Dysphagia in Stroke: A Prospective Study of Quantitative Aspects of Swallowing in Dysphagic Patients

This is a prospective study of 100 consecutive stroke patients. Within 24 h after stroke onset they were asked specifically about swallowing complaints and subjected to a clinical examination including neurologic examination, Mini-Mental test, and Barthel score. Dysphagic patients were examined with the repetitive oral suction swallow test (the ROSS test) for quantitative evaluation of oral and pharyngeal function at 24 h, after 1 week, and after 1 month. At 6 months, the patients were interviewed about persistent dysphagia. Seventy-two patients could respond reliably at 24 h after the stroke onset and 14 of these complained of dysphagia. Non-evaluable patients were either unconscious, aphasic, or demented. The presence of dysphagia was not influenced by age or other risk factors for stroke. Facial paresis, but no other clinical findings, were associated with dysphagia. Dysphagia 24 h after stroke increased the risk of pneumonia but did not influence the length of hospital stay, the manner of discharge from hospital, or the mortality. The initial ROSS test, during which the seated patient ingests water through a straw, was abnormal in all dysphagic stroke patients. One-third of the patients were unable to perform the test completely. Above all, dysfunction was disclosed during forced, repetitive swallow. All phases of the ingestion cycle were prolonged whereas the suction pressures, bolus volumes, and swallowing capacities were low. Abnormalities of quantitative swallowing variables decreased with time whereas the prevalences of swallowing incoordination and abnormal feeding-respiratory pattern became more frequent. After 6 months, 7 patients had persistent dysphagia. Five of these were initially non-evaluable because of unconsciousness, aphasia, or dementia.     

Pharmacological Treatment of Dysphagia in Stroke

The pharynx is important for a normal swallow and it has been suggested that pharmacological agents may play a role in the management of pharyngeal dysphagia, but none have been formally evaluated. A pilot double-blind, placebo-controlled study was undertaken in 17 hospitalized patients with persistent dysphagia 2 weeks after stroke. Patients were randomized to treatment with slow-release nifedipine 30 mg orally (n = 8) or placebo (n = 9) following specialist swallowing assessment and videofluoroscopy to exclude severe dysphagia. Videofluoroscopy was repeated after 4 weeks of treatment. Fourteen patients (active 6, placebo 8) completed the study. Two patients died (active 1, placebo 1) and 1 patient in the active group had to be withdrawn because of progressive heart failure. Initial assessment showed impairment in the pharyngeal phase with delayed triggering of swallow, poor laryngeal elevation, and prolonged pharyngeal transit times in all patients. Silent aspiration was seen in 4 patients (active 2, placebo 2). Improvement in swallowing was seen in 8 patients (active 5, placebo 3) at the end of 4 weeks. There were significant changes in the pharyngeal transit time (mean −1.34 second; 95% C.I. −2.56, −0.11) and swallow delay (mean −1.91 seconds; 95% C.I. −3.58, −0.24) in the active group suggesting improvement in the initiation of pharyngeal contractions and reduction in the time taken for the bolus to transverse the pharynx. A similar change was not seen in the placebo group. It is suggested that pharmacological agents such as nifedipine may have a role in the management of stroke-related dysphagia and merit further investigation.     

Swallowing Abnormalities after Acute Stroke: A Case Control Study

Dysphagia is a common and potentially fatal complication of acute stroke. However, the underlying pathophysiology, especially the relative importance of motor and sensory dysfunction, remains controversial. We conducted a case control study of 23 acute stroke patients (mean age = 72 yr) at a median of 6 days poststroke and 15 healthy controls (mean age = 76 yr). We used novel methods to assess swallowing in detail, including a timed videoendoscopic swallow study and oral sensory threshold testing using electrical stimulation. Vocal cord mobility and voluntary pharyngeal motor activity were impaired in the stroke group compared with the controls (p= 0.01 and 0.03). There was a delay during swallowing in the time to onset of epliglottic tilt in the stroke group, particularly for semisolids (p= 0.02) and solids (p= 0.01), consistent with a delay in initiation of the swallow. Sensory thresholds were not increased in the stroke group compared with controls. We conclude that pharyngeal motor dysfunction and a delay in swallow initiation are common after acute stroke. Vocal cord mobility is reduced, and this may result in reduced airway protection. We found no evidence to support the hypothesis that oropharyngeal sensory dysfunction is common after acute stroke.     

