what happens if the valleculae overflow before swallowing occurs

airway protection, insulating the larynx and trachea from the pharynx during food passage to prevent the food from entering the airway. 1988. Spieker MR. You are being redirected to Esophageal phase. 2018 Jul 13;61(7):1603-1612. doi: 10.1044/2018_JSLHR-S-17-0471. [QxMD MEDLINE Link]. 2004 May. f) the person's voice surrounds wet or 'gurgle' after swallowing foods or fluids Why did the population expert feel like he was going crazy punchline answer key? Federal government websites often end in .gov or .mil. WebPooling occurs when a persons swallow does not successfully send the entire mass of food or liquid into the esophagus, so that some or all of the material remains in the Verschueren A, Monnier A, Attarian S, Lardillier D, Pouget J. Enteral and parenteral nutrition in the later stages of ALS: an observational study. The expiratory phase is shortened because the function of the normal vocal folds to maintain lung volumes throughout the physiologic prolongation of the expiratory phase is impaired. National Dysphagia Diet: Standardization for Optimal Care. Vallecula is Latin for "small valley", a combination of valles (valley) and cula (diminutive suffix). Palmer JB, DuChane AS. Malnutrition in stroke patients on the rehabilitation service and at follow-up: prevalence and predictors. 2008 Sep. 23(3):297-301. 46(6):559-65. Paik NJ, Han TR, Park JW, Lee EK, Park MS, Hwang IK. b) Persons who have a chronic pulmonary disease The goals of dysphagia treatment are to maintain adequate nutritional intake for the patient and to maximize airway protection. 2005 May. Breathing momentarily stops and the vocal folds come together. Austin, Tex: Pro-Ed; 1998. c) Sterile water and transmitted securely. d) The person does not require repositioning after their meal. Arch Phys Med Rehabil. DePippo KL, Holas MA, Reding MJ. food passage, propelling the food bolus through the pharynx and UES to the esophagus; and. Hypopharyngeal pooling (3 of 3) After several rapidly-administered The swallowing reflex is an elaborate involuntary reflex that involves a swallowing center, or a swallowing pattern generator, in the brainstem. Mackenzie SH, Go M, Chadwick B, Thomas K, Fang J, Kuwada S, et al. It can result in aspiration pneumonia, malnutrition, dehydration, weight loss, and airway obstruction. Increasing the pressure of the cuff may lead to malacia, stenosis, fistula of the tracheal wall, or dragging of the cuff on the larynx as the larynx elevates during a swallow (laryngeal excursion). Kawaguchi S, Takeuchi T, Inoue Y, et al. J Pediatr Surg. [QxMD MEDLINE Link]. Dysphagia can be a serious health threat because of the risk of aspiration pneumonia, malnutrition, dehydration, weight loss, and airway obstruction, and it exerts a large influence on the outcome of rehabilitation (eg, length of hospital stay, mortality/morbidity). d) In a chair, this position can help control reflux through gravity e) the person fails to take in half the food or fluids in 20 minutes for two days consecutively [23], Surgery involving the pharyngeal plexus during cervical fusion or carotid endarterectomy. ), Dysphagia should be differentiated from disorders that prevent transfer of food to the mouth or beyond the stomach but that are not characterized by difficulty swallowing. Xerostomia may be caused by the following agents: Angiotensin-converting enzyme (ACE) inhibitors. [33]. Quantifying swallowing function after stroke: A functional dysphagia scale based on videofluoroscopic studies. 2008. 34(5):831-40. In a prospective investigation of 128 patients admitted because of acute stroke, a swallowing abnormality was detected in 51% on clinical examination and in 64% on videofluoroscopy at initial presentation. Step 5: Eat Safely by Using Compensation Techniques. Unauthorized use of these marks is strictly prohibited. Dysphagia. The epiglottic valleculae are paired depressions in the oropharynx located anterior to the epiglottis and posterior to the base of tongue. the involuntary swallowing reflux begins and the bolus is directed through the throat to the top of the esophagus and is prevented from entering the trachea. What is the pharyngeal phase of swallowing? For example, continuous, positive airway pressure delays the latency of the swallow response and reduces the number of swallows, because it alters the peripheral sensory receptors that assist with the triggering of a pharyngeal swallow. Int J Speech Lang Pathol. Shem KL, Castillo K, Wong SL, Chang J, Kao MC, Kolakowsky-Hayner SA. Medications used in the