the simulated cough. Cough flow velocity was computed for a base case and four simulated cases. Airway clearance was evaluated through assessment of the fate of particles in the airway following simulated cough. RESULTS: Peak-expiratory phase resulted in very high airway velocities for all simulated cases modelled. The highest velocity predicted was 49.96 m/s, 88 m/s, and 117 m/s for Cases 1 and 3, Base case, and Cases 2 and 4 respectively. In the base case, 25% of the penetrants cleared the laryngeal airway. The highest percentage (50%) of penetrants clearing the laryngeal airway are observed in Case 2 (with -40% CPD, +40% PCF), while only 12.5% cleared in Case 3 (with +40% CPD, -40% PCF). The proportion that cleared in Cases 1 and 4 was 37.5%. CONCLUSION: Airway modelling may be beneficial to the study of aspiration in patients with impaired cough function including those with upper airway and neurological diseases. It can be used to enhance understanding of cough flow dynamics within the airway and to inform strategies for treatment with "cough-assist devices" or devices to improve cough strength. LEVEL OF EVIDENCE: N/A.

Electrical stimulation therapy for dysphagia: a follow-up survey of USA dysphagia practitioners.

The aim of this study was to compare current application, practice patterns, clinical outcomes, and professional attitudes of dysphagia practitioners regarding electrical stimulation (e-stim) therapy with similar data obtained in 2005. A web-based survey was posted on the American Speech-Language-Hearing Association Special Interest Group 13 webpage for 1 month. A total of 271 survey responses were analyzed and descriptively compared with the archived responses from the 2005 survey. Results suggested that e-stim application increased by 47% among dysphagia practitioners over the last 10 years. The frequency of weekly e-stim therapy sessions decreased while the reported total number of treatment sessions increased between the two surveys. Advancement in oral diet was the most commonly reported improvement in both surveys. Overall, reported satisfaction levels of clinicians and patients regarding e-stim therapy decreased. Still, the majority of e-stim practitioners continue to recommend this treatment modality to other dysphagia practitioners. Results from the novel items in the current survey suggested that motor level e-stim (e.g. higher amplitude) is most commonly used during dysphagia therapy with no preferred electrode placement. Furthermore, the majority of clinicians reported high levels of self-confidence regarding their ability to perform e-stim. The results of this survey highlight ongoing changes in application, practice patterns, clinical outcomes, and professional attitudes associated with e-stim therapy among dysphagia practitioners.

Effect of transcutaneous electrical stimulation amplitude on timing of swallow pressure peaks between healthy young and older adults.

OBJECTIVES: This study compared the effect of transcutaneous electrical stimulation (TES) amplitude on timing of lingual-palatal and pharyngeal peak pressures during swallowing in healthy younger and older adults. BACKGROUND: Transcutaneous electrical stimulation amplitude is one parameter that may have different impacts on the neuromotor system and swallowing physiology. One aspect of swallowing physiology influenced by age is the timing of swallowing events. However, the effect of varying TES amplitudes on timing of swallowing physiology is poorly understood, especially in older adults. MATERIALS AND METHODS: Thirty-four adults (20 younger and 14 older) swallowed 10 ml of nectar-thick liquid under three TES conditions: no stimulation, low-amplitude stimulation and high-amplitude stimulation. TES was delivered by surface electrodes on the anterior neck. Timing of pressure peaks for lingual-palatal contacts and pharyngeal pressures were measured under each condition. RESULTS: A significant age × stimulation amplitude interaction was identified for the base of tongue (BOT) [F(2,62) = 5.087, p < 0.009] and the hypopharynx (HYPO) [F(2,62) = 3.277, p < 0.044]. At the BOT, low-amplitude TES resulted in slower swallows in the younger adults compared with no TES. In older adults, low-amplitude TES resulted in faster swallows compared with high-amplitude TES. At the HYPO, no significant differences were identified in pressure timing across the three TES amplitudes in both age groups. In each case, low-amplitude TES resulted in faster swallows in older adults compared with younger adults. CONCLUSIONS: Transcutaneous electrical stimulation influences pharyngeal pressure timing differently in young and old people, which questions the appropriateness of using a 'one-size-fits-all' TES amplitude for rehabilitating people with dysphagia.

Immediate effects of transcutaneous electrical stimulation on physiological swallowing effort in older versus young adults.

OBJECTIVE: This study compared the immediate impact of different transcutaneous electrical stimulation (TES) amplitudes on physiological swallowing effort in healthy older adults versus young adults. BACKGROUND: Swallowing physiology changes with age. Reduced physiological swallowing effort in older adults including lower lingua-palatal and pharyngeal pressures may increase risk for swallowing dysfunction (i.e. dysphagia). Transcutaneous electrical stimulation (TES) has been advocated as an adjunctive modality to enhance outcomes in exercise-based therapy for individuals with dysphagia. However, significant variation in how TES is applied during therapy remains and the physiological swallowing response to TES is poorly studied, especially in older adults. MATERIALS AND METHODS: Physiological change in swallowing associated with no stimulation, sensory stimulation and motor stimulation was compared in 20 young adults versus 14 older adults. Lingua-palatal and pharyngeal manometric pressures assessed physiological swallowing effort. RESULTS: Multivariate analyses identified interactions between age and stimulation amplitude on lingual and pharyngeal functions. Motor stimulation reduced anterior tongue pressure in both age groups but selectively reduced posterior lingua-palatal pressures in young adults only. Sensory stimulation increased base of tongue (BOT) pressures in older adults but decreased BOT pressures in young adults. Motor stimulation increased hypopharyngeal pressures in both groups. CONCLUSION: Age and TES level interact in determining immediate physiological responses on swallow performance. A one-size-fit-all approach to TES in dysphagia rehabilitation may be misdirected.