The effects of VitalStim on clinical and research thinking in dysphagia.
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Biomedical Research↗
Biomedical subjects
Jeri A Logemann
Publications and source records attributed to Jeri A Logemann.
Effects of radiotherapy with or without chemotherapy on tongue strength and swallowing in patients with oral cancer.
BACKGROUND: Oral tongue strength and swallowing ability are reduced in patients treated with chemoradiotherapy for oral and oropharyngeal cancer. METHODS: Patients with oral or oropharyngeal cancer treated with high-dose chemoradiotherapy underwent tongue strength, swallowing, and dietary assessments at pretreatment and 1, 3, 6, and 12 months posttreatment. Tongue strength was assessed using the Iowa Oral Performance Instrument (IOPI). Oral and pharyngeal residue was evaluated utilizing videofluoroscopy. RESULTS: Mean maximum tongue strength dropped a nonsignificant amount immediately after treatment, and then increased significantly at 6- and 12-months posttreatment completion. Analyses were adjusted for patient dropout. Tongue strength was not significantly correlated with swallow observations of percentage oral and pharyngeal residue. Ability to eat various diet consistencies was reduced after treatment but improved over time at a rate similar to changes in oral intake and type of diet. CONCLUSIONS: Parallel but not significant changes in oral intake, diet, and tongue strength in the first year post chemoradiation therapy need further study in a larger population.
Adult↗
Site of disease and treatment protocol as correlates of swallowing function in patients with head and neck cancer treated with chemoradiation.
BACKGROUND: The relationship between type of chemoradiation treatment, site of disease, and swallowing function has not been sufficiently examined in patients with head and neck cancer treated primarily with chemoradiation. METHODS: Fifty-three patients with advanced-stage head and neck cancer were evaluated before and 3 months after chemoradiation treatment to define their swallowing disorders and characterize their swallowing physiology by site of lesion and chemoradiation protocol. One hundred forty normal subjects were also studied. RESULTS: The most common disorders at baseline and 3 months after treatment were reduced tongue base retraction, reduced tongue strength, and slowed or delayed laryngeal vestibule closure. Frequency of functional swallow did not differ significantly across disease sites after treatment, although frequency of disorders was different at various sites of lesion. The effects of the chemotherapy protocols were small. CONCLUSIONS: The site of the lesion affects the frequency of occurrence of specific swallow disorders, whereas chemoradiation protocols have minimal effect on oropharyngeal swallow function.
Adult↗
Update on clinical trials in Dysphagia.
Randomized clinical trials (RCTs) are often known as the gold standard in treatment efficacy studies. This article defines the characteristics of RCTs and the factors that investigators must consider in designing clinical trials in dysphagia. Design issues unique to behavioral treatments often used in dysphagia are discussed. Ongoing RCTs in dysphagia are described including studies of (1) the effectiveness of the Shaker exercise versus standardized treatment in patients with severe dysphagia resulting from stroke or treatment for head and neck cancer who have been nonoral for at least three months; (2) the comparative effects of nectar- and honey-thickened liquids versus chin tuck posture and in patients with dementia or Parkinson's disease with or without dementia who aspirate on thin liquids; and (3) the comparative effects of muscle exercise versus sensory postural therapy for dysphagia resulting from treatment for head and neck cancer. Issues in generalizing from the results of clinical trials are also described.
Clinical Protocols↗
Oral and oropharyngeal perceptions of fluid viscosity across the age span.
Research demonstrates that varying sensory input, including the characteristics of a bolus, changes swallow physiology. Altering the consistency of fluids is a common compensatory technique used in dysphagia management to facilitate change. However, it is not known what variations in viscosity can be perceived in the oral cavity or oropharynx or if age affects oral and oropharyngeal perceptions of fluid viscosity. This study aims to establish the ability of normal adults to perceive fluid viscosity in the oral cavity and oropharynx and to determine if, within this population, there are age-related changes in oral and oropharyngeal perceptions. Sensitivity was established by deriving the exponent for the psychophysical law for fluid viscosity in both the oral cavity and the oropharynx, using modulus-free magnitude estimation with Newtonian fluids of corn syrup and water. Sixty normal volunteers, aged 21-84 years, participated. Results indicate that the exponent for oral perception of fluid viscosity was 0.3298, while for oropharyngeal perception it was 0.3148. Viscosity perception deteriorates with increasing age. Men exhibited a more marked deterioration in sensitivity than women. This study contributes to the literature on oral and oropharyngeal perceptions and on aging. The results provide a basis for work with individuals with dysphagia.
