JA Logemann

Northwestern Memorial Hospital, Chicago, Illinois, United States

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Publications (112)

  • N. Nativ-Zeltzer · J. A. Logemann · S. G. Zecker · P. J. Kahrilas
    [Show abstract] [Hide abstract] ABSTRACT: Background: We aimed to define normative values for novel pressure topography metrics for high-resolution pharyngeal-esophageal manofluorography. The effects of age, gender, and bolus properties were examined. Methods: Concurrent high-resolution manometry (HRM) and videofluoroscopy data were collected from 22 younger (aged 21-40) and 22 older (aged 60-80) healthy subjects. Pressure topography was analyzed by correlating pressure domains with videofluoroscopic events. Nine pressure topography metrics of the pharyngeal and proximal esophageal swallow were extracted; four of these were also compared with previously obtained esophageal HRM studies to assess the effects of catheter diameter. Key results: Older individuals exhibited more vigorous contractility in the pharynx than did younger subjects with all bolus types, but the greatest values for both groups were with effortful swallow and on that measure the age groups were similar. Upper esophageal sphincter (UES) intrabolus pressure during sphincter opening was also greater in the older subjects. Some gender differences were observed, particularly related to proximal esophageal contractile vigor. Bolus consistency had no consistent effect. Studies using the larger catheter diameter resulted in significantly greater contractile vigor in the UES and proximal esophagus. Conclusions & inferences: Older adults exhibited more vigorous pharyngeal contractions than young adults, albeit within a similar range of capacity, perhaps reflecting a compensatory response to other age-related physiological changes. Greater UES intrabolus pressures observed during bolus transit in the older group likely reflect reduced UES compliance with age. Normative data on novel HRM metrics collected in this study can serve as a reference for future clinical studies.
    Article · Jan 2016 · Neurogastroenterology and Motility
  • Barbara Roa Pauloski · Alfred W Rademaker · Jerilyn A Logemann · [...] · Bharat B Mittal
    [Show abstract] [Hide abstract] ABSTRACT: Background: Intensity-modulated radiotherapy (IMRT) is hoped to protect structures important for swallow function. We compared posttreatment swallow function in 7 pairs of patients with head and neck cancer treated with either IMRT or conventional radiotherapy (RT). Methods: Patients were matched on tumor characteristics. Swallowing function was evaluated with the modified barium swallow procedure pretreatment and at 3 and 6 months postcancer treatment completion. Swallows were analyzed for bolus transit times, bolus residues, laryngeal closure (LAC) duration, cricopharyngeal opening (CPO) duration, and oropharyngeal swallow efficiency (OPSE). Data were analyzed using multifactor repeated measures analysis of variance and adjusted for baseline function. Results: Main effect of radiation type was significant for all measures on at least 1 bolus type. Patients treated with IMRT demonstrated shorter bolus transit times, less oral and pharyngeal residue, longer LAC, and larger OPSE. Conclusion: Patients treated with IMRT demonstrated faster, more efficient swallows, and greater airway protection. © 2014 Wiley Periodicals, Inc. Head Neck, 2014.
    Article · Aug 2014 · Head & Neck
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    Bharat B Mittal · Barbara Roa Pauloski · Alfred W Rademaker · [...] · Jerilyn A Logemann
    [Show abstract] [Hide abstract] ABSTRACT: Background: No objective data are available to assess the potential damage induction chemotherapy alone contributes to swallowing physiology and salivary production in patients with locally and regionally confined head and neck cancer. Methods: Thirteen patients with head and neck cancer were evaluated preinduction and postinduction chemotherapy. Assessment included: (1) percentage of nutrition taken orally and food consistencies in diet; (2) videofluorographic swallow evaluation; (3) whole mouth saliva collection; (4) quality-of-life questionnaire; and (5) pain and oral mucositis scores. Results: All patients were able to consume most foods and took 100% of their nutrition orally both preinduction and postinduction chemotherapy. Although a number of swallow measures worsened, no statistically significant differences were observed in diet, quality of life measures, pain, or saliva weight, or in most temporal swallow measures. Pharyngeal residue decreased significantly after chemotherapy. Conclusion: Induction chemotherapy alone did not significantly negatively alter swallowing physiology and salivary secretion, although the trend was toward worsening in function.
