{"title":"Effortful Swallow Maneuver and Modifications on Swallow Dynamics in Healthy Adults.","authors":"Ali Barikroo","doi":"10.1159/000539171","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Effortful swallow (ES) is a widely used technique in dysphagia management, believed to strengthen oropharyngeal muscles and enhance swallowing safety and efficiency. Although its impact on the oral phase of swallowing is well documented, its effects on pharyngeal swallowing physiology remain inconsistent. This study aimed to elucidate the effects of ES on swallowing kinematics and timing, addressing existing inconsistencies in the literature.</p><p><strong>Methods: </strong>This study involved 22 healthy adults using archived videofluoroscopic swallowing studies. Participants performed three swallow trials of 10 mL puree under regular conditions and with the ES maneuver. The outcome measures comprised swallow timing and kinematic measures. Swallow timing parameters included time to maximum hyoid and laryngeal excursion, laryngeal vestibule closure (LVC) reaction and duration, pharyngeal constriction duration, pharyngoesophageal segment (PES) opening duration, and swallow duration. Swallow kinematic parameters encompassed hyoid and laryngeal excursions, pharyngeal constriction ratio, and maximum PES width. All variables were analyzed via videofluoroscopy. Paired t tests were used to examine the effect of ES on each outcome measure, with a significance threshold set at p < 0.004.</p><p><strong>Results: </strong>The ES maneuver significantly increased the duration of LVC, pharyngeal constriction, PES opening, and overall swallow duration. It also improved the pharyngeal constriction ratio. However, there were no significant changes in hyoid and laryngeal excursions. Submental muscle activity showed a notable increase during ES.</p><p><strong>Conclusion: </strong>The study demonstrates that ES can effectively modify certain temporal and kinematic aspects of swallowing, particularly by prolonging key phases and enhancing pharyngeal constriction. These findings suggest the potential utility of ES in dysphagia rehabilitation, especially in cases that require prolonged pharyngeal constriction, LVC, and PES opening. However, the limited impact on hyoid and laryngeal excursions along with LVC reaction time indicates that ES may not address all aspects of dysphagia. The findings highlight the need for tailored therapeutic approaches in dysphagia management, considering individual physiological impairment profiles.</p>","PeriodicalId":12114,"journal":{"name":"Folia Phoniatrica et Logopaedica","volume":null,"pages":null},"PeriodicalIF":1.1000,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Folia Phoniatrica et Logopaedica","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000539171","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Effortful swallow (ES) is a widely used technique in dysphagia management, believed to strengthen oropharyngeal muscles and enhance swallowing safety and efficiency. Although its impact on the oral phase of swallowing is well documented, its effects on pharyngeal swallowing physiology remain inconsistent. This study aimed to elucidate the effects of ES on swallowing kinematics and timing, addressing existing inconsistencies in the literature.
Methods: This study involved 22 healthy adults using archived videofluoroscopic swallowing studies. Participants performed three swallow trials of 10 mL puree under regular conditions and with the ES maneuver. The outcome measures comprised swallow timing and kinematic measures. Swallow timing parameters included time to maximum hyoid and laryngeal excursion, laryngeal vestibule closure (LVC) reaction and duration, pharyngeal constriction duration, pharyngoesophageal segment (PES) opening duration, and swallow duration. Swallow kinematic parameters encompassed hyoid and laryngeal excursions, pharyngeal constriction ratio, and maximum PES width. All variables were analyzed via videofluoroscopy. Paired t tests were used to examine the effect of ES on each outcome measure, with a significance threshold set at p < 0.004.
Results: The ES maneuver significantly increased the duration of LVC, pharyngeal constriction, PES opening, and overall swallow duration. It also improved the pharyngeal constriction ratio. However, there were no significant changes in hyoid and laryngeal excursions. Submental muscle activity showed a notable increase during ES.
Conclusion: The study demonstrates that ES can effectively modify certain temporal and kinematic aspects of swallowing, particularly by prolonging key phases and enhancing pharyngeal constriction. These findings suggest the potential utility of ES in dysphagia rehabilitation, especially in cases that require prolonged pharyngeal constriction, LVC, and PES opening. However, the limited impact on hyoid and laryngeal excursions along with LVC reaction time indicates that ES may not address all aspects of dysphagia. The findings highlight the need for tailored therapeutic approaches in dysphagia management, considering individual physiological impairment profiles.
简介:努力吞咽法(ES)是吞咽困难治疗中广泛使用的一种技术,据信可以增强口咽肌肉,提高吞咽的安全性和效率。尽管其对吞咽口腔阶段的影响已得到充分证实,但其对咽部吞咽生理的影响仍不一致。本研究旨在阐明 ES 对吞咽运动学和时间的影响,解决文献中存在的不一致问题:本研究使用存档的视频荧光屏吞咽研究,涉及 22 名健康成人。参与者在常规条件下和 ES 操作下进行了三次吞咽 10 毫升果泥的试验,重点是咽部挤压。结果测量包括吞咽计时和运动测量。吞咽计时参数包括舌骨和喉部最大偏移时间、喉前庭关闭反应和持续时间、咽部收缩持续时间、咽食管段(PES)打开持续时间和吞咽持续时间。吞咽运动参数包括舌骨和喉的偏移、咽收缩比和最大 PES 宽度。所有变量均通过荧光屏进行分析。采用配对 t 检验来检验 ES 对各项结果指标的影响,显著性阈值设定为 p <0.004:结果:ES 操作明显延长了喉前庭闭合、咽收缩、PES 开放和整体吞咽持续时间。它还改善了咽收缩比。不过,舌骨和喉的偏移没有明显变化。ES 期间,门下肌活动明显增加:研究表明,ES 能有效改变吞咽的某些时间和运动方面,尤其是通过延长关键阶段和增强咽部收缩。这些研究结果表明了 ES 在吞咽困难康复中的潜在作用,尤其是在需要长时间咽部收缩、喉前庭关闭和 PES 开放的病例中。然而,ES 对舌骨和喉偏移以及喉前庭闭合反应时间的影响有限,这表明 ES 可能无法解决吞咽困难的所有方面。这些研究结果突出表明,在吞咽困难的治疗过程中,需要考虑到个体的生理损伤情况,采取量身定制的治疗方法。
期刊介绍:
Published since 1947, ''Folia Phoniatrica et Logopaedica'' provides a forum for international research on the anatomy, physiology, and pathology of structures of the speech, language, and hearing mechanisms. Original papers published in this journal report new findings on basic function, assessment, management, and test development in communication sciences and disorders, as well as experiments designed to test specific theories of speech, language, and hearing function. Review papers of high quality are also welcomed.