Gary H Mccullough

• PhD
• Head of Faculty at Appalachian State University

Objective : The purpose of the study was to investigate the effects of flow phonation voice therapy on laryngeal physiology and vocal quality in persons with primary Muscle Tension Dysphonia (MTD1). Methods : Seventeen participants with a diagnosis of MTD1 completed the study. Participants were randomized to two groups. Group 1 (9 participants) re...

Purpose Social isolation is linked to cognitive decline and depression, which can be risk factors for developing dementia. The purpose of this study was to determine which of a variety of factors were associated with communicative participation as measured by social network size. Method Three hundred thirty-seven adults aged 65 years or older were...

Purpose This clinical focus article considers the roles of the clinical swallow examination (CSE) as a clinically meaningful assessment method used in both adult and pediatric populations. Method This clinical focus article explores the utility of the CSE across the life span. Specifically, components, reliability, standardized assessments, and li...

Purpose The purpose of this investigation was to determine the effects of intensive stage rehearsal and performance on perceptual, acoustic, and aerodynamic measures of voice, and to determine the impact of knowledge and practice of vocal hygiene on measures of voice during intensive vocal performance. Methods Nineteen stage actors who were partic...

The act of swallowing is “multidimensional” and involves contributions from several neuroanatomical structures. A stroke affecting any of these areas is likely to cause some amount of physiologic impairment in deglutition. This paper explores current and emerging evidence for rehabilitative exercises for physiological impairments in deglutition due...

A clinical swallowing examination (CSE) is generally believed to be inadequate for making judgments regarding swallowing physiology compared to objective assessments. A large volume of studies has heavily focused on identifying aspiration using a CSE and research addressing physiologic information gathered from a CSE is sparse. The purpose of this...

Bolus volume has been widely studied, and research has demonstrated a variety of physiological impacts on swallowing and swallowing disorders. Oral perception of bolus volume has not, to our knowledge, been investigated in association with normal ageing processes. Research suggests many sensory changes with age, some within the oral cavity, and cha...

Timely and efficient upper esophageal sphincter (UES) opening may be critical to safe transport of food or liquid to the stomach and to prevent aspiration during the swallow. The purpose of this study was to examine the temporal and biomechanical characteristics of the UES opening in stroke survivors. Maximum duration and width of the UES opening w...

Purpose The purpose of this study was to investigate the utility of telepractice for delivering flow phonation exercises to persons with primary muscle tension dysphonia (MTD). Method Fourteen participants with a diagnosis of primary MTD participated, 7 on site and 7 at remote locations. Each participant received 12 treatment sessions across 6 wee...

The objective of this review is to gather available evidence regarding the role of the cerebellum in swallowing-related functions. We reviewed literature on cerebellar functions related to healthy swallowing, patterns of dysphagia in individuals with cerebellar lesions, and the role of the cerebellum in therapeutic intervention of neurogenic dyspha...

The Mendelsohn maneuver has been used as both a compensatory strategy and a rehabilitation exercise since it was first described in the mid-1980s. Its purpose has been widely agreed upon: to improve hyolaryngeal movement and, consequently, opening of the upper esophageal sphincter during deglutition. Reports of success with the maneuver in isolatio...

• Objective: To provide an evidence-based clinical update on the pathophysiology, assessment, and treatment of spasmodic dysphonia (SD). • Methods: We reviewed the extant literature on SD spanning predominantly the past 2 decades. References were extracted from Medline and PubMed using search terms of spasmodic dysphonia, pathophysiology, assessmen...

Objectives Identify outcome predictors by correlating clinical variables with postoperative videofluoroscopic swallow study (VFSS). Methods Retrospective chart review of 36 patients treated at an academic tertiary center between September 2009 and November 2012. Results Fifteen females and 21 males with a mean age of 54 years (range 7-81); 17 cas...

The primary aim of this study was to investigate the immediate effects of partial versus complete head rotation and chin tuck on pharyngeal swallowing pressures and durations in the pharynx and UES of normal, healthy adults. Ten individuals (3 men and 7 women; age range 54-76 years) served as participants. Solid-state intraluminal manometry was per...

