Timing and sequencing of oro-pharyngeal swallow events in persistent dysphagia post-stroke | Revista de Logopedia, Foniatría y Audiología

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Notes: B1 – onset of oral bolus transport; B2 – end of oral bolus transport; IPS – initiation of pharyngeal swallow; TBR1 – onset of tongue base retraction; TBRmax – maximum tongue base retraction; TBR2 – end of tongue base retraction; SPstart – onset of soft palate elevation; SPclose – maximum soft palate elevation; SPrest – end of soft palate elevation; BV1 – arrival of bolus in vallecula; BV2 – vallecular clearance; BP1 – arrival of bolus in pyriform sinus; BP2 – pyriform clearance; EIstart – onset of epiglottic inversion; EIclose – maximum epiglottic inversion; Erest – end of epiglottic inversion; H1 – onset of hyoid movement; H2Y – maximum superior motion of hyoid; H2X – maximum anterior motion of hyoid; H3 – onset of hyoid descend; H4 – end of hyoid movement; AEstart – onset of ary-epiglottic elevation; AEclose – maximal aryepiglottic elevation; LVOstart – onset of laryngeal opening; LVOend – end of laryngeal opening; UESpop – upper esophageal sphincter opening; UESmax – maximum upper esophageal sphincter opening; UESCstart – onset of upper esophageal sphincter closing; UESCend – end of upper esophageal sphincter closing" ] ] ] "textoCompleto" => "IntroductionPrevious reports about temporal coordination of swallowing events revealed that movements are not necessarily sequential (<a class="elsevierStyleCrossRefs" href="#bib0025">Kendall et al., 2003; Martin-Harris et al., 2005; Martin-Harris et al., 2003; Mendell & Logemann, 2007; Molfenter et al., 2014</a>) unlike popularly believed. Swallowing function is now viewed as sets of clusters of movements that are finely coordinated across time, a ‘process model’ of swallow (<a class="elsevierStyleCrossRef" href="#bib0080">Matsuo & Palmer, 2009</a>). Video-fluroscopy is popularly used for studying the physiological movements but the cluster of events varied with the temporal reference points used (<a class="elsevierStyleCrossRefs" href="#bib0025">Kendall et al., 2003; Martin-Harris et al., 2003; Molfenter et al., 2014</a>).The sequencing of events in healthy swallows is altered with age (<a class="elsevierStyleCrossRefs" href="#bib0050">Logemann et al., 2000; Martin-Harris et al., 2005; Mendell & Logemann, 2007; Shaker et al., 1994; Zamir et al., 1996</a>), functional status (<a class="elsevierStyleCrossRef" href="#bib0010">Brodsky et al., 2018</a>), and bolus characteristics (<a class="elsevierStyleCrossRefs" href="#bib0025">Kendall et al., 2003; Mendell & Logemann, 2007; Ren et al., 1993</a>) as an adaptation to changing demands and capacities. The major focus of this line of research has been on typical execution (<a class="elsevierStyleCrossRefs" href="#bib0025">Kendall et al., 2003; Logemann et al., 2000; Martin-Harris et al., 2005, 2003; Molfenter et al., 2014; Ren et al., 1993; Shaker et al., 1990; Zamir et al., 1996</a>), and all concluded with the call for identifying the differences in these functions in atypical population. A recent study for coordination of laryngeal dynamics with upper esophageal sphincter (UES) opening in individuals receiving mechanical ventilation concluded that delayed pharyngo-laryngeal kinematics was indicative of muscle weakness associated with Acute Respiratory Distress Syndrome (<a class="elsevierStyleCrossRef" href="#bib0010">Brodsky et al., 2018</a>). Otherwise, there have been limited attempts towards probing the timing and sequencing of events in atypical swallows.It is logical to assume that, in persons with suspected deficits in sensori-motor integration, such as in the post-stroke, the temporal integration is deviant compared to healthy individuals. Interestingly, the post-stroke population is also one among the populations with highest prevalence of dysphagia (<a class="elsevierStyleCrossRefs" href="#bib0075">Martino et al., 2005; Takizawa et al., 2016</a>). Survivors recover in terms of severity of symptoms over a course of time (<a class="elsevierStyleCrossRefs" href="#bib0060">Mann et al., 1999; Nilsson et al., 1998; Smithard et al., 1997</a>). Characteristics of lesion such as severity (<a class="elsevierStyleCrossRefs" href="#bib0005">Broadley et al., 2003; Toscano et al., 2015</a>), type (<a class="elsevierStyleCrossRef" href="#bib0145">Toscano et al., 2015</a>), location (<a class="elsevierStyleCrossRef" href="#bib0005">Broadley et al., 2003</a>), and presence of specific physiological impairments (<a class="elsevierStyleCrossRef" href="#bib0060">Mann et al., 1999</a>) have shown to predict persisting dysphagia in stroke survivors. It is not known if an impaired programming of the swallow sequence could also be a factor for poor recovery of swallowing difficulties in stroke survivors. Further, temporal disintegration may possibly contribute to the high impact of dysphagia on quality of life in post-stroke survivors. However, most instrumental evaluations limit its focus to crude physiological performances rather than its coordination. Temporal assessments may have direct applications in clinical decision making and effective management of swallowing disorders. Currently, there are no studies in the post-stroke population in this direction.Therefore, the current study was taken up with the aim of investigating the temporal coordination and sequencing of swallow events in persistent post-stroke dysphagia during single liquid swallows. We hypothesised a difference in the time of onset and order of oro-pharyngeal swallow events in this group of clinical population. We assumed that if the persistent dysphagia was associated with physiological weakness alone, then the temporal coordinates of swallowing events would be delayed with no alterations in the sequence. Specifically, we (1) derived the time of onset (2) studied the coordination across time, and (3) derived a timeline of pre-defined oro-pharyngeal swallow events during single liquid barium swallows in persons with persistent dysphagia post-stroke.MethodsThe study involved secondary analysis of videofluroscopic swallowing study (VFSS) recordings of individuals with long standing dysphagia post-stroke. Participants and their VFSS studies were selected based on pre-determined inclusion criteria. Frame-by-frame analysis for occurrence of specific physiological targets was used as data for studying the temporal coordination and sequence of oro-pharyngeal swallow in this population.ParticipantsThis study reviewed the video-fluroscopic swallowing study (VFSS) database of 116 individuals post-stroke seen for dysphagia rehabilitation from December 2016 to January 2018. During this period, the protocols for evaluation of swallowing in the study centre were standardised. The database included VFSS studies conducted on individuals with dysphagia for clinical and a previous research purpose conducted with a different objective. These data files were scrutinised independently by two investigators for the following inclusion criteria:Quality of imaging: (i)No frequent shift in image boundaries, and (ii) VFSS recordings generated at 30 pulse/sec.Bolus presentation: (i) At least one presentation of 5ml liquid barium, and (ii) Bolus presented via cup or spoon.Severity of dysphagia: Airway penetration score of ≤4 (<a class="elsevierStyleCrossRef" href="#bib0035">Kim et al., 2011</a>).Medical records of selected participants (n=89) were screened for demographic and diagnostic evaluation details and a total of 23participants (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) satisfying the below mentioned criteria were selected.<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•History of single or first attack of Cerebro-Vascular Accident (CVA)</li><li class="elsevierStyleListItem" id="lsti0010">•Confirmed diagnosis of CVA by a neurologist with CT/MRI scan (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</li><li class="elsevierStyleListItem" id="lsti0015">•Initial/Pre-therapy VFSS recording obtained at least after 4 weeks post-stroke.</li><li class="elsevierStyleListItem" id="lsti0020">•No history of developmental/surgical alterations in oral, pharyngeal, laryngeal or esophageal structures.</li><li class="elsevierStyleListItem" id="lsti0025">•No history of long term swallowing difficulties prior to cerebro-vascular accident</li></ul><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The final set of participants (n=23) belonged to an age range 49–78 years (17 males, 6 females). Among them, 39% (n=9) had right sided, 35% (n=8) had left sided, and only participant had bilateral lesion. Majority of them had Middle Cerebral artery stroke (61%) and 22% had veretebro-basilar stroke. Two participants had thalamic stroke and another two had a history of brainstem involvement.InstrumentationThe videofluroscopy data were collected from the collaborating institutes under the supervision of trained Speech-Language Pathologists (SLPs) employed in these centres, and recorded using GE Innova 3131 Biplane (GE Healthcare, USA) and Cios Alpha (Siemens Healthcare Private Limited, Germany) with the quality of recordings controlled with the selection criteria of 30 pulses/second, as mentioned in the previous section.Bolus presentedThe single 5ml liquid barium (.95g/ml Barium sulphate oral suspension, Microbar® suspension) swallow of the 23 individuals was selected for further analysis. The rationale for this selection was because this volume is commonly used for instrumental evaluations for clinical purpose in persons with dysphagia. Boluses were controlled for its volume and were presented directly from the measurement cup or using a spoon.ProcedureWritten consent was obtained from all the participants for use of assessment and rehabilitation data (a) as a routine procedure during clinical evaluation, or (b) specifically for the research purpose. The procedure followed for the study was in line with the bio-behavioural ethics committee and technical research advisory committee of the collaborating institutions. A non-random sample of secondary data, selected based on aforementioned criteria was used for analysis.All recordings included in the study showed that the individuals held the bolus in their oral cavity and swallowed the 5ml bolus in upright, neutral head position on instruction of the SLP (Cued Swallow). Time of onset of each event was obtained from the VFSS frames in the lateral view with lips in the anterior, velum in posterio-superior, posterior pharyngeal wall in posterior and upper esophageal sphincter in the inferior boundary. Frame-by frame analysis was carried out during playback using UleadVideostudio® Movie Wizard (Version 11).The oro-pharyngeal physiologies included in the present study were selected after a thorough review of recent literature. The operational definitions for each physiology were retained as in the literature so as to enable comparisons, wherever possible (<a class="elsevierStyleCrossRefs" href="#bib0015">Cook et al., 1989; Kendall & Leonard, 2001; Kendall et al., 2003; Logemann et al., 2000; Logemann et al., 2002; Martin-Harris et al., 2003; Mendell & Logemann, 2007; Molfenter et al., 2014; Ohmae et al., 1995; Shaker et al., 1990; Zamir et al., 1996</a>). A total of 29 events were defined and identified from the VFSS recording (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The absolute temporal measures were noted directly from the digital video play back timer by one of the investigators and another qualified Speech-Language Pathologist. Inter-judge agreement in frame selection was considered at ±3ms (1 frame length). Discrepancies were re-evaluated independently and resolved after discussion. At the end of analysis, the data consisted of time of onset of each of the 29 events for 5ml liquid barium swallow from each VFSS recording, a total of 667 data points.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>As the absolute time coordinates varied across recordings, end of UES closing (UESCend) was taken as the reference for calculation of relative temporal measures. This was for two reasons: (1) It indicates the completion point of an active forward swallow sequence; (2) UES activity is least affected by voluntary swallowing behaviours (<a class="elsevierStyleCrossRef" href="#bib0125">Shaker et al., 1993</a>). As the study dealt with atypical population, it was expected that VFSS would reveal absence or inefficient movements of at least one of the structures involved in oro-pharyngeal swallow, therefore not qualifying as a reference point. The UES function, being least affected in post-stroke was assumed to be present in maximum number of participants (at least partially), therefore could be a common reference point for most participants.ResultsThe data on absolute time of events was converted to relative measures with reference to UESCend using the formula [time of occurrence of the event (absolute)-time of occurrence of the last event (UESCend)]. This data was tested for normality (Kolomogorov–Smirnov test) and was found to be heavily one tailed. As the data did not satisfy the assumption of normal distribution, non-parametric tests were used for all further statistical comparisons. <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the central tendency and dispersion measures for each event studied. Most of the events occurred prior to UESCend (negative) while only six events occurred simultaneously or after the reference event (TBR2, SPrest, Erest, H4, LVOStart, and LVOend).