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Dysphagia pp 519-538 | Cite as

Direct and Indirect Therapy: Neurostimulation for the Treatment of Dysphagia After Stroke

  • Satish Mistry
  • Emilia Michou
  • Dipesh H. Vasant
  • Shaheen Hamdy
Part of the Medical Radiology book series (MEDRAD)

Abstract

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 a limited evidence-base and little in the way of objective outcome measures providing scientific support for any observed changes. Moreover, swallowing can recover in some patients to a safe level within weeks, making it 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 which warrants systematic investigation. In this chapter, we review current knowledge and discuss some of the pioneering work conducted by researchers from both our laboratory and others in the field of human swallowing over the last decade. This chapter provides 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 also describes how using these neurostimulation techniques to manipulate the brain’s natural capacity to reorganise (cortical plasticity) after injury or in response to new stimuli is helping in the process of developing novel therapies for the treatment of dysphagia and other motor disorders in humans.

Keywords

Transcranial Magnetic Stimulation Cortical Excitability Anodal tDCS Transcranial Direct Current Stimulation Dysphagic Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

DOSS

Dysphagia outcome and severity scale

fMRI

Functional magnetic resonance

PAS

Paired associative stimulation

PES

Pharyngeal electrical stimulation

PET

Positron emission tomography

rTMS

Repetitive transcranial magnetic stimulation

tDCS

Transcranial direct current stimulation

TMS

Transcranial magnetic stimulation

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Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • Satish Mistry
    • 1
  • Emilia Michou
    • 1
  • Dipesh H. Vasant
    • 1
  • Shaheen Hamdy
    • 1
    • 2
  1. 1.Department of Inflammation Sciences, Salford Royal NHS Foundation TrustUniversity of ManchesterManchesterUK
  2. 2.Department of GI Sciences (Clinical Sciences Building), Salford Royal NHS Foundation TrustInflammation Sciences Research Group, University of ManchesterManchesterUK

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