Improvements resulting from respiratory-swallow phase training visualized in patient-specific computational analysis of swallowing mechanics

Abstract

The aim of this study was to visualise improved swallowing mechanics resulting from respiratory–swallow phase training using patient-specific computational analysis of Modified Barium Swallow (MBS) videofluoroscopic images. Imaging from a single subject showing improved MBSImP™© scores in 17 of 18 pre- to post-treatment swallows was selected for analysis. Using a semi-automated MATLAB tracker tool, a frame-by-frame annotation of 10 coordinates mapping muscle functional groups was performed during oropharyngeal swallowing. Computational analysis of coordinate shape change was executed using MorphoJ software to determine differences in swallowing mechanics associated with multiple independent variables. Canonical variant analysis indicated significant differences in mechanics associated with respiratory–swallow phase training (D = 1.92, p < 0.0001). Vectors allowed for visualisation of changes in swallowing mechanics associated with respiratory–swallow phase training. A regression of shape associated with laryngeal vestibular closure on respiratory–swallow phase training was highly significant (p < 0.0001) and accounted for 94.1% of the variance.

Keywords:

• Deglutition
• swallowing mechanics
• computational analysis
• patient specific
• videofluoroscopy
• respiratory–swallow training

Acknowledgements

The authors acknowledge medical illustration student Ali Ennis for her contribution to this manuscript and support from the Medical Scholars Program of the Medical College of Georgia at Georgia Regents University. Completion of this project was supported in part by the following grants: NIDCD 1R21DC010480-A1, Respiratory phase training effects on swallow impairment in oropharyngeal cancer, 2009–2011; VARR&D C7135R, Respiratory–swallow training in veterans with oropharyngeal cancer, 2010–2013; NIDCD, 1K24DC12801, Research and mentoring on swallowing impairment and respiratory–swallow coordination, 2013–2017. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Veterans Administration or the National Institute on Deafness and Other Communication Disorders or the National Institutes of Health.

Funding

This work was supported by the Health Services Research and Development [grant number C7135R]; National Institute on Deafness and Other Communication Disorders [grant number 1K24DC12801], [grant number 1R21DC010480-A1]; Medical College of Georgia [Medical Scholars Program].