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Swallowing is a complex neuromuscular activity regulated by the autonomic nervous system. Millions of adults suffer from dysphagia (impaired or difficulty swallowing), including patients with neurological disorders, head and neck cancer, gastrointestinal diseases, and respiratory disorders. Therapeutic treatments for dysphagia include interventions by speech-language pathologists designed to improve the physiology of the swallowing mechanism by training patients to initiate swallows with sufficient frequency and during the expiratory phase of the breathing cycle. These therapeutic treatments require bulky, expensive equipment to synchronously record swallows and respirations, confined to use in clinical settings. This paper introduces a wireless, wearable technology that enables continuous, mechanoacoustic tracking of respiratory activities and swallows through movements and vibratory processes monitored at the skin surface. Validation studies in healthy adults (n = 67) and patients with dysphagia (n = 4) establish measurement equivalency to existing clinical standard equipment. Additional studies using a differential mode of operation reveal similar performance even during routine daily activities and vigorous exercise. A graphical user interface with real-time data analytics and a separate, optional wireless module support both visual and haptic forms of feedback to facilitate the treatment of patients with dysphagia.

Purpose: The elements of impaired swallowing biomechanics are visually assessed and scored by clinicians using a standardized and validated tool for assessing type and severity of physiological impairments using the Modified Barium Swallow Impairment Profile (MBSImP). However, the functional anatomical correlates that underly noted impairments using MBSImP scoring have not been measured. The purpose of this study was to determine whether differences in MBSImP component scores represent differences in underlying swallowing mechanics as measured by computational analysis of swallowing mechanics (CASM) to better define underlying mechanisms of impairment. Method: A retrospective analysis of modified barium swallow studies from physician-referred adult patients with dysphagia was scored using the MBSImP for laryngeal elevation, anterior hyoid excursion, epiglottic movement, pharyngoesophageal segment opening, and tongue base retraction. A canonical variate analysis (CVA) was performed to determine the movement of anatomical landmarks associated with MBSImP component scores using the CASM method. Mahalanobis distances (D) were then used to detect differences among MBSImP scores for each component assessed. Results: CVA showed significant differences (p < 0.0001) in Mahalanobis distance (D > 1) between MBSImP component scores of 0-1, 0-2, 0-3, or 0-4, as applicable, depending on the component. Discriminant function analyses revealed concomitant increase/worsening in MBSImP score with changes in anatomical positioning of structures. Conclusions: Ratings of swallowing impairment and physiology using the MBSImP have distinct biomechanical correlates with anatomical movements of swallowing. These data further demonstrate how swallowing mechanics are highly interrelated. Understanding these linkages between anatomical and physiological movement within impaired swallowing biomechanics is essential in more specific characterization and treatment of dysphagia.

Purpose: The purpose of this study was to extend the assessment of the psychometric properties of the Modified Barium Swallow Impairment Profile (MBSImP). Here, we re-examined structural validity and internal consistency using a large clinical-registry data set and formally examined rater reliability in a smaller data set. Method: This study consists of a retrospective structural validity and internal consistency analysis of MBSImP using a large data set (N = 52,726) drawn from the MBSImP Swallowing Data Registry and a prospective study of the interrater and intrarater reliability of a subset of studies (N = 50) rated by four MBSImP-trained speech-language pathologists. Structural validity was assessed via exploratory factor analysis. Internal consistency was measured using Cronbach's alpha for each of the multicomponent MBSImP domains, namely, the oral and pharyngeal domains. Interrater reliability and intrarater reliability were measured using the intraclass correlation coefficient (ICC). Results: The exploratory factor analysis showed a two-factor solution with factors precisely corresponding to the scale's oral and pharyngeal domains, consistent with findings from the initial study. Component 17, that is, the esophageal domain, did not load onto either factor. Internal consistency was good for both the oral and pharyngeal domains ([alpha][subscript oral] = 0.81, [alpha][subscript pharyngeal] = 0.87). Interrater reliability was found to be good with ICC[subscript interrater] = 0.78 (95% confidence interval [CI; 0.76, 0.80]). Intrarater reliability was good for each rater, ICC[subscript Rater-1] = 0.82 (95% CI [0.77, 0.86]), ICC[subscript Rater-2] = 0.83 (95% CI [0.79, 0.87]), ICC[subscript Rater-3] = 0.87 (95% CI [0.83, 0.90]), and ICC[subscript Rater-4] = 0.87 (95% CI [0.83, 0.90]). Conclusions: This study leverages a large-scale, clinical data set to provide strong, generalizable evidence that the MBSImP assessment method has excellent structural validity and internal consistency. In addition, the results show that MBSImP-trained speech-language pathologists can demonstrate good interrater and intrarater reliability.

