Assessing Swallowing and Mastication Using the Swallowing Proficiency for Eating and Drinking Protocol Among Healthy Adults.

BACKGROUND: Objective evaluation of swallowing using single bolus consistency are popular among Speech-Language Pathologists (SLPs) but has limited generalization to other bolus consistencies. The Swallowing Proficiency for Eating and Drinking (SPEAD) test assesses the oral and pharyngeal phases of swallowing using three different consistencies. OBJECTIVES: The aim of this study was to establish normative data for the SPEAD test among healthy individuals aged 20-79 years. METHOD AND MATERIALS: One hundred and twelve healthy adults recruited from the community were divided into three age groups (20-39.11, 40-59.11, & 60-79.11 years). Participants swallowing 100 g of water and thickened Electral, and 6.67 g of Parle Monaco was video recorded for data analysis. RESULTS: Cronbachs Alpha test indicated good to excellent internal consistency and inter-class correlation test revealed a high level of inter-rater reliability for all SPEAD parameters. Older adults exhibited a higher number of bites, chews, and swallows, and required more time to swallow compared to younger and middle adults. Similarly, speed of ingestion and SPEAD rate were lowest in older adults. SPEAD indices also showed significant differences across the three consistencies at p < 0.01. CONCLUSION: In summary, the SPEAD test was found to be feasible, reliable, and valid in healthy adults of India between 20 and 79 years of age. The age and sex based normative data established in this study will enable SLPs in assessing the presence and / or absence of swallowing difficulties in the oral and pharyngeal phases across different consistencies using one test.

Test of mastication and swallowing solids in healthy individuals aged 6 to 20 years: A normative study in an Indian context.

BACKGROUND: The Test of Mastication and Swallowing Solids (TOMASS) is a reliable tool for assessing chewing and swallowing in healthy adults, using commercially available crackers. TOMASS-Children (TOMASS-C) is the paediatric version of TOMASS. OBJECTIVE: The present study aimed to establish normative data for TOMASS-C using a validated regional commercial cracker among healthy individuals aged between 6-20 years of India. METHODS: 327 healthy individuals between 6-20 years were recruited in a cross-sectional study design following a convenient sampling procedure. Participants consumed one validated regional cracker and the procedure was video recorded. Data were stratified according to age groups (6-7, 8-9, 10-13, 14-17 and 18-20 years) and sex (boys and girls). Two Speech Language Pathologists independently analysed the video recordings to derive discrete bites, masticatory cycles, swallows and total swallow time indices. Using them, time/swallow, masticatory cycles/bite, swallows/bite and time/bite were calculated. RESULTS: All parameters of TOMASS-C had moderate to good (0.6-0.85) test-retest reliability and moderate to excellent (0.69-0.99) inter-rater reliability at p > .000. Younger participants took more bites, chewed more times and swallowed more frequently with longer chewing and swallowing time. Boys exhibited a lower number of swallows, shorter swallow time and reduced total masticatory time at p > .05. Additionally, girls demonstrated fewer bites and chewing cycles compared to boys at p > .05. CONCLUSION: TOMASS-C using a validated regional cracker was feasible and reliable. Normative data established for healthy boys and girls between 6-20 years offers much-needed quantitative data to objectively delineate individuals with and without chewing and swallowing solid food difficulties.

Prevalence of Self-Reported Swallowing Difficulties and Swallowing-Related Quality of Life Among Community-Dwelling Older Adults in India.

