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Biomedical subjects

J A Logemann

Publications and source records attributed to J A Logemann.

At least 109 records · Page 6Linked to original sources
PubMed1990

Relearning to swallow after stroke--application of maneuvers and indirect biofeedback: a case study.

A patient with medullary infarct recovered swallowing at 45 months after stroke by using a series of pharyngeal swallow maneuvers. Each maneuver effected quantifiable changes in specific elements of the pharyngeal swallow. The success of these maneuvers is the basis for the conceptualization of the pharyngeal swallow as a cluster of closely coordinated neuromuscular actions which are independently modifiable, rather than a single event.

Biofeedback, Psychology↗
PubMed1990

Effects of aging on the swallowing mechanism.

Normal swallow involves a number of closely coordinated neuromuscular events. Investigators have identified some small temporal changes in the swallow of older adults as compared with young adults. Further research is needed to define completely the primary effects of aging on deglutition. Many medical conditions that commonly affect the elderly can cause dysphagia. These are discussed in terms of their effects on swallow physiology. Diagnosis and treatment of dysphagia in the elderly should be pursued as aggressively as in the younger adult.

Aging↗
PubMed1989

Preliminary observations on the effects of age on oropharyngeal deglutition.

Swallows of 4 bolus volumes (1, 5, 10, 20 ml) were examined in three groups of subjects: 6 subjects 20-29 years of age, 12 subjects 30-59 years of age, and 6 subjects 60-79 years of age. A simultaneous manometric and videofluoroscopic data collection protocol permitted measurement of bolus transit, temporal aspects of the oropharyngeal swallow, and pharyngeal peristalsis. Statistically significant effects of increasing bolus volume were oral transit of the bolus head (decreased) and duration of cricopharyngeal opening (increased). Five measures were significantly changed with increasing age: duration of pharyngeal swallow delay (increased), duration of pharyngeal swallow response (decreased), duration of cricopharyngeal opening (decreased), peristaltic amplitude (decreased), and peristaltic velocity (decreased).

Adult↗
PubMed1989

Effects of intraoral prosthetics on swallowing in patients with oral cancer.

The swallowing patterns of four patients with oral cancer with intraoral palate reshaping/lowering protheses were studied with and without their prostheses 3 months postoperatively. The prostheses resulted in improved swallow efficiency, increased duration of tongue contact to the pharyngeal wall, and improved speed of movement of the bolus from the valleculae to the pyriform sinus. These results emphasize the effects of the tongue on the pharyngeal as well as oral stage of the swallow.

Deglutition↗
PubMed1989

Upper esophageal sphincter opening and modulation during swallowing.

Studies were done on 8 normal subjects with synchronized videofluoroscopy and manometry to facilitate a biomechanical analysis of upper esophageal sphincter opening and volume-dependent modulation during swallowing. Movements of the hyoid and larynx, dimensions of sphincter opening, and intraluminal sphincter pressure were determined at 1/30th-s intervals during swallows of 1, 5, 10, and 20 ml of liquid barium. Our analysis subdivided upper esophageal sphincter activity during swallowing into five phases: (a) relaxation, (b) opening, (c) distention, (d) collapse, and (e) closure. Sphincter relaxation occurred during laryngeal elevation and preceded opening by a mean period of 0.1 s. Opening occurred as the sphincter was pulled apart via muscular attachments to the hyoid such that the hyoid coordinates at which sphincter opening and closing occurred were constant among bolus volumes. Sphincter distention after opening was modulated by intrabolus pressures rather than graded hyoid movement. The generation of intrabolus pressure coincided with the posterior thrust of the tongue that culminated in pharyngeal wall contact and the initiation of pharyngeal peristalsis. Larger volume swallows were associated with greater intrabolus pressure and increased bolus head velocity. The duration of sphincter opening increased in conjunction with a prolongation of the anterior-superior excursion of the hyoid and a delay in the onset of pharyngeal peristalsis (the event that determined the timing of sphincter closure). We conclude that transsphincteric transport of increasing swallow bolus volumes is accomplished by modulating sphincter diameter, opening interval, and flow rate (reflected by bolus head velocity). Furthermore, upper esophageal sphincter opening is an active mechanical event rather than simply a consequence of cricopharyngeal relaxation.

