1997, 272 (4 Pt 1): G802-808. Tactile-thermal stimulation of the anterior faucial pillars is a traditional method to treat patients with neurogenic dysphagia, but evidence is scarce. On the other hand it remains unclear whether the observed effects are related to functional cortical reorganization or are more unspecific reactions to differences in attention due to the afferent input. Briefly, the individual MRIs were first transformed into a common anatomical space using SPM2. RD made substantial contributions to conception and design, and has given final approval of the version to be published. 2002, 17 (1): 1-12. We took care that the tongue was not at all touched by the ice stick. 10.1016/j.neuroimage.2004.02.041. Immediate effects of thermal-tactile stimulation on timing of swallow in idiopathic parkinson's disease. The required similarity between the resting stage and the two background stages in both examined groups was proven before by a direct comparison of these 3 stages. PubMed This illusion was first demonstrated in an experiment where three stimulators were touched with the middle three fingers of one hand (from D2: index finger to D4: ring finger). 10.1097/00001756-200504040-00005. Tactile thermal oral stimulation increases the cortical representation of swallowing. J Speech Hear Res. Manage cookies/Do not sell my data we use in the preference centre. Significant results may be attributed to the role of sensory stimulation in improving motor function in IPD, with emphasis on the impaired glossopharyngeal and vagus nerves in this population. J Clin Neurophysiol. Interestingly, the illusion was reported to disappear when the middle digit was lifted off the thermal stimulator, suggesting that tactile stimulation is … The present study revealed an increment of cortical swallowing activation after TTOS in healthy subjects. All authors read and approved the final version of the manuscript. Junghoefer M, Peyk P: Analysis of electrical potentials and magnetic fields of the brain. The effects of TTS on swallowing have not yet been investigated in IPD. The corresponding resting stage served as a control. 10.1016/0003-9993(93)90082-L. Daniels SK, Foundas AL, Iglesia GC, Sullivan MA: Lesion site in unilateral stroke patients with dysphagia. • Patient will utilize thermal tactile stimulation to increase oral sensation for safe consumption of least restrictive diet with (min/mod/max) verbal, visual and tactile cues • The patient will move the bolus to the back of the mouth and propel the food and liquid in a timely manner with thermal tactile stimulation to safely consume least restrictive diet with (min/mod/max) verbal, visual and tactile … Apart from that, electrical pharyngeal stimulation showed an increase of cortical excitability in different TMS studies [20, 38]. Event related desynchronizations in the beta frequency band during the five successive 200 ms time intervals of the swallowing execution phase is shown for both groups. Number of swallows (normal swallowing: 39 – 141 swallows in 15 min, mean 73.5; oral stimulation: 41 – 139, mean 73.7; p = 0.774) as well as duration per swallow (1.13 – 2.88 s, mean 2.06 s, oral stimulation: 1.37 – 2.68; mean: 2.15; p = 0.7945) did not differ between the two tasks. Methods. Neurobiol Aging. Clinical studies showed that tactile stimulation of the AFP increases swallowing speed and facilitates deglutition for several minutes. Further studies have to show if stimulation intensity, frequency or treatment duration lead to different results in swallowing behavior and in the consecutive cortical activations. 1998, 79 (1): 14-19. Stroke direction was from top (medial) to bottom (lateral). The amount of water swallowed during the two compared measurements was identical for each subject. Other studies supported a short-term effect (minutes) of thermal application but could not find a long-term effect (months) for this therapy [34, 35]. The immediate effects of TTS on swallowing were examined using oral, pharyngeal, and total transit times and pharyngeal delay times as outcome measures. The immediate effects of TTS on swallowing were examined using oral, pharyngeal, and total transit times and pharyngeal delay times as outcome measures. Google Scholar. The enhanced swallowing ability seen in dysphagic patients observed after application of TTOS [32, 33] supports the hypothesis of cortical reorganization. The corresponding resting stage (R) and two background stages (B1 and B2) are also shortened to 200 ms (Methods). Daniels SK, Corey DM, Fraychinaud A, DePolo A, Foundas AL: Swallowing lateralization: the effects of modified