Objections to the use of topical nasal anesthesia (TNA) during fiberoptic endoscopic evaluation of swallowing (FEES) with sensory testing (FEESST) have been raised, primarily because of the possibility of desensitizing the pharyngeal and laryngeal mucosa and affecting both the sensory and motor aspects of the swallow. Furthermore, it has been sugge...

The purposes of this study were to determine whether two bolus transition durations (oral transit time and pharyngeal transit time) were different during oropharyngeal swallowing in post-stroke patients who aspirated and who did not aspirate and to examine those differences across varying bolus viscosities. Means and standard deviations of oral tra...

The Mendelsohn maneuver, voluntary prolongation of laryngeal elevation during the swallow, has been widely used as a compensatory strategy to improve upper esophageal sphincter (UES) opening and bolus flow. Recent research suggests that when used as a rehabilitative exercise, it significantly improves duration of hyoid movement and positively impac...

Assessment of dysphagia may include instrumental or non-instrumental measures—frequently both. The clinical evaluation is a collection of, largely, non-instrumental measures, which may include a comprehensive history, a detailed oral motor and sensory physical exam, and trial swallows of liquids and foods. Each aspect of the clinical evaluation ser...

The purpose of this pilot study was to determine whether intensive use of the Mendelsohn maneuver in patients post stroke could alter swallow physiology when used as a rehabilitative exercise. Eighteen outpatients between 6 weeks and 22 months post stroke were enrolled in this prospective study using a crossover design to compare 2 weeks of treatme...

The relationship between arousal, perception, and visual neglect was examined in this case study. Cold pressor stimulation (CPS: immersing the foot in iced water) was used to manipulate arousal and to determine its effects on contralesional neglect, perception of stimulus intensity (magnitude estimation), reaction time, and an electrophysiological...

Context: While clinical successes and descriptions have been reported in a few texts, no data exist to define the utility of flow phonation to improve voice quality in patients with laryngeal hyperfunction. Aims: To provide pilot data regarding the utility of three exercises (gargling, cup bubble blowing, and stretch-and-flow) to improve phonatory...

Purpose The objective of the present investigation was to test the feasibility and clinical utility of a real-time Internet-based protocol for remote, telefluoroscopic evaluation of oropharyngeal swallowing. Method In this prospective cohort study, the authors evaluated 32 patients with a primary diagnosis of stroke or head/neck cancer. All patien...

Aspiration pneumonia is a leading cause of illness and death in persons who reside in long-term-care facilities and, combined with the lack of proper oral health care and services, the risk of aspiration pneumonia rises. The purpose of this article is to review recent literature on oral hygiene and oral care in long-term-care facilities and report...

Timely hyolaryngeal excursion and laryngeal closure are essential for safe transfer of the bolus during the pharyngeal swallow. The temporal measures stage transition duration (STD) and laryngeal closure duration (LCD) represent these physiological events. The purpose of this investigation was to determine whether small changes in bolus consistency...

Reduced maximal hyoid excursion has been suspected as one of the primary physiologic causes of aspiration after a stroke. Vertical and anterior displacement of hyoid excursion is critical to epiglottic closure for airway protection and the opening of the upper esophageal sphincter (UES). Without these carefully timed and well-executed components, t...

As a bolus enters the pharynx during the swallow, the airway is protected by laryngeal closure, a process characterized by approximation of the vocal folds plus approximation of the arytenoid cartilages to the base of the epiglottis. The purpose of this study was to measure initiation of laryngeal closure (ILC) and laryngeal closure duration (LCD)...

Vertical and anterior displacement of the hyoid bone is a critical biomechanical component of normal swallowing function. The purpose of this study was to evaluate the maximal vertical and anterior displacement of the hyoid bone during oropharyngeal swallowing. A retrospective review of video-fluoroscopic swallowing exams in 40 normal subjects vary...

The purpose of this study was to investigate the relationship between prolonged stage transition duration (STD) and aspiration. STDs and aspiration ratings were made from videofluoroscopic examinations previously obtained for other studies. Three groups of subjects were examined: (1) 20 stroke patients who aspirated, (2) 31 stroke patients who did...

