Buttons considered as gustatory can be identified, in addition to the tongue papillae, on the palate and vallecula. Buttons with similar morphology to those defined as gustatory have been found on the pharynx regions, where, at first, no taste is perceived. In the vallecula, even with the oral cavity anesthetized, the bitter taste transferred to the pharynx can be perceived by vagus nerve conduction 41 As far as we know, in the oral cavity there have not been described or observed any other morphological kind of receptors than that admitted as gustatory.
However, the oral cavity holds several other perceptions. Specific receptors to be stimulated are supposedly necessary. Nevertheless, there is no evidence indicating that any receptor is responsible for detecting only one type of stimulus 43 Nanci A. Mucosa oral. Rio de Janeiro: Elsevier RJ; It is possible that receptors deemed gustative are also able to receive other oral stimuli.
This hypothesis is reinforced by the presence of receptors morphologically similar to the gustatory receptor, where tastes are not perceived as palate, in the pharynx except the in vallecula and larynx 34 There are also gustatory perception descriptions by thermal stimulation of the tongue 44 Thermal taste, PROP responsiveness, and perception of oral sensations.
Physiol Behav. Cruz A, Green BG. Thermal stimulation of taste. Anatomically unique, the tongue, palate, pharynx and larynx are functional pairs, each side having independent innervation 1 1. From receptors on each side of the oral cavity, the trigeminal V , facial VII and glossopharyngeal IX nerves conduct information to the brainstem.
These mixed nerves lead sensitivity afferent pathway and motor command efferent pathway. The afferent pathways of the anterior two thirds of the tongue are supplied by the lingual nerve, which associates the trigeminal general sensibility with the facial nerve taste.
In the posterior third of the tongue, both the general sensibility and taste are conducted by the glossopharyngeal nerve 33 Ver Bras Cien Morfol. In its afferent pathways toward the brainstem, the trigeminal, facial and glossopharyngeal nerves of both sides will make ganglionar synapses similar to the posterior roots of the spinal cord.
The afferent pathway of the trigeminal nerve makes synapses in the trigeminal ganglion Gasser , the facial nerve, in the geniculate ganglion, and the glossopharyngeal, in the rostral ganglion upper one 1 1.
The trigeminal nerve V has three branches; upper ophthalmic , middle maxillary and lower mandibular. The upper and medium are exclusively sensitive, and the inferior, mixed. The sensitive fibers of the three branches innervate the face in transverse bands of representation. Regarding the oral cavity, the middle branch maxillary has sensitive responsibility for the upper arcade teeth, upper lip, cheeks, hard palate mouth mucosa and mucosa of the rhinopharynx.
From the trigeminal ganglion to the brainstem, all the sensory pathways will end in the posterior portion of the brainstem, over the trigeminal sensitive nucleus that occupies the medulla oblongata spinal tract nucleus of the cranial nerve V , the pons main sensory nucleus of the cranial nerve V and the midbrain midbrain nucleus of the cranial nerve V. Centrally the sensitive fibers divide into short, ascending branches that end in the main sensorial nucleus, to attend to tactile sensibility, and into long, descending branches that serve to tact, temperature and pain, also providing collateral pathways to the spinal nucleus of the cranial nerve V 29 It is believed that proprioceptive fibers from the midbrain nucleus of the trigeminal neve, in synapse with its motor nucleus located in the upper portion of the pons 47 Dantas AM.
Nervos cranianos motores. Unless expressly desired, these arcs allow reflex modulation of chewing intensity based on bolus consistency variations, even during the voluntary bolus chewing preparation.
The motor root of the trigeminal nerve emerges from the ventral portion of the pons and runs through the mandibular root to innervate the chewing muscles, the mylohyoid, the anterior belly of the digastric and the tensor muscle of the palate 1 1. The facial nerve VII is a mixed one, considering its motor root in association with the sensitive root given by the intermediate Wrisberg nerve 1 1.
