Swallowing occurs preferentially in the expiratory phase of the quiet breathing cycle and at mid-to-low tidal volume. This coordinative pattern imparts important biomechanical advantages to ...swallowing and airway protection and facilitate laryngeal elevation, laryngeal vestibular and vocal fold closure, and cricopharyngeal sphincter opening. This preferred coordinative relationship between breathing and swallowing is impaired in a variety of patient populations, including head and neck cancer survivors with dysphagia. We developed a training protocol to re-establish more optimal phasing of swallowing with breathing in these patients with striking outcomes, including reduced swallowing physiological impairments and improved airway protection. This motivated us to continue to refine and expand this training protocol and develop new assistive technologies for swallowing monitoring outside of the lab. In this review, we highlight the origins of our optimal respiratory-swallowing coordination hypothesis, describe the biomechanical advantages it provides, carefully describe our training protocol and findings, and chart a course for the next phase of this work. Our overall goal is to harness technology combined with carefully constructed learning paradigms to improve the lives of patients with impaired respiratory-swallowing coordination consequent to a variety of pathologies including head and neck cancer and degenerative neurological conditions such as Parkinson’s disease.
Abstract Background Preterm infants are at high risk of encountering oral feeding difficulties. Early sensorimotor interventions may improve oral feeding skills in preterm infants. Aim To further ...explore the effects of an oral (O), tactile/kinesthetic (T/K), and combined (O + T/K) sensorimotor intervention on preterm infants' nutritive sucking, swallowing and their coordination with respiration. Study design Seventy-five infants (29 0.3, standard error of mean, SEM weeks gestation, 49 males/26 females) were randomly assigned to an O group involving sensorimotor input to the oral structures; a T/K group involving sensorimotor input to the trunk and limbs; a combined (O + T/K) group; and a control group. Outcome measures Stage of sucking, suction and expression amplitudes (mm Hg), suck–swallow ratio, stability of suck–swallow interval, and swallow–respiration patterns. Results The O group had significantly more advanced sucking stages, and greater suction and expression amplitudes than controls p ≤ 0.035, effect size (ES) > 0.6. The suck–swallow ratio and stability of suck–swallow intervals did not significantly differ among groups (p ≥ 0.181, ES ≤ 0.3). The three interventions led to fewer swallows bracketed by prolonged respiratory pauses compared to controls (pause–swallow–pause, p ≤ 0.044, ES ≥ 0.7). The T/K and combined (O + T/K) groups had greater occurrence of swallows bracketed by expiration than the control and O groups (expiration–swallow–expiration, p ≤ 0.039, ES ≥ 0.3). Conclusion The O intervention enhanced specific components of nutritive sucking. All three interventions resulted in improved swallow–respiration coordination. Sensorimotor interventions have distributed beneficial effects that go beyond the specific target of input.
Aim The aim of this study was to determine whether oral, tactile/kinaesthetic (T/K), or combined (oral+T/K) interventions enhance oral feeding performance and whether combined interventions have an ...additive/synergistic effect.
Method Seventy‐five preterm infants (mean gestational age 29wk; standard error of the mean SEM 0.3wk; mean birthweight 1340.3g; SEM 52.5g; 49 males and 26 females) were randomly assigned to one of three intervention groups or a control group. The oral group received sensorimotor input to the oral structures, the T/K group received sensorimotor input to the trunk and limbs, and the combined group received both. The outcomes were time from introduction of nipple feeding to independent oral feeding (d), proficiency (intake in the first 5min, %), volume transfer (%), rate of transfer (mL/min), volume loss (%), and length of hospital stay (d).
