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Biomedical subjects

J A Logemann

Publications and source records attributed to J A Logemann.

At least 19 recordsLinked to original sources
PubMed1997

Super-supraglottic swallow in irradiated head and neck cancer patients.

BACKGROUND: After radiotherapy to the head and neck, many patients experience swallowing difficulties. Preliminary work indicates that these patients benefit from the super-supraglottic swallow maneuver. METHODS: Lateral videofluoroscopic studies examined oropharyngeal swallowing in 9 patients who suffered from dysphagia after radiation to the head and neck. Each patient completed two swallows each of 1 mL or 3 mL liquid barium without a voluntary swallow maneuver and with the super-supraglottic swallow designed to close the entrance to the airway early. The videotape of each swallow was digitized and the location of pharyngeal structures marked throughout the swallow. Movement over time plots were generated to measure changes in structural movement resulting from the maneuver. RESULTS: The super-supraglottic swallow resulted in changes in airway entrance closure and hyolaryngeal movement. One patient who aspirated without the maneuver stopped aspirating with the maneuver. Two others had aspiration reduced to a trace with the maneuver. Fewer swallowing disorders were observed with the maneuver. CONCLUSION: The super-supraglottic swallow results in improved biomechanics of swallow in irradiated head and neck cancer patients.

Adult↗
PubMed1997

Oral sensory discrimination of fluid viscosity.

This study was designed to investigate the ability of normal young adult volunteers to sensorially identify Newtonian fluids of specified viscosities. Twenty subjects, 10 men and 10 women between the ages of 18 and 29 years participated. Seven stimuli, consisting of combinations of corn syrup and water, with viscosities ranging from 2 to 2,240 centipoise (cP) were prepared and characterized using a coaxial rotational viscometer. Subjects were presented with two anchor stimuli representing the extremes of the range of viscosities as a basis from which the experimental stimuli were judged. The seven experimental stimuli were randomly presented to each subject 10 times. The accuracy with which the subjects identified the viscosity of the fluid was significant at p < 0.01. The pattern of response was not significantly different across subjects nor gender. There were no differences in performance throughout the duration of the study. The repeat presentation of the anchor points did not significantly affect performance. Further research on oral perception of viscosity, and the processes that mediate changes in swallow physiology resulting from changes in viscosity is required.

Adult↗
PubMed1997

Role of the modified barium swallow in management of patients with dysphagia.

The modified barium swallow is a radiographic (videofluoroscopic) procedure designed to define the anatomy and physiology of the patient's oropharyngeal swallow and examine the effectiveness of selected rehabilitation strategies designed to eliminate aspiration or excess oral or pharyngeal residue (the symptoms of the patient's dysphagia). Rehabilitation strategies introduced during the modified barium swallow after the patient's oropharyngeal anatomy and physiology have been defined include (1) postural changes to redirect food flow and change pharyngeal dimensions, (2) sensory enhancement techniques, and (3) swallow maneuvers. Combining the modified barium swallow with a follow-up swallowing rehabilitation plan can decrease the cost and time for rehabilitation of patients with dysphagia. In some cases the patient can begin safe oral intake immediately after the modified barium swallow, and therapy may not be needed if consistent spontaneous recovery is anticipated.

Administration, Oral↗
PubMed1997

Speech and swallowing rehabilitation for head and neck cancer patients.

Head and neck cancer and its treatment frequently cause changes in both speech and swallowing, which affect the patient's quality of life and ability to function in society. The exact nature and severity of the post-treatment changes depend on the location of the tumor, the choice of treatment, and the availability and use of speech and swallowing therapy during the first 3 months after treatment. This paper reviews the literature on speech and swallowing problems in various types of treated head and neck cancer patients. Effective swallowing rehabilitation depends on the inclusion of a video-fluorographic assessment of the patient's oropharyngeal swallow in the post-treatment evaluation. Pilot data support the use of range of motion (ROM) exercises for the jaw, tongue, lips, and larynx in the first 3 months after oral or oropharyngeal ablative surgical procedures, as patients who perform ROM exercises on a regular basis exhibit significantly greater improvement in global measures of both speech and swallowing, as compared with patients who do not do these exercises.

