Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL.
Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, OH.
J Speech Lang Hear Res. 2022 Oct 17;65(10):3798-3808. doi: 10.1044/2022_JSLHR-22-00047. Epub 2022 Sep 8.
The elements of impaired swallowing biomechanics are visually assessed and scored by clinicians using a standardized and validated tool for assessing type and severity of physiological impairments using the Modified Barium Swallow Impairment Profile (MBSImP). However, the functional anatomical correlates that underly noted impairments using MBSImP scoring have not been measured. The purpose of this study was to determine whether differences in MBSImP component scores represent differences in underlying swallowing mechanics as measured by computational analysis of swallowing mechanics (CASM) to better define underlying mechanisms of impairment.
A retrospective analysis of modified barium swallow studies from physician-referred adult patients with dysphagia was scored using the MBSImP for laryngeal elevation, anterior hyoid excursion, epiglottic movement, pharyngoesophageal segment opening, and tongue base retraction. A canonical variate analysis (CVA) was performed to determine the movement of anatomical landmarks associated with MBSImP component scores using the CASM method. Mahalanobis distances () were then used to detect differences among MBSImP scores for each component assessed.
CVA showed significant differences ( < .0001) in Mahalanobis distance ( > 1) between MBSImP component scores of 0-1, 0-2, 0-3, or 0-4, as applicable, depending on the component. Discriminant function analyses revealed concomitant increase/worsening in MBSImP score with changes in anatomical positioning of structures.
Ratings of swallowing impairment and physiology using the MBSImP have distinct biomechanical correlates with anatomical movements of swallowing. These data further demonstrate how swallowing mechanics are highly interrelated. Understanding these linkages between anatomical and physiological movement within impaired swallowing biomechanics is essential in more specific characterization and treatment of dysphagia.
临床医生使用标准化和经过验证的工具，通过评估改良吞咽障碍影像检查（MBSImP）评估生理障碍的类型和严重程度，对吞咽生物力学的受损元素进行视觉评估和评分。然而，MBSImP 评分所记录的功能解剖学相关性尚未得到测量。本研究的目的是确定 MBSImP 成分评分的差异是否代表通过吞咽力学计算分析（CASM）测量的潜在吞咽力学差异，以更好地定义损伤的潜在机制。
对来自有吞咽困难的医生转诊的成年患者的改良钡餐研究进行回顾性分析，使用 MBSImP 对喉抬高、前舌骨运动、会厌运动、咽食管段开口和舌骨基底部回缩进行评分。使用典型变量分析（CVA）通过 CASM 方法确定与 MBSImP 成分评分相关的解剖标志的运动。然后使用马氏距离（）来检测每个评估的 MBSImP 成分评分之间的差异。
CVA 显示，在 MBSImP 成分评分 0-1、0-2、0-3 或 0-4（取决于成分）之间，马氏距离（>1）的差异具有统计学意义（<0.0001）。判别函数分析表明，随着结构解剖位置的变化，MBSImP 评分增加/恶化。
使用 MBSImP 评估吞咽障碍和生理学具有明显的生物力学相关性，与吞咽的解剖运动相关。这些数据进一步证明了吞咽力学是高度相互关联的。了解吞咽生物力学中受损吞咽生物力学的解剖和生理运动之间的这些联系对于更具体地描述和治疗吞咽困难至关重要。
