Swallowing, ingestion and dysphagia: a reappraisal

Abnormalities of swallowing are unappreciated complications of many neurologic disorders. However, the standard phases of swallowing, with their emphasis on reflex aspects, inadequately account for dysphagia in many neurologic patients. Disorders of oral activity prior to swallow initiation may also be responsible for dysphagic symptoms. Therefore, the inclusion of the phases of deglutition within the more encompassing process of ingestion is proposed. The volitional component of food intake is stressed and its relationship to dysphagia in the neurologic patient is discussed. A general diagnostic and therapeutic approach is included.