Dysphagia: Neurological and Behavioral Aspects

Dorianne Feldman and Marlís González-Fernández

2011, Part 14, 1375-1386, DOI: 10.1007/978-0-387-92271-3_88


Swallowing is an intricate, yet fundamental process which is often interrupted by neurologic disease and senescence and has a major impact on the overall health, quality of life, and nutritional status of those affected. A number of neurologic conditions are associated with dysphagia including Parkinson’s disease (PD), amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), dementia, and traumatic brain injury (TBI). Of these, stroke is the most common. Although swallowing problems may be exclusive to one phase of swallowing, deficits can be seen in multiple stages – oral, pharyngeal, and/or esophageal. The health risk is enormous, particularly in the elderly, and includes aspiration pneumonia, malnutrition, dehydration, and weight loss. There are several challenges when caring for these individuals who often are socially estranged and besieged by other medical conditions, physical impairments, cognitive dysfunction, immune system deficiencies, and poor nutrition at baseline which together complicate medical decision making often causing further decline. Age-related changes, whether anatomic, physiologic, or psychologic, also accompany normal swallowing and are not considered to be pathologic. As the number of individuals 65 years of age and older increases, the ability to diagnose and manage swallowing disorders will be of extreme importance. For the most part, treatment focuses on dietary modification, compensatory, and rehabilitative techniques. When swallowing is not permissible, consideration of enteral feeding via percutaneous endoscopic gastrostomy tube or, for short-term purposes, with use of oral or nasogastric feeding tubes is necessary. With a better knowledge and awareness of the swallowing process, including its relation to the existing disease state, complication risk, and importance of rehabilitation services, care can be coordinated effectively to improve overall health, wellbeing, and quality of life.

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