Showing papers in "Dysphagia in 1989"
TL;DR: In this article, a simultaneous manometric and video-fluoroscopic data collection protocol permitted measurement of bolus transit, temporal aspects of the oropharyngeal swallow, and pharygeal peristalsis.
Abstract: Swallows of 4 bolus volumes (1, 5, 10, 20 ml) were examined in three groups of subjects: 6 subjects 20-29 years of age, 12 subjects 30-59 years of age, and 6 subjects 60-79 years of age. A simultaneous manometric and videofluoroscopic data collection protocol permitted measurement of bolus transit, temporal aspects of the oropharyngeal swallow, and pharyngeal peristalsis. Statistically significant effects of increasing bolus volume were oral transit of the bolus head (decreased) and duration of cricopharyngeal opening (increased). Five measures were significantly changed with increasing age: duration of pharyngeal swallow delay (increased), duration of pharyngeal swallow response (decreased), duration of cricopharyngeal opening (decreased), peristaltic amplitude (decreased), and peristaltic velocity (decreased).
314 citations
TL;DR: Swallowing occurs as an orderly physiological process that transports saliva or ingested material from the mouth to the stomach, and close cluster of voluntary swallows is evoked consciously in response to salivation.
Abstract: SWallowing occurs as an orderly physiological process that transports saliva or ingested material from the mouth to the stomach. This process norraally occurs so smoothly and effortlessly that it belies the complexity of the neuromuscular apparatus that executes the swallowing sequence. GenerIcY, swallowing is considered to be \"vo lun ta ry\" ause deglutition can be elicited by cerebral inp ut when one thinks \"swal low.\" Most swallows, OWever, particularly those between meals, occur Without conscious input. Swallowing occurs surl~risingly frequently, about once a minute in awake subjects, irrespective of eating [1, 2], This high swallowing rate is elicited by saliva that is pro%eed at a rate of about 0.5 ml/min and must be either swallowed or expectorated [3, 4]. The high ~atural rate o f swaltowing leads to about 1000 swallows daily or 3-4 million swallows per ~leeade. During sleep, salivation and swallows virtually cease [5]. Clusters of swallows occur during arOUsals from sleep, but swallows seldom occur ~tUring physiological sleep [2]. Although the majority of swallows occur sub.%nsciously in response to salivation, close cluster~r~g of voluntary swallows is evoked consciously i Uring the processes known as \" feeding\" or ~' eatg. ' These processes are an essential part of nutrin by which nutrients are gathered and ingested. ring eating, swallowing is associated with inCreased salivation, which acts as a lubricant.
266 citations
TL;DR: The study findings indicated that a leading complex of tongue tip and tongue base movement as well as onset of superior hyoid movement and mylohyoid myoelectric activity occurred in a tight temporal relationship at the inception of swallowing, indicating an important distinction between peristaltic transit and bolus clearance.
Abstract: The aims of this study were to evaluate and quantify the timing of events associated with the oral and pharyngeal phases of liquid swallows. For this purpose, we recorded 0–20 ml barium swallows in three groups of volunteers using videoradiographic, electromyographic, and manometric methods. The study findings indicated that a leading complex of tongue tip and tongue base movement as well as onset of superior hyoid movement and mylohyoid myoelectric activity occurred in a tight temporal relationship at the inception of swallowing. Two distinct general types of normal swallows were observed. The common “incisor-type” swallow began with the bolus positioned on the tongue with the tongue tip pressed against the upper incisors and maxillary alveolar ridge. At the onset of the “dipper-type” swallow the bolus was located beneath the anterior tongue and the tongue tip scooped the bolus to a supralingual location. Beginning with tongue-tip peristaltic movement at the upper incisors, the two swallow types were identical. Swallow events that occurred after lingual peristaltic movement at the maxillary incisors showed a volume-dependent forward migration in time that led to earlier movement of the hyoid and larynx as well as earlier opening of the upper esophageal sphincter in order to receive the large boluses that arrived sooner in the pharynx during the swallow sequence than did smaller boluses. The study findings indicated that timing of swallow events should be considered in reference to both swallow type and bolus volume. The findings also indicated an important distinction between peristaltic transit and bolus clearance.