Adult↗
Levels of evidence supporting dysphagia interventions: where are we going?
This article describes and compares methodologies for collecting data on the outcomes and efficacy of dysphagia treatments. Several examples are included that distinguish these various types of studies. Study designs that are unique to dysphagia such as assessing the immediate effectiveness of treatment strategies of the instrumental study are described.
Deglutition Disorders↗
Preparation of speech-language pathologists in the United States: The Master's degree.
In order to become credentialed as a speech-language pathologist in the United States, a masters's degree is required. This degree integrates course work with clinical practica. Course work covers normal anatomy and physiology involved in human communication and swallowing, disorders affecting these functions and methods of evaluation and treatment across the life span. Generally this master's degree education requires 1(1/2) to 2 years for students with some background course work on the undergraduate level.
Clinical Competence↗
Challenges in the design and conduct of a randomized study of two interventions for liquid aspiration.
BACKGROUND: Liquid aspiration during swallowing has been linked to pneumonia, the most common cause of infectious death in the elderly. This paper examines the key issues in the design and implementation of the first multisite, randomized behavioral trial in dysphagia in an aging population. The study evaluated two commonly used treatments with respect to short-term and long-term management of liquid aspiration and subsequent pneumonia in dysphagic geriatric participants with dementia and/or Parkinson's disease. METHODS: Discussed are lessons learned during the conduct of this trial and include (1) ethical and methodological design issues, (2) pragmatic implementation of procedures and forms, (3) importance of multiple communication and monitoring strategies, (4) response to funding issues, and (5) changes in staff and facilities. RESULTS: In order to complete this trial the researchers were required to provide more support than anticipated in tasks such as completion of regulatory requirements by sites, supplementing site staff to identify potential study participants using a 'circuit rider' approach, continued recruitment of new sites and staff throughout the course of the trial, adapting forms and procedures and managing within economic constraints in a changing trial environment. LIMITATIONS: Many of the challenges faced by the researchers were not anticipated when the study began. Successful strategies are described for these unanticipated difficulties, based on retrospective evaluation. CONCLUSIONS: Successful conduct of clinical trials in long-term care environments that are heavily impacted by changes extraneous to the trial design and with staff typically new to clinical trials is possible but success depends on logistical flexibility.
Aged↗
Swallow physiology in patients with trach cuff inflated or deflated: a retrospective study.
BACKGROUND: Past research has suggested that medical diagnosis and trach cuff conditions may contribute to swallow physiology changes in patients with tracheostomy. This study attempts to investigate the differences in swallow physiology between patients with trach cuff-inflated and trach cuff-deflated conditions with respect to four medical diagnostic categories: neuromuscular disorder, head and neck cancer, respiratory diseases, and general medical diagnosis. METHODS: Retrospective database analysis of videofluoroscopic study results in 623 patients with tracheostomies with trach cuff-inflated or cuff-deflated conditions. Swallow disorders were examined for each patient. RESULTS: The frequencies of reduced laryngeal elevation and silent aspiration were found to be significantly higher in the cuff-inflated condition than the cuff-deflated condition. Significant swallow physiology changes were also found to be significantly different among various medical diagnostic categories. CONCLUSIONS: It is important to evaluate changes in swallow physiology under both the trach cuff-inflated and cuff-deflated conditions to fully assess swallow function.
Deglutition↗
The role of exercise programs for dysphagia patients.
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Deglutition Disorders↗
The relationship between observations and measures of oral and pharyngeal residue from videofluorography and scintigraphy.
