Effects of Barium Concentration on Oropharyngeal Swallow Timing Measures

Videofluoroscopy is commonly used for evaluating oropharyngeal swallowing but requires radiopaque contrast (typically barium). Prior studies suggest that some aspects of swallowing, including timing measures of oral and pharyngeal bolus transit, vary depending on barium concentration. The aim of our study was to identify timing differences in healthy swallowing between “thin” (40 % w/v concentration) and “ultrathin” (22 % w/v concentration) barium solutions. Twenty healthy adults (Ten women; mean age = 31 years) each performed a series of three noncued 5-ml swallows each of ultrathin and thin liquid barium solutions in videofluoroscopy. Timing measures were compared between barium concentrations using a mixed-model ANOVA. The measures of interest were stage transition duration, pharyngeal transit time, and duration of upper esophageal sphincter opening. Significant differences were observed in the timing measures of swallowing with respect to barium concentration. In all cases, longer durations were seen with the higher barium concentration. Barium concentration influences timing parameters in healthy swallowing, even between ultrathin and thin concentrations. Clinicians need to understand and control for the impact of different barium stimuli on swallowing physiology.     

Swallowing Physiology of Sequential Straw Drinking

The goal of this study was to examine deglutitive physiology during sequential straw drinking in healthy young adults (n = 15) to learn how sequential swallowing differs from single swallows. The physiology of single swallows has been studied extensively in healthy adults and in adults with a variety of debilitating conditions, but the physiology of sequential swallows has not been studied adequately. Videofluoroscopic analysis revealed three distinct patterns of hyolaryngeal complex (HLC) movement during sequential straw swallows: opening of the laryngeal vestibule after each swallow (Type I, 53%), continued vestibule closure after each swallow (Type II, 27%), and interchangeable vestibule opening and closing during the swallow sequence (Mixed, 20%). Unlike discrete swallowing, the onset of the pharyngeal swallow occurred when the bolus was inferior to the valleculae in the majority of subjects and was significantly associated with HLC movement pattern. The leading bolus edge was inferior to the valleculae at swallow onset for Type II movement patterns. For Type I movement patterns, bolus position at swallow onset was randomly distributed between three anatomical positions: superior to the valleculae, at the level of the valleculae, and inferior to the valleculae. Preswallow pharyngeal bolus accumulation, which is common during mastication, was evident and significantly associated with the HLC pattern of opened laryngeal vestibule after each swallow. These data suggest that in healthy young adults, sequential swallows differ physiologically from discrete swallows and indicate substantial variability in deglutitive biomechanics.     

Bolus Location at the Initiation of the Pharyngeal Stage of Swallowing in Healthy Older Adults

This study characterized the vertical position of the bolus head at the onset of the pharyngeal swallow in healthy older adults. Lateral-view videofluoroscopic (VF) images were obtained from ten healthy volunteers (age-71.6 ± 7.5 years, mean± SD) as they swallowed 5-cc thin liquid barium aliquots. For each swallow, the bolus head and several anatomic landmarks were digitally recorded from the image in which pharyngeal swallow-related hyoid bone elevation began. Vertical distance between the bolus head and the intersection of the tongue base and mandibular ramus (TMI) was computed. Bolus head position at swallow onset ranged from 47.4-mm above to 34.9-mm below the TMI (2.2 ± 14.4-mm, mean ± SD). Although the bolus head was below the level of the TMI for the majority of swallows, neither penetration nor aspiration occurred. For individual subjects, mean bolus head position ranged from 25.8 ± 5.0-mm above to 15.5 ± 6.5-mm below the TMI. Whereas five of ten subjects initiated the pharyngeal swallow with the bolus head consistently above or consistently below the TMI, five subjects initiated swallowing with the bolus head either above or below the TMI across trials. Older adults commonly initiate thin-liquid swallows with the bolus head well below the TMI without associated penetration or aspiration. Thus, bolus position alone does not differentiate between normal and pathologic swallowing within the healthy elderly. Bolus position at pharyngeal swallow onset can vary substantially from trial to trial within an individual, suggesting that the triggering of swallowing depends on multiple influences. This research was supported by NSERC grant No. 0GPO171208 and an Ontario Ministry of Health Career Scientist Award to REM.     

