Neurorehabilitation strategies for poststroke oropharyngeal dysphagia: from compensation to the recovery of swallowing function
| Autor: | Hatice Kumru, Ernest Palomeras, Natàlia Vilardell, Pere Clavé, Christopher Cabib, Daniel Alvarez-Berdugo, Omar Ortega, Fermín Mearin, Desiree Muriana, Rosa Terré, Laia Rofes |
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| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
medicine.diagnostic_test business.industry Laryngeal vestibule General Neuroscience medicine.medical_treatment Electromyography Electroencephalography medicine.disease General Biochemistry Genetics and Molecular Biology Transcranial magnetic stimulation 03 medical and health sciences 0302 clinical medicine Physical medicine and rehabilitation medicine.anatomical_structure History and Philosophy of Science Swallowing Medicine 030211 gastroenterology & hepatology medicine.symptom business Stroke 030217 neurology & neurosurgery Neurorehabilitation Oropharyngeal dysphagia |
| Zdroj: | Annals of the New York Academy of Sciences. 1380:121-138 |
| ISSN: | 0077-8923 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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