INTRODUCÃO: O objetivo da reabilitação em disfagia orofaríngea é estabilizar o aspecto nutricional e eliminar os riscos de aspiração laringotraqueal e consequentes complicações associadas. Um estudo sistemático que permita estabelecer o processo de reabilitação fonoaudiológica da disfagia orofaríngea, bem estruturado com base e em evidências e demonstração dos indicadores de qualidade, ainda se faz necessário para nortear a atuação clínica. O objetivo da pesquisa foi a aplicação da primeira fase de um ensaio clínico, onde o PTFDO foi avaliado em seu efeito terapêutico. A medida de efeito adotada foi a manifestação da alteração funcional considerada como mudança benéfica positiva (segurança para deglutição do alimento, por via oral, após a aplicação do tratamento). MÉTODO: Este foi um estudo longitudinal de efeito de tratamento, determinado por medidas comparativas entre pré e pós teste. A população alvo do estudo alvo foram pacientes adultos, encaminhados ao Ambulatório de Disfagia, HCFMUSP, para avaliação e tratamento fonoaudiológico. O período de seleção dos participantes foi de 24 meses, sendo avaliados para elegibilidade todos os pacientes encaminhados pelas equipes médicas do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Para avaliação clínica fonoaudiológica da deglutição foram aplicados protocolos clínicos padronizados, PARD e PITA. Após a avaliação inicial, foram compostos 3 grupos de alocação, com base no padrão funcional da deglutição. A alocação dos participantes foi realizada com base na classificação do paciente segundo a Escala Funcional ASHA NOMS. Todos os participantes, independente do grupo de alocação, realizaram o mesmo programa terapêutico, composto por número de sessões fechadas, com técnicas especificas, bem como sua frequência e intensidade. As técnicas realizadas nas sessões presenciais, também foram repetidas diariamente pelos participantes. RESULTADOS: Foram incluídos de acordo com os critérios pré-estabelecidos um total de 138 participantes. Nos três grupos existe uma redução significativa dos sinais para disfagia, tendo em comum no pós tratamento a presença de deglutições múltiplas em todos os grupos CONCLUSÃO: Os dados obtidos demonstram efetividade na reabilitação da disfagia orofaríngea por meio da terapia tradicional, utilizando sessões presenciais e orientações em casa, num período de quatro semanas / INTRODUCTION: The aim of rehabilitation in oropharyngeal dysphagia is to stabilize the nutritional aspect and eliminate the risk of tracheal aspiration and subsequent complications associated. A systematic study to establish the process of voice rehabilitation of oropharyngeal dysphagia, well structured and based on evidence and statement of quality indicators are still needed to guide clinical practice. The research objective was the implementation of the first phase of a clinical trial where the PTFDO was valued at its therapeutic effect. The adopted measure of effect was the manifestation of the functional alteration considered positive beneficial change (for food safety swallowing orally, after application of the treatment). METHODS: This was a longitudinal study of treatment effect, determined by comparative measurements between pre and post test. The target study target population been adult patients referred to the Clinic of Dysphagia, HCFMUSP for evaluation and speech therapy. The period of selection of participants was 24 months, being evaluated for eligibility all patients referred by medical personnel of the Central Institute of the Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo. For clinical examination of swallowing were applied standardized clinical protocols, PARD and PITA. After the initial assessment, it was made 3 allocation groups, based on functional pattern of swallowing. The allocation of participants was based on patients\' classification according to Functional Scale ASHA NOMS. All participants, regardless of the allocation group, underwent the same treatment program, consisting of number of closed sessions, with specific techniques as well as their frequency and intensity. The techniques used in classroom sessions were also repeated daily by the participants. RESULTS: We included according to pre-established criteria a total of 138 participants. In all three groups there is a significant reduction in the signs for dysphagia, in common post treatment the presence of multiple swallows in all CONCLUSION groups: The data demonstrate effectiveness in the rehabilitation of oropharyngeal dysphagia through traditional therapy using classroom sessions and guidelines at home, over a four week period

