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At least 793 records · Page 44Linked to original sources
PubMed1975

Comparison of activity in pontine versus medullary neurones during swallowing.

1. On decerebellectomized sheep lightly anaesthetized with fluothane, the activity of 49 neurones in the pontine relay (see Car et al., 1975) was recorded with microelectrodes following stimulation of afferents in the superior laryngeal nerve (SLN), 2. These pontine neurones (PN) exhibited an "initial activity" (one or a few spikes) for stimulation either of the homolateral SLN (35 PN) or glossopharyngeal nerve (14 PN). This initial activity had a latency between 1.5 and 4 msec. When swallowing was induced by SLN stimulation, a later discharge appeared. This "swallowing activity" consisted of a variable burst of spikes. 3. The effect of curarization was tested for 13 PN. It always eliminated the "swallowing activity". 4. A clear antidromic response of 16 PN (26 tested PN) was induced by stimulating the thalamic VPM nucleus. This stimulation failed to elicit an antidromic response in medullary neurones (14 tested) located in the nucleus of the tractus solitarius. 5. It is concluded that PN are probably sensory relay neurones which inform higher nervous centres of the state of oropharyngeal receptors; whereas medullary swallowing neurones are really interneurones involved in the programming of the wallowing motor sequence.

Animals↗
PubMed1988

Excitatory and inhibitory postsynaptic potentials in cat hypoglossal motoneurons during swallowing.

The postsynaptic potentials produced in cat genioglossus and styloglossus motoneurons (GG- and SG-Mns) during swallowing were studied. During swallowing elicited by placing water on the dorsum of the tongue, the GG-muscle discharged for 80-210 ms (mean +/- S. D. 123 +/- 31 ms, N = 59) and was abruptly suppressed, and the SG-muscle began discharging in synchrony with the GG-muscle and discharged for 200-360 ms (mean +/- S. D. 247 +/- 36 ms, N = 59). The GG- and the SG-Mns were identified if unitary muscle activity followed the induced spike of the motoneuron one-for-one. During swallowing, excitatory postsynaptic potentials (EPSPs) were evoked in the SG-Mns regardless of the respiratory drive on the SG-Mns, and inhibitory postsynaptic potential (IPSP) or EPSP-IPSP was evoked on the GG-Mns regardless of the respiratory drive on the GG-Mns. By increasing the intracellular concentration of chloride ions, the IPSP elicited in the GG-Mn during swallowing was turned into a depolarizing potential. In immobilized cats, a depolarizing potential and a depolarizing-hyperpolarizing potential sequence was evoked successively on a tongue retractor motoneuron and a tongue protruder motoneuron by repetitive electrical stimulation of the superior laryngeal nerve.

Action Potentials↗
PubMed1995

Durational aspects of oral swallow in neurologically normal children and children with cerebral palsy: an ultrasound investigation.

Little data exist on the oral management of food boluses in neurologically normal children or children with cerebral palsy (CP). Twenty children with spastic CP and 20 neurologically normal children (age range: 6.2-12.9 years) were monitored with ultrasound imaging of the oral cavity during liquid and solid bolus tasks. A lip-cup contact detector synchronized to ultrasound image output was used during liquid tasks. Data collected from recorded ultrasound images were used to assess durational aspects of the oral phase of swallowing in neurologically normal children and children with CP. Coordinated analysis of ultrasound images with lip-cup contact data allowed timing of intervals in the pre-oral and oral phases of swallowing during liquid feeding tasks. Children with CP required more time than neurologically normal children for collection, preparation, oral transit, and total oral swallow time for 5-ml liquid boluses. Total oral swallow time was longer for solid bolus tasks in children with CP. Oral transit time for solid boluses was significantly longer than for liquid boluses in neurologically normal children and children with CP.

Beverages↗
PubMed1995

Swallowing therapy of neurologic patients: correlation of outcome with pretreatment variables and therapeutic methods.

The results of swallowing therapy in 58 patients with neurologic disorders are presented. All patients received tube feeding, either partially or exclusively, at admission, and successful outcomes, defined as exclusively oral feeding, were achieved in 67% of patients over a median treatment interval of 15 weeks. A subset of 11 patients who had experienced disease onset 25 weeks or more prior to admission nonetheless had a similar success rate of 64%. No other pretreatment variable, including age, localization of lesion, type or degree of aspiration, or cognitive status, correlated with successful outcome. Indirect therapy methods such as stimulation techniques and exercises to enhance the swallowing reflex, alter muscle tone, and improve voluntary function of the orofacial, lingual, and laryngeal musculature were utilized in all but 1 patient. Direct methods including compensatory strategies such as head and neck positioning, and techniques such as supraglottic swallowing and the Mendelsohn maneuver were additionally employed in nearly one-half of patients. Swallowing therapy is associated with successful outcome, as defined by exclusively oral feeding, among patients with neurogenic dysphagia, regardless of pretreatment variables including time since disease onset. Indirect treatment methods appear to be effective when used either alone or in combination with direct methods. Achievement of oral feeding is not associated with undue risk of pneumonia. Further rigorous scientific studies are needed.

