PubMed Health⌕ Search

Biomedical subjects

J A Logemann

Publications and source records attributed to J A Logemann.

At least 73 records · Page 4Linked to original sources
PubMed1994

Glossopharyngeal evoked potentials in normal subjects following mechanical stimulation of the anterior faucial pillar.

The anterior faucial pillar, which is innervated by the glossopharyngeal nerve, is thought to be important in eliciting the pharyngeal swallow in awake humans. Glossopharyngeal evoked potentials (GPEP), elicited by mechanically stimulating this structure, were recorded from 30 normal adults using standard averaging techniques and a recording montage of 16 scalp electrodes. Ten of the subjects experienced a desire to swallow in response to stimulation. Repeatable responses were recorded from all 30 subjects. The GPEPs recorded from the posterior scalp were W-shaped and consisted of P1, N1, P2, N2 and P3 peaks. Mean latencies of P1, N1 and P2 were 11, 16 and 22 msec, respectively, for both left and right pillar stimulation. In contrast, latencies of N2 and P3 varied significantly between left and right pillar stimulation. Mean latencies of N2 and P3 were 27 and 34 msec for left, and 29 and 35 msec for right pillar stimulation. Topographical maps acquired at peak latencies for P1, N1 and P2 revealed consistent asymmetrical voltage distributions between the two hemispheres; the largest responses were recorded from the hemisphere ipsilateral to the side of stimulation. The scalp topography of N2 and P3 varied between male and female subjects as well as between left and right pillar stimulation. These findings support the hypothesis that mechanical stimulation to the anterior faucial pillar alone can elicit repeatable responses from the central nervous system. The integration of this subcortical/cortical activity with that of the medullary swallowing center may play an important role in eliciting the pharyngeal swallow.

Adult↗
PubMed1994

Oropharyngeal swallow efficiency as a representative measure of swallowing function.

The purpose of this investigation was to correlate oropharyngeal swallow efficiency (OPSE), a summary measure of swallowing function, with its component variables. Videofluorographic assessment of oropharyngeal swallow resulted in the measurement of multiple measures of swallow function in five patient populations and a group of normal volunteers. In total, 759 swallows were studied in 149 persons. Specific dimensions of impairment were identified in the patient groups. Multiple regression analyses were used to relate multiple component variables to OPSE. In patient groups with distinct swallow impairments, OPSE was shown to be representative of the dimensions of impairment. In patient groups with limited impairment and in normal volunteers, the strongest correlates of OPSE were bolus transit times. In all groups, at least four variables were significantly related to OPSE and the squared multiple correlation coefficients ranged from 76% to 89%. We conclude that oropharyngeal swallow efficiency is a representative summary measure of swallowing function across populations characterized by a wide range of swallowing impairment.

Adult↗
PubMed1994

Pharyngeal effects of bolus volume, viscosity, and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects.

The oropharyngeal swallow of 10 patients with mild dysphagia at 3 weeks after a cerebrovascular accident (stroke), 10 normal subjects, and 8 neurologically impaired patients with moderate to severe dysphagia was studied videofluorographically to examine the effects of 2 bolus temperatures (room temperature and 33 degrees F), 2 volumes, and 2 viscosities on the durations of pharyngeal stage swallow events and the frequency and nature of oropharyngeal swallowing problems and bolus transit. Normal subjects exhibited significantly longer pharyngeal response times and longer laryngeal elevation only for 1 ml cold liquid. The stroke patients and the 8 significantly dysphagic neurologically impaired patients exhibited very few significant effects of temperature on swallowing disorders or swallow measures. Increases in bolus volume and viscosity decreased pharyngeal delay times in both neurologically impaired patient groups. Stroke patients exhibited significantly longer pharyngeal delay times but shorter pharyngeal response times, laryngeal closure, cricopharyngeal opening, and laryngeal elevation than normal subjects on some bolus volumes and viscosities. Results are discussed in terms of the potentially therapeutic effects of bolus volume and viscosity.

Adolescent↗
PubMed1994

Mechanisms of recovery of swallow after supraglottic laryngectomy.

