Volitional control of food transport and bolus formation during feeding

When healthy individuals eat solid food, chewed food is usually transported to the oropharynx where it accumulates before swallowing (stage II transport). We tested the hypothesis that this transport process can be altered by volition. Eight healthy young subjects ate 8 g pieces of cookie with barium while movements were recorded with videofluorography. There were two trials for each subject, each with different instructions: 1) without command: to eat the cookie in his/her usual manner; 2) with command: to chew the cookie, give a signal when ready to swallow, and then swallow on command of the investigator. We measured the number of chewing cycles, the duration of each stage in the feeding sequence, and the position of the leading edge of the barium at time of command and at swallow onset. Sequence duration was longer with than without command (P = 0.02), primarily because of an increase in the number of chewing cycles (P = 0.02). The leading edge was typically higher in the foodway at the time of swallow onset with than without command (P = 0.06). Under the command condition, stage II transport was delayed, and transport to the valleculae was inhibited. Volition alters swallow initiation in both the timing and location of the food bolus relative to the airway.