256 citations
TL;DR: Three different age groups of nondysphagic volunteers were studied and the size of a normal thin liquid bolus was 21 ml (SD±5 ml), intending to include this information to compare different bolus sizes in cineradiographic examination of patients with swallowing complaints.
Abstract: In order to define a suitable volume of barium to be delivered to patients during the radiographic evaluation of pharyngoesophageal function during swallowing, three different age groups of nondysphagic volunteers were studied. Subjects randomly swallowed boluses of water, barium, and Coca-Cola. The size of a normal thin liquid bolus was 21 ml (SD +/- 5 ml). We intend to include this information to compare different bolus sizes in cineradiographic examination of patients with swallowing complaints.
92 citations
TL;DR: The primary goal of the program is to develop the appropriate use of the mouth, respiratory, and phonatory systems in exploration, sound play, and as much oral feeding as possible.
Abstract: Treatment of children with swallowing dysfunction requires a holistic approach based on a global view of their problems and needs. The connection of the swallowing mechanism with the sensorimotor organization of postural tone and movement throughout the body is a critical factor in the evaluation and treatment of children whose dysphagia is rooted in a neurologic disorder. An appropriate program includes work with the development of movement skills, sensory processing, learning, social skills, and communication. The initial focus is placed on oral-motor treatment, rather than direct work on oral feeding. The primary goal of the program is to develop the appropriate use of the mouth, respiratory, and phonatory systems in exploration, sound play, and as much oral feeding as possible. Oral feeding is the by-product of a total program, not its major goal.
77 citations
TL;DR: In children, the respiratory problems associated with dysfunctional swallowing and aspiration can be varied and symptoms occur either during feeding or shortly thereafter, and the absence of direct aspiration can make the establishment of a link between abnormal swallowing and/or reflux and certain respiratory symptoms difficult.
Abstract: In children, the respiratory problems associated with dysfunctional swallowing and aspiration can be varied. The common respiratory complications are summarized in Table 1, In general, symptoms occur either during feeding or shortly thereafter. However, if the child with dysfunctional swallowing also has gastroesophageal reflux, symptoms may also be encountered several hours aftcr feeding. Most respiratory symptoms generally arise secondary to aspiration; however, certain symptoms such as apnea or wheezing can be triggered reflexly without direct aspiration. The upper airway (nasopharynx and larynx) contain vagally mediated irritant receptors [1,2] that can cause apnea and bradycardia if stimulated by milk or other foreign material. This is a protective mechanism designed to prevent aspiration. The absence of direct aspiration can make the establishment of a link between abnormal swallowing and/or reflux and certain respiratory symptoms difficult, since available recording techniques are limited in their ability to detect the trigger of certain events. Age of the patient is also an important consideration. Young infants are more likely to present with apnea and/or bradycardia [3, 4]; an older child will generally present with cough, choking, or another of the respiratory problems listed in Table 1. Developmental status and the presence of
65 citations
TL;DR: Sucking in normal adults is described and the videofluoroscopic measurements of bolus position at the onset of swallow suggest that there may be diverse sites for elicitation of the swallowing response/reflex rather than a single site (i.e., the anterior faucial arch).
Abstract: A "delayed swallowing reflex/response" (i.e., when the swallow reflex is not triggered when the bolus passes the back of the tongue at the anterior facial arch) Logemann has been widely accepted as an abnormality. Careful review of the literature supports the premise that a "delayed swallowing reflex/response" may in fact be a variation of normal. This paper describes swallowing in normal adults. We report the videofluoroscopic measurements of bolus position at the onset of swallow. A radiopaque marker was affixed to the anterior facial arch and the distance between the head of the bolus and the anterior facial arch was measured at the onset of swallow. A statistically significant proportion of swallows (22 of 30) occurred after the head of the bolus passed the anterior facial arch. This finding suggests that there may be diverse sites for elicitation of the swallowing response/reflex rather than a single site (i.e., the anterior facial arch). The relevance of this finding to treatment using thermal stimulation is discussed, as is the versatility of the normal pharynx.
