Healthy Volunteers Immediately Adapt to Submental Stimulation During Swallowing.
Healthy Volunteers Immediately Adapt to Submental Stimulation During Swallowing.
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DOI：
10.1111/ner.13537
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发表时间：
2022-12
期刊：
影响因子：
--
通讯作者：
Ludlow CL
中科院分区：
文献类型：
--
作者：
Safi MF;Martin S;Gray L;Ludlow CL
舌骨上方和下方的经皮刺激用于帮助吞咽障碍(吞咽困难)患者，但显示出不同的效果。以前，舌骨下经皮刺激降低舌骨和喉对吞咽运动的抵抗力，而舌骨上刺激对舌咽运动没有影响，无论是休息时还是吞咽时。最近，覆盖颧下区的AMPCARE电极被用于吞咽治疗和抵抗治疗相结合。为了深入了解AMPCARE电极对吞咽过程中运动的影响，我们使用视频透视对健康志愿者进行了研究。我们假设AMPCARE刺激可能会抬高舌骨，但不会抬高喉部，增加前庭开口，可能会降低吞咽安全性。在接受视频透视检查的同时，7名健康志愿者(平均年龄51岁，5名男性)在至少10次试验中吞咽了5毫升的液体钡，试验随机分为三种情况：静止刺激、无刺激吞咽和有刺激吞咽。静息刺激时，舌骨和喉部有明显的前移(单尾p；0.05)，舌骨和喉部无上移，舌骨和喉部距离增加。当比较吞咽时有无咽下刺激时，志愿者在刺激时显著减少舌骨前运动(p=0.028)，增加舌骨抬高(p=0.043)，而不改变喉前或喉上的运动或舌骨与喉部之间的距离。健康志愿者立即通过减少舌骨前运动和增加上舌骨运动而不改变喉部运动来纠正精神下刺激的影响，以防止刺激增加前庭开放。这表明，健康的志愿者有一种吞咽运动模式的内部图式，并对刺激的效果进行前馈校正。
Transcutaneous stimulation above and below the hyoid is used to assist patients with swallowing disorders (dysphagia) but has shown different effects. Previously, infrahyoid transcutaneous stimulation lowered the hyoid and larynx resisting swallowing movement while suprahyoid stimulation had no effects on hyolaryngeal movement either at rest or during swallowing. More recently AMPCARE electrodes, covering the submental region, are used for swallowing therapy in combination with resistance therapy. To gain insight into the effects of AMPCARE electrodes on movement during swallowing, we studied healthy volunteers using video-fluoroscopy. We hypothesized that AMPCARE stimulation might elevate the hyoid but not the larynx increasing vestibular opening potentially reducing swallowing safety. While undergoing video-fluoroscopy, seven healthy volunteers (mean age 51, 5 males) swallowed 5 ml of liquid barium on at least 10 trials randomly ordered across three conditions: stimulation at rest, swallowing without stimulation and swallowing with stimulation. During stimulation at rest, significant (one tailed p< 0.05) anterior movement occurred in the hyoid and larynx, no superior hyoid and laryngeal movement and an increase in the distance between the hyoid and larynx. When comparing swallowing with and without submental stimulation, during stimulation volunteers significantly reduced anterior hyoid motion (p = 0.028), and increased hyoid elevation (p= 0.043) without changing anterior or superior laryngeal movement or the distance between the hyoid and larynx. The healthy volunteers immediately corrected for the effects of submental stimulation by reducing hyoid anterior motion and increasing superior hyoid motion without changing laryngeal motion to prevent increased vestibule opening with stimulation. This suggests that healthy volunteers had an internal schema for swallowing movement patterning with feedforward correction for the effects of stimulation.
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