The Relationship Between Submental Surface Electromyography and Hyo-Laryngeal Kinematic Measures of Mendelsohn Maneuver Duration

Alba M Azola, Lindsey R Greene, Isha Taylor-Kamara, Phoebe Macrae, Cheryl Anderson, Ianessa A Humbert, Alba M Azola, Lindsey R Greene, Isha Taylor-Kamara, Phoebe Macrae, Cheryl Anderson, Ianessa A Humbert

Abstract

Purpose: The Mendelsohn Maneuver (MM) is a commonly prescribed technique that is taught to individuals with dysphagia to improve swallowing ability. Due to cost and safety concerns associated with videofluoroscopy (VFS) use, submental surface electromyography (ssEMG) is commonly used in place of VFS to train the MM in clinical and research settings. However, it is unknown whether ssEMG accurately reflects the prolonged hyo-laryngeal movements required for execution of the MM. The primary goal of this study was to examine the relationship among ssEMG duration, duration of laryngeal vestibule closure, and duration of maximum hyoid elevation during MM performance.

Method: Participants included healthy adults and patients with dysphagia due to stroke. All performed the MM during synchronous ssEMG and VFS recording.

Results: Significant correlations between ssEMG duration and VFS measures of hyo-laryngeal kinematic durations during MM performance ranged from very weak to moderate. None of the correlations in the group of stroke patients reached statistical significance.

Conclusion: Clinicians and researchers should consider that the MM involves novel hyo-laryngeal kinematics that may be only moderately represented with ssEMG. Thus, there is a risk that these target therapeutic movements are not consistently being trained.

Figures

Figure 1.
Figure 1.
Raw and rectified data (y-axis: volts; x-axis: seconds) are shown for 1-kHz data (A = Raw, B = Rectified) and 10-kHz data (C = Raw, D = Rectified). EMG = electromyography; MM = Mendelsohn Maneuver.
Figure 2.
Figure 2.
A: Full LVC MM trials of ssEMG and kinematics measure in all participants (seconds) at 1-kHz (white) and 10-kHz (black) sampling frequency. B: Full LVC MM trials of kinematic measures in all participants (seconds). LVC = laryngeal vestibule closure; MM = Mendelsohn Maneuver; ssEMG = submental surface electromyography; dMHE = duration of maximum hyoid elevation; dLVC = duration of laryngeal vestibule closure.
Figure 3.
Figure 3.
Full LVC MM trials of ssEMG and kinematic measures separated by healthy adults (black dots, left graphs) and stroke patients (white dots, right graphs). LVC = laryngeal vestibule closure; MM = Mendelsohn Maneuver; ssEMG = submental surface electromyography; dMHE = duration of maximum hyoid elevation; dLVC = duration of laryngeal vestibule closure.

