how to create barcode in using c# DISORDERS OF THE AUTONOMIC NERVOUS SYSTEM, RESPIRATION, AND SWALLOWING 477 in Microsoft Office


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syringomyelia-syringobulbia and rarely multiple sclerosis, polio, and brainstem tumors may have the same effects; or (4) a less well de ned mechanism of slowed or discoordinated swallowing arising from corticospinal disease (pseudobulbar palsy, hemispheral stroke) or from diseases of the basal ganglia (mainly Parkinson disease) that alter the timing of breathing and swallowing and permit the airway to remain open as food passes through the posterior pharynx In the latter cases a decreased frequency of swallowing also causes saliva to pool in the mouth (leading to drooling) and adds to the risk of aspiration Although the case has been made above that swallowing is a brainstem re ex, aspiration and swallowing dif culty after severe stroke occur in a surprisingly large number of cases of cerebral infarction and hemiparesis without brainstem damage The problem is most evident during the rst few days after a hemispheral stroke on either side of the brain (Meadows) These effects last for weeks and render the patient subject to pneumonia and fever In the clinical and uoroscopic study by Mann and colleagues, half of patients still had manifest abnormalities of swallowing 6 months after their strokes Some insight into the nature of swallowing dysfunction after stroke is provided by Hamdy and colleagues, who correlated the presence of dysphagia with a lesser degree of motor representation of pharyngeal muscles in the unaffected hemisphere, as assessed by magnetic stimulation of the cortex
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Pain on swallowing occurs under a different set of circumstances, the one of most neurologic interest being glossopharyngeal neuralgia (pages 163 and 1185) Video uoroscopy has become a useful tool in determining the presence of aspiration during swallowing and in differentiating the several types of dysphagia The movement of the bolus by the tongue, the timing of re ex swallowing, and the closure of the pharyngeal and palatal openings are judged directly by observation of a bolus of food mixed with barium or of liquid barium alone However, authorities in the eld, such as Wiles, whose reviews are recommended (see also Hughes and Wiles), warn that unquali ed dependence on video uoroscopy is unwise They remark that observation of the patient swallowing water and repeated observation of the patient while eating can be equally informative Having the patient swallow water is a particularly effective test of laryngeal closure; the presence of coughing, wet hoarseness or breathlessness, and/or the need to swallow small volumes slowly are indicative of a high risk of aspiration Based on bedside observations and on video uoroscopy studies, an experienced therapist can make recommendations regarding the safety of oral feeding, changes in the consistency and texture of the diet, postural adjustments, and the need to insert a tracheostomy or feeding tube
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