Skip to main content

Advertisement

SpringerLink
Log in

Electrokinesiographic Study of Oropharyngeal Swallowing in Neurogenic Dysphagia

  • Review
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

Electrokinesiographic study of swallowing (EKSS) can be useful for the assessment of patients with suspected or overt neurogenic dysphagia. EKSS consists of multichannel recording of the electromyographic (EMG) activity of the suprahyoid/submental muscle complex (SHEMG), the EMG activity of the cricopharyngeal muscle (CPEMG), and the laryngopharyngeal mechanogram (LPM). The LPM is an expression of the mechanical changes that the laryngopharyngeal structures undergo during the pharyngeal phase of swallowing. This method allows detailed evaluation of the magnitude, duration and temporal relations of the different events that characterize oropharyngeal swallowing, and thus in-depth exploration both of physiological deglutition mechanisms and of pathophysiological features of swallowing in neurogenic dysphagia. Furthermore, EKSS can guide dysphagia treatment strategies, allowing identification of optimal solutions for single patients. For instance, CPEMG recording can identify incomplete or absent relaxation of the upper esophageal sphincter during the pharyngeal phase of swallowing, thus suggesting a therapeutic approach based on botulinum toxin injection into the cricopharyngeal muscle. More recently, the ‘shape’ of SHEMG and the reproducibility of both SHEMG and LPM over repeated swallowing acts have been implemented as novel electrokinesiographic parameters. These measures could be valuable for straightforward non-invasive investigation of dysphagia severity and response to dysphagia treatment in clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Bass NH, Morrell RM. The neurology of swallowing. In: Groher ME, editor. Dysphagia, diagnosis and management. 2nd ed. Boston, Massachusetts: Butterworth-Heinemann; 1992. p. 1–30.

    Google Scholar 

  2. Jean A. Brain stem control of swallowing: neuronal network and cellular mechanisms. Physiol Rev. 2001;81:929–69. https://doi.org/10.1152/physrev.2001.81.2.929.

    Article  CAS  PubMed  Google Scholar 

  3. Martin-Harris B. Coordination of respiration and swallowing. GI Motility online. 2006. https://doi.org/10.1038/gimo10.

    Article  Google Scholar 

  4. Zito A, Bini P, Todisco M, Cosentino G, Mauramati S, Paoletti M, Marasco V, Marchioni E, Alfonsi E. A rare syndrome causing neurogenic dysphagia. Dysphagia. 2020. https://doi.org/10.1007/s00455-020-10208-w.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Zald DH, Pardo JV. The functional neuroanatomy of voluntary swallowing. Ann Neurol. 1999;46:281–6. https://doi.org/10.1002/1531-8249(199909)46:3%3c281::AID-ANA2%3e3.0.CO;2-L.

    Article  CAS  PubMed  Google Scholar 

  6. Martin RE, MacIntosh BJ, Smith RC, Barr AM, Stevens TK, Gati JS, Menon RS. Cerebral areas processing swallowing and tongue movement are overlapping but distinct: a functional magnetic resonance imaging study. J Neurophysiol. 2004;92:2428–43. https://doi.org/10.1152/jn.01144.2003.

    Article  PubMed  Google Scholar 

  7. Mosier K, Patel R, Liu WC, Kalnin A, Maldjian J, Baredes S. Cortical representation of swallowing in normal adults: functional implications. Laryngoscope. 1999;109:1417–23. https://doi.org/10.1097/00005537-199909000-00011.

    Article  CAS  PubMed  Google Scholar 

  8. Kern MK, Jaradeh S, Arndorfer RC, Shaker R. Cerebral cortical representation of reflexive and volitional swallowing in humans. Am J Physiol Gastrointest Liver Physiol. 2001;280:G354-360. https://doi.org/10.1152/ajpgi.2001.280.3.G354.

    Article  CAS  PubMed  Google Scholar 

  9. Hamdy S, Aziz Q, Rothwell JC, Singh KD, Barlow J, Hughes DG, Tallis RC, Thompson DG. The cortical topography of human swallowing musculature in health and disease. Nat Med. 1996;2:1217–24. https://doi.org/10.1038/nm1196-1217.