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Coordination of events across time was studied by running the test of difference with repeated measure. Friedman test indicated significant difference in temporal points (χ2(28)=196.74, p=.00) across the events. Multiple post-hoc at 95% confidence level would provide inconclusive results with small effect size and hence was not done. Alternatively, events were arranged in ascending order of central tendency and sets of consecutive events were tested for significant difference using Friedman test. If a significant difference was found (p<.05), the variable creating the difference was eliminated. Sets that did not show any statistical significant difference (p>.05) was classified as one cluster.With the above method, five possible functional clusters with varied number of events within each could be identified (1) Initiation of pharyngeal swallow, arrival of bolus in vallecula, onset of ary-epiglottic elevation and onset of hyoid movement, (2) onset of tongue base retraction, vallecular clearance, arrival of bolus in pyriform sinus, onset of epiglottic inversion, end of oral bolus transport, maximum soft palate elevation, and maximum superior motion of hyoid, (3) maximum tongue base retraction, maximum epiglottic inversion, maximal aryepiglottic elevation, maximum anterior motion of hyoid, pyriform clearance, and onset of upper esophageal sphincter closing, (4) end of soft palate elevation, onset of laryngeal opening, and end of upper esophageal sphincter closing and (5) end of epiglottic inversion, end of tongue base retraction and end of hyoid movement. Another six events could not be classified into any of the identified clusters and were separated in time compared to other events. These events were (1) onset of oral bolus transport, (2) onset of soft palate elevation, (3) upper esophageal sphincter opening, (4) maximum upper esophageal sphincter opening, (5) onset of hyoid descend and (6) end of laryngeal opening.To better understand the temporal coordination of these events in persons with dysphagia post-stroke, the central tendency measures (mean and median) were arranged in the order of descending relative onset time. As the order of swallowing events was similar with both mean and median, a time line was generated with mean onset time and standard error (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). From this figure, onset of bolus transport marked the beginning of swallow and the motor sequence was completed with the full opening of laryngeal vestibule. Though the pharyngeal events fell into a continuum of airway protection and bolus transport, the onset of bolus transport was a stand-alone event. This indicated that the population had difficulty triggering the IPS but once triggered, the sequence continued without much interference. Another region of shift from the linear pattern was observed from UESCstart and after UESCend. Multiple deviations from typical sequence were revealed supporting the hypotheses made and indicating that temporal in-coordination could be in fact a factor for unresolved dysphagia in post-stroke survivors.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>DiscussionIn this study, we put into test the hypotheses that temporal in-coordination and alteration of sequence of swallowing events at the oro-pharyngeal stages could be associated with persistent dysphagia in post-stroke. Detailed analysis of single liquid swallows during radiological study using frame by frame analysis method was conducted. Though the method of analysis has been used in previous studies, the present study has extended the findings to a less studied population in greater detail. As far as the authors know, this study is the first in this genre that explores temporal coordination and sequencing of swallow events in post-stroke dysphagia. The study has included onset, maximum performance and offset of each event related to bolus transport and airway de-coupling with concrete definitions thereby opening the scope for future research. Overall, the findings of the present study indicated that temporal in-coordination and deviance in sequence of oro-pharyngeal swallow events is closely associated with persistent dysphagia in post-stroke individuals.As the study was retrospective in nature, recordings were not strictly controlled for time. It was necessary therefore that the events be marked to a common time line for any statistical verification to be performed. It was only a logical decision to consider UESCend as the reference point for reasons mentioned in the previous sections. This decision was supported with missing data points for bolus transport events and absence of clear onset of certain physiological events. Upper esophageal function was present in all participants, at least partially. The results of the present study revealed that this function was not necessarily the last point of swallow sequence. It was only after the bolus tail passed through the upper esophageal sphincter that the airway decoupling was released with complete opening of laryngeal vestibule as the final movement in a swallow sequence in this population.Results of descriptive statistical analysis indicated that the temporal coordinates were highly dispersed from the central measure. High variability in sequencing was reported by Kendall and collegues (2003) and confirmed by <a class="elsevierStyleCrossRef" href="#bib0090">Molfenter et al. (2014)</a> in typical swallows and they found that the variability was higher in small volumes. This study was only a preliminary attempt in this direction considering the heterogeneity in symptoms and severity of dysphagia exhibited by the population studied.Five functional clusters of swallowing were identified in post-stroke individuals. Superficially, these clusters indicated trigger, bolus transport, peak of pharyngeal swallow, completion of bolus transport and return to position for the next cycle. There were events that overlapped in each of these clusters. The six events that could not be classified into the clusters occurred at a different point compared to other events. Temporal disintegration of onset of bolus propulsion (B1) from the sequence of events may be justified for its volitional component but the other five events were expected to be associated with reflexive pharyngeal events. Further research is needed to confirm if these events are broken from the strands of swallowing as a result of brain damage or if they are independent functions in the sequence of swallowing.Among the events that fell into cluster classification, few could be supported with previous research. A study on deglutition related laryngeal closure mechanism in humans suggested that posterior tilting of epiglottis is related to hyo-laryngeal elevation, bolus transport and tongue base retraction (<a class="elsevierStyleCrossRef" href="#bib0045">Logemann et al., 1992</a>). The current study expanded this view to post-stroke dysphagia with the second cluster identified in the current study.A healthy swallow is completed within one second (<a class="elsevierStyleCrossRef" href="#bib0040">Logemann, 1998</a>). The analysis of VFSS images indicated that liquid swallows took longer in post-stroke (1.79s on an average) for transferring the bolus from mouth to UES. Increased oral and pharyngeal transit times have been reported previously as a consequence of physiological inefficiencies (<a class="elsevierStyleCrossRefs" href="#bib0030">Kim & Han, 2005; Mann et al., 1999; Perlman et al., 1994</a>). Though the duration of swallow prolonged, certain physiological sequences reported in typical swallows were retained in this population as well. The aryepiglottic elevation occurred before epiglottic descent and the onset of tongue base retraction occurred before onset of superior elevation of hyoid (<a class="elsevierStyleCrossRef" href="#bib0120">Shaker et al., 1990</a>) and maximum hyo-laryngeal elevation was obtained after the opening of UES in typical swallows (<a class="elsevierStyleCrossRef" href="#bib0025">Kendall et al., 2003</a>). Clear indications of shuffling of event sequence were also evident which could be discussed as bolus transport and airway decoupling sequence.Bolus Transport Sequence: The ‘leading complex’ of bolus transport in healthy individuals (<a class="elsevierStyleCrossRef" href="#bib0015">Cook et al., 1989</a>)was preserved in this population with the onset of tongue base retraction and hyo-laryngeal elevation occurring within in .1s of each other. In typical swallow, the peristaltic movement squeezes the bolus from the point of its entry into pharynx at the level of soft palate till upper esophageal sphincter (<a class="elsevierStyleCrossRef" href="#bib0080">Matsuo & Palmer, 2009</a>). Contrary to this, the site of onset of pharyngeal action was tongue base which progressed upwards to soft palate in post-stroke population. Even at the point of maximum closure and return to resting phase, progression did not follow the typical sequence from soft palate to UES.Bolus head reached pyriform sinus at least .47s prior to opening of UES unlike the prior or simultaneous activity in typical swallows (<a class="elsevierStyleCrossRef" href="#bib0025">Kendall et al., 2003</a>). The disturbed sequence suggests that the bolus transport and clearance deficits in post-stroke dysphagia may be associated with an in coordinated pharyngeal peristalsis.Airway Decoupling Sequence: In a typical swallow, the airway closure started from bottom and progressed upwards with epiglottis as the most superficial shield for laryngeal inlet (<a class="elsevierStyleCrossRefs" href="#bib0045">Logemann et al., 1992; Matsuo & Palmer, 2009</a>). The population in the present study initiated the sequence in the bottom up direction with onset of ary-epiglottic closure followed by epiglottic inversion but the maximal laryngeal elevation was delayed compared to maximal epiglottic inversion. The action of vocal folds could not be visualised using video-fluroscopy. On release of the airway protection too, laryngeal vestibular opening started earlier but was completed later compared to epiglottic action. This suggests a slowed laryngeal movement could be associated with post-stroke dysphagia.A recent study suggested slowness, not delay of laryngeal elevation as the cause of penetration/aspiration (<a class="elsevierStyleCrossRef" href="#bib0095">Nativ-Zeltzer et al., 2014</a>). The current study, however, also indicate an overlapping delay in laryngeal elevation in post-stroke. The head of swallowed bolus had already reached the vallecula before the laryngeal elevation was triggered (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) compared to the finding in typical population that they initiate laryngeal elevation before the bolus enter pharynx (<a class="elsevierStyleCrossRef" href="#bib0120">Shaker et al., 1990</a>). The coordination sequences in aryepiglottic contraction, maximum hyoid elevation and upper esophageal activity in typical swallows of small volumes (<a class="elsevierStyleCrossRefs" href="#bib0025">Kendall et al., 2003; Molfenter et al., 2014</a>) could not be observed in this study.The findings of the current study indicated that persons with persistent post-stroke dysphagia deviate from typical sequence not only in the volitional but also the reflexive sequences of swallow. As clearly observed, timing as well as sequencing of swallow events were deviated in this population studied. Apart from a peripheral inefficiency related to motor weakness, a central error in programming of swallow sequence may be related to persistent dysphagia post-stroke. This may need further conclusive evidence with large scale research.LimitationsThough a large number of data was screened for inclusion, only a limited number of data could be included in an attempt to have homogeneity. This homogeneity could be obtained only in certain aspects of medical history and diagnosis. The findings of this study may not be relevant to all types, sites and pathologies. Each of these variables need to be exclusively studied for its effect on temporal sequencing in swallowing function. Being a retrospective study, possible variability in sequence and time coordinates across trials and bolus characteristics could not be considered. As the evidences on adaptations of swallowing physiology to varied bolus characteristics are building up, higher bolus volumes, thicker consistencies, tastes and temperatures need to be studied in similar methods. Future research may address these issues and attempt to replicate or validate the observations made on larger, controlled population.ConclusionsThe present study provided preliminary evidence of difference in the timing and sequencing of occurrence of oral and pharyngeal swallow events in persistent dysphagia post-stroke. Few events seem to behave independently from others while the five functional clusters identified from the study occurred almost