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Journal ArticleDOI

Oropharyngeal swallowing in normal adults of different ages.

01 Sep 1992-Gastroenterology (Elsevier)-Vol. 103, Iss: 3, pp 823-829
TL;DR: Several parameters, including total duration of oropharyngeal swallowing, were significantly longer in the oldest age group than in any other age group, and females had a longer duration of upper esophageal sphincter (UES) opening.
About: This article is published in Gastroenterology.The article was published on 1992-09-01. It has received 610 citations till now. The article focuses on the topics: Presbyphagia & Swallowing.
Citations
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Journal ArticleDOI
01 Jul 2003-Chest
TL;DR: Elderly patients with clinical signs suggestive of dysphagia and/or who have CAP should be referred for a swallow evaluation and consideration for treatment with an angiotensin-converting enzyme inhibitor.

813 citations

Journal ArticleDOI
TL;DR: The MBSImp demonstrated clinical practicality, favorable inter- and intrarater reliability following standardized training, content, and external validity, and reflects potential for establishment of a new standard for quantification and comparison of oropharyngeal swallowing impairment across patient diagnoses as measured on MBSS.
Abstract: The aim of this study was to test reliability, content, construct, and external validity of a new modified barium swallowing study (MBSS) tool (MBSImp) that is used to quantify swallowing impairment. Multiple regression, confirmatory factor, and correlation analyses were used to analyze 300 in- and outpatients with heterogeneous medical and surgical diagnoses who were sequentially referred for MBS exams at a university medical center and private tertiary care community hospital. Main outcome measures were the MBSImp and index scores of aspiration, health status, and quality of life. Inter- and intrarater concordance were 80% or greater for blinded scoring of MBSSs. Regression analysis revealed contributions of eight of nine swallow types to impressions of overall swallowing impairment (p ≤ 0.05). Factor analysis revealed 13 significant components (loadings ≥ 0.5) that formed two impairment groupings (oral and pharyngeal). Significant correlations were found between Oral and Pharyngeal Impairment scores and Penetration-Aspiration Scale scores, and indexes of intake status, nutrition, health status, and quality of life. The MBSImp demonstrated clinical practicality, favorable inter- and intrarater reliability following standardized training, content, and external validity. This study reflects potential for establishment of a new standard for quantification and comparison of oropharyngeal swallowing impairment across patient diagnoses as measured on MBSS.

490 citations

Journal ArticleDOI
TL;DR: The findings indicate that lingual exercise enables acute and chronic dysphagic stroke patients to increase lingual strength with associated improvements in swallowing pressures, airway protection, and lingual volume.

445 citations

Journal ArticleDOI
TL;DR: To determine the effects of an 8‐week progressive lingual resistance exercise program on swallowing in older individuals, the most “at risk” group for dysphagia, an 8-week study is conducted.
Abstract: OBJECTIVES: To determine the effects of an 8-week progressive lingual resistance exercise program on swallowing in older individuals, the most ‘‘at risk’’ group for dysphagia. DESIGN: Prospective cohort intervention study. SETTING: Subjects were recruited from the community at large. PARTICIPANTS: Ten healthy men and women aged 70 to 89. INTERVENTION: Each subject performed an 8-week lingual resistance exercise program consisting of compressing an air-filled bulb between the tongue and hard palate. MEASUREMENTS: At baseline and Week 8, each subject completed a videofluoroscopic swallowing evaluation for kinematic and bolus flow assessment of swallowing. Swallowing pressures and isometric pressures were collected at baseline and Weeks 2, 4, and 6. Four of the subjects also underwent oral magnetic resonance imaging (MRI) to measure lingual volume. RESULTS: All subjects significantly increased their isometric and swallowing pressures. All subjects who had the MRI demonstrated increased lingual volume of an average of 5.1%. CONCLUSION: The findings indicate that lingual resistance exercise is promising not only for preventing dysphagia due to sarcopenia, but also as a treatment strategy for patients with lingual weakness and swallowing disability due to frailty or other age-related conditions. The potential effect of lingual exercise on reducing dysphagiarelated comorbidities (pneumonia, malnutrition, and dehydration) and healthcare costs while improving quality of life is encouraging. J Am Geriatr Soc 53:1483–1489, 2005.