Adult↗
PubMed1989

Tipper and dipper types of oral swallows.

We characterized the normal patterns relating to the onset of the oral-swallowing phase in patients with normal oral motor function. The main pattern of swallowing was of the tipper type, in which swallowing is initiated with the tip of the tongue against the incisors and the bolus is in a supralingual position. However, a second pattern of a dipper-type swallow occurred, in which part of the bolus initially is positioned beneath the anterior part of the tongue. This circumstance requires that the tongue dip beneath the bolus in order to elevate the bolus above the tongue. Dipper swallows occurred in all age groups, but were more prevalent in subjects 60 years or older. Recognition of this component in normal swallowing patterns is essential for optimal evaluation of normal subjects and patients with an abnormal oral phase of swallowing.

Barium Sulfate↗
PubMed1989

The benefit of head rotation on pharyngoesophageal dysphagia.

This study examined the effect of head rotation on the mechanics of swallowing in healthy subjects, as well as the effects of this postural change on the oropharyngeal swallow of five patients with lateral medullary syndrome (LMS). Videofluoroscopic studies of swallowing in the normal subjects revealed that head rotation to either side increased upper esophageal sphincter (UES) opening diameter by an average of 2mm without affecting the period of UES opening or the oropharyngeal transit time. Maximal rotation of the head to the right or left caused the bolus to lateralize away from the direction of rotation, and also caused a significant (18mmHg or 35%) fall in UES pressure. In the face forward position, the LMS patients exhibited barium residue in the pharynx and pyriform sinuses, as well as diminished UES opening diameter. The fraction of the bolus swallowed and the UES opening diameter increased significantly with the head turned toward the paretic side in the LMS patients. We conclude that head rotation can improve swallowing in patients with unilateral oropharyngeal dysphagia. Two potentially beneficial effects were observed: (1) functional exclusion of the relatively flaccid, weakened pharyngeal wall, and (2) reduced UES tone. Which of these mechanisms is operative probably depends on the dominant mechanisms of dysphagia. In individuals with substantial impairment of UES opening, head turning reduces the resistance of the sphincter that must be overcome by pharyngeal contraction. In individuals with a flaccid hemipharynx, which dissipates pharyngeal pressure, head rotation excludes these structures from the bolus path and allows pharyngeal pressure to be directed at the UES.

Adult↗
PubMed1988

Upper esophageal sphincter function during deglutition.

Upper esophageal sphincter function was investigated during swallows of graded volumes in 8 normal volunteers. Concurrent recordings of video-fluoroscopic and manometric studies were obtained and correlated with each other by means of a videotimer. Maximal upper esophageal sphincter (UES) pressure was typically located 1.5 cm distal to the air-tissue interface between the hypopharynx and the proximal margin of the sphincter. The region in which UES pressure was greater than or equal to 50% maximal averaged 1.0 cm in length. Thus, the physiologic high-pressure zone of the UES corresponds in size and location to that of the cricopharyngeus muscle. Fluoroscopic analysis of sphincter movement indicated that the sphincter high-pressure zone moved 2.0-2.5 cm orally during swallowing and that the magnitude of the orad movement was directly related to the volume of barium swallowed. The maximal anterior-posterior diameter of sphincter opening during a swallow ranged from 0.9 to 1.5 cm and was also directly related to the volume swallowed. The intervals of UES opening and relaxation increased significantly with increasing bolus volume; the duration of UES relaxation ranged from a mean of 0.37 s for dry swallows to 0.65 s for 20-ml swallows. Thus, the dynamics of UES function during deglutition are dependent upon the volume of the swallowed bolus. Larger bolus volumes are accommodated by both an increased diameter of sphincter opening and by prolongation of the interval of sphincter relaxation. Analysis of the timing of other reference points within the pharyngeal swallow sequence indicated that as the manometric interval of UES relaxation increased, the period of laryngeal elevation was prolonged, the UES relaxed earlier and contracted later, and the interval between the onset of laryngeal elevation and hypopharyngeal contraction increased.

Adolescent↗
PubMed1988

Manofluorography of deglutition after total laryngopharyngectomy.