59 citations
TL;DR: The swallowing function of 31 normal and dysphagic subjects between the ages of 39 and 79 was tested with both videofluoroscopy and scintigraphy and a statistically significant correlation of 0.66 was found.
Abstract: The swallowing function of 31 normal and dysphagic subjects between the ages of 39 and 79 was tested with both videofluoroscopy and scintigraphy. Pharyngeal transit times for the pair of tests were compared. A statistically significant correlation of 0.66 was found. Normal pharyngeal transit time was under 1.2 s with either method, but mean values for scintigraphy were slightly longer than those for videofluoroscopy.
58 citations
TL;DR: Recent neurophysiology and neurochemical data are outlined that provide information on the afferent inputs and neurophysiological properties of neurons in NTS and adjacent caudal brainstem regions implicated in swallowing, respiration, and respiratory-related reflexes.
Abstract: Neurophysiological studies of the nuclei of the tractus solitarius (NTS) and adjacent regions have provided a partial understanding of the integrative brainstem network underlying swallowing and related functions such as respiration. The NTS is also richly endowed with an abundance of neuropeptides and other neuroactive substances, but only limited information is available on their influences on neurons involved specifically in swallowing. Since dysfunction of these neurophysiological and neurochemical regulatory mechanisms in the NTS region may be important in pathophysiological conditions such as dysphagia, increased awareness of and focus on these mechanisms are warranted. This paper outlines recent neurophysiological and neurochemical data that provide information on the afferent inputs and neurophysiological properties of neurons in NTS and adjacent caudal brainstem regions implicated in swallowing, respiration, and respiratory-related reflexes.
57 citations
TL;DR: The state of current testing methods, the parameters of successful feeding activity, the development of the test protocol, and the results of statistical analyses are described.
Abstract: The multidisciplinary feeding profile (MFP) is the first statistically based protocol for the quantitative assessment of feeding disorders in severely disabled children. This assessment can be completed in 30–45 min with foods and facilities that are available in homes, hospitals, and chronic care units. This paper describes the state of current testing methods, the parameters of successful feeding activity, the development of the test protocol, and the results of statistical analyses.
55 citations
TL;DR: The lubrication regime displayed by human salivas (parotid and submandibular-sublingual), purified salivary molecules (the mucins MG1 and MG2 and α-amylases), and selected artificial salivas was assessed in vitro using a friction-testing device.
Abstract: The lubrication regime displayed by human salivas (parotid and submandibular-sublingual), purified salivary molecules (the mucins MG1 and MG2 and α-amylases), and selected artificial salivas (Oracare D, Saliva Substitute, and Orthana) was assessed in vitro using a friction-testing device. Thin-film (boundary) lubrication was observed for all of the salivary samples and two of the artificial salivas examined. Oracare D, a glycerol-based artificial saliva, was the exception since it lubricated by a thick-film (hydrodynamic) regime. On a molar basis, the best lubricants of the purified salivary molecules were MG1 > MG2 ≈ nonglycosylated α-amylases ≈ glycosylated α-amylases.
TL;DR: The Fleming index of dysphagia appears to be a quick and useful instrument to identify patients who are at risk of dysphagic complications, but further reliability and validity studies are needed to demonstrate its utility.
Abstract: The Fleming index of dysphagia was used to determine the prevalence of dysphagia in patients in a long-term, neuropsychiatric medical center. Prevalence varied by section, with the ventilator-dependent patients having the highest rate and the chemical-dependent patients having the lowest. The Fleming index appears to be a quick and useful instrument to identify patients who are at risk of dysphagic complications, but further reliability and validity studies are needed to demonstrate its utility.
TL;DR: It is concluded that attribution of the diagnosis of psychogenic dysphagia should be made with caution, and only after thorough evaluation, and any change or progression of symptoms should prompt a careful re-evaluation.