Dysphagia following Anterior Cervical Spine Surgery

Although previous reports have identified dysphagia as a potential complication of anterior cervical spine surgery (ACSS), current understanding of the nature and etiologies of ACSS-related dysphagia remains limited. The present study was undertaken to describe the patterns of dysphagia that may occur following ACSS. Thirteen patients who exhibited new-onset dysphagia following ACSS were studied retrospectively by means of chart review and videofluoroscopic swallow study analysis. Results indicated that a variety of swallowing impairments occurred following ACSS. In 2 patients, prevertebral soft tissue swelling near the surgical site, deficient posterior pharyngeal wall movement, and impaired upper esophageal sphincter opening were the most salient videofluoroscopic findings. In another 5 patients, the pharyngeal phase of swallowing was absent or very weak, with resulting aspiration in 3 cases. In contrast, an additional 4 patients exhibited deficits primarily of the oral preparatory and oral stages of swallowing including deficient bolus formation and reduced tongue propulsive action. Finally, 2 patients exhibited impaired oral preparatory and oral phases, a weak pharyngeal swallow, as well as prevertebral swelling. Thus, a variety of swallowing deficits, due possibly to neurological and/or soft tissue injuries, may occur following ACSS.     

Videofluorographic Study of Swallowing in Parkinson's Disease

We studied 16 patients with Parkinson's disease (PD) with dysphagia and 8 young and 7 elderly normal controls videofluorographically to evaluate the nature of swallowing disorders in PD patients. In 13 patients, abnormal findings in the oral phase were residue on the tongue or residue in the anterior and lateral sulci, repeated pumping tongue motion, uncontrolled bolus or premature loss of liquid, and piecemeal deglutition. Thirteen patients showed abnormal findings in the pharyngeal phase, including vallecular residue after swallow, residue in pyriform sinuses, and delayed onset of laryngeal elevation. Ten of these patients also showed abnormal findings in both the oral and pharyngeal phases. Aspiration was seen in 9 patients. The oral transit duration was significantly longer in the patients with and without aspiration than in the control subjects. The stage transition duration, pharyngeal transit duration, duration of the upper esophageal sphincter (UES) opening, and total swallow duration were significantly longer in the patients with and without aspiration than in the young controls, but were not longer than in the elderly controls. These durational changes in the pharyngeal phase of swallowing were similar to those in the elderly controls. The findings suggest that the disturbed motility in the oral phase of swallowing may be due to bradykinesia. Although PD patients with dysphagia evince a variety of swallowing abnormalities, the duration of pharyngeal swallowing may remain within the age-related range until the symptoms worsen.     

Effects of Physostigmine on Swallowing and Oral Motor Functions in Patients with Progressive Supranuclear Palsy: A Pilot Study

The purpose of this pilot study was to investigate whether cholinergic stimulation reduces swallowing and oral motor disturbances in patients with progressive supranuclear palsy (PSP). A controlled, double-blind crossover trial of physostigmine, a centrally active cholinesterase inhibitor, and placebo was conducted. Patients were randomized to a 10-day crossover placebo-controlled double-blind trial of physostigmine at their previously determined best dose administered orally every 2 hr, six times per day. Patients were evaluated with ultrasound imaging of the oropharynx and an oral motor examination at baseline and during the third or fourth days of each study phase (placebo and drug). Under the double-blind placebo-controlled conditions, patients showed no statistically significant improvement in oral motor functions or swallow durations. Because patients with PSP have increased sensitivity to cholinergic blockade compared with control subjects, studies with newer, more potent cholinergic stimulating agents need further exploration. Suggestions for future research include the evaluation of newer direct cholinergic agonists in the treatment of the less-impaired PSP patients who may have a greater number of cholinergic neurons preserved and the evaluation of combined therapies.     