dual-task interference. Terms and Conditions, A difference plot of both conditions demonstrates stronger desynchronization in the stimulation condition compared to the reference measurement (see figure 1c). It is hypothesized that the touch and cold stimulation increases “oral awareness” and provides “an alerting sensory stimulus to the cortex and brainstem, such Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. This method involves stroking or rubbing the anterior faucial pillars with a cold probe In the alpha frequency band and other cortical areas no significant activation was observed in either of the two conditions. This study is aimed to investigate whether thermal oral (tongue) stimulation can modulate … The surface temperature of the stick was between -1° and 3°C. Hamdy S, Aziz Q, Rothwell JC, Hobson A, Barlow J, Thompson DG: Cranial nerve modulation of human cortical swallowing motor pathways. To define the active frequency bands and to examine the temporal sequencing of activation time-frequency plots were calculated using wavelet analysis. Springer Nature. 2002, 318 (2): 73-76. Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. Clin Neurophysiol. Google Scholar. Informed consent was obtained from each subject after the nature of the study was explained in accordance to the principles of the Declaration of Helsinki (2008). 1991, 34 (6): 1257-1268. Ludlow CL, Humbert I, Saxon K, Poletto C, Sonies B, Crujido L: Effects of surface electrical stimulation both at rest and during swallowing in chronic pharyngeal Dysphagia. Dysphagia. By using this website, you agree to our c) The difference plot of both measurements (without oropharyngeal stimulation minus with oropharyngeal stimulation) reveals variations mainly during deglutition (after M1). Therefore the results of the normal swallowing condition found in the present study are mainly concordant with the previous investigation. Thermal Receptors Nerve endings beneath the epidermis report to the brain on cold and warmth as feedback of tactile stimulation. Google Scholar. Julie Regan, Margaret Walshe, W. Oliver Tobin, Research output: Contribution to journal › Article › peer-review. The immediate effects of TTS on swallowing were examined using oral, pharyngeal, and total transit times and pharyngeal delay times as outcome measures. Dziewas R, Ritter M, Schilling M, Konrad C, Oelenberg S, Nabavi DG, Stogbauer F, Ringelstein EB, Ludemann P: Pneumonia in acute stroke patients fed by nasogastric tube. The end of task-specific muscle activity was defined as a decrease in amplitude or frequency of the EMG signal greater than 50%. Furlong PL, Hobson AR, Aziz Q, Barnes GR, Singh KD, Hillebrand A, Thompson DG, Hamdy S: Dissociating the spatio-temporal characteristics of cortical neuronal activity associated with human volitional swallowing in the healthy adult brain. Otolaryngol Head Neck Surg. RMS of EMG amplitude across the swallow interval (M0 – M2) showed no difference in EMG power by comparison swallowing after and without oropharyngeal stimulation (p = 0.8347). Arch Phys Med Rehabil. Article Current strategies of swallowing therapy involve on the one hand modification of either eating behaviour or swallowing technique and on the other hand facilitation of swallowing with the use of TTOS. TTS significantly reduced median pharyngeal transit time on fluids (0.20 s, 95% CI = 0.12-0.28, p = 0.004) and on paste (0.3 s, 95% CI = 0.08-0.66, p = 0.01). This is to our knowledge the first study showing cortical changes elicited by this simple swallowing therapy technique. It helps trigger a swallow by stimulating the anterior pillars of faces. Teismann IK, Steinstraeter O, Schwindt W, Ringelstein EB, Pantev C, Dziewas R: Age-related changes in cortical swallowing processing. 10.1016/j.otohns.2004.03.013. 2007, 22 (1): 1-10. Due to the startup procedure of the MEG system the overall time between stimulation and the beginning of the measurements was between 2 and 3 minutes. 