This study aims to develop an understanding of the lived experience of family carers of people with PIMD and dysphagia, in relation to mealtimes and food. Policy in recent years has begun to address the inequalities faced by people with learning disabilities and it is striving to improve their lives and the services offered to them. People with profound intellectual and multiple disabilities (PIMD) often have additional eating and drinking difficulties (dysphagia). People with dysphagia require ongoing support and guidance, to maximize their health, specifically their nutrition and hydration. In order to ensure that this support is appropriate, useful and sensitive to the needs of individuals and their families, it is important to try and view mealtimes through the eyes of these individuals and their families. The aims of this study emerged from observations made during my clinical work as a Speech & Language Therapist (SLT) and from engaging in discussion with family carers. In particular it has become increasingly clear from clinical practice that family carers often have different points of view about their son or daughter with profound intellectual and multiple disabilities, than those of professionals. These different points of view are often not clearly articulated by carers or professionals, and clinical interventions may become marked with conflict. This study is sited within a mental health and learning disability NHS trust in the north east of England. It utilises a phenomenological methodology and employs mixed methods to obtain data. Data collection took place between June 2013 and August 2014. Medical descriptions do not capture how it feels to live with impairment and resulting disability. Only when we examine this and allow individuals to tell their stories, as experts in their experiences, can we understand and offer support accordingly and ensure more functional and beneficial interactions and interventions. Findings are presented around four themes – the meaning of food and mealtimes, relationships, roles within the family and challenges. Findings are discussed in relation to the existing literature and recommendations are made for practice and for future research. During this study the adult child is mainly referred to as the ‘child’. For clarity, this is not in any way meant to convey the individual’s presentation as having PIMD as akin to being a child. The term is used to represent the relationship between the parents and the child. Despite the fact that the individuals are adults, they are still the children of the parents, and the relationship is a parent-son/daughter relationship. For brevity the term ‘child’ is used in preference to ‘adult child’. The use of the term has been agreed with the parents participating in the study. All names are assumed and have been chosen by the participants. In the course of this thesis the direct giving of food to the individuals with disabilities is termed ‘feeding’. I acknowledge this term may be associated with potentially negative connotations. The term ‘feeding’ has been used because it is the term used widely in the literature, because it was used by the family carers in their narratives and because there is no other suitable substitute which adequately describes the direct provision of food from one person in to the mouth of another.

Made available in DSpace on 2014-06-11T19:22:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-05-07Bitstream added on 2014-06-13T20:48:32Z : No. of bitstreams: 1 fresca_a_me_botfm.pdf: 331178 bytes, checksum: 1089a9ca98c48ae16944fa75faebc949 (MD5) / Universidade Estadual Paulista (UNESP) / Objetivo: Avaliação da qualidade de vida dos pacientes portadores de câncer de esôfago inoperável submetidos à inserção de stents esofágicos auto-expansíveis como opção no tratamento paliativo da neoplasia avançada. Pacientes e métodos: Avaliação prospectiva de 50 pacientes admitidos no Departamento de Endoscopia do Hospital de Câncer de Barretos com câncer de esôfago inoperável, em estágio avançado e com indicação de tratamento paliativo no período de agosto de 2007 a setembro de 2009. Os pacientes foram encaminhados para o Departamento de Endoscopia após serem estadiados pela classificação TNM e realizados exames. Após definido o tratamento paliativo com stent, os pacientes foram avaliados nas primeiras 24 horas (M0) ainda em ambiente hospitalar, 7dias (M1), 8 (M2) e 16 (M3) semanas após a colocação do stent, aplicando o questionário EORTC QLQ-C30 (versão 3), Escala do Índice de Karnofsky, classificação do grau disfagia, sintoma de dor retroesternal através escala numérico-verbal, avaliação nutricional e tempo de sobrevida. As perguntas foram respondidas pelos pacientes e nos casos de dificuldade de entendimento ou leitura os mesmos foram orientados por uma equipe de enfermagem treinada. Resultados: dos 50 pacientes que participaram do estudo, 41 eram homens (82%) e 9 eram mulheres (18%). Os stents utilizados, todos autoexpansíveis, de tecnologia totalmente brasileira, foram 32 recobertos e 18 descobertos e o local mais comum da neoplasia maligna foi o terço médio do esôfago e o tipo histológico carcinoma de células escamosas em todos os pacientes. A disfagia