Adult↗
PubMed1994

The association of swallowing dysfunction and aspiration pneumonia.

The medical literature has emphasized that aspiration of gastric contents or oral bacteria is a common cause of aspiration pneumonia. Swallowing disorders have been implicated in this disease but not studied at the time that aspiration pneumonia was diagnosed. A significant difference was found in the incidence of videofluoroscopically confirmed oropharyngeal swallowing problems in a group of patients diagnosed with aspiration pneumonia (AP) when compared with patients with nonaspiration pneumonia (NAP). Six of the 9 patients in the AP group aspirated during the videofluoroscopic evaluation and 2 others were considered to be at risk for aspiration. None of the 7 NAP patients demonstrated swallowing problems or aspiration. A significant difference in oral transit time also occurred between the two groups. Liquid was found to have a significantly faster oral transit time than paste or a cookie. Pharyngeal transit times were not found to be significantly different. Although there were only a small number of patients who met the criteria for this pilot study, a strong association was found between swallowing dysfunction and aspiration pneumonia.

Adult↗
PubMed1994

Swallowing/ventilation interactions during oral swallow in normal children and children with cerebral palsy.

Many children with cerebral palsy (CP) suffer from feeding disorders. Twenty children with spastic CP and 20 neurologically normal children (age range 6.2-12.9 years) were monitored with ultrasound imaging of the oral cavity synchronized with surface electromyographic (EMG) recordings of masseter and infrahyoid muscles and respiratory inductance plethysmograph (RIP) recordings during feeding tasks. A lip-cup contact detector signaled contact of the drinking cup on the lip during liquid tasks. Children with CP required more time than normals for collection and organization of 5 ml and 75 ml liquid boluses for swallowing. The ventilatory preparation phase, recovery to baseline resting ventilatory pattern after swallowing, and total time for task completion were longer in children with CP for 5-ml and 75-ml tasks. The interval from lip-cup contact until alteration of ventilation from baseline resting ventilatory pattern was longer for children with CP during 75-ml tasks but not for 5-ml tasks. The interval from completion of the task-related cookie swallow until initiation of the next swallow was longer in children with CP than in normal children. These data provide evidence that children with CP manage solid boluses more easily than liquid boluses and small liquid boluses more easily than large liquid boluses. This investigation statistically confirms empirically based recommendations that children with CP be allowed more time to complete feeding tasks and consume small volume drinks rather than large volume drinks.

Cerebral Palsy↗
PubMed1994

Objective distance measurements from videofluorographic swallow studies using computer interactive analysis: technical note.

Application of new technologies to study swallowing and its disorders will facilitate better understanding of both normal and disordered swallowing. Recent application of computer-assisted analysis of video-fluorographic swallow tapes has enhanced objective measurement of distance as well as timing characteristics of swallowing. Application of these systems requires consideration of system capability, calibration for distance measures, nature of measurements, and potential clinical/research benefits. This report describes a commercially available computer-interactive system for analyzing video images, discusses calibration procedures, and demonstrates practical applications using defined measures.

Calibration↗
PubMed1983

Diagnostic value of "bread-barium" swallow in patients with esophageal symptoms.

The value of a "bread-barium" swallow for diagnosis of disordered esophageal motility was examined in 53 patients, 20 of whom complained of dysphagia, 20 retrosternal chest pain, and 13 heartburn; a further 19 subjects served as controls. Esophageal manometry in the patients with dysphagia and chest pain revealed major abnormalities in 14 compared with the bread-barium swallow which showed changes consistent with esophageal spasm in 20. The standard barium swallow examination revealed major abnormalities in only five of these patients. The bread-barium examination is simple, complements the routine barium swallow, and is of value in patients with symptoms suggesting disturbed motility. It does not replace conventional studies for the diagnosis of esophageal motility disorders.

Barium Sulfate↗
PubMed1993

A protocol for the videofluorographic swallowing study.

