The Pathway from Anatomy and Physiology to Diagnosis: A Developmental Perspective on Swallowing and Dysphagia

Abstract

Dysphagia results from diverse and distinct etiologies. The pathway from anatomy and physiology to clinical diagnosis is complex and hierarchical. Our approach in this paper is to show the linkages from the underlying anatomy and physiology to the clinical presentation. In particular, the terms performance, function, behavior, and physiology are often used interchangeably, which we argue is an obstacle to clear discussion of mechanism of pathophysiology. We use examples from pediatric populations to highlight the importance of understanding anatomy and physiology to inform clinical practice. We first discuss the importance of understanding anatomy in the context of physiology and performance. We then use preterm infants and swallow-breathe coordination as examples to explicate the hierarchical nature of physiology and its impact on performance. We also highlight where the holes in our knowledge lie, with the ultimate endpoint of providing a framework that could enhance our ability to design interventions to help patients. Clarifying these terms, and the roles they play in the biology of dysphagia will help both the researchers studying the problems as well as the clinicians applying the results of those studies.

Keywords: Animal models; Deglutition; Pathophysiology; Pediatric.

Fig 1.

Problems in performance come from earlier in the hierarchy, in the underlying anatomy and physiology. The black lines indicate the normal pathway. The crossed arrows represent interactions between functions and environments that produce performance. The red lines and text indicate that pathophysiology result from problems in underlying anatomy or physiology. These in turn can either directly generate pathological functions, the specific components that constitute performance, or produce functions that interact with specific environmental issues to result in performance failure.