melhorou significativamente... / Objectives: Evaluation of quality of life in patients with inoperable esophageal cancer submitted to insertion of self expandable stent as an option on the palliative treatment of advanced neoplasia. Patients and methods: Prospective evaluation of 50 patients admitted at the endoscopy department of Barretos Cancer Hospital with inoperable esophageal cancer in an advanced state with indication of palliative treatment during the period from August 2007 to September 2009. The patients were forwarded to the endoscopy department after being staged by the TNM classification. After have defined the palliative treatment with stent, patients were evaluated during on the first 24 hours (M0) still at the hospital, 7 days (M1), 8(M2) and 16(M3) weeks, after stent placement applying the EORTC QLQ-C30 (version 3) questionnaire, scale of the Karnofsky index, dysphagia, retrosternal pain symptoms, through verbal numeric scale, nutritional evaluation, and survival time. The questions were answered by the patients and in cases of difficulty in understanding or reading they were guided by a trained nursing staff. They followed exclusion and inclusion criteria for the stent insertion. Results: of 50 patients that participated on the study, 41 were men (82 %) and 9 women (18%). The stents used were all self expandable stent of totally Brazilian technology , 32 were covered and 18 uncovered and the most common places for malignant neoplasia were the third medium of the esophagus and the histological type were squamous cells carcinoma in all patients... (Complete abstract click electronic access below)

O maior receio dos profissionais que atendem pacientes com queixa de disfagia é a dificuldade em diagnosticá-la, durante a avaliação clínica, principalmente quando os mesmos não apresentam sinais clínicos sugestivos de penetração e/ou aspiração laringotraqueal. Portanto, o objetivo deste estudo foi comparar a avaliação clínica da deglutição ao resultado da videofluoroscopia e à filmagem da videofluoroscopia, buscando identificar sinais comuns que sugiram e comprovem a aspiração silente. Foi realizado um estudo observacional e prospectivo com 49 pacientes adultos com diagnóstico de Acidente Vascular Cerebral. Uma anamnese foi realizada para coleta de informações. A avaliação clínica, incluiu a avaliação estrutural e funcional. Houve monitoração do paciente através da oximetria de pulso e a observação da ausculta cervical e sinais clínicos. Na videofluoroscopia, o paciente manteve-se monitorado pela oximetria e parâmetros clínicos foram analisados. Durante a videofluoroscopia o paciente foi filmado por uma câmera para posterior análise clínica. Em ambas as avaliações foi oferecido ao paciente a consistência líquida no volume de 100 ml no copo. As avaliações foram realizadas por profissionais distintas, ambas cegas uma na avaliação da outra. Dos pacientes avaliados 46 (94%) indivíduos apresentaram diagnóstico de Acidente Vascular Cerebral isquêmico. Do total, sete apresentaram aspiração, sendo que seis foram silente. A alteração da ausculta cervical na avaliação clínica e a presença de resíduo oral na filmagem se associaram a aspiração silente detectada na videofluoroscopia. Não foi observado relação entre alteração de saturação de oxigênio e aspiração silente. / The greatest fear of the professionals who attend patients with complaints of dysphagia is the difficulty in diagnosing it during the clinical evaluation, especially when they do not present clinical signs suggestive of laryngotracheal penetration and / or aspiration. Therefore, the objective of this study was to compare the clinical evaluation of swallowing to the videofluoroscopic result and videofluoroscopic filming, in order to identify common signs that suggest and prove the silent aspiration. An observational and prospective study was conducted with 49 adult patients with a diagnosis of stroke. An anamnesis was performed to collect information. Clinical evaluation included structural and functional assessment. There was patient monitoring through pulse oximetry and observation of cervical auscultation and clinical signs. In videofluoroscopic, the patient was monitored by oximetry and clinical parameters were analyzed. During the videofluoroscopic the patient was filmed by a camera for further clinical examination. In both evaluations was offered 100 ml of the liquid in the cup. The evaluations were performed by distinct professionals, both blinded one in the evaluation of the other. Of the patients evaluated, 46 (94%) individuals had a diagnosis of ischemic stroke. Of the total, seven had aspiration, six of which were silent. Alteration of the cervical auscultation in clinical evaluation and presence of oral residue in filming were associated with silent aspiration detected in videofluoroscopic. No relation between alteration of oxygen saturation and silent aspiration was observed.