The purpose of this study was to examine acute care registered nurses' (RNs') self-reported levels of compliance with speech-language pathologists' (SLPs') recommendations for safe feeding and swallowing techniques and proper oral hygiene care techniques in the care of adult with dysphagia. A survey was distributed to approximately 230 acute care R...

Although it is well known now that age affects swallowing function, few data have been reported for larger bolus sizes, such as 20 mL or sequential cup swallows, and few have reported data on the "oldest old," or those older than 80 years. The purpose of this investigation was to provide data for future investigations on adults, ranging in age from...

This study used linear regression to define the relationship between pragmatic performance and functional communication by 27 individuals with aphasia, including 14 with fluent aphasia and 13 with non-fluentaphasia. Pragmatic performance was measured with the Pragmatic Protocol. Functional communication was measured using the ASHA Functional Assess...

The purpose of this investigation was to determine the utility of clinical swallowing examination (CSE) measures for detecting aspiration as defined by videofluoroscopic swallowing examination (VFSE). This study, involving 165 participants, is a follow-up to a previously published investigation of 60 participants. Findings are compared with that in...

The purpose of this investigation was to examine the temporal differences among three measures of pharyngeal stage transition in 40 normal subjects. The measures were (1) Pharyngeal Delay Time (PDT), (2) Stage Transition Duration (STD), and (3) Delayed Pharyngeal Swallow (DPS). Results showed a significant difference between younger and older subje...

A hotly debated topic in oropharyngeal dysphagia is the Clinical Swallowing Examination's (CSE) importance in clinical practice. That debate can profit from the application of evidence-based medicine's (EBM) principles and procedures. These can guide both appropriate data collection and interpretation as will be demonstrated in the present report....

Unlabelled: A hotly debated topic in oropharyngeal dysphagia is the Clinical Swallowing Examination's (CSE) importance in clinical practice. That debate can profit from the application of evidence-based medicine's (EBM) principles and procedures. These can guide both appropriate data collection and interpretation as will be demonstrated in the pre...

This study examined the effects of tracheostomy cuff deflation and one-way speaking valve placement on swallow physiology. Fourteen nonventilator-dependent patients completed videofluoroscopic swallow studies (VFSS) under three conditions: (1) cuff inflated, (2) cuff deflated, and (3) one-way valve in place. Four additional patients with cuffless t...

Research has shown that swallowing in adults is affected by bolus consistency. Little is known, however, regarding the effect of bolus consistency on swallowing in children. Electromyographic (EMG) data from typically developing five- and eight-year-old-children and adults were obtained from the following muscles as they swallowed boluses of differ...

Unlabelled: While detecting the presence of aspiration is only one aspect of a noninstrumented examination of swallowing function, it is an important component due to its potential health status consequences. The purpose of this investigation was to investigate the sensitivity and specificity of clinical/bedside examination signs for predicting as...

Interjudge reliability for videofluoroscopic (VFS) swallowing evaluations has been investigated, and results have, for the most part, indicated that reliability is poor. While previous studies are well-designed investigations of interjudge reliability, few reports of intrajudge reliability are available for VFS measures derived from frame-by-frame...

This study investigates inter- and intrajudge reliability of a clinical examination of swallowing in adults. Several investigations have sought correlations between clinical indicators of dysphagia and the actual presence of dysphagia as determined by videofluoroscopy. Whereas some investigations have reported interjudge reliability for the videofl...

The purposes of this investigation were: (a) to determine which clinical/bedside and videofluoroscopic (VFS) examination methods and measures clinicians believe should be employed to assess swallowing in adults with neurogenic etiologies, (b) to determine which clinical/bedside and VFS examination methods and measures clinicians actually use, and (...

When rating the severity of dysphagia, judgments regarding the presence or absence of aspiration have the greatest face validity of all measures employed. In 1996, Rosenbek and colleagues introduced an 8-point scale designed to rate the severity of penetration/ aspiration on the depth the bolus travels in the airway and the patient's response to th...

Thesis (Ph. D. in Hearing and Speech Sciences)--Vanderbilt University, 1997. Includes bibliographical references (leaves 201-208).