This paper presents a detailed protocol for performing the videofluorographic swallowing study (VFSS), and describes how it evolved from its antecedents. The objectives of the VFSS are both diagnostic and therapeutic. Preparing for the VFSS is described, including the equipment, food preparation, and a brief discussion of the clinical evaluation. The detailed description of the VFSS procedure covers the position of the patient, the foods presented, the views obtained, modifications of feeding and swallowing that are commonly employed, the standardized set of observations, and reporting the results. Criteria for deviating from the protocol or aborting the study are presented. The VFSS does not necessarily end when a patient aspirates. Indeed, the complete evaluation of aspiration, and the effects of maneuvers designed to reduce it, is a major purpose of the VFSS. Modifications of feeding and swallowing are tested empirically during the study. The modifications include therapeutic and compensatory techniques that may improve the safety and efficiency of swallowing. A rationale for deciding which modifications to test in a given patient is discussed. The protocol has been used successfully in more than 350 patients. It has improved the efficiency and quality of our videofluorographic examinations.

Barium Sulfate↗
PubMed1992

Clinical and videofluoroscopic evaluation of swallowing in 41 patients with neurologic disease.

Forty-one patients with neurologic disease (ND) were evaluated by clinical and videofluoroscopic examination of the oral cavity and pharynx to assess location and severity of swallowing dysfunction using various bolus consistencies. Four different materials were given to each patient, and included low- and high-viscosity barium suspensions, barium paste, and paste-coated cookie. Thirty-five patients had abnormalities of both oral and pharyngeal function. Four patients had pharyngeal dysfunction only, and two patients were normal. Mild swallowing difficulties occurred in five patients (12%), moderate dysfunction in 29 patients (71%), and severe dysfunction in five patients (12%). Thirty-two patients had pharyngeal stasis, which was symmetric in 30 patients (94%) and asymmetric in two. Site of stasis was not related to the type of neurologic disease. Fifteen patients aspirated, most of them (13 of 15) with the low-viscosity barium suspension. The predominance of aspiration with the low-viscosity liquid emphasizes the importance of clinical and videofluoroscopic evaluation of swallowing in dysphagic patients with ND for appropriate feeding recommendations. Thus, videofluoroscopy complemented the clinical examination and defined the type and severity of swallowing abnormalities and aspiration, when present.

Amyotrophic Lateral Sclerosis↗
PubMed1985

Dynamic imaging for swallowing reeducation.

Dynamic imaging is frequently indispensable for the rational treatment of disordered swallowing. The effects of test feeding techniques, bolus modification, patient positioning, and respiratory maneuvers are all best documented by visualizing and recording the swallowing of radiopacified boluses. What is seen becomes the basis of patients' reeducation in swallowing. Greatest effectiveness results when the radiologic examination is shared with those responsible for the patient's rehabilitation in swallowing.

Cineradiography↗
PubMed1990

A kinematic study of the oropharyngeal swallowing of a liquid.

Swallowing can become a problem for people with advanced age or laryngeal cancer, especially after surgical resection. The purpose of this study was to quantify the mechanical transport of the bolus through the throat by simultaneously comparing the instantaneous position and velocity of the bolus to the generation of pressure at different sites in the oropharyngeal cavity. Swallows of barium liquid were analyzed using Manofluorography, which simultaneously recorded pressure and barium position through a split screen display. Frame-by-frame analysis was used to describe bolus motion. The graph of head and tail movement showed an hourglass shape with an initial slow, then rapid movement of the bolus head. The peak bolus head velocity averaged 47 cm/s and the maximum acceleration was 460 cm/s2. Comparison of pressure traces with the kinematic curves revealed the relative timings of tongue movement, negative suction pressure from the pharyngoesophageal segment and the contraction wave. The magnitude of the gravity and resistance forces were estimated and relative strengths compared. The pharynx can be viewed as a dynamic conduit with changing diameters. The tongue driving force initially drove the bolus. Laryngeal elevation and the pharyngoesophageal segment developed a prebolus negative suction pressure ahead of the bolus. For vertical swallowing of the barium liquid, gravity played the dominant role in head transport. Contraction of the pharyngeal walls served to clear the tail of the bolus from the pharynx. These results aid in the understanding of the physiology of normal swallowing and provide quantitative data for the evaluation of oropharyngeal reconstruction.

Biomechanical Phenomena↗
PubMed1992

Swallowing in torticollis before and after rhizotomy.

To determine risk factors for dysphagia after ventral rhizotomy, videofluoroscopic barium swallowing examinations were done on 41 spasmodic torticollis patients before and after surgery. Radiologic abnormalities were present in 68.3% of the patients before surgery, but these were only mildly abnormal in the majority. After surgery 95.1% showed radiologic abnormalities which were moderate or severe in one-third of the patients. Swallowing abnormalities correlated significantly with duration of torticollis and subjective complaints of swallowing difficulty both before and after surgery, but not with age, sex, or type of torticollis. The major acute postoperative finding was aggravation of preexisting pharyngeal dysfunction. Follow-up from about half of our original sample showed that gradual improvement occurred from 4 to 24 weeks after surgery by subjective report. We review the innervation of intrinsic and extrinsic pharyngeal musculature, and suggest that C1-3 rhizotomies and selective sectioning of the spinal accessory nerve are responsible for aggravation of pharyngeal swallowing dysfunction in the acute postsurgical period.