Pneumonia in Stroke Patients: A Retrospective Study

This is a retrospective study of 378 consecutive stroke patients who were referred between June 1994 and June 1997 for videofluorographic study of oropharyngeal swallow. Patients who had radiation therapy, brain tumor, brain surgery, head and/or spinal cord trauma, oral–pharyngeal disease or surgery, or other neurologic diseases in addition to the stroke were excluded from the study. Patients were assigned to two groups: one with pneumonia and one without pneumonia. One hundred one patients were included in the pneumonia group, and 277 patients were included in the nonpneumonia group. Within the pneumonia group, patients were assigned to an acute pneumonia group (pneumonia within 6 months poststroke) and a chronic pneumonia group (pneumonia more than 6 months poststroke). Variables examined in the study included patients' medical history and the findings from the videofluorographic studies. Pearson chi-square analysis was used to identify those variables that were significantly different between the pneumonia and nonpneumonia patient groups and between the acute and chronic pneumonia groups. Results showed that stroke patients who developed pneumonia had a significantly higher incidence of multiple-location and unspecified lesion strokes, chronic airway disease in their medical history, and aspiration during the videofluorographic studies when compared with patients who did not develop pneumonia. Within the pneumonia group, the acute pneumonia group was found to have a significantly higher incidence of hypertension and diabetes in their medical history and a significantly higher incidence of aspiration and reduced laryngeal elevation during the videofluorographic studies. Between 48% and 55% of all stroke patients in the study aspirated. Patients who suffered multiple strokes, brainstem stroke, or subcortical stroke had the greatest frequency of aspiration.     

A Preliminary Comparison of Videofluoroscopy of Swallow and Pulse Oximetry in the Identification of Aspiration in Dysphagic Patients

Pulse oximetry has recently received attention in the dysphagia literature because of its possible contribution to the management of neurogenic dysphagia. The present study was devised to examine whether pulse oximetry could be exploited to determine episodes of aspiration in patients with known dysphagia of neurologic origin. To this end, pulse oximetry was undertaken in six patients undergoing videofluoroscopic study of swallow. Normal controls also underwent pulse oximetry during feeding. The results indicate that there is no clear-cut relationship between changes in arterial oxygenation and aspiration. However, some support is found for the association between altered arterial oxygenation and oral feeding in dysphagic individuals. Further research in both normals and compromised individuals is needed.     

The Natural History of Dysphagia following a Stroke

To assess the frequency and natural history of swallowing problems following an acute stroke, 121 consecutive patients admitted within 24 hours of the onset of their stroke were studied prospectively. The ability to swallow was assessed repeatedly by a physician, a speech and language therapist, and by videofluoroscopy. Clinically 51% (61/121) of patients were assessed as being at risk of aspiration on admission. Many swallowing problems resolved over the first 7 days, through 28/110 (27%) were still considered at risk by the physician. Over a 6-month period, most problems had resolved, but some patients had persistent difficulties (6, 8%), and a few (2, 3% at 6 months) had developed swallowing problems. Ninety-five patients underwent videofluoroscopic examination within a median time of 2 days; 21 (22%) were aspirating. At 1 month a repeat examination showed that 12 (15%) were aspirating. Only 4 of these were persistent; the remaining 8 had not been previously identified. This study has confirmed that swallowing problems following acute stroke are common, and it has been documented that the dysphagia may persist, recur in some patients, or develop in others later in the history of their stroke.     

Treatment of Dysphagia Improves Nutritional Conditions in Stroke Patients

Dysphagia is a common symptom in stroke patients, and malnutrition is prevalent among these patients. Thus far, nutritional effects of dysphagic treatment have not been evaluated. The aim of the present report was to study the effects of swallowing techniques on nutritional and anthropometric variables. A survey with follow-up was performed at the Departments of Geriatric Medicine and Neurology, Malm? University Hospital, Sweden. Thirty-eight stroke patients, 53-89 years of age, with subjective complaints of dysphagia and oral/pharyngeal dysfunction according to videofluoroscopic barium swallowing examination (VSBE), were given swallowing treatment. The treatment included oral motor exercise, different swallowing techniques, positioning, and diet modification. Plasma protein levels, body composition, VSBE, and a viso-analogical scale for subjective complaints were repeated before and after treatment. At baseline, 94% of cases had signs of penetration and 50-72% had plasma protein levels below recommended levels. Treatment reduced the degree of oral dysfunction, (dissociation) and pharyngeal dysfunction (penetration and constrictor paresis). Sixty percent of cases showed an improved overall VSBE score, and improved levels of albumin and total iron-binding capacity were restricted to this group. In cases with unchanged or decreased VSBE score, body weight was reduced and a negative correlation to total iron-binding capacity was noted (r = -0.60, p < 0.05). Changes of subjective complaints did not correlate with swallowing function or nutritional improvements. Swallowing treatment improves swallowing function, and improved swallowing function is associated with improvements in nutritional parameters. Subjective complaints is not sufficient to evaluate the clinical course, and nutritional parameters should be monitored in patients with oral or pharyngeal dysfunction.     