This study examines oropharyngeal swallow disorders and measures of pharyngeal and laryngeal movement during deglutition from videofluorographic studies of oropharyngeal swallow in 9 patients who had undergone supraglottic laryngectomy and 9 age-matched normal subjects. The swallows of surgical patients were examined at 2 weeks and 3 months postoperatively. Two critical factors in recovery of swallowing were identified: (a) airway closure at the laryngeal entrance, that is, the space between the arytenoid cartilage and the base of the tongue, and (b) the movement of the tongue base to make complete contact with the posterior pharyngeal wall. When patients achieved these two functions, they returned to normal swallowing. The duration of tongue base contact to the posterior pharyngeal wall and extent of anterior movement of the arytenoid increased significantly from 2 weeks to 3 months in the surgical patients. At 2 weeks postsurgery, patients who had undergone supraglottic laryngectomy exhibited significantly shorter airway closure and tongue base to pharyngeal wall contact, reduced laryngeal elevation, increased width of cricopharyngeal (CP) opening, and later onset of airway closure and tongue base movement than normal subjects. These significant differences remained at 3 months postoperatively, although swallow measures were moving toward normal in the patients who had undergone supraglottic laryngectomy. Comparison of patients not eating at 2 weeks with patients at the time of first eating revealed significantly longer duration of tongue base contact to the pharyngeal wall, longer duration of airway closure, and greater movement of the arytenoid in patients who were eating. Results indicate that the focus of swallowing therapy after supraglottic laryngectomy should be on improvement of posterior movement of the tongue base and anterior tilting of the arytenoid to close the airway entrance and improve bolus propulsion (in the case of the tongue base).

Barium Sulfate↗
PubMed1994

Coordination between respiration and swallowing: respiratory phase relationships and temporal integration.

The coordination of breathing and swallowing was studied in 13 young healthy adult subjects during the administration of graduated volumes of water (3, 10, and 20 ml). Simultaneous submental electromyography, respiratory plethysmography, and fiber-optic endoscopy revealed a well-timed pattern between physiological respiratory events and related swallowing events. Expiration was the phase of respiration that was most closely associated with deglutition. Respiration was usually maintained at the onset of deglutition and halted before the onset of laryngeal elevation. The apneic interval was approximately 1 s for the 3-, 10-, and 20-ml boluses. A large-volume (100-ml) straw swallow resulted in variable respiration-swallowing patterns and in statistically significant differences (P < 0.01) in the duration of apneic pause and laryngeal excursion. The expiratory phase of respiration resumed nearly 0.50 s before the completion of swallowing. Clinical implications of the findings are addressed and related to aspiration and pulmonary complications in dysphagic patients.

Adolescent↗
PubMed1994

Effects of postural change on aspiration in head and neck surgical patients.

This study was designed to define the effects of postural change on liquid aspiration during videofluorographic examination of oropharyngeal swallow in head and neck surgical patients. Thirty-two patients were given two swallows of five different amounts of liquid barium as tolerated. When aspiration occurred, the patient's head and/or body position was changed, new posture being determined by the swallowing disorder identified as the cause of the aspiration. Postural techniques were successful in eliminating aspiration on at least one volume of liquid in 81% of these patients. Patients in all surgical groups were able to use postures with equal success. A variety of positions were used in each type of surgical patient, indicating that these patients exhibited a variety of swallowing problems. Results emphasize the importance of introducing postural techniques during the radiographic study of oropharyngeal swallow to facilitate safe oral intake of liquids.

Adult↗
PubMed1994

Surgical variables affecting postoperative swallowing efficiency in oral cancer patients: a pilot study.

This study examined the correlation between swallow function at 3 months postoperatively and surgical variables including volume resected, flap volume, ratio of flap volume to volume resected, percentage of oral tongue, tongue base, and anterior and lateral floor of mouth resected, and whether or not the mandible was preserved in 30 surgically treated oral cancer patients. Swallows of measured amounts of liquid and paste (pudding) materials were examined videofluoroscopically. Nine measures of swallow function were completed for each swallow. A factor analysis of all swallow variables was done for liquid and for paste consistencies to determine whether one measure was statistically representative of all swallow measures. This analysis indicated that oral pharyngeal swallow efficiency (OPSE) represented all measures for both liquid and paste consistencies. Then the correlation between OPSE and surgical variables was defined. Only percentage of oral tongue and percentage of tongue base resected were significantly negatively correlated with OPSE. That is, OPSE decreased for both liquid and paste as percentage of oral tongue or percentage of tongue base resected increased. Results are discussed in terms of diet choices and surgical management.

Deglutition↗
PubMed1994

Phonetic features by babies with unilateral cleft lip and palate.

Twenty-three babies with nonsyndromic unilateral cleft lip and palate were audiotaped at regular intervals from 5 to 35 months of age. Narrow phonetic transcription of their comfort-state vocalizations and word approximations was accomplished to describe phonetic development over time and according to the nonrandomized age of palatoplasty. The babies that had earlier palatal repair produced significantly higher percentages of oral stops after 12 months of age than babies with similar clefts that had later palatal repair. No significant differences are evident, however, according to age of palatoplasty, for mean frequency use of oral fricatives up to 3 years of age. For all 23 babies, regardless of the age of palatoplasty intervention, time is an even stronger variable than age of palatoplasty for development of palatal, alveolar and velar place features, oral stops, and oral fricatives.

Age Factors↗
PubMed1994

Non-imaging techniques for the study of swallowing.

