Swallowing disorders, which are frequent in geriatrics, are linked to multiple pathologies: cancer, stroke, neurocognitive disorders, acute confusion, vigilance disorders, etc. They can have serious consequences and therefore require special care. From the identification of the disorders by the doctor, the nurse, the caregiver, to the speech therapy assessment, through the adaptation of the diet by the dietician, the management of swallowing disorders concerns all the medical and paramedical staff. The aim of this article is to present the main existing recommendations to promote the patient\'s feeding despite the presence of these disorders.

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According to the \"pain adaptation model\", temporomandibular disorder (TMD)-related pain induces a paradoxical activity of masticatory muscles: an agonistic hypoactivity during jaw closing and an antagonistic activity during jaw opening (agonist/antagonist co-activation). However, this model suffers several weaknesses; notably, it does not explain all types of neck muscle activities in neck pain (NP), which is a very prevalent TMD comorbid condition. In NP, neck muscle antagonistic activity is increased, and agonistic activity is decreased as postulated by the pain adaptation model. However, synergistic and compensatory activity may occur and agonistic activity may be unchanged or even increased as postulated within the \"vicious cycle theory\". Thus, both theories would apply partly as outlined currently in musculoskeletal disorders (MSD). Besides pain, psychological stress may also induce motor dysfunction in TMD and NP. In NP, rehabilitation may increase agonistic activity and decrease compensatory activity and antagonistic activity, thus inducing a switch from agonist/antagonist co-activation towards reciprocal inhibition. Thus, rehabilitation-induced motor activity changes constitute a new research field that should improve MSD therapeutics. Additionally, immature tongue function (so-called infantile swallow) might be connected to TMD where low agonistic activity of masticatory muscles would be compensated by facial muscle hyperactivity during oropharyngeal phase of deglutition.

Rehabilitation of temporomandibular joint dysfunctions has for a long time tried to treat symptoms: pain relief, joint kinetics restoration, disk re-capture by manual maneuvers. The authors present their own therapeutic approach, which is no longer limited to symptoms, but addresses the causes and identifies risk factors to prevent relapse.

In this study, the responses of thyroarytenoid (TA) and cricopharyngeus (CP) muscles were simultaneously recorded to peripheral magnetic stimulation of the vagus nerve. Recordings were performed in 13 subjects by means of concentric needle EMG electrodes inserted in the TA and CP. Magnetic shocks were delivered to the vagus nerve with a round coil placed occipitally, while EMG was silent in the TA. In all subjects, clear-cut responses were obtained simultaneously in both muscles. In TA compared to CP, the maximum amplitude of the responses were higher, whereas the onset latency was shorter. Our results revealed that simultaneous recordings of TA and CP motor responses to occipital magnetic stimulation enabled a reliable evaluation of their peripheral innervation by the vagus nerve.

OBJECTIVE: To investigate electrophysiological parameters of swallowing in all stages of Alzheimer\'s disease.
METHODS: Forty Alzheimer\'s disease patients, 20 age-matched normal controls and 20 young normal controls were included. Dysphagia limit (DL) and sequential water swallowing (SWS) tests were performed. Cardiac rhythm, respiration and sympathetic skin responses were concomitantly recorded.
RESULTS: Dysphagia was found in 30/40 (75%) of Alzheimer\'s disease patients. Mean volume at the DL test was significantly reduced (16.5±1.0mL) in the Alzheimer\'s disease group. Swallowing and apnea times in the SWS test were significantly prolonged in elderly controls, but even longer in Alzheimer\'s disease patients.
CONCLUSIONS: Alzheimer\'s disease patients had electrophysiological features of dysphagia, even in the early period of disease. The cortical involvement and severity of cognitive disorder can increase swallowing problems, but subclinical signs of dysphagia may be observed even in patients with mild or moderate Alzheimer\'s disease.

OBJECTIVE: To characterize the motor command of the soft palate muscles using a magnetic stimulation technique.
METHODS: Motor evoked potentials (MEPs) were recorded in 10 right-handed and 5 left-handed subjects at the midline of the palate or on the right or left hemipalate to peripheral and cortical magnetic stimulation.
RESULTS: Mean palatal MEP amplitude ranged from 0.06 to 0.26mV to peripheral stimulation and from 0.36 to 1.09mV to cortical stimulation. In hemipalate recordings, MEPs to peripheral stimulation had greater amplitude when recorded ipsilaterally to the stimulation side, whereas MEPs to cortical stimulation were symmetrical. In midline recordings, right-handed subjects showed greater palatal MEP amplitude to right (rather than left) peripheral stimulation and to left (rather than right) cortical stimulation. Mean palatal MEP latency ranged from 4.0 to 4.1ms to peripheral stimulation and from 9.0 to 10.2ms to cortical stimulation; mean central conduction time ranged from 4.9 to 6.2ms.
CONCLUSIONS: Palatal MEPs were easily and reliably obtained, including selective responses in each hemipalate. A bilateral cortical command of the palate is supported by our results, with a possible predominant motor drive from the left hemisphere in right-handed subjects.