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Impaired Movement Scaling and Reduced Synchrony with Vestibule Closure Characterize Swallowing in Severe Dysphagia

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Abstract

The contribution of hyoid and laryngeal movement deficits to penetration or aspiration in dysphagia is unclear, partly due to large variations in normal hyolaryngeal kinematics for swallowing. In healthy volunteers, laryngeal and hyoid kinematics relate to the requirements for laryngeal vestibule closure suggesting a central schematic control of movement magnitude and patterning for airway protection. Our first aim was to determine if patients with severe dysphagia showed evidence of an impaired swallowing schema, by examining if their kinematic measures were related to their hyolaryngeal space before swallow onset, and if hyolaryngeal movement synchrony for vestibule closure was disrupted. Our second aim was to determine the kinematic measures that predicted bolus penetration and aspiration in dysphagia. The methods included two-dimensional measures of the hyoid and laryngeal anterior and superior displacement and velocity, and the change in laryngeal vestibule area made from videofluoroscopic swallow recordings of 21 healthy volunteers and 21 patients with dysphagia on tube feeding secondary to the stroke or head and neck cancer. The results demonstrated that the patients did not adapt their hyolaryngeal movements during swallowing to their initial hyolaryngeal space. Further, none of the patients’ measures of hyoid or laryngeal peak velocity timing were synchronized with vestibule closure, demonstrating a disorganized movement patterning. Laryngeal elevation peak velocity independently predicted penetration and aspiration. In conclusion, the central schema for swallowing patterning was disturbed, impairing the integration of kinematic actions for airway protection in severe dysphagia, while laryngeal peak elevation velocity predicted penetration and aspiration on patient swallows.

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Acknowledgements

The authors would like to thank Ms Hui Hui Gan for her contribution as the second rater for kinematic measurements.

Funding

The first author received funding from the Singapore General Hospital for her doctoral studies. Partial funding for this study came from the American Speech-Language-Hearing Foundation Graduate Student Scholarship awarded to the first author in 2013.

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Authors and Affiliations

  1. Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA, USA

    Seng Mun Wong, Erin Kamarunas & Christy L. Ludlow

  2. Department of Speech Therapy, Singapore General Hospital, Outram Road, Singapore, Singapore

    Seng Mun Wong

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  1. Seng Mun Wong
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  2. Erin Kamarunas
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  3. Christy L. Ludlow
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Correspondence to Seng Mun Wong.

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Wong, S.M., Kamarunas, E. & Ludlow, C.L. Impaired Movement Scaling and Reduced Synchrony with Vestibule Closure Characterize Swallowing in Severe Dysphagia. Dysphagia 35, 643–656 (2020). https://doi.org/10.1007/s00455-019-10067-0

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