60 Upward Effortful Pitch Glide as a Predictor of Swallow Function in Upper Vs. Lower Motor Neuron Lesions

Faculty Mentor: Julie Barkmeier-Kraemer (Otolaryngology, University of Utah)

Objective: This study addressed the correspondence between maximum pharyngeal constriction (PCmax) during effortful upward pitch glide task using nasoendoscopy compared with similar measures from videofluoroscopic swallow studies (VFSS) of swallowing function in individuals with upper (UMN) vs lower motor neuron (LMN) lesions. Whereas videofluoroscopy enables measurement of the timing and distance of structural movements during swallowing (a non-volitional task), nasoendoscopy enables direct observation of the upper airway structures and evaluation of pharyngeal function during a volitional vocal task considered predictive of swallow function. The purpose of this study was to evaluate the use of a volitional vocal task during nasoendoscopy to predict non-volitional pharyngeal function during swallowing in patients with upper vs lower motor neuron lesions.

Methods: Comparisons were made between PCmax measures from VFSS and nasoendoscopy in 26 individuals with UMN (N = 13) or LMN (N = 13) etiologies of dysphagia. Two judges rated the degree and symmetry of PCmax in paired nasoendoscopic images contrasting quiet breathing (i.e. minimum pharyngeal constriction) and highest pitch production (i.e. PCmax). Judges rated each subject twice in a randomized order to obtain intra- and inter-rater reliability estimates. Judge 1 achieved 96% and Judge 2 achieved 92% intra-rater agreement. Inter-rater agreement was 63% overall. Judges reached consensus on items with differing ratings prior to final analysis. Final nasoendoscopy PCmax ratings were compared to VFSS measures within and between UMN and LMN groups using univariate linear regression analysis using an alpha level of .1 due to the small sample size.

Preliminary Results: A significant difference occurred between nasoendoscopic ratings and VFSS PCmax measures between UMN and LMN groups (p<.054). Stronger correspondence was shown for the LMN group than the UMN group. Nasoendoscopic ratings did not accurately predict VFSS PCmax measurement outcomes in 1/3 of the UMN group.

Conclusions: Nasoendoscopic ratings of PCmax during upward pitch glide may not accurately predict VFSS measures in 1/3 of individuals with UMN lesions.

Discussion: The UMN group was primarily comprised of subjects with subcortical lesions. For this reason, in addition to a small initial sample size, this study will continue until we can recruit 20 participants in the LMN group, and 10 subcortical and 10 cortical participants in the UMN group. Data analysis is anticipated to be complete in February 2023.