We examined measures of oral and pharyngeal residues from scintigraphic studies and estimates/observations from videofluorographic (modified barium swallow) studies taken on the same day but not concurrently in 16 dysphagic patients of varying etiologies presenting with oral and/or pharyngeal dysphagia. Oral and pharyngeal residuals following the swallow were quantified scintigraphically and were then compared with measures of residuals obtained from the modified barium swallow. Estimates of oral and pharyngeal residues from the modified barium swallows were generated by a trained observer who was blinded to the scintigraphic data. Positive and significant Spearman correlations between oral and pharyngeal residue measures from scintigraphy and observations of oral and pharyngeal residues from modified barium swallows were found. This supports the validity of observations of oral and pharyngeal residues in clinical studies. Limitations of these observations are discussed.
Aged↗
Beyond efficacy and effectiveness: conducting economic analyses during clinical trials.
Few studies have examined cost issues in the field of dysphagia. This study presents cost data collected during a clinical trial in speech-language pathology, demonstrating the types of cost analyses that can be conducted and highlighting obstacles and issues facing investigators who seek to conduct economic analyses in this arena. Seventy-nine patients were enrolled in the clinical trial to assess the impact of a swallowing intervention on swallowing and speech function. The patients were at least one year past treatment for head and neck cancer. No significant intervention differences were detected in these outcomes. A companion economic analysis was conducted in 37 of these patients using patient diaries and followup with identified health care providers. Analyses indicated that (1) the intervention did not significantly reduce health care expenditures; (2) indirect costs and costs of hospitalizations are both important factors to consider during a trial; and (3) health care costs of this population are high relative to the rest of the U.S. population. Attrition from the overall study population can pose a serious threat to the viability of an economic study. The article concludes with a discussion of how these issues can be addressed in future studies.
Adult↗
Xerostomia: 12-month changes in saliva production and its relationship to perception and performance of swallow function, oral intake, and diet after chemoradiation.
BACKGROUND: Previous investigators have found permanent changes in saliva production after chemoradiation but have not examined these in relation to swallowing measures, diet changes, and patient comfort over time. METHODS: Thirty patients with advanced stage cancer of the oropharynx treated with chemoradiation were followed with videofluoroscopic swallow studies, a measure of stimulated total saliva production, a questionnaire of their perception of dry mouth, and a questionnaire on the nature of their oral intake at pretreatment until 12 months after treatment. RESULTS: Saliva declined significantly from pretreatment to 12 months. Swallowing-related complaints increased significantly over the 12 months, especially in patients with lower saliva weights. Diet choices increased over time after treatment, except crunchy foods. Swallow measures did not relate to saliva weight. CONCLUSIONS: Reduced saliva weight does not correlate with slowed or inefficient swallow. Instead, reduced saliva weight seems to change patients' perceptions of their swallowing ability and, on that basis, their diet choices.
Adult↗
Eating ability in head and neck cancer patients after treatment with chemoradiation: a 12-month follow-up study accounting for dropout.
BACKGROUND: Head and neck cancer patients treated with chemoradiation have difficulty eating a normal diet. This study was designed to characterize eating ability over 12 months after chemoradiation treatment. Analyses take patient dropout into account. METHODS: Two hundred fifty-five patients with head and neck cancer treated with chemoradiation were followed for 12 months. Eating ability was analyzed using generalized linear model methods that accounted for non-ignorable dropout. RESULTS: Eating ability was compromised immediately after treatment and improved over 12 months to near pretreatment levels. Ability to eat at most 50% of the diet orally did not return to baseline levels (p <.05). However, the percent of patients eating a normal diet did return to baseline levels. Accounting for dropout modified the results, but the pattern of significance was similar. CONCLUSIONS: Treatment of head and neck cancer with chemoradiation has a significant effect on eating ability, which improves after 12 months after treatment.
Adult↗
The effects of taste and consistency on swallow physiology in younger and older healthy individuals: a surface electromyographic study.
