Effects of Chin-Down Maneuver on Pharyngeal Pressure Generation According to Dysphagia and Viscosity

Objective@#To demonstrate the effects of chin-down maneuver on swallowing by using high-resolution manometry (HRM). @*Methods@#HRM data of 20 healthy subjects and 64 dysphagic patients were analyzed. Participants swallowed 5 mL of thin and honey-like liquids in neutral and chin-down positions. HRM was used to evaluate maximal velopharyngeal pressure/area, maximal tongue base pressure/area, maximal pharyngeal constrictor pressure, pre-/post-swallow upper esophageal sphincter (UES) peak pressure, minimal UES pressure, UES activity time, and nadir duration. @*Results@#Compared to the neutral position, the chin-down maneuver significantly increased tongue base pressure in both normal and dysphagic groups as well as for both honey-like and thin viscosities, although the honey-like liquid did not reach statistical significance in the dysphagic group. Regarding pharyngeal constrictors and pre-swallow peak UES pressure, the healthy group showed a significant decrease in thin liquid swallowing and decreasing tendency in honeylike liquid swallowing. UES nadir duration was significantly decreased for honey-like liquid swallowing in the dysphagic group and for both thin and honey-like liquids in the healthy group. UES nadir duration of honey-like and thin flow swallowing in the dysphagia group was 0.26 seconds after the chin-down maneuver, which was severely limited. @*Conclusion@#This study showed a different kinetic effect of the chin-down maneuver between the healthy and dysphagic groups, as well as between thin and honey-like viscosities. The chin-down maneuver increased tongue base pressure and decreased UES nadir duration, which the latter was severely limited in dysphagic patients. Therefore, appropriate application of the chin-down maneuver in clinical practice is required.

Effects of Chin-Down Maneuver on Pharyngeal Pressure Generation According to Dysphagia and Viscosity

Objective@#To demonstrate the effects of chin-down maneuver on swallowing by using high-resolution manometry (HRM). @*Methods@#HRM data of 20 healthy subjects and 64 dysphagic patients were analyzed. Participants swallowed 5 mL of thin and honey-like liquids in neutral and chin-down positions. HRM was used to evaluate maximal velopharyngeal pressure/area, maximal tongue base pressure/area, maximal pharyngeal constrictor pressure, pre-/post-swallow upper esophageal sphincter (UES) peak pressure, minimal UES pressure, UES activity time, and nadir duration. @*Results@#Compared to the neutral position, the chin-down maneuver significantly increased tongue base pressure in both normal and dysphagic groups as well as for both honey-like and thin viscosities, although the honey-like liquid did not reach statistical significance in the dysphagic group. Regarding pharyngeal constrictors and pre-swallow peak UES pressure, the healthy group showed a significant decrease in thin liquid swallowing and decreasing tendency in honeylike liquid swallowing. UES nadir duration was significantly decreased for honey-like liquid swallowing in the dysphagic group and for both thin and honey-like liquids in the healthy group. UES nadir duration of honey-like and thin flow swallowing in the dysphagia group was 0.26 seconds after the chin-down maneuver, which was severely limited. @*Conclusion@#This study showed a different kinetic effect of the chin-down maneuver between the healthy and dysphagic groups, as well as between thin and honey-like viscosities. The chin-down maneuver increased tongue base pressure and decreased UES nadir duration, which the latter was severely limited in dysphagic patients. Therefore, appropriate application of the chin-down maneuver in clinical practice is required.

Characteristics of Neuropathic Pain in Patients With Spinal Cord Injury

OBJECTIVE: To characterize neuropathic pain in patients with spinal cord injury (SCI) according to classification used in the study by Baron et al. (Baron classification), a classification of neuropathic pain based on the mechanism. To also compare the patterns of neuropathic pain in SCI patients with those in patients with other etiologies and to determine the differences in patterns of neuropathic pain between the etiologies. METHODS: This was a descriptive cross-sectional study. We used the Baron classification to investigate the characteristics of neuropathic pain in SCI. Sixty-one SCI patients with neuropathic pain (The Leeds assessment of neuropathic symptoms and signs score > or =12) were enrolled in this study between November 2012 and August 2013, after excluding patients <20 of age, patients with visual analog scale (VAS) score <3, pregnant patients, and patients with systemic disease or pain other than neuropathic pain. RESULTS: The most common pain characteristic was pricking pain followed by electrical pain and numbness. The mean VAS score of at-level neuropathic pain was 7.51 and that of below-level neuropathic pain was 6.83. All of the patients suffered from rest pain, but 18 (54.6%) patients with at-level neuropathic pain and 20 (50.0%) patients with below-level neuropathic pain suffered from evoked pain. There was no significant difference in between at-level and below-level neuropathic pains. CONCLUSION: The result was quite different from the characteristics of post-herpetic neuralgia, but it was similar to the characteristics of diabetic neuropathy as shown in the study by Baron et al., which means that sensory nerve deafferentation may be the most common pathophysiologic mechanism of neuropathic pain after SCI. Since in our study, we included short and discrete symptoms and signs based on diverse mechanisms, our results could be helpful for determining further evaluation and treatment.

Conduction Study of Dorsomedial Cutaneous Nerve to the Great Toe

OBJECTIVE: The dorsomedial cutaneous nerve (DMCN) to the great toe is a branch of the medial dorsal cutaneous nerve, which originates from the superficial peroneal nerve. The objective of this study is to standardize the electrodiagnostic technique, and to investigate the usefulness of dorsomedial cutaneous nerve (DMCN) conduction study in patients with peripheral neuropathy. METHOD: Sixty two legs in 31 normal adults and 56 legs in 28 patients with the clinical signs and symptoms as well as electrodiagnostic evidences of peripheral neuropathy were evaluated with the DMCN conduction study. The stimulating electrode was placed over the lateral 1/3 between medial and lateral malleoli and the active electrode was placed over 12 mm medial and 10 mm proximal to the extensor hallucis longus tendon over the 1st metatarsophalangeal joint. RESULTS: The mean values of DMCN conduction study in normal adults were 2.95+/-0.47 msec for onset latency, 3.58+/-0.43 msec for peak latency, 6.67+/-2.87microvolt in amplitude, and 12.96+/-1.17 cm for distance from active electrode to stimulation point. There were statistically significant differences between normal and patients groups in all parameters except the distance. CONCLUSION: A method for DMCN conduction study was introduced which could be used as a valuable technique for the early evaluation of peripheral neuropathy.