Self-reported swallowing difficulties are highly prevalent but underreported among older adults. The aging population in India is increasing, yet there is a lack of empirical data on self-reported swallowing difficulties in older adults. In the present study, we aimed to estimate the prevalence of self-reported swallowing difficulties and assess the swallowing-related quality of life (QOL) among community-dwelling older adults in India. We recruited 361 older adults (60-91 years) from the community. Participants completed the Eating Assessment Tool-10 (EAT-10) to assess self-reported swallowing difficulties and the Dysphagia Handicap Index (DHI) to assess swallowing-related QOL. Participants rated the EAT-10 from 0 for 'no problem' to 4 for 'severe problem'. The DHI rating included 0 for 'never', 2 for 'sometimes', and 4 for 'always'. The total scores of EAT-10 and DHI were summarised using descriptive statistics. Statistically significant differences between pass-fail groups of EAT-10 and DHI were evaluated using an independent t-test and multivariate analysis of variance test, respectively. The overall mean score for EAT-10 was 3.34, and 7.56 for DHI, with higher scores observed among females. 36.6% of older adults self-reported experiencing swallowing difficulties, while 47.4% self-reported having poor swallowing-related QOL at p < 0.05. A strong positive correlation (r = 0.86) was found between EAT-10 and total DHI scores at p < 0.001. The present study sheds light on the widespread yet underreported issue of self-reported swallowing difficulties and the impact on swallowing-related QOL among older adults in India. These findings emphasize the urgent need for early swallowing screening programs among older adults.

A Survey of Speech-Language Pathologists' Applications of Motor Learning Principles in Dysphagia Therapy in Adults in India.

PURPOSE: In the study, we investigated whether speech-language pathologists (SLPs) in India use practice and feedback conditions of motor learning principles (MLPs), including biofeedback, in dysphagia therapy in adults using a problem-solution approach. METHOD: Based on a literature review and clinical experience, we developed and validated a hypothetical case involving an adult with dysphagia (representing the problem) and a purpose-built 22-item questionnaire (representing the solution). We distributed the questionnaire electronically by sending an e-mail to 2,069 SLPs and also published a flyer on the dysphagia special interest group of India. RESULTS: A total of 107 SLPs anonymously submitted their responses. In practice conditions, most of the SLPs reported following massed over distributed, small over large, blocked over random, whole over part, variable over constant, and internal over external practice strategies. In feedback conditions, most of the participants reported using knowledge of results over performance, high over low, immediate over delayed, and self over therapist feedback strategies. Lastly, more than two thirds of SLPs did not use biofeedback devices for dysphagia therapy. CONCLUSION: The findings from our study indicate that SLPs in India do not adhere uniformly to the recommended practices of MLPs for dysphagia therapy in adults.

Vocal Fatigue in Beat Boxers.

PURPOSE: Beatboxers are elite professional voice users with increased vocal loading and therefore are at high risk for developing vocal fatigue. Scientific literature has a wealth of information on self-perceived ratings of vocal fatigue in teachers and singers but not in beat boxers. AIM OF THE STUDY: The present study measured vocal fatigue in beat boxers and compared their rating of vocal tiredness with two control groups. METHOD: One hundred seventeen participants enrolled in an online survey. 40 nonsingers, 37 beat boxers, and 40 untrained singers filled the 19 questions of the standardized Vocal Fatigue Inventory in the English language on the Google Form platform. RESULTS: Mean scores suggest nonsingers rating lowest scores of vocal tiredness followed by beat boxers, and ratings of untrained singers were highest. Statistical significance was observed between and within-group analysis at P < 0.05. Self-awareness of experiencing vocal fatigue was 72.5% and 48.6% in untrained singers and beat boxers, respectively. CONCLUSION: In sum, the state of evidence suggests that beat boxers have lower scores of vocal fatigue than untrained singers.

A Survey on Machine Learning Approaches for Automatic Detection of Voice Disorders.

The human voice production system is an intricate biological device capable of modulating pitch and loudness. Inherent internal and/or external factors often damage the vocal folds and result in some change of voice. The consequences are reflected in body functioning and emotional standing. Hence, it is paramount to identify voice changes at an early stage and provide the patient with an opportunity to overcome any ramification and enhance their quality of life. In this line of work, automatic detection of voice disorders using machine learning techniques plays a key role, as it is proven to help ease the process of understanding the voice disorder. In recent years, many researchers have investigated techniques for an automated system that helps clinicians with early diagnosis of voice disorders. In this paper, we present a survey of research work conducted on automatic detection of voice disorders and explore how it is able to identify the different types of voice disorders. We also analyze different databases, feature extraction techniques, and machine learning approaches used in these research works.