    Full-text Article · Apr 2014 · Head & Neck
  • Jerilyn A. Logemann
    [Show abstract] [Hide abstract] ABSTRACT: Normal oropharyngeal swallowing is a complex set of neuromotor behaviors containing three phases: (1) oral preparation to break food down to a swallowable consistency; (2) oral phase, which propels food from the mouth; (3) pharyngeal phase creates pressure to push food into the esophagus, and includes valve functions, which prevent food from entering the nose or airway and allow food into the esophagus. Systematic changes in normal oropharyngeal swallow are based on volume, viscosity, temperature and food textures/taste of the food swallowed as well as age. Patients with oropharyngeal swallowing difficulties (dysphagia) react differently to these systematic variables in food characteristics. This review manuscript presents the results of a series of studies that examine the role of each of the stages of the oropharyngeal swallow. The importance of the definition of food viscosity in the care of dysphagic patients and the role of food production companies in this effort are emphasized. Practical ApplicationsThe body of research work that we are summarizing and reviewing here is designed to provide a baseline regarding normal oropharyngeal swallow function in adults against which abnormalities in swallow can be compared. Understanding swallow disorders in the oral and pharyngeal stages of oropharyngeal deglutition enables food scientists to develop food textures, which are most successfully swallowable by specific types of dysphagic patients. All of the studies reviewed here have been approved by the Northwestern University Institutional Review Board.
    Article · Apr 2014 · Journal of Texture Studies
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    Barbara Roa Pauloski · Jerilyn A Logemann · Alfred W Rademaker · [...] · Mary Bacon
    [Show abstract] [Hide abstract] ABSTRACT: Background: Treatment for head and neck cancer can reduce peripheral sensory input and impair oropharyngeal swallow. This study examined the effect of enhanced bolus flavor on liquid swallows in these patients. Methods: Fifty-one patients treated for head and neck cancer with chemoradiation or surgery and 64 healthy adult control subjects served as subjects. All were randomized to receive sour, sweet, or salty bolus flavor. Patients were evaluated at 7-10 days, 1 month, and 3 months after completion of tumor treatment. Control subjects received 1 assessment. Results: All bolus flavors affected oropharyngeal swallow; sour flavor significantly shortened pharyngeal transit time across all evaluations. Conclusions: Sour flavor influenced the swallow of patients treated for head and neck cancer, as well as that of control subjects in a manner similar to those with neurologic impairment observed in an earlier study. Sour flavor may improve the speed of pharyngeal transit regardless of whether a patient has suffered peripheral or central sensory damage.
    Full-text Article · Aug 2013 · Head & Neck
  • Noga Nativ-Zeltzer · Peter J Kahrilas · Jerilyn A Logemann
    [Show abstract] [Hide abstract] ABSTRACT: Manofluorography, that is, the concurrent use of manometry and videofluorography for the evaluation of pharyngeal dysphagia, has not been widely used clinically, partially because of various limitations of conventional manometry. Technological advancements in recent years have led to substantial improvements in manometric devises, which can now overcome many of the shortcomings of standard manometry. In parallel with this, studies examining the utility of high-resolution manometry for the evaluation of pharyngeal disorders of swallowing have begun to emerge. This review summarizes the technological developments in manometry and the existing literature on pharyngeal high-resolution manofluorography with pressure topography. The article also discusses the potential clinical value of high-resolution pharyngeal-esophageal pressure topography and suggests directions for future investigations. Studies conducted so far have shown heterogeneous approaches to utilizing high-resolution manofluorography. These studies have revealed important information regarding its diagnostic potential and researchers have devised innovative methods of measurements. However, substantial research is required to transform manofluorography into a clinically useful tool. There is a need to conduct validation studies, correlating manometric measures with structural changes in the swallow seen on videofluorography and devise diagnostic methods that utilize the advantages of both tools. Furthermore, studies comparing healthy and clinical populations are needed to identify measures most clinically significant in order to develop diagnostic paradigms.
