Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada.
Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada.
J Speech Lang Hear Res. 2019 May 21;62(5):1338-1363. doi: 10.1044/2019_JSLHR-S-18-0448.
Purpose Thickened liquids are frequently used as an intervention for dysphagia, but gaps persist in our understanding of variations in swallowing behavior based on incremental thickening of liquids. The goal of this study was to establish reference values for measures of bolus flow and swallowing physiology in healthy adults across the continuum from thin to extremely thick liquids. Method A sex-balanced sample of 38 healthy adults underwent videofluoroscopy and swallowed 20% weight-to-volume concentration barium prepared in thin and slightly, mildly, moderately, and extremely thick consistencies using a xanthan gum thickener. Participants took comfortable sips and swallowed without a cue; sip volume was measured based on presip and postsip cup weights. A standard operating procedure (the ASPEKT method: Analysis of Swallowing Physiology: Events, Kinematics and Timing) was used to analyze videofluoroscopy recordings. Results The results clarify that, for thin liquid sips (10-14 ml), a single swallow without clearing swallows is typical and is characterized by complete laryngeal vestibule closure, complete pharyngeal constriction, and minimal postswallow residue. Aspiration was not seen, and penetration was extremely rare. Bolus position at swallow onset was variable, extending as low as the pyriform sinuses in 37% of cases. With thicker liquids, no changes in event sequencing, laryngeal vestibule closure, pharyngeal constriction, or postswallow residue were seen. The odds of penetration were significantly reduced. A longer timing interval until onset of the hyoid burst movement was seen, with an associated higher bolus position at swallow onset. Other timing measures remained unaffected by changes in bolus consistency. Conclusion The results include new reference data for swallowing in healthy adults across the range from thin to extremely thick liquids.
浓稠液体常被用作吞咽困难的干预手段，但我们对液体逐渐变浓稠时吞咽行为的变化仍缺乏了解。本研究的目的是为健康成年人从稀薄到极浓稠液体连续体中测量食团流动和吞咽生理的各项指标建立参考值。
一个均衡性别比例的 38 名健康成年人参与了透视检查，使用黄原胶增稠剂分别吞咽了稀薄、稍稠、轻度稠、中度稠和极稠 20%重量-体积浓度的钡。参与者舒适地小口吞咽，无需提示；根据预饮和后饮杯的重量来测量单次吞咽量。使用标准操作程序（ASPEKT 方法：吞咽生理分析：事件、运动学和时间）分析透视录像。
结果表明，对于稀薄液体（10-14ml），单次吞咽而无需清除吞咽是典型的，其特征是完全关闭会厌前庭、完全收缩咽部和最小的吞咽后残留。未观察到吸入，且很少发生渗透。食团在吞咽开始时的位置是可变的，在 37%的情况下可延伸至梨状窦。随着液体变稠，事件序列、会厌前庭关闭、咽部收缩或吞咽后残留均无变化。渗透的可能性显著降低。直到舌骨爆发运动开始的时间间隔延长，与吞咽开始时食团位置较高相关。其他时间测量不受食团一致性变化的影响。
结果包括了健康成年人从稀薄到极浓稠液体连续体中吞咽的新参考数据。
