Effects of Bolus Holding on Respiratory–Swallow Coordination in Parkinson's Disease

Purpose: The aim of this study was to examine the effects of bolus holding on respiratory–swallow coordination (RSC) in people with Parkinson's disease (PD). Method: People with PD were prospectively recruited to undergo RSC assessment using simultaneous respiratory inductive plethysmography and flexible laryngoscopy. During RSC assessment, participants swallowed 5-ml thin liquid boluses during held and nonheld swallowing tasks. Measures of RSC were analyzed for each swallow, which included respiratory pause duration, lung volume at swallow initiation, respiratory phase patterning, and the presence of paradoxical respiratory movements. Multilevel statistical modeling was used to determine if differences in RSC were present between the held and nonheld tasks. Results: Thirty-three participants were enrolled. When compared to the nonheld swallows, the held swallows exhibited shorter respiratory pauses ( p = .001, R 2 = .019), lower lung volumes at swallow initiation ( p < .001, R 2 = .116), more frequent exhale–swallow–exhale patterns ( p < .001, OR = 4.30), and less frequent paradoxical respiratory movements ( p = .001, OR = 0.43). Conclusions: Findings from this study revealed that bolus holding significantly influences RSC in people with PD. This demonstrates that bolus holding may be an efficacious strategy to immediately improve RSC in PD. However, clinicians and researchers should consider avoiding bolus holding during swallowing evaluations if attempting to assess RSC behaviors that are most typical for the examinee.

Cardiopulmonary coupling analysis using smart wearables and mobile computing

Cardiopulmonary coupling (CPC) analysis links heart and respiration rates to assess sleep-related parameters. Typically, the CPC is measured using multi-lead electrocardiography (ECG) and ECG-derived respiration (EDR). Novel textile shirts with embedded ECG sensors offer convenient and continuously monitored sleep at home. We investigate the feasibility of a shirt with textile sensors (Pro- Kit, Hexoskin, Quebec, Canada) for CPC analysis by mobile computing. ECG data is continuously transmitted from the shirt to a smartphone via Bluetooth Low Energy (BLE). We customize a CPC algorithm and use twelve whole-night recordings from four volunteers to perform qualitative and quantitative analysis. We compare EDR with respiratory inductive plethysmography (RIP). In average, EDR and RIP differ 17.22%. After one night, the batteries are reduced to approx. 70% (shirt) and 90% (smartphone). The run time for CPC processing is approx. 3 min. Hence, smart wearables in combination with mobile computing show technical feasibility for CPC analysis. Eventually, this could yield a useful solution for sleep analysis of non-expert users in a private environment.

Respiratory–Swallow Coordination Training Improves Swallowing Safety and Efficiency in a Person With Anoxic Brain Injury

Purpose The aim of this study was to assess the effects of respiratory–swallow coordination training (RSCT) on respiratory–swallow coordination (RSC), swallowing safety (penetration/aspiration), and swallowing efficiency (pharyngeal residue) in a person with anoxic brain injury. Method A 68-year-old man with anoxic brain injury, tachypnea, and severe dysphagia was recruited to participate in a prospective AABAA single-subject experimental design. RSC, swallowing safety, and swallowing efficiency were measured at each assessment using respiratory inductive plethysmography and flexible endoscopic evaluations of swallowing. Data were analyzed descriptively using Cohen's d effect size. Outcome measures were compared pre-RSCT to post-RSCT, and pre-RSCT to a 1-month retention assessment. Results Improvements in RSC were observed immediately post-RSCT ( d = 0.60). These improvements were maintained upon retention assessment 1 month later ( d = 0.60). Additionally, improvements in swallowing safety ( d = 1.73), efficiency ( d = 1.73), and overall dysphagia severity ( d = 1.73) were observed immediately post-RSCT and were maintained upon retention assessment 1 month later ( d = 1.73). Conclusions Clinically meaningful improvements in RSC were observed following four sessions of RSCT, which were subsequently associated with large improvements in swallowing safety and efficiency. RSCT may be an efficacious, clinically feasible skill-based exercise for people with anoxic brain injury, suboptimal RSC, and dysphagia. Future work is needed to expand these findings in a larger cohort of people with dysphagia.

Knitted Coil for Inductive Plethysmography

Knitting a thin insulated metal wire simultaneously with elastic yarn in the round creates a coil with a self-inductance close to a wound coil. This knit is flexible and can be stretched, allowing the diameter of the coil to change, resulting in a change of its self-inductance. It is found that rib stitch gives the highest inductance but stocking stitch gives the highest variation of self-inductance with changing diameter. The feasibility of using the knitted coil for inductive plethysmography is demonstrated by simulated breathing in a baby jumper with knitted coils.