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Swallowing and Dysphagia Rehabilitation: Translating Principles of Neural Plasticity Into Clinically Oriented Evidence

Susan G. Butler
Wake Forest University School of Medicine, Winston-Salem, NC

Stephanie K. Daniels
Michael E. DeBakey VA Medical Center, Houston, TX

Roxann Diez Gross
University of Pittsburgh School of Medicine, Pittsburgh, PA

Susan Langmore
University of California, San Francisco, CA

Cathy L. Lazarus
New York University School of Medicine, New York, NY

Bonnie Martin-Harris
Medical University of South Carolina, Charleston, SC

Daniel McCabe
Bath VA Medical Center, Bath, NY

Nan Musson
North Florida/South Georgia Veterans Healthcare System, Gainesville, FL

John Rosenbek
University of Florida, Gainesville, FL

Contact author: JoAnne Robbins, VAMC GRECC 11G, 2500 Overlook Terrace, Madison, WI 53705. E-mail: jrobbin2{at}wisc.edu.

Purpose: This review presents the state of swallowing rehabilitation science as it relates to evidence for neural plastic changes in the brain. The case is made for essential collaboration between clinical and basic scientists to expand the positive influences of dysphagia rehabilitation in synergy with growth in technology and knowledge. The intent is to stimulate thought and propose potential research directions.

Method: A working group of experts in swallowing and dysphagia reviews 10 principles of neural plasticity and integrates these advancing neural plastic concepts with swallowing and clinical dysphagia literature for translation into treatment paradigms. In this context, dysphagia refers to disordered swallowing associated with central and peripheral sensorimotor deficits associated with stroke, neurodegenerative disease, tumors of the head and neck, infection, or trauma.

Results and Conclusions: The optimal treatment parameters emerging from increased understanding of neural plastic principles and concepts will contribute to evidence-based practice. Integrating these principles will improve dysphagia rehabilitation directions, strategies, and outcomes. A strategic plan is discussed, including several experimental paradigms for the translation of these principles and concepts of neural plasticity into the clinical science of rehabilitation for oropharyngeal swallowing disorders, ultimately providing the evidence to substantiate their translation into clinical practice.

KEY WORDS: rehabilitation, nervous system, swallowing treatment, dysphagia, evidence-based practice

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