Effects of a Dual Swallow-Attention Task on Swallow and Cognitive Performance Measures.

Research evidence has mounted that cognitive distracters can be detrimental to concurrent motor performance. Yet, few investigations have probed how cognitive distracters might impact dysphagia (swallowing impairment) though secondary tasks, like watching television, now compete with swallowing in a 21st-century lifestyle. Accordingly, we sought to determine whether cognitive distracters while swallowing alter swallowing or cognitive performance among healthy young adults. Participants were 30 healthy volunteers 18-24 years of age who underwent a baseline swallow task (BST), a baseline cognitive task (BCT), and a dual task (DT) in randomized order. The BST consisted of consuming 100 mL of (a) luke warm water (LWW) and (b) carbonated sweet water (CSW). The BCT involved pressing a key to indicate speed or reaction time for completing a number recognition task. In the DT condition, swallow and cognitive tasks were performed concurrently. Volume/swallow (V/S), time/swallow (T/S), and swallow capacity (SC) indices were derived for the swallow task and reaction time in milliseconds reflected cognitive task performance. On comparison between baseline and the DT condition, there was a decrease in V/S, increase in T/S, and an overall reduction in SC across LWW and CSW. Moreover, there was a slower cognitive reaction time in the DT condition. A significant repeated measures of ANOVA difference was noted between baseline and DT conditions ( p < .001). We conclude that swallowing should not be done in the presence of cognitively distracters.

Does Cerebral Hemispheric Laterality Control Swallow Performance?

OBJECTIVES: It is well established that the brainstem regulates the act of swallow. However, the role of cortex and its influence on swallowing are still a question. Hence, the present study aimed to investigate if cerebral hemispheric laterality controls swallow activity. METHODS: Thirty normal right handed participants were subjected to time test of swallow using 100 ml of water. Dual paradigm was used to investigate hemispheric laterality for swallowing which involved listening to the speech or music stimuli presented binaurally while swallowing. The clinician measured total time taken and hyolaryngeal movement simultaneously which was used to calculate volume/time, volume/swallow, and time/swallow on an offline basis. RESULTS: Results revealed that swallow performance decreased with the dual task paradigm compared to baseline swallow. These results are suggestive of cortex playing a role during swallowing in the dual task paradigm. Moreover, quantitative parameters like volume/swallow and volume/time were affected more when speech was competing with swallowing. However, music exerted greater interference over the speech for time/swallow. CONCLUSIONS: These results suggests that there exists differential cue lateralization hypothesis which means volume related parameters are controlled by left hemisphere and time related swallowing parameters are controlled at the right hemisphere.

Spectral Analysis of Hypernasality in Cleft Palate Children: A Pre-Post Surgery Comparison.

INTRODUCTION: Change in resonance is the most commonly experienced speech problems in children diagnosed with cleft lip and palate. The degree of nasality during normal speech production is maintained by the changes in velopharyngeal port. These variations in speech signal are reported to be successfully captured using acoustical tools like spectral analysis. AIM: The present study investigated to note voice low tone to high tone ratio (VLHR) values for phonation samples of individuals with cleft palate before and after surgery. MATERIALS AND METHODS: Thirty children with congenital cleft of palate within 8 to 15 years of age participated in the study. Three trials of sustained vowels (/a/,/i/ and /u/) were recorded at their comfortable pitch and loudness level in a noise free room using a hand held dynamic microphone. Praat software that utilized Hillenbrand algorithm was used to extract the VLHR values for samples recorded before and after recovery from the surgery. RESULTS: Statistical analysis revealed significant decrease in VLHR values after surgery in comparison to before the surgery. Analysis of Variance revealed statistical significant difference at 95% confidence level. CONCLUSION: It is concluded that VLHR parameter could be used as an index to measure nasality and can be included in the routine tool assessment protocol.