    Article · Apr 2012 · Dysphagia
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    [Show abstract] [Hide abstract] ABSTRACT: Acute oral mucositis is associated with pain and impaired swallowing. Little information is available on the effects of chronic mucositis on swallowing. Sixty patients treated for cancer of the head and neck were examined during the first year after their cancer treatment. Oral mucosa was rated with the Oral Mucositis Assessment Scale. Stimulated whole-mouth saliva, oral pain rating, percent of oral intake, and 2 subscales of the Performance Status Scale for Head and Neck (PSS-HN) cancer were also collected. Mucositis scores and pain ratings decreased over time while functional measures of eating improved over time. Reduction in chronic mucositis was correlated with improved oral intake and diet. Lack of association with pain was attributed to the absence of ulcerations. Continued impairment of oral intake during the first year posttreatment may be related to oral mucosal changes and other factors.
    Full-text Article · Jun 2011 · Head & Neck
  • JA Logemann · K Larsen
    [Show abstract] [Hide abstract] ABSTRACT: The oropharyngeal swallow involves a rapid, highly coordinated set of neuromuscular actions beginning with lip closure and terminating with opening of the upper esophageal sphincter. Evaluation of the oropharyngeal swallow usually involves the use of a modified barium swallow radiographic study with the goals of (i) defining the patient's swallow anatomy and physiology causing the dysphagia; and (ii) evaluating the immediate effectiveness of treatment procedures including selected postures, sensory enhancement, swallow maneuvers, and diet changes. Exercise programs may be helpful, but their immediate effects cannot be examined during the initial modified barium swallow. Exercise programs can be evaluated on a second radiographic study 3-4 weeks later. The resultant report should include all of this information. The speech-language pathologist is usually the professional most involved in the evaluation and treatment. Medications and surgery have a very limited role in the treatment of oropharyngeal dysphagia.
    Article · May 2011 · Diseases of the Esophagus
  • Kara J. Ayala · Jerilyn A. Logemann
    [Show abstract] [Hide abstract] ABSTRACT: The effects of alterations in bolus sensory characteristics - including temperature, taste, and viscosity - on oropharyngeal swallow function in healthy young, old, and very old subjects were examined. This study also reported the nature of normal age-associated swallow changes in relation to use over a lengthy swallow protocol. Three subject groups of thirty healthy adults (ages 20-30, 60-70, and 80-90 years) were examined via videofluoroscopy in a 45-swallow protocol. Boluses containing specific tastes (sweet, sour), temperature (cold, cold+sour), and viscosity (paste) alterations were administered. Significant differences in oropharyngeal swallow efficiency (OPSE) were found between the oldest groups compared to the young for all bolus conditions. The sour and cold+sour conditions demonstrated significantly higher OPSE scores for all ages. Three of the oldest subjects each aspirated once. OPSE scores were significantly lower in the last set of swallows compared to the first set, indicating a possible effect with repeated use. It appears that the swallowing mechanism successfully ages but is susceptible to many normal age-related changes. Despite these differences, swallow safety and efficiency do not appear to be compromised in any of the targeted age groups over a series of 45 swallows.
    Article · Sep 2010 · Journal of medical speech-language pathology
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    [Show abstract] [Hide abstract] ABSTRACT: A Histogram Analysis in Radiation Therapy (HART) program was primarily developed to increase the efficiency and accuracy of dose-volume histogram (DVH) analysis of large quantities of patient data in radiation therapy research. The program was written in MATLAB to analyze patient plans exported from the treatment planning system (Pinnacle 3 ) in the American Association of Physicists in Medicine/Radiation Therapy Oncology Group (AAPM/RTOG) format. HART-computed DVH data was validated against manually extracted data from the planning system for five head and neck cancer patients treated with the intensity-modulated radiation therapy (IMRT) technique. HART calculated over 4000 parameters from the differential DVH (dDVH) curves for each patient in approximately 10-15 minutes. Manual extraction of this amount of data required 5 to 6 hours. The normalized root mean square deviation (NRMSD) for the HART-extracted DVH outcomes was less than 1%, or within 0.5% distance-to-agreement (DTA). This tool is supported with various user-friendly options and graphical displays. Additional features include optimal polynomial modeling of DVH curves for organs, treatment plan indices (TPI) evaluation, plan-specific outcome analysis (POA), and spatial DVH (zDVH) and dose surface histogram (DSH) analyses, respectively. HART is freely available to the radiation oncology community.