445 citations

Journal ArticleDOI
TL;DR: Only elderly subjects showed a pattern of liquid swallowing pressure generation in which multiple lingual gestures were required to reach peak pressure (termed "pressure building"), a pattern demonstrated by both young and elderly groups for semisolids.
Abstract: Background. The tongue plays a key role in bolus propulsion through the oropharyngeal chamber. In this study, possible age effects on the magnitude and timing of lingual pressure generation were analyzed. Methods. Oral pressure was measured during isometric and swallowing tasks for 10 elderly (mean age 5 81 years) and 10 young (mean age 5 51 years) subjects. Three trials each of the isometric task and swallows of three different boluses (3 ml semisolid, 3 ml liquid, and 10 ml liquid) were performed by each subject. The timing and magnitude of isometric and swallowing pressure generation along with the pattern of the swallowing pressure waveform were analyzed. Results. Whereas maximum lingual isometric pressures decreased with age ( p , .001), no significant age difference was found for swallowing pressure. Time taken to reach peak pressure also was reduced with age in both the isometric task and swallows of liquid boluses ( p , .05), while no significant age effect was found for semisolid swallows. Finally, only elderly subjects showed a pattern of liquid swallowing pressure generation in which multiple lingual gestures were required to reach peak pressure (termed “pressure building”), a pattern demonstrated by both young and elderly groups for semisolids. Conclusions. Decreased lingual strength with age combined with unchanging swallowing pressure leads to a decreased “pressure reserve,” perhaps leaving older individuals more at risk for dysphagia resulting from insults directly or indirectly to the swallowing system. Additionally, swallowing is generally “slowed” with age, apparently due to both central and peripheral factors, and this change may have an impact on bolus flow outcomes.

379 citations

References
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Journal ArticleDOI
TL;DR: A simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely.

76,181 citations

01 Jan 2002
TL;DR: The Mini-Mental State (MMS) as mentioned in this paper is a simplified version of the standard WAIS with eleven questions and requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
Abstract: EXAMINATION of the mental state is essential in evaluating psychiatric patients.1 Many investigators have added quantitative assessment of cognitive performance to the standard examination, and have documented reliability and validity of the several “clinical tests of the sensorium”.2*3 The available batteries are lengthy. For example, WITHERS and HINTON’S test includes 33 questions and requires about 30 min to administer and score. The standard WAIS requires even more time. However, elderly patients, particularly those with delirium or dementia syndromes, cooperate well only for short periods.4 Therefore, we devised a simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely. It is “mini” because it concentrates only on the cognitive aspects of mental functions, and excludes questions concerning mood, abnormal mental experiences and the form of thinking. But within the cognitive realm it is thorough. We have documented the validity and reliability of the MMS when given to 206 patients with dementia syndromes, affective disorder, affective disorder with cognitive impairment “pseudodementia”5T6), mania, schizophrenia, personality disorders, and in 63 normal subjects.

70,887 citations

Journal ArticleDOI
P. Jacob1, Peter J. Kahrilas1, Jeri A. Logemann1, V. Shah1, T. Ha1 
TL;DR: It is concluded that transsphincteric transport of increasing swallow bolus volumes is accomplished by modulating sphincter diameter, opening interval, and flow rate (reflected by bolus head velocity), rather than simply a consequence of cricopharyngeal relaxation.

415 citations

Journal ArticleDOI
TL;DR: The dynamics of UES function during deglutition are dependent upon the volume of the swallowed bolus, and larger bolus volumes are accommodated by both an increased diameter of sphincter opening and by prolongation of the interval of spHincter relaxation.

351 citations

Journal ArticleDOI
TL;DR: In this article, a simultaneous manometric and video-fluoroscopic data collection protocol permitted measurement of bolus transit, temporal aspects of the oropharyngeal swallow, and pharygeal peristalsis.
Abstract: 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).

314 citations