Special communicationSwallowing Neurorehabilitation: From the Research Laboratory to Routine Clinical Application
Section snippets
Neuromodulatory Techniques in Swallowing Rehabilitation
The last decade in particular has seen the emergence of neuromuscular electrical stimulation (NMES) protocols in rehabilitation medicine. In general, NMES uses the application of pulsed electrical currents to muscles, nerves, or neuromuscular junctions with the therapeutic benefits thought to arise from improvements in muscle strength, stamina, and reaction time.17 Based on these general concepts, a number of differing protocols for applying NMES as a swallowing rehabilitation intervention have
Experimental Transcranial Brain Stimulation and Swallowing Rehabilitation
TMS and tDCS are the most common transcranial brain stimulation techniques, which stimulate neuronal networks within the brain through the intact skull with little or no discomfort. Both techniques are currently only used in experimental and clinical dysphagia research settings. TMS is based on concepts of electromagnetism, and can be applied either as single magnetic pulses (single- or paired-pulse TMS) or trains of magnetic pulses (repetitive TMS [rTMS]). Single-pulse TMS is used
Provision of Experimental Brain Stimulation Services in Clinical Dysphagia Rehabilitation
Although rTMS is already being tested in large-scale clinical trials as a treatment for other health conditions (eg, treatment-resistant depression and tinnitus), brain stimulation for the purpose of swallowing rehabilitation is currently only used by trained researchers conducting carefully monitored experimental protocols in a few research centers across the world. As more data are collected and if outcomes support the viability of neurostimulation protocols, the natural progression will be a
Professional Training: Guidelines For Ensuring Optimal Patient Care
The development of reliable and standardized brain stimulation protocols for routine clinical use should be accompanied by the development of guidelines for the training and application of these paradigms in clinical practice. To date, no international or national guidelines have been established that outline the training requirements for experimental brain stimulation. The International Federation of Clinical Neurophysiology is currently in the process of developing such guidelines.40 Although
Access to Stimulation Equipment: Practical Considerations
Unlike NMES devices, which are relatively inexpensive and can be operated by a patient or carer using clinician-defined protocols, experimental brain stimulation tools, especially rTMS, are expensive (>$10,000 U.S.) and cannot be patient operated. Therefore, patients will be required to attend the swallowing rehabilitation service providers' clinics to receive treatment. This may be clinically optimal, since paired application of brain stimulation with conventional swallowing rehabilitation
Conclusions
We conclude that the currently available research evidence suggests that experimental brain stimulation holds the potential for (1) inducing changes in the motor cortical areas that are involved in swallowing, which outlast the stimulation period, and importantly, (2) that such experimentally induced plastic changes can under certain circumstances be relevant for swallowing function. Given the promising potential that these novel rehabilitation techniques hold for improving the health, safety,
References (55)
- et al.
Submental surface electromyographic measurement and pharyngeal pressures during normal and effortful swallowing
Arch Phys Med Rehabil
(2005) - et al.
The effect of effortful swallow on pharyngeal manometric measurements during saliva and water swallowing in healthy participants
Arch Phys Med Rehabil
(2008) Apnea-associated reduction in lower esophageal sphincter tone in premature infants
J Pediatr
(2009)- et al.
Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening
Gastroenterology
(2002) - et al.
Driving plasticity in the human adult motor cortex is associated with improved motor function after brain injury
Neuron
(2002) - et al.
Theta burst stimulation of the human motor cortex
Neuron
(2005) - et al.
Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research
Clin Neurophysiol
(2009) - et al.
A magnetic resonance spectroscopy study of brain glutamate in a model of plasticity in human pharyngeal motor cortex
Gastroenterology
(2009) - et al.
Facilitating skilled right hand motor function in older subjects by anodal polarization over the left primary motor cortex
Neurobiol Aging
(2010) - et al.
