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Defining Normal Sequential Swallowing Biomechanics

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Abstract

Little is known about the physiology of a common fluid ingestion pattern—sequential swallowing. This study investigated sequential swallowing biomechanics in healthy adults. Archival normative videofluoroscopic swallow studies were analyzed for hyolaryngeal complex (HLC) patterning and biomechanical measures from the first 2 swallows of a 90-mL thin liquid sequential swallow task. The effects of age, sex, HLC type, and swallow order were explored. Eighty-eight participants were included in the primary analyses as they performed sequential swallows. HLC Type I (airway opens, epiglottis approaches baseline) and Type II (airway remains closed, epiglottis remains inverted) most commonly occurred (47% each), followed by Type III (mixed, 6%). Age was significantly associated with Type II and longer hypopharyngeal transit, total pharyngeal transit (TPT), swallow reaction time (SRT), and duration to maximum hyoid elevation. Males demonstrated significantly greater maximum hyoid displacement (Hmax) and longer duration of maximum hyoid displacement. Significantly larger maximum hyoid-to-larynx approximation was linked to the first swallow, while the subsequent swallow had significantly longer oropharyngeal transit, TPT, and SRT. Secondary analyses included an additional 91 participants who performed a series of discrete swallows for the same swallow task. Type II had significantly greater Hmax than Type I and series of discrete swallows. Sequential swallowing biomechanics differ from discrete swallows, and normal variance exists among healthy adults. In vulnerable populations, sequential swallowing may challenge swallow coordination and airway protection. Normative data allow comparison to dysphagic populations. Systematic efforts are needed to further standardize a definition for sequential swallowing.

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All data generated or analyzed during this study are included in this published article and its supplementary information files.

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Acknowledgements

This work was partially supported by the Veterans Affairs CDA-1 (RR&D1IK1RX001628-01A1 to Kendrea Garand), the National Institute on Deafness and Other Communication Disorders (K24DC12801 to Bonnie Martin-Harris), the South Carolina Clinical & Translational Research Institute, with an academic home at the Medical University of South Carolina, National Center for Advancing Translational Sciences (TL1 TR000061 to Kathleen Brady, Project PI: Kendrea Garand), the American Speech-Language-Hearing Foundation to Kendrea Garand, and the Evelyn Trammell Trust (to Bonnie Martin-Harris).

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Authors and Affiliations

  1. Department of Communication Science and Disorders, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA, 15260, USA

    Kevin Renz Ambrocio & Kendrea L. Garand

  2. Speech Science, School of Psychology, The University of Auckland, M&HS Bldg 507, 28 Park Ave, Grafton, Auckland, 1023, New Zealand

    Anna Miles

  3. Department of Speech Pathology & Audiology, University of South Alabama, 5721 USA Dr North, Mobile, AL, 36688, USA

    Ankita M. Bhutada & Dahye Choi

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  1. Kevin Renz Ambrocio
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Correspondence to Kendrea L. Garand.

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Ambrocio, K.R., Miles, A., Bhutada, A.M. et al. Defining Normal Sequential Swallowing Biomechanics. Dysphagia 38, 1497–1510 (2023). https://doi.org/10.1007/s00455-023-10576-z

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