The effects of TTS on swallowing have not yet been investigated in IPD. Clinical studies showed that tactile stimulation of the AFP increases swallowing speed and facilitates deglutition for several minutes. 2008. Group analysis of multiple subjects' data was performed as previously published [47–50]. All participants tolerated the study without any difficulty. 2002, 113 (3): 354-366. 10.1006/nimg.2000.0611. @article{e2cb596f5bcb48c6ae5af3f8794b7bf6. 2004, 22 (4): 1447-1455. To eliminate a bias due to the forced swallows directly before measurement subjects were instructed to swallow 5 times about 3 minutes before the beginning of the MEG recording in the condition without TTOS. It is still unclear whether these findings will translate into a clinically beneficial effect. First results in this field of research revealed an increased cortical excitability evoked by pharyngeal stimulation [20, 21]. Despite the high incidence of aspiration pneumonia after stroke, treatment options for accelerating the recovery of swallowing by improving physiology and reducing aspiration remain limited. 1989, 153 (6): 1197-1199. To distinguish the swallowing execution phase, each individual's EMG signal was used to mark the swallowing related muscle activation. This procedure was performed directly before the corresponding MEG measurement. http://creativecommons.org/licenses/by/2.0. 2001, 25 (2): 249-271. Dysphagia. The corresponding resting stage (R) and two background stages (B1 and B2) are also shortened to 200 ms (Methods). Median pharyngeal delay time was reduced on fluids (0.20 s, 95% CI = 0.12-0.34, p = 0.002). 10.1046/j.1365-2982.2000.00232.x. We hypothesized an increased swallowing related activation of the somatosensory cortex after oropharyngeal stimulation compared to the baseline condition without prior stimulation. Dziewas R, Soros P, Ishii R, Chau W, Henningsen H, Ringelstein EB, Knecht S, Pantev C: Neuroimaging evidence for cortical involvement in the preparation and in the act of swallowing. 1996, 11 (3): 198-206. 1993, 74 (12): 1295-1300. Significant activation in group analysis is shown (p < 0.001). The ex situ FTIR spectra of the 1: 1 (termed as pXDA-rich) film upon thermal stimulation are shown in Figure 4. TTS did not significantly alter median oral transit time on either fluid or paste consistency. 1998, 79 (1): 14-19. Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. By providing sensory stimulation via a cold probe to the anterior faucial arches, sensitivity within the oral cavity is purported to be heightened, leading to a more rapid triggering of the pharyngeal swallow upon Each individual's EMG signal was used to mark the beginning of main muscle activation (M1) and the end of the task-specific muscle activity (M2) for every single swallow (see figure 4). To analyze the chronological changes during swallowing separate calculation of SAM images for each 200 ms interval was calculated. After an initial increase of more than 50% of EMG activity, the beginning of main muscle activation (M1; 100% increase of activation) and the end of swallowing specific muscle activation (M2; 50% decrease of activation) were marked. The tip of the tube was placed in the corner of the mouth between the buccal part of the teeth and the cheek. Similar activation is found in both hemispheres before swallowing onset. She was funded by the Deutsche Forschungsgemeinschaft. 1974, 23 (8): 737-743. CAS Thermal tactile oral stimulation (TTOS) is an established method to treat patients with neurogenic dysphagia especially if caused by sensory deficits. These calculations were done using EMEGS (ElectroMagnetic-EncephaloGraphy Software; http://www.emegs.org/), a tool for analyzing neuroscientific data developed in MATLAB [45]. of thermal sensation disappeared when the middle finger was withdrawn from the central (neutral) stimulator, indicating that congruent tactile stimulation is essential for TR to occur (Green, 1977). Rosenbek JC, Roecker EB, Wood JL, Robbins J: Thermal application reduces the duration of stage transition in dysphagia after stroke. Logemann J: Evaluation and treatment of swallowing disorders. Article Arch Phys Med Rehabil. Disadvantages are higher inter- and intraindividual variability and a higher artifact rate [43]. To estimate the maximal null distribution (see below), a third marker was set to distinguish background activity from the onset of swallowing preparation (M0). The effects of TTS on swallowing have not yet been investigated in IPD. 10.1007/BF00261272. BMC Neuroscience , 10(1), 71. JFORL J Fr Otorhinolaryngol Audiophonol Chir Maxillofac. Due to the startup procedure of the MEG system the overall time between stimulation and the beginning of the measurements was between 2 and 3 minutes. 10.1097/00005537-200212000-00015. Median total transit time was also reduced on fluids (0.48 s, 95% CI = 0.00-1.17, p = 0.049) and on paste (0.52 s, 95% CI = 0.08-1.46, p = 0.033). / Regan, Julie; Walshe, Margaret; Tobin, W. Oliver. The surface temperature of the stick was between -1° and 3°C. In lesion studies left hemispheric infarction was associated with oral stage dysfunction, while dysfunction of the pharyngeal stage was related to right hemispheric lesions [39, 40]. Different behavioural studies examined the effect of oropharyngeal stimulation before. 2004, 115 (10): 2382-2390. c) The difference plot of both measurements (without oropharyngeal stimulation minus with oropharyngeal stimulation) reveals variations mainly during deglutition (after M1). Submental recording of muscle activation is a simple and reliable noninvasive screening method for evaluating swallowing with low levels of discomfort [42]. Vaiman M, Eviatar E, Segal S: Surface electromyographic studies of swallowing in normal subjects: a review of 440 adults. Bottom Line: Not effective as a long-term rehab strategy mixed results in the short term as a compensatory strategy, but overall seemed to speed up the total duration of the swallow due to faster triggering of the pharyngeal swallow appeared to increase stimulation of the brain, From the filtered MEG data, SAM was used to generate a 20 × 20 × 14 cm volumetric pseudo-t images [46] with 3 mm voxel resolution for both frequency bands. ---Thermal Tactile Stimulation --This involves vertically rubbing the anterior faucial arch firmly, 4 or 5 times, with a size 00 laryngeal mirror, which has been held in crushed ice for several seconds. The electrodes were connected to a bipolar amplifier (DSQ 2017E EOG/EMG system, CTF Systems Inc., Canada), and the nominal gain was set at 1. Dysphagia. Dive into the research topics of 'Immediate effects of thermal-tactile stimulation on timing of swallow in idiopathic parkinson's disease'. Clinical sequelae of dysphagia in this group include weight loss and aspiration pneumonia, the latter of which is the leading cause of hospital admissions and death in IPD. The Laryngeal Mirror provides thermal-tactile stimulation during swallowing therapy. IT performed analysis and interpretation of data and drafted the manuscript. In contrast to this, TTOS revealed increased bihemispheric activation with predominant activation of the left somatosensory cortical areas during the whole swallowing interval. Google Scholar. Neurosci Lett. Nichols TE, Holmes AP: Nonparametric permutation tests for functional neuroimaging: a primer with examples. Correspondence to Therefore the results of the normal swallowing condition found in the present study are mainly concordant with the previous investigation. 2006, 21 (1): 21-27. Teismann IK, Dziewas R, Steinstraeter O, Pantev C: Time-dependent hemispheric shift of the cortical control of volitional swallowing. Report 1. PubMed Clinical sequelae of dysphagia in this group include weight loss and aspiration pneumonia, the latter of which is the leading cause of hospital admissions and death in IPD. Median total transit time was also reduced on fluids (0.48 s, 95% CI = 0.00-1.17, p = 0.049) and on paste (0.52 s, 95% CI = 0.08-1.46, p = 0.033). Between 600 ms and 1 s right hemispheric lateralization of activation could be observed. TTS significantly reduced median pharyngeal transit time on fluids (0.20 s, 95% CI = 0.12-0.28, p = 0.004) and on paste (0.3 s, 95% CI = 0.08-0.66, p = 0.01). © 2021 BioMed Central Ltd unless otherwise stated. 2009, 30 (1): 92-100. The time intervals of (3) and (4) were used to estimate the maximum null distribution. 1991, 34 (6): 1257-1268. Arch Phys Med Rehabil. T1-weighted sagittal anatomical images with in-plane resolution of 512 × 512 (0.6 × 0.6 mm resolution) and 320 slices (0.5 mm thickness) were recorded using spoiled gradient echo imaging. Median pharyngeal delay time was reduced on fluids (0.20 s, 95% CI = 0.12-0.34, p = 0.002). J Neurol Neurosurg Psychiatry. Little is known about the possible mechanisms by which this interventional therapy may work. Median pharyngeal delay time was reduced on fluids (0.20 s, 95% CI = 0.12-0.34, p = 0.002). 