Deglutition↗
PubMed1996

Oropharyngeal accommodation to swallow volume.

BACKGROUND & AIMS: The oropharyngeal swallow accommodates a range of bolus volumes with substantial impact on its dynamic radiographic appearance despite being a nearly reflexive sequence. The aim of this study was to analyze the mechanism of volume accommodation. METHODS: Coordination of the glossopalatal junction, velopharyngeal junction, laryngeal vestibule, and upper esophageal sphincter (UES) and intraluminal pharyngeal dimensions were measured from biplane videofluoroscopic swallowing studies in 8 volunteers during 1- and 20-mL swallows. These measurements were applied to three-dimensional reconstructions of the pharyngeal swallow, permitting analysis of their effect on intraluminal volume and propulsive function. RESULTS: Dividing the pharyngeal swallow into periods of reconfiguration, sustained reconfiguration, and offset of reconfiguration, volume accommodation occurred by a 0.2-second prolongation of reconfiguration, preserving the coordination of the onset and offset events. Augmented reconfiguration increased the dimensions of the pharyngeal chamber, caused more rapid bolus expulsion, and increased UES distention. However, maximal transphincteric flow per unit area across the UES was constant, showing its compliance. CONCLUSIONS: Volume accommodation is accomplished by augmenting and prolonging pharyngeal reconfiguration from a respiratory to deglutitive pathway. This modification in the timing of neurally mediated events is amplified by its mechanical consequences, resulting in the different cineradiographic appearance and propulsive attributes of large and small volume swallows.

Adult↗
PubMed1996

Screening, diagnosis, and management of neurogenic dysphagia.

Patients with dysphagia as a result of neurologic disease can be effectively evaluated and managed, particularly if the dysphagia is recognized before any medical complications such as aspiration pneumonia appear. Management can be cost-effective and efficient when assessment not only defines symptoms but their underlying anatomic or physiologic cause and treatment is designed to eradicate the abnormalities in structure or function. The specific nature of the oropharyngeal dysphagia may also point to the nature of the underlying neurologic damage or disease process. Involvement of a speech-language pathologist early in the neurogenic patient's dysphagia care can speed recovery and reduce cost.

Deglutition Disorders↗
PubMed1996

Swallowing disorders in head and neck cancer patients treated with radiotherapy and adjuvant chemotherapy.

The nature of swallowing problems was examined in nine patients treated primarily with external-beam radiation and adjuvant chemotherapy for newly diagnosed tumors of the head and neck. All subjects underwent videofluorographic examination of their swallowing. Three analyses were completed, including the following: observations of motility disorders, residue, and aspiration; temporal analyses; and biomechanical analyses. Oropharyngeal swallow efficiency was calculated for the first swallow of each bolus. Swallow motility disorders were observed in both the oral and pharyngeal stages. Seven of the nine patients demonstrated reduced posterior tongue base movement toward the posterior pharyngeal wall and reduced laryngeal elevation during the swallow. Oropharyngeal swallow efficiency measures were significantly lower in the nine irradiated patients than in age-matched normal subjects. Between patients and normal subjects, significant differences were found in the measures of timing and distance of pharyngeal structural movements during the swallow, as well as in the measures of coordination during the swallow. Although treatment of head and neck cancer with external-beam radiation is designed to provide cancer cure and preserve organ functioning, oral and pharyngeal motility for swallow can become compromised if external-beam radiation treatment is provided to either the larynx or tongue base regions.

Adult↗
PubMed1996

Pharyngeal swallowing elicited by fluid infusion: role of volition and vallecular containment.

