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Open Access Thesis

Keywords

Deglutition--Measurement;

Abstract

Even though the Modified Barium Swallow (l\1BS) is the gold standard for the evaluation of swallowing disorders, the MBS has several limitations ( e.g., invasiveness, cost and portability). Noninvasive tools to measure swallowing ability at low cost and with low risk to the patient are desirable. Recently, thin film, piezoelectric technology (Computerized Laryngeal Analyzer: CLA) has become available which allows for noninvasive biomechanical analysis of swallowing. Noninvasive biomechanical measurement of swallowing is possible due to the close correlation of hyolaryngeal movement, airway protection and upper esophageal sphincter (UES) opening (Jacob, Kahrilas, Logemann, Shah, & Ha, 1989). The vertical and anterior motion of the hyolaryngeal complex defines the onset and offset of the pharyngeal swallow, airway protection, UES opening. Piezoelectric techniques capture the complex movements of the hyolaryngeal sling and the CLA system develops a real-time graphic display of the motions and calculates amplitude and temporal movement parameters. The dependent variables captured by the CLA include swallowing onset, duration, amplitude, acceleration and magnitude. Further, Hageman, Crow, and Ritchie (1997) have developed a piezoelectric biomechanical profile technique (P-BAS) to capture a swallowing profile or an overall impression of swallowing efficiency. It has been well established that swallowing efficiency is affected by the material being swallowed (Logemann, 1983). Compensatory interventions for dysphagia often involve systematic manipulation of the food to be swallowed. The literatu.re is also replete with reports demonstrating the systematic temporal and amplitude relationships among the movements of swallowing especially the larynx as bolus volumes and consistencies vary (e.g., Jones, 1994) For example, as the bolus volume increases, the UES remains open longer and the larynx remains elevated longer. Further, it has been suggested by various authors (e.g., Groh er, 1992 and Logemann, 1983) that swallowing efficiency decreases with increasing age. Gupta, Reddy, and Canilang ( 1996) and Hageman et al. ( 1997) have demonstrated the capability of surface measurement of swallowing movements. Hageman et al. ( 1997) proposed a profile system (P-BAS) to capture an overall efficiency measure of hyolaryngeal movement. However, these techniques have not been applied across a wide range of ages or swallowing tasks. Therefore, the purpose of this research was to measure the swallowing capability of normal swallows and to examine their swallowing capability across several swallowing tasks (e.g., swallows that are dry, thin liquid or thick liquid). In addition, the relationship between skin fold thickness over the laryngeal prominence and CLA dependent measures was examined. Further, the interjudge reliability of the P-BAS scoring system was tested. Sixty-eight subjects ranging in age from 20 to 96 years took part. They swallowed small and large volumes of thin and thick liquids (pudding or applesauce). The swallowing movements (swallowing onset, duration, amplitude, magnitude, acceleration, and P-BAS) were captured using the CLA thin film piezoelectric hardware and software. Swallowing onset time was not significantly different across ages but swallowing onset time was significantly different by swallowing task. Onset times for a small liquid bolus tended to be shorter than onset times the thicker bolus. Further, the onset time for a small thick bolus was shorter than the onset time for large thick bolus. Finally, the dry swallows had the longest onset times. The remaining CLA computed dependent variables did not significantly differ across ages or swallowing task. Two aspects of the P-BAS technique were examined. First, interjudge reliability was found to be high and highest for the elderly swallowers. Second, P-BAS scores differed significantly across age with all three age groups significantly different from each other. Further, there was a significant interaction across swallowing task and the P-BAS scores showing that the large thick bolus was least difficult for oldest swallowers and most difficult for the younger swallowers. Finally, there were significant, albeit low correlations between skin fold thickness and movement amplitude and velocity. The correlations between skin fold thickness and temporal measures ( e.g., swallowing onset) were insignificant. These findings were interpreted to mean that swallowing efficiency decreases with age and that the piezoelectric profile system (P-BAS) is especially sensitive to those changes. The P-BAS system is a reliable technique to evaluate to evaluate swallowing efficiency. Further, we believe those swallowing tasks would have varied significantly across ages except for large intersubject variability which reduced power and resulted in statistically insignificant findings for the remaining dependent piezoelectric variables. Consequently, isolated biomechanical parameters, outside of a profile system, may not be reliable enough at this point to document swallowing activity.

Year of Submission

1998

Degree Name

Master of Arts

Department

Department of Communicative Disorders

First Advisor

Carlin F. Hageman

Second Advisor

Ken Bleile

Third Advisor

Julia Wallace

Comments

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Date Original

1998

Object Description

1 PDF file (96 leaves)

Language

en

File Format

application/pdf

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