    Article  CAS  PubMed  Google Scholar 

  10. Hamdy S, Rothwell JC, Brooks DJ, Bailey D, Aziz Q, Thompson DG. Identification of the cerebral loci processing human swallowing with H2(15)O PET activation. J Neurophysiol. 1999;81:1917–26. https://doi.org/10.1152/jn.1999.81.4.1917.

    Article  CAS  PubMed  Google Scholar 

  11. Abe S, Wantanabe Y, Shintani M, Tazaki M, Takahashi M, Yamane GY, Ide Y, Yamada Y, Shimono M, Ishikawa T. Magnetoencephalographic study of the starting point of voluntary swallowing. Cranio. 2003;21:46–9. https://doi.org/10.1080/08869634.2003.11746231.

    Article  PubMed  Google Scholar 

  12. Penfield W, Boldrey E. Somatic motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation. Brain. 1937;60:389–443. https://doi.org/10.1093/brain/60.4.389.

    Article  Google Scholar 

  13. Barker AT, Jalinous R, Freeston IL. Non-invasive magnetic stimulation of human motor cortex. Lancet. 1985;1:1106–7. https://doi.org/10.1016/s0140-6736(85)92413-4.

    Article  CAS  PubMed  Google Scholar 

  14. Jestrović I, Coyle JL, Sejdić E. Decoding human swallowing via electroencephalography: a state-of-the-art review. J Neural Eng. 2015;12: 051001. https://doi.org/10.1088/1741-2560/12/5/051001.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hamdy S, Mikulis DJ, Crawley A, Xue S, Lau H, Henry S, Diamant NE. Cortical activation during human volitional swallowing: an event-related fMRI study. Am J Physiol. 1999;277:G219-225. https://doi.org/10.1152/ajpgi.1999.277.1.G219.

    Article  CAS  PubMed  Google Scholar 

  16. Alfonsi E, Versino M, Merlo IM, Pacchetti C, Martignoni E, Bertino G, Moglia A, Tassorelli C, Nappi G. Electrophysiologic patterns of oral-pharyngeal swallowing in parkinsonian syndromes. Neurology. 2007;68:583–9. https://doi.org/10.1212/01.wnl.0000254478.46278.67.

    Article  CAS  PubMed  Google Scholar 

  17. Miller AJ. The neuroscientific principles of swallowing and dysphagia. San Diego, California: Singular Publishing Group; 1999. p. 100–1.

    Google Scholar 

  18. Mosier K, Bereznaya I. Parallel cortical networks for volitional control of swallowing in humans. Exp Brain Res. 2001;140:280–9. https://doi.org/10.1007/s002210100813.

    Article  CAS  PubMed  Google Scholar 

  19. Martin RE, Goodyear BG, Gati JS, Menon RS. Cerebral cortical representation of automatic and volitional swallowing in humans. J Neurophysiol. 2001;85:938–50. https://doi.org/10.1152/jn.2001.85.2.938.

    Article  CAS  PubMed  Google Scholar 

  20. McCullough GH, Wertz RT, Rosenbek JC, Mills RH, Webb WG, Ross KB. Inter- and intrajudge reliability for videofluoroscopic swallowing evaluation measures. Dysphagia. 2001;16:110–8. https://doi.org/10.1007/PL00021291.

    Article  CAS  PubMed  Google Scholar 

  21. Roman S, Huot L, Zerbib F, Bruley des Varannes S, Gourcerol G, Coffin B, Ropert A, Roux A, Mion F. High-resolution manometry improves the diagnosis of esophageal motility disorders in patients with dysphagia: a randomized multicenter study. Am J Gastroenterol. 2016;111:372–80. https://doi.org/10.1038/ajg.2016.1.

    Article  PubMed  Google Scholar 

  22. Sundaram PS, Subramanyam P. Scintigraphic evaluation of swallowing. In: Thankappan K, Iyer S, Menon JR (eds) Dysphagia management in head and neck cancers. Springer; 2018, p. 89–100

  23. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11:93–8. https://doi.org/10.1007/BF00417897.

    Article  CAS  PubMed  Google Scholar 

  24. Langmore SE, Schatz K, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia. 1988;2:216–9. https://doi.org/10.1007/BF02414429.

