A Novel Hierarchical Framework for Measuring the Complexity and Irregularity of Multimodal Speech Signals and Its Application in the Assessment of Speech Impairment in Amyotrophic Lateral Sclerosis

Purpose The purposes of this study are to develop a novel multimodal framework for measuring variability at the muscular, kinematic, and acoustic levels of the motor speech hierarchy and evaluate the utility of this framework in detecting speech impairment in amyotrophic lateral sclerosis (ALS). Method The myoelectric activities of three bilateral jaw muscle pairs (masseter, anterior temporalis, and anterior belly of digastric), jaw kinematics, and speech acoustics were recorded in 13 individuals with ALS and 10 neurologically healthy controls during sentence reading. Thirteen novel measures (six muscular, three kinematic, four acoustic), which characterized two different but interrelated aspects of variability—complexity and irregularity—were derived using linear and nonlinear methods. Exploratory factor analysis was applied to identify the latent factors underlying these measures. Based on the latent factors, three supervised classifiers—support vector machine (SVM), random forest (RF), and logistic regression (Logit)—were used to differentiate between the speech samples for patients and controls. Results Four interpretable latent factors were identified, representing the complexity of jaw kinematics, the irregularity of jaw antagonists functioning, the irregularity of jaw agonists functioning, and the irregularity of subband acoustic signals, respectively. Based on these latent factors, the speech samples for patients and controls were classified with high accuracy (> 96% for SVM and RF; 88.64% for Logit), outperforming the unimodal measures. Two factors showed significant between-groups differences, as characterized by decreased complexity of jaw kinematics and increased irregularity of jaw antagonists functioning in patients versus controls. Conclusions Decreased complexity of jaw kinematics presumably reflects impaired fine control of jaw movement, while increased irregularity of jaw antagonists functioning could be attributed to reduced synchronization of motor unit firing in ALS. The findings provide preliminary evidence for the utility of the multimodal framework as a novel quantitative assessment tool for detecting speech impairment in ALS and (potentially) in other neuromotor disorders.

Preemptive Utilization of Anterior Belly of the Digastric Muscle Flaps in Transoral Robotic Radical Tonsillectomy

Objective To demonstrate the use of an anterior belly of the digastric muscle flap (ABDMF) during transoral robotic radical tonsillectomy (TORRT) with concomitant neck dissection with the intent of preventing the formation of postoperative pharyngocutaneous fistulas. Study Design Retrospective study. Setting Single academic tertiary care center. Methods In this study, all patients were included who underwent TORRT plus limited pharyngectomy with concomitant neck dissection and ABDMF for the treatment of oropharyngeal squamous cell carcinoma between September 2012 and September 2020. The rate of fistula formation was assessed in patients with preemptive utilization of ABDMF. Results A total of 43 patients underwent TORRT with neck dissection and ABDMF. No patients developed a fistula in the postoperative period or associated morbidity with the use of this flap. Conclusion Preemptive use of ABDMF in TORRT with concomitant neck dissection represents a reconstructive option that may help prevent the formation of pharyngocutaneous fistula by reinforcing the posteroinferior boundary of the parapharyngeal space.

Ultrasound examination of swallowing disorder characteristics in patients with oncopathology of the oral cavity

The aim of the study was to compare the dynamics of oral and oropharyngeal muscles contraction during swallowing in normal individuals and in patients with malignant tumors depending on the clinical disease using ultrasound. Materials and methods. The study included 29 patients aged 38–55 years (men), normtrophic, who were treated in the Department of Head and Neck Tumors of Podolsk Regional Oncology Center for malignant tumors of the tongue, floor of the mouth and oropharynx. Among them, there were 12 patients with cancer of the lateral tongue surface, 9 - with oral mucosa cancer and 8 – with tongue base cancer. Scanning was performed in the sagittal and frontal planes with a 7.5 MHz sensor in two modes (B and M) at rest and during swallowing in several stages on the TOSHIBA device (Model USDI-A500A/EL; Serial No. ELA14Z2082). B-mode was the main one in all the studied areas where one image frame was vertically lined up. The swallowing act was assessed in M-mode (a length of the axial movement). The obtained indicators were compared with the normal ones. Results. The work was carried out to verify the musculoskeletal complex involved in the act of swallowing. Measurements of several indicators were performed revealing a violation of the swallowing act, namely a decrease in indicators in the longitudinal and lateral examination of the sublingual muscle group in B-mode and M-mode in patients diagnosed with cancer of the tongue base and mucosa of the mouth floor. In addition, a deviation and displacement of the musculoskeletal complex to the healthy contralateral side with preserved muscle function in patients diagnosed with the lateral tongue surface cancer was revealed by M-mode ultrasound of the swallowing act. Conclusions. In patients with malignant tumors of the lateral tongue surface, the longitudinal examination of the sublingual muscle group in B-mode ultrasound showed decreased indicators by 7 % and in the lateral projection of the anterior belly of the digastric muscle in M-mode – by 3.5 times. In tongue base cancer, the mentohyoid distance was merely 4 mm reduced during the act of swallowing, and in the longitudinal projection of the sublingual muscle group - by only 5 %. In oral mucosa cancer, there was the lowest reduction in the mentohyoid distance, about 4 mm when swallowing, (in healthy people 8–12 mm) and decreased indicators in longitudinal examination of the sublingual muscle group by 8 % in B-mode, in lateral M-mode ultrasound – by 2 mm.