The taste of the anterior two thirds of the tongue on each side are its responsibility. From the tongue, this afferent, pre-ganglionic route follows through the lingual nerve association of nerves V and VII , and afterwards through the tympanic cord nerve facial branch , to make synapses on the geniculate ganglion. Through the intermediate nerve, the postganglionic fibers afferent visceral special - gustative route synapse in the solitary tract nucleus of the medulla oblongata, associated with the general afferent visceral fibers, providing sensitive innervation to the mucosa of the nasal cavities and soft palate 1 1.
The parasympathetic efferent fibers of the facial nerve, originating from the upper salivary nucleus located on each side of the upper portion of the medulla oblongata, run through the intermediate nerve and afterwards through the tympanic cord nerve to make synapses in the submandibular ganglion. Thence, through postganglionic fibers, they stimulate salivary secretion of the submandibular and sublingual glands 1 1. The motor portion of the facial nerve has its nucleus on the ventral portion of the pons.
Its fibers stimulate the skin-inserted muscles in the face, neck and scalp, as well as the posterior belly of digastric and stylohyoid muscles 1 1. The glossopharyngeal IX nerve comes out of the skull together with the vagus X and accessory XI nerves. The visceral general afferent and the visceral special afferent fibers of the glossopharyngeal nerve are associated.
The visceral general afferent fibers are responsible for the general sensitivity of the oropharynx mucosa and the posterior third of the tongue, and the special visceral afferent fibers, for the taste of the posterior third of the tongue.
These preganglionic fibers make synapses with the upper ganglion. The postganglionic fibers will end at the solitary tract nucleus 1 1. The parasympathetic fibers stimulate the salivary secretion after synapses with the optic ganglion, from which postganglionic fibers emerge to innervate the parotid gland 1 1.
Nevertheless, it has already been considered as motor to the superior pharyngeal constrictor muscle, whose activity had been previously attributed to the vagus nerve, responsible for the motor innervation of all pharyngeal constrictors muscles 1 1.
The vagus X nerve has relationships extending from the cervical region to the abdomen transverse colon. Its sensory afference sensory pathway connects with the solitary tract nucleus located in the medulla oblongata. The visceral special efference motor pathway comes from the ambiguous nucleus in the ventral region of the medulla oblongata, and the parasympathetic fibers visceral general efference , from the dorsal motor nucleus of the vagus 1 1.
The visceral special afferent taste and visceral general afferent sensibility pathways of the vagus nerve, after synapses in a peripheral ganglion lower or caudal , have their postganglionic fibers end at the solitary tract nucleus, similar to that observed in the intermediate portion of the facial nerve and in the glossopharyngeal one.
The visceral general afferent fibers conduct impulses related to the sensitivity of the pharynx, larynx, trachea and esophagus, and the visceral special afferent route lead taste stimuli from receptors on the vallecula and from a small posterior area of the tongue next to the vallecula 1 1.
The visceral general efferent parasympathetic fibers of the vagus nerve originate in the vagus dorsal motor nucleus, and from it, on each side, they gather in a single-trunk, descending pathway, emitting branches in the cervical, thoracic and abdominal region, where they end. These preganglionic fibers will establish synapses in peripheral ganglia of the parasympathetic vegetative or autonomous nervous system, close to, or even inside, the viscera walls 1 1.
The visceral special efferent motor fibers of the vagus originate in the ambiguous nucleus, and are responsible for innervation of the striated muscles of the pharynx, larynx and esophagus 1 1.
The accessory XI nerve, not always considered among those related to swallowing control, presents special visceral efferent fibers coming from the ambiguous nucleus motor to striated muscles of branchial origin that would join this type of special visceral efferent fibers of the vagus.
Thus, in addition to the vagus X nerve, the accessory XI one would also be responsible for the motor innervation of the striated portions of the pharynx, larynx and esophagus. A possible second association between the vagus and accessory nerves would be the presence of parasympathetic fibers general visceral efferent in the accessory nerve, with origin in the dorsal nucleus of the vagus, which would accompany the vagus nerve fibers 1 1.
