When treating dysphagia, “Functional electrical stimulation” is used for the purpose of improving muscle function, which is useful for swallowing. During swallowing, contraction of suprahyoid muscle is one of the first events that triggers the swallowing reflex and helps the bolus prevent aspiration during swallowing. Moreover, one of the aims of Functional Electrical Stimulation (FES) on the neck is to augment the hyolaryngeal elevation. However, depending on the current intensity and electrodes placement, the outcomes may vary. Although FES is a relatively new treatment method in comparison to traditional treatment techniques for dysphagia, presenting clear evidence and effectiveness is uncertain due to the application of various techniques. Therefore, this study is designed to know the effects of FES according to intensity of stimulation and placement of electrode.
Deglutition Disorders ; Deglutition* ; Electric Stimulation ; Electrodes* ; Methods ; Neck ; Reflex

OBJECTIVE: To investigate changes of swallowing function after ballooning dilatation (BD) and the Botox injection (BI) into the cricopharyngeus muscle in patients with severe dysphagia. METHOD: Nine severe dysphagic patients with cricopharyngeal dysfunction (CPD) who underwent BD and/or BI into the cricopharyngeal muscle were retrospectively reviewd. Patients who had severe dysphagia (Functional Oral Intake Scale (FOIS)≤2) after at least 3 months of the conventional swallowing therapy were included by a thorough review of medical records with videofluoroscopic swallowing study (VFSS). Before and after several interventions (BD and/or BI), swallowing function was evaluated using VFSS. RESULT: Among 9 patients, 5 underwent both BD and BI, and the other 4 patients underwent only BD. Four among 9 cases showed that interventions were effective. Of the 5 cases with both BD and BI, 2 cases were effective for treatment of CPD. In all the effective 4 cases, pyriform sinus residue seemed to be related with FOIS. Of those cases, one case had long-term effect (more than 4 months) and the other 3 case had short term effect (less than 4 months). CONCLUSION: Interventions were effective in 4 among 9 cases with severe CPD and the therapeutic effect was sustained for more than 4 months. The results suggest that in CPD patients, the BD or BI into UES could be considered in selected patients.
Botulinum Toxins* ; Deglutition ; Deglutition Disorders ; Dilatation* ; Fluoroscopy ; Humans ; Medical Records ; Methods ; Pharyngeal Muscles ; Pyriform Sinus ; Retrospective Studies

Dysphagia is a common manifestation of myasthenia gravis (MG), but it has been rarely reported as the only symptom. We report a 46-year-old man who complained of dysphagia without any other symptoms. Based on a videofluoroscopic swallowing study (VFSS), he showed decreased tongue base retraction, premature bolus loss, and incomplete velopharyngeal closure. He also showed impaired laryngeal elevation that caused incomplete laryngeal closure and aspiration with a small amount of thin fluid. Laryngoscopic evaluations, brain magnetic resonance imaging, and repetitive nerve stimulation tests were unremarkable. Since the acetylcholine receptor antibody level was elevated, he was diagnosed with MG. Treatment with pyridostigmine was initiated and the dysphagia symptoms improved completely. MG is one possible cause of unexplained dysphagia. Therefore, neurological examination is required when abnormal findings are observed in VFSS, and evaluations for MG may be important for the final diagnosis.
Acetylcholine ; Brain ; Deglutition ; Deglutition Disorders* ; Diagnosis ; Early Diagnosis ; Fluoroscopy ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Myasthenia Gravis* ; Neurologic Examination ; Pyridostigmine Bromide ; Tongue

Williams syndrome is a multiple-system disorder, caused by deletion of the locus 7q11-23 gene and characterized by an ‘elfin’ facial appearance, developmental delay, cardiovascular disorders, and transient hypercalcemia. Vertebral abnormalities in Williams syndrome have not been reported yet, except for one case report on cervical stenosis at the C1 level. In this case, the authors incidentally found Williams syndrome with the fusion of the fifth and sixth cervical vertebrae and an associated dysphagia showing delayed, forward-deviating esophageal passage during a videofluoroscopic swallowing study. The authors could not confirm whether the multiple cervical vertebrae fusion was related with the Williams syndrome or was just incidental. However, because physiatrists frequently encounter children with Williams syndrome and numerous kinds of developmental delay, if a patient with Williams syndrome suffers from swallowing difficulty, evaluation of dysphagia and cervical abnormalities should be considered. The present authors report the case of multiple cervical vertebral fusion in Williams syndrome.
Cervical Vertebrae ; Child ; Constriction, Pathologic ; Deglutition ; Deglutition Disorders* ; Female ; Humans ; Hypercalcemia ; Williams Syndrome*