simultaneously with no significant difference in the time of occurrence. Many events related to bolus transport and airway decoupling were deviant and may be associated with the penetration/aspiration symptoms seen in this clinical population. Future research is warranted to take these observations further and to identify if the sequential variations are clinically relevant.ContributorsAll authors have significantly contributed towards conceptualization, data collection, analysis, interpretation and report preparation. The final report was approved by the authors before publication.FundingThe study included data collected for a previous research work funded by the AIISH Research Fund (ARF) (Sanction number: SH/CDN/ARF-44/2016-17) retrospectively analysed with different objectives.Conflict of interestThe authors declare no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres1788399" "titulo" => "Abstract" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results and conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1567527" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1788398" "titulo" => "Resumen" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0020" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0025" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0030" "titulo" => "Resultados y conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1567526" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Participants" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Instrumentation" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Bolus presented" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Procedure" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:3 [ "identificador" => "sec0040" "titulo" => "Discussion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Limitations" ] ] ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Contributors" ] 10 => array:2 [ "identificador" => "sec0065" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflict of interest" ] 12 => array:2 [ "identificador" => "xack631611" "titulo" => "Acknowledgement" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-08-13" "fechaAceptado" => "2022-01-20" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1567527" "palabras" => array:6 [ 0 => "Temporal measures" 1 => "Order" 2 => "Cerebrovascular accident" 3 => "Physiology" 4 => "Deglutition" 5 => "Disorder" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1567526" "palabras" => array:6 [ 0 => "Medidas temporales" 1 => "Orden" 2 => "Accidente cerebrovascular" 3 => "Fisiología" 4 => "Deglución" 5 => "Trastorno" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Introduction and objectivesEvidence from videofluoroscopic analysis of healthy swallowing physiology shows that typical swallowing function is not entirely ‘sequential’ but are clusters of precisely coordinated movements. It is unknown if disruption of this fine orchestra of events could be associated with persistent dysphagia in individuals post-stroke. This investigation studied the time of onset and sequencing of specific oro-pharyngeal swallowing events as seen in the modified barium swallow study in a population with airway penetration of swallowed bolus post-stroke. Materials and methodsA retrospective frame to frame analysis of 29 time points in single cued 5ml liquid barium swallows obtained from 23 individuals who satisfied inclusion criteria was conducted independently by two investigators. Relative temporal measures with reference to upper esophageal sphincter activity were calculated. Results and conclusionStatistical analysis revealed five temporal clusters of swallowing events while the onset of oral bolus transport, soft palate elevation, upper esophageal sphincter opening, hyoid descent, and complete laryngeal closing occurred independently. A timeline of event sequences was also developed that showed multiple deviations from the known sequences reported in healthy swallowing literature. There was a delay as well as deviance from known normality in the order of swallowing events considered in this study. The findings suggested a difference in the underlying programming for a swallow in post-stroke dysphagia, that may also contribute to the airway intrusion. The study provides preliminary evidence for the inclusion of temporal measures of swallowing physiology during an instrumental assessment of swallowing function in persons with dysphagia." "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results and conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Introducción y objetivosLa evidencia del análisis videofluoroscópico de la fisiología de la deglución saludable muestra que la función de la deglución típica no es completamente «secuencial», sino que son grupos de movimientos coordinados con precisión. Se desconoce si la interrupción de esta fina armonía de eventos podría asociarse con una disfagia persistente en individuos después del accidente cerebrovascular. Esta investigación estudió el tiempo de inicio y la secuenciación de eventos específicos de deglución orofaríngea, como se observa en el estudio modificado de deglución de bario en una población con penetración de las vías respiratorias del bolo ingerido después del accidente cerebrovascular. Materiales y métodosEl análisis retrospectivo paso a paso de 29 momentos de la deglución de 5ml de bario líquido analizados en 23 individuos que cumplieron con los criterios de inclusión fue realizado de forma independiente por dos investigadores. Se calcularon medidas temporales relativas a la actividad del esfínter esofágico superior. Resultados y conclusionesEl análisis estadístico reveló cinco grupos temporales de eventos de deglución, mientras que el inicio del transporte de bolo oral, la elevación del paladar blando, la apertura del esfínter esofágico superior, el descenso de hioides y el cierre laríngeo completo se produjeron de forma independiente. También se desarrolló una línea de tiempo de secuencias de eventos que mostraba múltiples desviaciones de las secuencias conocidas reportadas en la literatura de deglución saludable. Hubo un retraso, así como una desviación de la normalidad en el orden de los eventos de deglución considerados en este estudio. Los hallazgos sugirieron una diferencia en la programación subyacente para una deglución en la disfagia tras el accidente cerebrovascular, que también puede contribuir a la intrusión de las vías respiratorias. El estudio proporciona evidencia preliminar para la inclusión de medidas temporales de la fisiología de la deglución durante una evaluación instrumental de la función de deglución en personas con disfagia." "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0020" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0025" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0030" "titulo" => "Resultados y conclusiones" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1519 "Ancho" => 2167 "Tamanyo" => 169583 ] ] "descripcion" => array:1 [ "en" => "Temporal sequence of oro-pharyngeal swallowing events in post-stroke. Notes: B1 – onset of oral bolus transport; B2 – end of oral bolus transport; IPS – initiation of pharyngeal swallow; TBR1 – onset of tongue base retraction; TBRmax – maximum tongue base retraction; TBR2 – end of tongue base retraction; SPstart – onset of soft palate elevation; SPclose – maximum soft palate elevation; SPrest – end of soft palate elevation; BV1 – arrival of bolus in vallecula; BV2 – vallecular clearance; BP1 – arrival of bolus in pyriform sinus; BP2 – pyriform clearance; EIstart – onset of epiglottic inversion; EIclose – maximum epiglottic inversion; Erest – end of epiglottic inversion; H1 – onset of hyoid movement; H2Y – maximum superior motion of hyoid; H2X – maximum anterior motion of hyoid; H3 – onset of hyoid descend; H4 – end of hyoid movement; AEstart – onset of ary-epiglottic elevation; AEclose – maximal aryepiglottic elevation; LVOstart – onset of laryngeal opening; LVOend – end of laryngeal opening; UESpop – upper esophageal sphincter opening; UESmax – maximum upper esophageal sphincter opening; UESCstart – onset of upper esophageal sphincter closing; UESCend – end of upper esophageal sphincter closing" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Notes: MCA=Middle Cerebral Artery." "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Participant # \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age (in years) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gender \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diagnosis \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right MCA stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left and right MCA stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right MCA stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left MCA stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left thalamic stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right MCA stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left MCA stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right MCA stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right MCA stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right MCA stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vertebro-basilar stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left MCA stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vertebro-basilar stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right MCA lacunar stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right Lateral medullary syndrome \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vertebro-basilar stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left thalamic stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vertebro-basilar stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right and Left MCA stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vertebro-basilar stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left MCA stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right Lateral medullary syndrome \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left MCA stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic and diagnostic details of participants." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sl. No. \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Event \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Definition \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onset of oral bolus transport (B1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first movement of the most anterior part of the bolus from a stable or “hold” position. In case of multiple attempts to swallow, the onset of first movement associated with shift in bolus position was considered. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">End of oral bolus transport (B2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with the tail of bolus at the posterior nasal spine. In case of multiple attempts to swallow, the offset of last lingual movement associated with shift in bolus position was considered. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Initiation of pharyngeal swallow (IPS) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">First frame showing the bolus head reaching the tongue base at the point it crosses the ramus of the mandible. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onset of tongue base retraction (TBR1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">First frame showing posterior movement of tongue base towards posterior pharyngeal wall for bolus propulsion. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maximum tongue base retraction (TBRmax) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">First frame showing maximum approximation of tongue base to posterior pharyngeal wall. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">End of tongue base retraction (TBR2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">First frame with the base of the tongue returned to resting position after maximum retraction. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onset of soft palate elevation (SPstart) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with upward movement of velum towards posterior pharyngeal wall for closure of nasopharynx associated with bolus propulsion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maximum soft palate elevation (SPclose) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with maximum approximation of velum towards posterior pharyngeal wall for closure of nasopharynx associated with bolus propulsion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">End of soft palate elevation (SPrest) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with return of velum to its resting position after maximal closure of nasopharynx associated with bolus propulsion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arrival of bolus in vallecula (BV1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with the head of the bolus in the vallecular region. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vallecular clearance (BV2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with the tail of the bolus leaving the vallecular region. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arrival of bolus in pyriform sinus (BP1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with the head of the bolus in the pyriform region. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pyriform clearance (BP2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with the tail of the bolus leaving the pyriform region. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onset of epiglottic inversion (EIstart) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with medial shift of tip of epiglottis towards the laryngeal vestibule. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maximum epiglottic inversion (EIclose) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with maximum medial shift of tip of epiglottis towards the laryngeal vestibule. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">End of epiglottic inversion (Erest) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with return of tip of epiglottic to resting position after a maximal epiglottic inversion. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onset of hyoid movement (H1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first quick and robust antero-superior movement of hyoid bone. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maximum superior motion of hyoid (H2Y) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with maximum superior displacement of the hyoid bone. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maximum anterior motion of hyoid (H2X) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with maximum anterior displacement of the hyoid bone. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onset of hyoid descend (H3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with a downward displacement of hyoid from maximal anterio-superior displacement. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">End of hyoid movement (H4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with hyoid return to resting position after maximal anterio-superior displacement. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onset of Ary-epiglottic elevation(AEstart) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with a superior displacement of Ary-epiglottic folds \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maximal Aryepiglottic elevation (AEclose) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with maximum approximation of Ary-epiglottic folds leading to minimum air contrast between epiglottis and aryepiglottic folds \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onset of laryngeal opening (LVOstart) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with a downward displacement of aryepiglottic folds after maximal approximation. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">End of laryngeal opening (LVOend) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with return of aryepiglottic folds to resting position after maximal approximation. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Upper Esophageal Sphincter Opening (UESpop) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with the head of the bolus entering the esophagus through the upper esophageal sphincter. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maximum Upper Esophageal Sphincter Opening (UESmax) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with maximum opening of upper esophageal sphincter seen as a wide flow of barium entering the esophagus. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onset of Upper Esophageal Sphincter closing (UESCstart) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with a narrowing of upper esophageal sphincter opening from its maximum opening. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">End of Upper Esophageal sphincter closing (UESCend) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The first frame with complete obstruction of upper esophageal sphincter with no bolus flow through the sphincter. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "Oro-pharyngeal swallowing events and their definitions as used in the current study." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sl. No. \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Event \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onset of oral bolus transport (B1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−1.00 (1.49) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">End of oral bolus transport (B2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.50 (.53) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Initiation of pharyngeal swallow (IPS) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.88 (.63) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onset of tongue base retraction (TBR1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.85 (.63) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maximum tongue base retraction (TBRmax) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.14 (.62) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">End of tongue base retraction (TBR2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.09 (.52) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onset of soft palate elevation (SPstart) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.85 (.74) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maximum soft palate elevation (SPclose) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.18 (.74) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">End of soft palate elevation (SPrest) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.00 (.78) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arrival of bolus in vallecula (BV1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.85 (1.43) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vallecular clearance (BV2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.82 (1.27) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arrival of bolus in pyriform sinus (BP1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.82 (1.00) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pyriform clearance (BP2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.06 (.51) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onset of epiglottic inversion (EIstart) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.53 (.53) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maximum epiglottic inversion (EIclose) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.11 (.52) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">End of epiglottic inversion (Erest) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.04 (.83) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onset of hyoid movement (H1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.84 (.53) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maximum superior motion of hyoid (H2Y) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.17 (.75) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maximum anterior motion of hyoid (H2X) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.08 (.54) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onset of hyoid descend (H3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.03 (.49) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">End of hyoid movement (H4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.12 (.41) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onset of Ary-epiglottic elevation(AEstart) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.85 (.55) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maximal Aryepiglottic elevation (AEclose) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.09 (.49) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onset of laryngeal opening (LVOstart) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.00 (.32) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">End of laryngeal opening (LVOend) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.79 (.43) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Upper Esophageal Sphincter Opening (UESpop) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.15 (.52) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maximum Upper Esophageal Sphincter Opening (UESmax) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.15 (.50) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onset of Upper Esophageal Sphincter closing (UESCstart) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.06 (.49) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">End of Upper Esophageal sphincter closing (UESCend) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.00 (.00) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "Median and standard deviation (SD)of the 29 oro-pharyngeal events 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Review article

Timing and sequencing of oro-pharyngeal swallow events in persistent dysphagia post-stroke

Momento y secuencia de los eventos de deglución orofaríngea en la disfagia persistente post-ictus

Gayathri Krishnana,

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gayathrikrishnan.india@gmail.com

Corresponding author.

, Satypal Puri Goswamia, P. Manju Mohanb, Muralidharan Nairb, P.N. Sylajab, C. Kesavadasb

a All India Institute of Speech and Hearing, Naimisham Campus, Manasagangotri, Mysuru, India

b Sree Chitra Tirunal Institute of Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India

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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Temporal sequence of oro-pharyngeal swallowing events in post-stroke&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Notes&#58; B1 &#8211; onset of oral bolus transport&#59; B2 &#8211; end of oral bolus transport&#59; IPS &#8211; initiation of pharyngeal swallow&#59; TBR1 &#8211; onset of tongue base retraction&#59; TBRmax &#8211; maximum tongue base retraction&#59; TBR2 &#8211; end of tongue base retraction&#59; SPstart &#8211; onset of soft palate elevation&#59; SPclose &#8211; maximum soft palate elevation&#59; SPrest &#8211; end of soft palate elevation&#59; BV1 &#8211; arrival of bolus in vallecula&#59; BV2 &#8211; vallecular clearance&#59; BP1 &#8211; arrival of bolus in pyriform sinus&#59; BP2 &#8211; pyriform clearance&#59; EIstart &#8211; onset of epiglottic inversion&#59; EIclose &#8211; maximum epiglottic inversion&#59; Erest &#8211; end of epiglottic inversion&#59; H1 &#8211; onset of hyoid movement&#59; H2Y &#8211; maximum superior motion of hyoid&#59; H2X &#8211; maximum anterior motion of hyoid&#59; H3 &#8211; onset of hyoid descend&#59; H4 &#8211; end of hyoid movement&#59; AEstart &#8211; onset of ary-epiglottic elevation&#59; AEclose &#8211; maximal aryepiglottic elevation&#59; LVOstart &#8211; onset of laryngeal opening&#59; LVOend &#8211; end of laryngeal opening&#59; UESpop &#8211; upper esophageal sphincter opening&#59; UESmax &#8211; maximum upper esophageal sphincter opening&#59; UESCstart &#8211; onset of upper esophageal sphincter closing&#59; UESCend &#8211; end of upper esophageal sphincter closing</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Previous reports about temporal coordination of swallowing events revealed that movements are not necessarily sequential &#40;<a class="elsevierStyleCrossRefs" href="#bib0025">Kendall et al&#46;&#44; 2003&#59; Martin-Harris et al&#46;&#44; 2005&#59; Martin-Harris et al&#46;&#44; 2003&#59; Mendell &#38; Logemann&#44; 2007&#59; Molfenter et al&#46;&#44; 2014</a>&#41; unlike popularly believed&#46; Swallowing function is now viewed as sets of clusters of movements that are finely coordinated across time&#44; a &#8216;process model&#8217; of swallow &#40;<a class="elsevierStyleCrossRef" href="#bib0080">Matsuo &#38; Palmer&#44; 2009</a>&#41;&#46; Video-fluroscopy is popularly used for studying the physiological movements but the cluster of events varied with the temporal reference points used &#40;<a class="elsevierStyleCrossRefs" href="#bib0025">Kendall et al&#46;&#44; 2003&#59; Martin-Harris et al&#46;&#44; 2003&#59; Molfenter et al&#46;&#44; 2014</a>&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The sequencing of events in healthy swallows is altered with age &#40;<a class="elsevierStyleCrossRefs" href="#bib0050">Logemann et al&#46;&#44; 2000&#59; Martin-Harris et al&#46;&#44; 2005&#59; Mendell &#38; Logemann&#44; 2007&#59; Shaker et al&#46;&#44; 1994&#59; Zamir et al&#46;&#44; 1996</a>&#41;&#44; functional status &#40;<a class="elsevierStyleCrossRef" href="#bib0010">Brodsky et al&#46;&#44; 2018</a>&#41;&#44; and bolus characteristics &#40;<a class="elsevierStyleCrossRefs" href="#bib0025">Kendall et al&#46;&#44; 2003&#59; Mendell &#38; Logemann&#44; 2007&#59; Ren et al&#46;&#44; 1993</a>&#41; as an adaptation to changing demands and capacities&#46; The major focus of this line of research has been on typical execution &#40;<a class="elsevierStyleCrossRefs" href="#bib0025">Kendall et al&#46;&#44; 2003&#59; Logemann et al&#46;&#44; 2000&#59; Martin-Harris et al&#46;&#44; 2005&#44; 2003&#59; Molfenter et al&#46;&#44; 2014&#59; Ren et al&#46;&#44; 1993&#59; Shaker et al&#46;&#44; 1990&#59; Zamir et al&#46;&#44; 1996</a>&#41;&#44; and all concluded with the call for identifying the differences in these functions in