Welcome to Dysphagia Grand Rounds (www.dysphagiagrandrounds.com). DGR is an online monthly journal club for speech-language pathologists, focusing on swallowing and swallowing disorders . DGR will post one free dysphagia research article every month. Clinicians are encouraged to read the article and then watch a recorded webinar presented by Dr. Ianessa Humbert, where she further discusses the research study in detail. Clinician Rinki Varindani Desai poses questions at the end of each webinar to discuss its clinical implications. DGR webinars will guide clinicians in learning how to critically appraise dysphagia research literature and integrate it with their clinical practice. Once purchased, the webinars will be added to your DGR Yondo account here under the Courses tab for unlimited viewing, at your own pace. You will receive an email confirmation once you have purchased the course with access details. Thank you for being a part of this endeavor to bridge the research-practice gap in swallowing and swallowing disorders!
The 2017 DGR CEU Bundle is for clinicians who have subscribed to Dysphagia Grand Rounds webinars to earn ASHA CEUs.

Dysphagia Grand Rounds is partnering with an ASHA-approved CEU provider to make 1.0 CEUs (10 hours of continuing education) available to clinicians in 2017. All 10 DGR webinars (January – October 2017) will be available here as they are released, for an annual CEU bundle price of $175 ($150 for 10 webinars and a $25 administrative fee for ASHA CEU submission). Once purchased, clinicians will have unlimited access to watch the recorded webinars online at their own pace anytime. Learning assessment and CEU forms must be submitted just once at the end of the year to earn 1.0 ASHA CEUs. In each webinar, Dr. Ianessa Humbert will discuss the month's research study in detail, train clinicians to learn how to critically appraise dysphagia research literature and discuss the clinical implications of the study with clinician Rinki Varindani Desai at the end, to help clinicians integrate research with their clinical practice.

Here is a list of the 10 Dysphagia Grand Rounds webinar release dates and journal article titles for 2017:

  • DGR 1: January 31, 2017 | Oropharyngeal Swallow in Younger and Older Women - Videofluoroscopic Analysis
  • DGR 2: February 28, 2017 | Oral Perception of Liquid Volume Changes with Age
  • DGR 3: March 31, 2017 | Effects of Surface Electrical Stimulation Both at Rest and During Swallowing in Chronic Pharyngeal Dysphagia
  • DGR 4: April 30, 2017 | Aspiration and Swallowing in Parkinson Disease and Rehabilitation with EMST
  • DGR 5: May 31, 2017 | Randomized Trial Comparing Two Tongue-Pressure Resistance Training Protocols for Post-Stroke Dysphagia
  • DGR 6: June 30, 2017 | Effects of Oral Intake of Water in Patients with Oropharyngeal Dysphagia
  • DGR 7: July 31, 2017 | Omission of Dysphagia Therapies in Hospital Discharge Communications
  • DGR 8: August 31, 2017 | Preliminary Investigation of the Effect of Pulse Rate on Judgments of Swallowing Impairment and Treatment Recommendations
  • DGR 9: September 30, 2017 | Respiratory-Swallow Training in Patients with Head and Neck Cancer
  • DGR 10: October 31, 2017 | Preterm Infant Swallowing of Thin and Nectar-Thick Liquids - Changes in Lingual–Palatal Coordination and Relation to Bolus Transit

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In this free webinar, Dr. Ianessa Humbert provides an introduction to Dysphagia Grand Rounds (DGR) and an overview of basic research methods and terminologies for dysphagia clinicians. Watch this webinar before participating in the Dysphagia Grand Rounds series to have a better understanding of the anatomy of a research paper and commonly used statistical tests that will be discussed in DGR articles and courses throughout the year. Note: This course includes excerpts from the DGR 1 webinar.
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Dysphagia Grand Rounds 1

Article: Oropharyngeal Swallow in Younger and Older Women: Videofluoroscopic Analysis
Authors: Jeri A. Logemann, Barbara Roa Pauloski, Alfred W. Rademaker and Peter J. Kahrilas
Journal: Journal of Speech, Language and Hearing Research, June 2002, Vol. 45, 434-445

Download the article here for free: http://bit.ly/2jA8Vr7
ASHA members can also click here to access the article

Much of the initial research on normal swallowing has been conducted in young men. Recently, there has been increasing interest in determining whether there are differences between the sexes in swallowing function and in the effects of aging on swallowing in both sexes. This investigation examined the swallowing ability of 8 healthy young women between the ages of 21 and 29 and 8 healthy older women between the ages of 80 and 93 during two swallows each of 1 ml and 10 ml liquid boluses. Videofluoroscopic studies of these swallows were reviewed in slow motion and real time to confirm the absence of swallowing disorders. Kinematic analysis of each swallow was completed. Data on range of motion of pharyngeal structures and coordination characteristics of the oropharyngeal swallow were taken from this kinematic analysis. Position of the larynx at rest and length of neck were compared between the two groups. Data from this study were compared with previously published data on younger and older men. Interestingly, the range of motion of the older women was often greater than that of the young women. Only tongue base movement diminished significantly with age in women. Volume effects observed in duration and extent of movement during the 1 ml and 10 ml swallows were similar to those in earlier studies. Older women also exhibited an increased range of motion relative to the old men. This increase may indicate a compensation for aging effects not seen in older men.