Effects of Nasogastric Tubes on the Young, Normal Swallowing Mechanism

The present study aimed to investigate the effects of different-sized nasogastric tubes on swallowing speed and function in 10 young normal volunteers. Using X-ray visualization, liquid barium swallows were recorded on video (videofluoroscopy) under three experimental conditions: no nasogastric tube, fine-bore nasogastric tube, and wide-bore nasogastric tube. Nasogastric tubes slowed swallowing but did not alter swallowing function, namely bolus transit and clearance, and airway protection. The presence of a wide-bore nasogastric tube caused significant duration changes in several swallowing measures, namely duration of stage transition, duration of pharyngeal response, duration of pharyngeal transit, and duration of upper esophageal sphincter opening. Similar trends were seen for the fine-bore tube. The implications for nonoral feeding of patients with swallowing disorders are discussed.     

Effects of stroke‐induced damage to swallow‐related areas in the brain on swallowing mechanics of elderly patients

Aim: Our objective was to determine the relationship between defective swallowing mechanics and the location of brain lesions in stroke patients. Methods: We evaluated swallowing mechanics in 37 stroke patients and 10 age‐matched control subjects by videofluoroscopy. Subjects were asked to swallow 10 successive 1.0‐mL and three successive 2.5‐mL boluses of barium suspension at intervals of approximately 15–30 s. We measured oral transit time, pharyngeal delay time and pharyngeal transit time. Results: Patients could be divided into two groups based on the pharyngeal delay time for a 1.0‐mL bolus swallow. One group showed little variation during successive swallowing tests, similar to the control group. In the other group pharyngeal delay times varied during successive trials often tending to increase with successive swallows. Magnetic resonance imaging studies of the brain revealed infarcts or hemorrhages in swallow‐related areas in the latter group, while in the former group lesions were localized to areas unrelated to swallowing. Conclusion: Damage to swallow‐related areas may reduce their sensitivity to incoming signals from the oral cavity thereby impairing preparations to generate motor command signals and compromising their ability to send sufficient voluntary descending command signals to activate the swallowing central pattern generator located in the medulla. This deficiency becomes more evident with successive swallows and manifests as impaired swallowing mechanics.     

Effects of Carbonated Liquids on Oropharyngeal Swallowing Measures in People with Neurogenic Dysphagia

Aspiration is common in adults with neurogenic dysphagia and pharyngeal delay. This can lead to dehydration, malnutrition, and aspiration pneumonia. Diet modifications aimed at reducing thin liquid aspiration are partially successful or unpalatable or both. Carbonated liquids show some potential in influencing swallowing behavior. However, there is a paucity of evidence to support this intervention. This study compares the effects of carbonated thin liquids (CTL) with that of noncarbonated thin liquids (NCTL) on oropharyngeal swallowing in adults with neurogenic dysphagia and examines the palatability of the CTL stimulus. Seventeen people with pharyngeal delay attended for videofluoroscopy (VFSS). Outcome measures were oral transit time (OTT), pharyngeal transit time (PTT), stage transition duration (STD), initiation of the pharyngeal swallow (IPS), penetration-aspiration scale (PENASP), and pharyngeal retention (PR). A modification of Quartermaster Hedonic Scale (AQHS) was employed to assess palatability of the CTL. CTL vs. NCTL significantly decreased penetration and aspiration on 5-ml (P?=?0.028) and 10-ml (P?=?0.037) swallows. CTL had no significant effect on OTT, PTT, IPS, and PR for any volume of bolus. Only one participant disliked the CTL stimulus. These findings support the hypothesis that oropharyngeal swallowing can be modulated in response to sensory stimuli. Implications for research and clinical practice are discussed.     

Event Sequence Variability in Healthy Swallowing: Building on Previous Findings

This study builds on previous work by Kendall, Leonard, and McKenzie, which investigated event sequence variability for 12 paired events during swallowing by healthy volunteers. They identified four event pairs that always occurred in a stereotyped order and a most common occurring overall order of events during swallowing. In the current study, we investigated overall event sequencing and the same four paired events in a sample of swallows by healthy young (under 45 years old) volunteers. Data were collected during a 16-swallow lateral videofluoroscopy protocol, which included manipulations of bolus volume, barium density, bolus viscosity, and swallow cueing. Our results agreed with previous findings that variable event sequencing is found in healthy swallowing, and, in regard to obligatory sequencing of two paired events, movement of the arytenoids toward the base of the epiglottis begins prior to upper esophageal sphincter (UES) opening and maximum hyolaryngeal approximation occurs after UES opening. However, our data failed to replicate the previous findings that there is obligatory sequencing of maximum pharyngeal constriction after maximal UES distension and the UES opens before bolus arrival at the UES. The most common observed overall event sequence reported by Kendall et al. was observed in only 4/293 swallows in our dataset. Manipulations of bolus volume, bolus viscosity, barium concentration, swallow cueing, and swallow repetitions could not completely account for the differences observed between the two studies.     