    Article  CAS  PubMed  Google Scholar 

  25. Ertekin C, Pehlivan M, Aydoğdu I, Ertaş M, Uludağ B, Celebi G, Colakoğlu Z, Sağduyu A, Yüceyar N. An electrophysiological investigation of deglutition in man. Muscle Nerve. 1995;18:1177–86. https://doi.org/10.1002/mus.880181014.

    Article  CAS  PubMed  Google Scholar 

  26. Logemann JA. Evaluation and treatment of swallowing disorders, 2nd edn. Pro-Ed, Austin, Texas; 1998.

  27. Goyal RK, Paterson WG. Esophageal motility. In: Wood JD (ed) Handbook of physiology, the gastrointestinal system. Bethesda, Maryland; 1989, section 6, volume I (pt 2), chapter 22, p. 865–908.

  28. Lang IM. Upper esophageal sphincter. GI Motility online. 2006. https://doi.org/10.1038/gimo12.

    Article  Google Scholar 

  29. Lang IM, Shaker R. An overview of the upper esophageal sphincter. Curr Gastroenterol Rep. 2000;2:185–90. https://doi.org/10.1007/s11894-000-0059-z.

    Article  CAS  PubMed  Google Scholar 

  30. Sivarao DV, Goyal RK. Functional anatomy and physiology of the upper esophageal sphincter. Am J Med. 2000;108:27S-37S. https://doi.org/10.1016/s0002-9343(99)00337-x.

    Article  PubMed  Google Scholar 

  31. Alfonsi E, Bergamaschi R, Cosentino G, Ponzio M, Montomoli C, Restivo DA, Brighina F, Ravaglia S, Prunetti P, Bertino G, Benazzo M, Fontana D, Moglia A. Electrophysiological patterns of oropharyngeal swallowing in multiple sclerosis. Clin Neurophysiol. 2013;124:1638–45. https://doi.org/10.1016/j.clinph.2013.03.003.

    Article  CAS  PubMed  Google Scholar 

  32. Alfonsi E, Cosentino G, Mainardi L, Schindler A, Fresia M, Brighina F, Benazzo M, Moglia A, Alvisi E, Fierro B, Sandrini G. Electrophysiological investigations of shape and reproducibility of oropharyngeal swallowing: interaction with bolus volume and age. Dysphagia. 2015;30:540–50. https://doi.org/10.1007/s00455-015-9634-1.

    Article  PubMed  Google Scholar 

  33. Ertekin C, Aydoğdu I, Yüceyar N. Piecemeal deglutition and dysphagia limit in normal subjects and in patients with swallowing disorders. J Neurol Neurosurg Psychiatry. 1996;61:491–6. https://doi.org/10.1136/jnnp.61.5.491.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Gokyigit MC, Pazarci NK, Ercan I, Seker S, Turgut S, Ertekin C. Identification of distinct swallowing patterns for different bolus volumes. Clin Neurophysiol. 2009;120:1750–4. https://doi.org/10.1016/j.clinph.2009.07.039.

    Article  PubMed  Google Scholar 

  35. Bülow M. Psychogenic dysphagia. In: Shaker R, Belafsky PC, Postma GN, Easterling C, editors. Principles of deglutition. A multidisciplinary text for swallowing and its disorders: Springer; 2013. p. 771–6.

    Chapter  Google Scholar 

  36. DeLong MR, Wichmann T. Circuits and circuit disorders of the basal ganglia. Arch Neurol. 2007;64:20–4. https://doi.org/10.1001/archneur.64.1.20.

    Article  PubMed  Google Scholar 

  37. Hallett M. Parkinson revisited: pathophysiology of motor signs. Adv Neurol. 2003;91:19–28.

    PubMed  Google Scholar 

  38. Tsujimura T, Suzuki T, Yoshihara M, Sakai S, Koshi N, Ashiga H, Shiraishi N, Tsuji K, Magara J, Inoue M. Involvement of hypoglossal and recurrent laryngeal nerves on swallowing pressure. J Appl Physiol. 2018;124:1148–54. https://doi.org/10.1152/japplphysiol.00944.2017.

    Article  PubMed  Google Scholar 

  39. McCulloch TM, Jaffe D. Head and neck disorders affecting swallowing. GI Motility online. 2006. https://doi.org/10.1038/gimo36.

