During the clinical progression of amyotrophic lateral sclerosis (ALS) various disorders of the motor effector mechanisms of the pharynx may develop, impairing its functions of airway maintenance, swallow, or speech. Among ALS patients the disorders vary in distribution and sequence, but potentially affect each of these functions. Cineradiography is of strategic value in distinguishing the particular mechanisms of motor disability, whether paralysis, contracture, or atrophy, and also in the identification of motor compensations (6, 9). It is useful in demonstrating severity of disabilities and their potentially critical elements, as failure of laryngeal occlusion in swallowing. This information is essential for therapy, for facilitation of care and comfort, and at times for survival. Cineradiography, now generally available in medical centers, should be employed consistently in the evaluation and care of the ALS patient. Procedures Observations on 6 ALS subjects were selected from data of continuing studies of oral and pharyngeal function in neurologically impaired persons (3, 4, 7, 10). Each patient was clinically identified by standard criteria of neurological examination, including history of rapidly progressing neuromotor disability, electromy-ographic and muscle biopsy indications of motor unit involvement, and indications of higher level motor coordination. Each was free of intercurrent illness or of medication possibly affecting the motor disorder. The studies were performed when the subjects were well rested, and were programmed to avoid fatigue. Cineradiography was in transverse projection. This view demonstrates the spatial arrangement of cervical vertebrae, cranium, mandible, and the functionally related structures of tongue, hyoid, and larynx. It also shows diminution in mass of tongue or of prevertebral muscles. During variations in posture at the neck, possible contractures of the hyoid suspensory muscles may be shown and the cricopharyngeal bar abnormality may be seen during swallow. We particularly sought evidences of contracture in these muscles which might occasion additional specific methods of therapy, but none were found in these 6 patients. The laxity of the lateral walls of the pharynx is shown less well than in anteroposterior projection, but in the lower pharynx it may usually be inferred from the contours of the lateral pharyngeal or piriform sinuses as they are seen in transverse projection. In preparation for cineradiography, the anterior midline of face and neck was lined with barium paste. Unless the subjects were entirely lacking in swallow, a small amount of barium was given by mouth and also instilled into the nose. Subjects were “at ease” in upright position or, if their defense of pharyngeal airway was to be evaluated, they were supine. Their performances of flexion or extension, feeding, and speech were rehearsed until familiar. The trunk and lower portion of neck were lead-shielded.