DYSPHAGIA SWALLOWING

Dysphagia swallowing affected after stroke and how motor control and motor learning works



Dysphagia -swallowing affected after stroke and how motor control and motor learning works

Introduction 

“Dysphagia” is an impaired ability to swallow. Dysphagia can result from anatomic variation or neuromuscular impairment anywhere from the lips to the stomach. Although some investigators choose to consider the voluntary oral preparatory stage of deglutition as a separate stage, swallowing is traditionally described as a three-stage event (oral, pharyngeal, and esophageal). Historically, research as well as evaluation and treatment of dysphagia were directed primarily toward the esophageal stage, which is generally treated by a gastroenterologist. However, over the past few decades, speech-language pathologists have become increasingly responsible for the research in, as well as the diagnosis and treatment of, the oral and pharyngeal aspects of deglutition.

The neuroanatomical substrate of dysphagia reflects lower motor neuron innervation by cranial nerves V, VII, IX, X, and XII. Dysphagia can result from unilateral or bilateral cortical insult. Within the cortex, primary sites that contribute to deglution include the premotor cortex, primary motor cortex, primary somatosensory cortex, insula, and the ventroposterior medial nucleus of the thalamus. Other portions of the cortical system have also been found to be active during swallowing. Stroke often affects the first three to interrupt the normal control voluntary movements and mastication of food inside the mouth (more common in brain lesions) or to retard the gag reflex (more common in patient's brainstem lesions).

Dysphagia is common after stroke, is estimated to occur in 29% to 64% of patients, depending on the diagnostic method used. During rehabilitation after stroke, the incidence of dysphagia is reduced from 47% between the two to three weeks to 17% between the second and fourth months. Excessive secretions, the exaggerated movement of the tongue, facial weakness, cough during feeding, speech disorders and frequent pneumonias are some of the signs and symptoms that should make you think of dysphagia. Dysphagia is associated with weight loss, malnutrition, fluid depletion suction (inlet airway material below the level of the true vocal cords) and pneumonia. Many stroke patients with dysphagia and aspiration have not but are at increased risk. When the patient is unable to eat or drink enough fluids and solids should start enteral nutrition until you regain the ability to swallow.

Dysphagia affects 22 to 65% of patients after a cerebrovascular accident (CVA) and may persist for some months. Their detection is an important part of treatment in the acute phase of stroke, since it is a marker of poor prognosis in terms of morbidity and functional recovery. Dysphagia is observed in 24-45% of patients with neurological disorders in general, but in a study conducted with 105 patients with cerebrovascular disease, 13% were found in patients with unilateral hemispheric lesions, and even 71% in patients with bilateral lesions of trunk also found 30% of conscious patients who have difficulty swallowing on the first day after the stroke, but the percentage of dysphagia in these patients varies widely, depending on the size and location of the infarct ...