Timing of videofluoroscopic,manometric events,and bolus transit during the oral and pharyngeal phases of swallowing

The aims of this study were to evaluate and quantify the timing of events associated with the oral and pharyngeal phases of liquid swallows. For this purpose, we recorded 0–20 ml barium swallows in three groups of volunteers using videoradiographic, electromyographic, and manometric methods. The study findings indicated that a leading complex of tongue tip and tongue base movement as well as onset of superior hyoid movement and mylohyoid myoelectric activity occurred in a tight temporal relationship at the inception of swallowing. Two distinct general types of normal swallows were observed. The common “incisor-type” swallow began with the bolus positioned on the tongue with the tongue tip pressed against the upper incisors and maxillary alveolar ridge. At the onset of the “dipper-type” swallow the bolus was located beneath the anterior tongue and the tongue tip scooped the bolus to a supralingual location. Beginning with tongue-tip peristaltic movement at the upper incisors, the two swallow types were identical. Swallow events that occurred after lingual peristaltic movement at the maxillary incisors showed a volume-dependent forward migration in time that led to earlier movement of the hyoid and larynx as well as earlier opening of the upper esophageal sphincter in order to receive the large boluses that arrived sooner in the pharynx during the swallow sequence than did smaller boluses. The study findings indicated that timing of swallow events should be considered in reference to both swallow type and bolus volume. The findings also indicated an important distinction between peristaltic transit and bolus clearance.     

健康老年妇女吞咽功能的研究

目的　通过电视X线透视吞咽功能的研究 ,评价健康老年妇女液体吞咽运动 ,并对液体吞咽运动的影响因素进行分析。　方法　 4 0例健康老年妇女 ,老年前期组 (5 0～ 5 9岁 ) 2 0例 ;老年组 2 0例 ,年龄 6 0～ 79岁。进行电视X线透视液体吞咽功能检查 ,分别对口咽部相关结构进行运动学分析 ,比较不同液体食团体及年龄对健康老年妇女吞咽的影响。　结果　 (1 )老年组较老年前期组渗透、口咽部滞留发生率增高 ,两组渗透发生率分别为 :7 5 %、3 8% ;口腔滞留发生率分别为 :1 2 5 %、6 3% ;咽腔滞留发生率分别为 :2 6 5 %、1 7 5 % ;口咽传递时间、腭咽部关闭时间及环咽部开放时间延长 (均为P <0 0 5 ) ;喉、舌骨向上运动距离增大 (P <0 0 5 )。 (2 ) 1 0ml食团较 1ml渗透、口咽部滞留发生率增高 ,两组渗透发生率分别为 :8 8%、2 5 % ;口腔滞留发生率分别为 :1 3 8%、5 0 % ;咽腔滞留发生率分别为 :31 3%、1 3 8% ;口传递时间缩短而环咽部开放时间延长 (均为P <0 0 5 ) ;喉向上、前运动 ,舌骨向前、向上运动的距离增大 (P <0 0 5 )。　结论　临床应用电视X线透视吞咽功能检查并对口咽期吞咽功能进行运动学分析是可行的 ;年龄及食团体积均影响健康老年妇女的液体吞咽功能     

Pharyngeal clearance during swallowing: a combined manometric and videofluoroscopic study.

The deglutitive pharyngeal contraction was analyzed using simultaneous videofluoroscopic and manometric studies of eight volunteers. Anterior, posterior, and longitudinal movements of the pharyngeal surfaces, relative to the cervical vertebrae, were measured during swallows of 5 and 10 mL of liquid barium. Profound pharyngeal shortening during bolus transit through the pharynx eliminated access to the larynx and elevated the upper esophageal sphincter to within 1.5 cm of the retrolingual pharynx. Bolus head movement through the pharynx preceded the propagated pharyngeal contraction and registered manometrically as a slight intrabolus pressure before the major pressure complex. Contraction in the horizontal plane began after bolus head transit and culminated with stripping of the bolus tail through the pharynx. Prolonged upper sphincter opening with the larger-volume swallows resulted from a delayed onset rather than altered propagation of the horizontal pharyngeal contraction. It is concluded that the propagated pharyngeal contraction facilitates pharyngeal clearance but has a minimal role in the process of bolus propulsion during swallowing. The propagated contraction works in concert with profound pharyngeal shortening to minimize hypopharyngeal residue after a swallow.     

