Taste Manipulation and Swallowing Mechanics in Trauma-Related Sensory-Based Dysphagia.

Purpose This study explored the effects of high-concentration taste manipulation trials on swallow function in persons with sensory-based dysphagia. Method Dysphagia researchers partnered with clinical providers to prospectively identify traumatically injured U.S. military service members (N = 18) with sensory-based dysphagia as evidenced by delayed initiation and/or decreased awareness of residue/penetration/aspiration. Under videofluoroscopy, participants swallowed trials of 3 custom-mixed taste stimuli: unflavored (40% weight/volume [wt/vol] barium sulfate in distilled water), sour (2.7% wt/vol citric acid in 40% wt/vol barium suspension), and sweet-sour (1.11% wt/vol citric acid plus 8% wt/vol sucrose in 40% wt/vol barium suspension). Trials were analyzed and compared via clinical rating tools (the Modified Barium Swallow Impairment Profile [Martin-Harris et al., 2008] and the Penetration-Aspiration Scale [Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996]). Additionally, a computational analysis of swallowing mechanics (CASM) was applied to a subset of 9 swallows representing all 3 tastants from 3 participants. Results Friedman's tests for the 3 stimuli revealed significantly (p < .05) improved functional ratings for Penetration-Aspiration Scale and pharyngoesophageal opening. CASM indicated differences in pharyngeal swallowing mechanics across all tastant comparisons (p ≤ .0001). Eigenvectors revealed increased tongue base retraction, hyoid elevation, and pharyngeal shortening for sweet-sour and, to a lesser extent, sour than for unflavored boluses. Conclusion Advantageous changes in certain parameters of oropharyngeal swallowing physiology were noted with high-intensity tastants per both clinical ratings and subsequent CASM, suggesting potential therapeutic application for taste manipulation.

Dysphagia Management and Research in an Acute-Care Military Treatment Facility: The Role of Applied Informatics.

PURPOSE: This report describes the development and preliminary analysis of a database for traumatically injured military service members with dysphagia. METHODS: A multidimensional database was developed to capture clinical variables related to swallowing. Data were derived from clinical records and instrumental swallow studies, and ranged from demographics, injury characteristics, swallowing biomechanics, medications, and standardized tools (e.g., Glasgow Coma Scale, Penetration-Aspiration Scale). Bayesian Belief Network modeling was used to analyze the data at intermediate points, guide data collection, and predict outcomes. Predictive models were validated with independent data via receiver operating characteristic curves. RESULTS: The first iteration of the model (n = 48) revealed variables that could be collapsed for the second model (n = 96). The ability to predict recovery from dysphagia improved from the second to third models (area under the curve = 0.68 to 0.86). The third model, based on 161 cases, revealed "initial diet restrictions" as first-degree, and "Glasgow Coma Scale, intubation history, and diet change" as second-degree associates for diet restrictions at discharge. CONCLUSION: This project demonstrates the potential for bioinformatics to advance understanding of dysphagia. This database in concert with Bayesian Belief Network modeling makes it possible to explore predictive relationships between injuries and swallowing function, individual variability in recovery, and appropriate treatment options.