Distúrbios neurológicos como o Acidente Vascular Encefálico (AVE) podem causar alterações nos mecanismos responsáveis pela voz e deglutição, levando a quadros de disfonia e disfagia neurogênica, sendo que a maioria dos estudos aborda tais aspectos separadamente. O objetivo do presente trabalho foi estudar as funções de deglutição e voz, bem como a relação entre ambas, em indivíduos com sequelas de AVE. Foram analisados, para este estudo retrospectivo, os prontuários e exames de 30 idosos com média de 72 anos de idade. Foram realizados: aplicação de questionários referentes a queixas de deglutição e voz; avaliação perceptivo-auditiva da voz por meio da escala GRBASI; videoendoscopia da deglutição para classificação do grau da disfagia, da penetração e aspiração, além da taxa de gravidade de secreção; videoendoscopia da fonação, para observação de aspectos morfológicos e funcionais. Para verificar as correlações entre variáveis quantitativas e/ou qualitativas ordinais foi utilizado o Coeficiente de Correlação Spearman. Para verificar associação entre variáveis qualitativas nominais foram utilizados o teste exato de Fischer e o teste de Mann-Whitney. Em todos os testes foi adotado nível de significância de 5%. Para verificar a concordância entre juízes foi utilizada a estatística Kappa. Observou-se que 46% dos indivíduos referiu queixa vocal e voz muito fraca, 43% apresentou sensação de catarro preso na garganta e tosse; 46% dos indivíduos referiu dificuldades para mastigar, 36% engasgo durante as refeições e 32% ingestão de líquidos para ajudar na deglutição e tosse após as refeições. Na escala GRBASI, a maioria dos indivíduos apresentou o grau geral de disfonia e a rugosidade moderados para conversa espontânea e grau geral de disfonia e instabilidade moderados para a vogal /a/ sustentada. Com relação aos aspectos morfológicos, foi possível observar assimetria laríngea (73%), arqueamento bilateral da porção membranosa da prega vocal (77%) e saliência bilateral do processo vocal (77%). Quanto aos aspectos funcionais, observou-se fenda (57%), constrição supraglótica anteroposterior (57%) e constrição mediana (80%). A maioria dos indivíduos (83%) apresentou classificação 6 na escala DOSS, nível 1 para a consistência líquida (57%) e nível 0 para pastosa (57%) e sólida (63%) na escala de Taxa de Gravidade de Secreção. Foram encontradas relações entre sintomas de cansaço depois de falar muito com dificuldade para deglutir os alimentos (p=0,03), engasgo durante as refeições (p=0,00) e tosse após as refeições (p=0,01). Observou-se também relação entre catarro preso na garganta e engasgo durante as refeições (p=0,04), entre pigarro na garganta e ingestão de líquido para ajudar na deglutição (p=0,03), e entre pigarro na garganta e pigarro após as refeições (p=0,00). Ainda, foi observado que houve correlação entre estase em valécula para a consistência sólida e as características vocais de soprosidade (p=0,01) e astenia (p=0,02); relação entre a gravidade dos sinais de alteração da deglutição com a configuração laríngea. Concluiu-se que as características de voz e deglutição apresentadas pela população estudada foram