Clinical Focus
Effect of a Tongue-Holding Maneuver
on Posterior Pharyngeal Wall Movement
During Deglutition
Masako Fujiu
Jeri A. Logemann
Northwestern University, Evanston, IL
Effects of a tongue-holding maneuver on
anterior bulging of the posterior pharyngeal wall
(PPW) during swallowing were investigated in
10 young adult normal subjects. Videofluoro-
graphic images of 3-ml liquid barium swallows
were digitized to quantify the extent of anterior
bulge of the PPW with and without the maneu-
ver at the mid and the inferior levels of the
second cervical vertebra. A significant increase
in PPW bulging was seen with the maneuver at
both pharyngeal levels. These findings indicate
potential for developing new treatment tech-
niques to facilitate compensatory anterior
M
ovement of the posterior pharyngeal wall (PPW)
during deglutition has been investigated by a
number of researchers in the past (Basmajian &
Dutta, 1961; Ekberg & Borgstrom, 1989; Kahrilas,
Logemann, Lin, & Ergun, 1992; Palmer, Tanaka, &
Siebens, 1988; Perlman, Luschei, & Du Mond, 1989;
Ramsey, Watson, Gramiak, & Weinberg, 1955; Yoshida,
1979). In normal deglutition, the pharyngeal wall muscles
are known to contract progressively superiorly to inferiorly
during the pharyngeal stage of swallowing, which is seen
as an anterior bulge of the PPW in the lateral plane of
fluoroscopic images (Logemann, 1993a, pp. 7–15). Once
the pharyngeal swallow is triggered, anterior movement of
the PPW starts at the level of the upper oropharynx
(Ekberg & Borgstrom, 1989; Kahrilas et al., 1992). The
PPW, together with the medially moving lateral pharyngeal
walls, eventually meets with the posteriorly moving base
of tongue (BOT). This contact of the PPW and BOT
applies pressure to the bolus tail, and pharyngeal contrac-
tion progresses downward to the esophageal entrance
following the bolus tail (Ekberg & Borgstrom, 1989;
Kahrilas et al., 1992).
Anatomically, the superior, middle, and inferior
pharyngeal constrictor muscles are responsible for the
sequential contraction of the pharyngeal wall (Miller,
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movement of the PPW, which has not been a
target for direct treatment in the past. At
present, the tongue-holding maneuver can be
employed clinically as an easy method for
testing the compliance of the PPW videofluoro-
graphically. However, the use of the maneuver
per se, which inhibits posterior retraction of the
base of tongue (BOT), resulted in increasing
the pharyngeal (specifically vallecular) residue
after the swallow. The results also indicate the
importance of tongue movement in triggering
the pharyngeal swallow.
1982). Functionally, contraction of the PPW appears to be
important in three ways: (a) contact with the BOT, which
is the primary pressure generator during swallowing
(McConnel, 1988; McConnel, Cerenko, & Mendelsohn,
1988), to facilitate pressure generation for continuous
bolus propulsion through the pharynx; (b) shortening of the
pharynx for a safer and more efficient swallow (Kahrilas et
al., 1992; Palmer et al., 1988); and (c) clearance of the
bolus from the pharynx (Kahrilas et al., 1992).
To date, PPW contraction during swallowing has not
been thought to respond to direct treatment in dysphagic
patients (Logemann, 1993b, p. 173). Thus, little attention
has been paid in swallowing research to possible volitional
alteration in PPW movement. Clinically, however, an
increase in anterior bulging of the PPW has been observed
videofluorographically in some surgically treated oral
cancer patients during the course of their postoperative
recovery (Fujiu, Logemann, & Pauloski, 1995; Pauloski,
Logemann, Fox, & Colangelo, 1995). These were the
patients whose anterior portion of the tongue, which is
known to be important for the anchoring function during
bolus propulsion (Kahrilas, Lin, Logemann, Ergun, &
Facchini, 1993), was impaired with the tumor. We hypoth-
esize that, in these oral cancer patients, (a) the disturbed
anchoring function of the anterior tongue caused reduced
Fujiu • Association
Logemann 23
 range of BOT movement; and (b) reduced BOT movement
resulted in enhancing anterior bulge of the PPW. Since
there is an anatomical link between the BOT and the PPW
by way of the glossopharyngeus muscle, one portion of the
superior pharyngeal constrictor muscles (Zemlin, 1988, pp.
272–273), influence of BOT movement on PPW bulge is
possible.
This study was designed to investigate the potential for
compensatory movement of the PPW during swallowing
when movement of the BOT is restricted. A unique tongue-
holding maneuver was developed in order to inhibit
retraction of the BOT and potentially facilitate anterior
bulge of the PPW in normal subjects.
Methods
