The present study had two purposes. The first was to provide variability data on objectively measured durational parameters of swallowing as accomplished by dysphagic patients secondary to stroke. The second was to examine the short-term effects of thermal application on these same durational measures. The study employed a cross-over design with each dysphagic stroke subject swallowing 10 times in both untreated and treated conditions. Two findings emerged: (1) swallowing durations in the 22 dysphagic stroke subjects were highly variable within and across subjects and have distributions that were nonnormal with nonhomogeneous variances; (2) thermal application reduced duration of stage transition (DST) and total swallow duration (TSD). Implications of these findings are discussed.

Thermal application reduces the duration of stage transition in dysphagia after stroke

Dysphagia is a leading complication in stroke patients causing aspiration pneumonia, malnutrition and increased mortality. Current strategies of swallowing therapy involve on the one hand modification of eating behaviour or swallowing technique and on the other hand facilitation of swallowing with the use of pharyngeal sensory stimulation. Thermal tactile oral stimulation (TTOS) is an established method to treat patients with neurogenic dysphagia especially if caused by sensory deficits. Little is known about the possible mechanisms by which this interventional therapy may work. We employed whole-head MEG to study changes in cortical activation during self-paced volitional swallowing in fifteen healthy subjects with and without TTOS. Data were analyzed by means of synthetic aperture magnetometry (SAM) and the group analysis of individual SAM data was performed using a permutation test. Compared to the normal swallowing task a significantly increased bilateral cortical activation was seen after oropharyngeal stimulation. Analysis of the chronological changes during swallowing suggests facilitation of both the oral and the pharyngeal phase of deglutition. In the present study functional cortical changes elicited by oral sensory stimulation could be demonstrated. We suggest that these results reflect short-term cortical plasticity of sensory swallowing areas. These findings facilitate our understanding of the role of cortical reorganization in dysphagia treatment and recovery.

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Tactile thermal oral stimulation increases the cortical representation of swallowing

The purpose of this study was to investigate the relationships of four intensities of tactile-thermal application (TTA) to changes in duration of stage transition (DST) and performance on a newly designed scale of penetration and aspiration by groups of patients made dysphagic by stroke. Patients were randomly assigned to receive 150, 300, 450, or 600 trials of TTA during each of 2 weeks. Data on the time required to provide such treatment, the actual number of trials clinicians were able to provide, and on the influence of the four intensities are provided. No single intensity emerged as the most therapeutic. It is suggested that subsequent studies with larger groups include intensities between 300 and 550.

Comparing Treatment Intensities of Tactile-Thermal Application*

Two sets of experiments were conducted to examine the effects of two sensory modalities, temperature and taste, of foods on perceptual and motor aspects of swallowing in 20 young, healthy subjects (10 subjects for each experiment). A tasteless and odorless thickening agent was the basic testing material. The first experiment compared the swallowing of foods at four temperatures ranging from 5°C to 50°C. Food at 50°C was more acceptable for swallowing than at 5°C, 20°C, or 35°C. The suprahyoid muscles were less active during swallowing food at 50°C compared with swallowing food at the other three temperatures. The second experiment compared foods with the five basic taste qualities (sweetness, saltiness, sourness, bitterness, and umami) with a tasteless food (dissolved in distilled water) to examine the influence of gustatory sensation. The sweet and tasteless foods were somewhat more acceptable for swallowing than the sour and bitter foods. However, none of the foods differentially altered the motor parameters of swallowing. Interactive influences of temperature and gustatory sensations of foods on swallowing are discussed.

Influences of thermal and gustatory characteristics on sensory and motor aspects of swallowing.

The influence of thermal stimulation of the oral and pharyngeal mucosa on the elicitation of swallowing was studied in 14 healthy volunteers. The Repeated Dry Swallowing Test was used to study the ability to elicit swallows. The test consists of 11 manometrically recorded dry swallows performed at maximum speed. The time between swallows 1 and 11 (Swallowing Test Time) is considered a measure of the ease of eliciting the swallowing reflex. The study includes two controlled experiments, each consisting of an active test done immediately after a cold stimulus and a control done after a stimulus at body temperature. In one experiment the stimulus consisted of stimulation of the fauces with a laryngeal mirror and in the other of swallowing water. Each subject served as his or her own control. The order of the tests was randomized and the results read blindly. In the mirror experiment, the swallowing test times obtained after application of a cold laryngeal mirror did not differ significantly from those obtain...

Thermal Oral-Pharyngeal Stimulation and Elicitation of Swallowing

This study measured the temperature acceleration of a cold probe as it contacts human tissue. Both the effects of touching a cold probe to the oral cavity and maintaining contact of the cold probe with the oral cavity were investigated. The results indicated a rapid warming pattern. This warming is effected first by temperature changes resulting from the probe being moved from ice into room temperature and second by the contact to oral mucosa. In fact, in some cases, the probe had reached minimal cold sensation levels by the time it reached the oral cavity. Results also indicated that 6 sec after the probe is lifted from the ice, the temperature closely aproximates temperatures perceived as warm or at least neutral, but not cold.

Temperature acceleration in cold oral stimulation.

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Temperature acceleration in cold oral stimulation.