Papers Related to Lab Projects
Interactive computer program for biomechanical analysis of videoradiographic studies of swallowing
Logemann, J.A., Kahrilas, P.J., Begelman, J., Dodds, W.J., and Pauloski, B.R. (1989). Interactive computer program for biomechanical analysis of videoradiographic studies of swallowing. American Journal of Roentgenology, 153, 277-280.
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Measurement of movements of oral pharyngeal structures from videoradiographic studies is extremely time-consuming and difficult. Each video frame must be traced, and specific points of interest must be identified. Measurements from a single frame can take 30-60 minutes, making such analyses infeasible. To facilitate the biomechanical analysis of the pharyngeal swallow, the Video Analysis Laboratory at Northwestern University, Department of Communication Sciences and Disorders, developed an interactive computer program to digitize, enhance, and plot movement of anatomic structures in the oral cavity and pharynx from the onset through the termination of the swallow. This report describes the application of this program to the biomechanical analysis of swallowing.
Super-supraglottic swallow in irradiated head and neck cancer patients
Logemann, J.A., Pauloski, B.R., Rademaker, A.W., and Colangelo, L.A. (1997). Super-supraglottic swallow in irradiated head and neck cancer patients. Head and Neck, 19, 535-540.
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Background: After radiotherapy to the head and neck, many patients experience swallowing difficulties. Preliminary work indicates that these patients benefit from the super-supraglottic swallow maneuver.
Methods: Lateral videofluoroscopic studies examined oropharyngeal swallowing in 9 patients who suffered from dysphagia after radiation to the head and neck. Each patient completed two swallows each of 1 mL or 3 mL liquid barium without a voluntary swallow maneuver and with the super-supraglottic swallow designed to close the entrance to the airway early. The videotape of each swallow was digitized and the location of pharyngeal structures marked throughout the swallow. Movement over time plots were generated to measure changes in structural movement resulting from the maneuver.
Results: The super-supraglottic swallow resulted in changes in airway entrance closure and hyolaryngeal movement. One patient who aspirated without the maneuver stopped aspirating with the maneuver. Two others had aspiration reduced to a trace with the maneuver. Fewer swallow disorders were observed with the maneuver.
Temporal and biomechanical characteristics of oropharyngeal swallow in younger and older men
Logemann, J.A., Pauloski, B.R., Rademaker, A.W., Colangelo, L.A., Kahrilas, P. J., & Smith, C.H. (2000). Temporal and biomechanical characteristics of oropharyngeal swallow in younger and older men. Journal of Speech, Language, and Hearing Research, 43, 1264-1274.
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As the U.S. population ages, there is increasing need for data on the effects of aging in healthy elderly individuals over age 80. This investigation compared swallowing ability of 8 healthy younger men ages 21 to 29 and 8 healthy older men ages 80 to 94 during two swallows each of 1 ml and 10 ml liquid. Videofluoroscopic studies of these swallows were analyzed to confirm the absence of swallowing disorders. Biomechanical analysis of each swallow was completed from which data on temporal, range of motion and coordination characteristics of the oropharyngeal swallow were taken. Position of the larynx at rest, length of neck and pattern of hyoid bone movement were also compared between the two groups. None of the younger or older men exhibited any swallowing disorders. The C2 to C4 distance of older men was significantly shorter than for younger men, and laryngeal position at rest was lower than in younger men but not significantly so. Older men had a significantly longer pharyngeal delay than younger men and significantly faster onset of posterior pharyngeal wall movement in relation to first cricopharyngeal opening. The older men exhibited significantly reduced maximum vertical and anterior hyoid movement as compared to the younger men even when accounting for the difference in C2 to C4 distance in older men. These data support the hypothesis of reduced muscular reserve in the swallows of older men as compared to younger men. Older men also exhibited less width of cricopharyngeal opening than younger men at 10 ml volume, indicating less upper esophageal sphincter flexibility in the swallows of older men. The potential for exercise to improve reserve is discussed. Significant changes in extent of hyoid elevation and duration of cricopharyngeal opening were seen as liquid bolus volume increased.
Oropharyngeal swallow in younger and older women: Temporal and biomechanical characteristics
Logemann, J.A., Pauloski, B.R., Rademaker, A.W., & Kahrilas, P. J. (2002). Oropharyngeal swallow in younger and older women: Temporal and biomechanical characteristics. Journal of Speech and Hearing Research, 45, 434-445.
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There has been increasing interest in gender differences in swallowing function and in the effects of aging on swallowing in both genders. This investigation examined the swallowing ability of 8 healthy young women between the ages of 21 and 29 and 8 healthy older women between the ages of 80-93 during two swallows each of 1 ml and 10 ml liquid boluses. Videofluoroscopic studies of these swallows were reviewed in slow motion and real time to confirm the absence of swallowing disorders. Biomechanical analysis of each swallow was completed from which data on temporal, range of motion, and coordination characteristics of the oropharyngeal swallow were taken. Position of the larynx at rest and length of neck were compared between the two groups. None of the younger or older women exhibited any swallowing disorders. Data from this study were compared with previously published data on younger and older men. Interestingly, the older women often utilized increased range of motion as compared to the young women, and to the old men. This increase may indicate a compensation for aging effects not seen in older men.
