Physiological substrates of normal deglutition

Kennedy, J. Gerald; Kent, Raymond D.

doi:10.1007/bf02406277

Cited by 48 publications

(12 citation statements)

References 100 publications

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“…The chewing and swallowing process is a very fast one: The oropharyngeal and hypopharyngeal transport amounts to 300 ms only and shows a speed between 9 and 25 cm/s, but the esophageal transport needs 4-8 s and has a speed of 2-4 cm/s [17]. Therefore, real-time imaging is mandatory for monitoring these processes [13].…”

Section: Discussionmentioning

confidence: 98%

Measuring tongue volumes and visualizing the chewing and swallowing process using real-time TrueFISP imaging?initial clinical experience in healthy volunteers and patients with acromegaly

et al. 2004

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This study assessed both two-dimensional (2D) TrueFISP imaging for quantifying tongue volume and real-time TrueFISP imaging for evaluating chewing and swallowing in healthy volunteers and patients with acromegaly. In 50 healthy volunteers, tongue volumes were measured using a 2D TrueFISP sequence. Chewing and swallowing were visualized using a real-time TrueFISP sequence. Ten patients with acromegaly were examined twice with the same magnetic resonance imaging protocol: once prior to therapy and a second time 6 months after therapy. Prior to therapy, healthy volunteers had an average tongue volume of 140 ml for men and 90 ml for women, and patients with acromegaly had an average tongue volume of 180 ml for men and 145 ml for women. However, 6 months after therapy the mean tongue volumes in patients with acromegaly had decreased to 154 ml in the men and to 125 ml in the women. The chewing and swallowing process was normal in all volunteers. Prior to therapy, just two patients showed a chewing and swallowing pathology, which disappeared after therapy. Patients with acromegaly had larger tongue volumes than healthy volunteers, and TrueFISP imaging proved feasible for visualizing chewing and swallowing in real time and is capable of detecting possible pathologies. Furthermore, TrueFISP imaging can be used to monitor therapeutic approaches in patients with acromegaly.

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Section: Discussionmentioning

confidence: 98%

Measuring tongue volumes and visualizing the chewing and swallowing process using real-time TrueFISP imaging?initial clinical experience in healthy volunteers and patients with acromegaly

et al. 2004

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“…Both of these theories are based on the notion that the pharyngeal phase of deglutition is primarily ''reflexive'' in nature and occurs as the result of a predictable sequence of neuromuscular activity. There is evidence from human and animal studies to support both theories [9][10][11][12]. However, with the advent of sophisticated brain imaging techniques it has become increasingly clear that deglutition is an extremely complex activity that generally involves input from several higher CNS structures as well as sensory feedback [13].…”

Section: Discussionmentioning

confidence: 99%

“…Generally, it appeared that faster transit of the bolus, such as occurs during a larger-bolus swallow, results in less opportunity for variation and a more ''reflexive'' pattern of swallow event sequencing. There are currently two theories relating to how the central nervous system controls the sequence of events during the pharyngeal phase of swallowing [9,10]. The reflex chain theory holds that each motion of the pattern stimulates peripheral receptors whose afferent impulses trigger the next motion.…”

Section: Discussionmentioning

confidence: 99%

Sequence Variability During Hypopharyngeal Bolus Transit

2003

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The pharyngeal phase of deglutition is considered to occur in a reflexive, preprogrammed fashion. Previous studies have determined a general sequence of events based on the mean timing of bolus transit and swallowing gestures. Individual variability has not been studied, however. The purpose of this study was to determine the amount of sequence variability that normally occurs during the hypopharyngeal phase of deglutition. Dynamic swallow studies from 60 normal volunteers were evaluated and event sequence variability was determined for 12 two-event sequences during swallowing of three bolus sizes. There was found to be some variability in event sequences for almost all events evaluated except for the following: (1) arytenoid cartilage elevation always began prior to opening of the upper esophageal sphincter, (2) the sphincter always opened prior to the arrival of the bolus at the sphincter, (3) larynx-to-hyoid approximation always occurred after the onset of upper esophageal sphincter opening, and (4) maximum pharyngeal constriction always occurred after maximal distension of the upper esophageal sphincter. Variability was more common during swallowing of the smallest bolus size. This information may be helpful in evaluating event coordination in patients with dysphagia.

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“…Kennedy and Kent [12] discussed swallowing as having three levels of organization: (1) the bolus with its counteraction to muscle force;…”

mentioning

confidence: 99%

Predictors of survival after severe dysphagic stroke

et al. 2005

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Severe dysphagia requiring FGT is common in patients with stroke referred for neurorehabilitation. Patients who had a FGT in place at the time of discharge from the stroke rehabilitation unit or aspirated during VSS were substantially more likely to have died by the time of follow-up compared to those who had had the FGT removed and had no signs of aspiration on VSS. However functional outcome measurements (FIM, FCM) including the cognitive function (attention, concentration etc.) could play an important role for prediction of swallowing regeneration and survival in neurorehabilitation. These findings may have practical utility in guiding physicians and speech language pathologists when advising patients and families about prognosis in stroke survivors with severe dysphagia.

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Physiological substrates of normal deglutition

Cited by 48 publications

References 100 publications

Measuring tongue volumes and visualizing the chewing and swallowing process using real-time TrueFISP imaging?initial clinical experience in healthy volunteers and patients with acromegaly

Measuring tongue volumes and visualizing the chewing and swallowing process using real-time TrueFISP imaging?initial clinical experience in healthy volunteers and patients with acromegaly

Sequence Variability During Hypopharyngeal Bolus Transit

Predictors of survival after severe dysphagic stroke

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