semelhantes às frequentemente encontradas em idosos e que houve relações entre as funções de deglutição e voz. / Neurological disorders such as cerebrovascular accident (AVE) may cause changes in the mechanisms responsible for voice and swallowing, leading to dysphonia and neurogenic dysphagia and most studies addresses these aspects separately. The aim of this retrospective work was to study the functions of swallowing and voice as well as the relationship between them to individuals affected by sequel of stroke. We analyzed the medical charts of 30 patients averaging 72 years of age. Were performed: questionnaires regarding complaints of swallowing and voice; perceptual evaluation of voice through GRBASI scale; videoendoscopy of swallowing to classify the degree of dysphagia, penetration and aspiration, besides the severity rate of secretion; videoendoscopy of phonation, for observation of morphological and functional aspects. To verify the correlation between quantitative variables and / or qualitative ordinal was used Spearman Correlation Coefficient. To assess the association between nominal qualitative variables we used the Fisher exact test and Mann - Whitney. In all tests the level of significance was 5%. To verify the agreement between judges Kappa statistics was used. It was observed that 46% of the individuals reported voice complaints and very weak voice, 43% had feeling of phlegm stuck in throat and cough, 46% of subjects reported difficulty in chewing, 36% choking during meals and 32% drinking to assist in swallowing and coughing after meals. In GRBASI scale, most individuals showed grade and roughness moderate for spontaneous conversation and the grade and instability moderate for the vowel / a / sustained. With respect to morphology, was observed laryngeal asymmetry (73%), bilateral bowing of the membranous portion of the vocal fold (77%) and bilateral protrusion of the vocal process (77%). Regarding to the functional aspects, it was observed slit (57%), supraglottic anteroposterior constriction (57%) and median constriction (80%). Most individuals (83%) had rating 6 in DOSS scale, level 1 for liquid (57%) and level 0 to paste (57%) and solid (63%) in The Secretion Severity Rating scale. Relationships were found between symptoms of fatigue after speaking with much difficulty swallowing foods (p=0.03), choking during meals (p=0.00) and cough after meals (p=0.01). It was also observed relationship between phlegm stuck in my throat and choking during meals (p=0.04) between phlegm in the throat and fluid intake to aid in swallowing (p=0.03), and between phlegm in throat and hoarseness after meals (p=0.00). Still, it was observed that there was a correlation between stasis in the vallecula to solid and the vocal characteristics of breathiness (p=0.01), and asthenia (p=0.02), the relationship between the severity of the signs of swallowing disorders with laryngeal configuration. It was concluded that the characteristics of voice and swallowing presented by this study were similar to those often found in the elderly and that there were relations between the functions of swallowing and voice.