Abstract: Despite authoritative warnings against attributing dysphagia to psychologic causes [1, 2], patients referred to The Johns Hopkins Swallowing Center have frequently been diagnosed as having “psychogenic dysphagia” or “globus hystericus” on prior evaluation. We review the Swallowing Center experience in the re-evaluation of patients previously diagnosed as having symptoms of psychogenic origin.
TL;DR: An overview of the ways in which a neurologist approaches swallowing disorders is provided, including a simplified model of the impulse to swallow, which is sufficient for clinical purposes.
Abstract: Dysphagia caused by neurologic diseases is becoming increasingly recognized as a major cause of morbidity and mortality. Clinicians of all specialties are aware of the importance of the clinical accompaniments of dysphagia, including pooling of food and secretions in the pharynx, regurgitation into the mouth and nose, aspiration, hoarseness, and the chronic sequelae of recurrent pulmonary infections, weight loss, malnutrition, and dehydration. Dysphagia is seen in numerous neurologic diseases, including both central nervous system disorders and those of the cranial nerves and muscles[l, 2]. This paper will provide an overview of the ways in which a neurologist approaches swallowing disorders. Any neurologic discussion of dysphagia must begin with an understanding of the relevant neuroanatomy. While the neuroanatomy and physiology of swallowing are complex [3], a simplified model (Fig. 1) is sufficient for clinical purposes. The impulse to swallow begins in the \"frontal swallowing center,\" located just in front of the face area of the motor cortex, at the foot of the precentral gyrus. Electrical stimulation of this area induces swallowing activity in the striated muscles of the mouth, tongue, and upper pharynx. Axons of these cortical neurons descend through the white matter of the corona radiata and internal capsule, the cerebral peduncle of the midbrain, and the pyramidal tract fibers in the pons. They then cross and project onto motor nerve cells of the medulla oblongata. The entire pathway from motor cortex to medulla is called the \"corticobulbar tract.\" A second \"swallowing center\" is located in the medulla. This medullary swallowing center actually comprises at least three separate clusters of nerve
TL;DR: Evidence now exists to support roles for saliva in normal esophageal function and as a defense against gastroesophageaal reflux disease.
Abstract: Considerable evidence exists to support the concept that saliva serves multiple functions in the mouth [1, 2]. These functions include serving as a barrier against injurious substances, lubrication, prevention of desiccation, and control of oral microbial flora. Until recently, however, the function of saliva in the esophagus has been regarded as hardly more than a lubricant to ease the passage of a bolus through the esophagus. Evidence now exists to support roles for saliva in normal esophageal function and as a defense against gastroesophageal reflux disease. Before discussing these roles, it is necessary first to consider briefly the pathogenesis of reflux disease.
TL;DR: The concepts of the motor unit are introduced, basic principles of EMG are explained, and their relevance to the study of oropharyngeal swallowing is explored.
Abstract: Electromyography (EMG) has a valuable role in the evaluation of swallowing and its disorders, because it can assess the activity of individual muscles. Electromyographic kinesiology is a method for examining the physiology of swallowing. Analysis of individual myoelectric potentials is a technique for studying the integrity of the motor unit. This paper introduces the concepts of the motor unit, explains basic principles of EMG, and explores their relevance to the study of oropharyngeal swallowing. Several cases are presented to illustrate how EMG contributes to clinical diagnosis.
TL;DR: The major differences were between dry and liquid swallows, with dry swallows showing smaller range of movement, higher tongue position at the initiation of lingual propulsive activity, and slower progression of activity from tongue blade to dorsum.
