Maggie-Lee Huckabee1, Kristin Lamvik2, Richard Jones3. 1. Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand. Electronic address: maggie-lee.huckabee@canterbury.ac.nz. 2. Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand. 3. Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand; Department of Medical Physics & Bioengineering, Christchurch Hospital, New Zealand; Department of Medicine, University of Otago, Christchurch, New Zealand.
Abstract
OBJECTIVE: Clinical data are submitted as documentation of a pathophysiologic feature of dysphagia termed pharyngeal mis-sequencing and to encourage clinicians and researchers to adopt more critical approaches to diagnosis and treatment planning. BACKGROUND: Recent clinical experience has identified a cohort of patients who present with an atypical dysphagia not specifically described in the literature: mis-sequenced constriction of the pharynx when swallowing. As a result, they are unable to coordinate streamlined bolus transfer from the pharynx into the esophagus. This mis-sequencing contributes to nasal redirection, aspiration, and, for some, the inability to safely tolerate an oral diet. METHOD: Sixteen patients (8 females, 8 males), with a mean age of 44 years (range=25-78), had an average time post-onset of 23 months (range=2-72) at initiation of intensive rehabilitation. A 3-channel manometric catheter was used to measure pharyngeal pressure. RESULTS: The average peak-to-peak latency between nadir pressures at sensor-1 and sensor-2 was 15 ms (95% CI, -2 to 33 ms), compared to normative mean latency of 239 ms (95% CI, 215 to 263 ms). Rehabilitative responses are summarized, along with a single detailed case report. CONCLUSION: It is unclear from these data if pharyngeal mis-sequencing is (i) a pathological feature of impaired motor planning from brainstem damage or (ii) a maladaptive compensation developed in response to chronic dysphagia. Future investigation is needed to provide a full report of pharyngeal mis-sequencing, and the implications on our understanding of underlying neural control of swallowing.
OBJECTIVE: Clinical data are submitted as documentation of a pathophysiologic feature of dysphagia termed pharyngeal mis-sequencing and to encourage clinicians and researchers to adopt more critical approaches to diagnosis and treatment planning. BACKGROUND: Recent clinical experience has identified a cohort of patients who present with an atypical dysphagia not specifically described in the literature: mis-sequenced constriction of the pharynx when swallowing. As a result, they are unable to coordinate streamlined bolus transfer from the pharynx into the esophagus. This mis-sequencing contributes to nasal redirection, aspiration, and, for some, the inability to safely tolerate an oral diet. METHOD: Sixteen patients (8 females, 8 males), with a mean age of 44 years (range=25-78), had an average time post-onset of 23 months (range=2-72) at initiation of intensive rehabilitation. A 3-channel manometric catheter was used to measure pharyngeal pressure. RESULTS: The average peak-to-peak latency between nadir pressures at sensor-1 and sensor-2 was 15 ms (95% CI, -2 to 33 ms), compared to normative mean latency of 239 ms (95% CI, 215 to 263 ms). Rehabilitative responses are summarized, along with a single detailed case report. CONCLUSION: It is unclear from these data if pharyngeal mis-sequencing is (i) a pathological feature of impaired motor planning from brainstem damage or (ii) a maladaptive compensation developed in response to chronic dysphagia. Future investigation is needed to provide a full report of pharyngeal mis-sequencing, and the implications on our understanding of underlying neural control of swallowing.
Authors: Corinne A Jones; Ellen L Meisner; Courtney K Broadfoot; Sarah P Rosen; Christine R Samuelsen; Timothy M McCulloch Journal: Front Appl Math Stat Date: 2018-07-02
Authors: Karen B Ng; Esther Guiu Hernandez; Kerstin L C Erfmann; Richard D Jones; Phoebe Macrae; Maggie-Lee Huckabee Journal: Dysphagia Date: 2021-03-09 Impact factor: 3.438