Upward Effortful Pitch Glide as a Predictor of Pharyngeal Constriction in Individuals With Upper Versus Lower Motor Neuron Lesions.
Scott King, Elizabeth Lanza, Benjamin Schiedermayer and 2 others
PMID 42624478WHAT IT FOUND
During an upward pitch glide, nasoendoscopic ratings of pharyngeal constriction matched fluoroscopic swallowing measures in lower motor neuron lesions but not upper motor neuron lesions.
For upper motor neuron dysphagia, do not infer swallowing constriction from the glide alone.
Key findings
01In the LMN group, the reported odds ratios for higher nasoendoscopic constriction scores corresponding with normal fluoroscopic pharyngeal area scores were 2.2 for the 3-cc bolus (p = .032) and 1.91 for the 20-cc bolus (p = .053).
02In the UMN group, nasoendoscopic constriction scores did not significantly correspond with fluoroscopic pharyngeal area scores (p = .89 for the 20-cc bolus; p = .97 for the 3-cc bolus).
03A summated nasoendoscopic constriction score of 5 or greater corresponded with normal fluoroscopic pharyngeal area in the LMN group, but no predictive score was found for the UMN group.
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What it does not show
The study used retrospective medical records and included only 46 participants, with 24 in the LMN group and 22 in the UMN group. The upper motor neuron group was significantly older by ~10 years on average than the lower motor neuron group. Participants had to have both exams within 3 months, so the sample may represent only patients who received both procedures. The nasoendoscopic rating form was created for this study, and interrater reliability was moderate before consensus. No neurotypical adults were tested, so the meaning of a score of 5 or greater is not anchored to normal values. Only liquid boluses were studied, so the results may not apply to other bolus textures. The analysis did not account for body size scaling. Two participants did not complete the 20-cc bolus for safety reasons.
Declared interests
Funding was from the Undergraduate Research Opportunities Program at The University of Utah, The University of Utah Translational Research: Implementation, Analysis, and Design, and The University of Utah Voice, Airway, Swallowing Translational Research Lab. No competing commercial interest is reported in the supplied text.
The easy way to misread this
Do not conclude that an upward pitch glide can screen pharyngeal constriction during swallowing in all dysphagia populations. It corresponded with fluoroscopic swallowing measures in lower motor neuron lesions, but not in upper motor neuron lesions.