The Hypoglossal XII nerve, a motor one, has an individualized nucleus on the ventral-medial portion on each side of the medulla oblongata. It is responsible for the tongue extrinsic and intrinsic muscles. In addition, fibers from the cervical plexus in association with the hypoglossal nerve form the ansa cervicalis , from which a branch from the cervical plexus, usually C1, will innervate the geniohyoid muscle, one of the responsible for the hyoid-laryngeal displacement 1 1.
The pharyngeal plexus glossopharyngeal, vagus and accessory though vagus is considered responsible for the pharyngeal reflex phase, where afferent information from the pharynx reach the brainstem, generating efferent stimuli to the pharyngeal structures involved in this phase of the swallowing process. The pressure transfer from the oral cavity to the pharynx by distention would produce afferent stimuli that would reach the brainstem, in special the sensitive solitary tract nucleus.
From the sensitive nucleus, through interneurons of the reticular formation, the ventral motor ambiguous nucleus of the brainstem generates efferent motor stimuli to the pharyngeal structures. Several structural movements initiated during the voluntary oral phase, remain in progress until the end of the pharyngeal phase, such as hyoid-laryngeal elevation, swallowing apnea and tongue posterior projection, to pharynx, started during the oral ejection, without considering the palate tension produced by the trigeminal nerve.
The brainstem is formed by the medulla oblongata, the pons and the midbrain. The sensory nuclei are posteriorly located on both sides, and the motor ones, anteriorly. Interneurons and pathways of the reticular formation interconnect the sensory and motor nuclei in the brainstem.
These are also connected with peripheral receptors, cerebellum, and sensory and motor areas of the cerebral cortex through base nuclei, and with peripheral effectors like muscles and salivary glands 1 1. The brainstem receives and emits pathways with stimuli information to be integrated and distributed. During the oral phase, all the bolus characteristics are identified and analyzed by the cortex, which informs the brainstem the pattern to be employed by the oral effectors.
The brainstem, through the motor hypoglossal XII nerve, will stimulate intrinsic and extrinsic tongue muscles. The other swallowing muscles, as well as those involved in the pharyngeal phase, will be stimulated by motor fibers of visceral special efferent nerves V, VII, IX, X and XI. The brainstem also depolarizes visceral general efferent parasympathetic pathways to salivary glands nerves VII and IX 8 8. The vagus X , and maybe the accessory XI , send preganglionic parasympathetic fibers to the autonomic digestive system, through fibers from the vagus dorsal nucleus 1 1.
The swallowing cranial nerves go in and out of the cerebellum through the inferior, middle and superior cerebellar peduncles. The inferior one receives mainly afferent signals, the medium, only afferent signals, and the superior, mostly efferent signals.
Specific longitudinal pathways interconnect brainstem and cerebellum nuclei with base nuclei and cerebral cortex.
In addition to balance and muscle tone, the cerebellum acts by determining the temporal sequence of the synergistic contraction of the different skeletal striated muscles, which can generate delay of the motor signals by fractions of a second. It also acts by sequencing the motor activities from one movement to another, and can control the relation of agonist and antagonist muscles. When necessary, the cerebellum also can make adjustments in the motor activities produced by other parts of the brain 1 1.
Ascending and descending cerebellar pathways connect the cortex and the cerebellum. Originated in large parts of the premotor and motor cortex, the so-called cortex-pons-cerebellar pathway follows to nuclei in the pons and thence to the contralateral hemisphere of the cerebellum. The signs that enter the cerebellum connect with its nuclei and go out to send signals that are distributed to other parts of the brain.
The cerebellar pathway, whose role is to help coordinate the motor activity sequences initiated by the cerebral cortex, originates in the cerebellar cortex and, after connection with one of its main nuclei dentate , goes to the thalamus and will end in the cerebral cortex 8 8.
