title: Neurorehabilitation strategies for poststroke oropharyngeal dysphagia: from compensation to the recovery of swallowing function.
abstract: 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.
authors.affiliation: Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.
authors.forename: Christopher
authors.initials: C
authors.lastname: Cabib
authors.affiliation: Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.|Centro de Investigación Biomedica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: Omar
authors.initials: O
authors.lastname: Ortega
authors.affiliation: Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació, Universitat Autonoma de Barcelona, Badalona, Spain.
authors.forename: Hatice
authors.initials: H
authors.lastname: Kumru
authors.affiliation: Neurology Department, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.
authors.forename: Ernest
authors.initials: E
authors.lastname: Palomeras
authors.affiliation: Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.
authors.forename: Natalia
authors.initials: N
authors.lastname: Vilardell
authors.affiliation: Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.|Centro de Investigación Biomedica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Alvarez-Berdugo
authors.affiliation: Neurology Department, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.
authors.forename: Desirée
authors.initials: D
authors.lastname: Muriana
authors.affiliation: Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.|Centro de Investigación Biomedica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: Laia
authors.initials: L
authors.lastname: Rofes
authors.affiliation: Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació, Universitat Autonoma de Barcelona, Badalona, Spain.|Health Sciences Research Institute of the Germans Trias i Pujol Foundation, Barcelona, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Terré
authors.affiliation: Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació, Universitat Autonoma de Barcelona, Badalona, Spain.|Health Sciences Research Institute of the Germans Trias i Pujol Foundation, Barcelona, Spain.
authors.forename: Fermín
authors.initials: F
authors.lastname: Mearin
authors.affiliation: Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain. pere.clave@ciberehd.org.|Centro de Investigación Biomedica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain. pere.clave@ciberehd.org.|Health Sciences Research Institute of the Germans Trias i Pujol Foundation, Barcelona, Spain. pere.clave@ciberehd.org.
authors.forename: Pere
authors.initials: P
authors.lastname: Clavé
mesh_terms: D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D006801:Humans; D000066530:Neurological Rehabilitation / Q000379:methods; D009960:Oropharynx / Q000502:physiology*; D020127:Recovery of Function / Q000502:physiology*; D000071939:Stroke Rehabilitation / Q000379:methods*
keywords: neurorehabilitation; oropharyngeal dysphagia; stroke; swallowing disorders; therapy