Interprofessional Education at the University Level: Evidence, Models, and Future Directions.

Interprofessional education (IPE) continues to evolve as a critical component of providing quality health care. Emerging evidence suggests IPE is most effective if it exists across the continuum of academia to clinical practice. This article provides current evidence and models for IPE deliv-ery to students beginning in their academic programs.

A randomized controlled trial of the effects of flow phonation voice treatment for primary muscle tension dysphonia.

Objective: The purpose of the study was to investigate the effects of flow phonation voice therapy on laryngeal physiology and vocal quality in persons with primary Muscle Tension Dysphonia (MTD1).

Methods: Seventeen participants with a diagnosis of MTD1 completed the study. Participants were randomized to two groups.

Assessment Across the Life Span: The Clinical Swallow Evaluation.

Purpose This clinical focus article considers the roles of the clinical swallow examination (CSE) as a clinically meaningful assessment method used in both adult and pediatric populations. Method This clinical focus article explores the utility of the CSE across the life span. Specifically, components, reliability, standardized assessments, and limitations of the CSE within the adult and pediatric populations are highlighted.

The feasibility of a novel method of bystander CPR training: A pilot study.

Sudden cardiac arrest is a leading cause of death in the United States, with many occurring out of the hospital. Immediate response by bystanders, through the initiation of cardiopulmonary resuscitation (CPR), leads to increased survival; however, many do not respond due to lack of training and education. This study sought to determine the efficacy of a training model developed to rapidly and effectively train large numbers of individuals on hands-only CPR.

"Prologues to a Bad Voice": Effect of Vocal Hygiene Knowledge and Training on Voice Quality Following Stage Performance.

Purpose: The purpose of this investigation was to determine the effects of intensive stage rehearsal and performance on perceptual, acoustic, and aerodynamic measures of voice, and to determine the impact of knowledge and practice of vocal hygiene on measures of voice during intensive vocal performance.

Methods: Nineteen stage actors who were participating in the Arkansas Shakespeare Theatre festival took part in the study. Each participant completed auditory-perceptual, acoustic, aerodynamic, and quality of life measures before and after 1 month of intensive rehearsals and stage performances.

Utility of a Clinical Swallowing Exam for Understanding Swallowing Physiology.

A clinical swallowing examination (CSE) is generally believed to be inadequate for making judgments regarding swallowing physiology compared to objective assessments. A large volume of studies has heavily focused on identifying aspiration using a CSE and research addressing physiologic information gathered from a CSE is sparse. The purpose of this study was to examine the utility of the CSE for assessing physiology compared to videofluoroscopic swallowing studies (VFSS).

Telepractice Versus In-Person Delivery of Voice Therapy for Primary Muscle Tension Dysphonia.

Purpose: The purpose of this study was to investigate the utility of telepractice for delivering flow phonation exercises to persons with primary muscle tension dysphonia (MTD).

Method: Fourteen participants with a diagnosis of primary MTD participated, 7 on site and 7 at remote locations. Each participant received 12 treatment sessions across 6 weeks.

Upper esophageal sphincter opening during swallow in stroke survivors.

Objective: Timely and efficient upper esophageal sphincter (UES) opening may be critical to safe transport of food or liquid to the stomach and to prevent aspiration during the swallow. The purpose of this study was to examine the temporal and biomechanical characteristics of the UES opening in stroke survivors.

Method: Maximum duration and width of the UES opening were obtained from 15 stroke survivors with aspiration and 15 stroke survivors with no aspiration.

Role of cerebellum in deglutition and deglutition disorders.

The objective of this review is to gather available evidence regarding the role of the cerebellum in swallowing-related functions. We reviewed literature on cerebellar functions related to healthy swallowing, patterns of dysphagia in individuals with cerebellar lesions, and the role of the cerebellum in therapeutic intervention of neurogenic dysphagia since 1980. A collective understanding of these studies suggests that both hemispheres of the cerebellum, predominantly the left, participate in healthy swallowing.

Manometric measures of head rotation and chin tuck in healthy participants.

The primary aim of this study was to investigate the immediate effects of partial versus complete head rotation and chin tuck on pharyngeal swallowing pressures and durations in the pharynx and UES of normal, healthy adults. Ten individuals (3 men and 7 women; age range 54-76 years) served as participants. Solid-state intraluminal manometry was performed with the participants in the upright position while performing swallows with the head in the normal position, head rotated (partial and complete), chin tucked, and chin down.

Effects of topical nasal anesthetic on fiberoptic endoscopic examination of swallowing with sensory testing (FEESST).

Objections to the use of topical nasal anesthesia (TNA) during fiberoptic endoscopic evaluation of swallowing (FEES) with sensory testing (FEESST) have been raised, primarily because of the possibility of desensitizing the pharyngeal and laryngeal mucosa and affecting both the sensory and motor aspects of the swallow. Furthermore, it has been suggested that TNA is not necessary during FEES as it does not improve patient comfort or make the procedure easier for the endoscopist. The purpose of this double-blind, randomized, controlled, crossover clinical trial was to determine how gel TNA during flexible endoscopic evaluation of swallowing with sensory testing affects sensation, swallowing, and comfort rating scores in healthy non-dysphagic participants.

Oropharyngeal transition of the bolus in post-stroke patients.

Objective: The purposes of this study were to determine whether two bolus transition durations (oral transit time and pharyngeal transit time) were different during oropharyngeal swallowing in post-stroke patients who aspirated and who did not aspirate and to examine those differences across varying bolus viscosities.

Design: Means and standard deviations of oral transit time and pharyngeal transit time were analyzed on 5 ml of thin and nectar thick liquids and puree swallows from videofluoroscopic swallowing examinations of 30 post-stroke patients. Statistical comparisons were made by repeated measures analysis of variance, with the within-subject variable being the three consistencies and the between-subject variable being the two groups.