    Article  Google Scholar 

  40. Cowan AJ, Skinner M, Berk JL, Sloan JM, O’hara C, Seldin DC, Sanchorawala V. Macroglossia - not always AL amyloidosis. Amyloid. 2011;18:83–6. https://doi.org/10.3109/13506129.2011.560217.

    Article  PubMed  Google Scholar 

  41. Jones HN, Muller CW, Lin M, Banugaria SG, Case LE, Li JS, O’Grady G, Heller JH, Kishnani PS. Oropharyngeal dysphagia in infants and children with infantile Pompe disease. Dysphagia. 2010;25:277–83. https://doi.org/10.1007/s00455-009-9252-x.

    Article  PubMed  Google Scholar 

  42. Wittmann AL. Macroglossia in acromegaly and hypothyroidism. Virchows Arch A Pathol Anat Histol. 1977;373:353–60. https://doi.org/10.1007/BF00432533.

    Article  CAS  PubMed  Google Scholar 

  43. Ertekin C, Aydogdu I, Yüceyar N, Kiylioglu N, Tarlaci S, Uludag B. Pathophysiological mechanisms of oropharyngeal dysphagia in amyotrophic lateral sclerosis. Brain. 2000;123:125–40. https://doi.org/10.1093/brain/123.1.125.

    Article  PubMed  Google Scholar 

  44. Barbiera F, Condello S, De Palo A, Todaro D, Mandracchia C, De Cicco D. Role of videofluorography swallow study in management of dysphagia in neurologically compromised patients. Radiol Med. 2006;111:818–27. https://doi.org/10.1007/s11547-006-0075-7.

    Article  CAS  PubMed  Google Scholar 

  45. Briani C, Marcon M, Ermani M, Costantini M, Bottin R, Iurilli V, Zaninotto G, Primon D, Feltrin G, Angelini C. Radiological evidence of subclinical dysphagia in motor neuron disease. J Neurol. 1998;245:211–6. https://doi.org/10.1007/s004150050207.

    Article  CAS  PubMed  Google Scholar 

  46. Cosentino G, Alfonsi E, Mainardi L, Alvisi E, Brighina F, Valentino F, Fierro B, Sandrini G, Bertino G, Berlangieri M, De Icco R, Fresia M, Moglia A. The importance of the reproducibility of oropharyngeal swallowing in amyotrophic lateral sclerosis. An electrophysiological study. Clin Neurophysiol. 2017;128:792–8. https://doi.org/10.1016/j.clinph.2017.02.006.

    Article  CAS  PubMed  Google Scholar 

  47. Aydogdu I, Ertekin C, Tarlaci S, Turman B, Kiylioglu N, Secil Y. Dysphagia in lateral medullary infarction (Wallenberg’s syndrome): an acute disconnection syndrome in premotor neurons related to swallowing activity? Stroke. 2001;32:2081–7. https://doi.org/10.1161/hs0901.094278.

    Article  CAS  PubMed  Google Scholar 

  48. Umay EK, Unlu E, Saylam GK, Cakci A, Korkmaz H. Evaluation of dysphagia in early stroke patients by bedside, endoscopic, and electrophysiological methods. Dysphagia. 2013;28:395–403. https://doi.org/10.1007/s00455-013-9447-z.

    Article  PubMed  Google Scholar 

  49. Alfonsi E, Merlo IM, Ponzio M, Montomoli C, Tassorelli C, Biancardi C, Lozza A, Martignoni E. An electrophysiological approach to the diagnosis of neurogenic dysphagia: implications for botulinum toxin treatment. J Neurol Neurosurg Psychiatry. 2010;81:54–60. https://doi.org/10.1136/jnnp.2009.174698.

    Article  CAS  PubMed  Google Scholar 

  50. Alfonsi E, Restivo DA, Cosentino G, De Icco R, Bertino G, Schindler A, Todisco M, Fresia M, Cortese A, Prunetti P, Ramusino MC, Moglia A, Sandrini G, Tassorelli C. Botulinum toxin is effective in the management of neurogenic dysphagia. Clinical-electrophysiological findings and tips on safety in different neurological disorders. Front Pharmacol. 2017;8:80. https://doi.org/10.3389/fphar.2017.00080.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Baijens LW, Speyer R. Effects of therapy for dysphagia in Parkinson’s disease: systematic review. Dysphagia. 2009;24:91–102. https://doi.org/10.1007/s00455-008-9180-1.

    Article  PubMed  Google Scholar 

  52. McFarland NR, Hess CW. Recognizing atypical parkinsonisms: “red flags” and therapeutic approaches. Semin Neurol. 2017;37:215–27. https://doi.org/10.1055/s-0037-1602422.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Jaradeh S. Muscle disorders affecting oral and pharyngeal swallowing. GI Motility online. 2006. https://doi.org/10.1038/gimo35.

    Article  Google Scholar 

  54. Daniels SK. Neurological disorders affecting oral, pharyngeal swallowing. GI Motility online. 2006. https://doi.org/10.1038/gimo34.

    Article  Google Scholar 

  55. Ertekin C, Tarlaci S, Aydogdu I, Kiylioglu N, Yuceyar N, Turman AB, Secil Y, Esmeli F. Electrophysiological evaluation of pharyngeal phase of swallowing in patients with Parkinson’s disease. Mov Disord. 2002;17:942–9. https://doi.org/10.1002/mds.10240.

    Article  PubMed  Google Scholar 

  56. Seçil Y, Arıcı Ş, İncesu TK, Gürgör N, Beckmann Y, Ertekin C. Dysphagia in Alzheimer’s disease. Neurophysiol Clin. 2016;46:171–8. https://doi.org/10.1016/j.neucli.2015.12.007.

    Article  PubMed  Google Scholar 

  57. Jones CA, Hammer MJ, Hoffman MR, McCulloch TM. Quantifying contributions of the cricopharyngeus to upper esophageal sphincter pressure changes by means of intramuscular electromyography and high-resolution manometry. Ann Otol Rhinol Laryngol. 2014;123:174–82. https://doi.org/10.1177/0003489414522975.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Müller J, Wenning GK, Verny M, McKee A, Chaudhuri KR, Jellinger K, Poewe W, Litvan I. Progression of dysarthria and dysphagia in postmortem-confirmed parkinsonian disorders. Arch Neurol. 2001;58:259–64. https://doi.org/10.1001/archneur.58.2.259.

    Article  PubMed  Google Scholar 

  59. Ertekin C (2014) Electrophysiological evaluation of oropharyngeal dysphagia in Parkinson's disease. J Mov Disord.2014;7:31–56. https://doi.org/10.14802/jmd.14008

  60. Litvan I, Sastry N, Sonies BC. Characterizing swallowing abnormalities in progressive supranuclear palsy. Neurology. 1997;48:1654–62. https://doi.org/10.1212/wnl.48.6.1654.

    Article  CAS  PubMed  Google Scholar 

  61. Shaker R. Reflex interaction of pharynx, esophagus, and airways. GI Motility Online. 2006. https://doi.org/10.1038/gimo11.

    Article  Google Scholar 

  62. Elidan J, Shochina M, Gonen B, Gay I. Electromyography of the inferior constrictor and cricopharyngeal muscles during swallowing. Ann Otol Rhinol Laryngol. 1990;99:466–9. https://doi.org/10.1177/000348949009900610.

    Article  CAS  PubMed  Google Scholar 

  63. Restivo DA, Palmeri A, Marchese-Ragona R. Botulinum toxin for cricopharyngeal dysfunction in Parkinson’s disease. N Engl J Med. 2002;346:1174–5. https://doi.org/10.1056/NEJM200204113461517.

    Article  PubMed  Google Scholar 

  64. Restivo DA, Casabona A, Nicotra A, Zappia M, Elia M, Romano MC, Alfonsi E, Marchese-Ragona R. ALS dysphagia pathophysiology: differential botulinum toxin response. Neurology. 2013;80:616–20. https://doi.org/10.1212/WNL.0b013e318281cc1b.

    Article  CAS  PubMed  Google Scholar 

  65. Vaiman M, Eviatar E, Segal S. Evaluation of normal deglutition with the help of rectified surface electromyography records. Dysphagia. 2004;19:125–32. https://doi.org/10.1007/s00455-003-0504-x.