Adult↗
PubMed1992

Food intake by maneuver; an extreme compensation for impaired swallowing.

We report two young patients able to exist on exclusively oral intake despite an absent pharyngeal swallow response. Videofluoroscopic swallowing studies showed that both patients used a sequence of devised maneuvers rather than a coordinated pharyngeal swallow to move the bolus, protect the airway, and open the upper esophageal sphincter during bolus ingestion. We conclude that it is possible for young, highly motivated individuals to maintain oral intake despite ablation of neurologic elements crucial for the normal swallow response.

Adolescent↗
PubMed1991

Use of the electroglottograph for measurement of temporal aspects of the swallow: preliminary observations.

The electroglottograph (EGG) is a non-invasive, electrical impedance device that was developed for observing vocal fold contract during phonation. After a thorough study of the frequency response characteristics of the EGG, we found that the EGG output can be used to identify maximum laryngeal displacement and the duration of laryngeal movement during swallowing. With a small intranasal pressure transducer placed beneath the velum and the EGG electrodes placed externally on the thyroid cartilage, additional information on the temporal aspects of the swallow can be measured. The EGG has direct clinical application when teaching such techniques as the safe swallow and Mendelsohn maneuver and it is useful as a research technique when using repeated measures designed to study the swallow reflex.

Deglutition↗
PubMed1997

Surface electromyographic characteristics of swallowing in dysphagia secondary to brainstem stroke.

Surface electromyography (SEMG) provides an noninvasive avenue for evaluating swallowing physiology. This report describes SEMG characteristics associated with swallow attempts in 6 dysphagic patients who had suffered brainstem stroke compared with 6 age and gender-matched controls. Results indicated that patients with dysphagia secondary to brainstem stroke differed in both amplitude and timing aspects of swallowing attempts from asymptomatic controls. Specifically, the results indicated that during swallow attempts, dysphagic patients produced more muscle activity over a shorter duration and with less coordination than controls. Potential physiological mechanisms of these results are discussed.

Aged↗
PubMed1998

The physiologic cause of swallowing sounds: answers from heart sounds and vocal tract acoustics.

A hypothetical discussion of the cause of swallowing sounds is presented. It is suggested that the pharynx contains a number of valves and pumps that produce reverberations within the pharynx to generate swallowing sounds. As heart sounds are propagated via vibration of muscles and valves, it is further suggested that an analogy exists between the generation of heart sounds and swallowing sounds. This new theory is known as the cardiac analogy hypothesis. The inability of the current literature to explain the cause of swallowing sounds is seen to limit the diagnostic potential of cervical auscultation for dysphagia assessment. Future investigators are encouraged to prove or disprove the cardiac analogy hypothesis.

Acoustics↗
PubMed1998

Fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST) in healthy controls.

The purpose of this study was to introduce a new method of bedside assessment of both the motor and sensory components of swallowing called fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST). This approach combines the established bedside endoscopic swallowing evaluation with a more recently described technique that allows objective determination of laryngopharyngeal (LP) sensory discrimination thresholds by delivering air pulse stimuli to the mucosa innervated by the superior laryngeal nerve via a flexible endoscope. A prospective study was conducted of FEESST in 20 healthy control subjects, mean age of 34 +/- 11 years. LP sensory thresholds were defined as either normal (< 4.0 mmHg air pulse pressure [APP]), moderate deficit (4.0-6.0 mmHg APP), or severe deficits (> 6.0 mmHg APP). Subsequent to LP sensory testing, food of varying consistencies, mixed with green food coloring, was given and attention was paid to spillage, laryngeal penetration, pharyngeal residue, aspiration, and reflux. Therapeutic maneuvers such as postural changes and airway protection techniques were performed on each subject to determine if the assessed swallowing parameters were affected by maneuvers. All patients completed the study; all had normal LP sensory discrimination thresholds (2.9 +/- 0.7 mmHg APP). There were no instances of spillage, laryngeal penetration, or aspiration. Two of 20 subjects had pharyngeal residue and 2 of 20 had reflux. Institution of therapeutic maneuvers resulted in a predictable change in the endoscopic view of the laryngopharyngeal anatomy. FEESST provides comprehensive, objective sensory and motor information about deglutition in the bedside setting and might have implications for the bedside diagnosis and management of patients with dysphagia.

Adult↗