Videofluoroscopic Evaluation of Swallowing in Chagas�� Disease

Dysphagia is the most common digestive symptom reported by patients with Chagas’ disease. The condition results from abnormalities of esophageal motility. Our hypothesis is that there are also alterations of oral and pharyngeal transit during swallowing. We studied by videofluoroscopy the oral and pharyngeal transit during swallowing in 17 patients with dysphagia, a positive serologic test for Chagas’ disease, and radiologic demonstration of esophageal involvement. The study also included 15 asymptomatic healthy volunteers. Each subject swallowed in duplicate 5 and 10 ml of liquid and paste barium boluses. Chagas’ disease patients had a longer oropharyngeal transit with the 5-ml liquid bolus (p = 0.03), and a longer oral transit (p = 0.01) and pharyngeal transit (p = 0.04) with the 10-ml liquid bolus than controls. There was no difference between patients and controls with swallows of the 5-ml paste bolus. With swallows of the 10-ml paste bolus, the oropharyngeal transit (p = 0.05), pharyngeal transit (p = 0.04), pharyngeal clearance (p = 0.02), and UES opening (p = 0.01) took a longer amount of time in Chagas’ disease patients than in controls. We conclude that the duration of pharyngeal transit is longer in patients with Chagas’ disease than in normal subjects, especially with a bolus of pasty consistency and a volume of 10 ml.     

Upper esophageal sphincter opening and modulation during swallowing

Studies were done on 8 normal subjects with synchronized videofluoroscopy and manometry to facilitate a biomechanical analysis of upper esophageal sphincter opening and volume-dependent modulation during swallowing. Movements of the hyoid and larynx, dimensions of sphincter opening, and intraluminal sphincter pressure were determined at 1/30th-s intervals during swallows of 1, 5, 10, and 20 ml of liquid barium. Our analysis subdivided upper esophageal sphincter activity during swallowing into five phases: (a) relaxation, (b) opening, (c) distention, (d) collapse, and (e) closure. Sphincter relaxation occurred during laryngeal elevation and preceded opening by a mean period of 0.1 s. Opening occurred as the sphincter was pulled apart via muscular attachments to the hyoid such that the hyoid coordinates at which sphincter opening and closing occurred were constant among bolus volumes. Sphincter distention after opening was modulated by intrabolus pressures rather than graded hyoid movement. The generation of intrabolus pressure coincided with the posterior thrust of the tongue that culminated in pharyngeal wall contact and the initiation of pharyngeal peristalsis. Larger volume swallows were associated with greater intrabolus pressure and increased bolus head velocity. The duration of sphincter opening increased in conjunction with a prolongation of the anterior-superior excursion of the hyoid and a delay in the onset of pharyngeal peristalsis (the event that determined the timing of sphincter closure). We conclude that transsphincteric transport of increasing swallow bolus volumes is accomplished by modulating sphincter diameter, opening interval, and flow rate (reflected by bolus head velocity). Furthermore, upper esophageal sphincter opening is an active mechanical event rather than simply a consequence of cricopharyngeal relaxation.     

Hyoid-Bolus Transit Latencies in Normal Swallow

Pharyngeal swallow delay is frequently found in dysphagic patients and is thought to be a factor in a range of swallowing problems, including aspiration. Implicit in notions of swallow “delay” is a temporal interval between two events that is longer than normal. However, there appears to be little agreement about which referent events should be considered in determining delay. A number of pharyngeal bolus transit points and various pharyngeal gestures have been used in delays determined from fluoroscopic evidence, and other referents have been used in electromyographic and manometric studies of swallow. In this study latencies between the first movement of the hyoid and several pharyngeal bolus transit points were calculated from fluoroscopic swallow studies in normal nondysphagic adults. Means and standard deviations of these latencies are provided for a 3-cc and a 20-cc bolus and for both nonelderly and elderly adults. The data may be a useful resource for relating the specific latencies investigated to concepts of pharyngeal swallow delay, in particular, when assessing videofluoroscopic studies using a similar protocol.     