    Full-text Article · Jan 2010 · Journal of Applied Clinical Medical Physics
  • Article · Nov 2009 · Fuel and Energy Abstracts
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    Barbara Roa Pauloski · Alfred W. Rademaker · Cathy Lazarus · [...] · Jerilyn A. Logemann
    [Show abstract] [Hide abstract] ABSTRACT: Pharyngeal manometry complements the modified barium swallow with videofluoroscopy (VFS) in diagnosing pressure-related causes of dysphagia. When manometric analysis is not feasible, it would be ideal if pressure information about the swallow could be inferred accurately from the VFS evaluation. Swallowing function was examined using VFS and concurrent manometry in 18 subjects (11 head and neck patients treated with various modalities and 7 healthy adults). Nonparametric univariate and multivariate analyses revealed significant relationships between manometric and fluoroscopic variables. Increases in pressure wave amplitude were significantly correlated with increased duration of tongue base to pharyngeal wall contact, reduced bolus transit times, and oropharyngeal residue. Pharyngeal residue was the most important VFS variable in reflecting pharyngeal pressure measurements. Certain VFS measures were significantly correlated with measures of pressure assessed with manometry. Further research is needed before observations and measures from VFS alone may be deemed sufficient for determining pressure-generation difficulties during the swallow in patients who are unable or unwilling to submit to manometric testing.
    Full-text Article · Jun 2009 · Dysphagia
  • Barbara Roa Pauloski PhD · Jerilyn A. Logemann PhD · Laura A. Colangelo MS · [...] · Ramon Esclamado MD
    [Show abstract] [Hide abstract] ABSTRACT: Postoperative speech function may be influenced by a number of treatment variables. The objective of this study was to examine the relationships among various treatment factors to determine the impact of these measures on speech function. Speech function was tested prospectively in 142 patients with surgically treated oral and oropharyngeal cancer 3 months after treatment. Each patient's speech was recorded during a 6- to 7-minute conversation and while performing a standard articulation test, producing speech outcome measures of percent correct consonant phonemes and percent conversational understandability. Correlational analyses were used to determine the relationships among the speech outcome measures and 14 treatment parameters. Speech function was mildly to moderately negatively correlated with most surgical resection variables, indicating that larger amounts of tissue resected were associated with worse speech function. Overall measures of conversational understandability and percent correct consonant phonemes were related to extent of oral tongue resection, floor of mouth resection, soft palate resection, and total volume of tissue resected. These relationships varied depending on the method of surgical closure. Method of surgical reconstruction had a profound impact on postoperative speech function 3 months after treatment and was an important factor in determining how oral tongue resection influenced articulation and intelligibility. The combination of closure type, percent oral tongue resected, and percent soft palate resected had the strongest relationship with overall speech function for patients with surgically treated oral and oropharyngeal cancer 3 months after treatment.
    Article · Jan 2009 · The Laryngoscope
  • Article · Jan 2009 · Medical Physics
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    [Show abstract] [Hide abstract] ABSTRACT: Earlier studies of the effect of 6 weeks of the Shaker Exercise have shown significant increase in UES opening and anterior excursion of larynx and hyoid during swallowing in patients with upper esophageal sphincter (UES) dysfunction, resulting in elimination of aspiration and resumption of oral intake. This effect is attributed to strengthening of the suprahyoid muscles, as evidenced by comparison of electromyographic changes in muscle fatigue before and after completion of the exercise regime. The effect of this exercise on thyrohyoid muscle shortening is unknown. Therefore the aim of this study was to determine the effect of the exercise on thyrohyoid muscle shortening. We studied 11 dysphagic patients with UES dysfunction. Six were randomized to traditional swallowing therapy and five to the Shaker Exercise. Videofluoroscopy was used to measure deglutitive thyrohyoid shortening before and after completion of assigned therapy regimen. Maximum thyrohyoid muscle shortening occurred at close temporal proximity to the time of maximal thyroid cartilage excursion. The percent change in thyrohyoid distance from initiation of deglutition to maximal anterior/superior hyoid excursion showed no statistically significant difference between the two groups prior to either therapy (p = 0.54). In contrast, after completion of therapy, the percent change in thyrohyoid distance in the Shaker Exercise group was significantly greater compared to the traditional therapy (p = 0.034). The Shaker Exercise augments the thyrohyoid muscle shortening in addition to strengthening the suprahyoid muscles. The combination of increased thyrohyoid shortening and suprahyoid strengthening contributes to the Shaker Exercise outcome of deglutitive UES opening augmentation.