Learning about the Dynamic Swallowing Process Using an Interactive Multimedia Program

The management of dysphagia is the largest recognized subspecialty in the field of speech-language pathology. Practicing speech-language pathologists require a comprehensive theoretical and functional knowledge base to underpin the safe and effective management of people with dysphagia. Students need to develop an understanding of the normal integrated swallow and how it can be affected to appreciate the assessment or treatment of dysphagia. Although students are well motivated to learn this material, assimilating knowledge of the dynamic nature of the swallow has typically been problematic because of its complex character. The limitations of currently available teaching resources have been addressed by the production of an interactive multimedia program that includes integrated presentation of text, graphics, voice-overs, and video and animation sequences to highlight various aspects of the swallowing process. Students can selectively manipulate parts of this process to understand the normal swallow and to simulate different aspects of dysfunction and the consequent effects on swallow safety and efficiency. Feedback from students, faculty, and experts has demonstrated that The Dynamic Swallow would be a valued tool in the teaching of dysphagia.     

Clinical and Radiologic Evaluation Reveals High Prevalence of Abnormalities in Young Adults with Dysphagia

The purpose of this study was to retrospectively evaluate the radiologic findings in young adults with dysphagia undergoing barium swallow and to compare these with the final clinical diagnosis. Clinical history, barium swallow, endoscopy (21 patients), manometry (18 patients), 24 h pH monitoring (4 patients), and outcome of treatments were studied and compared in 43 patients aged 14–30 years (mean 24 years). There were 26 men and 17 women. Duration of symptoms varied between 2 weeks and 22 years and included globus (n = 22), obstruction (n = 31), water brash (n = 6), classic reflux symptoms (n = 10), atypical reflux symptoms (n = 9), slow eating (n = 6), and vomiting (n = 11). The final diagnosis was achalasia (n = 2), arteria lusoria (n = 1), esophagitis (n = 1), esophageal dysfunction (n = 11), esophageal stricture (n = 5), gastroesophageal reflux disease (n = 8), and pharyngeal dysfunction (n = 2). Thirteen patients were assessed to be normal. The result of the barium swallow was in agreement with the final diagnosis in all but 3 patients who were assessed as normal, and the final diagnosis was esophagitis (n = 1), dysmotility (n = 1), and reflux disease (n = 1). Anatomic and functional abnormalities are common in young adults with dysphagia. Barium swallow reveals the explanation of the symptoms in 70% of such patients. Radiology therefore should be the method of choice for the investigation of dysphagic young adults.     

Oropharyngeal Dysphagia in Esophageal Cancer Before and After Transhiatal Esophagectomy

Although dysphagia is the predominant symptom of esophageal cancer, the nature of the swallowing deficit remains unclear, particularly regarding an oropharyngeal motor component. The present study examined the oropharyngeal swallow in patients with esophageal cancer before and following transhiatal esophagectomy. Videofluoroscopic data were obtained from ten patients with esophageal cancer before and following transhiatal esophagectomy as they swallowed 2-, 5-, and 10-cc aliquots of liquid and puree, and 0.5 and 1 tsp of solid. Each swallow was rated on 36 parameters by three independent judges. Swallow-related hyoid bone movement, computed from digitized segments of the videofluoroscopic data, was compared pre- and postsurgically. All patients showed at least mild abnormality of the oropharyngeal swallow preoperatively. Abnormalities involved all stages of swallowing in nine of the ten patients; however, the oral preparatory/oral stage was relatively more impaired than the pharyngeal stage in the majority of patients. Postsurgically, all patients exhibited at least a mild oropharyngeal swallowing impairment. New or increased postoperative deficits involved the pharyngeal stage of swallowing, whereas oral stage abnormalities were generally improved or unchanged following surgery. Swallow-related hyoid kinematics were highly variable both before and following surgery. Anterior hyoid bone excursion was significantly reduced postoperatively in one patient and significantly increased in one patient. Patients with esophageal cancer exhibit oropharyngeal dysphagia, with different profiles of abnormality before and following esophagectomy.     