Results Infants in the three intervention groups achieved independent oral feeding 9–10 days earlier than those in the control group (p<0.001; effect size 1.9–2.1). Proficiency (p≤0.002; effect size 0.7–1.4) at the time of one to two and three to five oral feedings per day, volume transfer (p≤0.001; effect size 0.8–1.1) at one to two, three to five, and six to eight oral feedings per day, and overall rate of transfer (p≤0.018; effect size 0.8–1.1) were greater, and overall volume losses were less (p≤0.007; effect size 0.9–1.1), than in the control group (p≤0.042). The combined group attained independent oral feeding at a significantly younger postmenstrual age than controls (p=0.020) and had clinically greater proficiency than the T/K group (p=0.020; effect size 0.7) and oral group (p=0.109; effect size 0.5). Length of hospital stay was not significantly different between groups (p=0.792; effect size 0.02–0.3).
Interpretation Oral and T/K interventions accelerated the transition from introduction to independent oral feeding and enhanced oral feeding skills. T/K has beneficial effects beyond the specific targeted system. The combined sensorimotor intervention led to an additive/synergistic effect for proficiency, further benefiting this population.
Mother–infant interactional synchrony has been hypothesized to be crucial for the development of many key neurodevelopmental behaviors in infants, including speech and language. Assessing synchrony ...is challenging because many interactive behaviors may be subtlety, if at all, observable in overt behaviors. Physiological measures, therefore, may provide valuable physiological/biological markers of mother–infant synchrony. We have developed a multilevel measurement platform to assess physiological synchrony, attention, and vocal congruency during dynamic face‐to‐face mother–infant interactions. The present investigation was designed to provide preliminary data on its application in a group of 10 mother–infant dyads (20 subjects) ranging in age from 7 to 8.5 months at the time of the experimentation. Respiratory kinematics, heart rate, and vocalization were recorded simultaneously from mothers and infants during nonstructured, face‐to‐face interactions. Novel statistical methods were used to identify reliable moments of synchrony from cross‐correlated, mother–infant respiration and to tag infant attention from heart rate deceleration. Results revealed that attention, vocal contingency, and respiratory synchrony are temporally clustered within the dyad interaction. This temporal alignment is consistent with the notion that biological synchrony provides a supportive platform for infant attention and mother–infant contingent vocalization.
Although a clear risk of mortality is associated with obesity, the risk of mortality associated with overweight is equivocal. The objective of this study is to estimate the relationship between BMI ...and all-cause mortality in a nationally representative sample of Canadian adults. A sample of 11,326 respondents aged ≥25 in the 1994/1995 National Population Health Survey (Canada) was studied using Cox proportional hazards models. A significant increased risk of mortality over the 12 years of follow-up was observed for underweight (BMI <18.5; relative risk (RR) = 1.73, P < 0.001) and obesity class II+ (BMI >35; RR = 1.36, P <0.05). Overweight (BMI 25 to <30) was associated with a significantly decreased risk of death (RR = 0.83, P < 0.05). The RR was close to one for obesity class I (BMI 30–35; RR = 0.95, P >0.05). Our results are similar to those from other recent studies, confirming that underweight and obesity class II+ are clear risk factors for mortality, and showing that when compared to the acceptable BMI category, overweight appears to be protective against mortality. Obesity class I was not associated with an increased risk of mortality.
Aim
The aim of this retrospective study was to assess the relationship between feeding–swallowing difficulties (FSDs) and later language impairments in children.
Method
Retrospective analyses were ...carried out using the clinical files of 82 children with language impairments from a large urban rehabilitation center. Two subgroups of these children were established: children with motor impairments, referred to as the language impairment with motor impairment (‘LI+MI’) subgroup (n=23, mean age 4y 6mo, SD 8.7mo), and children without motor impairments, referred to as the language impairment without motor impairment (‘LI–MI’) subgroup (n=59, mean age 5y, SD 8mo). The prevalence of food selectivity, difficulties in sucking, salivary control issues, and food transition difficulties was extracted. Data were compared with a general population estimate of FSDs.
