title: Pharyngeal mis-sequencing in dysphagia: characteristics, rehabilitative response, and etiological speculation.
abstract: OBJECTIVE
  Clinical data are submitted as documentation of a pathophysiologic feature of dysphagia termed pharyngeal mis-sequencing and to encourage clinicians and researchers to adopt more critical approaches to diagnosis and treatment planning.
  
  
  BACKGROUND
  Recent clinical experience has identified a cohort of patients who present with an atypical dysphagia not specifically described in the literature: mis-sequenced constriction of the pharynx when swallowing. As a result, they are unable to coordinate streamlined bolus transfer from the pharynx into the esophagus. This mis-sequencing contributes to nasal redirection, aspiration, and, for some, the inability to safely tolerate an oral diet.
  
  
  METHODS
  Sixteen patients (8 females, 8 males), with a mean age of 44 years (range=25-78), had an average time post-onset of 23 months (range=2-72) at initiation of intensive rehabilitation. A 3-channel manometric catheter was used to measure pharyngeal pressure.
  
  
  RESULTS
  The average peak-to-peak latency between nadir pressures at sensor-1 and sensor-2 was 15 ms (95% CI, -2 to 33 ms), compared to normative mean latency of 239 ms (95% CI, 215 to 263 ms). Rehabilitative responses are summarized, along with a single detailed case report.
  
  
  CONCLUSIONS
  It is unclear from these data if pharyngeal mis-sequencing is (i) a pathological feature of impaired motor planning from brainstem damage or (ii) a maladaptive compensation developed in response to chronic dysphagia. Future investigation is needed to provide a full report of pharyngeal mis-sequencing, and the implications on our understanding of underlying neural control of swallowing.
authors: Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand. Electronic address: maggie-lee.huckabee@canterbury.ac.nz.
authors: Maggie-Lee
authors: ML
authors: Huckabee
authors: Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand.
authors: Kristin
authors: K
authors: Lamvik
authors: Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand; Department of Medical Physics & Bioengineering, Christchurch Hospital, New Zealand; Department of Medicine, University of Otago, Christchurch, New Zealand.
authors: Richard
authors: R
authors: Jones
mesh_terms: D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology* / Q000534:rehabilitation*; D056228:Feedback, Sensory / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010609:Pharyngeal Muscles / Q000503:physiopathology; D010614:Pharynx / Q000503:physiopathology*; D011930:Reaction Time / Q000502:physiology; D016896:Treatment Outcome
keywords: Central pattern generator; Deglutition; Dysphagia; Neurosurgery; Parkinson's disease; Stroke