Subjects were 10 healthy male adults between ages 19
and 26 years with the mean age of 23 years. Six swallows
of 3 ml liquid barium were performed, alternating with and
without the tongue-holding maneuver (three swallows
each). For the tongue-holding maneuver, the subjects were
asked to protrude the tongue maximally but comfortably,
holding it between the central incisors, after a bolus was
introduced into the mouth (Figure 1). The fluorographic
images of the lateral view of each swallow were recorded
with a videocassette recorder (Sony U-matic, model VO-
5800) at 30 frames per second. Temporal information was
encoded on the videotape with a counter-timer at 0.01-s
intervals (Thalner Electronics). Only the initial swallow on
each bolus was used for the biomechanical and temporal
analyses. Repeated dry swallows were not analyzed.
Biomechanical Analysis
Twenty to 30 frames of the videofluorographic images
of each swallow, including the start and the end of BOT-
PPW contact, were digitized to quantify the anterior
FIGURE 1. Sagittal section of the head showing tongue
position without and with the maneuver. The subject was
asked to protrude the tongue maximally but comfortably,
holding it between the central incisors, after a bolus was
introduced into the mouth.
tongue
tongue
epiglottis epiglottis
No Maneuver Tongue Holding Maneuver
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movement of the PPW, using an interactive computer
program (Logemann, Kahrilas, Begelman, Dodds, &
Pauloski, 1989). The following three measures were
obtained for each swallow at the mid and the inferior levels
of the second cervical vertebra (C2): (a) extent of PPW
bulging during BOT-PPW contact; (b) onset of the BOT-
PPW contact in relation to cricopharyngeal opening
(CPO); and (c) duration of the BOT-PPW contact. Mean
values for each measure for the three swallows with and
without maneuver were calculated from the individual
subjects for statistical analyses (paired t-test).
In measuring the extent of anterior bulge of the PPW
(Figure 2), the anterior-inferior corner of the C4 was marked
as an anchor point (labeled as “c”). Another point on the
anterior-inferior corner of the C2 (labeled as “b”) was also
marked, forming the line “bc” for the approximate posture of
the vertebral column. The distance between point “b” and a
point on the surface of the PPW “a” was measured by
drawing a line perpendicular to the line “bc”. The line “ab” is
the extent of anterior bulge of the PPW. The same distance
measurement was performed at the level of mid C2.
Temporal Measures and Observations
The following six temporal measures and three observa-
tions were obtained from frame-by-frame analysis of the
video images. Intraobserver reliability for all measures and
observations ranged from 96% to 100%. Interobserver
reliability ranged from 85% to 100%.
Temporal Measures:
1. Oral transit time (OTT): the interval from the onset of
oral tongue movement propelling the bolus posteriorly
until the bolus head reaches the point where the
posterior line of the ramus of the mandible crosses the
BOT.
2. Pharyngeal response time (PRT): the interval from the
onset of rapid laryngeal elevation as an indicator of the
triggering of the pharyngeal swallow, or the pharyngeal
swallow response, until the bolus tail passes through the
cricopharyngeal region.
3. Pharyngeal delay: the time lag between the end of oral
transit and the triggering of the pharyngeal response.
4. Onset of airway closure in relation to CPO: the time
difference between the first arytenoid to epiglottic base
contact and the first CPO.
5. Duration of airway closure: the interval from the first
arytenoid to epiglottic base contact until the end of the
contact.
6. Duration of CPO: the interval from the first opening of
the cricopharyngeal region until the bolus tail passes the
region.
Observations:
7. Approximate percentage of residue: residual material
after the swallow estimated by percentage for the entire
oral cavity (total oral residue), entire pharynx (total
pharyngeal residue), and specifically in the valleculae
(vallecular residue).
February 1996
 FIGURE 2. Video print (above) and line drawing (below) illustrating measurement of the extent of anterior bulge of the posterior
pharyngeal wall (PPW). The anterior-inferior corner of C4 is marked as an anchor point (“c”) for determining the postural angle of
the vertebral column. Another point on the vertebral surface corresponding to the anterior-interior corner of C2 was marked as “b.”
Distance was measured by drawing a line, between point “b” and a point opposite on the PPW surface “a,” that is perpendicular to
the postural line “bc.” The same measurement method was performed at mid C2.

