Jeffrey Bruce Palmer

Jeffrey Bruce Palmer
Johns Hopkins University | JHU · Department of Physical Medicine and Rehabilitation

M.D.

About

124
Publications
82,119
Reads
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10,295
Citations
Additional affiliations
January 2017 - present
Johns Hopkins University
Position
  • Professor Emeritus
January 2016 - January 2018
Fujita Health University
Position
  • Professor (Full)
April 1997 - present
Fujita Health University
Position
  • Professor
Education
July 1980 - June 1983
University of Washington
Field of study
  • Rehabilitation Medecine
July 1980 - June 1983
University of Washington
Field of study
  • Physical Medcine and Rehabilitation
September 1976 - June 1980
New York University
Field of study
  • Medicine

Publications

Publications (124)
Article
Objective: During the mastication of solid food, the tongue pushes the bolus laterally to place it onto occlusal surfaces as the jaw is opened. This movement is referred to as tongue-pushing (TP). TP has an important role in efficient chewing, but its kinematic mechanisms remain unclear. The present study quantified the kinematics of TP and its co...
Article
Full-text available
Understanding bolus flow patterns in swallowing (rheology, the study of flow) is fundamental to assessment and treatment of dysphagia. These patterns are complex and poorly understood. A liquid swallow is typically biphasic, including air, so the actual bolus has both liquid and gas phases. We report a novel observation of annular two-phase flow (a...
Article
Objectives : When normal subjects eat solid food,the bolus is formed in the oropharynx prior to swallowing.When subjects chew liquid or a mixture of solid and liquid before swallowing,liquid frequently enters the hypopharynx before swallow onset.The purpose of this study was to determine whether transport to the hypopharynx is due to muscle activit...
Article
Objective This study investigated the effects of bolus consistency on pharyngeal volume during swallowing using three‐dimensional kinematic analysis. Methods Eight subjects (2 males, 6 females, mean ± SD 44± 10 years old) underwent a 320‐row area detector scan during swallows of 10‐ml of honey‐thick liquid and thin liquid. Critical event timing (h...
Chapter
Altered speech, language, and cognitive dysfunction result from a direct insult to the brain due to various neurologic disorders. Distinctive patterns of language use have been associated with certain neurologic conditions. In the majority of individuals, the left brain contains centers of language, whereas the right brain has a distinct role in co...
Article
Objectives: Dysphagia in patients with myositis is associated with an increased risk of aspiration pneumonia. However, the pathophysiology of dysphagia is poorly understood. The goal of this study was to understand how myositis affects swallowing physiology on videofluoroscopic swallow study (VFSS). Design: Retrospective review of video fluorosc...
Article
Full-text available
Pharyngeal residue, the material that remains in the pharynx after swallowing, is an important marker of impairments in swallowing and prandial aspiration risk. The goals of this study were to determine whether the 2D area of post-swallow residue accurately represents its 3D volume, and if the laterality of residue would affect this association. Th...
Article
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To evaluate timing and duration differences in airway protection and esophageal opening after oral intubation and mechanical ventilation for acute respiratory distress syndrome (ARDS) survivors versus age-matched healthy volunteers. Orally intubated adult (≥ 18 years old) patients receiving mechanical ventilation for ARDS were evaluated for swallow...
Article
Full-text available
Older adults may evidence changes in swallowing physiology. Our goals were to identify dysphagia risk in community-dwelling older adults with no history of dysphagia, and to compare swallowing physiology and safety between older and younger adults. Thirty-two older adults with no history of dysphagia were prospectively recruited and completed the D...
Article
The cover image, by Kannit Pongpipatpaiboon et al., is based on the original Article Pharyngeal swallowing in older adults: Kinematic analysis using three‐dimensional dynamic computed tomography. DOI: 10.1111/joor.12703.
