Dysphagia Management in Neurological Disorders

Dysphagia in neurological disorders arises when lesions in cortical, brainstem or peripheral pathways disrupt the coordinated sequence of voluntary and reflexive movements required for safe swallowing. Common in stroke, Parkinson’s disease, multiple sclerosis and traumatic brain injury, it predisposes individuals to malnutrition, dehydration, aspiration pneumonia and increased mortality. Management demands a multidisciplinary approach, beginning with systematic screening and diagnostic evaluation using clinical bedside assessments and instrumental techniques such as videofluoroscopy or endoscopic evaluation of swallowing. Interventions combine compensatory strategies—postural adjustments, swallow manoeuvres and texture-modified diets—with rehabilitative exercises to strengthen orofacial and pharyngeal muscles. Neuromuscular electrical stimulation, transcranial magnetic stimulation and pharmacological agents targeting neuromodulatory circuits have emerged as adjuncts to therapy. Concurrently, tailored nutritional formulations informed by rheological modelling and continuous monitoring via wearable sensors promise to refine risk stratification and personalise treatment. By mitigating complications, reducing hospital stays and enhancing quality of life, effective dysphagia management holds global significance, particularly in ageing populations and resource-limited settings.

Research from Nature Portfolio

Recent studies have elucidated the neural circuits underlying electroacupuncture-based rehabilitation in post-stroke dysphagia. A 2023 murine model investigation revealed that stimulation at the CV23 acupoint restores swallowing by engaging excitatory neurons in layer 5 of the primary motor cortex and their projections to the parabrachial nucleus and nucleus tractus solitarii. Activation of this M1–PBN–NTS circuit ameliorated impairment in mylohyoid muscle activity and drinking behaviour, suggesting that targeted neuromodulation strategies grounded in central motor control could complement conventional therapies for post-stroke swallowing dysfunction.

Dysphagia Management in Neurological Disorders publication trend

The graph below shows the total number of articles in dysphagia management in neurological disorders across all publications each year (not limited to Nature Index journals).

Technical terms

Dysphagia: Difficulty or impairment in swallowing due to neuromuscular or structural dysfunction.

Aspiration pneumonia: Lung infection resulting from inhalation of oropharyngeal contents into the airway.

Bolus: A cohesive mass of chewed food or fluid formed in the mouth for swallowing.

Electromyography (EMG): Technique for recording the electrical activity of muscles during function.

Viscosity: A measure of a fluid’s resistance to flow, critical for controlling bolus transit and safety.

Kirigami electrode: A flexible sensor design featuring patterned cuts that maintain skin contact during movement.

Parabrachial nucleus (PBN) and nucleus tractus solitarii (NTS): Brainstem centres integrally involved in coordinating the swallowing reflex and airway protection.

References

1. Towards designing dysphagia foods: Recent advances in influencing factors and computer modeling for the swallowing of thickened fluids. Trends in Food Science & Technology (2023).
2. Electroacupuncture improves swallowing function in a post-stroke dysphagia mouse model by activating the motor cortex inputs to the nucleus tractus solitarii through the parabrachial nuclei. Nature Communications (2023).
3. Wearable, epidermal devices for assessment of swallowing function. npj Flexible Electronics (2023).
4. Automatic Clinical Assessment of Swallowing Behavior and Diagnosis of Silent Aspiration Using Wireless Multimodal Wearable Electronics. Advanced Science (2024).