Evaluating Oral Stimulation as a Treatment for Dysphagia after Stroke

Deglutitive aspiration is common after stroke and can have devastating consequences. While the application of oral sensory stimulation as a treatment for dysphagia remains controversial, data from our laboratory have suggested that it may increase corticobulbar excitability, which in previous work was correlated with swallowing recovery after stroke. Our study assessed the effects of oral stimulation at the faucial pillar on measures of swallowing and aspiration in patients with dysphagic stroke. Swallowing was assessed before and 60 min after 0.2-Hz electrical or sham stimulation in 16 stroke patients (12 male, mean age = 73 ± 12 years). Swallowing measures included laryngeal closure (initiation and duration) and pharyngeal transit time, taken from digitally acquired videofluoroscopy. Aspiration severity was assessed using a validated penetration-aspiration scale. Preintervention, the initiation of laryngeal closure, was delayed in both groups, occurring 0.66 ± 0.17 s after the bolus arrived at the hypopharynx. The larynx was closed for 0.79 ± 0.07 s and pharyngeal transit time was 0.94 ± 0.06 s. Baseline swallowing measures and aspiration severity were similar between groups (stimulation: 24.9 ± 3.01; sham: 24.9 ± 3.3, p = 0.2). Compared with baseline, no change was observed in the speed of laryngeal elevation, pharyngeal transit time, or aspiration severity within subjects or between groups for either active or sham stimulation. Our study found no evidence for functional change in swallow physiology after faucial pillar stimulation in dysphagic stroke. Therefore, with the parameters used in this study, oral stimulation does not offer an effective treatment for poststroke patients.Abbreviations: mA = milliamps; FP = faucial pillar; LCD = laryngeal closure duration; OTT = oral transit time; PTT = pharyngeal transit time; SRT = swallow response time; TMS = transcranial magnetic stimulation; UES = upper esophageal sphincter.     

Dysphagia—Ingestion or Deglutition?: A Proposed Paradigm

The current classifications of dysphagia are based on local structural or central nervous system pathology causing dysfunction of the aerodigestive tract. The result is a clinical science grounded in the analysis of the swallow with its lingual, pharyngeal, and esophageal stages. Adding bolus preparation to the swallowing paradigm improves but still constrains the study of dysphagia and treatment of the dysphagic patient. Those pre-oral facets of mealtime behavior that may evoke or exacerbate dysphagia remain beyond the existing classification boundaries imposed by the conceptual swallow and anatomic aerodigestive tract. We offer a more inclusive strategy for investigating dysphagia based on a five-stage process of ingestion: pre-oral (anticipatory), preparatory, lingual, pharyngeal, and esophageal. The first stage considers the interaction of pre-oral motor, cognitive, psychosocial, and somataesthetic elements engendered by the meal. The limited literature regarding the interaction of the pre-oral stage with other ingestion stages, in both normal subjects and patients with cortical, basal ganglia, and psychogenic diseases, is reviewed. The neurophysiologic and clinical justifications for embracing a pre-oral stage, and thus for the paradigm shift from deglutition to ingestion, are presented.     

Rehabilitation of Neurogenic Dysphagia with Percutaneous Endoscopic Gastrostomy

Neurogenic oropharyngeal dysphagia is common in nursing home populations, and the risk of aspiration is sufficient to indicate the need for percutaneous endoscopid gastrostomy (PEG) feedings. Although intake provided through the PEG may meet the nutritional and hydration requirements for this group of patients, the risk of complication, e.g., aspiration of reflux, skin breakdown at the site of insertion, potential for infection, digestive difficulties, higher risk of rehospitalization, pneumonia, prolonged nursing home stay, and greater morbidity than for those without PEG tubes, may compromise the gains accrued from the ease of feeding. In an attempt to reduce these complications and return individuals to per orum (PO) diets, a program was developed to treat the dysphagia. Sixteen male nursing home patients were enrolled in a treatment program based on videofluoroscopic examination. Interventions included combinations of dietary consistency modifications, compensatory techniques, and direct swallow retraining. Results indicated such an approach reintroduced successful oral feeding in all patients, improved dietary consistency, resulted in a mean weight gain of 5.1 pounds, yielded a mean albumin increase of 0.5 g/dl, and allowed PEG tubes to be removed in 10 of the 16 patients. As a result of intervention, these findings suggest significant benefits in both quality of life issues and health care savings for this neurogenically based population.     