Fujiu • Logemann 25
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 8. Resting position of the hyoid bone: level of the hyoid
bone in relation to the cervical vertebrae prior to the
onset of posterior propulsion of the bolus.
9. Location of the bolus head at the onset of the pharyn-
geal swallow: pharyngeal structure(s) that bolus head
reaches when the pharyngeal swallow is triggered.
For statistical analyses, paired t-tests were used for
measures (1) through (7), and the sign test was used for
measure (8).
Results
Biomechanical Analysis
All of the 10 subjects exhibited an increase in anterior
bulge of the PPW with the maneuver as compared to their
swallows without the maneuver. Figure 3 shows the
difference in the degree of anterior bulge of the PPW with
and without the maneuver during BOT-PPW contact in one
of the subjects (Subject 1). This subject exhibited notable
changes in anterior bulge with and without the maneuver
for all his swallows, although, in some subjects, the
difference was less obvious. The graphs in Figure 4 show
sequential movements of the PPW and BOT during a
swallow at the levels of mid C2 and inferior C2. This is the
same swallow of the same subject (Subject 1) that is shown
in Figure 3.
Paired t-tests indicated that PPW bulging was signifi-
cantly greater with maneuver than without maneuver at
both mid C2 and inferior C2 (p < 0.01) (Table 1). There
FIGURE 3. Video prints of a subject illustrating the difference in the degree of anterior bulge of the PPW without (left) and with
(right) the maneuver during initial BOT-PPW contact. Anterior bulge of the PPW is greater with the maneuver than without the
maneuver.
26 American Journal of Speech-Language Pathology • Vol. 5 • No. 1
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was no statistically significant difference in the onset of the
BOT-PPW contact in relation to CPO or in the duration of
BOT-PPW contact between the swallows with and without
the maneuver (Table 1).
When these three measures were compared between
mid C2 and inferior C2 with the maneuver (Table 2),
anterior bulge of the PPW was significantly greater at mid
C2 than at inferior C2 (p < 0.01). The onset of BOT-PPW
contact was significantly earlier (p < 0.01), and contact
duration was significantly longer, at mid C2 than at inferior
C2 (p < 0.01). These characteristics are also evident in the
graphs in Figure 4.
Temporal Measures and Observations
There was no statistically significant difference with
and without the maneuver in the temporal measures
examined in this study, except the duration of airway
closure, which was significantly shorter with the maneuver
than without the maneuver (p < 0.05) (Table 3). Although
not statistically significant, delay time was approximately
0.1 s longer with the maneuver than without the maneuver.
Some differences were noted with the maneuver in the
three observations. Table 4 shows the change in approxi-
mate percentage of residue. There was no statistically
significant difference in oral residue with and without the
maneuver (p > 0.05). However, there was a significant
increase in total pharyngeal residue with the maneuver (p <
0.05). When specific locations of the pharyngeal residue
were examined, vallecular residue was increased signifi-
cantly with the maneuver (p < 0.01) but not the residue in
February 1996
 TABLE 1. Anterior bulge of the PPW at mid C2 and inferior C2.