Characterising the central mechanisms of sensory modulation in human swallowing motor cortex
Clin Neurophysiol
(2004)
Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex
Gastroenterology
Increased postoperative posterior pharyngeal wall movement in patients with anterior oral cancer: preliminary findings and possible implications for treatment
Am J Speech Lang Pathol
Augmentation of deglutitive upper esophageal sphincter opening in the elderly by exercise
Am J Physiol
A penetration-aspiration scale
Dysphagia
Evaluation and treatment of swallowing disorders
Fiberoptic endoscopic examination of swallowing safety: a new procedure
Dysphagia
Clinical measurement of pharyngeal surface electromyography: exploratory research
Neurorehabil Neural Repair
Timing of pharyngeal and upper esophageal sphincter pressures as a function of normal and effortful swallowing in young healthy adults
Dysphagia
Effects of bolus volume on pharyngeal contact pressure during normal swallowing
Dysphagia
Evaluation of manometric measures during tongue-hold swallows
Am J Speech Lang Pathol
A direct intervention program for chronic neurogenic dysphagia secondary to brainstem stroke
Dysphagia
Outcomes of swallowing rehabilitation in chronic brainstem dysphagia: a retrospective evaluation
Dysphagia
Functional benefits of dysphagia therapy using adjunctive sEMG biofeedback
Dysphagia
Principles of electrical stimulation
Examining the evidence on neuromuscular electrical stimulation for swallowing
Arch Otolaryngol
Emerging modalities in dysphagia rehabilitation: neuromuscular electrical stimulation
N Z Med J
Electric stimulation approaches to the restoration and rehabilitation of swallowing: a review
Neurol Res
Cited by (29)
Differences in brain networks during consecutive swallows detected using an optimized vertex–frequency algorithm
2017, NeuroscienceCitation Excerpt :Previous studies showed that the brain’s plasticity enables reorganization of the sensory and motor cortex (Robbins et al., 2008; Rosenkranz et al., 2008; Davenport et al., 2011). This reorganization is correlated with the rehabilitation of patients, who are suffering from some neurological conditions, such as stroke (Hamdy et al., 2000; Doeltgen and Huckabee, 2012). This leads us to speculate that the analysis of swallowing and swallowing disorders from a brain activity perspective could yield useful insights into how to exploit this reorganization to better rehabilitate neurogenic dysphagia.
Moderate-to-Severe Traumatic Brain Injury in Children: Complications and Rehabilitation Strategies
2015, Journal of Pediatric Health CareCitation Excerpt :In addition to traditional compensatory techniques, recent approaches to treatment of swallow dysfunction have included use of electrical stimulation for modulation of neuronal systems affecting swallowing function. Trained speech language pathologists apply electrodes to the skin at the oropharyngeal neuromuscular junctions to deliver pulses of electrical stimulation to the muscles needed for swallowing in conjunction with ingestion of food or liquids (Doeltgen & Huckabee, 2012; Miller, 2011). Oral motor integrity plays an integral part in the ability to manage oral secretions as well.
Transcranial non-invasive brain stimulation in swallowing rehabilitation following stroke - A review of the literature
2015, Physiology and BehaviorCitation Excerpt :International collaboration must be encouraged to perform trials with sufficient numbers to accurately determine which paradigms may be superior to others in order to facilitate the eventual progression of the most effective and safe paradigms into clinical practice. As demonstrated in this review and previous commentaries [5,6], the current evidence base is in a process of rapid growth with the promising implication that NBS may provide an effective and safe adjunct to swallowing rehabilitation practice. There are several practical implications that accompany the eventual progression of NBS paradigms into clinical practice.
Magnetoencephalographic evidence for the modulation of cortical swallowing processing by transcranial direct current stimulation
2013, NeuroImageCitation Excerpt :Venkatakrishnan et al. (2011) found effects to persist for up to 25 min post-tDCS which is presumably in the range of our study since MEG recording of all three swallow tasks took half an hour and the effects were still visible in the “challenged swallow task” which was conducted at last. Only recently, Doeltgen and Huckabee (2012) discussed whether this duration of after-effects could on its own ever be sufficient to be therapeutically meaningful. Since simultaneous training and neuromodulation are currently regarded as the most promising approach to promote the brain's intrinsic neural repair mechanisms, they concluded this time window of experimentally enhanced cortical excitability to be long enough to provide most conventional rehabilitative training protocols.
Treatment of oropharyngeal dysphagia with neuromuscular electrostimulaiton
2013, Medicina Clinica
Supported by a Postdoctoral Australian Biomedical Research Fellowship from the National Health and Medical Research Council of Australia.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.