atypical population&#46; A recent study for coordination of laryngeal dynamics with upper esophageal sphincter &#40;UES&#41; opening in individuals receiving mechanical ventilation concluded that delayed pharyngo-laryngeal kinematics was indicative of muscle weakness associated with Acute Respiratory Distress Syndrome &#40;<a class="elsevierStyleCrossRef" href="#bib0010">Brodsky et al&#46;&#44; 2018</a>&#41;&#46; Otherwise&#44; there have been limited attempts towards probing the timing and sequencing of events in atypical swallows&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It is logical to assume that&#44; in persons with suspected deficits in sensori-motor integration&#44; such as in the post-stroke&#44; the temporal integration is deviant compared to healthy individuals&#46; Interestingly&#44; the post-stroke population is also one among the populations with highest prevalence of dysphagia &#40;<a class="elsevierStyleCrossRefs" href="#bib0075">Martino et al&#46;&#44; 2005&#59; Takizawa et al&#46;&#44; 2016</a>&#41;&#46; Survivors recover in terms of severity of symptoms over a course of time &#40;<a class="elsevierStyleCrossRefs" href="#bib0060">Mann et al&#46;&#44; 1999&#59; Nilsson et al&#46;&#44; 1998&#59; Smithard et al&#46;&#44; 1997</a>&#41;&#46; Characteristics of lesion such as severity &#40;<a class="elsevierStyleCrossRefs" href="#bib0005">Broadley et al&#46;&#44; 2003&#59; Toscano et al&#46;&#44; 2015</a>&#41;&#44; type &#40;<a class="elsevierStyleCrossRef" href="#bib0145">Toscano et al&#46;&#44; 2015</a>&#41;&#44; location &#40;<a class="elsevierStyleCrossRef" href="#bib0005">Broadley et al&#46;&#44; 2003</a>&#41;&#44; and presence of specific physiological impairments &#40;<a class="elsevierStyleCrossRef" href="#bib0060">Mann et al&#46;&#44; 1999</a>&#41; have shown to predict persisting dysphagia in stroke survivors&#46; It is not known if an impaired programming of the swallow sequence could also be a factor for poor recovery of swallowing difficulties in stroke survivors&#46; Further&#44; temporal disintegration may possibly contribute to the high impact of dysphagia on quality of life in post-stroke survivors&#46; However&#44; most instrumental evaluations limit its focus to crude physiological performances rather than its coordination&#46; Temporal assessments may have direct applications in clinical decision making and effective management of swallowing disorders&#46; Currently&#44; there are no studies in the post-stroke population in this direction&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Therefore&#44; the current study was taken up with the aim of investigating the temporal coordination and sequencing of swallow events in persistent post-stroke dysphagia during single liquid swallows&#46; We hypothesised a difference in the time of onset and order of oro-pharyngeal swallow events in this group of clinical population&#46; We assumed that if the persistent dysphagia was associated with physiological weakness alone&#44; then the temporal coordinates of swallowing events would be delayed with no alterations in the sequence&#46; Specifically&#44; we &#40;1&#41; derived the time of onset &#40;2&#41; studied the coordination across time&#44; and &#40;3&#41; derived a timeline of pre-defined oro-pharyngeal swallow events during single liquid barium swallows in persons with persistent dysphagia post-stroke&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">The study involved secondary analysis of videofluroscopic swallowing study &#40;VFSS&#41; recordings of individuals with long standing dysphagia post-stroke&#46; Participants and their VFSS studies were selected based on pre-determined inclusion criteria&#46; Frame-by-frame analysis for occurrence of specific physiological targets was used as data for studying the temporal coordination and sequence of oro-pharyngeal swallow in this population&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Participants</span><p id="par0030" class="elsevierStylePara elsevierViewall">This study reviewed the video-fluroscopic swallowing study &#40;VFSS&#41; database of 116 individuals post-stroke seen for dysphagia rehabilitation from December 2016 to January 2018&#46; During this period&#44; the protocols for evaluation of swallowing in the study centre were standardised&#46; The database included VFSS studies conducted on individuals with dysphagia for clinical and a previous research purpose conducted with a different objective&#46; These data files were scrutinised independently by two investigators for the following inclusion criteria&#58;</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Quality of imaging&#58;</span> &#40;i&#41;No frequent shift in image boundaries&#44; and &#40;ii&#41; VFSS recordings generated at 30 pulse&#47;sec&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Bolus presentation&#58;</span> &#40;i&#41; At least one presentation of 5<span class="elsevierStyleHsp" style=""></span>ml liquid barium&#44; and &#40;ii&#41; Bolus presented via cup or spoon&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Severity of dysphagia&#58;</span> Airway penetration score of &#8804;4 &#40;<a class="elsevierStyleCrossRef" href="#bib0035">Kim et al&#46;&#44; 2011</a>&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Medical records of selected participants &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>89&#41; were screened for demographic and diagnostic evaluation details and a total of 23participants &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; satisfying the below mentioned criteria were selected&#46;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0055" class="elsevierStylePara elsevierViewall">History of single or first attack of Cerebro-Vascular Accident &#40;CVA&#41;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Confirmed diagnosis of CVA by a neurologist with CT&#47;MRI scan &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Initial&#47;Pre-therapy VFSS recording obtained at least after 4 weeks post-stroke&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">No history of developmental&#47;surgical alterations in oral&#44; pharyngeal&#44; laryngeal or esophageal structures&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">No history of long term swallowing difficulties prior to cerebro-vascular accident</p></li></ul></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The final set of participants &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#41; belonged to an age range 49&#8211;78 years &#40;17 males&#44; 6 females&#41;&#46; Among them&#44; 39&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#41; had right sided&#44; 35&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41; had left sided&#44; and only participant had bilateral lesion&#46; Majority of them had Middle Cerebral artery stroke &#40;61&#37;&#41; and 22&#37; had veretebro-basilar stroke&#46; Two participants had thalamic stroke and another two had a history of brainstem involvement&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Instrumentation</span><p id="par0085" class="elsevierStylePara elsevierViewall">The videofluroscopy data were collected from the collaborating institutes under the supervision of trained Speech-Language Pathologists &#40;SLPs&#41; employed in these centres&#44; and recorded using GE Innova 3131 Biplane &#40;GE Healthcare&#44; USA&#41; and Cios Alpha &#40;Siemens Healthcare Private Limited&#44; Germany&#41; with the quality of recordings controlled with the selection criteria of 30 pulses&#47;second&#44; as mentioned in the previous section&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Bolus presented</span><p id="par0090" class="elsevierStylePara elsevierViewall">The single 5<span class="elsevierStyleHsp" style=""></span>ml liquid barium &#40;&#46;95<span class="elsevierStyleHsp" style=""></span>g&#47;ml Barium sulphate oral suspension&#44; Microbar&#174; suspension&#41; swallow of the 23 individuals was selected for further analysis&#46; The rationale for this selection was because this volume is commonly used for instrumental evaluations for clinical purpose in persons with dysphagia&#46; Boluses were controlled for its volume and were presented directly from the measurement cup or using a spoon&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Procedure</span><p id="par0095" class="elsevierStylePara elsevierViewall">Written consent was obtained from all the participants for use of assessment and rehabilitation data &#40;a&#41; as a routine procedure during clinical evaluation&#44; or &#40;b&#41; specifically for the research purpose&#46; The procedure followed for the study was in line with the bio-behavioural ethics committee and technical research advisory committee of the collaborating institutions&#46; A non-random sample of secondary data&#44; selected based on aforementioned criteria was used for analysis&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">All recordings included in the study showed that the individuals held the bolus in their oral cavity and swallowed the 5<span class="elsevierStyleHsp" style=""></span>ml bolus in upright&#44; neutral head position on instruction of the SLP &#40;Cued Swallow&#41;&#46; Time of onset of each event was obtained from the VFSS frames in the lateral view with lips in the anterior&#44; velum in posterio-superior&#44; posterior pharyngeal wall in posterior and upper esophageal sphincter in the inferior boundary&#46; Frame-by frame analysis was carried out during playback using UleadVideostudio&#174; Movie Wizard &#40;Version 11&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The oro-pharyngeal physiologies included in the present study were selected after a thorough review of recent literature&#46; The operational definitions for each physiology were retained as in the literature so as to enable comparisons&#44; wherever possible &#40;<a class="elsevierStyleCrossRefs" href="#bib0015">Cook et al&#46;&#44; 1989&#59; Kendall &#38; Leonard&#44; 2001&#59; Kendall et al&#46;&#44; 2003&#59; Logemann et al&#46;&#44; 2000&#59; Logemann et al&#46;&#44; 2002&#59; Martin-Harris et al&#46;&#44; 2003&#59; Mendell &#38; Logemann&#44; 2007&#59; Molfenter et al&#46;&#44; 2014&#59; Ohmae et al&#46;&#44; 1995&#59; Shaker et al&#46;&#44; 1990&#59; Zamir et al&#46;&#44; 1996</a>&#41;&#46; A total of 29 events were defined and identified from the VFSS recording &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The absolute temporal measures were noted directly from the digital video play back timer by one of the investigators and another qualified Speech-Language Pathologist&#46; Inter-judge agreement in frame selection was considered at &#177;3<span class="elsevierStyleHsp" style=""></span>ms &#40;1 frame length&#41;&#46; Discrepancies were re-evaluated independently and resolved after discussion&#46; At the end of analysis&#44; the data consisted of time of onset of each of the 29 events for 5<span class="elsevierStyleHsp" style=""></span>ml liquid barium swallow from each VFSS recording&#44; a total of 667 data points&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">As the absolute time coordinates varied across recordings&#44; end of UES closing &#40;UESCend&#41; was taken as the reference for calculation of relative temporal measures&#46; This was for two reasons&#58; &#40;1&#41; It indicates the completion point of an active forward swallow sequence&#59; &#40;2&#41; UES activity is least affected by voluntary swallowing behaviours &#40;<a class="elsevierStyleCrossRef" href="#bib0125">Shaker et al&#46;&#44; 1993</a>&#41;&#46; As the study dealt with atypical population&#44; it was expected that VFSS would reveal absence or inefficient movements of at least one of the structures involved in oro-pharyngeal swallow&#44; therefore not qualifying as a reference point&#46; The UES function&#44; being least affected in post-stroke was assumed to be present in maximum number of participants &#40;at least partially&#41;&#44; therefore could be a common reference point for most participants&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0115" class="elsevierStylePara elsevierViewall">The data on absolute time of events was converted to relative measures with reference to UESCend using the formula &#91;time of occurrence of the event &#40;absolute&#41;-time of occurrence of the last event &#40;UESCend&#41;&#93;&#46; This data was tested for normality &#40;Kolomogorov&#8211;Smirnov test&#41; and was found to be heavily one tailed&#46; As the data did not satisfy the assumption of normal distribution&#44; non-parametric tests were used for all further statistical comparisons&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the central tendency and dispersion measures for each event studied&#46; Most of the events occurred prior to UESCend &#40;negative&#41; while only six events occurred simultaneously or after the reference event &#40;TBR2&#44; SPrest&#44; Erest&#44; H4&#44; LVOStart&#44; and LVOend&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Coordination of events across time was studied by running the test of difference with repeated measure&#46; Friedman test indicated significant difference in temporal points &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span>&#40;28&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>196&#46;74&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;00&#41; across the events&#46; Multiple post-hoc at 95&#37; confidence level would provide inconclusive results with small effect size and hence was not done&#46; Alternatively&#44; events were arranged in ascending order of central tendency and sets of consecutive events were tested for significant difference using Friedman test&#46; If a significant difference was found &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#44; the variable creating the difference was eliminated&#46; Sets that did not show any statistical significant difference &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#62;</span><span class="elsevierStyleHsp" style=""></span>&#46;05&#41; was classified as one cluster&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">With the above method&#44; five possible functional clusters with varied number of events within each could be identified &#40;1&#41; Initiation of pharyngeal swallow&#44; arrival of bolus in vallecula&#44; onset of ary-epiglottic elevation and onset of hyoid movement&#44; &#40;2&#41; onset of tongue base retraction&#44; vallecular clearance&#44; arrival of bolus in pyriform sinus&#44; onset of epiglottic inversion&#44; end of oral bolus transport&#44; maximum soft palate elevation&#44; and maximum superior motion of hyoid&#44; &#40;3&#41; maximum tongue base retraction&#44; maximum epiglottic inversion&#44; maximal aryepiglottic elevation&#44; maximum anterior motion of hyoid&#44; pyriform clearance&#44; and onset of upper esophageal sphincter closing&#44; &#40;4&#41; end of soft palate elevation&#44; onset of laryngeal opening&#44; and end of upper esophageal sphincter closing and &#40;5&#41; end of epiglottic inversion&#44; end of tongue base retraction and end of hyoid movement&#46; Another six events could not be classified into any of the identified clusters and were separated in time compared to other events&#46; These events were &#40;1&#41; onset of oral bolus transport&#44; &#40;2&#41; onset of soft palate elevation&#44; &#40;3&#41; upper esophageal sphincter opening&#44; &#40;4&#41; maximum upper esophageal sphincter opening&#44; &#40;5&#41; onset of hyoid descend and &#40;6&#41; end of laryngeal opening&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">To better understand the temporal coordination of these events in persons with dysphagia post-stroke&#44; the central tendency measures &#40;mean and median&#41; were arranged in the order of descending relative onset time&#46; As the order of swallowing events was similar with both mean and median&#44; a time line was generated with mean onset time and standard error &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; From this figure&#44; onset of bolus transport marked the beginning of swallow and the motor sequence was completed with the full opening of laryngeal vestibule&#46; Though the pharyngeal events fell into a continuum of airway protection and bolus transport&#44; the onset of bolus transport was a stand-alone event&#46; This indicated that the population had difficulty triggering the IPS but once triggered&#44; the sequence continued without much interference&#46; Another region of shift from the linear pattern was observed from UESCstart and after UESCend&#46; Multiple deviations from typical sequence were revealed supporting the hypotheses made and indicating that temporal in-coordination could be in fact a factor for unresolved dysphagia in post-stroke survivors&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">In this study&#44; we put into test the hypotheses that temporal in-coordination and alteration of sequence of swallowing events at the oro-pharyngeal stages could be associated with persistent dysphagia in post-stroke&#46; Detailed analysis of single liquid swallows during radiological study using frame by frame analysis method was conducted&#46; Though the method of analysis has been used in previous studies&#44; the present study has extended the findings to a less studied population in greater detail&#46; As far as the authors know&#44; this study is the first in this genre that explores temporal coordination and sequencing of swallow events in post-stroke dysphagia&#46; The study has included onset&#44; maximum performance and offset of each event related to bolus transport and airway de-coupling with concrete definitions thereby opening the scope for future research&#46; Overall&#44; the findings of the present study indicated that temporal in-coordination and deviance in sequence of oro-pharyngeal swallow events is closely associated with persistent dysphagia in post-stroke individuals&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">As the study was retrospective in nature&#44; recordings were not strictly controlled for time&#46; It was necessary therefore that the events be marked to a common time line for any statistical verification to be performed&#46; It was only a logical decision to consider UESCend as the reference point for reasons mentioned in the previous sections&#46; This decision was supported with missing data points for bolus transport events and absence of clear onset of certain physiological events&#46; Upper esophageal function was present in all participants&#44; at least partially&#46; The results of the present study revealed that this function was not necessarily the last point of swallow sequence&#46; It was only after the bolus tail passed through the upper esophageal sphincter that the airway decoupling was released with complete opening of laryngeal vestibule as the final movement in a swallow sequence in this population&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Results of descriptive statistical analysis indicated that the temporal coordinates were highly dispersed from the central measure&#46; High variability in sequencing was reported by Kendall and collegues &#40;2003&#41; and confirmed by <a class="elsevierStyleCrossRef" href="#bib0090">Molfenter et al&#46; &#40;2014&#41;</a> in typical swallows and they found that the variability was higher in small volumes&#46; This study was only a preliminary attempt in this direction considering the heterogeneity in symptoms and severity of dysphagia exhibited by the population studied&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Five functional clusters of swallowing were identified in post-stroke individuals&#46; Superficially&#44; these clusters indicated trigger&#44; bolus transport&#44; peak of pharyngeal swallow&#44; completion of bolus transport and return to position for the next cycle&#46; There were events that overlapped in each of these clusters&#46; The six events that could not be classified into the clusters occurred at a different point compared to other events&#46; Temporal disintegration of onset of bolus propulsion &#40;B1&#41; from the sequence of events may be justified for its volitional component but the other five events were expected to be associated with reflexive pharyngeal events&#46; Further research is needed to confirm if these events are broken from the strands of swallowing as a result of brain damage or if they are independent functions in the sequence of swallowing&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Among the events that fell into cluster classification&#44; few could be supported with previous research&#46; A study on deglutition related laryngeal closure mechanism in humans suggested that posterior tilting of epiglottis is related to hyo-laryngeal elevation&#44; bolus transport and tongue base retraction &#40;<a class="elsevierStyleCrossRef" href="#bib0045">Logemann et al&#46;&#44; 1992</a>&#41;&#46; The current study expanded this view to post-stroke dysphagia with the second cluster identified in the current study&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">A healthy swallow is completed within one second &#40;<a class="elsevierStyleCrossRef" href="#bib0040">Logemann&#44; 1998</a>&#41;&#46; The analysis of VFSS images indicated that liquid swallows took longer in post-stroke &#40;1&#46;79<span class="elsevierStyleHsp" style=""></span>s on an average&#41; for transferring the bolus from mouth to UES&#46; Increased oral and pharyngeal transit times have been reported previously as a consequence of physiological inefficiencies &#40;<a class="elsevierStyleCrossRefs" href="#bib0030">Kim &#38; Han&#44; 2005&#59; Mann et al&#46;&#44; 1999&#59; Perlman et al&#46;&#44; 1994</a>&#41;&#46; Though the duration of swallow prolonged&#44; certain physiological sequences reported in typical swallows were retained in this population as well&#46; The aryepiglottic elevation occurred before epiglottic descent and the onset of tongue base retraction occurred before onset of superior elevation of hyoid &#40;<a class="elsevierStyleCrossRef" href="#bib0120">Shaker et al&#46;&#44; 1990</a>&#41; and maximum hyo-laryngeal elevation was obtained after the opening of UES in typical swallows &#40;<a class="elsevierStyleCrossRef" href="#bib0025">Kendall et al&#46;&#44; 2003</a>&#41;&#46; Clear indications of shuffling of event sequence were also evident which could be discussed as bolus transport and airway decoupling sequence&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Bolus Transport Sequence&#58;</span> The &#8216;leading complex&#8217; of bolus transport in healthy individuals &#40;<a class="elsevierStyleCrossRef" href="#bib0015">Cook et al&#46;&#44; 1989</a>&#41;was preserved in this population with the onset of tongue base retraction and hyo-laryngeal elevation occurring within in &#46;1<span class="elsevierStyleHsp" style=""></span>s of each other&#46; In typical swallow&#44; the peristaltic movement squeezes the bolus from the point of its entry into pharynx at the level of soft palate till upper esophageal sphincter &#40;<a class="elsevierStyleCrossRef" href="#bib0080">Matsuo &#38; Palmer&#44; 2009</a>&#41;&#46; Contrary to this&#44; the site of onset of pharyngeal action was tongue base which progressed upwards to soft palate in post-stroke population&#46; Even at the point of maximum closure and return to resting phase&#44; progression did not follow the typical sequence from soft palate to UES&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Bolus head reached pyriform sinus at least &#46;47<span class="elsevierStyleHsp" style=""></span>s prior to opening of UES unlike the prior or simultaneous activity in typical swallows &#40;<a class="elsevierStyleCrossRef" href="#bib0025">Kendall et al&#46;&#44; 2003</a>&#41;&#46; The disturbed sequence suggests that the bolus transport and clearance deficits in post-stroke dysphagia may be associated with an in coordinated pharyngeal peristalsis&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Airway Decoupling Sequence&#58;</span> In a typical swallow&#44; the airway closure started from bottom and progressed upwards with epiglottis as the most superficial shield for laryngeal inlet &#40;<a class="elsevierStyleCrossRefs" href="#bib0045">Logemann et al&#46;&#44; 1992&#59; Matsuo &#38; Palmer&#44; 2009</a>&#41;&#46; The population in the present study initiated the sequence in the bottom up direction with onset of ary-epiglottic closure followed by epiglottic inversion but the maximal laryngeal elevation was delayed compared to maximal epiglottic inversion&#46; The action of vocal folds could not be visualised using video-fluroscopy&#46; On release of the airway protection too&#44; laryngeal vestibular opening started earlier but was completed later compared to epiglottic action&#46; This suggests a slowed laryngeal movement could be associated with post-stroke dysphagia&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">A recent study suggested slowness&#44; not delay of laryngeal elevation as the cause of penetration&#47;aspiration &#40;<a class="elsevierStyleCrossRef" href="#bib0095">Nativ-Zeltzer et al&#46;&#44; 2014</a>&#41;&#46; The current study&#44; however&#44; also indicate an overlapping delay in laryngeal elevation in post-stroke&#46; The head of swallowed bolus had already reached the vallecula before the laryngeal elevation was triggered &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; compared to the finding in typical population that they initiate laryngeal elevation before the bolus enter pharynx &#40;<a class="elsevierStyleCrossRef" href="#bib0120">Shaker et al&#46;&#44; 1990</a>&#41;&#46; The coordination sequences in aryepiglottic contraction&#44; maximum hyoid elevation and upper esophageal activity in typical swallows of small volumes &#40;<a class="elsevierStyleCrossRefs" href="#bib0025">Kendall et al&#46;&#44; 2003&#59; Molfenter et al&#46;&#44; 2014</a>&#41; could not be observed in this study&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">The findings of the current study indicated that persons with persistent post-stroke dysphagia deviate from typical sequence not only in the volitional but also the reflexive sequences of swallow&#46; As clearly observed&#44; timing as well as sequencing of swallow events were deviated in this population studied&#46; Apart from a peripheral inefficiency related to motor weakness&#44; a central error in