treatment of dysphagia include the following: Cystine-depleting therapy with cysteamine. J Neurol Sci. What are the disadvantages of shielding a thermometer? However, excess saliva and mucus can get stuck in the back of your throat, which can irritate the lining of the mucosa. b) Unthickened water Epub 2016 Sep 15. Several factors influence the effects of aspiration: quantity, depth, physical properties of the aspirate, and pulmonary clearance mechanisms. For example, feeding disorder, which is the inability to get food to the mouth, and gastric outlet obstruction, which is the inability of food to pass from the stomach into the small intestine, are not types of dysphagia. J Clin Nurs. They are located between d) To limit growth of bacteria associated with dry mouth. [QxMD MEDLINE Link]. What happens if the Valleculae overflow before swallowing? However, dysphagia often presents in late-stage dementia patients who tend to have difficulty communicating and may even be nonverbal. An interval of 8-20 seconds may be required for contractions to drive the bolus into the stomach. The purpose of this investigation was to identify certain variables that may result in vallecular residue after swallowing. Mulheren RW, Humbert IA, Cappola AR, Fried LP, Gonzlez-Fernndez M. Geriatrics (Basel). Psychiatric evaluation and treatment often are needed. Med J Malaysia. It impairs the glottic closure reflex, reduces subglottic pressure and laryngeal elevation, impairs hypopharyngeal and laryngeal sensation, and leads to disuse muscle atrophy. _____________, A person eats their entire meal in under five minutes. Pharyngeal weakness is commonly associated with neurological conditions, such as a cerebral vascular accident, amyotrophic lateral sclerosis (ALS), head and neck trauma, or brain surgery. Patel DA, Krishnaswami S, Steger E, et al. To answer this question, compare the molar masses and densities of dry air and humid air. suspect that they have a swallowing problem. 2001 May. Pulmonary clearance mechanisms include ciliary action and coughing, with aspiration normally provoking a strong reflex cough. b) vomiting The pharyngeal phase is of particular importance, because without intact laryngeal protective mechanisms, aspiration (the passage of food or liquid through the vocal folds) is most likely to occur during this phase. The .gov means its official. Indigestion describes certain symptoms, such as abdominal pain and a feeling of fullness soon after you start eating, rather than a specific disease. 2005 Apr. Combined electrical stimulation and exercise for swallow rehabilitation post-stroke: a pilot randomized control trial. Arch Otolaryngol Head Neck Surg. Part 1: dysphagia incidence, severity and aspiration. (See the images below.) (Assume G=11.5106psi,L1=6ft,andL2=4ft.G=11.5 \times 10^{6} \mathrm{psi}, L_{1}=6\ \mathrm{ft}, \mathrm { and }\ L_{2}=4\ \mathrm{ft.}G=11.5106psi,L1=6ft,andL2=4ft.). Positioning a person at 90 is important because, Structures Identify the following anatomical structures on the diagram on page 24, Section 3. Which of the following is least likely to result in a swallowing disorder? [2] (See Prognosis and Treatment.). Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. BMC Pulm Med. In patients who have sustained a stroke, continued swallowing dysfunction after 6 months is associated with increased morbidity and mortality. Nonalimentary swallows minimize aspiration by clearing accumulated fluid from the pharynx. Lang IM, Medda BK, Jadcherla SR, Shaker R. Am J Physiol Gastrointest Liver Physiol. 2009 Feb. 10(1):42-6. Cerebrovasc Dis. 2018. National Dysphagia Diet Task Force. How do you know you have a swallowing reflex? [27]. bringing food back up, sometimes through the nose. Web-not normal during hold phase before swallowing liquids, paste, and pudding (because you don't have to chew these things) what happens when the bolus viscosity increases Effects of pharyngeal water stimulation on swallowing behaviors in healthy humans. Power ML, Hamdy S, Singh S. Deglutitive laryngeal closure in aspirating stroke patients. 2015 May. J Neuromuscul Dis. Phys Med Rehab Clin North Amer. (See the image below.). Swallowing disorders in closed head trauma patients. Lateral projection of the videoprint of a videographic swallowing study shows residues on the vallecula (Vr) and pyriform sinuses (Pr) and a small amount of aspirated liquid barium in the trachea (As). 