Results
FSDs were documented in 62% of the clinical files; 87% of these files were from the LI+MI subgroup and 53% were from the LI–MI subgroup. Among each subgroup of children with language impairments, the prevalence of FSDs was significantly higher than the general population estimate of 20% (LI+MI:χ2=55.965, df=1, p<0.001; LI–MI: χ2 =32.807, df=1, p<0.001). Furthermore, the prevalence of FSDs was significantly higher in children with language impairments and motor impairments than in those with language impairments but without motor impairments (χ2=6.936, df=1, p<0.01). Both food transition difficulties (χ2=14.99, df=1, p<0.001) and salivary control issues (χ2=5.02, df=1, p=0.02) were more frequent in the LI+MI subgroup than in the LI–MI subgroup. Combinations of two or more FSDs were also more frequent in the LI+MI subgroup than in the LI–MI subgroup (χ2=4.19, df=1, p=0.04).
Interpretations
These findings suggest that early FSDs may be used as a potential marker for language impairment. However, larger prospective studies are needed to confirm this.
What this paper adds
First study to explore the relationship between feeding‐swallowing difficulties (FSDs) and language impairment in children with and without motor impairments.
Reveals that the prevalence of FSDs in both subgroups of children is higher than a general population estimate.
Findings also suggested that combinations of FSD may profile language impairment children with motor impairment.
Sets the stage for future prospective studies to assess FSDs as clinical indicators of later language impairment.
This article is commented on by Lefton‐Greif on pages 795–796 of this issue.
Respiratory movements were recorded from 10 dyads (20 subjects) during quiet breathing, reading aloud, spontaneous monologue, scripted dialog, and spontaneous conversation. Timing measures of ...inspiratory, expiratory, and total cycle duration were used to compare respiratory function during quiet breathing, listening, and speech. Cross-correlation analyses of the respiratory movements of conversational partners provided an index of conversational synchrony. Inspiratory duration was found to be the most consistent and sensitive measure for discriminating quiet breathing from speech breathing. In the scripted dialog and spontaneous conversation conditions, respiratory kinematics changed during listening to more closely resemble speech, and systematic changes were observed in anticipation of turn-taking speech onset. For the breathing cycles immediately surrounding turn changes and simultaneously produced vocal events, the kinematic signals of conversational partners were strongly correlated. Results are discussed in the context of similar findings concerning conversational interactions and motor preparation for speech.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
When speakers engage in conversation, acoustic features of their utterances sometimes converge. We examined how the speech rate of participants changed when a confederate spoke at fast or slow rates ...during readings of scripted dialogues. A beat-tracking algorithm extracted the periodic relations between stressed syllables (beats) from acoustic recordings. The mean interbeat interval (IBI) between successive stressed syllables was compared across speech rates. Participants' IBIs were smaller in the fast condition than in the slow condition; the difference between participants' and the confederate's IBIs decreased across utterances. Cross-correlational analyses demonstrated mutual influences between speakers, with greater impact of the confederate on participants' beat rates than vice versa. Beat rates converged in scripted conversations, suggesting speakers mutually entrain to one another's beat.
The CT Colonography Reporting and Data System (C-RADS) has withstood the test of time and proven to be a robust classification scheme for CT colonography (CTC) findings. C-RADS version 2023 ...represents an update on the scheme used for colorectal and extracolonic findings at CTC. The update provides useful insights gained since the implementation of the original system in 2005. Increased experience has demonstrated confusion on how to classify the mass-like appearance of the colon consisting of soft tissue attenuation that occurs in segments with acute or chronic diverticulitis. Therefore, the update introduces a new subcategory, C2b, specifically for mass-like diverticular strictures, which are likely benign. Additionally, the update simplifies extracolonic classification by combining E1 and E2 categories into an updated extracolonic category of E1/E2 since, irrespective of whether a finding is considered a normal variant (category E1) or an otherwise clinically unimportant finding (category E2), no additional follow-up is required. This simplifies and streamlines the classification into one category, which results in the same management recommendation.
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