Article
Objectives: To assess the effect of age on swallowing with a focus on structural movement, timing, and duration of physiologic events. Design: Cross-sectional study. Setting: Tertiary University Medical Center. Participants: Community-dwelling adults (3 age groups): younger 20 to 39 (n=23; mean 32 ± 5), middle-aged 40 to 59 (n=29; mean 49 ±...
Article
Full-text available
This study investigated the effects of Mendelsohn maneuver with three-dimensional kinematic analysis. Nine female speech-language pathologists (nine females, mean ± SD 27.1 ± 3.5 years old) underwent 320-row area detector scan during swallows of 4-ml nectar-thick liquid using with no maneuvers (control) and with Mendelsohn maneuver (MM). Critical e...
Article
This study investigated the effects of three different volumes of honey-thick liquid on the temporal characteristics of swallowing. Twenty six healthy subjects (15 males, 11 females) underwent 320-Row Area Detector CT scan while swallowing 3, 10, and 20ml of honey-thick liquid barium. Three-dimensional images were created at 10 images/s. Kinematic...
Article
Objective When eating solids, stage II transport (St2Tr) propels triturated food into the pharynx for bolus formation and storage before swallowing. Although the existence of St2Tr is acknowledged, the reason for its existence remains unclear. Understanding it may facilitate development of food appropriate for individuals with dysphagia. The purpos...
Article
Rationale: Nearly 60% of patients who are intubated in intensive care units (ICUs) experience dysphagia after extubation, and approximately 50% of them aspirate. Little is known about dysphagia recovery time after patients are discharged from the hospital. Objective: To determine factors associated with recovery from dysphagia symptoms after hos...
Article
Full-text available
Food oral processing and pharyngeal food passage cannot be observed directly from the outside of the body without instrumental methods. Videofluoroscopy (X-ray video recording) reveals the movement of oropharyngeal anatomical structures in two dimensions. By adding a radiopaque contrast medium, the motion and shape of the food bolus can be also vis...
Article
Communication and swallowing disorders are common after stroke. Targeted surveillance followed by prompt evaluation and treatment is of paramount importance. The overall goals of rehabilitation for impaired swallowing and communication and swallowing deficits may differ based on the specific deficits caused by the stroke but the main goal is always...
Conference Paper
The objective of this study was to compare area and volume of pharyngeal residue after swallowing using dynamic 320-detector row computed tomography (3D-CT). In a prospective observational cohort study at an urban academic medical center, we evaluated thirteen subjects with dysphagia due to brainstem stroke. Interventions included dynamic 3D-CT of...
Article
Full-text available
Swallowing is one of the basic activities in humans. The pharynx functions as an airway and a food channel, and a pharyngeal swallow usually occurs after bolus transport from the oral cavity. However, direct fluid infusion through a catheter into the hypopharynx produces a pharyngeal swallow without the oral stage in experimental situations. The pu...
Article
Full-text available
Although oropharyngeal and laryngeal structures are essential for swallowing, the three-dimensional (3D) anatomy is not well understood, due in part to limitations of available measuring techniques. This study uses 3D images acquired by 320-row area detector computed tomography ('320-ADCT'), to measure the pharynx and larynx and to investigate the...
Article
When eating solid food, the tongue intermittently propels triturated food to the oropharynx or valleculae, where a bolus accumulates before swallowing. The tongue motion during this food transport (stage II transport, STII) is distinctly different from that during chewing, and is more similar to the oral propulsive stage of swallowing. Therefore, w...
Article
Methods: We performed a secondary analysis of a prospective cohort study in which investigators evaluated 178 eligible patients with ALI who were mechanically ventilated via oral endotracheal tube. The patients were recruited from 13 ICUs at four teaching hospitals in Baltimore, Maryland. Patient demographic and clinical factors, types of ICU, and...
Article
Full-text available
Purpose: The purpose of the study is to compare neuromuscular electrical stimulation (NMES) vs sham on leg strength at hospital discharge in mechanically ventilated patients. Materials and methods: We conducted a randomized pilot study of NMES vs sham applied to 3 bilateral lower extremity muscle groups for 60 minutes daily in the intensive care...
