Lung volumes associated with swallowing different bolus volumes and consistencies

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Lung volumes associated with swallowing different
bolus volumes and consistencies

• Karen Wheeler, Ph.D.1
• Jessica Huber, Ph.D.2
• Teresa Pitts, M.A.3, 4
• Christine Sapienza, Ph.D.3, 4

1 Department of Speech and Hearing Science,
Arizona State University 2 Department of
Speech, Language, and Hearing Sciences, Purdue
University 3 Department of Communication
Sciences and Disorders, University of Florida 4
Malcom Randall VA Medical Center Gainesville, FL
2
Respiration and Swallowing

• Common anatomical space (peripheral and central)
  (e.g., Miller, 1982 1993)
• Predictable pattern Ex-Ex, In-Ex (e.g., Hiss et
  al., 2001 Hiss et al., 2003 Klahn Perlman,
  1999 Martin et al., 1994 Martin-Harris et al.,
  2003 Paydarfar et al., 1995Shaker et al., 1992)

GI Motility online (May 2006) doi10.1038/gimo10
http//www.entcentre.co.za/images/throat.gif
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Lung volume and swallowing

• Effects on swallow physiology
• Role of subglottal air pressure
• Effects of Tracheostomy
• Measured in healthy individual
• Bolus variability and tidal volume

Gross et al., 2003 Gross et al., 2005 Kijima et
al., 2000 Preiksaitis Mills, 1996
4
Lung volumes and speech

• 38 70 VC
• Rib cage and abdominal contributions
• Neural targets based on task?
• Given known differences related to bolus
  parameters in swallowing

(e.g., Hixon et al., 1973 Hixon et al., 1976
Hoit et al., 1998 Huber et al., 2005)
from Zemlin, 1998
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Purpose

• To identify lung volume initiations (LVIs)
  associated with swallowing boluses of different
  volumes and consistencies
• 10mL, 20mL thin liquid
• 3mL thin paste and thick paste
• To identify differences in LVIs between different
  bolus volumes and consistencies
• Hypotheses
• no significant differences in lung volume
  initiation (LVI) would exist between
  single-swallow boluses (thin liquid, thin paste,
  and thick paste) of different consistencies
• significant differences in LVI would exist for
  different bolus volumes of thin liquid (10mL and
  20mL)

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Methods

• Prospective experimental study, 1 participant
  group
• Healthy young adults
• 9 Females, 19 27 years
• 11 Males, 18 28 years
• Normal oral anatomy
• No history of
• Dysphagia
• Chronic respiratory disease
• Head/Neck cancer
• Neurologic disease/stroke

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Procedures

• Lung volume and Kinematic data
• Digital Spirometer (ADInstruments Inc.)
• Respiratory inductance plethysmograph
  (Respitrace, Ambulatory monitoring)
• Swallow measurement
• Surface electromyography
• (sEMG) (Delsys Bagnoli 8 EMG
• system)
• Contact throat microphone
• Visual identification of neck movement

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Tasks

• Rest breathing, speech-like breathing,
  swallow-like breathing, vital capacity
• Swallow tasks (self-feeding) 3 trials each
• 10mL water (thin small) - cup
• 20mL water (thin large) - cup
• 3mL pudding/applesauce (thin paste) - spoon
• 3mL peanut butter/cheese spread (thick paste) -
  spoon
• PowerLab (ADInstruments) ? Desktop computer (Dell
  Optiplex, Dell Inc.) ?Chart Software
  (ADInstruments) ?MATLAB (7.1, Mathworks, inc.
  Huber et al., 2005)

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Measures Swallow onset LVI-EEL Swallow
offset LVT-EEL LVE
Duration Time inspired / VC inspired Time
expired / VC expired SOT
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Statistics

• Descriptive Means and standard deviations
• Repeated measures analysis of variance (ANOVA)
  within subject factor bolus type

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Results
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(No Transcript)
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Duration
SOT
Time inspired
Time expired
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Pre-swallow
Post-swallow
occurrence in expiratory phase
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Repeated measures ANOVA

• Within subject factor bolus type
• thin small
• thin large
• thin paste
• thick paste

Dependent variables 1. LVI-EEL 2. Pre-swallow
respiratory phase (pre-phase) 3. Swallow onset
time (SOT)

• Significant effect found for bolus type
• F 3.082, df 15, p .002

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Significant effect for bolus type F 3.082,
df 15, p .002
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Post-hoc analysis Tukey HSD significant
differences between thin large and thick paste
for LVI-EEL (significance at .01) LVI-EEL p
.002
LVI-EEL
10.66
5.54
Means
9.12
7.34
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Trends based on post-hoc analysis nearly
significant differences between thin small and
thin paste for pre-swallow respiratory phase
(significance at .01) p .018
Pre-swallow expiration
Mean 71 72 91 85
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Trends based on post-hoc analysis nearly
significant differences between thin small, thin
large, and the paste consistencies (significance
at .01) p .019
Means
1.07
1.05
1.45
1.62
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Discussion

• LVI-EEL
• thins small - 9.12, large - 10.66
• pastes thin - 7.34, thick - 5.55

• Generally higher for thins
• Effect of subglottal pressure
• Priming the system

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Trends

• Trend towards more consistent pre-phase
  expiration with paste consistencies (85-91 paste
  versus 71-72 thin)
• In agreement with previous study (e.g., Klahn
  Perlman, 1999 Martin-Harris et al., 2003, 2005)
• Trend towards longer SOT with paste consistencies
  (1.06 sec. thin versus 1.50 sec. paste)
• In agreement with previous study (e.g., Klahn
  Perlman 1999)

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LVI-EEL and SOT

• Continuing to breathe to higher lung volume prior
  to swallowing? (Shorter SOT)

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• Impact of disease processes
• On inspiratory muscle strength
• achieving the target lung volume, subglottal
  pressure
• Swallow timing
• On expiratory muscle strength
• achieving the target subglottal pressure?
• On glottal closure implications of manipulating
  lung volume prior to swallow?