During healthy swallowing the oral and pharyngeal neuromusculature systems must accommodate to varying bolus characteristics, with precisely coordinated timing and enough contractile force to safely propel different materials through the upper aero digestive tract. Impaired bolus accommodation implies underlying swallowing path physiology which may result in increased morbidities and mortality, especially among elderly individuals. Given the explosion in aging within the US population and pursuant burden on the Healthcare system, it is imperative that swallowing-related prevention or rehabilitation programs be developed. In this regard a comprehensive knowledge of the effects of aging on bolus accommodation is paramount. Unfortunately, prior studies of bolus accommodation in the elderly have been incomplete. Few studies have investigated swallowing effort and bolus accommodation, and fewer still have investigated the effects of volitionally increasing swallowing effort, a routinely recommended technique in swallowing rehabilitation, on bolus accommodation in this population. Therefore, this cross sectional study aims to identify and describe changes in pressure and movement parameters, as a function of bolus accommodation (volume and viscosity) during swallowing. Additionally we propose to identify and describe the effect of volitionally increasing effort during swallowing on pressure and movement parameters within a cohort of healthy elderly individuals. A minimum of 32 self-rated healthy adults between 60-90 years of age, volunteering from community or web site advertisement, will be recruited. Participants will undergo standardized clinical, endoscopic, and fluoroscopic swallowing evaluations. During the fluoroscopic evaluation, participants will wear three data collection sensors: a 3-bulb array affixed to the palate, a surface electromyography electrode affixed on the skin over the sub mental muscles, and a 2.1 mm diameter manometric catheter inserted trans-nasally into the pharynx. Sensors will be integrated with the fluoroscopy equipment to capture oral and pharyngeal effort and hyo-laryngeal movement for each swallow. Participants will swallow a series of 32 boluses, systematically varying in volume and viscosity, under two conditions (typical and effortful swallowing). Boluses include 5 and 10 ml of thin, nectar, and pudding barium, and 5 and 10 ml equivalent volumes of fresh banana impregnated with barium;each material will be swallowed twice. This proposal directly addresses key research objectives by using a novel approach that measures multiple effort and movement parameters simultaneously, an approach that heretofore has not been undertaken. It is necessary because it expands upon the best efforts of previous studies and fills critical research gaps. Results from this study will provide comprehensive data on effects of healthy aging on ability to generate sufficient swallowing effort and will serve as a guide to future intervention studies.
This single center, cross-sectional study will take a novel approach and investigate the effects of bolus accommodation on multiple swallowing effort and movement parameters simultaneously, during typical and volitionally effortful swallowing, in a cohort of 32 healthy elderly individuals. Results of this investigation will provide more detailed data than currently exists, furthering the knowledge base regarding aging effects on swallowing physiology and function. It is anticipated that this level of detailed information will help future investigations distinguishing effects of natural aging from pathologic aging, a natural step in developing new treatment protocols for the rehabilitation of swallowing disorders.