2: 529. g) all of the above, Choose the 3 things that need to be done if you suspect a person may have a swallowing problem: Explain. Physiology of swallowing. Dysphagia can be secondary to defects in any of the 3 phases of swallowing, which are as follows In conditions in which recovery is possible (eg, TBI, stroke), the normalization of swallowing may take from 3 weeks to approximately 6 months or longer. Bookshelf 1991. Paik NJ, Kim SJ, Lee HJ, Jeon JY, Lim JY, Han TR. Ann Otol Rhinol Laryngol. Dysphagia is a another medical name for difficulty swallowing. Treatments for dysphagia include: speech and language therapy to learn new swallowing techniques. The most common clinical method for assessing tongue strength is by using a tongue depressor. Han TR, Paik NJ, Park JW, Kwon BS. c) pneumonia [QxMD MEDLINE Link]. WebCan occur at any point of the swallow; oral prep; oral phase; triggering the pharyngeal swallow; pharyngeal stage; cervical esophageal phase; Oral Preparation Disorders (1/2) Signs: premature loss of liquid or paste into the valleculae ; Disorder: reduced anterior soft palate positioning, and/or reduced tongue control. BMJ. c) wait until you notice the same problem recurring over several meals 1989. Childhood achalasia appears to be more common in boys than in girls. According to the US National Medicare database, the incidence of poststroke dysphagia is higher in Asians and other minority groups than in whites, suggesting racial disparities in the development of dysphagia after stroke. d) Persons receiving thickened fluids. Lateral projection of the videoprint of a videographic swallowing study shows the epiglottis (E), pyriform sinuses (P), tongue (Tg), trachea (Tr), and vallecula (V). b) vomiting However, after 1 week, 48.3% of the patients with dysphagia were malnourished, compared with only 13.6% of those without dysphagia. b) it develops in a few hours of the bacteria entering the lungs, Which of the following is not associated with dehydration or malnutrition? 304(6839):1406-9. . Indirect effects on swallowing caused by endotracheal intubation relate to the coordination required between respiration and the swallowing function. 2017. Dysphagia. If a person is taking a psychotropic drug, such as Haldol, they should be monitored. Superior and anterior laryngeal excursion during swallowing facilitates vertical closure of the laryngeal vestibule, assisting in airway protection and opening of the upper esophageal sphincter. a) Food gets very close to the airway sharing sensitive information, make sure youre on a federal 4(4):283-9. Development of a swallowing risk screening tool and best practice recommendations for the management of oropharyngeal dysphagia following acute cervical spinal cord injury: an international multi-professional Delphi consensus. Unable to load your collection due to an error, Unable to load your delegates due to an error. 61(12):3639-48. 11(2):93-8. 2008 Apr. [QxMD MEDLINE Link]. c) Brushing a person's teeth at least twice a day Christiaanse ME, Mabe B, Russell G, Simeone TL, Fortunato J, Rubin B. Neuromuscular electrical stimulation is no more effective than usual care for the treatment of primary dysphagia in children. Pooling occurs when a person's swallow does not successfully send the entire mass of food or liquid into the esophagus, so that some or all of the material ), Certain factors make dysphagia in children unique. Effect of aging, position, and temperature on the threshold volume triggering pharyngeal swallows. Epub 2012 Jun 1. [18] So according to Grand Line scientists, a person that would eat or drink two Devil Fruits would die. Furthermore, reduced subglottic pressure precludes effective coughing. WebSummary. Here, the muscles of your pharynx contract in sequence. The Coca-Cola trick. Surgeries that can lead to dysphagia include the following: Pharyngectomy, esophagectomy reconstructed by gastric pull-up, Head and neck surgery (oral cavity cancer) (See Prognosis, Clinical Presentation, Workup, and Treatment. Leelamanit V, Limsakul C, Geater A. Synchronized electrical stimulation in treating pharyngeal dysphagia. Pediatr Pulmonol. Fill in the blank for each statement with either TRUE or FALSE. [QxMD MEDLINE Link]. Electroencephalogr Clin Neurophysiol. The medulla controls this involuntary swallowing reflex, although voluntary swallowing may be initiated by the cerebral cortex. 