    Full-text Article · Sep 2008 · Dysphagia
  • N. Koneru · J.A. Logemann · M. Gopalkrishnan · [...] · B. Mittal
    Article · Feb 2007 · Radiotherapy and Oncology
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    [Show abstract] [Hide abstract] ABSTRACT: Current research demonstrates that swallow function is impaired after treatment with organ-sparing chemoradiotherapy. Few studies, however, have related observed swallowing disorders with the patient's oral intake and diet in a large cohort of patients. Swallowing function was examined using the modified barium swallow (MBS) procedure in 170 patients treated with radiotherapy with or without chemotherapy for cancer of the head and neck at 5 evaluation points: pretreatment and at 1, 3, 6, and 12 months posttreatment. Fisher's exact test was used to examine the relationship between swallow motility disorders and oral intake or diet consistencies. Limitations in oral intake and diet during the first year after cancer treatment were significantly related to reduced laryngeal elevation, reduced cricopharyngeal opening, and rating of nonfunctional swallow on at least 1 swallow of any bolus type. Swallow motility disorders had a significant impact on the eating ability of patients after treatment for head and neck cancer with radiotherapy with or without chemotherapy. © 2006 Wiley Periodicals, Inc. Head Neck, 2006
    Full-text Article · Dec 2006 · Head & Neck
  • Susan E. Langmore · Jerilyn A. Logemann · Cathy Lazarus
    Article · Aug 2006
  • [Show abstract] [Hide abstract] ABSTRACT: Fourteen participants (six females, eight males) ranging in age from 7 years 11 months to 18 years 2 months (mean 11y 7mo) with a confirmed diagnosis of spastic cerebral palsy (CP) were included in the study. Participants included those who drooled (CP+, n=14); age- and sex-matched children with spastic CP who were dry to mild and never to infrequent droolers (CP-, n=14) as well as typically developing peers (CTRL, n=14) served as controls. Frequency of swallowing was measured by using simultaneous cervical ausculation and videotaping of the head and neck. Saliva production was measured with the Saxon test, a simple gauze-chewing procedure. In addition, Pediatric Evaluation of Disability Inventory (PEDI), Test of Nonverbal Intelligence-3 (TONI-3), dysarthria severity scale, and Gross Motor Function Classification System (GMFCS) scores were obtained for each participant. Both groups of participants with CP tended to swallow less frequently than typically developing participants and tended to produce less saliva than typically developing controls; however, these differences were not statistically significant. No correlation was found between amount of saliva produced and amount drooled (r=0.245). An analysis of variance (ANOVA) conducted on the PEDI functional skills mean scores indicated significant differences between the three groups (F(2,39)=23.522,p<0.0001). Likewise, an ANOVA conducted on the TONI-3 scores revealed statistically significant differences between the three groups (F(2,39)=31.761, p<0.0001). A Spearman's rho correlation indicated that GMFCS scores were not significantly correlated with drooling severity (Spearman's rho correlation=0.3951,p=0.037). Drooling severity was found to be positively correlated with dysarthria severity (Spearman's rho correlation=0.82,p<0.0001). These findings suggest that drooling in patients with CP is related to swallowing difficulties rather than hypersalivation.
    Article · Jan 2005 · Developmental Medicine & Child Neurology
  • JoAnne Robbins · Jackie Hind · Jerilyn Logemann
    [Show abstract] [Hide abstract] ABSTRACT: Unlabelled: Most of us who have clinical practices firmly contend that the treatments we provide cause beneficial changes in the lives of our patients. Indeed, our clinical experience engenders strong convictions to the point of believing that withholding treatment creates ethical violations. Intellectually, however, we must recognize that the value of treatment needs to be validated through scientific evidence. This paper examines the use of randomized clinical trials as a means of obtaining the type of evidence relevant for work in health care settings. Learning outcomes: (1) Readers will be able to explain why randomized clinical trials are conducted. (2) Readers will be able to describe the challenges faced when conducting randomized clinical trials. (3) Readers will be able to explain the ethical considerations involved in study design. (4) Readers will be able to describe the implementation and procedures used in Protocol 201. (5) Readers will be able to describe the two dysphagia interventions and the expected short and long-term effects of these interventions.
    Article · Sep 2004 · Journal of Communication Disorders