Respiratory and Acoustic Signals Associated with Bolus Passage during Swallowing

In order to advance our understanding of the relation between respiration and deglutition, simultaneous videofluoroscopy and respirodeglutometry was performed. Fifteen normal, healthy, young adults (20-29 years of age) were connected to a respirodeglutometer and positioned for simultaneous videofluoroscopic assessment in the lateral plane. Subjects performed three swallows each of a 5-ml and a 10-ml bolus of liquid barium and a 5-ml bolus of paste barium, for a total of nine swallows per subject. Location of the bolus head as identified with videofluoroscopy was associated with eight respirodeglutometric variables. In addition, temporal relations for seven respirodeglutometric variables were calculated as a function of bolus volume and viscosity. Significant temporal differences were found for five of the variables by volume. No significant temporal differences were noted by viscosity. Expiration occurred before 79% and after 96% of the swallows. The number of inspirations preceding a swallow suggested a possible effect resulting from the need to hold a bolus in the mouth before receiving instructions to swallow during videofluoroscopic assessment. This effect may be important during patient evaluation. For a significant number of swallows, respiratory flow ceased before the velum was fully elevated.     

Variation in Temporal Measures of Swallowing: Sex and Volume Effects

Temporal measures of healthy swallowing appear to be variably sensitive to bolus and participant factors based on a recent meta-analysis of studies in the deglutition literature. In this carefully controlled study of healthy young volunteers, balanced for sex and height, we sought to understand the influence of bolus volume and participant sex on the three durations and three intervals most frequently reported in the deglutition literature. Three boluses per target volume (5, 10, and 20 ml) were repeated for each participant (n = 20, 10 male) using a spontaneous swallow paradigm in lateral view videofluoroscopy. None of the temporal durations or intervals was found to be correlated with participant height above an a priori cutoff point of r ≥ 0.3. Further, none of the temporal durations or intervals varied significantly by participant sex. Bolus volume significantly impacted upper esophageal sphincter (UES) opening duration, laryngeal closure duration, the laryngeal closure-to-UES opening interval, and the pharyngeal transit time interval, but not hyoid movement duration or the stage transition duration interval. When participants are sampled in such a manner as to represent the range of height reported to be typical for both sexes in the population, sex does not significantly influence temporal measures of swallowing.     

Videofluorographic Study of Swallowing in Parkinson's Disease

We studied 16 patients with Parkinson's disease (PD) with dysphagia and 8 young and 7 elderly normal controls videofluorographically to evaluate the nature of swallowing disorders in PD patients. In 13 patients, abnormal findings in the oral phase were residue on the tongue or residue in the anterior and lateral sulci, repeated pumping tongue motion, uncontrolled bolus or premature loss of liquid, and piecemeal deglutition. Thirteen patients showed abnormal findings in the pharyngeal phase, including vallecular residue after swallow, residue in pyriform sinuses, and delayed onset of laryngeal elevation. Ten of these patients also showed abnormal findings in both the oral and pharyngeal phases. Aspiration was seen in 9 patients. The oral transit duration was significantly longer in the patients with and without aspiration than in the control subjects. The stage transition duration, pharyngeal transit duration, duration of the upper esophageal sphincter (UES) opening, and total swallow duration were significantly longer in the patients with and without aspiration than in the young controls, but were not longer than in the elderly controls. These durational changes in the pharyngeal phase of swallowing were similar to those in the elderly controls. The findings suggest that the disturbed motility in the oral phase of swallowing may be due to bradykinesia. Although PD patients with dysphagia evince a variety of swallowing abnormalities, the duration of pharyngeal swallowing may remain within the age-related range until the symptoms worsen.     

Preterm Infant Swallowing of Thin and Nectar-Thick Liquids: Changes in Lingual–Palatal Coordination and Relation to Bolus Transit

Tongue–soft palate coordination and bolus head pharyngeal transit were studied by means of postacquisition kinematic analysis of videofluoroscopic swallowing images of ten preterm infants referred from hospital NICUs due to poor oral feeding and suspicion of aspiration. Sequences of coordinated tongue–soft palate movements and bolus transits during swallows of thin-consistency and nectar-thick-consistency barium were digitized, and time series data were used to calculate continuous relative phase, a measure of coordination. During swallows of nectar-thick compared to thin barium, tongue–soft palate coordination was more likely to be antiphase, bolus head pharyngeal transit time was longer, and coordination was significantly correlated with bolus head pharyngeal transit. Analysis of successive swallows indicated that tongue–soft palate coordination variability decreased with nectar-thick but not with thin-consistency barium. Together, the results suggest that slower-moving bolus transits may promote greater opportunity for available sensory information to be used to modulate timing of tongue–soft palate movements so that they are more effective for pumping liquids.     