10.1016/0003-9993(93)90082-L. Daniels SK, Foundas AL, Iglesia GC, Sullivan MA: Lesion site in unilateral stroke patients with dysphagia. Thermal–tactile stimulation (TTS) is a technique employed by clinicians to target a delayed pharyngeal swallowing reflex. Though from the submental EMG data no clear cut between oral and pharyngeal phase can be defined, it is likely that the beginning of submental muscle activation represents at least part of the oral phase, while about 500 ms later and in the end of the recorded submental muscle activation the pharyngeal phase is taking place. This study compared the effectiveness of neuromuscular electrical stimulation and thermal tactile oral stimulation, a traditional swallowing recovery treatment, in patients with sub-acute dysphagia caused by stroke. Additionally to the observed and well known behavioural changes following oropharyngeal stimulation few studies focussed on its effects regarding the cortical level. CAS Then the spatial normalized activation maps were obtained by applying this transformation to the individual SAM volumes. Thermal tactile oral stimulation (TTOS) is an established method to treat patients with neurogenic dysphagia especially if caused by sensory deficits. 1993, 74 (9): 973-976. This is also supported by the MEG study of our group mentioned above [29]. Gastroenterology. Magnetoencephalography (MEG) can monitor cortical activity with a high temporal and spatial resolution [22]. This illusion was first demonstrated in an experiment where three stimulators were touched with the middle three fingers of one hand (from D2: index finger to D4: ring finger). volume 10, Article number: 71 (2009) Tactile stimulation includes the activating of nerve signals beneath the skin's surface that inform the body of texture, temperature and other touch-sensations. 2. Thermal tactile stimulation also, known as thermal application is one type of therapy used for the treatment of swallowing disorders. Surface EMG was measured with two pairs of bipolar skin electrodes (Ag-AgCl) placed on the submental muscle groups [42, 44]. Our results and their interpretation are also supported by behavioural studies employing TTOS showing both changes of oral phase tasks, like a heightened sensitivity of the oral cavity [19] and a reduced delay in swallowing initiation, and modification of the pharyngeal phase, like an improved triggering of the swallowing reflex [32, 33]. 10.1007/s00455-005-9007-2. Exp Brain Res. 2. Though long term changes in swallowing behavior after TTOS could not be shown yet, our findings may point to therapeutical approaches in swallowing rehabilitation. Lazzara and co-workers could show that TTOS on 25 patients with different neurologic diseases resulted in an improved triggering of the swallowing reflex in 23 of these patients [33]. 2003, 20 (1): 135-144. Google Scholar. California Privacy Statement, 1999, 116 (2): 455-478. Changes in the beta-frequency-band during swallowing execution compared to the resting stage. This method involves stroking or rubbing the anterior faucial pillars with a cold probe Neuroimage. Aviv JE, Martin JH, Sacco RL, Zagar D, Diamond B, Keen MS, Blitzer A: Supraglottic and pharyngeal sensory abnormalities in stroke patients with dysphagia. Hum Brain Mapp. Power ML, Fraser CH, Hobson A, Singh S, Tyrrell P, Nicholson DA, Turnbull I, Thompson DG, Hamdy S: Evaluating oral stimulation as a treatment for dysphagia after stroke. 10.1016/j.otohns.2004.03.013. The EMG recording of one swallowing act is shown (surface electrodes, recording from the submental muscles). In the present study functional cortical changes elicited by oral sensory stimulation could be demonstrated. Furlong PL, Hobson AR, Aziz Q, Barnes GR, Singh KD, Hillebrand A, Thompson DG, Hamdy S: Dissociating the spatio-temporal characteristics of cortical neuronal activity associated with human volitional swallowing in the healthy adult brain. The significance of activated brain regions was investigated by the permutation test method described by Chau and co-workers (2004). Postural Techniques (compensatory procedures): Limit the amount of each bolus so the bolus can be held in the pharyngeal recesses and the volume is not so large that it will overflow into the open airway. 10.1007/BF00265206. 10.1002/hbm.20488. Many thermal tactile displays have been developed to Dysphagia is a leading complication in stroke patients causing aspiration pneumonia, malnutrition and increased mortality. Dysphagia. 10.1007/s00455-001-0095-3. 1995, 16 (5): 1087-1092. Immediate effects of thermal-tactile stimulation on timing of swallow in idiopathic parkinson's disease. Daniels SK, Brailey K, Priestly DH, Herrington LR, Weisberg LA, Foundas AL: Aspiration in patients with acute stroke. PubMed Central 2000, 12 (6): 567-572. According to these results MEG data were then filtered in the alpha and beta band. TTS did not significantly alter median oral transit time on either fluid or paste consistency. Tactile-thermal stimulation of the anterior faucial pillars is a traditional method to treat patients with neurogenic dysphagia, but evidence is scarce. Tactile thermal oral stimulation increases the cortical representation of swallowing (2009) Comparing Treatment Intensities of Tactile-Thermal Application (1998) Neuromuscular electrical and thermal-tactile stimulation for dysphagia caused by stroke: A randomized controlled trial (2009) Brain Topogr. It is still unclear whether these findings will translate into a clinically beneficial effect. Jean A, Car A, Roman C: Comparison of activity in pontine versus medullary neurones during swallowing. Key words: swallowing, dysphagia, stroke, neuromuscular electrical stimulation. TTS significantly reduced median pharyngeal transit time on fluids (0.20 s, 95% CI = 0.12-0.28, p = 0.004) and on paste (0.3 s, 95% CI = 0.08-0.66, p = 0.01). Either thermal or taste stimuli are supposed to heighten the sensitivity for swallowing in the oral cavity thereby leading to a more rapid triggering of the swallowing reflex [19]. Pommerenke studied tactile stimuli at several places in the oral cavity and found that the faucial pillars were the most sensitive in triggering swallowing. Lazzara L, Lazarus C, Logemann J: Effects of thermal stimulation on patients with swallowing disorders – A videofluoroscopic analysis. TR is an important phenomenon that reflects how thermal and tactile modalities coordinate to resolve Part of BMC Neurol. Google Scholar. Informed consent was obtained from each subject after the nature of the study was explained in accordance to the principles of the Declaration of Helsinki (2008). This paper reviews the method’s history and selected data, outlines the theoretical underpinnings of sensory stimulation, reminds readers of what is required to bring a treatment from the laboratory to the clinic, and ends with some notions about the importance of belief and data in rehabilitation. Median pharyngeal delay time was reduced on fluids (0.20 s, 95% CI = 0.12-0.34, p = 0.002). Comparisons between the two time intervals, the two hemispheres, and the two groups were performed using two-way ANOVA followed by post-hoc t-tests. Otolaryngol Head Neck Surg. TW and SS have made contributions to conception and design and did data acquisition. 10.1007/s00455-006-9029-4. 10.1097/00001756-200504040-00005. Until now, the underlying basic physiological consequences induced by oropharyngeal stimulation are still unknown [19]. According to the changes of the time-frequency analysis MEG data were than filtered within two frequency bands: alpha (8–13 Hz) and beta (13–30 Hz). BMC Neuroscience About 80 years ago sensory stimulation was first advocated as a method for facilitating swallowing [11]. 1995, 10 (1): 1-5. Teismann IK, Steinstraeter O, Schwindt W, Ringelstein EB, Pantev C, Dziewas R: Age-related changes in cortical swallowing processing. While the artifacts caused by oropharyngeal muscle activation during the act of swallowing make it difficult to study activation in subcortical and bulbar structures, the cortical areas especially the sensorimotor areas can be examined in detail. Vision should be focused on the video screen during measurement to reduce eye movement artifacts. The examiner who set the markers to the datasets was blinded to the two tasks. Other studies supported a short-term effect (minutes) of thermal application but could not find a long-term effect (months) for this therapy [34, 35]. By this the level of attention was kept stable and avoided falling asleep. This simple stimulation paradigm was chosen due to its non invasivness and its easy bedside application. Right hemispheric activation increases over time with a slight decrease in the last time frame (see figure 3). Neurogastroenterol Motil. TTS did not significantly alter median oral transit time on either fluid or paste consistency. 10.1152/ajpgi.00114.2003. Colors represent the level of frequency power (fT/Hz), with lower numbers (blue) indicating a decrease in power (ERD) and higher numbers (red) an increase in power (ERS). Based on their findings, Daniels and co-workers suggested a left hemisphere control for volitional aspects of swallowing and a right hemisphere control for reflexive swallowing behaviour. Y-axis represents frequencies in Hertz. Cold stimulation of the AFP before swallowing hastened the onset of the pharyngeal swallowing phase and reduced the swallowing latency [32, 33]. 1996, 6: 30-34. The MEG recording was done with and without oral stimulation in all 15 subjects investigated. The immediate effects of TTS on swallowing were examined using oral, pharyngeal, and total transit times and pharyngeal delay times as outcome measures. J Clin Neurophysiol. Afterwards the two time intervals "execution" (1) and "predeglution" (5) were defined for further calculations. Thermal–tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. Cook IJ, Kahrilas PJ: AGA technical review on management of oropharyngeal dysphagia.
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