Swallowing has its motor control bilaterally represented in the cerebral cortex 48 The cortical topography of human swallowing in health and disease. Nat Med. Cortical activation during human volitional swallowing: an event-related fMRI study. Am J Physiol Gastrointes. J Neurophysiol. The role of the cerebral cortex in swallowing. This bilateral representation means that peripheral stimuli reach both cerebral hemispheres, with admitted dominance of one of them.
This dominance assumes that, in physiological conditions, the dominant hemisphere inhibits the function of the contralateral one. In dysphagia due to involvement of the dominant hemisphere, it has been observed that the contralateral hemisphere can increase its representation, with apparent functional recovery 52 Recovery of swallowing after dysphagic stroke relates of functional reorganization in the intact motor cortex. Functional magnetic resonance imaging study on dysphagia after unilateral hemisferic stroke: a preliminar study.
J Neurol Neurosurg Psychiatry. Cortical swallowing processing in early subacute stroke. BMC Neurol. The oral phase, being voluntary, allows us to decide whether to swallow the oral content.
The cortical area with the oral control capacity has been identified in the lower portion of the precentral gyrus frontal cortex and postcentral gyrus parietal cortex , where sensitivity somatosensory cortex and motor control somatomotor cortex are separated by the central sulcus 55 Penfield W, Jasper H.
Epilepsy and the functional anatomy of the human brain. Epilepsy and brain function: commons ideas of Hughlings-Jckson and wilder Penfield. Epilepsy Behav. Figure 1. FIGURE 1 Lateral view of an anatomical specimen brain , highlighting the sensory, postcentral and the motor, precentral gyrus, separated by the central sulcus. The main anatomical elements are described over the figure. The intraoral qualification, linked to sensory pathways of the cranial pairs V, VII and IX, with nuclei in the brainstem, will have visceral afferent general and special stimuli conducted thought base nuclei up to the cerebral cortex.
From the cortex, efferent direct or indirect commands involving the base nuclei reach the motor nuclei of the brainstem, under cerebellar mediation, from where the motor pathways of these nerve pairs coordinate the dynamics of the peripheral effectors 1 1. From the trigeminal V sensory nucleus, tactile sensitivity pathways pass to the thalamus and cortex trough secondary dorsal tracts.
From the spinal nucleus of the cranial pair V, tactile, pain and temperature pathways go to thalamus and cortex via the secondary ventral tract. The facial VII and glossopharyngeal IX nerves connect with the cerebral cortex through sensitive fibers coming from the solitary tract nucleus through medial lemniscus and thalamus. The efferent pathways from the cortex to the brainstem motor nuclei of these three pairs of cranial nerves, modulated by the cerebellum, occur with bilateral mainly cross connections of the cortex-nuclear tract voluntary.
These voluntary pathways will end in the brainstem in connection with the motor nucleus of the nerves V and VII, as well as with motor neurons of the pair IX in the ambiguous nucleus 28 The oral phase can be classified into five subtypes: 1 Nutritional voluntary oral phase; 2 Primary cortical voluntary oral phase; 3 Semi-automatic oral phase; 4 Subsequent gulps oral phase; and 5 Spontaneous oral phase. These five oral phase possibilities occur in association with pharyngeal and esophageal reflex phases.
The nutritive swallowing following chewing, with the bolus prepared and qualified, will put it usually over the tongue organize and transfer it eject to the pharynx 57 The voluntary oral phase of swallowing leads information to the cortex by the afferent pathways of the nerves V, VII and IX mixed pairs that allow the cortex to activate the motor portions of these mixed nerves in association with the hypoglossal XII - motor pair. Originating in peripheral receptors, afferent pathways reach the brainstem.
From the sensory nuclei of the cranial pair V, through the secondary ventral and dorsal tracts, they reach the thalamus and cortex with tactile also volume and viscosity , thermal and possibly nociceptive sensations.