Article
Full-text available
Few studies have reported the activation sequence of the swallowing muscles in healthy human participants. We examined temporal characteristics of selected hyoid muscles using fine wire intramuscular electromyography (EMG). Thirteen healthy adults were studied using EMG of the anterior belly of digastric (ABD), geniohyoid (GH), sternohyoid (SH), an...
Article
Full-text available
Stage II transport (St2Tr) is propulsion of triturated food into the pharynx for storage before swallowing via tongue squeeze-back against the palate. To clarify the phenomenology of St2Tr, we examined the effects of food consistency and the number of chewing cycles on the number of St2Tr cycles in a chew-swallow sequence. We recorded chew-swallow...
Article
Purpose To evaluate demographic and clinical factors associated with self-reported dysphagia after oral endotracheal intubation and mechanical ventilation in patients with acute lung injury (ALI) Materials and Methods Prospective cohort study of 132 ALI patients who had received mechanical ventilation via oral endotracheal tube Results The primar...
Article
We examined the temporospatial characteristics of stage I oral food transport, in which a piece of solid food is moved from the anterior oral cavity to the postcanine region for chewing. Anteroposterior transport is accomplished by carrying food posteriorly on the surface of the tongue, in contrast to the squeeze-back mechanism of stage II transpor...
Article
When chewing solid food, part of the bolus is propelled into the oropharynx before swallowing; this is named stage II transport (St2Tr). However, the tongue movement patterns that comprise St2Tr remain unclear. We investigated coronal jaw and tongue movements using videofluorography. Fourteen healthy young adults ate 6 g each of banana, cookie, and...
Article
OBJECTIVE:: To evaluate the potential annual net cost savings of implementing an ICU early rehabilitation program. DESIGN:: Using data from existing publications and actual experience with an early rehabilitation program in the Johns Hopkins Hospital Medical ICU, we developed a model of net financial savings/costs and presented results for ICUs wit...
Chapter
The oral cavity is a chamber surrounded by and containing hard and soft tissues, notably the lips, cheeks, tongue, palate, and teeth. The oral cavity is the entrance to the digestive, vocal, and (at times) the respiratory tract. Thus, the structures of the oral cavity serve multiple functions in speaking, breathing, mastication and swallowing. Mast...
Article
Full-text available
Purpose The authors write this letter to clarify some of the points raised by Dr. Giselle Carnaby about their article titled “Clinical Experience Using the Mann Assessment of Swallowing Ability (MASA) for Identification of Patients at Risk for Aspiration in a Mixed-Disease Population” (González-Fernández, Sein, & Palmer, 2011). The intention of thi...
Article
The present study examined the effect of bolus viscosity on the onset of laryngeal closure (relative to hyoid elevation), the duration of laryngeal closure, and other key events of swallowing in ten healthy volunteers. All volunteers underwent 320-row area detector computed tomography swallow studies while swallowing 10 ml of honey-thick barium (5...
Article
Full-text available
Background: As the population ages and critical care advances, a growing number of survivors of critical illness will be at risk for intensive care unit (ICU)-acquired weakness. Bed rest, which is common in the ICU, causes adverse effects, including muscle weakness. Consequently, patients need ICU-based interventions focused on the muscular system...
Article
Full-text available
Inamoto Y, Kagaya H, Saitoh E, Kanamori D, Shibata S, Fujii N, Katada K, Palmer J B. Inter-rater and intra-subject reliability for the evaluation of swallowing kinematics using 320-row area detector computed tomography. Jpn J Compr Rehabil Sci 2012; 3: 59-65. Objective: The purpose of this study was to examine the inter-rater reliability and intra-...
Article
Millions of patients are discharged from intensive care units annually. These intensive care survivors and their families frequently report a wide range of impairments in their health status which may last for months and years after hospital discharge. To report on a 2-day Society of Critical Care Medicine conference aimed at improving the long-ter...