OBJECTIVE: To investigate the influence of the swallowing posture and liquid thickness on the easiness of pill swallowing in healthy adults. METHOD: The subjects were 12 healthy young group (19-40 years) and 10 elderly group (65- years). Each subject was examined under videofluoroscopy while swallowing barium-containing placebo pills with six different methods: free fluid with neutral (FN), chin down (FD), chin up (FU), head rotated to left (FL), head rotated to right postures (FR), and thickened fluid with neutral posture (TN). The subjects rated their ease of pill swallowing on a 5-point Likert scale. Time variables were evaluated from the videofluoroscopy images. RESULT: FD, FU and FL were rated significantly less comfortable than FN for pill swallowing. Duration from the start signal to the mandible angle and to laryngeal elevation was significantly prolonged with FD and FL compared to FN. Duration from the start signal to the upper esophageal sphincter was significantly prolonged with FD compared to FN. There were no significant differences on either easiness of swallowing or the time variables between FN and TN. Duration from the start signal to the mandible angle and to the upper esophageal sphincter was significantly longer in the elderly group than the young group with all swallowing methods except FU. In the elderly group, duration from the start signal to laryngeal elevation was significantly shorter with FU than FN. CONCLUSION: Chin down posture is uncomfortable and prolong swallowing time during pill swallowing. In the neutral posture, pill swallowing with thickened fluid is comparable to that with free fluid. Chin up posture may shorten pill swallowing time in elderly.
Adult* ; Aged ; Chin ; Deglutition Disorders ; Deglutition* ; Esophageal Sphincter, Upper ; Fluoroscopy ; Head ; Humans ; Mandible ; Methods ; Posture*

OBJECTIVE: Understanding the neural functional organization of swallowing in the elderly is essential when diagnosing and treating older adults with swallowing difficulties. While brain-imaging studies in young adults have implicated multiple cortical regions in swallowing, only a few investigations were performed on older subjects. In this study, we aimed to compare neural activation in regions for swallowing between healthy young and older adults and to better understand neural control of deglutition, complex sensory-motor process which occurs as a result of old age. METHOD: Fifteen young and fifteen older healthy individuals without a swallowing problem were examined with functional magnetic resonance imaging (fMRI) during voluntary saliva swallowing. Functional image data was obtained with a T2 gradient-echo, echo planar imaging (EPI) pulse sequence optimized for blood-oxygen level dependent (BOLD) contrast. Two samples t-test was conducted to perform group comparison (younger adults versus older adults) for the areas in which the activation was larger for the swallowing condition than the non-swallow condition. RESULT: Both groups showed activations in areas involved in the motor control and execution. In both groups, main regions of activation included bilateral prefrontal cortex, primary somatosensory cortex, insula, basal ganglia, and cerebellum. Between-group comparisons revealed statistically stronger activations in the prefrontal cortex and middle temporal gyrus of older adults during swallowing. CONCLUSION: This study provides evidence that swallowing requires larger and more widespread areas of neural control in older adults group, especially in prefrontal cortex and inferior frontal gyrus. These findings suggest that more demanding swallowing tasks are necessary for elderly patients because of their inefficient neural network due to their age.
Adult ; Aged ; Basal Ganglia ; Cerebellum ; Deglutition* ; Echo-Planar Imaging ; Humans ; Magnetic Resonance Imaging* ; Methods ; Prefrontal Cortex ; Saliva ; Somatosensory Cortex ; Temporal Lobe ; Young Adult

Dysphagia is a dysfunction that occurs during the swallowing process, which involves the oral, pharyngeal, and esophageal stages of the swallowing route. Dysphagia is a prevalent symptom in elderly patients with degenerative diseases such as stroke, dementia, and Parkinson's disease. Dysphagia that occurs in the elderly is often caused by oral phase dysfunction. Oral phase dysfunction is a problem that occurs during the first stage of swallowing. The symptoms of age-associated dysphagia are the following signs: increased oral residual and longer mastication with slower oral bolus transit movement. Dysphagia can lead to malnutrition, dehydration, weight loss, functional decline, and fear of eating and drinking as well as a decrease in quality of life (QOL). Modification in viscosity and texture of food is usually helpful in resolving the nutritional problem of patients presenting signs of oral phase dysfunction. The degree of dietary modification can affect compliance of the diet. Adequate assessment and dietary modifications are important for successful dietary intervention for the elderly patients.
Aged ; Aging* ; Compliance ; Deglutition ; Deglutition Disorders* ; Dehydration ; Dementia ; Diet* ; Drinking ; Eating ; Food Habits* ; Humans ; Malnutrition ; Mastication ; Parkinson Disease ; Quality of Life ; Stroke ; Viscosity ; Weight Loss