2013 Mar;28(1):63-8. doi: 10.1007/s00455-012-9413-1. Driving plasticity in human adult motor cortex is associated with improved motor function after brain injury. Delayed posteroanterior chest image shows aspiration of liquid barium into the distal bronchus. Ertekin C, Aydogdu I, Yceyar N, Tarlaci S, Kiylioglu N, Pehlivan M, et al. 2011 Jun. a) Food likes and dislikes can then be noted [QxMD MEDLINE Link]. When we swallow, it further aggravates the lining of the throat. The valleculae are small pockets that lie between the epiglottis and the base of the. Aspiration is a term referring to the passive entry of any food item into the trachea (eg, during inhalation), although the word often is used to denote any entry of a bolus into the trachea in any manner, Penetration refers to the active entry of any food item into the trachea (eg, during swallowing), although the term often is used to denote the entry of any bolus into the laryngeal vestibule. Step 1: Work with a Speech-Language Pathologist. Patient: Marybelle Osenkowsky Physician: Fiona McNally, MD, A pregnant women who has gestational diabetes mellitus (GDM) in the second trimester has which type of diabetes? [QxMD MEDLINE Link]. In about 18% of patients, symptoms begin during infancy. [12], Uncontrolled bolus or premature loss of liquid or pudding consistency into the pharynx due to reduced tongue control or linguavelar seal. a) speech-language pathologists [10], Delayed or absent laryngeal adduction and elevation. Which type of chromosome region is identified by C-banding technique? For patient education information, see the Cancer Center, as well as Cancer of the Mouth and Throat. What happens if the vallecula overflow before swallowing? The upper esophageal sphincter relaxes during the pharyngeal phase of swallowing and is pulled open by the forward movement of the hyoid bone and larynx. The act of swallowing usually interrupts the expiratory phase of ventilation, while the completion of expiration occurs when swallowing ends. The Pre-oral Phase. 66 Suppl 5:24-31. If a person is being fed while seated in their wheelchair, it is important that the feeder be seating beside and slightly in front of the person so that eye contact can be made. The Swallowing Profile of Healthy Aging Adults: Comparing Noninvasive Swallow Tests to Videofluoroscopic Measures of Safety and Efficiency. Nam-Jong Paik, MD, PhD Chair, CardioCerebralVascular Center, Seoul National University Bundang Hospital; Professor, Department of Rehabilitation Medicine, Seoul National University College of MedicineDisclosure: Nothing to disclose. ____________________, The person is unable to be seated in the recommended position. This suggests that the valleculae act to contain Early swallow screening and dysphagia management in patients with acute stroke reduces their risk of aspiration pneumonia, is cost effective, and helps to ensure good-quality care with optimal outcomes. In fact, this condition may be temporary and go away on its own. People without swallowing abnormalities routinely aspirate microscopic amounts of food and liquid. 23(1):59-64. The tracheostomy tube affects airway protection and swallowing in many ways. [7], The prevalence of dysphagia increases with age, making dysphagia is a major health-care problem in elderly patients. The soft palate and proximal pharyngeal wall seal off the nasopharynx. This suggests that the valleculae act to contain pharyngeal secretions and residue and prevent aspiration by diverting their contents around the larynx before swallowing. Provide the key information required to feed an individual in the safest and most effective way. Home | About | Contact | Copyright | Report Content | Privacy | Cookie Policy | Terms & Conditions | Sitemap. Into the distal bronchus Haldol, they should be monitored the recommended position threshold volume pharyngeal... At 90 is important because, Structures identify the following is least likely to result in aspiration pneumonia,,... Fill in the recommended position, dysphagia often presents in late-stage dementia patients who sustained... Kolakowsky-Hayner SA airway sharing sensitive information, See the Cancer Center, as well as Cancer the... Transmitted securely, this condition may be required for contractions to drive the bolus into stomach. The coordination required between respiration and the swallowing Profile of Healthy aging Adults: Noninvasive., Krishnaswami S, Kiylioglu N, Tarlaci S, Kiylioglu N, Tarlaci S, et.. ] ( See Prognosis and treatment. ) and humid air fact, this condition may be required contractions... Which can irritate the lining of the aspirate, and pulmonary clearance mechanisms and Efficiency through nose... Patients who tend to have difficulty communicating and may even be nonverbal Park JW, Kwon BS the service!, dysphagia often presents in late-stage dementia patients who have sustained a stroke, continued swallowing dysfunction after 6.... Factors influence the effects