References

    1. Alfonsi E., Bergamaschi R., Cosentino G., Ponzio M., Montomoli C., Restivo D. A., … Moglia A. (2013). Electrophysiological patterns of oropharyngeal swallowing in multiple sclerosis. Clinical Neurophysiology, 124, 1638–1645.
    1. Bisch E. M., Logemann J. A., Rademaker A. W., Kahrilas P. J., & Lazarus C. L. (1994). Pharyngeal effects of bolus volume, viscosity, and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects. Journal of Speech and Hearing Research, 37, 1041–1059.
    1. Boden K., Hallgren A., & Witt Hedström H. (2006). Effects of three different swallow maneuvers analyzed by videomanometry. Acta Radiologica, 47, 628–633.
    1. Bülow M., Olsson R., & Ekberg O. (2001). Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in patients with pharyngeal dysfunction. Dysphagia, 16, 190–195.
    1. Chi-Fishman G., & Sonies B. C. (2000). Motor strategy in rapid sequential swallowing: New insights. Journal of Speech, Language, and Hearing Research, 43, 1481–1492.
    1. Crary M. A., Carnaby Mann G. D., & Groher M. E. (2006). Biomechanical correlates of surface electromyography signals obtained during swallowing by healthy adults. Journal of Speech, Language, and Hearing Research, 49, 186–193.
    1. Crary M. A., Carnaby Mann G. D., & Groher M. E. (2007). Identification of swallowing events from sEMG signals obtained from healthy adults. Dysphagia, 22, 94–99.
    1. Crary M. A., Carnaby Mann G. D., Groher M. E., & Helseth E. (2004). Functional benefits of dysphagia therapy using adjunctive sEMG biofeedback. Dysphagia, 19, 160–164.
    1. Dantas R. O., & Dodds W. J. (1990). Effect of bolus volume and consistency on swallow-induced submental and infrahyoid electromyographic activity. Brazilian Journal of Medical Biological Research, 23, 37–44.
    1. Ding R., Larson C. R., Logemann J. A., & Rademaker A. W. (2002). Surface electromyographic and electroglottographic studies in normal subjects under two swallow conditions: Normal and during the Mendelsohn Manuever. Dysphagia, 17, 1–12.
    1. Ekberg O. (1982). Closure of the laryngeal vestibule during deglutition. Acta Otolaryngological, 93, 123–129.
    1. Ekberg O., & Sigurjonsson S. (1982). Movement of epiglottis during deglutition. Gastrointestinal Radiologica., 7, 101–107.
    1. Fink B. R. (1974). Folding mechanism of the human larynx. Acta Otolaryngologica, 78, 124–128.
    1. Fink B. R., & Demarest R. J. (1978). Laryngeal biomechanics. New York, NY: Raven Press.
    1. Fink B. R., Martin R. W., & Rohrmann C. A. (1979). Biomechanics of the human epiglottis. Acta Otolaryngologica., 87, 554–559.
    1. Hind J. A., Nicosia M. A., Roecker E. B., Carnes M. L., & Robbins J. (2001). Comparison of effortful and noneffortful swallows in healthy middle-aged and older adults. Archives of Physical Medicine and Rehabilitation, 82, 1661–1665.
    1. Hoffman M. R., Mielens J. D., Ciucci M. R., Jones C. A., Jiang J. J., & McCulloch T. M. (2012). High-resolution manometry of pharyngeal swallow pressure events associated with effortful swallow and the Mendelsohn Maneuver. Dysphagia, 27, 418–426.
    1. Ives J. C., & Wigglesworth J. K. (2003). Sampling rate effects on surface EMG timing and amplitude measures. Clinical Biomechanics (Bristol, Avon), 18, 543–552.
    1. Kahrilas P. J., Logemann J. A., Krugler C., & Flanagan E. (1991). Volitional augmentation of upper esophageal sphincter opening during swallowing. American Journal of Physiology, 260, G450–G456.
    1. Lazarus C., Logemann J. A., & Gibbons P. (1993). Effects of maneuvers on swallowing function in a dysphagic oral cancer patient. Head Neck, 15, 419–424.
    1. Logemann J. A., Kahrilas P. J., Cheng J., Pauloski B. R., Gibbons P. J., Rademaker A. W., & Lin S. (1992). Closure mechanisms of laryngeal vestibule during swallow. American Journal of Physiology, 262, G338–G344.
    1. Masako F., & Logemann J. A. (1996). Effect of a tongue-holding maneuver on posterior pharyngeal wall movement during deglutition. American Journal of Speech-Language Pathology, 5, 23–30.
    1. McCullough G. H., Kamarunas E., Mann G. C., Schmidley J. W., Robbins J. A., & Crary M. A. (2012). Effects of Mendelsohn Maneuver on measures of swallowing duration post stroke. Top Stroke Rehabilitation, 19, 234–243.
    1. Nagaya M., Kachi T., Yamada T., & Sumi Y. (2004). Videofluorographic observations on swallowing in patients with dysphagia due to neurodegenerative diseases. Nagoya Journal of Medical Science, 67, 17–23.
    1. Ohmae Y., Logemann J. A., Kaiser P., Hanson D. G., & Kahrilas P. J. (1996). Effects of two breath-holding maneuvers on oropharyngeal swallow. Annals of Otological Rhinological Laryngology, 105, 123–131.
    1. Palmer P. M., Jaffe D. M., McCulloch T. M., Finnegan E. M., Van Daele D. J., & Luschei E. S. (2008). Quantitative contributions of the muscles of the tongue, floor-of-mouth, jaw, and velum to tongue-to-palate pressure generation. Journal of Speech, Language, and Hearing Research, 51, 828–835.
    1. Park T., Kim Y., Ko D. H., & McCullough G. (2010). Initiation and duration of laryngeal closure during the pharyngeal swallow in post-stroke patients. Dysphagia, 25, 177–182.
    1. Pearson W. G. Jr., Hindson D. F., Langmore S. E., & Zumwalt A. C. (2013). Evaluating swallowing muscles essential for hyolaryngeal elevation by using muscle functional magnetic resonance imaging. International Journal of Radiation Oncological Biological Physiology, 85, 735–740.
    1. Power M. L., Hamdy S., Singh S., Tyrrell P. J., Turnbull I., & Thompson D. G. (2007). Deglutitive laryngeal closure in stroke patients. Journal of Neurology, Neurosurgery, & Psychiatry, 78, 141–146.
    1. Salmoni A. W., Schmidt R. A., & Walter C. B. (1984). Knowledge of results and motor learning: A review and critical reappraisal. Psychological Bulletin, 95, 355–386.
    1. Sidaway B., Ahn S., Boldeau P., Griffin S., Noyes B., & Pelletier K. (2008). A comparison of manual guidance and knowledge of results in the learning of a weight-bearing skill. Journal of Neurological Physical Therapy, 32, 32–38.
    1. Stepp C. E. (2012). Surface electromyography for speech and swallowing systems: Measurement, analysis, and interpretation. Journal of Speech, Language, and Hearing Research, 55, 1232–1246.
    1. van Vliet P. M., & Wulf G. (2006). Extrinsic feedback for motor learning after stroke: What is the evidence? Disability Rehabilitation, 28(13–14), 831–840.
    1. Wheeler-Hegland K. M., Rosenbek J. C., & Sapienza C. M. (2008). Submental sEMG and hyoid movement during Mendelsohn Maneuver, effortful swallow, and expiratory muscle strength training. Journal of Speech, Language, and Hearing Research, 51, 1072–1087.
    1. Zamir Z., Ren J., Hogan W. J., & Shaker R. (1996). Coordination of deglutitive vocal cord closure and oral-pharyngeal swallowing events in the elderly. European Journal of Gastroenterological Hepatology, 8, 425–429.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj