Perry Bridget J, Martino Rosemary, Yunusova Yana, Plowman Emily K, Green Jordan R
MGH Institute of Health Professions, 79/96 13th Street, Charlestown, MA, 02109, USA.
Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada.
Dysphagia. 2018 Dec;33(6):840-847. doi: 10.1007/s00455-018-9909-4. Epub 2018 May 17.
Early identification of bulbar involvement in persons with ALS is critical for improving diagnosis and prognosis; however, efficacious diagnostic markers have not yet been identified. The purpose of this study was to determine whether kinematic changes of the tongue and jaw during swallowing, measured using 3D electromagnetic articulography (EMA), predate clinically identifiable symptoms of speech and swallowing impairment in persons diagnosed with ALS. Data were collected from 16 adults diagnosed with ALS and 18 neurotypical controls. Groups were aged matched. Eligible participants with ALS were tolerating an unrestricted diet (FOIS = 7), produced intelligible speech (> 97%), and had a speaking rate greater than 150 words per minute. Participants completed a 3-mL water swallow task, during which EMA recorded kinematic measures of the anterior and posterior regions of tongue including lingual speed, range of motion, duration, coordination, and efficiency. Jaw speed and range of motion were also recorded. Persons diagnosed with ALS demonstrated reduced posterior lingual range of motion (11.40 mm ± 4.01 vs. 16.07 mm ± 5.27), slower posterior lingual speeds (83.67 mm/s ± 47.96 vs. 141.35 mm/s ± 66.54), increased lingual movement duration (13.46 s ± 6.75 vs. 9.21 s ± 3.28), and reduced lingual coordination (0.04 s ± 0.11 vs. 17 s ± 0.19) during the 3-oz water swallow task compared to controls. Persons diagnosed with ALS demonstrated increased range of motion (9.86 mm ± 5.38 vs. 6 mm ± 3.78) and increased jaw speed (68.62 mm/s ± 50.13 vs. 34.72 mm/s ± 17.75) during swallowing compared to controls. The current findings suggest that changes in lingual and jaw motor performance during a simple water swallow task are present in persons with ALS who are pre-symptomatic of clinically detectable bulbar impairment.
早期识别肌萎缩侧索硬化症（ALS）患者的延髓受累情况对于改善诊断和预后至关重要；然而，尚未确定有效的诊断标志物。本研究的目的是确定使用三维电磁关节造影（EMA）测量的吞咽过程中舌头和下颌的运动学变化是否早于被诊断为ALS的患者临床上可识别的言语和吞咽障碍症状。数据收集自16名被诊断为ALS的成年人和18名神经典型对照者。两组年龄匹配。符合条件的ALS参与者能够耐受无限制饮食（功能性口腔摄入量表[FOIS]=7），言语清晰（>97%），且说话速度大于每分钟150个单词。参与者完成了一项3毫升水吞咽任务，在此期间EMA记录了舌头前后区域的运动学测量值，包括舌速、运动范围、持续时间、协调性和效率。还记录了下颌速度和运动范围。与对照组相比，被诊断为ALS的人在3盎司水吞咽任务中表现出舌后运动范围减小（11.40毫米±4.01对16.07毫米±5.27）、舌后速度减慢（83.67毫米/秒±47.96对141.35毫米/秒±66.54）、舌运动持续时间增加（13.46秒±6.75对9.21秒±3.28）以及舌协调性降低（0.04秒±0.11对17秒±0.19）。与对照组相比，被诊断为ALS的人在吞咽过程中表现出运动范围增加（9.86毫米±5.38对6毫米±3.78）和下颌速度增加（68.62毫米/秒±50.13对34.72毫米/秒±17.75）。目前的研究结果表明，在一项简单的水吞咽任务中，舌和下颌运动表现的变化存在于临床上可检测到延髓损伤的无症状ALS患者中。