The Role of the Insular Cortex in Dysphagia

Recent data indicate that dysphagia may occur following unilateral cortical stroke; however, the elucidation of specific cytoarchitectonic sites that produce deglutition disorders remains unclear. In a previous study of unilateral cortical stroke patients with dysphagia, Daniels et al. [8] proposed that the insula may be important in swallowing as it was the most common lesion site in the patients studied. Therefore, 4 unilateral stroke patients with discrete lesions of the insular cortex were studied to further facilitate understanding of the role of the insula in swallowing. Dysphagia, as confirmed by videofluoroscopy, was evident in 3 of the 4 patients; all had lesions that involved the anterior insula, whereas the only patient without dysphagia had a lesion restricted to the posterior insula. These data suggest that the anterior insula may be an important cortical substrate in swallowing. The anterior insula has connections to the primary and supplementary motor cortices, the ventroposterior medial nucleus of the thalamus, and to the nucleus tractus solitarius, all of which are important regions in the mediation of oropharyngeal swallowing. Therefore, discrete lesions of the anterior insula may disrupt these connections and, thereby, produce dysphagia.     

The Dysphagia Outcome and Severity Scale

The Dysphagia Outcome and Severity Scale (DOSS) is a simple, easy-to-use, 7-point scale developed to systematically rate the functional severity of dysphagia based on objective assessment and make recommendations for diet level, independence level, and type of nutrition. Intra- and interjudge reliabilities of the DOSS was established by four clinicians on 135 consecutive patients who underwent a modified barium swallow procedure at a large teaching hospital. Patients were assigned a severity level, independence level, and nutritional level based on three areas most associated with final recommendations: oral stage bolus transfer, pharyngeal stage retention, and airway protection. Results indicate high interrater (90%) and intrarater (93%) agreement with this scale. Implications are suggested for use of the DOSS in documenting functional outcomes of swallowing and diet status based on objective assessment.     

Outcomes of Swallowing Rehabilitation in Chronic Brainstem Dysphagia: A Retrospective Evaluation

This study examines the functional and physiologic outcomes of treatment in a group of 10 patients with chronic dysphagia subsequent to a single brainstem injury. All patients participated in a structured swallowing treatment program at a metropolitan teaching hospital. This program differs from more traditional swallowing treatment by the inclusion of surface electromyography biofeedback as a treatment modality and the completion of 10 hr of direct treatment in the first week of intervention. A retrospective analysis of medical records and patient questionnaires was used to gain information regarding medical history, site of lesion, prior interventions, and patient perception of swallowing recovery. Physiologic change in swallowing treatment, as measured by severity ratings of videofluoroscopic swallowing studies, was demonstrated in nine of 10 patients after 1 week or 10 sessions of treatment. Functional change was measured by diet level tolerance after 1 week of treatment, at 6 months, and again at 1 year posttreatment. Eight of the 10 patients were able to return to full oral intake with termination of gastrostomy tube feedings, whereas two demonstrated no long-term change in functional swallowing. Of the eight who returned to full oral intake, the average duration of tube feedings following treatment until discontinuation was 5.3 months, with a range of 1–12 months. Six patients who returned to oral intake maintained gains in swallowing function, and two patients returned to nonoral nutrition as the result of a new unrelated medical condition.     

Lateral Pharyngeal Wall Motion during Swallowing Using Real Time Ultrasound

B-mode ultrasound imaging has been used primarily to detect temporal and spatial movements of the tongue during the oral preparatory and oral stages of swallowing. The purpose of this study was to investigate the application of M-mode (motion mode) ultrasound imaging as a method to quantify the duration and displacement of single regions along the lateral pharyngeal wall during swallows of two bolus volumes and during three swallow maneuvers (supraglottic, super-supraglottic and Mendelsohn maneuver). In 5 normal subjects, simultaneous B/M-mode images were captured at two regions along the lateral pharyngeal wall. Computer-assisted video analysis of each swallow sequence provided spatial coordinates and durational measures. Results indicated no significant differences in displacements of the lateral pharyngeal wall across bolus volumes, swallow maneuvers, or recording sites. Significant differences (p < 0.001) in lateral pharyngeal wall duration occurred as a function of volitional swallow maneuvers. Greater durations (p < 0.05) were found for the Mendelsohn and super-supraglottic swallow maneuvers. The data demonstrate that B/M-mode ultrasound imaging provides a simple, noninvasive method to visually examine movements of the lateral pharyngeal wall and may provide a clinical method for assessing the effects of direct swallowing therapies at the level of the mid-oropharynx.