programming of swallow sequence may be related to persistent dysphagia post-stroke&#46; This may need further conclusive evidence with large scale research&#46;</p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Limitations</span><p id="par0195" class="elsevierStylePara elsevierViewall">Though a large number of data was screened for inclusion&#44; only a limited number of data could be included in an attempt to have homogeneity&#46; This homogeneity could be obtained only in certain aspects of medical history and diagnosis&#46; The findings of this study may not be relevant to all types&#44; sites and pathologies&#46; Each of these variables need to be exclusively studied for its effect on temporal sequencing in swallowing function&#46; Being a retrospective study&#44; possible variability in sequence and time coordinates across trials and bolus characteristics could not be considered&#46; As the evidences on adaptations of swallowing physiology to varied bolus characteristics are building up&#44; higher bolus volumes&#44; thicker consistencies&#44; tastes and temperatures need to be studied in similar methods&#46; Future research may address these issues and attempt to replicate or validate the observations made on larger&#44; controlled population&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusions</span><p id="par0200" class="elsevierStylePara elsevierViewall">The present study provided preliminary evidence of difference in the timing and sequencing of occurrence of oral and pharyngeal swallow events in persistent dysphagia post-stroke&#46; Few events seem to behave independently from others while the five functional clusters identified from the study occurred almost simultaneously with no significant difference in the time of occurrence&#46; Many events related to bolus transport and airway decoupling were deviant and may be associated with the penetration&#47;aspiration symptoms seen in this clinical population&#46; Future research is warranted to take these observations further and to identify if the sequential variations are clinically relevant&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Contributors</span><p id="par0205" class="elsevierStylePara elsevierViewall">All authors have significantly contributed towards conceptualization&#44; data collection&#44; analysis&#44; interpretation and report preparation&#46; The final report was approved by the authors before publication&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Funding</span><p id="par0220" class="elsevierStylePara elsevierViewall">The study included data collected for a previous research work funded by the <span class="elsevierStyleGrantSponsor" id="gs1">AIISH Research Fund</span> &#40;ARF&#41; &#40;Sanction number&#58; SH&#47;CDN&#47;ARF-44&#47;2016-17&#41; retrospectively analysed with different objectives&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interest</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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    "fechaRecibido" => "2019-08-13"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Evidence from videofluoroscopic analysis of healthy swallowing physiology shows that typical swallowing function is not entirely &#8216;sequential&#8217; but are clusters of precisely coordinated movements&#46; It is unknown if disruption of this fine orchestra of events could be associated with persistent dysphagia in individuals post-stroke&#46; This investigation studied the time of onset and sequencing of specific oro-pharyngeal swallowing events as seen in the modified barium swallow study in a population with airway penetration of swallowed bolus post-stroke&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A retrospective frame to frame analysis of 29 time points in single cued 5<span class="elsevierStyleHsp" style=""></span>ml liquid barium swallows obtained from 23 individuals who satisfied inclusion criteria was conducted independently by two investigators&#46; Relative temporal measures with reference to upper esophageal sphincter activity were calculated&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results and conclusion</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Statistical analysis revealed five temporal clusters of swallowing events while the onset of oral bolus transport&#44; soft palate elevation&#44; upper esophageal sphincter opening&#44; hyoid descent&#44; and complete laryngeal closing occurred independently&#46; A timeline of event sequences was also developed that showed multiple deviations from the known sequences reported in healthy swallowing literature&#46; There was a delay as well as deviance from known normality in the order of swallowing events considered in this study&#46; The findings suggested a difference in the underlying programming for a swallow in post-stroke dysphagia&#44; that may also contribute to the airway intrusion&#46; The study provides preliminary evidence for the inclusion of temporal measures of swallowing physiology during an instrumental assessment of swallowing function in persons with dysphagia&#46;</p></span>"
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        "resumen" => "<span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introducci&#243;n y objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La evidencia del an&#225;lisis videofluorosc&#243;pico de la fisiolog&#237;a de la degluci&#243;n saludable muestra que la funci&#243;n de la degluci&#243;n t&#237;pica no es completamente &#171;secuencial&#187;&#44; sino que son grupos de movimientos coordinados con precisi&#243;n&#46; Se desconoce si la interrupci&#243;n de esta fina armon&#237;a de eventos podr&#237;a asociarse con una disfagia persistente en individuos despu&#233;s del accidente cerebrovascular&#46; Esta investigaci&#243;n estudi&#243; el tiempo de inicio y la secuenciaci&#243;n de eventos espec&#237;ficos de degluci&#243;n orofar&#237;ngea&#44; como se observa en el estudio modificado de degluci&#243;n de bario en una poblaci&#243;n con penetraci&#243;n de las v&#237;as respiratorias del bolo ingerido despu&#233;s del accidente cerebrovascular&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Materiales y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El an&#225;lisis retrospectivo paso a paso de 29 momentos de la degluci&#243;n de 5<span class="elsevierStyleHsp" style=""></span>ml de bario l&#237;quido analizados en 23 individuos que cumplieron con los criterios de inclusi&#243;n fue realizado de forma independiente por dos investigadores&#46; Se calcularon medidas temporales relativas a la actividad del esf&#237;nter esof&#225;gico superior&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Resultados y conclusiones</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El an&#225;lisis estad&#237;stico revel&#243; cinco grupos temporales de eventos de degluci&#243;n&#44; mientras que el inicio del transporte de bolo oral&#44; la elevaci&#243;n del paladar blando&#44; la apertura del esf&#237;nter esof&#225;gico superior&#44; el descenso de hioides y el cierre lar&#237;ngeo completo se produjeron de forma independiente&#46; Tambi&#233;n se desarroll&#243; una l&#237;nea de tiempo de secuencias de eventos que mostraba m&#250;ltiples desviaciones de las secuencias conocidas reportadas en la literatura de degluci&#243;n saludable&#46; Hubo un retraso&#44; as&#237; como una desviaci&#243;n de la normalidad en el orden de los eventos de degluci&#243;n considerados en este estudio&#46; Los hallazgos sugirieron una diferencia en la programaci&#243;n subyacente para una degluci&#243;n en la disfagia tras el accidente cerebrovascular&#44; que tambi&#233;n puede contribuir a la intrusi&#243;n de las v&#237;as respiratorias&#46; El estudio proporciona evidencia preliminar para la inclusi&#243;n de medidas temporales de la fisiolog&#237;a de la degluci&#243;n durante una evaluaci&#243;n instrumental de la funci&#243;n de degluci&#243;n en personas con disfagia&#46;</p></span>"
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Temporal sequence of oro-pharyngeal swallowing events in post-stroke&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Notes&#58; B1 &#8211; onset of oral bolus transport&#59; B2 &#8211; end of oral bolus transport&#59; IPS &#8211; initiation of pharyngeal swallow&#59; TBR1 &#8211; onset of tongue base retraction&#59; TBRmax &#8211; maximum tongue base retraction&#59; TBR2 &#8211; end of tongue base retraction&#59; SPstart &#8211; onset of soft palate elevation&#59; SPclose &#8211; maximum soft palate elevation&#59; SPrest &#8211; end of soft palate elevation&#59; BV1 &#8211; arrival of bolus in vallecula&#59; BV2 &#8211; vallecular clearance&#59; BP1 &#8211; arrival of bolus in pyriform sinus&#59; BP2 &#8211; pyriform clearance&#59; EIstart &#8211; onset of epiglottic inversion&#59; EIclose &#8211; maximum epiglottic inversion&#59; Erest &#8211; end of epiglottic inversion&#59; H1 &#8211; onset of hyoid movement&#59; H2Y &#8211; maximum superior motion of hyoid&#59; H2X &#8211; maximum anterior motion of hyoid&#59; H3 &#8211; onset of hyoid descend&#59; H4 &#8211; end of hyoid movement&#59; AEstart &#8211; onset of ary-epiglottic elevation&#59; AEclose &#8211; maximal aryepiglottic elevation&#59; LVOstart &#8211; onset of laryngeal opening&#59; LVOend &#8211; end of laryngeal opening&#59; UESpop &#8211; upper esophageal sphincter opening&#59; UESmax &#8211; maximum upper esophageal sphincter opening&#59; UESCstart &#8211; onset of upper esophageal sphincter closing&#59; UESCend &#8211; end of upper esophageal sphincter closing</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Participant &#35;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diagnosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">Right MCA stroke&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Left and right MCA stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right MCA stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left MCA stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left thalamic stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right MCA stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left MCA stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right MCA stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right MCA stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right MCA stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vertebro-basilar stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left MCA stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vertebro-basilar stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right MCA lacunar stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right Lateral medullary syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vertebro-basilar stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left thalamic stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vertebro-basilar stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right and Left MCA stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vertebro-basilar stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left MCA stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right Lateral medullary syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left MCA stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Demographic and diagnostic details of participants&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sl&#46; No&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Event&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Definition&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Onset of oral bolus transport &#40;B1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first movement of the most anterior part of the bolus from a stable or &#8220;hold&#8221; position&#46; In case of multiple attempts to swallow&#44; the onset of first movement associated with shift in bolus position was considered&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">End of oral bolus transport &#40;B2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with the tail of bolus at the posterior nasal spine&#46; In case of multiple attempts to swallow&#44; the offset of last lingual movement associated with shift in bolus position was considered&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Initiation of pharyngeal swallow &#40;IPS&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">First frame showing the bolus head reaching the tongue base at the point it crosses the ramus of the mandible&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Onset of tongue base retraction &#40;TBR1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">First frame showing posterior movement of tongue base towards posterior pharyngeal wall for bolus propulsion&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maximum tongue base retraction &#40;TBRmax&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">First frame showing maximum approximation of tongue base to posterior pharyngeal wall&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">End of tongue base retraction &#40;TBR2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">First frame with the base of the tongue returned to resting