Sensory problems are frequently found in stroke patients, but also occur frequently in other neurological conditions (4). Due to decreased pharyngeal sensitivity, the coordination between swallowing and closure of the larynx is disrupted. As a result, the bolus enters the pharynx before the pharyngeal phase of swallowing has been triggered. In general, these patients will aspirate thin liquids (1).
Other neurogenic disorders might cause motor problems (i.e. on the level of the pharyngeal and laryngeal muscles). Due to general muscle weakness, chewing can be difficult and the pharyngeal muscles might no longer be able to propel the bolus into the oesophagus. Food gets stuck in the pharynx and patients are at risk of choking. These patients often have less problems drinking thin liquids. In some patients, lip closure is insufficient due to facial paralysis, or the bolus cannot be collected in the centre of the tongue due to paralysis of the tongue musculature. This results in food residue in the oral cavity (1,3,4).
Swallowing requires motor planning and coordination. It is known that some neurological conditions, e.g. stroke and dementia, can influence the motor planning of swallowing. In these cases an apraxia of swallowing can occur: a patient puts food in his mouth but seems to have forgotten what to do with it.
Problems in the coordination of swallowing can result in a situation where certain structures (like pharyngeal constrictor or the upper oesophageal sphincter) might have a good motor response to swallowing, but this response is out of sequence. In some neurological patients for instance, the lower pharyngeal constrictors might contract before the middle pharyngeal constrictors contract, resulting in a propulsion force which directs the bolus into the direction of the oral cavity instead of the oesophagus (1,8).
1. Matsuo, K., Palmer, J.B. (2008). Anatomy and physiology of feeding and swallowing: normal and abnormal. Phys Med Rehab Clin N Am 19, 691-707.
2. Ekberg, O., Hamdy, S., Woisard, V., Wuttge-Hannig, A., Ortega, P. (2002). Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia 17, 139-146.
3. Logemann, J. (1999). Evaluation and treatment of swallowing disorders. 2nd ed. Austin: Pro-Ed.
4. Rofes, L., Arreola, V., Akmirali, J., Cabré, M., Camins L., García-Peris, P., Speyer, R., Clavé, P. (2011). Diagnosis and management of oropharyngeal dysphagia and its nutritional and respiratory complications in the elderly. Gastroenterology Research and Practice Volume 2011, Article ID 818979, 13 pages.
7. Bogaardt, H. (2009). Current aspects of assessment and treatment of dysphagia. PhD-thesis, University of Amsterdam, The Netherlands.
8. Easterling E.A. and Robbins, E. (2008). Dementia and dysphagia. Geriatric Nursing 29, 275-285.
9. Kuhnt, T., Becker, A., Bloching, M., Schubert, J., Klautke, G., Fietkau, R., Dunst, J. (2006). Phase II trial of a simultaneous radiochemotherapy with cisplatinum and paclitaxel in combination with hyperfractionated-accelerated radiotherapy in locally advanced head and neck tumors. Medical Oncology 23, 325-334.
10. Simental, A.A., Carrau, R.L. (2004). Assessment of swallowing function in patients with head and neck cancer. Current Oncology Reports 6, 162-165.
11. Steele, C., Greenwood, C., Robertson, C. (1997). Mealtime difficulties in a home for the aged: not just dysphagia. Dysphagia 12, 45-50.
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