Without Maneuver With Maneuver p Value

Mean SD Mean SD

Mid C2
PPW bulge (mm) 10.226 2.405 12.670 2.901 <0.001a
Onset of BOT-PPW contact to CPO (s) -0.053 0.155 -0.034 0.086 0.765
Duration of BOT-PPW contact (s) 0.390 0.069 0.408 0.057 0.544

Inferior C2
PPW bulge (mm) 8.633 1.893 9.880 2.754 <0.005a
Onset of BOT-PPW contact to CPO (s) 0.085 0.082 0.097 0.077 0.506
Duration of BOT-PPW contact (s) 0.289 0.089 0.267 0.078 0.364
a
Significant p < 0.01

TABLE 2. Anterior bulge of the PPW at mid C2 and inferior C2 with manuever.

Mid C2 Inferior C2 p Value

Mean SD Mean SD

PPW bulge (mm) 12.670 2.901 9.873 2.754 <0.0001a

Onset of BOT-PPW contact to CPO (s) -0.034 0.086 0.097 0.077 <0.0001a
Duration of BOT-PPW contact (s) 0.408 0.057 0.267 0.078 <0.0001a
a
Significant p < 0.01

FIGURE 4. Movements of the posterior pharyngeal wall (PPW) and base of tongue (BOT) over time during a swallow at the levels of
mid C2 and inferior C2 with the maneuver. Time zero (0.0) corresponds to the opening of the cricopharyngeal region. At the start of
the graph, PPW and BOT were separated. The two structures eventually come to contact, first at the mid C2 level, and later at the
inferior C2 level. Separation of the PPW and BOT at both mid and inferior C2 occurs at the same time.

10

Pharyngeal Wall

0 Mid C2
Base of Tongue
Movement in mm

-10

10

Pharyngeal Wall

0 Inferior C2
Base of Tongue

-10
-0.3 -0.2 -0.1 0.0 0.1 0.2 0.3 0.4 0.5
Time in Seconds

Fujiu • Logemann 27
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 TABLE 3. Temporal measures with and without maneuver.

Without Maneuver With Maneuver p Value

Mean (s) SD Mean (s) SD

PPW bulge (mm) 12.670 2.901 9.873 2.754 <0.0001a

OTT 0.371 0.208 0.309 0.074 0.391
PRT 0.685 0.091 0.675 0.081 0.572
Pharyngeal delay -0.070 0.111 0.176 0.488 0.103
Airway closure onset to CPO -0.098 0.064 -0.106 0.062 0.746
Airway closure duration 0.527 0.134 0.448 0.119 0.025a
CPO duration 0.385 0.086 0.388 0.076 0.914
a
Significant p < 0.05

TABLE 4. Approximate percentage of residue with and without maneuver.

Without Maneuver With Maneuver p Value

Mean (%) SD Mean (%) SD

Total Oral Residue 2.217 0.783 3.967 21.895 0.222

Total Pharyngeal Residue 2.264 1.821 5.160 17.329 0.016a
Vallecular Residue 1.101 0.438 2.434 2.744 0.004b
Other Pharyngeal Residue 1.163 0.977 2.726 3.389 0.110
a
Significant p < 0.05
b
Significant p < 0.01

other pharyngeal locations, such as the aryepiglottic folds
and pyriform sinuses (p > 0.1).
In 7 of the 10 subjects, the resting position of the hyoid
bone was slightly higher with the maneuver. This was
statistically significant (sign test, p < 0.05) The change in
position was approximately 8 mm. In all of the 10 subjects,
on swallows with the maneuver, the bolus head reached
lower pharyngeal structures before the pharyngeal swallow
was triggered. Without the maneuver, the pharyngeal
swallow was triggered when the bolus head was between
the posterior tongue and the valleculae. With the maneu-
ver, triggering of the pharyngeal swallow took place when
the bolus head was between the BOT and the pyriform
sinuses.
Discussion
Contraction of the PPW and its contact with BOT is an
essential part of the pharyngeal swallow. However, in the
past, PPW contraction has not been thought to respond to
direct treatment in dysphagic patients (Logemann, 1993b,
p. 173), and no therapeutic technique directed to the PPW
has been introduced. This study demonstrates that, in
normal young adults, the degree of anterior bulging of the
PPW can be altered by changing the position of the
anterior tongue. Specifically, the anterior bulge of the PPW
during swallowing was significantly greater with the
tongue-holding maneuver than without the maneuver, at
the levels of mid and inferior C2 (Table 1).
Previous studies from our laboratory indicate that
increased anterior bulge of the PPW occurred over time in
patients with an impairment in the anterior tongue (Fujiu et
al., 1995; Pauloski et al., 1995). We speculate that the
patient’s impairment in the anterior tongue disturbed its
anchoring function during swallowing and affected
posterior retraction of the BOT. Since there is an anatomic
link between the PPW and the BOT by the glossopharyn-
geus muscle (Zemlin, 1988, pp. 272–273), we hypothesize
that disturbance in one end of the muscle’s attachment
might have affected the attachment of the other end.
Although the mean age of the subjects in this study (i.e., 23
years) is younger than that of the oral cancer patients in the
other two studies mentioned above (i.e., 58 and 55 years,
respectively), a study by Robbins, Hamilton, Lof, and
Kempster (1992) suggests no significant age effect on the
PPW movement. If that is the case, the same mechanisms
and hypotheses might be applied to both groups. Signifi-
cantly earlier onset of PPW-BOT contact at mid C2 than at
inferior C2 (Table 2 and Figure 4) confirmed the concept
of sequential contraction of the pharyngeal constrictor
muscles during the pharyngeal swallow (Ekberg &
Borgstrom, 1989; Kahrilas et al., 1992).
Clinically, the tongue-holding maneuver may be
employed for two purposes: (a) evaluation and (b) treat-
ment. Since the use of this maneuver immediately facili-
tated anterior bulge of the PPW, it can be used as an easy
method for testing the compliance of the PPW in
dysphagic patients. Individuals with a more compliant