Article
Full-text available
Purpose To determine the clinical performance characteristics of the Mann Assessment of Swallowing Ability (MASA) for predicting aspiration (determined by videofluoroscopic swallowing study [VFSS]) in a mixed population. Method We selected 133 cases clinically evaluated using MASA and VFSS from January through June 2007. Ordinal risk rating (ORR)...
Article
A 320-detector-row multislice computed tomography (320-MSCT) scanner can acquire a volume data set covering a maximum range of 16 cm and can generate axial images 0.5-mm thick at 0.5-mm intervals. Three-dimensional (3D) images reconstructed from the thin axial slices include multiplanar reconstruction and 3D-CT. Single-phase 3D images are reconstru...
Book
A stroke can alter two people's lives in an instant. For the person who has had a stroke, simple tasks suddenly become difficult or impossible. For that person's partner, life seems to revolve mostly around the stroke survivor's needs. Such a drastic change naturally requires making many, sometimes taxing, adjustments. In this book, two experts in...
Article
Full-text available
The present study examined the effect of bolus viscosity on the onset of laryngeal closure (relative to hyoid elevation), the duration of laryngeal closure, and other key events of swallowing in ten healthy volunteers. All volunteers underwent 320-row area detector computed tomography swallow studies while swallowing 10 ml of honey-thick barium (5...
Article
Full-text available
Cyclic soft palate elevation is temporally associated with masticatory jaw movement. However, the soft palate is normally lowered during nasal breathing to maintain retropalatal airway patency. We tested the hypothesis that the frequency and amplitude of soft palate elevation associated with mastication would be reduced during inspiration. Movement...
Article
Full-text available
To (1) reduce deep sedation and delirium to permit mobilization, (2) increase the frequency of rehabilitation consultations and treatments to improve patients' functional mobility, and (3) evaluate effects on length of stay. Seven-month prospective before/after quality improvement project. Sixteen-bed medical intensive care unit (MICU) in academic...
Article
The purpose of this study was to (1) depict normal dynamic swallowing and (2) measure (a) the temporal characteristics of three components of laryngeal closure, i.e., true vocal cord (TVC) closure, closure of the laryngeal vestibule at the arytenoid to epiglottic base, and epiglottic inversion, and (b) the temporal relationship between these levels...
Article
Full-text available
Tongue movement is temporo-spatially coordinated with jaw and hyoid movements during eating and speech. As such, we evaluated: (1) the correlation between the tongue with jaw and hyoid movements during eating and speech and (2) the relative influence of the jaw and hyoid on determining tongue movement. Lateral projection videofluorography was recor...
Article
Videofluoroscopic examination of swallowing (VF) is the gold standard in diagnosis and management of dysphagia. During VF, the patient ingests radiopaque foods and liquids, and oral, pharyngeal, and esophageal stages of swallowing physiology are observed and evaluated. Aspiration is defined as passage of materials through the vocal folds, and laryn...
Article
The aim of this study was to describe the frequency, physiologic effects, safety, and patient outcomes associated with traditional rehabilitation therapy in patients who require mechanical ventilation. Prospective observational report of consecutive patients ventilated 4 or more days and eligible for rehabilitation in a single medical intensive car...
Article
Full-text available
The aim of this study was to determine the accuracy of dysphagia coding using the International Classification of Diseases version 9 (ICD-9) code 787.2. We used the administrative database of a tertiary hospital and sequential videofluorographic swallowing study (VFSS) reports for patients admitted to the same hospital from January to June 2007. Th...
Article
Full-text available
The pathways for air and food cross in the pharynx. In breathing, air may flow through either the nose or the mouth, it always flows through the pharynx. During swallowing, the pharynx changes from an airway to a food channel. The pharynx is isolated from the nasal cavity and lower airway by velopharyngeal and laryngeal closure during the pharyngea...
Article
Full-text available
Eating and swallowing are complex behaviors involving volitional and reflexive activities of more than 30 nerves and muscles. They have two crucial biologic features: food passage from the oral cavity to stomach and airway protection. The swallowing process is commonly divided into oral, pharyngeal, and esophageal stages, according to the location...
