Reduced pharyngeal constriction is associated with impaired swallowing efficiency in Amyotrophic Lateral Sclerosis (ALS).
Reduced pharyngeal constriction is associated with impaired swallowing efficiency in Amyotrophic Lateral Sclerosis (ALS).
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DOI：
10.1111/nmo.13450
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发表时间：
2018-12
影响因子：
3.5
通讯作者：
Plowman EK
中科院分区：
文献类型：
--
作者：
Waito AA;Tabor-Gray LC;Steele CM;Plowman EK
吞咽效率低下是肌萎缩侧索硬化症（ALS）患者普遍存在但研究不足的问题。虽然减少咽部收缩已被确定为中风后吞咽效率低下的机制，但这种关系尚未在ALS人群中进行经验性检验。本研究旨在描述ALS患者样本中吞咽效率的特征，并研究咽部收缩与吞咽效率之间的关系。26名ALS成人接受了视频荧光透视吞咽研究，包括3 mL-薄，20 mL-薄和3 mL-布丁丸。将全长记录分段为推注片段并随机进行分析。我们记录了每次推注的吞咽总数，并获得了咽部收缩面积和谷状窦和梨状窦中吞咽后残留物的标准化像素测量值。使用具有斯皮尔曼相关性的线性混合模型来确定咽部收缩和吞咽效率之间的关系，并添加了丸剂体积和厚度的因素。与正常人相比，ALS患者的咽部收缩减少，谷状窦和梨状窦残留增加。减少咽部收缩对谷状和梨状窦残留物的存在以及每次丸剂的吞咽次数有显著影响。增加的食团厚度与增加的谷残留物相关，而增加的食团体积与减少的咽部收缩相关。结果在p<0.05时具有显著性。我们的研究结果表明，减少咽部收缩是一个重要的生理参数相关的吞咽效率低下的ALS。需要进一步开展工作，以证实这些初步结果，并调查减轻这种损害的因素。摘要：进行本研究以1）表征患有ALS的个体的样本中的吞咽效率和咽部收缩，和2）探索咽部收缩减少作为吞咽无效的潜在机制。我们的结果显示，样本中低效率吞咽的患病率很高，并确定咽部收缩的减少与低效率吞咽相关（即，吞咽后咽部残留物、多次吞咽）。
Swallowing inefficiency is a prevalent but understudied problem in individuals with Amyotrophic Lateral Sclerosis (ALS). Although reduced pharyngeal constriction has been identified as a mechanism contributing to swallowing inefficiency following stroke, this relationship has not been empirically tested in the ALS population. This study sought to characterize profiles of swallowing efficiency in a sample of ALS patients and investigate relationships between pharyngeal constriction and swallowing efficiency. Twenty-six adults with ALS underwent videofluoroscopic swallowing studies, involving 3mL-thin, 20mL-thin, and 3mL-pudding boluses. Full-length recordings were segmented into bolus clips and randomized for analysis. We recorded the total number of swallows per bolus and obtained normalized pixel-based measures of pharyngeal constriction area and post-swallow residue in the vallecular and pyriform sinuses. Linear mixed models with Spearman’s correlations were used to determine relationships between pharyngeal constriction and swallowing efficiency, with added factors of bolus volume and thickness. Individuals with ALS demonstrated reduced pharyngeal constriction and increased vallecular and pyriform sinus residue, compared to norms. Reduced pharyngeal constriction had a significant effect on the presence of vallecular and pyriform sinus residue, as well as the number of swallows per bolus. Increased bolus thickness was associated with increased vallecular residue, while increased bolus volume was associated with reduced pharyngeal constriction. Results were significant at p<0.05. Our results suggest that reduced pharyngeal constriction is a significant physiological parameter related to swallow inefficiency in ALS. Future work is needed to corroborate these preliminary results and investigate factors to mitigate such impairments. Abbreviated abstract: This study was conducted to 1) characterize swallowing efficiency and pharyngeal constriction in a sample of individuals with ALS and 2) explore reduced pharyngeal constriction as a potential mechanism for swallowing inefficiency. Our results showed a high prevalence of inefficient swallowing in the sample, and identified that reductions in pharyngeal constriction are associated with inefficient swallowing (i.e., post-swallow pharyngeal residue, multiple swallows).
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影响因子：
6.3
作者：
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通讯作者：
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DOI：
10.1682/jrrd.2011.09.0180
发表时间：
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