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NCT03192358

Physiological Flow of Liquids Used in Dysphagia Management (Neuro)

Completed Results posted Last updated 15 September 2022
What this trial tests

trial testing Videofluoroscopic Swallowing Examination in Amyotrophic Lateral Sclerosis in 40 participants. Completed in 31 December 2020.

Timeline
1 November 2017
Primary endpoint
31 December 2020
31 December 2020

Quick facts

Lead sponsorUniversity Health Network, Toronto
StatusCompleted
Study typeOBSERVATIONAL
Enrollment40
Start date1 November 2017
Primary completion31 December 2020
Estimated completion31 December 2020
Sites1 location across United States

Drugs / interventions tested

Conditions studied

Sponsor

University Health Network, Toronto

Who can join

Adults 18 to 90, any sex, with Amyotrophic Lateral Sclerosis or Parkinson Disease. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Number of Participants With Residue of Concern (Observational) Primary · Single timeframe (baseline only)

Residue is material remaining behind in the pharynx after the swallow. We measured residue by tracing the area of barium visible on a lateral view x-ray (in pixels, using ImageJ software) and dividing that area by the squared length C2-C4 cervical spine. This cervical spine scalar provides a common anatomical reference that is a proxy for pharyngeal size, and enables the comparison of residue severity across different people with different neck length and pharynx size. Smaller values are considered better. The 75th percentile healthy reference values for this measure are 1.7% on thin liquids,

GroupValue95% CI
Amyotrophic Lateral Sclerosis: Thin Liquids6
Amyotrophic Lateral Sclerosis: Slightly Thick Liquids6
Amyotrophic Lateral Sclerosis: Mildly Thick Liquids3
Amyotrophic Lateral Sclerosis: Moderately Thick Liquids6
Amyotrophic Lateral Sclerosis: Extremely Thick Liquids4
Parkinson Disease: Thin Liquid2
Parkinson Disease: Slightly Thick Liquids3
Parkinson Disease: Mildly Thick Liquids3
Parkinson Disease: Moderately Thick Liquids1
Parkinson Disease: Extremely Thick Liquids2
Maximum Anterior Isometric Tongue Pressure Primary · Single timeframe (baseline only)

Tongue strength was measured using a tongue pressure measurement system called the Iowa Oral Performance Instrument (IOPI). A small disposable bulb filled with air was placed in the mouth, just behind the front teeth. Participants were asked to press the front of their tongue upwards against the bulb as hard as possible. This task was repeated 3 times. The maximum value obtained across 3 repetitions was recorded as "maximum anterior isometric pressure". Higher values represent greater tongue strength. We report group mean values and standard deviations for this measure.

GroupValue95% CI
Amyotrophic Lateral Sclerosis34± 19
Parkinson Disease55± 17
Regular Effort Saliva Swallow Tongue Pressure Primary · Single timeframe (baseline only)

Tongue strength was measured using a tongue pressure measurement system called the Iowa Oral Performance Instrument (IOPI). A small disposable bulb filled with air was placed in the mouth, just behind the front teeth. Participants were asked to swallow their saliva with the bulb in this position. This task was repeated 3 times. The mean value obtained across 3 repetitions was recorded as "regular effort saliva swallow tongue pressure". Higher values represent greater tongue strength. We report group mean values and standard deviations for this measure.

GroupValue95% CI
Amyotrophic Lateral Sclerosis19± 12
Parkinson's Disease17± 8
Number of Participants With Unsafe Swallows (Observational) Primary · Baseline (Single timepoint only)

Swallowing safety was measured using the 8-point Penetration-Aspiration Scale, an 8-point categorical scale which captures the depth to which any material enters the airway and whether or not the material is ejected. Levels 1 and 2 on the scale are considered safe, while levels \> 2 are considered unsafe. Actual scale scores (1-8) were recorded and then converted to binary categorical scores (\< 3 vs \>/= 3). We report the frequency (count) of participants showing scores \> 2 by bolus consistency.

GroupValue95% CI
Amyotrophic Lateral Sclerosis: Thin Liquids10
Amyotrophic Lateral Sclerosis: Slightly Thick Liquids9
Amyotrophic Lateral Sclerosis: Mildly Thick Liquids7
Amyotrophic Lateral Sclerosis: Moderately Thick Liquids6
Amyotrophic Lateral Sclerosis: Extremely Thick Liquids3
Parkinson Disease: Thin Liquid2
Parkinson Disease: Slightly Thick Liquids1
Parkinson Disease: Mildly Thick Liquids1
Parkinson Disease: Moderately Thick Liquids0
Parkinson Disease: Extremely Thick Liquids1
Maximum Posterior Isometric Tongue Pressure (Observational). Secondary · Single timeframe (baseline only)

Tongue strength was measured using a tongue pressure measurement system called the Iowa Oral Performance Instrument (IOPI). A small disposable bulb filled with air was placed in the mouth, with the front margin of the sensor aligned with the first molar tooth. Participants were asked to press the back of their tongue upwards against the bulb as hard as possible. This task was repeated 3 times. The maximum value obtained across 3 repetitions was recorded as "maximum posterior isometric pressure". Higher values represent greater tongue strength. We report group mean values and standard deviation

GroupValue95% CI
Amyotrophic Lateral Sclerosis29± 20
Parkinson Disease51± 19
Number of Participants With Multiple Swallows Per Bolus (Observational) Secondary · Single timeframe (baseline only)

The number of swallows needed to clear a single bolus will be counted. A single swallow is considered efficient, while 2+ swallows for one bolus is considered atypical. We will report the number of participants with \> 1 swallow per bolus.