Afferent general sensitivity and special taste pathways led by the cranial nerves VII and IX reach the solitary tract nucleus in the dorsal region of the medulla oblongata. From this, afferent pathways connect with the base nuclei, including thalamus, and then with the cerebral cortex on the postcentral gyrus of both hemispheres, transferring the received afferent signals to the precentral gyrus, from where efferent pathways go to the brainstem motors nuclei V, VII, IX, XII.
Based on the hemisphere dominance, one can conclude that both afferent general sensitive and special taste , and efferent special motors and general parasympathetic pathways interconnecting both sides of cortex and brainstem arrive and leave as direct and cross paths. This organization gives to each cerebral hemisphere the total information collected in the oral cavity, enabling effective commands from each hemisphere to reach both sides of the brainstem, integrating the cranial nerves that act in the oral phase 58 After activating the sensorial cortex on both sides from the base nuclei, the peripheral information passes to the motor cortex, where the necessary intensity is modulated and re-transmitted to the base nuclei and brainstem.
In the latter, the efferent pathways of the trigeminal, facial and hypoglossal nerves would produce an oral dynamic that would end by ejecting its contents into the pharynx.
Although one of the hemispheres is dominant, both are fully informed, allowing them to exercise full functions 48 There is evidence that the dysphagia generated by injury to the dominant hemisphere allows increase in the representation of the non-dominant non-injured hemisphere, associated with apparent function recovery 52 There are pathways crossing from one side to the other through the corpus callosum, integrating the hemispheres.
Thus, in healthy individuals, the dominant cortex can exert inhibitory action on the contralateral one by a connection that passes through the corpus callosum. It is also possible to consider the existence of excitatory pathways from the dominant motor cortex to the base nuclei of the contralateral hemisphere. This organization would explain not only the already evidenced function recovery when there is lesion of the dominant hemisphere 52 It is also possible to assume that these excitatory pathways exist in both directions.
Between the brainstem and the cortex, there are also interconnected pathways arriving at, and leaving from, the cerebellum, considered able to modulate muscular contraction intensity and sequence. In this way, cerebellar pathways connect with efferent voluntary cortex-nuclear pathways that will make synapses with the motor nuclei of the cranial nerves V, VII, IX and XII. From these nuclei, the efferent stimuli follow to the oral effectors, providing them with signaling of adequate contraction intensity and sequence, coordinated by the cortex and modulated by the cerebellum.
The bolus volume and viscosity will interfere with the muscular contraction intensity, defined by the cortex according to the oral qualification, to generate the necessary oral ejection.
Nevertheless, the contraction activation sequence of the effectors will be common to all sequences involving the oral phase, suggesting that the neural organization has a predefined sequence. Taste and temperature do not exert influence on the oral muscular contraction intensity defined by the cortex.
This observation means that, within limits of acceptability, chemical-reception, thermo-reception and certainly pain-reception do not interfere with the oral activity, which is governed by the mechanical reception, in particular volume and viscosity, which will affect the amount of motor units to be depolarized for an effective oral phase.
The generation of the necessary and adequate muscular contraction intensity will be responsible for the information to be passed and maintained during the reflex phase of swallowing. The pressure intensity transferred by the oral phase will be the stimulus to be answered to by the neural control of the reflex pharyngeal phase. The esophageal phase, also reflex, should be influenced at least partly by the oral phase 57 One can describe the basic dynamics of the swallowing oral phase as follows: The Dental arcades touch one another by chewing muscle contraction pair V.
This dental arcades position allows skin-inserted muscles, in special buccinators and orbicularis oris pair VII , to generate intraoral pressure resistance to prevent pressure escape out of the oral cavity during the bolus transference to the pharynx. The pressurized and resistant oral cavity will enable ejection of the bolus by the tongue pair XII , which will transfer pressure and bolus to the pharynx. Still as part of the oral phase actions, the tensor veli palatini muscle pair V will provide resistance to the soft palate, which will be superiorly and posteriorly projected by the levator veli palatini muscle against the first fascicle of the pharynx superior constrictor muscle pterygo-pharyngeus fascicle at the beginning of the pharyngeal phase.
