Swallowing Physiology and Impairment in Individuals with Amyotrophic Lateral Sclerosis (ALS)
Year: 2019
Type: dissertation
Abstract: Dysphagia, or swallowing impairment, is a common symptom of bulbar disease in Amyotrophic Lateral Sclerosis (ALS). Dysphagia in ALS significantly affects quality of life and places an affected individual at risk of developing chest infections, becoming malnourished, and shortened life expectancy. The purpose of this doctoral thesis is to provide a comprehensive overview of swallowing physiology in ALS and elucidate potential relationships between swallowing physiology and clinical swallowing function. The first chapter of this thesis provides an introductory overview of normal swallowing, dysphagia, and ALS pathology, highlighting commonly reported swallowing impairments and associated complications in individuals with ALS. Chapter 2 builds on this discussion through a comprehensive review of research literature on dysphagia in ALS. Following scoping review methodology, we identified research trends and areas for further exploration, including a need for further quantitative analysis of swallowing physiology. Chapter 3 involves a retrospective, cross-sectional study of swallowing physiology in ALS, using quantitative videofluoroscopic analysis. Measures of pharyngeal area at maximum constriction and swallow-related hyoid kinematics were obtained and compared against reference data to test face validity of the measures and identify changes associated with disease pathology. Through this analysis, we identified reductions in maximum pharyngeal constriction and anterior hyoid movement, compared to healthy reference data. Further, we revealed relationships between enlarged maximum pharyngeal constriction areas and measures of swallowing inefficiency. Expanding on these findings, we completed a comprehensive summary of swallowing physiology and function in ALS, summarized in Chapter 4, comparing additional metrics of swallowing physiology against healthy norms, examining relationships between parameters of swallowing physiology and function (i.e., safety/efficiency), and exploring modulatory effects of liquid thickness. Proposed approaches to future research, incorporating theories of motor control and methodological frameworks, are provided in Chapter 5.
Source: TSpace (University of Toronto)
Author: Ashley A. Waito
Language: English
Subfield: Speech and Hearing
Field: Health Professions
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2975995223