Physiological Flow of Liquids Used in Dysphagia Management (Neuro)

University Health Network, Toronto

Status: Completed

Conditions: Dysphagia; Parkinson Disease; Amyotrophic Lateral Sclerosis

Treatments: Diagnostic Test: Videofluoroscopic Swallowing Examination; Other: Tongue Strength Measurement

Study type: Observational

Funder types: Other; NIH

Identifiers

NCT03192358

IRB201701608 (Other Identifier)

CAPCR 17-5421 (NIH_Neuro) (Other Identifier)

17-5421

5R01DC011020-05 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

For individuals with neurodegenerative conditions, such as Amyotrophic Lateral Sclerosis and Parkinson disease, swallowing impairment (i.e., dysphagia) is a common and serious symptom. Dysphagia places the affected individual at risk for secondary health consequences, including malnutrition and aspiration pneumonia, and negatively affects quality of life.

Thickened liquids are commonly recommended for individuals with dysphagia, as they flow more slowly and reduce the risk of entry into the airway. However, there is limited understanding about how changes in liquid thickness modulate swallowing physiology in individuals with neurodegenerative conditions, and previous reports have shown that increased liquid thickness may contribute to the accumulation of residue in the throat.

The purpose of this study is to explore swallowing physiology and function in individuals with neurodegenerative conditions, across five levels of liquid thickness (thin, slightly-thick, mildly-thick, moderately-thick, and extremely-thick), and to identify boundaries of "optimal liquid thickness", which maintain airway safety, without contributing to the accumulation of significant residue. Results from this study will help guide the clinical recommendations for thickened liquids in dysphagia management.

Full description

This observational research study will measure swallowing function in individuals with Amyotrophic Lateral Sclerosis or Parkinson's disease. The aims of this study are to (1) identify parameters of swallowing physiology that are associated with impaired swallowing safety and efficiency, and (2) explore how liquid thickness influences swallowing function.

Participation in this research study involves a single appointment at the University of Florida Swallowing Systems Core laboratory located at Shands Hospital, Gainesville. The appointment will last approximately 1 hour, and will involve tasks to measure tongue-strength, and a dynamic swallowing x-ray (known as videofluoroscopy) to evaluate swallowing function. A selection of demographic information (e.g., age, onset of symptoms) will also be recorded.

To measure tongue strength, participants will be given a disposable air-filled bulb and asked to perform a series of tongue presses, and swallow their saliva. Next, during the videofluoroscopy, participants will take sips of various liquids ranging in thickness from thin (like water), to extremely-thick (similar to the consistency of pudding or yogurt). The liquids will be mixed with a safe substance called barium, to make them visible on x-ray images. After the videofluoroscopy has been completed, each participant will have their tongue strength measured again, which will conclude their participation in the study.

Swallowing physiology will be measured from the videofluoroscopy images, post-hoc, by an experienced team of blinded raters.

Enrollment: 40 patients

Sex: All

Ages: 18 to 90 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adults (18+) with a confirmed diagnosis of Amyotrophic Lateral Sclerosis (ALS) or Parkinson's disease (PD)

Exclusion criteria

• People with a prior medical history of stroke
• People with a prior medical history of acquired brain injury
• People with a prior medical history of spinal or spinal cord injury
• People with a prior medical history of cancer or surgery in the head and neck region
• People who have had radiation to the head and neck for cancer
• People who have a prior history of swallowing problems (e.g., from childhood, medical complication)
• People with significant breathing difficulties (e.g., rely on mechanical ventilation)
• People who rely solely on tube-feeding for all meals and nutrition
• People who have Type I (insulin-dependent) Diabetes
• Women who are pregnant
• People who have allergies to barium, potato starch, corn starch, xanthan gum, milk products, latex or dental glue

Trial design

40 participants in 2 patient groups

Amyotrophic Lateral Sclerosis

Description:

We will be recruiting individuals with confirmed or probably ALS, who experience speech or swallowing problems, to attend one data collection session. All participants will undergo the same protocol, including a Videofluoroscopic Swallowing Examination, and Tongue Strength Measurement.

Treatment:

Other: Tongue Strength Measurement

Diagnostic Test: Videofluoroscopic Swallowing Examination

Parkinson's Disease

Description:

We will be recruiting individuals with a diagnosis of Parkinson's disease, who experience speech or swallowing problems, to attend one data collection session. All participants will undergo the same protocol, including a Videofluoroscopic Swallowing Examination, and Tongue Strength Measurement.

Treatment:

Other: Tongue Strength Measurement

Diagnostic Test: Videofluoroscopic Swallowing Examination