•  Muscle groups that are commonly affected are those innervated by the cranial nerves, the bulbar muscles.  This can cause facial weakness, misarticulation, difficulty chewing and impaired swallowing, and weakness of the neck flexors and extensors.  Lips can also be affected, inability to whistle, or eat with utensils.

•  Often gives rise to impaired swallowing and chewing.

•  Eating becomes undesirable b/c patient has to support their jaw, lower lip, and floor of mouth to fight gravity.

•  Patient often has to turn head sideways to allow the throat to become more narrow.

•  Palatal weakness may give rise to regurgitation of fluids through the nose

•  Patients use coughing to compensate for choking; problem b/c of aspiration and it won't work due to respiratory muscle exhaustion.

•  Saliva can build up in mouth and pneumonia is also a problem

•  Increased  pharyngeal phase time

•  Decreased pharyngeal motility as demonstrated by residual material in the valleculae and pyriform sinuses bilaterally

•  Reduced laryngeal elevation

•  Laryngeal penetration is secondary to overflow of residual material

•  Silent aspirations (after swallow) are possible

•  Possible cricopharyngeal disfunction