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Kinematic and Temporal Factors Associated with Penetration–Aspiration in Swallowing Liquids

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Abstract

In this study we undertook careful analysis of 13 quantitative physiological variables related to oropharyngeal swallowing from a sample of 42 subacute patients referred for dysphagia assessment. Each patient underwent a videofluoroscopic swallowing examination in which they swallowed up to five boluses of 22 % w/v ultrathin liquid barium suspension administered by teaspoon. Our goal was to determine whether scores on 13 kinematic or temporal parameters of interest were independently associated with the presence of penetration–aspiration in the final compiled dataset of 178 swallows. Participants were classified as aspirators based on the presence of at least one swallow that demonstrated a Penetration–Aspiration Scale score of ≥3. The parameters of interest included six kinematic parameters for capturing hyoid position, three swallow durations [laryngeal closure duration, hyoid movement duration, and upper esophageal sphincter (UES) opening duration], and four swallow intervals (laryngeal closure to UES opening, bolus dwell time in the pharynx prior to laryngeal closure, stage transition duration, and pharyngeal transit time). Mixed-model repeated-measures ANOVAs were conducted to determine the association between each parameter and aspiration status. Only 1 of the 13 parameters tested distinguished aspirators from nonaspirators: aspirators demonstrated significantly shorter UES opening duration. In addition, a trend toward reduced maximum superior position of the hyoid was seen in aspirators. Limitations and future considerations are discussed.

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Acknowledgments

This work was a portion of the first author’s doctoral research for which she received funding from the Natural Sciences and Engineering Research Council (Canada) Create CARE program, the Ontario Student Opportunity Trust Fund, and the Ontario Graduate Studies scholarship program. The second author holds a New Investigator award from the Canadian Institutes of Health Research. The authors thank Sarah Hori, Chelsea Leigh, and Clemence Tsang for assistance with data collection and analysis and acknowledge the support of Toronto Rehabilitation Institute, which receives funding under the Provincial Rehabilitation Research Program from the Ministry of Health and Long-term Care in Ontario. The views expressed do not necessarily reflect those of the ministry.

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The authors have no conflicts of interest to disclose.

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Correspondence to Sonja M. Molfenter.

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Molfenter, S.M., Steele, C.M. Kinematic and Temporal Factors Associated with Penetration–Aspiration in Swallowing Liquids. Dysphagia 29, 269–276 (2014). https://doi.org/10.1007/s00455-013-9506-5

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