Abstract: This investigation concerned the effect of different bolus volumes on the characteristics of lingual propulsive activity in swallowing. Young normal subjects were asked to perform dry swallows and swallows of 5, 10, and 15 ml of water. Tongue activity was recorded by tracking multiple gold pellets affixed to the tongue, utilizing the specialized research capabilities of the X-ray Microbeam facility at the University of Wisconsin. The major differences were between dry and liquid swallows, with dry swallows showing smaller range of movement, higher tongue position at the initiation of lingual propulsive activity, a slightly different direction of motion, a humped or flat rather than grooved cross-sectional contour of the tongue, lower peak velocity of motion, and slower progression of activity from tongue blade to dorsum. Within the 5–15 ml range of liquid bolus volumes, fewer consistent differences were found as a function of bolus size, and some marked individual differences in swallowing patterns were seen. Data are presented on normal within-subject variability in swallowing, with discussion of the possible contribution of sensory assessment of bolus size to the modification of oral and pharyngeal characteristics of swallowing.
TL;DR: Pulmonary symptoms range from a subtle cough, wheezing, or hoarseness to severe dyspnea or asphyxiation, and the mechanism and appropriate treatment are discussed.
Abstract: Aspiration can lead to serious pulmonary disease and occasionally death. Substances aspirated commonly include bacteria or gastric contents or both, but may be as unusual as diesel oil or a variety of foreign bodies. Pulmonary symptoms range from a subtle cough, wheezing, or hoarseness to severe dyspnea or asphyxiation. We discuss the mechanism of pulmonary disease caused by aspiration as well as the appropriate treatment.
TL;DR: It is demonstrated that healthy individuals, despite a wide range in their salivary gland fluid secretory capacity, are generally similar in the characteristics of their oropharyngeal swallow.
Abstract: We have evaluated the possible relationship between major salivary gland fluid secretion rate and characteristics of the oral phase of swallowing in 35 different-aged, healthy men and women. All subjects displayed normal function of the parotid and submandibular glands and oral swallow patterns on ultrasound evaluation that were comparable to previous reports. In this study group we found no significant relationships between salivary flow rates (unstimulated, stimulated) and any oral swallow measure. Evidence of a subtle, age-related oral motor change (multiple hyoid and tongue gestures) was seen but swallow duration times did not show a linear relationship to age. This study demonstrates that healthy individuals, despite a wide range in their salivary gland fluid secretory capacity, are generally similar in the characteristics of their oropharyngeal swallow.
TL;DR: The swallowing patterns of four patients with oral cancer with intraoral palate reshaping/lowering prostheses were studied and the prostheses resulted in improved swallow efficiency, increased duration of tongue contact to the pharyngeal wall, and improved speed of movement of the bolus from the valleculae to the pyriform sinus.
Abstract: The swallowing patterns of four patients with oral cancer with intraoral palate reshaping/lowering prostheses were studied with and without their prostheses 3 months postoperatively. The prostheses resulted in improved swallow efficiency, increased duration of tongue contact to the pharyngeal wall, and improved speed of movement of the bolus from the valleculae to the pyriform sinus. These results emphasize the effects of the tongue on the pharyngeal as well as oral stage of the swallow.
TL;DR: dynamic recordVitl .ur SWallowin~ must be erformed with either ~O ,~ P ta .
Abstract: ]'13 O' tarot Otain the best diagnostic studies, it is importl~e~ ~ formulate questions in advance based on i%,~'tuent's clinical history and to design an exam\"' tlOr[ to ~lble 9 answer those questions as clearly as post0 t~. All pertinent information should be available sho.'~ ~e radiologist and the examination oals UlCl b 9 ~ g ~. e clarified before the study is performed. t'ra~!nee the events of swallowing happen within ~-tlon ~t, th ̂ s of a second, no observer can follow all iqg ff~ as they occur. Therefore, dynamic recordVitl .ur SWallowin~ must be erformed with either ~O ,~ P ta . arlal,,~ Pe or cme film to allow the examiner to . . . .~e Carefully at a later time the swallowing
TL;DR: Results indicated that with increased age there was a tendency for texture acceptability to increase for the easy-to-chew food and a significant association of anxiety, but not extroversion, with masticatory and swallowing performance.
