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      Pharyngeal electrical stimulation device for the treatment of neurogenic dysphagia: technology update

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          Abstract

          Neurogenic dysphagia (ND) can occur in patients with nervous system diseases of varying etiologies. Moreover, recovery from ND is not guaranteed. The therapeutic approaches for oropharyngeal ND have drastically changed over the last decade, mainly due to a better knowledge of the neurophysiology of swallowing along with the progress of neuroimaging and neurophysiological studies. For this reason, it is a priority to develop a treatment that is repeatable, safe, and can be carried out at the bedside as well as for outpatients. Pharyngeal electrical stimulation (PES) is a novel rehabilitation treatment for ND. PES is carried out via location-specific intraluminal catheters that are introduced transnasally and enable clinicians to stimulate the pharynx directly. This technique has demonstrated increasingly promising evidence in improving swallowing performance in patients with ND associated with stroke and multiple sclerosis, probably by increasing the corticobulbar excitability and inducing cortical reorganization of swallowing motor cortex. In this article, we update the reader as to both the physiologic background and past and current studies of PES in an effort to highlight the clinical progress of this important technique.

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          Most cited references24

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          Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex.

          The aim of this study was to determine the mechanism for recovery of swallowing after dysphagic stroke. Twenty-eight patients who had a unilateral hemispheric stroke were studied 1 week and 1 and 3 months after the stroke by videofluoroscopy. Pharyngeal and thenar electromyographic responses to magnetic stimulation of multiple sites over both hemispheres were recorded, and motor representations were correlated with swallowing recovery. Dysphagia was initially present in 71% of patients and in 46% and 41% of the patients at 1 and 3 months, respectively. Cortical representation of the pharynx was smaller in the affected hemisphere (5 +/- 1 sites) than the unaffected hemisphere (13 +/- 1 sites; P
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            Driving plasticity in human adult motor cortex is associated with improved motor function after brain injury.

            Changes in somatosensory input can remodel human cortical motor organization, yet the input characteristics that promote reorganization and their functional significance have not been explored. Here we show with transcranial magnetic stimulation that sensory-driven reorganization of human motor cortex is highly dependent upon the frequency, intensity, and duration of stimulus applied. Those patterns of input associated with enhanced excitability (5 Hz, 75% maximal tolerated intensity for 10 min) induce stronger cortical activation to fMRI. When applied to acutely dysphagic stroke patients, swallowing corticobulbar excitability is increased mainly in the undamaged hemisphere, being strongly correlated with an improvement in swallowing function. Thus, input to the human adult brain can be programmed to promote beneficial changes in neuroplasticity and function after cerebral injury.
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              Sensory Input Pathways and Mechanisms in Swallowing: A Review

              Over the past 20 years, research on the physiology of swallowing has confirmed that the oropharyngeal swallowing process can be modulated, both volitionally and in response to different sensory stimuli. In this review we identify what is known regarding the sensory pathways and mechanisms that are now thought to influence swallowing motor control and evoke its response. By synthesizing the current state of research evidence and knowledge, we identify continuing gaps in our knowledge of these mechanisms and pose questions for future research.
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                Author and article information

                Journal
                Med Devices (Auckl)
                Med Devices (Auckl)
                Medical Devices: Evidence and Research
                Medical Devices (Auckland, N.Z.)
                Dove Medical Press
                1179-1470
                2018
                04 January 2018
                : 11
                : 21-26
                Affiliations
                [1 ]Neurological Unit, Garibaldi Hospital, Catania, Italy
                [2 ]School of Translational Medicine—Inflammation Sciences, Faculty of Medical and Human Sciences, University of Manchester, Salford Royal Hospital, Salford, UK
                Author notes
                Correspondence: Domenico A Restivo, Neurological Unit, Garibaldi Hospital, Piazza S. Maria di Gesù 5, 95100 Catania, Italy, Tel +39 095 7593 909, Fax +39 095 7593 934, Email darestivo@ 123456libero.it
                Article
                mder-11-021
                10.2147/MDER.S122287
                5757971
                29379319
                c998a1a3-5932-40f0-975d-cb9bb953a151
                © 2018 Restivo and Hamdy. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Biotechnology
                pharyngeal electrical stimulation,swallowing,neurogenic dysphagia,swallowing motor cortex,pharynx,catheter

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