Neuromuscular electrical stimulation (NMES) is a relatively new therapeutic approach for dysphagia, involving the application of electrical current across the skin to excite the nerve or muscle tissue. Recently, investigators are trying to establish a scientific basis for NMES, but there is still debate over the effect of NMES in dysphagia rehabilitation. Moreover, there is a paucity of evidence about patient selection, electrode placement, stimulation parameters, and application duration. This paper is aimed to review recent evidence of NMES for dysphagia management.
Deglutition Disorders ; Deglutition* ; Electric Stimulation* ; Electrodes ; Humans ; Patient Selection ; Rehabilitation ; Research Personnel ; Skin

OBJECTIVE: The aim of this study is to analyze relationships between dysphagia, and the timing and frequency of videofluoroscopic swallowing studies (VFSS) in patients with acute stroke. METHOD: We retrospectively reviewed the medical records of 111 patients with acute stroke whose dysphagia were evaluated by VFSS. The data were analyzed with descriptive statistics, t-test, and one-way ANOVA; Pearson correlation coefficient was also reported for all analyses. RESULT: Dysphagia was significantly different by transit time from stroke onset to arrival at the hospital (F=4.74, P=.011), paralysis site (F=3.05, P=.032), nasogastric tube (t=−3.81, P=.001), and diet just before the first VFSS (F=23.27, P<.001). VFSS timing was significantly different by smoking (t=2.88, P=.005), underlying disease (t=−3.58, P=.001), transit time from stroke onset to arrival at the hospital (F=5.90, P=.004), type of stroke (t=−5.24, P<.001), paralysis site (F=5.89, P=.001), nasogastric tube (t=−4.86, P=.001), surgery or angiography (t=−2.22, P=.032), level of consciousness (F=6.07, P=.000), length of stay (F=53.73, P=.001), department (F=16.37, P<.001), and diet just before the first VFSS (F=5.38, P=.006). VFSS frequency was significantly different by type of stroke (t=2.69, P=.008), nasogastric tube (t=−5.11, P=.001), length of stay (F=19.41, P=.001), department (F=7.18, P<.001), and the diet just before the first VFSS (F=16.67, P<.001). There was a significant correlation between dysphagia degree and the timing and frequency of VFSS. CONCLUSION: The more severe the degree of dysphagia, the longer the VFSS timing, and the greater VFSS frequency. The findings could be used for establishing systematic nursing care plans and active nursing intervention for dysphagia-related characteristics.
Angiography ; Consciousness ; Deglutition Disorders* ; Deglutition* ; Diet ; Humans ; Length of Stay ; Medical Records ; Methods ; Nursing ; Paralysis ; Patient Care Planning ; Retrospective Studies ; Smoke ; Smoking ; Stroke*

Anatomically, the oral cavity is an organ of the digestive system that is anteriorly delimited by the lips, posteriorly by the oropharynx, superiorly by the hard and soft palates, and inferiorly by the tongue (anterior 2/3) and floor of the mouth, and surrounded by a buccal mucosa that lines the cheeks. Oral mucosal diseases represent several conditions that can affect oral function, systemic health, and quality of life for patients. In the swallowing stage, oral mucosa of lip, buccal, gingiva and tongue plays an important role as well as the movement of tongue during oral preparatory and oral stage. Therefore, oral mucosal diseases that cause pain and odynophagia can have serious adverse effects on swallowing. Proper diagnosis and treatment of oral mucosal disease will be helpful in the treatment of dysphagia due to oral mucosal diseases.
Cheek ; Deglutition ; Deglutition Disorders* ; Diagnosis ; Digestive System ; Gingiva ; Humans ; Lip ; Mouth ; Mouth Mucosa ; Mucositis ; Mucous Membrane ; Oral Stage ; Oropharynx ; Palate ; Quality of Life ; Tongue