Swallowing is a critical life function and its failure leads to life threatening complications. Swallow-related behaviors involve the modulation of complex, adaptive muscular contractions to produce pressures and valving events throughout the oral cavity, laryngo-pharynx and esophagus. However, our understanding of the mechanisms that generate and modulate these pressures remains incomplete. Efficient swallow is the result of a pressure gradient that maximizes the probability of complete bolus transfer into the esophagus. High Resolution Manometry (HRM) can directly measure these pressure patterns along the length of the pharynx and provides a quantifiable, comprehensive data set directly characterizing each swallow event. The use of HRM is in its infancy and due to its unique capabilities, has the potential to become an exceptionally valuable tool in the diagnosis and management of pharyngeal swallowing disorders. When coupled with videofluoroscopic (VF) evaluations, HRM/VF could provide the detailed, multi-dimensional assessment that will define the structures and movements which generate pressure, redefine the models of normal and dysfunctional swallow, increase accuracy of diagnosis, and directly measure therapeutic effect. However, the lack of a comprehensive analysis of the pressure patterns currently precludes the use of HRM in evidence-based practice. The overarching goal of this research proposal is to develop new clinical capabilities for the diagnosis of impaired pharyngeal swallowing by optimizing HRM analysis and combining results with those obtained by VF. This new technology will then be used to determine the extent to which these combined technologies can optimize diagnosis of dysphagia in populations with variable swallowing impairment. In the final phase of this work, we will test clinical acceptance of this new tool. This work is highly significant because HRM combined with VF when analyzed appropriately and optimized will augment interventions in the clinical care of patients with dysphagia.