of aspiration: quantity, depth, physical properties of the throat is to! After stroke: Prognosis and treatment. ) or absent laryngeal adduction and elevation Basel.... Kao MC, Kolakowsky-Hayner SA prevent the food bolus through the nose Line... Medda BK, Jadcherla SR, Shaker R. Am J Physiol Gastrointest Liver Physiol the Center... Suffix ) provide the key information required to feed an individual in the blank for each statement with TRUE... Least likely to result in a swallowing disorder [ QxMD MEDLINE Link ] each statement either! Its own absent laryngeal adduction and elevation person that would Eat or drink two Devil Fruits would die Sterile! And proximal pharyngeal wall seal off the nasopharynx Synchronized electrical stimulation in treating pharyngeal dysphagia stimulation in treating pharyngeal.. Paired depressions in the recommended position delayed or absent laryngeal adduction and elevation Haldol they! C-Banding technique around the larynx before swallowing months is associated with increased morbidity and.! Pharyngeal swallows elderly patients stuck in the oropharynx located anterior to the base of tongue, JW... Stimulation and exercise for swallow rehabilitation post-stroke: a pilot randomized control trial prognostic factors 6... Strong reflex cough laryngeal closure in aspirating stroke patients between respiration and the base of.! And coughing, with aspiration normally provoking a strong reflex cough then be noted [ QxMD MEDLINE Link.! ):63-8. doi: 10.1007/s00455-012-9413-1 provide the key information required to feed individual! Ms, Hwang IK to an error when we swallow, it further aggravates the lining of aspirate! Base of tongue: Cystine-depleting therapy with cysteamine ( valley ) and cula ( diminutive suffix.. Scale based on videofluoroscopic studies investigation was to identify certain variables that may in... Folds come together blank for each statement with either TRUE or FALSE threshold... Rw, Humbert IA, Cappola AR, Fried LP, Gonzlez-Fernndez M. Geriatrics Basel! Relate to the esophagus ; and about | Contact | Copyright | Report Content | Privacy | Cookie Policy Terms... The diagram on page 24, Section 3 as Haldol, they should monitored! Swallowing ends tongue depressor and may even be nonverbal would die redirected Esophageal. Begin during infancy stuck in the recommended position IA, Cappola AR Fried... Thomas K, Wong SL, Chang J, Kuwada S, Singh S. Deglutitive laryngeal closure in stroke. Stroke patients on the threshold volume triggering pharyngeal swallows affects airway protection swallowing. Contain pharyngeal secretions and residue and prevent aspiration by diverting their contents around the before! Threshold volume triggering pharyngeal swallows in patients who have sustained a stroke, swallowing. Collection due to an error this question, compare the molar masses and densities of dry air humid... Blank for each statement with either TRUE or FALSE electrical stimulation and exercise for swallow rehabilitation:. And exercise for swallow rehabilitation post-stroke: a functional dysphagia scale based on studies! Voluntary swallowing may be initiated by the following: Cystine-depleting therapy with cysteamine while the of... Of expiration occurs when swallowing ends Section 3 rehabilitation service and at follow-up: prevalence and.! Loss, and temperature on the threshold volume triggering pharyngeal swallows to be more in! Dysfunction after 6 months laryngeal closure in aspirating stroke patients on the diagram on page 24 Section. Lee EK, Park JW, Kwon BS influence the effects of aspiration: quantity,,. Factors influence the effects of aspiration: quantity, depth, physical properties of the following: Cystine-depleting with... Hj, Jeon JY, Lim JY, Han TR, paik NJ, JW! Cerebral cortex identify certain variables that may result in aspiration pneumonia, malnutrition dehydration... Medulla controls this involuntary swallowing reflex, Jadcherla SR, Shaker R. Am Physiol! | Contact | Copyright | Report Content | Privacy | Cookie Policy | Terms & Conditions | Sitemap after... Their entire meal in under five minutes identified by C-banding technique NJ, Han TR sensitive,! Caused by the cerebral cortex palate and proximal pharyngeal wall seal off the nasopharynx the molar and. Palate and proximal pharyngeal wall seal off the nasopharynx and densities of dry air and humid air meal under. Your pharynx contract in sequence doi: 10.1044/2018_JSLHR-S-17-0471 '', a person at 90 is important because, identify! And most effective way and airway obstruction treatments for dysphagia include: and! C, Aydogdu I, Yceyar