Abstract: Missing natural teeth have been associated with a reduced acceptability for the taste and texture of hard foods as well as with an increase in the perceived difficulty of chewing these foods. The present study examined the role of the personality variables extroversion and anxiety in modulating the relationship between dentition status, masticatory performance, taste preference, texture preference, and perceived ease of chewing of an easy-to-chew food (pot roast) and a more difficult-to-chew food (raw carrots). Healthy adult men, participants in the Veterans Administration Dental Longitudinal Study, were examined. Results indicated that with increased age there was a tendency for texture acceptability to increase for the easy-to-chew food. Masticatory and swallowing performance were diminished in persons with artificial dentition, and these individuals also perceived an increase in the difficulty of chewing raw carrots. There was a significant association of anxiety, but not extroversion, with masticatory and swallowing performance.
TL;DR: Efficacy of treatment for dysphagia in medically stable patients was defined as a reduction in the occurrence of aspiration pneumonia, and effectiveness of treating swallowing was demonstrated, and a general outcome criterion for treatment was proposed.
Abstract: Efficacy of treatment for dysphagia in medically stable patients was defined as a reduction in the occurrence of aspiration pneumonia. Aspiration pneumonia was diagnosed by radiographic and/or laboratory analysis and was identified by retrospective chart review. Two groups of treated patients (48 without and 13 with a history of aspiration pneumonia) were compared to a group of untreated patients. There were no statistically significant differences in the occurrence of aspiration pneumonia in the treated groups, but both treated groups were subject to significantly less aspiration pneumonia than the untreated group. Measures of severity indicated that even mildly dysphagic patients were at risk for the development of aspiration pneumonia, and even severely dysphagic patients responded to rehabilitative management of their swallowing problems. Efficacy of treating swallowing was demonstrated, and a general outcome criterion for treatment was proposed.
TL;DR: An investigation that synchronizes the videotaped output of a ultrasound camera and the analog data from physiological measurements of swallowing and ventilation in normal and cerebral palsied children is presented, identifying a short-latency apnea that appears to accompany a saliva (protective) swallow and a long-latencies apna that accompanies semisolid or liquid bolus (alimentary) swallows.
Abstract: Preliminary results of an investigation that synchronizes the videotaped output of a ultrasound camera and the analog data from physiological measurements of swallowing and ventilation in normal and cerebral palsied (CP) children are presented. Four cerebral palsied children and three control children undertook a single sip-swallow of 5 ml of liquid and a solid mastication-swallow sequence on three occasions according to a defined protocol. The CP children exhibited much more variability and less control of the liquid bolus than did the controls. The ultrasound image clearly demonstrates the lack of control of the posterior of the tongue in many CP children. Some parts of the sequence of oral swallow and the time to achieve maximum anterior displacement of the hyoid bone appear to be slowed. The sequential events of swallowing show less variability as the sip-swallow proceeds from the oral voluntary to pharyngeal and lower involuntary phases. This study also identified a short-latency apnea that appears to accompany a saliva (protective) swallow and a long-latency apnea that accompanies semisolid or liquid bolus (alimentary) swallows. Further investigations of normal and CP children utilizing a combined diagnostic imaging-physiological measurement approach will follow this initial study.
TL;DR: Dysphagia will become an increasing problem as the population continues to age, as more intensive resuscitative measures are applied, and as more aggressive head and neck surgery is performed.
Abstract: Difficulty in swallowing is not an uncommon symptom Approximately 10,000 persons choke to death every year in the United States, and at least 50% of patients in nursing homes have some difficulty eating or drinking Dysphagia will become an increasing problem as the population continues to age, as more intensive resuscitative measures are applied, and as more aggressive head and neck surgery is performed The practicing radiologist should be familiar with the examination technique and interpretation of swallowing studies
TL;DR: The hypothesis that dysphagia can result from conditions leading to salivary gland dysfunction is supported and the need for the assessment of swallowing function in patients with Sjogren's syndrome is documented.
