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Thickened liquids are frequently recommended to reduce the risk of aspiration in patients with oropharyngeal dysphagia. Although it has previously been reported that tongue-palate pressures increase when swallowing spoon-thick and semi-solid consistencies compared to thin liquids, relatively little is known about how swallowing behaviors differ when swallowing liquids of nectar- or honey-thick consistency. Furthermore, previous studies have primarily used starch-based thickeners, and little is known about swallowing behaviors with xanthan gum-thickened liquids, which have recently been introduced for dysphagia management. In this study, we measured variations in tongue-palate pressures during the swallowing of liquids thickened to apparent viscosities of 190, 250, and 380 mPa s at 50/s using increasing concentrations of xanthan gum (0.5, 0.63 and 0.87 w/w%). The viscosity differences between these nectar- and honey-thick stimuli were confirmed to exceed sensory perceptual discrimination thresholds. Data were collected from 78 healthy adults in two sex-balanced age-groups (young; mature) and compared to reference values obtained during water swallowing. The results confirm that increased amplitudes of tongue-palate pressure were used when swallowing the thickened liquid stimuli, compared to swallows of water, and for the honey-thick liquid compared to the two nectar-thick liquids. Age-related reductions were seen in tongue strength but not in swallowing pressures, which fell below 40 % of maximum isometric pressure values. Thus, the use of xanthan gum-thickened liquids is unlikely to tax the swallowing system in terms of tongue pressure generation requirements, even in seniors with reduced maximum isometric tongue pressure measures.
Approximately 87% of the respondents to ASHA's 2005 Health Care Survey in Speech-Language Pathology (ASHA, 2005) indicated that they were the primary providers of dysphagia services in their facilities. In the same survey, 16% of speech-language pathologists (SLPs) working in health care settings reported that they provide dysphagia services to infants and/or children. Results of the 2003 Omnibus Survey (ASHA, 2003) also indicated that 13.8% of SLPs practicing in the schools now treat children with dysphagia. Diagnosis and treatment of swallowing disorders are included in the SLPs' scope of practice (ASHA, 2001). Graduate programs must respond to the education and training demands implicit in this scope of practice and provide students with knowledge and skills required to effectively evaluate and treat dysphagia across a variety of populations and practice settings.
This updated version of the Graduate Curriculum on Swallowing and Swallowing Disorders (Adult and Pediatric Dysphagia) reflects these changes as well as the expansion of the knowledge base in this critical area of clinical practice. The revised curriculum, with its outline and references, can serve as a model for university programs. Because the development of any course is unique to the instructor and the academic institution, the Division on Swallowing and Swallowing Disorders has attempted to provide this material in a format that will allow instructors to design their own curricula. New and important work in swallowing continues to be published; therefore, the references should not be regarded as an exhaustive list, but instead as a resource to be updated by each instructor as appropriate. Included in the reference sections are classic and theoretical summaries for the more advanced graduate seminar, as well as basic texts, journal articles, and treatment manuals for the clinical components and the basic practitioner. The reference lists are divided into three sections, general dysphagia references, adult dysphagia references, and pediatric dysphagia references; each is organized by topic.
The student will demonstrate the ability to devise research-supported therapy/management plans for the treatment of specific swallowing impairments, taking into account motivation level, quality of life, cultural, ethical, and moral issues.
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Supraglottic cancers typically present with sore throat, painful swallowing, referred ear pain, change in voice quality, or enlarged neck nodes. Early vocal cord cancers are usually detected because of hoarseness. By the time they are detected, cancers arising in the subglottic area commonly involve the vocal cords; thus, symptoms usually relate to contiguous spread.
Surgery and radiation therapy have been the standards for treatment of laryngeal cancer; however, outcome data from randomized trials are limited. Studies have attempted to address the question of whether to use surgery or radiation, but the studies have been underpowered.[1] Selection of primary surgery versus radiation therapy-based treatment should be made in a multidisciplinary setting with consideration of disease stage, comorbidities, and functional status, including voice and swallowing outcomes and lung capacity.
I'm 54. Elly is 52. When we first got together, I thought sex was as static as eye color. I had no idea how it could evolve and mature. We're not two horny college kids humping our brains out on a single mattress to Dylan's "Blonde on Blonde" LP. We still do it to music -- in addition to the Stones, there are Springsteen and Indigo Girls CDs stacked up on our boom box -- but now we're on a king-size bed surrounded by scented candles, and the action has mellowed. I forget who said it, but it's true: Older sex is less like the Fourth of July, more like Thanksgiving. In our case, it's a feast with the occasional bone in the stuffing -- the bones being our enduring difference in desired frequency.
Elly and I met in college. We were introduced by a mutual friend at a screening of an obscure movie, "Lilith," with Warren Beatty, Jean Seberg, Peter Fonda and Gene Hackman, about a therapist who falls in love with a patient. (Every now and then when we notice it's on TV, we try to catch it.) Elly was a freshman, all of 18. I was an "older man," a 20-year-old junior. We have kids those ages now, and it amazes us how immature they seem. We ask each other if we were that clueless, and suppose we were. It never occurred to us when we were that age that life is long, and that we could grow and change together -- as individuals and partners in marriage and in a sexual relationship.
From the moaning sounds Elly made, I inferred that she enjoyed having her labia licked. I felt delighted. After a while, I climbed back up and presented my erection to her lips. She took me inside her mouth, tentatively at first, then more confidently. I loved it. When Elly sucked me, I was crazy in love with her. I think I proposed marriage the first 10 times she did it. She had the good sense not to take those outbursts seriously. In addition, she never objected to my coming in her mouth or to swallowing my semen. I've always felt tremendously grateful for this erotic gift. I know it's an issue for many couples. Years ago, when Bo Derek starred in the movie "10," the numerical rating given to the perfect woman, a joke made the rounds among my friends: What's an 11? A 10 who swallows. I feel sorry for men whose lovers won't do that.
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