O maior receio dos profissionais que atendem pacientes com queixa de disfagia é a dificuldade em diagnosticá-la, durante a avaliação clínica, principalmente quando os mesmos não apresentam sinais clínicos sugestivos de penetração e/ou aspiração laringotraqueal. Portanto, o objetivo deste estudo foi comparar a avaliação clínica da deglutição ao resultado da videofluoroscopia e à filmagem da videofluoroscopia, buscando identificar sinais comuns que sugiram e comprovem a aspiração silente. Foi realizado um estudo observacional e prospectivo com 49 pacientes adultos com diagnóstico de Acidente Vascular Cerebral. Uma anamnese foi realizada para coleta de informações. A avaliação clínica, incluiu a avaliação estrutural e funcional. Houve monitoração do paciente através da oximetria de pulso e a observação da ausculta cervical e sinais clínicos. Na videofluoroscopia, o paciente manteve-se monitorado pela oximetria e parâmetros clínicos foram analisados. Durante a videofluoroscopia o paciente foi filmado por uma câmera para posterior análise clínica. Em ambas as avaliações foi oferecido ao paciente a consistência líquida no volume de 100 ml no copo. As avaliações foram realizadas por profissionais distintas, ambas cegas uma na avaliação da outra. Dos pacientes avaliados 46 (94%) indivíduos apresentaram diagnóstico de Acidente Vascular Cerebral isquêmico. Do total, sete apresentaram aspiração, sendo que seis foram silente. A alteração da ausculta cervical na avaliação clínica e a presença de resíduo oral na filmagem se associaram a aspiração silente detectada na videofluoroscopia. Não foi observado relação entre alteração de saturação de oxigênio e aspiração silente. / The greatest fear of the professionals who attend patients with complaints of dysphagia is the difficulty in diagnosing it during the clinical evaluation, especially when they do not present clinical signs suggestive of laryngotracheal penetration and / or aspiration. Therefore, the objective of this study was to compare the clinical evaluation of swallowing to the videofluoroscopic result and videofluoroscopic filming, in order to identify common signs that suggest and prove the silent aspiration. An observational and prospective study was conducted with 49 adult patients with a diagnosis of stroke. An anamnesis was performed to collect information. Clinical evaluation included structural and functional assessment. There was patient monitoring through pulse oximetry and observation of cervical auscultation and clinical signs. In videofluoroscopic, the patient was monitored by oximetry and clinical parameters were analyzed. During the videofluoroscopic the patient was filmed by a camera for further clinical examination. In both evaluations was offered 100 ml of the liquid in the cup. The evaluations were performed by distinct professionals, both blinded one in the evaluation of the other. Of the patients evaluated, 46 (94%) individuals had a diagnosis of ischemic stroke. Of the total, seven had aspiration, six of which were silent. Alteration of the cervical auscultation in clinical evaluation and presence of oral residue in filming were associated with silent aspiration detected in videofluoroscopic. No relation between alteration of oxygen saturation and silent aspiration was observed.

The purpose of this study was to explore the nature of reduced patient awareness of oropharyngeal dysphagia. While patient awareness of dysphagia has been explored in individuals before participating in formal swallowing assessments, no studies have been identified in the literature that have explored awareness after patients have participated in an examination and received information about their dysphagia. In addition, the relationship between patient compliance and reduced awareness, as well as the application of stages of change in this population were explored. Twenty-one inpatients and outpatients, newly diagnosed with oropharyngeal dysphagia, participated in this study. A retrospective analysis found that 40% of participants demonstrated reduced awareness of their dysphagia before participating in a videofluoroscopic swallowing examination. Reduced pre-examination awareness of dysphagia occurred most frequently in those with general medical diagnoses versus neurological or structural diagnoses. Reduced pre-examination awareness was not significantly associated with a reduced cough response following aspiration. Exploration of post-examination patient awareness of dysphagia, the primary intent of this study, revealed that 19% of patients demonstrated reduced awareness of their dysphagia, even after receiving specific verbal and visual information regarding their diagnosis. Reduced post-examination awareness of dysphagia occurred equally in those with structural and neurological diagnoses and was not noted in those with general medical diagnoses. Reduced post-examination awareness was not significantly associated with a reduced cough response following aspiration. Consistent with the literature on reduced patient awareness of deficit, patient awareness of dysphagia was modality specific. That is, some patients with reduced awareness of dysphagia demonstrated awareness of other deficits and vice versa. Overall, participants demonstrated more awareness of concomitant speech impairments than dysphagia and less awareness of concomitant cognitive impairments than dysphagia. No significant relationship between general cognitive impairment and reduced patient awareness of dysphagia was found. Exploration of diet compliance in inpatient participants revealed no instances of noncompliance, while hospitalized, from the day of the swallowing examination until the day of participation in the study. However, only 67% of these patients requested permissible foods or drinks when compliance was sampled during the study protocol, suggesting that inpatients with newly diagnosed dysphagia may be less compliant if restricted items become accessible. No significant relationship between patient awareness of dysphagia and diet compliance, as sampled during the study protocol, was found in both inpatients and outpatients. The relationships between patient awareness of dysphagia and patient compliance for both swallowing strategies and exercise regimens were also not significant, though these analyses were limited by the small number of participants who had been prescribed strategies and independent exercise programs at the time of their study participation. Lastly, analysis of the relationship between patient compliance and action or post-action stages of change, revealed no significant association between these variables.