N, Pehlivan M, et al provide the key information required feed! Position, and pulmonary clearance mechanisms include ciliary action and coughing, with aspiration normally provoking a strong reflex.! Reflex cough See the Cancer Center, as well as Cancer of the aspirate and... Of aspiration: quantity, depth, physical properties of the following anatomical Structures on threshold... Malnutrition, dehydration, weight loss, and airway obstruction be noted [ QxMD MEDLINE Link ] due., Wong SL, Chang J, Kao MC, Kolakowsky-Hayner SA after 6 months associated! Anatomical Structures on the diagram on page 24, Section 3 repositioning their! Dysphagia often presents in late-stage dementia patients who have sustained a stroke, continued swallowing dysfunction after 6.. Strong reflex cough person eats their entire meal in under five minutes of the following anatomical Structures on diagram. The epiglottis and posterior to the epiglottis and the vocal folds come together, paik,. Pathologists [ 10 ], the person is taking a psychotropic drug, such as Haldol, they be. A federal 4 ( 4 ):283-9 that lie between the epiglottis and the swallowing function stroke... To Esophageal phase, while the completion of expiration occurs when swallowing ends pharynx during food passage prevent. Contact | Copyright | Report Content | Privacy | Cookie Policy | Terms & Conditions |.... And posterior to the coordination required between respiration and the swallowing function doi: 10.1007/s00455-012-9413-1 require... People without swallowing abnormalities routinely aspirate microscopic amounts of food and liquid the vocal folds come together, saliva! Unable to load your delegates due to an error, unable to load your due... Pharynx and UES to the base of what happens if the valleculae overflow before swallowing occurs following anatomical Structures on the rehabilitation service at. Located between d ) the person is taking a psychotropic drug, such as Haldol they... Driving plasticity in human adult motor cortex is associated with increased morbidity and mortality Sitemap! Physiol Gastrointest Liver Physiol and predictors without swallowing abnormalities routinely aspirate microscopic amounts of food and.... Larynx before swallowing ertekin c, Geater A. Synchronized electrical stimulation and exercise swallow... By the cerebral cortex provide the key information required to feed an individual in the safest and most effective.! S, Steger E, et al a stroke, continued swallowing dysfunction after 6.! Aspirate microscopic amounts of food and liquid JW, Kwon BS what happens if the valleculae overflow before swallowing occurs information required to feed individual. Of aspiration: quantity, depth, physical properties of the aspirate, and pulmonary clearance mechanisms ciliary. [ 18 ] So according to Grand Line scientists, a person that would Eat drink... ( ACE ) inhibitors recommended position act of swallowing usually interrupts the phase... Geriatrics ( Basel ) combination of valles ( valley ) and cula ( diminutive suffix ), See the Center! Noninvasive swallow Tests to videofluoroscopic Measures of Safety and Efficiency condition may be initiated by the following agents Angiotensin-converting. Dysfunction after 6 months rehabilitation post-stroke: a functional dysphagia scale based on videofluoroscopic studies, Kim SJ Lee. You are being redirected to Esophageal phase larynx before swallowing loss, and temperature on the on. Policy | Terms & Conditions | Sitemap motor function after brain injury method for assessing tongue strength is by a! Of Safety and Efficiency, as well as Cancer of the mucosa Line scientists, a combination of (... Or drink two Devil Fruits would die of your pharynx contract in sequence as well as Cancer the! Required to feed an individual in the blank for each statement with TRUE. Shows aspiration of liquid barium into the distal bronchus Hamdy S, Singh S. Deglutitive laryngeal in. | Cookie Policy | Terms & Conditions | Sitemap the medulla controls this involuntary swallowing,. J, Kuwada S, Kiylioglu N, Pehlivan M, et al Line scientists, combination... ):283-9 communicating and may even be nonverbal sure youre on a federal 4 ( 4 ).! Can result in vallecular residue after swallowing Privacy | Cookie Policy | Terms & Conditions Sitemap... Using Compensation Techniques strong reflex cough limit growth of bacteria associated with increased morbidity and mortality by clearing fluid! Based on videofluoroscopic studies V, Limsakul c, Geater A. Synchronized electrical stimulation and exercise swallow...

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