28 American Journal of Speech-Language Pathology • Vol. 5 • No. 1 February 1996

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 PPW may show greater increases in anterior bulge of the
PPW over time.
Although more systematic studies in patient populations
are needed before applying the maneuver in treatment, the
results of this study suggest the potential for developing
new approaches in therapy. Interestingly, in our previous
study (Fujiu et al., 1995), an increase in anterior bulge of
the PPW was particularly notable in the patients who had
received “range of motion exercises” for the tongue, which
were not for facilitation of the PPW movement. Such
exercises are designed to extend vertical and antero-
posterior range of motion of the tongue (Logemann, 1989,
p. 1027), and are likely to affect the muscles attached to the
tongue base. It is possible that the lingual range of motion
exercises influenced the function of the glossopharyngeus
muscle from its lingual attachment, and anatomically
facilitated the greater movement of its pharyngeal attach-
ment, the PPW.
In addition to its impact on PPW movement, the
maneuver also affected other aspects of swallowing. In the
present study, three negative outcomes, which could
increase the risk of aspiration in some dysphagic patients,
were observed. These include: (a) increased pharyngeal
residue, particularly in the valleculae; (b) shortened
duration of airway closure; and (c) increased pharyngeal
delay time in triggering the pharyngeal swallow.
The statistically significant increase in the total pharyn-
geal residue with the maneuver, particularly in the vallecu-
lae, is considered to be caused by reduced BOT movement
introduced by the maneuver. Even though the maneuver
facilitated anterior bulge of the PPW, holding the anterior
portion of the tongue resulted in reduced posterior move-
ment of the BOT. Under such conditions, anterior bulge of
the PPW might not be sufficient to clear material from the
valleculae. These results confirm the importance of BOT
retraction in clearing the bolus from the valleculae.
Presumably, in a swallow in which tongue movement is
not inhibited, pharyngeal clearance may be improved when
anterior bulge of the PPW is increased.
Shortened airway closure with the maneuver might be
explained as follows. Since posterior retraction of the BOT
is reduced with the maneuver, posterior movement of the
epiglottic base, a key component in airway entrance
closure (Logemann et al., 1992), may also be reduced. This
might have resulted in later onset and earlier separation of
the arytenoid to epiglottic base contact with the maneuver
than without the maneuver. Even though the time differ-
ence in each component of closure is not significantly
different, the total of both differences, reflected in duration
of airway closure, may be significant. This may explain
why, in this study, there was no statistically significant
difference in the onset of arytenoid to epiglottic base
contact with and without the maneuver, but the duration of
airway closure was significantly shorter with the maneuver
than without the maneuver.
Application of the maneuver also resulted in an approxi-
mately 0.1-s increase in pharyngeal delay time. Although
the value was not statistically significant, the difference
might be clinically important because of the higher risk of
aspiration. As a matter of fact, in all of the 10 subjects, the
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bolus head reached lower pharyngeal structures with the
maneuver before the pharyngeal swallow was triggered. It
appears that the 0.1-s increase in pharyngeal delay time
introduced by the maneuver allowed the bolus to flow to a
lower level of the pharynx. Slightly elevated resting
position of the hyoid bone before the swallow with the
maneuver might also have contributed to bringing the
pharyngeal structures to a higher level, so that the bolus