Effects of the Mendelsohn maneuver on extent of hyoid movement and UES opening post-stroke.

The Mendelsohn maneuver, voluntary prolongation of laryngeal elevation during the swallow, has been widely used as a compensatory strategy to improve upper esophageal sphincter (UES) opening and bolus flow. Recent research suggests that when used as a rehabilitative exercise, it significantly improves duration of hyoid movement and positively impacts duration of UES opening (DOUESO). The data presented here were derived from that same prospective crossover study of 18 participants with dysphagia post-stroke evaluated with videofluoroscopy after treatment using the Mendelsohn maneuver versus no treatment.

Effects of Mendelsohn maneuver on measures of swallowing duration post stroke.

Purpose: The purpose of this pilot study was to determine whether intensive use of the Mendelsohn maneuver in patients post stroke could alter swallow physiology when used as a rehabilitative exercise.

Method: Eighteen outpatients between 6 weeks and 22 months post stroke were enrolled in this prospective study using a crossover design to compare 2 weeks of treatment with 2 weeks of no treatment. Each participant received an initial videofluoroscopic swallow study (VFSS) and an additional VFSS at the end of each week for 1 month for a total of 5 studies.

Teledynamic evaluation of oropharyngeal swallowing.

Purpose: The objective of the present investigation was to test the feasibility and clinical utility of a real-time Internet-based protocol for remote, telefluoroscopic evaluation of oropharyngeal swallowing.

Method: In this prospective cohort study, the authors evaluated 32 patients with a primary diagnosis of stroke or head/neck cancer. All patients participated in 2 separate fluoroscopic swallowing evaluations--one traditional on site and one telefluoroscopic off site--through the use of a telemedicine system.

Improvement in arousal, visual neglect, and perception of stimulus intensity following cold pressor stimulation.

The relationship between arousal, perception, and visual neglect was examined in this case study. Cold pressor stimulation (CPS: immersing the foot in iced water) was used to manipulate arousal and to determine its effects on contralesional neglect, perception of stimulus intensity (magnitude estimation), reaction time, and an electrophysiological correlate of ascending reticular activating system activity (i.e.

Stage transition and laryngeal closure in poststroke patients with dysphagia.

Timely hyolaryngeal excursion and laryngeal closure are essential for safe transfer of the bolus during the pharyngeal swallow. The temporal measures stage transition duration (STD) and laryngeal closure duration (LCD) represent these physiological events. The purpose of this investigation was to determine whether small changes in bolus consistency and volume affect these temporal measures in poststroke patients who aspirate, poststroke patients who do not aspirate, and nonneurologically impaired control subjects.

The association between oral microorgansims and aspiration pneumonia in the institutionalized elderly: review and recommendations.

Aspiration pneumonia is a leading cause of illness and death in persons who reside in long-term-care facilities and, combined with the lack of proper oral health care and services, the risk of aspiration pneumonia rises. The purpose of this article is to review recent literature on oral hygiene and oral care in long-term-care facilities and report new findings regarding associated risks for aspiration pneumonia, as well as research on oral care and health outcomes. The PubMed MeSH database was utilized to direct a specific search by entering terms "aspiration pneumonia" and "oral hygiene" from 1970 to 2009, which yielded 34 articles.

Initiation and duration of laryngeal closure during the pharyngeal swallow in post-stroke patients.

As a bolus enters the pharynx during the swallow, the airway is protected by laryngeal closure, a process characterized by approximation of the vocal folds plus approximation of the arytenoid cartilages to the base of the epiglottis. The purpose of this study was to measure initiation of laryngeal closure (ILC) and laryngeal closure duration (LCD) in three groups of subjects: (1) ten stroke patients who aspirated before and during the swallow (aspirators), (2) ten stroke patients who did not aspirate (nonaspirators), and (3) ten normal control subjects. Means and standard deviations of ILC and LCD were analyzed for both 5-ml and 10-ml thin-liquid boluses using a 100-ms timer during subsequent analysis of videofluoroscopic swallowing examinations.

Maximal hyoid excursion in poststroke patients.

Reduced maximal hyoid excursion has been suspected as one of the primary physiologic causes of aspiration after a stroke. Vertical and anterior displacement of hyoid excursion is critical to epiglottic closure for airway protection and the opening of the upper esophageal sphincter (UES). Without these carefully timed and well-executed components, the bolus cannot pass safely through the pharynx.

Function of text structure in jurors' comprehension and decision making.

The Story Model of Juror Decision Making proposes that jurors develop a story of the case, match the story to verdict templates, and then select the best match between the story and the verdict. The present research investigated the effect different text structures in opening statements and closing arguments had on jurors' recognition for trial information and decision-making. It was hypothesized: (1) narrative opening statements would enhance story construction and (2) comparison-expository closing arguments would enhance story classification.

Maximum hyoid displacement in normal swallowing.

Vertical and anterior displacement of the hyoid bone is a critical biomechanical component of normal swallowing function. The purpose of this study was to evaluate the maximal vertical and anterior displacement of the hyoid bone during oropharyngeal swallowing. A retrospective review of video-fluoroscopic swallowing exams in 40 normal subjects varying by age and gender was performed.

Stage transition duration in patients poststroke.

The purpose of this study was to investigate the relationship between prolonged stage transition duration (STD) and aspiration. STDs and aspiration ratings were made from videofluoroscopic examinations previously obtained for other studies. Three groups of subjects were examined: (1) 20 stroke patients who aspirated, (2) 31 stroke patients who did not aspirate, and (3) 15 normal subjects.