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      Sensory Input Pathways and Mechanisms in Swallowing: A Review

      , 1 , 2 , 3 , 4 , 5 , 6



      Deglutition, Deglutition disorders, Sensation, Sensory pathways, Physiology

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          Over the past 20 years, research on the physiology of swallowing has confirmed that the oropharyngeal swallowing process can be modulated, both volitionally and in response to different sensory stimuli. In this review we identify what is known regarding the sensory pathways and mechanisms that are now thought to influence swallowing motor control and evoke its response. By synthesizing the current state of research evidence and knowledge, we identify continuing gaps in our knowledge of these mechanisms and pose questions for future research.

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          Most cited references 142

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          MBS measurement tool for swallow impairment--MBSImp: establishing a standard.

          The aim of this study was to test reliability, content, construct, and external validity of a new modified barium swallowing study (MBSS) tool (MBSImp) that is used to quantify swallowing impairment. Multiple regression, confirmatory factor, and correlation analyses were used to analyze 300 in- and outpatients with heterogeneous medical and surgical diagnoses who were sequentially referred for MBS exams at a university medical center and private tertiary care community hospital. Main outcome measures were the MBSImp and index scores of aspiration, health status, and quality of life. Inter- and intrarater concordance were 80% or greater for blinded scoring of MBSSs. Regression analysis revealed contributions of eight of nine swallow types to impressions of overall swallowing impairment (p /= 0.5) that formed two impairment groupings (oral and pharyngeal). Significant correlations were found between Oral and Pharyngeal Impairment scores and Penetration-Aspiration Scale scores, and indexes of intake status, nutrition, health status, and quality of life. The MBSImp demonstrated clinical practicality, favorable inter- and intrarater reliability following standardized training, content, and external validity. This study reflects potential for establishment of a new standard for quantification and comparison of oropharyngeal swallowing impairment across patient diagnoses as measured on MBSS.
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            Effects of a sour bolus on oropharyngeal swallowing measures in patients with neurogenic dysphagia.

            This study examines the effects of a sour bolus (50% lemon juice, 50% barium liquid) on pharyngeal swallow measures in two groups of patients with neurogenic dysphagia. Group 1 consisted of 19 patients who had suffered at least one stroke. Group 2 consisted of 8 patients with dysphagia related to other neurogenic etiologies. All patients were selected because they exhibited delays in the onset of the oral swallow and delays in triggering the pharyngeal swallow on boluses of 1 ml and 3 ml liquid barium during videofluoroscopy. Results showed significant improvement in oral onset of the swallow in both groups of patients and a significant reduction in pharyngeal swallow delay in Group 1 patients and in frequency of aspiration in Group 2 patients with the sour as compared to the non-sour boluses. Other selected swallow measures in both subject groups also improved with the sour bolus. Volume effects were present but not as consistently as in prior studies. Implications for swallow therapy are discussed.
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              Cerebral cortical representation of automatic and volitional swallowing in humans.

              Although the cerebral cortex has been implicated in the control of swallowing, the functional organization of the human cortical swallowing representation has not been fully documented. Therefore, the present study determined the cortical representation of swallowing in fourteen healthy right-handed female subjects using single-event-related functional magnetic resonance imaging (fMRI). Subjects were scanned during three swallowing activation tasks: a naïve saliva swallow, a voluntary saliva swallow, and a water bolus swallow. Swallow-related laryngeal movement was recorded simultaneously from the output of a bellows positioned over the thyroid cartilage. Statistical maps were generated by computing the difference between the magnitude of the voxel time course during 1) a single swallowing trial and 2) the corresponding control period. Automatic and volitional swallowing produced activation within several common cortical regions, the most prominent and consistent being located within the lateral precentral gyrus, lateral postcentral gyrus, and right insula. Activation foci within the superior temporal gyrus, middle and inferior frontal gyri, and frontal operculum also were identified for all swallowing tasks. In contrast, activation of the caudal anterior cingulate cortex was significantly more likely in association with the voluntary saliva swallow and water bolus swallow than the naïve swallow. These findings support the view that, in addition to known brain stem areas, human swallowing is represented within a number of spatially and functionally distinct cortical loci which may participate differentially in the regulation of swallowing. Activation of the insula was significantly lateralized to the right hemisphere for the voluntary saliva swallow, suggesting a functional hemispheric dominance of the insula for the processing of swallowing.

                Author and article information

                Springer-Verlag (New York )
                3 September 2010
                3 September 2010
                December 2010
                : 25
                : 4
                : 323-333
                [1 ]Toronto Rehabilitation Institute, 550 University Avenue, #12030, Toronto, ON M5G 2A2 Canada
                [2 ]Holland Bloorview Kids Rehab, Toronto, ON Canada
                [3 ]Department of Speech-Language Pathology, University of Toronto, Toronto, ON Canada
                [4 ]Graduate Department of Rehabilitation Sciences, University of Toronto, Toronto, ON Canada
                [5 ]Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON Canada
                [6 ]Division of Orthodontics, Department of Orofacial Sciences, School of Dentistry, University of California at San Francisco, San Francisco, CA 94143 USA
                © The Author(s) 2010
                Review Article
                Custom metadata
                © Springer Science+Business Media, LLC 2010


                sensory pathways, deglutition, physiology, deglutition disorders, sensation


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