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Dysphagia Grand Rounds 2

Article: Oral Perception of Liquids Volume Changes with Age
Authors: Erin Kamarunas, Gary H. McCullough, Mark Mennemeier, and Tiffany Munn
Journal: Journal of Oral Rehabilitation. 2015;42(9):657-662

Download DGR 2 article here:


Bolus volume has been widely studied, and research has demonstrated a variety of physiologic impacts on swallowing and swallowing disorders. Oral perception of bolus volume has not, to our knowledge, been investigated in association with normal aging processes. Research suggests many sensory changes with age, some within the oral cavity, and changes in swallowing function with age have been defined. The role of perception in oropharyngeal deglutition with age requires further investigation.

To establish the psychophysical relationship between liquid volume and oral perception and examine changes with age.

Healthy young and older adults were prospectively assessed using a magnitude estimation task differentiating five volumes of water delivered randomly to the oral cavity.

A fourfold increase in liquid volume is required by older participants to perceive an approximate twofold increase in the perception of volume compared with younger healthy adults.

Sensory receptors in the oral cavity provide a feedback loop that modulates the swallowing motor response so that it is optimal for the size and consistency of the bolus. Changes in perception of bolus volume with age are consistent with other perceptual changes and may provide valuable information regarding sensorineural rehabilitation strategies in the future.

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Dysphagia Grand Rounds 3

Article: Effects of Surface Electrical Stimulation Both at Rest and During Swallowing in Chronic Pharyngeal Dysphagia
Authors: Christy L. Ludlow, Ianessa Humbert, Keith Saxon, Christopher Poletto, Barbara Sonies, and Lisa Crujido
Journal: Dysphagia. 2007; 22(1):1-10

Download DGR 3 article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1790908/

We tested two hypotheses using surface electrical stimulation in chronic pharyngeal dysphagia: that stimulation 1) lowered the hyoid bone and/or larynx when applied at rest, and 2) increased aspiration, penetration or pharyngeal pooling during swallowing. Bipolar surface electrodes were placed on the skin overlying the submandibular and laryngeal regions. Maximum tolerated levels of stimulation were applied while patients held their mouth closed at rest. Videofluoroscopic recordings were used to measure hyoid movements in the superior-inferior (s-i) and anterior-posterior (a-p) dimensions and the subglottic air column (s-i) position while stimulation was on and off. Patients swallowed 5 ml liquid when stimulation was off, at low sensory stimulation levels, and at maximum tolerated levels (motor). Speech pathologists blinded to condition, tallied the frequency of aspiration, penetration, pooling and esophageal entry from videofluorographic recordings of swallows. Only significant (p=0.0175) hyoid depression occurred during stimulation at rest. Aspiration and pooling were significantly reduced only with low sensory threshold levels of stimulation (p=0.025) and not during maximum levels of surface electrical stimulation. Those patients who had reduced aspiration and penetration during swallowing with stimulation had greater hyoid depression during stimulation at rest (p= 0.006). Stimulation may have acted to resist patients’ hyoid elevation during swallowing.

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Dysphagia Grand Rounds 4

Article: Aspiration and Swallowing in Parkinson Disease and Rehabilitation with EMST: A Randomized Trial
Authors: M.S. Troche, M.S. Okun, J.C. Rosenbek, N. Musson, H.H. Fernandez, R. Rodriguez, J. Romrell, T. Pitts, K.M. Wheeler-Hegland, and C.M. Sapienza
Journal: Neurology. 2010;75(21):1912-1919

Download DGR 4 article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995389/


Dysphagia is the main cause of aspiration pneumonia and death in Parkinson disease (PD) with no established restorative behavioral treatment to date. Reduced swallow safety may be related to decreased elevation and excursion of the hyolaryngeal complex. Increased submental muscle force generation has been associated with expiratory muscle strength training (EMST) and subsequent increases in hyolaryngeal complex movement provide a strong rationale for its use as a dysphagia treatment. The current study's objective was to test the treatment outcome of a 4-week device-driven EMST program on swallow safety and define the physiologic mechanisms through measures of swallow timing and hyoid displacement.

This was a randomized, blinded, sham-controlled EMST trial performed at an academic center. Sixty participants with PD completed EMST, 4 weeks, 5 days per week, for 20 minutes per day, using a calibrated or sham, handheld device. Measures of swallow function including judgments of swallow safety (penetration–aspiration [PA] scale scores), swallow timing, and hyoid movement were made from videofluoroscopic images.

No pretreatment group differences existed. The active treatment (EMST) group demonstrated improved swallow safety compared to the sham group as evidenced by improved PA scores. The EMST group demonstrated improvement of hyolaryngeal function during swallowing, findings not evident for the sham group.

EMST may be a restorative treatment for dysphagia in those with PD. The mechanism may be explained by improved hyolaryngeal complex movement.