Nonalimentary swallows minimize aspiration by clearing accumulated fluid from the pharynx. This study aimed to define 1) the pharyngeal sensory field to elicit swallowing and 2) the effect of infusion rate, volition, taste, and temperature on pharyngeal swallows. Test solutions were directed into the valleculae at 6.5, 11.5, and 32 ml/min through a catheter in eight healthy volunteers. Deglutition was signaled with electromyography and electroglottography. Spatial distribution of infusate before swallowing was studied using videofluoroscopy coupled with a video timer. Volitional control was assessed with rapid or restrained swallows. Pharyngeal swallow latency decreased as the instillation rate increased, was potently modified with volition, and was unchanged by infusate taste or temperature. Water infusion into the valleculae did not trigger pharyngeal swallowing until liquids overflowed and reached the aryepiglottic folds or pyriform sinuses. The variation in swallow latency among flow rates was mainly due to the duration of liquid containment within the valleculae. This suggests that the valleculae act to contain pharyngeal secretions and residue and prevent aspiration by diverting their contents around the larynx before swallowing.

Adult↗
PubMed1996

Effects of two breath-holding maneuvers on oropharyngeal swallow.

This study quantified the effects of the supraglottic maneuver (SGM) and super supraglottic maneuver (SSGM) on laryngeal and pharyngeal movements before and during swallow. Simultaneous videofluoroscopic and videoendoscopic examinations of oropharyngeal swallowing were performed in eight healthy volunteers with and without maneuvers. Data analysis compared 1) temporal relationships of oropharyngeal events, 2) airway conditions at the time of selected oropharyngeal events, and 3) biomechanical computer analysis of swallowing events. Using these maneuvers, normal subjects produced earlier cricopharyngeal opening, prolonged pharyngeal swallow, some degree of laryngeal valving before swallow, and change in extent of vertical laryngeal position before swallow. These changes are more successful and maintained longer with the SSGM than the SGM. We concluded that breath-holding maneuvers alter not only airway conditions before swallow but also both the temporal relationships and biomechanical events during oropharyngeal swallow.

Adult↗
PubMed1995

Biomechanical analysis of the pharyngeal swallow in postsurgical patients with anterior tongue and floor of mouth resection and distal flap reconstruction.

The purpose of this study was to examine changes in the biomechanics of pharyngeal swallow after surgery in eight patients (six men and two women) with anterior tongue and floor of mouth resections with distal flap reconstruction. Eight normal age-matched subjects were also studied. Swallowing performance was assessed following a standardized protocol with videofluoroscopy preoperatively and at 1 and 3 months postoperatively for the oral cancer patients. The normal subjects received a single videofluoroscopic study. Computer-assisted biomechanical analysis was used to mark the movements of specific oropharyngeal structures over time throughout the swallow of calibrated boluses. Statistical analyses revealed that tongue base, pharyngeal wall, hyoid, laryngeal, and cricopharyngeal movements during the swallow were altered significantly after surgery for the cancer patients. Some oropharyngeal structural movements differed from those of normal control subjects before surgery. In this study, biomechanical measures indicated that there was recovery in some aspects of the pharyngeal swallow in this patient group. The duration of tongue base to pharyngeal wall contact, which was significantly reduced preoperatively and at 1 month after surgery, increased significantly to within normal levels by the 3-month postoperative evaluation. Duration of laryngeal closure and the onset of laryngeal closure relative to cricopharyngeal opening also improved significantly to within normal levels by the 3-month postoperative evaluation.

Adult↗
PubMed1995

Effects of a sour bolus on oropharyngeal swallowing measures in patients with neurogenic dysphagia.

This study examines the effects of a sour bolus (50% lemon juice, 50% barium liquid) on pharyngeal swallow measures in two groups of patients with neurogenic dysphagia. Group 1 consisted of 19 patients who had suffered at least one stroke. Group 2 consisted of 8 patients with dysphagia related to other neurogenic etiologies. All patients were selected because they exhibited delays in the onset of the oral swallow and delays in triggering the pharyngeal swallow on boluses of 1 ml and 3 ml liquid barium during videofluoroscopy. Results showed significant improvement in oral onset of the swallow in both groups of patients and a significant reduction in pharyngeal swallow delay in Group 1 patients and in frequency of aspiration in Group 2 patients with the sour as compared to the non-sour boluses. Other selected swallow measures in both subject groups also improved with the sour bolus. Volume effects were present but not as consistently as in prior studies. Implications for swallow therapy are discussed.