The suprahyoid muscles elevate the hyoid and larynx, opening the pharyngeal-esophageal transition because it undoes the tweezers action between the vertebral body and larynx. The elevation of the hyoid and larynx that acts by undoing of the tweezers action, produced by the apposition of the larynx against the spine is coordinated mainly by the cranial nerves V and VII and also by C1 through the ansa cervicalis.
The hyoid elevation starts at the end of the oral phase, and stays active till the end of pharyngeal phase. Contraction of the longitudinal stylopharyngeus muscle IX will reduce the pharyngeal distal resistance.
Finally, in the end of oral phase, by possible involvement of the respiratory center on the floor of the fourth ventricle in the brainstem, swallowing apnea preventive apnea takes place. In sequence, but with an independent mechanism of apnea, beginning the pharyngeal phase, vocal folds adduction will occur. All the oral events remain active during the entire pharyngeal phase by assimilation of the reflex pharyngeal phase coordination 42 Rio de Janeiro: Elsevier; Coordination of respiration and swallowing: functional pattern and relevance of vocal folds closure.
Figure 2. FIGURE 2 Frontal view of schematic diagram over an anatomical specimen representing the neural control of the nutritional oral phase. Black, dotted lines represent the oral afferent pathways that pass through the 1 sensorial ganglion and connect with sensitive nuclei of the solitary tract and nerve V nuclei in the brainstem 2. From there, they connect with the base nuclei 3 through direct and cross pathways. From the base nuclei 3 , in nutritious swallowing the signals stimulate the postcentral sensorial and precentral motor gyruses 4 , which start the efferent motor pathway.
Note 1: Sensory pathways do not exist in the primary cortical voluntary oral phase. Red, solid lines represent efferent motor pathways from the cortex to the base nuclei 3 and brainstem nuclei 2 where nerves V, VII, IX and XII conduct the stimuli modulated by the cerebellum to the oral effectors. Note 2: In semiautomatic swallowing and while normality is maintained, motor responses are produced without cortical intervention. From the dominant hemisphere, there is an inhibiting pathway black, dashed line going to the opposite hemisphere and an excitatory pathway red, solid line and also to the base dominant nuclei to the non-dominant side.
This type of oral phase reproduces all dynamic events observed in the nutritive oral phase of swallowing, without having any intraoral content to be qualified. It happens as if the cerebral cortex imagined a bolus with such known features, that the efferent cortical motor area reproduces an oral ejection with the same characteristics and using the same efferent pathways that it would if that imagined bolus could be exposed to oral receptors.
Thus, this type of neural control does not have, as an integral part, the afferent signaling coming from the oral receptors to the sensitive cortex. In this way, the sequence from the motor cortex to the oral effectors will be exactly the same 58 This type of neural control is a temporary substitute for the one that occurs during the nutritional swallowing process.
It replaces the voluntary control of the nutritional oral phase when, in a repetitive way, this has its parameters qualified and accepted as usual and within appropriate limits. In such cases, if the attention has been divided with another interest that demands cortical activity, swallowing control can be replaced by a semiautomatic control, which will be processed in subcortical level base nuclei. Considering the proposed organization for the integration between base nuclei and cortex, we can hold that the base nuclei take control of the oral phase, maintaining its integrative activity, but repressing in their level the information brought from the periphery.
Nevertheless, the base nuclei retain the ability to reactivate cortical control at any time, in particular if changes are detected 58 I believe that the dominant hemisphere controls this semiautomatic process from its base nuclei, also through corpus callosum, on the same way of the inhibitory control. Subsequent gulps oral phase swallowing in subsequent gulps implies liquid intake that, in healthy individuals, demands depolarization of fewer motor units, because the necessary ejection force does not require too much effort.
From the oropharynx, the food bolus is further channeled by the back of the tongue and other muscles into the lower part of the pharynx throat. This step also requires the voluntary elevation of the soft palate in order to prevent food from entering the nose. The muscles that control the oral phase of swallowing are stimulated by nerves located in the brainstem, called cranial nerves.
