The Evolution of Swallowing Rehabilitation and Emergence of Biofeedback Modalities

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Abstract

Purpose of Review

The purpose of this review is to consolidate evidence related to the use of biofeedback in swallowing rehabilitation. Rather than a comprehensive review, we provide a historical and conceptual justification for integration of biofeedback modalities in the treatment of dysphagia.

Recent Findings

Although biofeedback has been used for decades in/as an adjunct to muscle strengthening rehabilitation programmes, advances in our understanding of swallowing neural control provide potential for new applications of technology to facilitate swallowing recovery. New research highlights the emergence of skill-based swallowing training, which focuses on adaptation of specific components of timing and coordination in the swallowing motor plan. This research suggests positive clinical outcomes using feedback that is impairment specific and is designed with principles of neuroplasticity in mind.

Summary

The emerging emphasis on motor control, rather than muscle strength, implicates a critical role for the use of biofeedback modalities to allow conscious insights into specific aspects of the generally obscure swallowing process.

Related collections

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The ability to induce cortical plasticity with non-invasive brain stimulation (NBS) techniques has provided novel and exciting opportunities for examining the role of the human cortex during a variety of behaviours. Additionally, and importantly, the induction of lasting changes in cortical excitability can, under some conditions, reversibly modify behaviour and interact with normal learning. Such findings have driven a large number of recent studies examining whether by using such approaches it might be possible to induce functionally significant changes in patients with a large variety of neurological and psychiatric conditions including stroke, Parkinson's disease and depression. However, even in neurologically normal subjects the variability in the neurophysiological and behavioural response to such brain stimulation techniques is high. This variability at present limits the therapeutic usefulness of these techniques. The cause of this variability is multifactorial and to some degree still unknown. However, a number of factors that can influence the induction of plasticity have been identified. This review will summarise what is known about the causes of variability in healthy subjects and propose additional factors that are likely to be important determinants. A greater understanding of these determinants is critical for optimising the therapeutic applications of non-invasive brain stimulation techniques.