Impact of tongue base and posterior pharyngeal wall biomechanics on pharyngeal clearance in irradiated postsurgical oral and oropharyngeal cancer patients
Pauloski, B.R. & Logemann, J. (2000). Impact of tongue base and posterior pharyngeal wall biomechanics on pharyngeal clearance in irradiated postsurgical oral and oropharyngeal cancer patients. Head and Neck, 22, 120-131.
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Background: Postsurgical oral and oropharyngeal cancer patients may experience pharyngeal clearance problems after completion of postoperative radiotherapy.
Methods: Swallowing was examined in six patients using videofluoroscopy for up to one year after surgery. Biomechanical analysis was used to mark movement of the tongue base and posterior pharyngeal wall during swallowing.
Results: The majority of patients experienced increased problems with pharyngeal clearance at or after their 6 month posthealing evaluation, generally 18 to 22 weeks after completion of radiotherapy. Pharyngeal residue was associated with a disruption in either tongue base or posterior pharyngeal wall movement.
Conclusions: Increased fibrosis of the pharyngeal musculature after completion of radiotherapy may have a negative impact on pharyngeal clearance in addition to any pharyngeal clearance problems resulting from surgical resection. Tongue base to posterior pharyngeal wall contact is essential but not sufficient for effective pharyngeal clearance. Sufficient duration of tongue base to posterior pharyngeal wall contact is also needed to provide adequate pharyngeal bolus driving pressure.
Biomechanical analysis of the pharyngeal swallow in post-surgical patients with anterior tongue and floor of mouth resection and distal flap reconstruction
Pauloski, B. R., Logemann, J. A., Fox, J. C., & Colangelo, L. A. (1995). Biomechanical analysis of the pharyngeal swallow in post-surgical patients with anterior tongue and floor of mouth resection and distal flap reconstruction. Journal of Speech and Hearing Research, 38, 110-123.
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The purpose of this study was to examine changes in the biomechanics of pharyngeal swallow after surgery in eight patients (six men and two women) with anterior tongue and floor of mouth resections with distal flap reconstruction. Eight normal age-matched subjects were also studied. Swallowing performance was assessed following a standardized protocol with videofluoroscopy preoperatively and at one and three months postoperatively for the oral cancer patients. The normal subjects received a single videofluoroscopic study. Computer assisted biomechanical analysis was used to mark the movements of specific oropharyngeal structures over time throughout the swallow of calibrated boluses. Statistical analyses revealed that tongue base, pharyngeal wall, hyoid, laryngeal, and cricopharyngeal movements during the swallow were altered significantly after surgery for the cancer patients. Some oropharyngeal structural movements differed from those of normal control subjects before surgery. In this study, biomechanical measures indicated that there was recovery in some aspects of the pharyngeal swallow in this patient group. The duration of tongue base to pharyngeal wall contact, which was significantly reduced preoperatively and at one month after surgery, increased significantly to within normal levels by the three month postoperative evaluation. Duration of laryngeal closure and the onset of laryngeal closure relative to cricopharyngeal opening also improved significantly to within normal levels by the three month postoperative evaluation.
Swallow Function and Perception of Dysphagia in Patients with Head and Neck Cancer
Pauloski, B.R., Rademaker, A.W., Logemann, J.A., Lazarus, C.L., Newman, L., Hamner, A., MacCracken, E., Gaziano, J., & Stachowiak, L. (2002). Swallow Function and Perception of Dysphagia in Patients with Head and Neck Cancer. Head and Neck, 24, 555-565.
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Background: The relationship between subjective complaints of dysphagia and objective measures of swallow function in patients with cancers of the oral cavity, pharynx, or larynx, treated with radiotherapy chemotherapy has not been well documented in the literature.
Methods: Swallowing function in 132 patients with various lesions was evaluated using videofluoroscopy and analyzed by patient complaint of dysphagia grouping.
Results: Patients with complaints of dysphagia demonstrated significantly worse swallow function as indicated by lower oropharyngeal swallow efficiency (OPSE), longer transit times, larger residues, and more swallows with aspiration. Patients with complaints of dysphagia also tended to take less of their nutrition by mouth and less variety of food consistencies in their diet as compared to those without complaint.
Conclusions: Patients were able to perceive decrements in their swallowing function as dysphagia and may have limited their oral intake in response to that perception. The ability to accurately perceive swallowing function may be useful for self-monitoring changes in dysphagia status during a course of swallow therapy.
