The role of the cerebral cortex in swallowing.
ABSTRACT This paper reviews clinical, neuroanatomical, and neurophysiological studies that have implicated the cerebral cortex in the initiation and/or regulation of swallowing as well as related functions such as mastication. Cortical dysfunction has been reported to result in a variety of swallowing impairments. Furthermore, swallowing can be evoked and/or modulated by stimulation applied to restricted regions of the cortex. Neuroanatomical investigations and single neuron recording studies also provide some insights into the cortical structures, pathways, and mechanisms that may mediate deglutition.
SourceAvailable from: Kimiko Abe-Saito
Conference Paper: Occurrences of Yawn and Swallow are Temporally Related[Show abstract] [Hide abstract]
ABSTRACT: Objective: Yawning and swallowing are mediated by brainstem circuits and recruit the upper aerodigestive tract musculature. Yawning may be associated with increased salivation, which in turn may elicit swallowing. Therefore, this study tested the hypothesis that occurrences of yawning and swallowing are temporally related. Method: Contagious yawning was evoked in 14 healthy adults (mean ± SD age: 25.1 ± 3.3 years; 8 female) who were blinded to the study hypothesis. Following a pre-treatment baseline period, the subjects viewed videotaped images of human yawning or mouth-opening (i.e., gape) during 2 experimental conditions, each followed by a baseline period: (1) yawn video viewing, (2) post-yawn-video baseline, (3) gape video viewing, and (4) post-gape-video baseline. Lateral-view video images of the subject’s head, neck and torso, as well as laryngeal and respiratory movement and neck acoustic signals, were recorded throughout all baseline and treatment conditions. Two blinded, trained judges independently analyzed the video data for all motor behaviors; swallows identified from the video analysis were subsequently verified through blinded physiologic data analysis. Result: The number of yawns produced during the entire experimental protocol of ~60 min was 12.6 ± 8.3 (mean ± SD). Overall, 82% of yawns were followed by a swallow within 10 seconds, with a yawn-swallow latency of 4.4 ± 1.7 seconds (mean ± SD). Moreover, the swallowing rate during the 10-second period immediately following yawning was approximately five times greater than the swallowing rate calculated over the remaining periods during which yawning did not occur (4.1 ± 1.4 versus 0.8 ± 0.4 swallow/min, means ± SD, p<0.001). Conclusion: These findings establish that occurrences of yawning and swallowing are temporally related. Therefore, stimulation of yawning may have potential as a clinical approach to facilitating swallowing in dysphagic populations.IADR General Session 2012; 06/2012
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ABSTRACT: ObjectiveTo determine predictors of early recovery of functional swallow in patients who had gastrostomy (percutaneous endoscopic gastrostomy [PEG]) placement for dysphagia and were discharged to inpatient rehabilitation (IPR) after stroke.MethodsA retrospective study of prospectively identified patients with acute ischemic and hemorrhagic stroke from July 2008 to August 2012 was conducted. Patients who had PEG during stroke admission and were discharged to IPR, were studied. We compared demographics, stroke characteristics, severity of dysphagia, stroke admission events and medications in patients who remained PEG-dependent after IPR with those who recovered functional swallow.ResultsPatients who remained PEG dependent were significantly older (73 vs. 54 years, p=0.009). Recovery of swallow was more frequent for hemorrhagic stroke patients (80% vs. 47%, p=0.079). Age, adjusting for side of stroke (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.82-0.98; p=0.016) and left-sided strokes, adjusting for age (OR, 15.15; 95% CI, 1.32-173.34; p=0.028) were significant predictors of swallow recovery. Patients who recovered swallowing by discharge from IPR were more likely to be discharged home compared to those who remained PEG-dependent (90% vs. 42%, p=0.009).ConclusionYounger age and left-sided stroke may be predictive factors of early recovery of functional swallow in patients who received PEG. Prospective validation is important as avoidance of unnecessary procedures could reduce morbidity and healthcare costs.08/2014; 38(4):467-75. DOI:10.5535/arm.2014.38.4.467This article is viewable in ResearchGate's enriched formatRG Format enables you to read in context with side-by-side figures, citations, and feedback from experts in your field.
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ABSTRACT: Background Transcranial direct current stimulation (tDCS) is a non-invasive technique used for modulating cortical excitability in vivo in humans. Here we evaluated the effect of tDCS on behavioral and electrophysiological aspects of physiological sucking and swallowing. Methods Twelve healthy subjects underwent three tDCS sessions (anodal, cathodal and sham stimulation) on separate days in a double-blind randomized order. The active electrode was placed over the right swallowing motor cortex. Repeated sucking and swallowing acts were performed at baseline and at 15 and 60 min after each tDCS session and the mean liquid bolus volume ingested at each time point was measured. We also calculated average values of the following electrophysiological parameters: 1) area and 2) duration of the rectified EMG signal from the suprahyoid/submental muscles related to the sucking and swallowing phases; 3) EMG peak amplitude for the sucking and swallowing phases; 4) area and peak amplitude of the laryngeal-pharyngeal mechanogram; 5) oropharyngeal delay. Results The volume of the ingested bolus significantly increased (by an average of about 30% compared with the baseline value) both at 15 and at 60 min after the end of anodal tDCS. The electrophysiological evaluation after anodal tDCS showed a significant increase in area and duration of the sucking phase-related EMG signal. Conclusions Anodal tDCS leads to stronger sucking of a liquid bolus in healthy subjects, likely by increasing recruitment of cortical areas of the swallowing network. This finding might open up interesting perspectives for the treatment of patients suffering from dysphagia due to various pathological conditions.Brain Stimulation 09/2014; 7(6). DOI:10.1016/j.brs.2014.09.007 · 5.43 Impact Factor