Daniels S K, Brailey K, Foundas A L
Audiology/Speech Pathology Service, Veterans Affairs Medical Center, New Orleans, Louisiana 70112-1262, USA.
Dysphagia. 1999 Spring;14(2):85-92. doi: 10.1007/PL00009592.
The mechanism and neural substrates that mediate lingual coordination during swallowing have not been well characterized. Although lingual discoordination during swallowing has been difficult to quantify, it has been defined as the random disorganization of anterior-posterior tongue movements evident in bolus propulsion. In a sample of consecutive acute stroke patients (n = 59), videofluoroscopic evaluation showed a 19% incidence of lingual discoordination during swallowing. Lingual discoordination during swallowing was not commonly associated with buccofacial apraxia, apraxia of speech, nor limb apraxia. Hemisphere and anterior-posterior localization did not predict occurrence of lingual discoordination. Lingual discoordination during swallowing occurred commonly in patients with subcortical lesions with the periventricular white matter (PVWM), the most common site of involvement. PVWM lesions may disconnect anterior and posterior cortical regions that are critical to oral control and coordination in swallowing, thereby producing lingual discoordination during swallowing. These data also suggest that the neural mechanisms that mediate lingual coordination may at least in part be independent of the neural systems that mediate buccofacial, limb, and speech praxis functions.
吞咽过程中调节舌协调的机制和神经基质尚未得到很好的描述。尽管吞咽过程中的舌不协调难以量化，但它被定义为在食团推进过程中前后舌运动的随机紊乱。在一组连续的急性中风患者样本（n = 59）中，视频荧光透视评估显示吞咽过程中舌不协调的发生率为19%。吞咽过程中的舌不协调通常与颊面失用症、言语失用症或肢体失用症无关。半球和前后定位并不能预测舌不协调的发生。吞咽过程中的舌不协调常见于伴有脑室周围白质（PVWM）的皮质下病变患者，PVWM是最常见的受累部位。PVWM病变可能会切断对吞咽时口腔控制和协调至关重要的前后皮质区域，从而在吞咽过程中产生舌不协调。这些数据还表明，调节舌协调的神经机制可能至少部分独立于调节颊面、肢体和言语实践功能的神经系统。