    Article  PubMed  Google Scholar 

  66. Kahrilas PJ, Logemann JA. Volume accommodation during swallowing. Dysphagia. 1993;8:259–265. https://doi.org/10.1007/BF01354548

  67. Crary MA, Carnaby Mann GD, Groher ME. Biomechanical correlates of surface electromyography signals obtained during swallowing by healthy adults. J Speech Lang Hear Res. 2006;49:186–93. https://doi.org/10.1044/1092-4388(2006/015).

    Article  PubMed  Google Scholar 

  68. Weber EH. De pulsu, resorpitione, auditu et tactu. Annotationes anatomicae et physiologicae. Lipsiae, Prostat apud C.F. Koehler; 1834.

  69. Gale MR. Lucretius: De Rerum Natura. Book V: Oxford University Press; 2009.

    Google Scholar 

  70. Cosentino G, Tassorelli C, Prunetti P, Todisco M, De Icco R, Avenali M, Minafra B, Zangaglia R, Valentino F, Pacchetti C, Bertino G, Mauramati S, Fresia M, Alfonsi E. Reproducibility and reaction time of swallowing as markers of dysphagia in parkinsonian syndromes. Clin Neurophysiol. 2020;131:2200–8. https://doi.org/10.1016/j.clinph.2020.06.018.

    Article  PubMed  Google Scholar 

  71. Cichero J. Swallowing from infancy to old age. In: Cichero JAY, Murdoch BE (eds) Dysphagia. Foundation, theory and practice, vol. 6. Wiley, Chichester; 2006, pp 26–46.

  72. Teismann IK, Warnecke T, Suntrup S, Steinsträter O, Kronenberg L, Ringelstein EB, Dengler R, Petri S, Pantev C, Dziewas R. Cortical processing of swallowing in ALS patients with progressive dysphagia–a magnetoencephalographic study. PLoS One. 2011;6:e19987. https://doi.org/10.1371/journal.pone.0019987.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Ertekin C. Voluntary versus spontaneous swallowing in man. Dysphagia. 2011;26:183–92. https://doi.org/10.1007/s00455-010-9319-8.

    Article  PubMed  Google Scholar 

  74. Uludag IF, Tiftikcioglu BI, Ertekin C. Spontaneous swallowing during all-night sleep in patients with Parkinson disease in comparison with healthy control subjects. Sleep. 2016;39:847–54. https://doi.org/10.5665/sleep.5640.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Cosentino G, Tassorelli C, Prunetti P, Bertino G, De Icco R, Todisco M, Di Marco S, Brighina F, Schindler A, Rondanelli M, Fresia M, Mainardi L, Restivo DA, Priori A, Sandrini G, Alfonsi E. Anodal transcranial direct current stimulation and intermittent theta-burst stimulation improve deglutition and swallowing reproducibility in elderly patients with dysphagia. Neurogastroenterol Motil. 2020;32:e13791. https://doi.org/10.1111/nmo.13791.

    Article  PubMed  Google Scholar 

  76. Aydogdu I, Tanriverdi Z, Ertekin C. Dysfunction of bulbar central pattern generator in ALS patients with dysphagia during sequential deglutition. Clin Neurophysiol. 2011;122:1219–28. https://doi.org/10.1016/j.clinph.2010.11.002.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors wish to thank Catherine Wrenn for the language revision of the manuscript.

Funding

None.

Author information

Authors and Affiliations

  1. Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy

    Enrico Alfonsi, Massimiliano Todisco, Mauro Fresia & Giuseppe Cosentino

  2. Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy

    Massimiliano Todisco, Cristina Tassorelli & Giuseppe Cosentino

  3. Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy

    Cristina Tassorelli

Authors
  1. Enrico Alfonsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Massimiliano Todisco
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mauro Fresia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cristina Tassorelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giuseppe Cosentino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Enrico Alfonsi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alfonsi, E., Todisco, M., Fresia, M. et al. Electrokinesiographic Study of Oropharyngeal Swallowing in Neurogenic Dysphagia. Dysphagia 38, 543–557 (2023). https://doi.org/10.1007/s00455-021-10336-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-021-10336-x

Keywords

Search

Navigation