10.1016/S1388-2457(02)00007-X. Thirteen participants with IPD and known dysphagia attended for videofluoroscopy during which standardised volumes of liquid barium and barium paste were administered preceding and immediately subsequent to TTS. The data were filtered during acquisition using a 150 Hz low-pass filter. Thermal tactile oral stimulation (TTOS) is an established method to treat patients with neurogenic dysphagia especially if caused by sensory deficits. Either thermal or taste stimuli are supposed to heighten the sensitivity for swallowing in the oral cavity thereby leading to a more rapid triggering of the swallowing reflex . Dysphagia. Thermal tactile stimulation also, known as thermal application (Rosenbek, Robbins, Fishback, & Levine, 1991, p. 1258) is one type of therapy used for the treatment of swallowing disorders. This swallowing rate was chosen to gain enough data within reasonable short measurement duration. By this physiological changes on the cortical level induced by this widely used tool of dysphagia rehabilitation are shown. This suggests that afferents from the oral-pharyngeal chemoreceptors can facilitate deglutition . In each subject, both measurements were 14 days apart. AJNR Am J Neuroradiol. Group analysis of SAM results revealed significant event related desynchronizations (ERD) in the beta frequency band located in the primary sensorimotor cortex (BAs 4, 3, 1, and 2) in both conditions (p < 0.05) (see figure 2). 10.1006/meth.2001.1238. In order to examine the chronological sequence of brain activation, the execution stage was divided into 5 parts, each lasting 200 ms. Time intervals including the according resting stages for the subsequent analysis were defined as follows (see figure 5): EMG recording with division of the execution stage. The immediate effects of TTS on swallowing were examined using oral, pharyngeal, and total transit times and pharyngeal delay times as outcome measures. To distinguish the swallowing execution phase, each individual's EMG signal was used to mark the swallowing related muscle activation. To estimate the maximal null distribution (see below), a third marker was set to distinguish background activity from the onset of swallowing preparation (M0). 1998, 13 (1): 10-11. To eliminate a bias due to the forced swallows directly before measurement subjects were instructed to swallow 5 times about 3 minutes before the beginning of the MEG recording in the condition without TTOS. Daniels SK, Brailey K, Priestly DH, Herrington LR, Weisberg LA, Foundas AL: Aspiration in patients with acute stroke. Little is known about the possible mechanisms by which this interventional therapy may work. Further examinations employing TTOS in dysphagic patients have to show that increased cortical activation is paralleled by an improved swallowing performance. [Purpose] The effectiveness of neuromuscular electrical stimulation in the rehabilitation of swallowing remains controversial. Significant results may be attributed to the role of sensory stimulation in improving motor function in IPD, with emphasis on the impaired glossopharyngeal and vagus nerves in this population. The aim of this study was to investigate the immediate effects of TTS on the timing of swallow in a cohort of people with IPD and known oropharyngeal dysphagia. Tactile-thermal application for treating dysphagia has a tumultous history. TTS did not significantly alter median oral transit time on either fluid or paste consistency. Though long term changes in swallowing behavior after TTOS could not be shown yet, our findings may point to therapeutical approaches in swallowing rehabilitation. Submental recording of muscle activation is a simple and reliable noninvasive screening method for evaluating swallowing with low levels of discomfort . In thermal referral, simultaneous presentation of thermal and tactile stimulation on different skin sites produces an illusory thermal sensation at the site of tactile stimulation. Moreover the authors compared the motor electrical stimulation (ES) approach with the thermal-tactile stimulation (TS) approach. channel, thermal stimulation has similar emotional effects when generating warm and cold sensations. Data were analyzed by means of synthetic aperture magnetometry (SAM) and the group analysis of individual SAM data was performed using a permutation test. Another advantage compared to needle EMG is the broader muscle spectrum that can be recorded. Fifteen healthy right-handed volunteers (7 males, 8 females, age range 25 – 57 years, mean 30.4 years) served as subjects. BMC Neurosci 10, 71 (2009). It is still unclear whether these findings will translate into a clinically beneficial effect. A pseudo-t value cancels the common-mode brain activity by subtracting the source power found in a defined control stage from the source power in the active stage. ---Thermal Tactile Stimulation --This involves vertically rubbing the anterior faucial arch firmly, 4 or 5 times, with a size 00 laryngeal mirror, which has been held in crushed ice for several seconds. The maximum pseudo-t value increased in the TTOS condition (34.1% in the right hemisphere, 13.6% in the left hemisphere). Key words : swallowing, dysphagia, stroke, neuromuscular electrical stimulation. 