Swallowing in myotonic muscular dystrophy: A videofluoroscopic study


      Leonard RJ, Kendall KA, Johnson R, McKenzie S. Swallowing in myotonic muscular dystrophy: a videofluoroscopic study. Arch Phys Med Rehabil 2001;82:979-85. Objectives: (1) To determine how swallow function in patients with myotonic muscular dystrophy (MD) differs from that of healthy controls, (2) to identify the contributors to and predictors of improvement, and (3) to evaluate strategies that facilitate swallowing. Design: Observational. Setting: University medical center. Participants: Eighteen adults with myotonic MD (age range, 24-58yr) and 60 healthy adult control subjects (age range, 18-73yr). Interventions: Swallow facilitation strategies. Main Outcome Measures: Between-group comparisons of mean bolus transit times, onsets of swallow gestures, and displacement measures obtained by dynamic lateral view videofluoroscopy. Results: The MD patients' bolus transit times were significantly longer, and onsets of some swallow gestures were significantly delayed. Upper esophageal sphincter opening was prolonged (myotonic MD,.61 ±.13s; control,.5 ±.11s). Hyoid displacement was significantly less in men with myotonic MD (1.9 ±.05cm) than in male controls (2.4 ±.68cm); this difference was not observed between control and myotonic women. Of particular importance was the markedly reduced pharyngeal constriction found in the MD group. Conclusions: Weakness associated with the disease, as opposed to myotonia, was the most significant contributor to impairment. Persons at risk for aspiration may be identified by a measure of pharyngeal area. Selected strategies to facilitate pharyngeal clearing are worthwhile. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Harper PS
        Myotonic muscular dystrophy.
        2nd ed. WB Saunders, Philadelphia1989
        • Willig TN
        • Paulus J
        • Lacau Saint Guily J
        • Beon C
        • Navarro J
        Swallowing problems in neuromuscular disorders.
        Arch Phys Med Rehabil. 1994; 75: 1175-1181
        • Pruzansky W
        • Profis A
        Dysfunction of the alimentary tract in myotonic dystrophy.
        Isr J Med Sci. 1996; 2: 59-64
        • Kaida K
        • Kono S
        • Komiya T
        • Kawai M
        Imaging and pathological studies on the esophageal dysfunction in patients with myotonic dystrophy [Japanese].
        Rinsho Shinkeigaku. 1996; 36: 300-305
        • Nowak TV
        • Ionasescu V
        • Anuras S
        Gastrointestinal manifestations of the muscular dystrophies.
        Gastroenterology. 1982; 82: 800-810
        • Johnson ER
        • McKenzie SW
        Kinematic pharyngeal transit times in myopathy: evaluation for dysphagia.
        Dysphagia. 1993; 8: 35-40
        • Johnson ER
        • McKenzie S
        • Rubner D
        Hyoid movement in myopathy.
        Phonoscope. 1998; 1: 15-20
        • Leonard R
        • Kendall K
        Dysphagia assessment and treatment planning: a team approach.
        Singular Publishing Group, San Diego (CA)1997
        • Ohmae Y
        • Logemann JA
        • Kaiser P
        • Hanson DG
        • Kahrilas PJ
        Timing of glottic closure during a swallow.
        Head Neck. 1995; 17: 394-402
        • Maddock DJ
        • Gilbert RJ
        Quantitative relationship between liquid bolus flow and laryngeal closure during deglutition.
        Am J Physiol. 1993; 265: G704-G707
        • Cook IJ
        • Dodds WJ
        • Dantas RO
        • Kern MK
        • Massey BT
        • Shaker R
        • et al.
        Timing of videofluoroscopic, manometric events, and bolus transit during the oral and pharyngeal phases of swallowing.
        Dysphagia. 1989; 4: 8-15
        • Kahrilas PJ
        • Lin S
        • Chen J
        • Logemann JA
        Oropharyngeal accommodation to swallow volume.
        Gastroenterology. 1996; 111: 297-306
        • Curtis D
        • Cruess D
        • Dachman A
        • Maso E
        Timing in the normal pharyngeal swallow.
        Invest Radiol. 1984; 9: 523-529