The works contained in this dissertation were motivated by a desire to better understand the variability of patient performance on videofluoroscopic assessments of swallowing. Specifically, the variation present in kinematic and temporal measures of swallowing was investigated in three main phases: narrative literature review, healthy swallowing, and disordered swallowing. The primary goals were to identify which factors explain (or do not explain) variation, to develop methods to control for variation and to investigate the association between swallowing physiology and swallowing impairment. The literature reviews revealed wide ranges of variation for kinematic (Chapter 2) and temporal (Chapter 3) measures of swallowing in the existing literature on healthy deglutition. The kinematics (Chapter 4) and timing (Chapter 5) of swallowing were investigated in a prospectively collected sample of young healthy participants stratified by height. One main objective was to investigate the impact of participant size on physiological parameters of swallowing. Finally, kinematic and temporal measures of swallowing were investigated in a sample of patients referred for swallowing assessment (Chapter 6) to explore associations between swallowing physiology and impairment. The findings of this dissertation make several unique contributions to the dysphagia literature. It has demonstrated that inherent variation appears to exist in physiological measures of both healthy and disordered swallowing. Further, when certain sources of variation are controlled (such as participant size), men and women do not demonstrate significant differences for any of the parameters tested. Importantly, this work has demonstrated that participant size impacts the expected extent of hyoid excursion and that this variation can be controlled through normalization of hyoid movement to internal anatomical scalars. Two temporal variables trended toward detecting functional swallowing impairment. Finally, this dissertation provides the first set of normative reference values for parameters of swallowing with an ultra-thin liquid barium. Limitations are acknowledged and future work is suggested.
| Identifer | oai:union.ndltd.org:TORONTO/oai:tspace.library.utoronto.ca:1807/43670 |
| Date | 13 January 2014 |
| Creators | Molfenter, Sonja Melanie |
| Contributors | Steele, Catriona |
| Source Sets | University of Toronto |
| Language | en_ca |
| Detected Language | English |
| Type | Thesis |
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