Comparison of three different types of exercises for selective contractions of supra- and infrahyoid muscles

Several exercise methods, such as the Shaker exercise, tongue press exercise, chin tuck against resistance (CTAR) exercise, and submandibular push exercise, have been introduced to strengthen the muscles involved in swallowing. In this study, we compared the effectiveness of the CTAR, submandibular push, and Shaker exercises for the induction of selective supra- and infrahyoid muscle contractions using surface electromyography (EMG). This study is a prospective non-randomized controlled study. Twenty-five healthy subjects and 20 patients experiencing swallowing difficulty were enrolled. During the three different types of exercises, the root mean square (RMS) values of the sternocleidomastoid (SCM), suprahyoid (anterior belly of the digastric and mylohyoid muscles), and infrahyoid (sternothyroid and thyrohyoid muscles) muscles were analyzed using surface EMG. Differences in the activity of swallowing muscles among the three different exercises were analyzed using one-way repeated measured analysis of variance. In terms of both the maximum and mean RMS values of the suprahyoid muscle, the submandibular push exercise showed a larger RMS value than the CTAR and Shaker exercises in healthy subjects (p < 0.05). In terms of both the maximum and mean RMS values of the suprahyoid muscle, the Shaker exercise and submandibular push exercise showed a larger RMS value than the CTAR exercise in patients with swallowing difficulty (p < 0.05). The submandibular push exercise may be effective as a swallowing muscle exercise owing to its superiority in inducing selective contractions of the supra- and infrahyoid muscles. The CTAR and Shaker exercises are also effective in this regard.

Effect of Dysphagia Rehabilitation Using Kinesiology Taping on Oropharyngeal Muscle Hypertrophy in Post-Stroke Patients: A Double Blind Randomized Placebo-Controlled Trial

Background: It has recently been shown that suprahyoid muscle exercise using kinesiology taping (KT) increases the activation of the suprahyoid muscle in healthy adults, suggesting a potential therapeutic clinical exercise for dysphagia rehabilitation. This study investigated the effect of dysphagia rehabilitation using KT in stroke patients with dysphagia. Methods: Thirty subjects in South Korea were enrolled in this prospective placebo-controlled double-blind study. Participants were randomly assigned to the experimental and sham groups. In the experimental group, the tape was attached to the hyolaryngeal complex, pulled downward with approximately 70% tension, and then attached to the sternum and the clavicle bilaterally. In the sham group, the tape was applied similarly but without the tension. Both groups performed voluntary swallowing 50 times (10 times swallowing per set, times 5 sets) a day for 4 weeks with KT applied. Outcome measures were assessed using portable ultrasound equipment. The parameter measured was the change in thickness of the tongue muscle, mylohyoid muscle, and the anterior belly of the digastric muscle. Results: The experimental group showed statistically significant changes in the thickness of the tongue muscle, mylohyoid muscle, and anterior belly of the digastric muscle than the sham group (p = 0.007, 0.002, and 0.001). Conclusion: Dysphagia rehabilitation using KT is a technique that may promote oropharyngeal muscle thickness in patients with dysphagia after stroke.

Dancing larynx syndrome associated with trigeminal neuralgia secondary to multiple sclerosis

A 44-year-old man with multiple sclerosis (MS) presented with focal myoclonus of the mylohyoid and anterior belly of the digastric known as “dancing larynx” [1] which began after gamma knife radiation to the left trigeminal nerve root administered for trigeminal neuralgia (Video 1,). MRI brain showed T2 hyperintensity in the left cerebellopontine angle which expanded following radiation (Figure 1). He received botulinum toxin injections in the mylohyoid muscles with resolution of the movements. The “dancing larynx” was likely from irritation of the trigeminal nerve motor root or pons itself caused by the pontine lesion that enlarged after radiation.