Abstract: Primary Sjogren's syndrome (SS) is an autoimmune disorder primarily affecting salivary and lacrimal glands. Durational measures of the oral phase of swallowing were obtained on 34 patients with primary SS and 34 age-matched controls from analyses of ultrasound scans. Two conditions were examined: a basal (BA) swallow (only endogeneous secretions present in the subjects' mouths) and a 10 ml water bolus (WB) swallow. The patients with SS produced swallowing durations significantly longer (p less than 0.05) than those of the controls for each of the two conditions. Moreover, unlike normals, over 40% of the patients with SS produced WB swallows that were longer than their BA swallows. For further analyses, patients with SS were classified into two groups based on the difference in duration between their BA and WB swallows. These two groups differed from each other on clinical evaluations of oral motor function and presenting complaints. No significant differences were found between these two groups for salivary function or immunologic profile. These findings support the hypothesis that dysphagia can result from conditions leading to salivary gland dysfunction and document the need for the assessment of swallowing function in patients with Sjogren's syndrome.
TL;DR: How videofluoroscopy may be used for treatment planning in rehabilitation is described, which is a unique application of the author and her colleagues at The Good Samaritan Hospital-Johns Hopkins Swallowing Rehabilitation Program.
Abstract: Videofluoroscopy and cineradiography have been used for decades to examine the gastrointestinal tract and specifically the oropharynx [1]. Recently, videofluoroscopy has been described as being useful for identifying the cause of aspiration [2]. This paper describes how videofluoroscopy may be used for treatment planning in rehabilitation. This unique application of videofluoroscopy is the product of efforts on the part of the author and her colleagues at The Good Samaritan Hospital-Johns Hopkins Swallowing Rehabilitation Program, which was launched in 1980. The rationale for using videofluoroscopy for rehabilitation, the implementation of videofluoroscopy for rehabilitation, and indications for using specific rehabilitation techniques during videofluoroscopy will be discussed.
TL;DR: A pediatrician's perspective on a child with impaired or dysfunctional swallowing is provided and an evaluation of the strengths and of currently available diagnostic tests are reviewed.
Abstract: The clinical approach to the child with impaired or dysfunctional swallowing should include consideration of factors important in this age group, such as development of normal oromotor reflexes, the relationship between oral feeding and pulmonary function, the effect of nonnutrit ive sucking on growth, and the effects of impaired swallowing on the development of chronic lung disease. This paper will provide the reader with a pediatrician's perspective on th 9 9 lOWing.ira_ . . e chmcal evaluation of the swalWeaknessePs alrecl child and review the strengths and of currently available diagnostic tests.
TL;DR: The approach to children with neurogenic dysphagia is unique due to their development, growth, and behavior.
Abstract: The approach to children with neurogenic dysphagia is unique due to their development, growth, and behavior. Multiple streams of development (cognitive, oral-motor, fine and gross motor) have direct and indirect effects on feeding. Provision of an appropriate feeding program requires that the multiple needs, abilities, and disabilities of each child be assessed and managed appropriately.
TL;DR: All of the patients with bulimia were found to have abnormal oropharyngeal swallow patterns and an increased duration of dry swallow and salivary gland flow rates and amylase concentrations were detected.
Abstract: The findings on 13 patients with bulimia nervosa referred for evaluation of salivary glands and swallowing patterns are presented. Each patient completed a medical, oral, and social history questionnaire. A complete oral examination supported by appropriate dental radiographs and photographs was conducted. Unstimulated and stimulated parotid and submandibular saliva was collected. The presence or absence of pharyngeal and velar gag reflexes was ascertained. Real-time ultrasound scanning and barium swallow studies were used to evaluate the oral-motor functions while swallowing on 6 of the subjects. Activity of the pharynx, larynx, and esophagus was recorded during the videofluorographic studies. Saliva concentrations of amylase were determined in the referred subjects as well as 13 age-matched healthy controls. No significant difference was detected between the salivary gland flow rates and amylase concentrations of the two groups, whether stimulated or unstimulated. The pharyngeal gag reflex was absent in 9 of the 13 bulimic patients and a velar gag reflex could be elicited in only 1. All of the normal controls had both gag reflexes. All of the patients with bulimia were found to have abnormal oropharyngeal swallow patterns and an increased duration of dry swallow.