A number of non-imaging procedures have been used to study various aspects of swallow physiology including electromyography, electroglottography, manometry, the sounds of swallow, and the blue dye test. Each of these techniques is described according to the typical procedures used, the types of information produced and advantages and limitations when applied to the study of oropharyngeal swallow. For most accurate interpretation, the majority of these techniques are used concurrently with imaging procedures such as videofluorography.

Deglutition↗
PubMed1994

Rehabilitation of oropharyngeal swallowing disorders.

Patients with oropharyngeal swallowing disorders can be rehabilitated through a program of radiographic assessment to define the patient's anatomic or physiologic swallowing disorder(s), followed by use of carefully selected compensatory and/or therapeutic strategies. Compensatory strategies are designed to eliminate symptoms of swallowing disorders, i.e., aspiration and inefficient swallow, and include postural changes, enhancement of sensory input, changes in food characteristics (viscosity, temperature, taste), modifications in volume and speed of food presentation, and intraoral prosthetics. Therapeutic strategies are designed to change swallow physiology and include range of motion exercises, sensory motor integration procedures and swallow maneuvers. The effects of many of these procedures can be assessed during the radiographic diagnostic procedure, once the patient's oropharyngeal anatomy and swallowing physiology have been defined. In general, swallowing assessment should be completed as soon as the patient is identified as dysphagic, and an appropriate rehabilitation plan initiated.

Deglutition↗
PubMed1994

Multidisciplinary management of dysphagia.

Multidisciplinary management of dysphagia ensures that the dysphagic patient receives careful, in-depth assessment and treatment/rehabilitation of their swallowing disorders, and of its underlying etiology. Members of the team usually include the speech-language pathologist (swallowing therapist), gastroenterologist, radiologist, otolaryngologist, neurologist, pulmonologist, pharmacist, dietitian, occupational therapist, and physical therapist. Depending upon the setting, a pediatrician, physical medicine physician (physiatrist) or gerontologist may also be on the team. Respiratory medicine and nursing are usually also involved, as is the feeding staff. Respect for each other's expertise and easy communication between members of the team are crucial to success. Team operations should be continuously monitored for their overall efficacy and cost effectiveness.

Deglutition Disorders↗
PubMed1993

Noninvasive approaches to deglutitive aspiration.

Etiologies for aspiration are described. Noninvasive procedures to eliminate aspiration are outlined including postural techniques, variations in bolus volume, viscosity, taste and temperature, methods to enhance oral sensation, swallow maneuvers and exercise programs to improve neuromotor control for swallow. Specific disorders for which each procedure is appropriate are defined.

Deglutition Disorders↗
PubMed1993

Normal laryngeal valving patterns during three breath-hold maneuvers: a pilot investigation.

Synchronized videonasendoscopy and respiratory recordings were conducted in six healthy male subjects to evaluate activity of the arytenoid cartilages, true vocal folds, false vocal folds, and epiglottis during repeated trials of three breath-hold maneuvers: EASY hold, INHALE HARD hold, and INHALE/EXHALE HARD hold. Five of the six subjects demonstrated maximal laryngeal valving on the HARD breath-hold conditions. One subject showed maximal laryngeal valving on the EASY hold condition, and rarely demonstrated any medial displacement or contact of the laryngeal valves on either effortful breath-hold maneuver. Arytenoid approximation and true vocal fold closure were produced consistently by the majority of subjects on all breath-hold maneuvers, but false vocal fold approximation and anterior arytenoid tilting were accomplished by the majority of subjects only during the effortful breath-hold conditions. Intratrial and intersubject variation indicated that presence or degree of laryngeal valving cannot be assumed during a breath-hold maneuver. We conclude that videonasendoscopy has merit in assessing a patient's laryngeal valving ability and progress in effectively using a breath-hold maneuver for safe swallowing function.

Adolescent↗
PubMed1993

Oropharyngeal swallowing after stroke in the left basal ganglion/internal capsule.

One of the foci of Martin Donner's work was the neural control of swallowing. This present investigation continues that work by examining oropharyngeal swallowing in 8 patients identified with a single, small, left-basal ganglion/internal capsule infarction and 8 age-matched normal subjects. Stroke patients were assessed with a bedside clinical and radiographic swallowing assessment, and normal subjects received only the radiographic study. Results revealed disagreement between the bedside and radiographic assessments in one of the 8 stroke patients. Stroke and normal subjects differed significantly on some swallow measures on various bolus viscosities, but behaved the same as normal subjects on a number of measures. Differences in swallowing in the stroke subjects were not enough to prevent them from eating orally. The significant differences seen in the basal ganglia/internal capsule stroke subjects may result from damage to the sensorimotor pathways between the cortex and brainstem. These differences emphasize the importance of cortical input to the brainstem swallowing center in maintaining the systematic modulations characteristic of normal swallowing physiology.

Adult↗