position after maximum retraction&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Onset of soft palate elevation &#40;SPstart&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with upward movement of velum towards posterior pharyngeal wall for closure of nasopharynx associated with bolus propulsion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maximum soft palate elevation &#40;SPclose&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with maximum approximation of velum towards posterior pharyngeal wall for closure of nasopharynx associated with bolus propulsion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">End of soft palate elevation &#40;SPrest&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with return of velum to its resting position after maximal closure of nasopharynx associated with bolus propulsion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arrival of bolus in vallecula &#40;BV1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with the head of the bolus in the vallecular region&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vallecular clearance &#40;BV2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with the tail of the bolus leaving the vallecular region&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arrival of bolus in pyriform sinus &#40;BP1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with the head of the bolus in the pyriform region&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pyriform clearance &#40;BP2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with the tail of the bolus leaving the pyriform region&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Onset of epiglottic inversion &#40;EIstart&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with medial shift of tip of epiglottis towards the laryngeal vestibule&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maximum epiglottic inversion &#40;EIclose&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with maximum medial shift of tip of epiglottis towards the laryngeal vestibule&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">End of epiglottic inversion &#40;Erest&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with return of tip of epiglottic to resting position after a maximal epiglottic inversion&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Onset of hyoid movement &#40;H1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first quick and robust antero-superior movement of hyoid bone&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maximum superior motion of hyoid &#40;H2Y&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with maximum superior displacement of the hyoid bone&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maximum anterior motion of hyoid &#40;H2X&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with maximum anterior displacement of the hyoid bone&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Onset of hyoid descend &#40;H3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with a downward displacement of hyoid from maximal anterio-superior displacement&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">End of hyoid movement &#40;H4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with hyoid return to resting position after maximal anterio-superior displacement&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Onset of Ary-epiglottic elevation&#40;AEstart&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with a superior displacement of Ary-epiglottic folds&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maximal Aryepiglottic elevation &#40;AEclose&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with maximum approximation of Ary-epiglottic folds leading to minimum air contrast between epiglottis and aryepiglottic folds&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Onset of laryngeal opening &#40;LVOstart&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with a downward displacement of aryepiglottic folds after maximal approximation&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">End of laryngeal opening &#40;LVOend&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with return of aryepiglottic folds to resting position after maximal approximation&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Upper Esophageal Sphincter Opening &#40;UESpop&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with the head of the bolus entering the esophagus through the upper esophageal sphincter&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maximum Upper Esophageal Sphincter Opening &#40;UESmax&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with maximum opening of upper esophageal sphincter seen as a wide flow of barium entering the esophagus&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Onset of Upper Esophageal Sphincter closing &#40;UESCstart&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with a narrowing of upper esophageal sphincter opening from its maximum opening&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">End of Upper Esophageal sphincter closing &#40;UESCend&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The first frame with complete obstruction of upper esophageal sphincter with no bolus flow through the sphincter&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Oro-pharyngeal swallowing events and their definitions as used in the current study&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sl&#46; No&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Event&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Onset of oral bolus transport &#40;B1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;00 &#40;1&#46;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">End of oral bolus transport &#40;B2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&#46;50 &#40;&#46;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Initiation of pharyngeal swallow &#40;IPS&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&#46;88 &#40;&#46;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Onset of tongue base retraction &#40;TBR1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&#46;85 &#40;&#46;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maximum tongue base retraction &#40;TBRmax&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&#46;14 &#40;&#46;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">End of tongue base retraction &#40;TBR2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;09 &#40;&#46;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Onset of soft palate elevation &#40;SPstart&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&#46;85 &#40;&#46;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maximum soft palate elevation &#40;SPclose&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&#46;18 &#40;&#46;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">End of soft palate elevation &#40;SPrest&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;00 &#40;&#46;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arrival of bolus in vallecula &#40;BV1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&#46;85 &#40;1&#46;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vallecular clearance &#40;BV2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&#46;82 &#40;1&#46;27&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arrival of bolus in pyriform sinus &#40;BP1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&#46;82 &#40;1&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pyriform clearance &#40;BP2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&#46;06 &#40;&#46;51&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Onset of epiglottic inversion &#40;EIstart&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&#46;53 &#40;&#46;53&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maximum epiglottic inversion &#40;EIclose&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&#46;11 &#40;&#46;52&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">End of epiglottic inversion &#40;Erest&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#46;04 &#40;&#46;83&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Onset of hyoid movement &#40;H1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maximum superior motion of hyoid &#40;H2Y&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maximum anterior motion of hyoid &#40;H2X&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Onset of hyoid descend &#40;H3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">End of hyoid movement &#40;H4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;12 &#40;&#46;41&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Onset of Ary-epiglottic elevation&#40;AEstart&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&#46;85 &#40;&#46;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maximal Aryepiglottic elevation &#40;AEclose&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&#46;09 &#40;&#46;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Onset of laryngeal opening &#40;LVOstart&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;00 &#40;&#46;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">End of laryngeal opening &#40;LVOend&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;79 &#40;&#46;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Upper Esophageal Sphincter Opening &#40;UESpop&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&#46;15 &#40;&#46;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maximum Upper Esophageal Sphincter Opening &#40;UESmax&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&#46;15 &#40;&#46;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Onset of Upper Esophageal Sphincter closing &#40;UESCstart&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&#46;06 &#40;&#46;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">End of Upper Esophageal sphincter closing &#40;UESCend&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;00 &#40;&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
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                  """
              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Median and standard deviation &#40;SD&#41;of the 29 oro-pharyngeal events studied&#46;</p>"
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      "titulo" => "References"
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        0 => array:2 [
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            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "Broadley et al&#46;&#44; 2003"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Predictors of prolonged dysphagia following acute stroke"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:8 [
                            0 => "S&#46; Broadley"
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                            2 => "J&#46; Cottrell"
                            3 => "M&#46; Creevy"
                            4 => "E&#46; Teo"
                            5 => "D&#46; Yiu"
                            6 => "&#8230;"
                            7 => "P&#46;D&#46; Thompson"
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                    0 => array:2 [
                      "doi" => "10.1016/S0967-5868(03)00022-5"
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                        "tituloSerie" => "Journal of Clinical Neuroscience"
                        "fecha" => "2003"
                        "volumen" => "10"
                        "numero" => "3"
                        "paginaInicial" => "300"
                        "paginaFinal" => "305"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12763332"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "Brodsky et al&#46;&#44; 2018"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coordination of pharyngeal and laryngeal swallowing events during single liquid swallows after oral endotracheal intubation for patients with acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;B&#46; Brodsky"
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                            2 => "K&#46; Chilukuri"
                            3 => "M&#46; Huang"
                            4 => "J&#46;B&#46; Palmer"
                            5 => "D&#46;M&#46; Needham"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00455-018-9901-z"
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                        "tituloSerie" => "Dysphagia"
                        "fecha" => "2018"
                        "volumen" => "33"
                        "numero" => "6"
                        "paginaInicial" => "768"
                        "paginaFinal" => "777"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29713897"
                            "web" => "Medline"
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            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "Cook et al&#46;&#44; 1989"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Timing of videofluoroscopic&#44; manometric events&#44; and bolus transit during the oral and pharyngeal phases of swallowing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
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