Direct and indirect therapy: Neurostimulation for the treatment of dysphagia after stroke

© 2018, Springer International Publishing AG. Swallowing problems (dysphagia) are common after brain injury and can affect as many as 50% of patients in the period immediately after stroke. In some cases this can lead to serious morbidity, in particular malnutrition and pulmonary aspiration. Despite this, swallowing therapies remain controversial, with limited evidence base and few objective outcome measures that would provide scientific support for the observed changes. Moreover, swallowing can recover in some patients to a safe level within weeks, introducing stroke as an interesting model for understanding brain recovery and compensation. A better understanding of these adaptive processes, seen during the spontaneous recovery phase, may help in developing therapeutic interventions capable of driving brain changes and encouraging the recovery process and is therefore a key goal for clinical neuroscience research warranting systematic investigation. In this chapter, we will review current knowledge and discuss some of the pioneering work conducted by researchers in the field of human swallowing neuromodulation over the last decade. The chapter will provide insights as to how the cerebral control of swallowing can be studied non-invasively in the human brain using neuroimaging tools and neurostimulation techniques. In addition, it will describe how both using these neurostimulation techniques to manipulate the brain’s natural capacity to re-organise (cortical plasticity) after injury or in response to new stimuli and studying brain capacity to re-organise help in the development of novel therapies for the treatment of dysphagia and other motor disorders in humans.

Publication year:2019