2004, 115 (10): 2382-2390. 10.1007/BF00265206. 2003, 20 (1): 135-144. Clinical sequelae of dysphagia in this group include weight loss and aspiration pneumonia, the latter of which is the leading cause of hospital admissions and death in IPD. 1996, 11 (4): 225-233. Thirteen participants with IPD and known dysphagia attended for videofluoroscopy during which standardised volumes of liquid barium and barium paste were administered preceding and immediately subsequent to TTS. Similar activation is found in both hemispheres before swallowing onset. Additionally to the observed and well known behavioural changes following oropharyngeal stimulation few studies focussed on its effects regarding the cortical level. Despite the high incidence of aspiration pneumonia after stroke, treatment options for accelerating the recovery of swallowing by improving physiology and reducing aspiration remain limited. This method involves stroking or rubbing the anterior faucial pillars with a cold probe prior to having the patient swallow. This simple stimulation paradigm was chosen due to its non invasivness and its easy bedside application. Dysphagia. Dysphagia. Also taste stimuli have been shown effects on swallowing. In the present study we could demonstrate an increase of cortical activation after thermal tactile oral stimulation. The first study focusing on this topic in 1997 demonstrated a facilitation of the cortical pathways by cranial nerve stimulation . Dysphagia. Colors represent the level of frequency power (fT/Hz), with lower numbers (blue) indicating a decrease in power (ERD) and higher numbers (red) an increase in power (ERS). Median total transit time was also reduced on fluids (0.48 s, 95% CI = 0.00-1.17, p = 0.049) and on paste (0.52 s, 95% CI = 0.08-1.46, p = 0.033). 1999, 16 (6): 512-519. The time-frequency plots of the parietal channels were determined for both hemispheres and averaged across all subjects in each group. Together they form a unique fingerprint. The aim of this study was to investigate the immediate effects of TTS on the timing of swallow in a cohort of people with IPD and known oropharyngeal dysphagia. Significant results may be attributed to the role of sensory stimulation in improving motor function in IPD, with emphasis on the impaired glossopharyngeal and vagus nerves in this population. 10.1007/s00455-005-9007-2. McKeown MJ, Torpey DC, Gehm WC: Non-invasive monitoring of functionally distinct muscle activations during swallowing. There is little data reporting the effectiveness of this therapy. Since TS method is basically a sensory approach to trigger the swallowing reflex, this comparison in order to establish the efficacy of … 2005, 16 (5): 439-443. Thirteen participants with IPD and known dysphagia attended for videofluoroscopy during which standardised volumes of liquid barium and barium paste were administered preceding and immediately subsequent to TTS. The aim of this study was to investigate the immediate effects of TTS on the timing of swallow in a cohort of people with IPD and known oropharyngeal dysphagia. Median total transit time was also reduced on fluids (0.48 s, 95% CI = 0.00-1.17, p = 0.049) and on paste (0.52 s, 95% CI = 0.08-1.46, p = 0.033). This paper reviews the method’s history and selected data, outlines the theoretical underpinnings of sensory stimulation, reminds readers of what is required to bring a treatment from the laboratory to the clinic, and ends with some notions about the importance of belief and data in rehabilitation. Dodds WJ, Taylor AJ, Stewart ET, Kern MK, Logemann JA, Cook IJ: Tipper and dipper types of oral swallows. thermal-tactile stimulation is a better treatment for patients with swallowing disorders after stroke than thermal-tactile stimulation alone. 2008, 8 (1): 13-10.1186/1471-2377-8-13. CAS We suggest that these results reflect short-term cortical plasticity of sensory swallowing areas. Wavelet analysis of the parietal areas. 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In both conditions significantly alter median oral transit time on either fluid or paste consistency hypothesized that touch! Datasets was blinded to the anterior faucial pillars to speed up the pharyngeal swallowing phase 34.1 % the... S disease ( IPD ) right hemispheric lateralization, while a negative LI indicates hemispheric. Tobin, W. Oliver } '', https: //doi.org/10.1007/s00455-009-9244-x thermal stimulations on video... Sensor array ( Omega 275, CTF Systems Inc. ) of active resting! Skin 's surface that inform the body of texture, temperature and other touch-sensations self-paced volitional swallowing without stimulation!