reached these structures faster.
The increased pharyngeal delay time seen in this study
with the tongue-holding maneuver supports the hypothesis
that tongue movement may provide critical sensory input
to trigger the pharyngeal swallow. Larson (1985) posited
that lingual movements or a particular posturing of the
tongue could excite groups of receptors in such a way as to
trigger the pharyngeal swallow. Without smooth tongue
movement, the timing of sensory input to the swallowing
center (Jean, 1984) might not be adequate, in turn delaying
the triggering of the pharyngeal swallow.
When the oral tongue moves backward to propel the
bolus, high pressure is generated in the oral cavity
(Cerenko, McConnel, & Jackson, 1989; McConnel, 1988;
Shaker, Cook, Dodds, & Hogan, 1988). Such pressure and
bolus movement in combination with tongue movement
may stimulate mechanoreceptors and pressure receptors in
the oral cavity, including the anterior faucial pillars,
reported to be one of the most sensitive sites to elicit
swallowing with pressure (Pommerenke, 1928). Fujiu,
Toleikis, Logemann, and Larson (1994) provided electro-
physiological data to support the importance of applying
pressure to the anterior pillar in eliciting the pharyngeal
swallow in awake humans. Thus, the role the tongue plays
in triggering the pharyngeal swallow needs to be empha-
sized along with its relation to various sensory receptors in
the oral cavity, including chemoreceptors and mechanore-
ceptors, as well as proprioceptors in the tongue and other
oropharyngeal muscles.
Because of the possible increase in pharyngeal residue
and pharyngeal delay time, the tongue-holding maneuver
per se may not result in an immediate improvement in
swallowing function. Moreover, the shortened duration of
airway closure negatively affects the safety of swallowing
in some patients. However, the present study provides
clinicians with the possibility of actively changing the
degree of muscular contraction of the PPW, which has
previously been thought not to respond to treatment.
Further investigations concerning the value of the tongue-
holding maneuver as a treatment technique are warranted.
At the same time, additional research studies (e.g., mano-
metric and electromyographic studies) in both normal
individuals and patients are necessary, in order to better
understand the physiologic mechanisms underlying the
tongue-holding maneuver. Such information will help
clinicians to select adequate strategies for intervention and
appropriate candidates for a particular treatment technique.
Acknowledgments
The authors would like to express gratitude to Barbara Roa
Pauloski, Cathy Lazarus, and Joan C. Fox for their assistance in
Fujiu • Logemann 29
 data collection and analyses. This research was supported by
National Institute of Health Grants PO1-CA40007-09 and
R01-NS28525-03.
References
Basmajian, J. V., & Dutta, C. R. (1961). Electromyography of
the pharyngeal constrictors and levator palati in man.
Anatomical Record, 139, 561–563.
Cerenko, D., McConnel, F. M. S., & Jackson, R. T. (1989).
Quantitative assessment of pharyngeal bolus driving forces.
Otolaryngology–Head and Neck Surgery, 100, 57–63.
Ekberg, O., & Borgstrom, P. S. (1989). A graphic representa-
tion of pharyngeal wall motion during swallow: Technical
note. Dysphagia, 4, 43–47.
Fujiu, M., Logemann, J. A., & Pauloski, B. (1995). Increased
postoperative posterior pharyngeal wall movement in anterior
oral cancer patients: Preliminary findings and possible
implications for treatment. American Journal of Speech-
Language Pathology, 4(2), 24–30.
Fujiu, M., Toleikis, J. R., Logemann, J. A., & Larson, C. R.
(1994). Glossopharyngeal evoked potentials in normal
subjects following mechanical stimulation of the anterior
faucial pillar. Electroencephalography and Clinical Neuro-
physiology, 92, 183–195.
Jean, A. (1984). Control of the central swallowing program by