Purpose: The coordination of respiration with swallowing is critical for facilitation of airway protection and the efficiency of movements that propel ingested material through the upper aerodigestive tract. Confirmation of a predominant pattern in healthy adults provides a platform for comparison to aberrant patterns observed in the population with swallowing impairment (dysphagia). Method: A comprehensive search of published research in MEDLINE via PubMed 1946-2018, Embase 1947-2018, and Proquest Dissertations & Theses Global 1861-2018 was completed. Results: Thirty-seven articles meeting inclusion criteria were selected for data extraction, and the findings were reviewed. In addition, a meta-analysis of the data was completed. A significantly higher occurrence (p < 0.001) of expiration prior to and following the swallow was found when compared to 3 other patterns. The predominance of the pattern was influenced by increases in bolus volume when controlling for participant sample size. Conclusion: Determination of this predominant pattern provides a normative framework for evaluating respiratory-swallow coordination in adults across the age span and highlights the relevance for assessing and incorporating respiratory swallowing coordination during assessment and interventions.

Purpose: The purpose of the present study was to use a large swallowing database to explore and compare the swallow-physiology impairment profiles of five dysphagia-associated diagnoses: chronic obstructive pulmonary disease (COPD), dementia, head and neck cancer (HNC), Parkinson's disease (PD), and stroke. Method: A total of 8,190 patients across five diagnoses were extracted from a de-identified swallowing database, that is, the Modified Barium Swallow Impairment Profile Swallowing Data Registry, for the present exploratory crosssectional analysis. To identify the impairment profiles of the five diagnoses, we fit 18 partial proportional odds models, one for each of the 17 Modified Barium Swallow Impairment Profile components and the Penetration--Aspiration Scale, with impairment score as the dependent variable and diagnoses, age, sex, and race as the independent variables with interactions between age and diagnoses and between PD and dementia (in effect creating a PD with dementia [PDwDem] group). For components with > 5% missingness, we applied inverse probability weighting to correct for bias. Results: PD and COPD did not significantly differ on 13 of the 18 outcome variables (all ps > .02). Dementia, stroke, and PDwDem all showed worse impairments than COPD or PD on five of six oral components (all ps < .007). HNC had worse impairment than all diagnoses except PDwDem for nine of 10 pharyngeal components (all ps < .006). Stroke and HNC had worse penetration/ aspiration than all other diagnoses (all ps < .003). Conclusions: The present results show that there are both common and differing impairment profiles among these five diagnoses. These commonalities and differences in profiles provide a basis for the generation of hypotheses about the nature and severity of dysphagia in these populations. These results are also likely highly generalizable given the size and representativeness of the data set. Supplemental Material: https://doi.org/10.23641/asha.27478245 [ABSTRACT FROM AUTHOR]

