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Neurorehabilitation strategies for poststroke oropharyngeal dysphagia: from compensation to the recovery of swallowing function
Author(s) -
Cabib Christopher,
Ortega Omar,
Kumru Hatice,
Palomeras Ernest,
Vilardell Natalia,
AlvarezBerdugo Daniel,
Muriana Desirée,
Rofes Laia,
Terré Rosa,
Mearin Fermín,
Clavé Pere
Publication year - 2016
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1111/nyas.13135
Subject(s) - neurorehabilitation , swallowing , medicine , physical medicine and rehabilitation , dysphagia , transcranial magnetic stimulation , stroke (engine) , oropharyngeal dysphagia , electromyography , neuroscience , neuroplasticity , rehabilitation , stimulation , psychology , physical therapy , surgery , mechanical engineering , engineering
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.