inputs from the peripheral receptors: A review. Journal of the
Autonomic Nervous System, 10, 225–233.
Kahrilas, P. J., Lin, S., Logemann, J. A., Ergun, G. A., &
Facchini, F. (1993). Deglutitive tongue action: Volume
accommodation and bolus propulsion. Gastroenterology, 104,
152–162.
Kahrilas, P. J., Logemann, J. A., Lin, S., & Ergun, G. A.
(1992). Pharyngeal clearance during swallowing: A combined
manometric and videofluoroscopic study. Gastroenterology,
103, 128–136.
Larson, C. R. (1985). Neurophysiology of speech and swallow-
ing. Seminars in Speech and Language, 6, 275–291.
Logemann, J. A. (1989). Speech and swallowing rehabilitation
for head and neck tumor patients. In E. N. Myers & J. Y. Suen
(Eds.), Cancer of the head and neck (2nd ed., pp. 1021–1041).
New York: Churchhill Livingston.
Logemann, J. A. (1993a). Manual for the videofluorographic
study of swallowing. Austin, TX: Pro-Ed.
Logemann, J. A. (1993b). Rehabilitation of the patient after
treatment. In J. E. Niederhuber (Ed.), Current therapy in
oncology (pp. 169–174). St. Louis, MO: Mosby-Year Book.
Logemann, J. A., Kahrilas, P. J., Begelman, J., Dodds, W. J.,
& Pauloski, B. (1989). Interactive computer program for
biomechanical analysis of videoradiographic studies of
swallowing. American Journal of Roentgenology, 153,
277–280.
30 American Journal of Speech-Language Pathology • Vol. 5 • No. 1
Downloaded From: http://ajslp.pubs.asha.org/ by a Western Michigan University User on 02/15/2016
Terms of Use: http://pubs.asha.org/ss/rights_and_permissions.aspx
Logemann, J. A., Kahrilas, P. J., Cheng, J., Pauloski, B. R.,
Gibbons, P. J., Rademaker, A. W., & Lin, S. (1992).
Closure mechanisms of laryngeal vestibule during swallow.
American Journal of Physiology, 262, G338–G344.
McConnel, F. M. S. (1988). Analysis of pressure generation and
bolus transit during pharyngeal swallowing. Laryngoscope,
98, 71–78.
McConnel, F. M. S., Cerenko, D., & Mendelsohn, M. S.
(1988). Manofluorographic analysis of swallowing.
Otolaryngologic Clinics of North America, 21, 625–635.
Miller, A. J. (1982). Deglutition. Physiological Reviews, 62,
129–184.
Palmer, J. B., Tanaka, E., & Siebens, A. A. (1988). Motions of
the posterior pharyngeal wall in swallowing. Laryngoscope,
98, 414–417.
Pauloski, B. R., Logemann, J. A., Fox, J. C., & Colangelo, L.
(1995). Biomechanical analysis of the pharyngeal swallow in
postsurgical patients with anterior tongue and floor of mouth
resection and distal flap reconstruction. Journal of Speech and
Hearing Research, 38, 110–123.
Perlman, A. L., Luschei, E. S., & Du Mond, C. E. (1989).
Electrical activity from the superior pharyngeal constrictor
during reflexive and nonreflexive tasks. Journal of Speech and
Hearing Research, 32, 749–754.
Pommerenke, W. T. (1928). A study of the sensory areas
eliciting the swallowing reflex. American Journal of Physiol-
ogy, 84, 36–41.
Ramsey, G. H., Watson, J. S., Gramiak, R., & Weinberg, S. A.
(1955). Cinefluorographic analysis of the mechanism of
swallowing. Radiology, 64, 498–518.
Robbins, J., Hamilton, J. W., Lof, G. L., & Kempster, G. B.
(1992). Oropharyngeal swallowing in normal adults of
different ages. Gastroenterology, 103, 823–829.
Shaker, R., Cook, I. J. , Dodds, W. J., & Hogan, W. J. (1988).
Pressure-flow dynamics of the oral phase of swallowing.
Dysphagia, 3, 79–84.
Yoshida, T. (1979). Electromyographic and X-ray investigations
of normal deglutition. Otologia (Fukuoka), 25, 824–872.
Zemlin, W. (1988). Speech and hearing science: Anatomy and
physiology (3rd ed., pp. 272–273). Englewood Cliffs, NJ:
Prentice Hall.
Received April 18, 1994
Accepted June 19, 1995
Contact author: Jeri A. Logemann, PhD, Department of Commu-
nication Sciences & Disorders, Northwestern University, 2299
North Campus Drive, Evanston, IL 60208-3540
Key Words: swallowing, maneuver, videofluorography,
posterior pharyngeal wall, tongue
February 1996