NEUROGENIC DYSPHAGIA

The pathogenesis of neurogenic dysphagias is not restricted to sensori motor deficits of the oropharyngeal and laryngeal region but has to be viewed in most cases in terms of a disturbed swallowing reflex, a red uced elevation of the hyoid-larynx-complex, or a dysfunction of the up per esophageal sphincter (UES). Videofluoroscopy with high spatial and temporal resolution, radiomanometry (of the pharynx and the UES) and endoscopy play a pivotal role in the diagnosis of dysphagia and the de gree of aspirations. Invasive therapies are rarely indicated, because swallowing rehabilitation is very effective. By means of indirect (cau sal) methods (e.g. thermal stimulation) or direct (Compensatory) metho ds such as swallowing maneuvers about two thirds of patients who are d ependent on tube feeding on admission can be discharged as total oral feeders after a therapy duration of about: three months. Time between onset of disease and the beginning of swallowing therapy plays a minor role in respect of functional outcome. Based on logistic-regression a nalysis we found that the following admission variables were significa ntly associated with a poor outcome: difficulty managing one's secreti ons, low Barthel score, severely impaired oral feeding: higher age and the frequency of pneumonias during hospital stay were also (but only weakly) associated with a poor functional outcome. Among neuropsycholo gical disturbances attentional deficits are the ones which cause most problems during therapy. They correlate with a prolongation of therapy duration and can in severe cases make swallowing therapy impossible. The question whether EMC biofeedback training during rehabilitation is superior to rehabilitation alone with regard to outcome or therapy du ration is still unresolved. By use of new methods of three-dimensional movement analysis the assessment of laryngeal kinematics is possible. This allows measurement of degree of automaticity during motor learni ng and thereby monitoring of the course of swallowing rehabilitation.