Objectives

Dysphagia is linked to mortality risk among patients with profound intellectual and multiple disabilities (PIMD); the present study therefore aimed to clarify the characteristics of hyoid movements during swallowing and to examine the mechanism of dysphagia in patients with PIMD.

Methods

A retrospective video fluoroscopic swallowing study was conducted on 43 patients with PIMD (mean age = 25.4; 25 males, 18 females) and 24 healthy adults (mean age = 44.3; 16 males, 8 females). The movements of the hyoid bone and mandible were tracked frame by frame in the video footage, and their range of movements and trajectories were analyzed.

Results

Most patients showed atypical movement trajectories of the hyoid, such as insufficient anterior movement and increased range of mandibular downward movement, compared with normal adults. Moreover, the mechanism of dysphagia was revealed by structural equation modeling, indicating that insufficient anterior movement could lead to pharyngeal residue in the pyriform sinus.

Conclusion

The insufficient anterior movement of the hyoid could be caused by weak ventral suprahyoid muscles and atypical head and neck posture characteristic of patients with PIMD. It may be useful to predict pharyngeal residue from the range of hyoid movements and trajectories for the prevention of aspiration.

中文翻译：

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重度智障和多重残疾患者吞咽时舌骨运动及咽部残留机制

目标

吞咽困难与严重智力和多重残疾 (PIMD) 患者的死亡风险有关；因此，本研究旨在阐明吞咽过程中舌骨运动的特征，并检查 PIMD 患者吞咽困难的机制。

方法

对 43 名 PIMD 患者（平均年龄 = 25.4；25 名男性，18 名女性）和 24 名健康成人（平均年龄 = 44.3；16 名男性，8 名女性）进行了回顾性视频透视吞咽研究。在视频片段中逐帧跟踪舌骨和下颌骨的运动，并分析它们的运动范围和轨迹。

结果

与正常成人相比，大多数患者表现出非典型的舌骨运动轨迹，例如前运动不足和下颌向下运动范围增加。此外，结构方程模型揭示了吞咽困难的机制，表明前向运动不足可能导致梨状窦中的咽部残留。

结论

舌骨前移不足可能是由于 PIMD 患者舌骨上肌腹侧肌力较弱和头颈部姿势不典型所致。从舌骨运动和轨迹的范围预测咽部残留物可能是有用的，以防止误吸。