The cranial nerves involved in coordinating this stage include the trigeminal nerve, the facial nerve, and the hypoglossal nerve. As the food bolus reaches the pharynx, special sensory nerves activate the involuntary phase of swallowing. The swallowing reflex, which is mediated by the swallowing center in the medulla the lower part of the brainstem , causes the food to be further pushed back into the pharynx and the esophagus food pipe by rhythmic and involuntary contractions of several muscles in the back of the mouth, pharynx, and esophagus.
Because the mouth and throat serve as an entryway for both food and air, the mouth provides a route for air to get into the windpipe and into the lungs, and it also provides a route for food to get into the esophagus and into the stomach.
A critical part of the pharyngeal phase is the involuntary closure of the larynx by the epiglottis and vocal cords, and the temporary inhibition of breathing.
The closure of the larynx by the epiglottis protects the lungs from injury, as food and other particles that enter into the lungs can lead to severe infections and irritation of the lung tissue. Lung infections caused by problems with the pharyngeal phase of the swallowing reflex are commonly known as aspiration pneumonia. As food leaves the pharynx, it enters the esophagus, a tube-like muscular structure that leads food into the stomach due to its powerful coordinated muscular contractions.
The passage of food through the esophagus during this phase requires the coordinated action of the vagus nerve , the glossopharyngeal nerve, and nerve fibers from the sympathetic nervous system. The esophagus has two important muscles that open and close reflexively as the food bolus is brought down during swallowing.
These muscles, called sphincters, allow the food bolus to flow in a forward direction while preventing it from going in the wrong direction regurgitation. Both esophageal sphincters, first the upper, and then the lower, open in response to the pressure of the food bolus and close after the food bolus passes.
The upper esophageal sphincter prevents food or saliva from being regurgitated back into the mouth, while the lower esophageal sphincter ensures that food remains in the stomach, preventing regurgitation back into the esophagus. In doing so, the esophageal sphincters serve as a physical barrier to regurgitated food.
In general, healthy people can swallow with very little deliberate thought and effort. If the nervous system is disrupted due to a stroke or another disease, then problems with swallowing can occur. Swallowing difficulties are referred to as dysphagia. Dysphagia can lead to problems such as choking, lack of appetite and weight loss, and aspiration pneumonia.
If you have experienced a stroke or another neurological illness, you may undergo a swallowing evaluation to determine whether you have dysphagia. It will remind you to do your exercises as prescribed. It will also provide helpful feedback on your progress to your SLP. Make a note of what exercises you performed and when you performed them.
Also, note any problems. Discuss them with your SLP. Your SLP and medical team will monitor your process. They may make changes to your exercise therapy, if necessary. This monitoring may include bedside swallowing exams or imaging tests. It may take a few weeks to notice an improvement in your swallowing. As your ability to swallow improves, your risk of aspiration may drop. Your SLP may be able to modify your diet. You may also be able to eat certain types of food again. This can improve your nutritional intake, your overall health, and your quality of life.
Continue to practice all your swallowing exercises as prescribed by your SLP. You will benefit most from following the prescribed therapy.
Your gains may be less if you miss practice sessions. To maximize your chance of a good outcome, work closely with all the members of your healthcare team to properly treat your condition. Health Home Treatments, Tests and Therapies. Why might I need closure of the larynx exercises?
Different conditions can lead to swallowing problems. How do I get ready for closure of the larynx exercises? Your SLP can tell you if there is anything else you need to do before starting. What happens during closure of the larynx exercises? As an example, you may be asked to perform the following exercises: Take a deep breath and hold it.
Keep holding your breath while you swallow. Immediately after swallowing, cough. This is called the supraglottic swallow.
Repeat a few times. Inhale and hold your breath very tightly. Bear down like you are having a bowel movement. Keep holding your breath and bearing down as you swallow. This is called a super-supraglottic swallow. There is no need to use food or liquid with either of these exercises.
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