Neurorehabilitation strategies for poststroke oropharyngeal dysphagia: from compensation to the recovery of swallowing function

Christopher Cabib, Omar Ortega, Hatice Kumru, Ernest Palomeras, Natalia Vilardell, Daniel Alvarez-Berdugo, Desirée Muriana, Laia Rofes, Rosa Terré, Fermín Mearin, Pere Clavé

Research output: Contribution to journalArticleResearchpeer-review

28 Citations (Scopus)

Abstract

© 2016 New York Academy of Sciences. Oropharyngeal dysphagia (OD) is very prevalent among poststroke patients, causing severe complications but lacking specific neurorehabilitation treatment. This review covers advances in the pathophysiology, diagnosis, and physiologically based neurorehabilitation strategies for poststroke OD. The pathophysiology of oropharyngeal biomechanics can be assessed by videofluoroscopy, as delayed laryngeal vestibule closure is closely associated with aspiration. Stroke may affect afferent or efferent neuronal circuits participating in deglutition. The integrity of oropharyngeal–cortical afferent pathways can be assessed by electroencephalography through sensory-evoked potentials by pharyngeal electrical stimulation, while corticopharyngeal efferent pathways can be characterized by electromyography through motor-evoked potentials by transcranial magnetic stimulation. Dysfunction in both cortico-mediated evoked responses is associated with delayed swallow response and aspiration. Studies have reported hemispherical asymmetry on motor control of swallowing and the relevance of impaired oropharyngeal sensitivity on aspiration. Advances in treatment include improvements in compensatory strategies but are mainly focused on (1) peripheral stimulation strategies and (2) central, noninvasive stimulation strategies with evidence of their clinical benefits. Characterization of poststroke OD is evolving from the assessment of impaired biomechanics to the sensorimotor integration processes involved in deglutition. Treatment is also changing from compensatory strategies to promoting brain plasticity, both to recover swallow function and to improve brain-related swallowing dysfunction.
Original languageEnglish
Pages (from-to)121-138
JournalAnnals of the New York Academy of Sciences
Volume1380
Issue number1
DOIs
Publication statusPublished - 1 Sep 2016

Keywords

  • neurorehabilitation
  • oropharyngeal dysphagia
  • stroke
  • swallowing disorders
  • therapy

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