Background: Although swallowing impairment is prevalent following lung transplantation, baseline respiratory and swallowing characteristics are often overlooked. Respiratory disease processes may predispose lung transplant candidates to altered respiratory‐swallow patterning and swallowing impairment. Methods: This cross‐sectional study included patients referred for a Modified Barium Swallow Study during lung transplant evaluation. Swallowing impairment was measured using the Modified Barium Swallow Impairment Profile and Penetration‐Aspiration Scale. Respiratory plethysmographic signals synchronized with videofluoroscopy were analyzed to determine phase patterning, pause duration, and rate. Mixed‐effects logistic regression was used to identify linkages between respiratory and swallowing measures. Key Results: Fifty patients were included and demonstrated delayed swallow initiation (49/50), oral residue (37/50), incomplete pharyngoesophageal segment opening (35/50), and esophageal retention (43/50). Airway invasion occurred infrequently (10/50). Atypical respiratory patterning was significantly associated with impairment in pharyngeal swallow initiation (OR [95% CI] = 1.76 [1.16, 2.68], p = 0.009), laryngeal elevation (OR [95% CI] = 1.45 [1.01, 2.07], p = 0.044), and laryngeal vestibular closure (OR [95% CI] = 2.57 [1.48, 4.46], p < 0.001). Increased pause duration was associated with impaired initiation (OR [95% CI] = 2.24 [1.20, 4.16], p = 0.011), laryngeal elevation (OR [95% CI] = 1.18 [1.03, 1.36], p = 0.018), laryngeal closure (OR [95% CI] = 1.28 [1.9, 1.50], p = 0.003), and tongue base retraction (OR [95% CI] = 1.33 [1.13, 1.56], p < 0.001). Conclusions & Inferences: Patients undergoing evaluation for lung transplant demonstrated impaired swallowing and phase patterning. Preliminary findings implicate the need for further evaluation of respiratory‐swallow coordination and its potential role in swallowing impairment before and after lung transplantation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to identify which swallowing task(s) yielded the worst performance during a standardized modified barium swallow study (MBSS) in order to optimize the detection of swallowing impairment. Method: This secondary data analysis of adult MBSSs estimated the probability of each swallowing task yielding the derived Modified Barium Swallow Impairment Profile (MBSImP™©; Martin-Harris et al., 2008) Overall Impression (OI; worst) scores using generalized estimating equations. The range of probabilities across swallowing tasks was calculated to discern which swallowing task(s) yielded the worst performance. Results: Large-volume, thin-liquid swallowing tasks had the highest probabilities of yielding the OI scores for oral containment and airway protection. The cookie swallowing task was most likely to yield OI scores for oral clearance. Several swallowing tasks had nearly equal probabilities (= 0.20) of yielding the OI score. Conclusions: The MBSS must represent impairment while requiring boluses that challenge the swallowing system. No single swallowing task had a sufficiently high probability to yield the identification of the worst score for each physiological component. Omission of swallowing tasks will likely fail to capture the most severe impairment for physiological components critical for safe and efficient swallowing. Results provide further support for standardized, well-tested protocols during MBSS.

Purpose: The purpose of this study was to test the feasibility for quantifying changes in oropharyngeal swallowing impairment in response to alteration in bolus viscosity using a reliable and valid method of observational measurement--the Modified Barium Swallow Impairment Profile (MBSImP). Method: This retrospective analysis included a heterogeneous cohort of 119 patients with suspected dysphagia that underwent a videofluoroscopic swallowing study as part of clinical care. Using consensus scoring, two expert clinicians assigned MBSImP scores to components related to oropharyngeal swallowing function between two bolus viscosities (thin liquid and pudding): epiglottic movement, laryngeal elevation, anterior hyoid excursion, tongue base retraction, pharyngeal stripping wave, and pharyngoesophageal segment opening (PESO). Comparisons between the two bolus viscosities were investigated for each component. Results: Higher (worse) scores were observed in the thin-liquid trial compared with the pudding trial for the following MBSImP components: anterior hyoid excursion (p = .03), epiglottic movement (p < .001), pharyngeal stripping wave (p < .001), and PESO (p = .002). Lower (better) scores were observed in the liquid trial compared with the pudding trial for one component--tongue base retraction (Component 15) only (p < .001). Conclusion: These findings provide further evidence for positive influences of viscosity on the swallow mechanism, including influences of sensory feedback on the sensorimotor swallow program. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this investigation was to determine bolus head timing and location relations with the onset of hyoid movement at the initiation of the pharyngeal swallow and at the onset of swallow-related apnea. Method: Bolus head timing and location and the timing of swallow-related apnea were recorded from frame-by-frame analyses of 5-ml single liquid swallows using dual-modality videofluoroscopy and nasal airflow recordings in 82 consecutive, healthy volunteers. The presence, depth, and response to airway entry were also recorded and related to the bolus head location and the onset of hyoid movement. Results: The majority of participants--80% on at least 1 trial--produced the onset of hyoid movement at pharyngeal swallow initiation after the bolus head passed the posterior angle of the mandible. There was a trend in older participants for later onset of hyoid movement and onset of apnea relative to bolus head arrival at the posterior angle of the mandible. Conclusion: Although entry of the bolus head into the pharynx prior to hyoid movement may result in a threat to the laryngeal airway, these data demonstrate that a "delay" by itself cannot be assumed to indicate a disordered swallow without coexisting impairments of swallowing physiology.