Dysphagia is a leading complication of a stroke. A nurse-driven bedside swallow screen can identify dysphagia and decrease the risk for complications such as aspiration pneumonia. At the project site, the use of the bedside swallow screen was at 33%; there was noncompliance with the use of the bedside swallow screen by the emergency department nurses. The purpose of the doctoral project was to increase the use of the bedside swallow screen. Published outcomes, research, and reports generated from archived data were the sources of evidence. The six sigma methodology was used to inform the quality improvement doctoral project. At the end of the quality improvement project, the posttest scores were statistically significantly higher than the pretest scores mean. The nurses' scores demonstrating level of confidence before the training (M = 68.39, SD = 10.86) were lower than scores indicating their level of confidence after the training (M = 79.55, SD = 10.56), and the paired t test showed statistical significance p < .001. The training made a statistically significant difference in the emergency department nurses' knowledge and confidence in performing the dysphagia screen. After the causes of low compliance were identified, strategies developed and implementation of the swallow screen in the emergency department increased. The quality improvement project improved the use of the dysphagia screen at the project site from 33% to 60%. The project made a positive impact on social change by reducing stroke patients' risk for complications.

Purpose: The chin down posture is a compensatory strategy commonly used to minimize the risk of aspiration in patients with a pharyngeal delay. There are several difficulties to determining if the chin down posture is effective at eliminating aspiration including: the variability on how to perform the posture, what the posture is called, and the anatomical changes resulting from the posture The main purpose of this study was to determine the anatomical changes associated with different postural positions (i.e., chin down, chin tuck, and head extended) using endoscopy. Method: Twenty healthy female subjects underwent nasoendoscopy and assumed four different head positions with and without a bolus in the oral cavity. Subjects were instructed on how to perform each posture prior to insertion of the endoscope. The four head position included a neutral, chin down (looking at the floor), chin tuck (chin to neck), and head extended position. Still images of each posture and condition were analyzed using ImageJ to measure the changes in area of airway opening and in distance between structures (e.g., posterior pharyngeal wall to epiglottis). Measured distances and area changes across postures were analyzed within and across subjects. Statistical and descriptive analyses were also completed. Results & Conclusions: The findings demonstrated that there are statistically significant differences in the anatomical structures of the pharynx when creating the chin down, chin tuck, and head extended positions. Furthermore, the presence of a small liquid bolus in the oral cavity played a significant role in changing the area observed in all postures compared to the non-bolus hold postures. Although we were unable to determine a significant statistical difference between the chin down and chin tuck postures, descriptive analyses of these postures lead to noticeable trends in airway opening and visible anatomy (e.g., laryngeal vestibule, vallecular space) across subjects. The chin tuck posture was found to provide subjects with the greatest decrease in area of airway opening from the neutral position, thus increasing airway protection.