Article
Dysphagia is a common problem after stroke associated with significant morbidity and mortality. Except for patients with brain stem strokes, particularly lateral medullary strokes, it is difficult to predict which cases are likely to develop swallowing dysfunction based on their neuroimaging. Clear models of swallowing control and integration of co...
Article
Full-text available
There has been little attention given to the relationship between variations in normal craniofacial morphology and swallowing physiology. This preliminary investigation evaluated the relationship between the Frankfort-mandibular plane angle (FMA) and hyoid displacement during swallowing. Hyoid movement was evaluated during 12-ml and 24-ml swallows...
Article
Full-text available
To determine whether the proportion of patients with stroke experiencing dysphagia differs among racial groups and whether this relation can be explained by stroke type or severity. Case-control study using California's Medical Information Reporting and New York's Statewide Planning and Research Cooperative System databases for 2002. Cases had prim...
Article
Full-text available
During feeding, solid food is chewed and propelled to the oropharynx, where the bolus gradually aggregates while the larynx remains open and breathing continues. The aggregated bolus in the valleculae is exposed to respiratory airflow, yet aspiration is rare in healthy individuals. The mechanism for preventing aspiration during bolus aggregation is...
Book
Spinal Cord Injury is a guide for people with SCI and their families. Combining first-person accounts with up-to-date medical information, the book addresses all aspects of spinal cord injury - recovery and coping, sex and family matters, transportation and housing, employment and leisure - and reviews the challenges encountered by people with spin...
Article
The "chin-down" or "chin-tuck" maneuver is a postural technique widely used in dysphagia treatment. The posture, however, does not have a precise anatomical definition. We studied the current practice of 42 speech-language pathologists (SLPs) in Japan and the U.S. with a questionnaire survey regarding the chin-down posture. The main findings were t...
Article
Full-text available
When healthy individuals eat solid food, chewed food is usually transported to the oropharynx where it accumulates before swallowing (stage II transport). We tested the hypothesis that this transport process can be altered by volition. Eight healthy young subjects ate 8 g pieces of cookie with barium while movements were recorded with videofluorogr...
Article
Preswallow bolus formation usually occurs in the mouth for liquids and in the oropharynx for solid foods. We examined the effect of chewing on the relationship between bolus transport and swallow initiation. Fifteen healthy subjects were imaged with lateral projection videofluorography while eating liquids, solid foods, and a mixture of liquid and...
Article
Full-text available
Mastication and food consistency each affect the passage of food through the oral cavity and pharynx and its coordination with swallow initiation. Since hemispheric stroke may damage cortico-medullary neural pathways, we hypothesized that it could also alter the coordination of eating and swallowing. Using videofluorography, we studied 30 individua...
Article
Full-text available
When healthy individuals eat solid food, chewed food is usually transported to the oropharynx where it accumulates before swallowing (stage II transport). We tested the hypothesis that this transport process can be altered by volition. Eight healthy young subjects ate 8 g pieces of cookie with barium while movements were recorded with videofluorogr...
Article
Full-text available
The soft palate moves rhythmically during feeding, but the timing and frequency of this motion are not known. We tested the hypothesis that cyclic soft palate motion is temporally linked to cyclic jaw movement. Nine healthy, asymptomatic human subjects with normal dentition ate solid food coated with barium. Videofluorographic recordings showed tha...
Article
Full-text available
Reduced length of stays for inpatient rehabilitation challenge psychologists to develop new models of psychosocial service. Crisis intervention is a useful model that can be adapted to meet the needs of stroke patients and their families. The authors describe a 1-session intervention, utilizing crisis intervention and psychoeducational and cognitiv...
Article
Full-text available
A simple, broadly applicable, standardized dysphagia severity scale would be useful to standardize dysphagia evaluations, to monitor recovery and efficacy of treatment and to study the consequences of dysphagia. We developed a global Dysphagia Severity Scale (DSS) from videofluorographic swallowing studies which included subjective clinical ratings...