The Effects of Aspiration Status, Liquid Type, and Bolus Volume on Pharyngeal Peak Pressure in Healthy Older Adults

The reasons for aspiration in healthy adults remain unknown. Given that the pharyngeal phase of swallowing is a key component of the safe swallow, it was hypothesized that healthy older adults who aspirate are likely to generate less pharyngeal peak pressures when swallowing. Accordingly, pharyngeal and upper esophageal sphincter pressures were examined as a function of aspiration status (i.e., nonaspirator vs. aspirator), sensor location (upper vs. lower pharynx), liquid type (i.e., water vs. milk), and volume (i.e., 5 vs. 10?ml) in healthy older adults. Manometric measurements were acquired with a 2.1-mm catheter during flexible endoscopic evaluation. Participants (N?=?19, mean age?=?79.2?years) contributed 28 swallows; during 8 swallows, simultaneous manometric measurements of upper and lower pharyngeal and upper esophageal pressures were obtained. Pharyngeal manometric peak pressure was significantly less for aspirators (mean?=?82, SD?=?31?mmHg) than for nonaspirators (mean?=?112, SD?=?20?mmHg), and upper pharyngeal pressures (mean = 85, SD = 32?mmHg) generated less pressure than lower pharyngeal pressures (mean?=?116, SD?=?38?mmHg). Manometric measurements vary with respect to aspiration status and sensor location. Lower pharyngeal pressures in healthy older adults may predispose them to aspiration.     

The Influence of Orolingual Pressure on the Timing of Pharyngeal Pressure Events

This study explored the influence of two methods of effortful swallow execution on the timing of pharyngeal pressure events. Participants were asked to either emphasize or minimize tongue-to-palate contact during performance of the maneuver. Twenty healthy participants were evaluated using concurrent submental surface electromyography (sEMG), orolingual manometry, and pharyngeal manometry. Each subject performed three repetitions of three counterbalanced tasks (noneffortful dry swallows, effortful dry swallows with tongue-to-palate emphasis, and effortful dry swallows with tongue-to-palate de-emphasis). Four variables were measured: Onset Lag vs. sEMG Peak, Peak Lag vs. sEMG Peak, Total Duration, and Percent Rise Time to Peak. Compared to noneffortful swallows, the effortful swallow task elicited significantly earlier onsets and peaks of pharyngeal pressures relative to the submental sEMG peak. Total pressure event durations were greater and rise times were significantly shorter. When comparing the two methods of effortful swallow execution, a longer latency to peak proximal pharyngeal pressure was found in the tongue-to-palate emphasis condition. These results support the interpretation that the effortful swallow maneuver involves generation of higher velocity bolus driving forces that propel the bolus into and through the pharynx with greater efficiency and that pressure is then sustained to facilitate more complete bolus clearance. Work performed at the Van der Veer Institute for Parkinson’s and Brain Research, Christchurch, New Zealand     

The Effects of Cervical Bracing Upon Swallowing in Young,Normal, Healthy Volunteers

Abstract The purpose of this study was to evaluate radiographically the effects of cervical bracing upon swallowing thin liquids and solid food in normal adults under three cervical bracing conditions. This was a prospective, repeated measures design study. Seventeen healthy adult volunteers between the ages of 30 and 50 were recruited from hospital staff. All subjects reported no previous history of swallowing difficulty or diseases that might affect swallowing. Subjects were radiographically observed swallowing thin liquids and solid food without cervical bracing and with three common cervical orthoses (Philadelphia collar, SOMI, and halo-vest brace). Order of bracing and type of bolus were randomized. Changes in swallowing function (point of initiation of swallow response, presence of pharyngeal residue, airway penetration, hyoid bone movement, diameter of oropharyngeal airway, and durational measurements) were analyzed by two independent raters. Eighty-two percent (14/17) of the subjects demonstrated radiographic changes under one or more of the bracing conditions. Forty-seven percent (8/17) of subjects demonstrated changes with point of initiation of the swallow response, 59% (10/17) demonstrated increased pharyngeal residue, and 23.5% (4/17) demonstrated changes with bolus flow with laryngeal penetration present. Aspiration did not occur under any of the bracing conditions. Changes noted in durational measurements for oral containment and total pharyngeal transit under the bracing conditions were not considered statistically significant. This study shows that cervical bracing does change swallowing physiology in normal healthy adults.