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Dysphagia Grand Rounds 5

Article: A Randomized Trial Comparing Two Tongue-Pressure Resistance Training Protocols for Post-Stroke Dysphagia

Authors: Catriona M. Steele, Mark T. Bayley, Melanie Peladeau-Pigeon, Ahmed Nagy, Ashwini M. Namasivayam, Shauna L. Stokely, and Talia Wolkin

Journal: Dysphagia. 2016;31(3):452-461

Download DGR 5 article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4871779/

The objective of this study was to compare the outcomes of two tongue resistance training protocols. One protocol (“Tongue-Pressure Profile Training”) emphasized the pressure-timing patterns that are typically seen in healthy swallows by focusing on gradual pressure release and saliva swallowing tasks. The second protocol (“Tongue-Pressure Strength and Accuracy Training”) emphasized strength and accuracy in tongue-palate pressure generation and did not include swallowing tasks. A prospective, randomized, parallel allocation trial was conducted. Of 26 participants who were screened for eligibility, 14 received up to 24 sessions of treatment. Outcome measures of posterior tongue strength, oral bolus control, penetration-aspiration and vallecular residue were made based on videofluoroscopy analysis by blinded raters. Complete data were available for 11 participants. Significant improvements were seen in tongue strength and post-swallow vallecular residue with thin liquids, regardless of treatment condition. Stage Transition Duration (a measure of the duration of bolus presence in the pharynx prior to swallow initiation, which had been chosen to capture impairments in oral bolus control) showed no significant differences. Similarly, significant improvements were not seen in median scores on the Penetration-Aspiration Scale. This trial suggests that tongue strength can be improved with resistance training for individuals with tongue weakness following stroke. We conclude that improved penetration-aspiration does not necessarily accompany improvements in tongue strength, however tongue-pressure resistance training does appear to be effective for reducing thin liquid vallecular residue.

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Dysphagia Grand Rounds 6

ARTICLE: Effects of oral intake of water in patients with oropharyngeal dysphagia

AUTHORS: Martha Karagiannis, Leonie Chivers and Tom Karagiannis

JOURNAL: BMC Geriatrics. 2011;11:9

Download DGR 6 article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3053239/


Dysphagia is associated with numerous medical conditions and the major intervention to avoid aspiration in people with dysphagia involves modifying the diet to thickened fluids. This is associated with issues related to patient quality of life and in many cases non-compliance leading to dehydration. Given these concerns and in the absence of conclusive scientific evidence, we designed a study, to further investigate the effects of oral intake of water in people with dysphagia.

We monitored lung related complications, hydration levels and assessed quality of life in two groups of people with dysphagia. The control group was allowed only thickened fluids and patients in the intervention group were allowed access to water for a period of five days.

Our findings indicate a significantly increased risk in the development lung complications in patients given access to water (6/42; 14.3%) compared to the control group (0/34; no cases). We have further defined patients at highest risk, namely those with degenerative neurologic dysfunction who are immobile or have low mobility. Our results indicate increased total fluid intake in the patients allowed access to water, and the quality of life surveys, albeit from a limited number of patients (24% of patients), suggest the dissatisfaction of patients to diets composed of only thickened fluids.

On the basis of these findings we recommend that acute patients, patients with severe neurological dysfunction and immobility should be strongly encouraged to adhere to a thickened fluid or modified solid consistency diet. We recommend that subacute patients with relatively good mobility should have choice after being well-informed of the relative risk.

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Dysphagia Grand Rounds 7

Article: Omission of Dysphagia Therapies in Hospital Discharge Communications
Authors: Amy Kind, Paul Anderson, Jacqueline Hind, Joanne Robbins, and Maureen Smith
Journal: Dysphagia. 2011;26(1):49-61.

Download DGR 7 article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2888892/


Despite the wide implementation of dysphagia therapies, it is unclear whether these therapies are successfully communicated beyond the inpatient setting.

To examine the rate of dysphagia recommendation omissions in hospital discharge summaries for high-risk sub-acute care (i.e., skilled nursing facility, rehabilitation, long-term care) populations.

Retrospective cohort study

All stroke and hip fracture patients billed for inpatient dysphagia evaluations by speech-language pathologists (SLPs) and discharged to sub-acute care in 2003-2005 from a single large academic medical center (N=187).

Dysphagia recommendations from final SLP hospital notes and from hospital (physician) discharge summaries were abstracted, coded, and compared for each patient. Recommendation categories included: dietary (food and liquid), postural/compensatory techniques (e.g., chin-tuck), rehabilitation (e.g., exercise), meal pacing (e.g., small bites), medication delivery (e.g., crush pills), and provider/supervision (e.g., 1-to-1 assist).

45% of discharge summaries omitted all SLP dysphagia recommendations. 47%(88/186) of patients with SLP dietary recommendations, 82%(93/114) with postural, 100%(16/16) with rehabilitation, 90%(69/77) with meal pacing, 95%(21/22) with medication, and 79%(96/122) with provider/supervision recommendations had these recommendations completely omitted from their discharge summaries.

Discharge summaries omitted all categories of SLP recommendations at notably high rates. Improved post-hospital communication strategies are needed for discharges to sub-acute care.

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