Adult↗
PubMed1995

Three-dimensional modeling of the oropharynx during swallowing.

The mechanical actions of swallowing in one volunteer were modeled in three dimensions. Biplane fluoroscopy and dynamic ultrafast computed tomography of adjacent levels of the pharynx were performed during swallows of liquid. Synchronized posteroanterior, lateral, and cross-sectional images were scanned and aligned in three dimensions with graphics-animation software. Modeling the oropharyngeal swallow helps analysis and visualization of the mechanics of swallowing, dysphagia, and compensatory therapeutic strategies.

Adult↗
PubMed1995

Physiology of oropharyngeal swallow in the cat: a videofluoroscopic and electromyographic study.

The majority of animal studies of deglutition have examined electrically stimulated swallows in sedated animals. This present investigation examined oropharyngeal and cervical esophageal swallow physiology in three awake normal domestic cats using concurrent electromyography (EMG) and videofluorography (VFG). Hooked wire electrodes were surgically implanted into six oropharyngeal muscles in each cat. During collection of VFG and EMG data, each cat ate barium-impregnated cat food while the fluorography tube focused on a lateral view of the oral cavity, pharynx, and cervical esophagus. A number of significant differences in the physiology of swallowing were found between the cat and human adult. The oral stage of swallow is much longer in the cat with bolus accumulation in the valleculae. Duration and components of the pharyngeal stage of swallow are much faster, and the pharyngeal stage occurs earlier in relation to bolus passage through the cricopharyngeus. In addition, the cat exhibits a marked superior constrictor bulge at the onset of the pharyngeal contractile wave and summation of the peristaltic waves in the esophagus, whereas the human adult does not. Feline swallow physiology is more similar to that of the human infant than that of human adults.

Animals↗
PubMed1995

Dysphagia: evaluation and treatment.

Normal swallowing consists of a set of physiologic behaviors which result in food, liquid or other substances moving safely and efficiently from the mouth to the stomach. Dysphagic patients may have difficulty with any one or more of the anatomic or physiologic components of the oral, pharyngeal or esophageal stages of the swallow. Evaluation of the dysphagic patient should identify the anatomic or physiologic abnormalities characterizing the patient's swallow and include introduction and assessment of the efficacy of treatment strategies. Treatment may involve compensatory management, such as postural changes or enhancing sensory input, or active muscle exercise with or without the introduction of food. Speech-language pathologists have taken the lead in research on normal swallow and evaluation and treatment strategies for dysphagia.

Deglutition↗
PubMed1995

Functional outcome after surgery for prevention of pharyngospasms in tracheoesophageal speakers. Part II: Swallow characteristics.

The swallowing function of 29 patients with primary tracheoesophageal puncture who received either a pharyngeal constrictor myotomy, a unilateral pharyngeal plexus neurectomy, or a unilateral pharyngeal plexus neurectomy with a small drainage myotomy limited to the cricopharyngeus was studied. Swallowing function data were collected on each patient at 3 weeks, 6 months, and 12 months after surgery using videofluoroscopy. Differences in swallowing function among the treatment groups were primarily the amounts and loci of oral and pharyngeal residues. The differing patterns of bolus residue may reflect the different mechanisms that were affected by the various procedures. Despite significant changes in some swallow measures, the patients did not complain of dysphagia. Oropharyngoesophageal swallow efficiency--a clinical measure that weighs the amount of bolus swallowed by total transit time--fell within normal limits for each patient group at each evaluation. This measure may be a better index of the patients' perceived normal swallow than the component variables of residue and transit times would suggest.

Deglutition↗