GroupValue95% CI
Amyotrophic Lateral Sclerosis: Thin Liquids6
Amyotrophic Lateral Sclerosis: Slightly Thick Liquids8
Amyotrophic Lateral Sclerosis: Mildly Thick Liquids9
Amyotrophic Lateral Sclerosis: Moderately Thick Liquids5
Amyotrophic Lateral Sclerosis: Extremely Thick Liquids8
Parkinson Disease: Thin Liquid6
Parkinson Disease: Slightly Thick Liquids3
Parkinson Disease: Mildly Thick Liquids2
Parkinson Disease: Moderately Thick Liquids2
Parkinson Disease: Extremely Thick Liquids2
Number of Participants Displaying Prolonged Pharyngeal Bolus Transit (Observational) Secondary · Single timeframe (baseline only)

The time interval from the first frame showing the bolus entering the pharynx (passing the shadow of the ramus of the mandible) until the first frame showing the bolus entering the upper esophageal sphincter was calculated (in milliseconds) for each bolus. The 75th percentile healthy reference values for this measure are 533 ms on thin liquids, 567 ms on slightly thick liquids, 701 ms on mildly thick liquids, 867 ms on moderately thick liquids and 1001 ms on extremely thick liquids. Pharyngeal transit durations above these values are considered prolonged and atypical. We will report the number

GroupValue95% CI
Amyotrophic Lateral Sclerosis: Thin Liquids5
Amyotrophic Lateral Sclerosis: Slightly Thick Liquids10
Amyotrophic Lateral Sclerosis: Mildly Thick Liquids7
Amyotrophic Lateral Sclerosis: Moderately Thick Liquids7
Amyotrophic Lateral Sclerosis: Extremely Thick Liquids8
Parkinson Disease: Thin Liquid5
Parkinson Disease: Slightly Thick Liquids4
Parkinson Disease: Mildly Thick Liquids5
Parkinson Disease: Moderately Thick Liquids5
Parkinson Disease: Extremely Thick Liquids6

Sponsor's own description

For individuals with neurodegenerative conditions, such as Amyotrophic Lateral Sclerosis and Parkinson disease, swallowing impairment (i.e., dysphagia) is a common and serious symptom. Dysphagia places the affected individual at risk for secondary health consequences, including malnutrition and aspiration pneumonia, and negatively affects quality of life. Thickened liquids are commonly recommended for individuals with dysphagia, as they flow more slowly and reduce the risk of entry into the airway. However, there is limited understanding about how changes in liquid thickness modulate swallowing physiology in individuals with neurodegenerative conditions, and previous reports have shown that increased liquid thickness may contribute to the accumulation of residue in the throat. The purpose of this study is to explore swallowing physiology and function in individuals with neurodegenerative conditions, across five levels of liquid thickness (thin, slightly-thick, mildly-thick, moderately-thick, and extremely-thick), and to identify boundaries of "optimal liquid thickness", which maintain airway safety, without contributing to the accumulation of significant residue. Results from this study will help guide the clinical recommendations for thickened liquids in dysphagia management.

Publications & conference data

3 peer-reviewed publications reference this trial (live from Europe PMC):

  1. The effect of liquid consistency on penetration-aspiration: a Bayesian analysis of two large datasets.
    Borders JC, Steele CM. · · 2024 · cited 5× · PMID 38463609 · DOI 10.3389/fresc.2024.1337971
  2. How Do Quantitative Videofluoroscopy Measures Differ Between People With Amyotrophic Lateral Sclerosis and Age-Matched Healthy Adults?
    Gandhi P, Waito AA, Peladeau-Pigeon M, Plowman EK, et al · · 2024 · cited 1× · PMID 39007704 · DOI 10.1044/2024_jslhr-24-00106
  3. Automated detection of chewing movements in videofluoroscopic swallowing studies using deep learning for landmark detection and motion analysis.
    Bandini A, Lasala A, Peladeau-Pigeon M, Dharmarathna I, et al · · 2026 · PMID 41330067 · DOI 10.1016/j.compbiomed.2025.111361

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Primary sources · FDA · ClinicalTrials.gov · EMA · SEC EDGAR · ChEMBL · Wikidata · full sourcing