Recent studies done on healthy older individuals have demonstrated elevated taste thresholds for sweet, sour, and salty taste. At suprathreshold levels, such individuals have also shown less ability to discriminate between different intensities of the same tastant. This study was designed to provide information on swallow timing and muscle contraction intensity variables in healthy older people during swallowing of liquid and cottage cheese consistencies in 3 taste conditions (sweet, salty, and sour). Taste and consistency were incorporated in the design of this study to determine not only the effect of taste and consistency independently, but also the effects of taste and consistency in combination. Surface electromyography (EMG) at 3 sites--the orbicularis oris inferior region, submental muscle region, and infrahyoid muscle region--were included in the study. Results revealed that the start of submental muscle activation was significantly later in older participants than in younger participants. The 3 taste conditions had higher EMG levels and shorter activation times than the no-taste condition, although different taste conditions and different muscle sites were affected differently. With thicker consistency, substantially increased EMG amplitude and duration were noted for all three sites. A more pronounced effect of taste was manifested as earlier submental or infrahyoid muscle activation when the three tastants were added to a thicker consistency. Interaction of taste, consistency, and age was also noted for onset time at the submental and infrahyoid sites.
Adolescent↗
Does laryngectomy improve swallowing after chemoradiotherapy? A case study.
Organ preservation protocols of high-dose chemoradiotherapy have become fairly common to treat head and neck cancers. However, significant swallowing problems can occur. This study examines swallowing, oral tongue pressures, and tongue base-to-pharyngeal wall pressures in a patient who underwent total laryngectomy for improvement of swallowing after chemoradiotherapy for treatment of a hypopharyngeal tumor. The patient underwent concurrent videofluorographic and manometric examination of swallowing and examination of oral tongue pressures after the laryngectomy. One healthy subject was used as a control. After the laryngectomy, the patient no longer aspirated; however, he could swallow only liquids and pureed foods. He demonstrated difficulty with bolus clearance through the oral cavity and pharyngocervical esophagus. Pharyngeal pressures were reduced compared with those of the control subject. While total laryngectomy will stop unremitting aspiration, swallowing after chemoradiation may be severely compromised. This may not be overcome by total laryngectomy.
Aged↗
Swallowing and speech ability after treatment for head and neck cancer with targeted intraarterial versus intravenous chemoradiation.
OBJECTIVE: RADPLAT (concurrent selective supradose intraarterial cisplatin and external-beam irradiation) delivers extraordinarily high cisplatin concentration to head and neck structures. This study was designed to quantify and compare RADPLAT and systemic chemoradiation treatment effects on swallowing and speech. METHODS: Videofluorographic swallowing studies and articulation testing of 14 head and neck cancer patients treated with RADPLAT were compared with 16 treated with systemic chemoradiation 1 month after treatment. RESULTS: RADPLAT and systemic chemoradiation patients did not differ significantly on most swallow outcome measures, and there was significantly less aspiration on 1 and 3 mL liquid for RADPLAT individuals. Speech function was comparable except for RADPLAT's significantly worse /s, z/ productions. CONCLUSIONS: Increased concentration of cisplatin to the head and neck did not result in generally reduced swallowing or articulatory function.
Adult↗
Surface electromyographic and electroglottographic studies in normal subjects under two swallow conditions: normal and during the Mendelsohn manuever.
Surface electromyography (EMG) has been used successfully in teaching patients swallow maneuvers in clinical settings. The present study aims to determine if surface EMG can reliably demonstrate differences in muscle activity between the normal swallow and the Mendelsohn maneuver and whether there is a close temporal relationship between submental muscles and laryngeal elevation as demonstrated by electroglottography (EGG). Surface EMG was measured from five muscle groups (superior and inferior orbicularis oris, masseter, submental and infrahyoid) in 20 normal subjects under two swallowing conditions: normal and during performance of the Mendelsohn maneuver. A significant difference in EMG activity from the submental muscle group between the normal swallow and the Mendelsohn maneuver indicates that EMG at this location can be used reliably to differentiate between these two swallow conditions. The onset of submental activity and laryngeal elevation occurred within 10 ms of each other. The offset of submental activity and the return of the larynx to its resting position occurred within 24 ms of each other. Regarding the temporal relationship among the five muscle groups, the sequence of the most frequent muscle initiation was orbicularis oris inferior. orbicularis oris superior, masseter. submental muscle group, and infrahyoid muscle group. The sequence of the most frequent muscle termination was orbicularis oris superior, orbicularis oris inferior, masseter, submental muscle group, and infrahyoid muscle group in both normal swallow and the Mendelsohn maneuver.
Adolescent↗