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Abstract Duration and Distance ABSTRACT DURATION AND DISTANCE OF HYOID BONE MOVEMENT AS OBSERVED BY ULTRASOUND: THE INFLUENCES OF FLAVOR AND NECTAR-THICK CONSISTENCY by Briana Christine Corcoran The purpose of this study was to establish parameters regarding the total distance and duration of hyoid bone displacement during water and sour boluses of regular and nectar-thick consistencies among young and older adults. Distance and duration parameters for hyoid bone displacement in adults will assist in safe and accurate diagnoses of dysphagia. Thirty-two young adults and five older adults were assessed via an ultrasonic procedure. Following the capture of a swallow, hyoid bone measurements and durations were obtained through frame-by-frame analysis. Results indicated that aging did not significantly affect the distance of hyoid bone movement when participants were presented with water, nectar-thick water, cranberry juice, and nectar thick-cranberry juice. Further analysis indicated that mean hyoid bone movement for the water condition was longer than the mean movement of all other conditions. Any change observed in duration of hyoid bone displacement was determined to be insignificant across all conditions. DURATION AND DISTANCE OF HYOID BONE MOVEMENT AS OBSERVED BY ULTRASOUND: THE INFLUENCES OF FLAVOR AND NECTAR-THICK CONSISTENCY A Thesis Submitted to the Faculty of Miami University in partial fulfillment of the requirements for the degree of Master of Arts Department of Speech Pathology and Audiology by Briana Christine Corcoran Miami University Oxford, Ohio 2011 Advisor______________________________________ Dr. Donna Scarborough, Ph.D. Reader_______________________________________ Kelly Knollman-Porter, M.A. Reader_______________________________________ Dr. Kathleen Hutchinson, Ph. D. TABLE OF CONTENTS CHAPTER 1: INTRODUCTION Introduction..........................................................................................................................1 CHAPTER 2: REVIEW OF THE LITERATURE Physiology of the Swallowing Mechanism: The Four Phases of Swallowing....................3 Overview of the Central Organization of Swallowing........................................................6 Brainstem.................................................................................................................6 Cortex.......................................................................................................................7 Integration of information for the brainstem and cortex..........................................7 Swallowing as Observed by Ultrasound..............................................................................8 Hyoid Bone Movement as Observed by Ultrasound.........................................................10 The Aging Swallow...........................................................................................................11 Anatomic Changes.................................................................................................11 Physiologic Changes..............................................................................................12 Treatment Techniques........................................................................................................13 Sour Bolus.............................................................................................................14 Consistency Changes.............................................................................................15 Cold Bolus.............................................................................................................16 Combination of Sour, Cold and Consistency.........................................................17 Statement and Significance of the Problem.......................................................................18 Purpose of the Study..........................................................................................................18 Research Question.............................................................................................................18 Statistical Hypotheses........................................................................................................19 CHAPTER III: METHODS AND PROCEDURES Recruitment and Selection of Subjects..............................................................................20 Research Procedures/Methods...........................................................................................20 Data Analysis.....................................................................................................................22 CHAPTER IV: RESULTS Research Question: What are the normal parameters that should be observed when using ultrasound to assess duration and distance of hyoid bone movement in adults?……………………………………………............................................................24 ii Hypothesis 1: Flavor will decrease the duration of hyoid bone movement.......................26 Hypothesis 2: Flavor will not influence the distance of hyoid bone movement................27 Hypothesis 3: Nectar-thick consistency will increase the duration and distance of hyoid bone movement..................................................................................................................27 Hypothesis 4: BMI and gender will not influence the duration or displacement of hyoid bone movement across all conditions................................................................................27 Hypothesis 5: As age increases, the duration of hyoid bone movement will increase across all conditions. Hypothesis 6: As age increases, the distance of hyoid bone movement will decrease across all conditions...................................................................27 CHAPTER V: DISCUSSION Discussion..........................................................................................................................28 First and second hypotheses...................................................................................28 Third hypothesis.....................................................................................................29 Fourth, fifth, and sixth hypotheses.........................................................................30 Limitations and Future Research.......................................................................................31 REFERENCES..............................................................................................................................38 APPENDICES Appendix A: Recruitment Permission Form......................................................................48 Appendix B: Description of the Study..............................................................................49 Appendix C: Recruitment Flyers.......................................................................................50 Appendix D: Informed Consent.........................................................................................52 Appendix E: Questionnaire................................................................................................54 Appendix F: Cognitive Screening......................................................................................56 iii LIST OF TABLES TABLE 1 – MEAN DISTANCE OF HYOID BONE MOVEMENT...........................................25 TABLE 2 – MEAN DURATION OF HYOID BONE MOVEMENT..........................................26 iv LIST OF FIGURES FIGURE 1 – B-MODE VIEW OF THE HYOID SHADOW........................................................32 FIGURE 2 – SCHEMATIC OF HYOID BONE AS SEEN VIA B-MODE.................................32 FIGURE 3 – SAMPLE MEASUREMENT IN B-MODE.............................................................33 FIGURE 4 – SAMPLE MEASUREMENT IN M-MODE............................................................33 FIGURE 5 – AGE RELATED CHANGES TO THE SWALLOW..............................................34 FIGURE 6 – RECEPTOR RESPONSE TO A WARM WATER BOLUS...................................35 FIGURE 7 – RECEPTOR RESPONSE TO A SOUR BOLUS....................................................35 FIGURE 8 – RECEPTOR RESPONSE TO A COLD WATER BOLUS.....................................36 FIGURE 9 – RECEPTOR RESPONSE TO A COLD, SOUR BOLUS........................................36 FIGURE 10 – MODE OF 84-YEAR-OLD VS. 20-YEAR-OLD..................................................37 v ACKNOWLEDGMENTS This thesis would not have been possible without the guidance and the help of several individuals who in one way or another contributed and extended valuable assistance in the preparation and completion of this study. I am forever appreciative to those people involved in helping me undertake this thesis and enabled me to develop a thorough understanding of the subject. I am heartily thankful to my thesis supervisor, Dr. Donna Scarborough for her patience, encouragement, insights, and unselfish support. For the past five years, she has challenged me to continually better myself as not only a professional but also as a student. It is a pleasure to thank those who made this thesis possible, Mrs. Kelly Knollman-Porter and Dr. Kathleen Hutchinson, provided much appreciated assistance and support as readers on my committee. I would like to show my gratitude to Annelise Blatt and Kimberly Hubacher, whose generosity and hard work contributed greatly to the completion of this project. In addition, I owe my deepest gratitude to my husband, Brian, for loving and supporting me in all respects throughout my academic career at Miami
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