Manofluorography is a new technique for the evaluation of swallowing that provides simultaneous display of manometry and videofluoroscopy on one video screen. Data are presented from a study of deglutition in 10 patients who had prior total laryngopharyngectomy with replacement by either jejunal graft or gastric pull-up. Factors that enhance bolus passage are the presence of a widely patent graft and an intact swallowing reflex. Factors that impair bolus transit include stricture, jejunal peristalsis, impaired lingual coordination, and stenosis at the anastomotic site. The swallowing patterns of these patients serve as models of the open and closed cavity swallow and illustrate principles of manofluorographic interpretation.

Anastomosis, Surgical↗
PubMed1988

Swallowing physiology and pathophysiology.

Many disturbances in oropharyngeal physiology can result in aspiration. Poor tongue movement in chewing or in the oral swallow can cause food to fall into the pharynx and into the open airway before swallowing. A delay in triggering the pharyngeal swallow can result in food falling into the airway during the delay when the airway is open. Reduced peristalsis in the pharynx, whether unilateral or bilateral, will cause residue in the pharynx after the swallow that can fall or be inhaled into the airway. Reduced laryngeal elevation causes food to catch at the top of the airway. This residual food is then easily aspirated during the inhalation after the swallow. Reduced laryngeal closure may result in food penetrating the larynx during the pharyngeal swallow. Cricopharyngeal dysfunction can result in material remaining in the pyriform sinus, with aspiration of material into the airway after the swallow. Aspiration may also occur because food returns or is refluxed from the stomach or esophagus back into the pharynx. Each of these causes of aspiration can occur in a variety of patients, including those with neurologic impairment or structural damage. Each of these causes of aspiration has a different treatment. Thus, accurate and in-depth evaluation of swallowing anatomy and physiology in the oral-pharyngeal region as well as in the esophagus is necessary in successful re-establishment of oral nutrition in the dysphagic patient. Currently, such thorough evaluation requires radiographic graphic techniques, that is, videofluoroscopy and often manometry as well.

Deglutition↗
PubMed1988

The role of the speech language pathologist in the management of dysphagia.

The speech language pathologist typically participates in the evaluation and treatment of dysphagia in the oral and pharyngeal stages of swallow. Bedside examination and a modified barium swallow permit examination of the neuromuscular components of the swallow and place the patient at minimal risk of aspiration. Compensatory and therapeutic procedures are then implemented to improve oropharyngeal function.

Deglutition Disorders↗
PubMed1988

Phonetic analyses of the speech development of babies with cleft palate.

Phonetic transcription was completed of the vocalizations of 23 babies with cleft palate at 9 specified ages from 3 to 36 months of age. Frequency of occurrence was calculated for: (1) consonant place features, (2) consonant manner features, (3) stop types, (4) fricative types, (5) vowel place features, and (6) vowel height features. The data are discussed for the entire population, for those babies with greater palatal tissue for whom palatoplasty was conducted at or prior to 12 months of age and for those babies with lesser tissue for whom palatoplasty was conducted after 12 months of age. Results suggest that (1) neither group used oral place features at the rate produced by babies born with intact velopharyngeal mechanisms, but that (2) the greater tissue group exhibited somewhat higher emergence of oral stop and fricative productions.

Child, Preschool↗
PubMed1987

Swallowing disorders in closed head trauma patients.

Fifty-three closed head trauma patients with dysphagia were examined videofluorographically to determine the specific nature of their swallowing disorder. Eighty-one percent of the patients exhibited a delayed or absent swallowing reflex while approximately 50% of the patients suffered from reduced tongue control, and 33% had reduced peristalsis. Laryngeal disorders and cricopharyngeal dysfunction occurred in a small number of patients. The average head trauma patient exhibited more than one swallowing motility problem. Twenty patients aspirated, with delayed or absent swallowing reflex as the most common etiology for the aspiration. Many of these patients did not produce a reflexive cough during or after they had aspirated material into their airway. For this reason, and since the pharyngeal stage of the swallow is extremely difficult to assess with presently available bedside techniques, videofluorographic evaluation becomes an invaluable tool for identification of the precise nature of the swallowing disturbance, the presence of aspiration, and the etiology of the aspiration.

Adult↗