Abstract There is a need in medicine and research for noninvasive, painless, safe and simple bed-side techniques to measure physiological processes associated with muscle function and activity. Bioelectrical Impedance Analysis (BIA) is a widely used, noninvasive, painless, safe and simple procedure for the measurement of body composition. However, although capable of producing accurate and reproducible data, it is known to be prone to movement artifacts. This poses the interesting question “Could impedance changes be used to monitor movement and, consequently, be related to muscle function or activity?” This project investigated the utility of impedance change as a monitoring technique for physiological processes that involve movement such as muscular contraction, the calf muscle pump, and swallowing. The impedance of leg muscle segments during locomotion, whilst riding a stationary exercise cycle, was measured at discrete frequencies and by bioimpedance spectroscopy to monitor muscle function or activity. Impedance traces were compared to information obtained by electromyography (EMG). Impedance, at a discrete frequency, was able to measure the cadence of cycling and its magnitude was related to the position of the pedal during the pedal cycle. When the cycling action was measured by bioimpedance spectroscopy, R0 and Zc showed a statistically significant difference, (p<0.05), between all angles of the pedal crank cycle while R∞ showed a statistically significant difference between angles in the lower hemisphere of the pedal crank cycle. The cyclical changes in impedance during cycling may be attributed to changes in shape and volume of the muscle during contraction as well as a volume change due to blood and lymph being pumped from the limb by the action of the calf muscle pump. Based on procedures used in the cycling studies, an impedance-based method for the measurement of calf muscle pump function during an exercise protocol, originally designed for use with air plethysmography, was developed. It was shown that impedance measured at 5 kHz provides a simple, non-invasive method for the measurement of the ejection fraction and ejection volume of the calf muscle pump as well as other haemodynamic variables. The impedance-based method was less technically challenging than accepted volumetric methods, such as air plethysmography and strain gauge plethysmography, and non-invasive c.f. ambulatory venous pressure, enabling it to be used repeatedly. Muscle function and activity is not confined to the legs so impedance changes in the arm and forearm during exercise were measured. Impedance measurements, at discrete frequencies and using bioimpedance spectroscopy, of the forearm during contractions of the hand were able to distinguish the difference between a ramp and a pulse contraction. When the impedance of the arm and forearm were plotted against the angle of the forearm to the horizontal during a bicep curl, there was an hysteresis effect. Impedance traces of a bicep curl were compared to an EMG trace of the same action. The larynx is a hollow muscular organ situated in the front of the neck above the trachea consisting of a framework of cartilages bound together by muscles and ligaments. The two major functions of the larynx are deglutition and phonation. Dysphagia, which is becoming more prevalent as the population ages, is defined as difficulty in swallowing thin liquids such as water or juices which splash into the trachea because the patient is unable to control the thin liquid bolus. Aspiration pneumonia and dehydration can be prevented by using thickened liquids which allow patients to achieve a safer swallowing response, but it is difficult to assess this response without interfering with the swallowing process. Impedance pharynography (IPG) is a technique using BIA to monitor an impedance waveform of the swallowing process that presents no radiation hazard to the patient, is non-invasive and does not require specialist trained personnel to operate it. Resistance changes across the neck were measured while subjects swallowed solutions of different viscosities. The resistance changes were distinctive and reproducible for each of the solutions of different viscosities which were swallowed. Measuring the function of the larynx by this method could be useful in the diagnosis and treatment of dysphagia. In conclusion, the studies described in this thesis demonstrate the potential usefulness of the measurement of change in impedance as a measure of muscle activity. Impedance-based methods can measure volume changes associated with changes in cross-sectional area of the muscles involved in contraction as well as compartmental fluid changes caused by the force of the contraction on the surrounding tissues including the vasculature. In particular, measuring the ejection fraction and other haemodynamic variables of the calf muscle pump by impedance has the potential to become the method of choice in the future because it is easy to use, inexpensive, non-invasive, safe, and hygenic. Measuring resistance changes across the neck during swallowing yields distinctive waveforms with features corresponding to the physiological phases of the swallowing process as well as identifying distinctive swallowing patterns associated with the different viscosities of liquids swallowed. Function of the larynx and the associated diseases of the larynx will potentially be easier to diagnose and treat with a safe, non-invasive, inexpensive, portable bed-side method of assessment such as BIA.