Changes of Timing Variables in Swallowing of Boluses With Different Viscosities in Patients With Dysphagia

• Published in: Archives of physical medicine and rehabilitation Vol. 94; no. 1; pp. 120 - 126
• Main Authors: Lee, Sang Il, MD, Yoo, Jong Yoon, MD, PhD, Kim, Minyoung, MD, PhD, Ryu, Ju Seok, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2013
• Subjects: Aged; Biomechanics; Cineradiography; Deglutition Disorders - classification; Deglutition Disorders - diagnostic imaging; Deglutition Disorders - physiopathology; Female; Fluoroscopy; Humans; Male; Middle Aged; Physical Medicine and Rehabilitation; Prospective Studies; Rehabilitation; Swallowing; Time Factors; Viscosity; Viscosity; latency of upper esophageal sphincter opening; UES; videofluoroscopic swallowing study; LLE; latency of peak laryngeal elevation; latency of epiglottis contact; upper esophageal sphincter; LEC; Swallowing; Biomechanics; LUEO; latency of laryngeal elevation; VFSS; Rehabilitation; pharyngoesophageal sphincter; Cineradiography; LPLE; PES
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2012.07.016

Abstract Objectives To evaluate the timing of the swallowing process and the effect of bolus viscosity on swallowing. Design Prospective observational study. Setting General teaching hospital, rehabilitation unit. Participants We enrolled patients with dysphagia (n=82) in a videofluoroscopic swallowing study (VFSS) from January 13, 2009, to October 22, 2009. Based on VFSS results, we classified patients as “thin-fluid aspirators” (n=40) or as “nonaspirators” (n=42). Interventions Swallowing of a 5-mL thick bolus and a 5-mL thin bolus in all patients. Main Outcome Measures Kinematic analysis of various variables during the swallowing process (pharyngeal phase), including epiglottis contact with the bolus, laryngeal elevation, pharyngeal constriction, and upper esophageal sphincter opening. Results In both groups, the thin bolus arrived at the vallecular pouch earlier than the thick bolus. During swallowing of the thick bolus, the thin-fluid aspirators had a delayed latency of upper esophageal sphincter opening, delayed laryngeal elevation to peak level, and significantly longer rise time of laryngeal elevation. Conclusions Our results indicate clear differences in the degree of adaptation to bolus viscosity between patients classified as thin-fluid aspirators and as nonaspirators. These differences were mainly in activities of laryngeal elevators rather than pharyngeal constrictors.