Treatment of dysphagia in patients with brain disorders

Abstract

Dysphagia is caused by various pathologic conditions of which brain disorders are the major etiology. If food materials enter an airway, aspiration pneumonia or serious asphyxia can develop, which necessitates early detection and proper management of dysphagia. Diagnosis of dysphagia includes history taking, physical examination, bedside screening tests, videofluoro-scopic swallowing study (VFSS), and fiberoptic endoscopic examination of swallowing (FEES). Dysphagia management or rehabilitation consists of direct and indirect training methods. The direct one consists of modification of the texture and viscosity (using fluid thickener) of the diet, and diverse compensatory techniques for posture change (chin tuck, head rotation, and head tilt), airway protection (supraglottic swallowing and super-supraglottic swallowing) and improvement of bolus passage (effortful swallowing, multiple swallowing, Mendelsohn maneuver). Indirect training methods without using food are made up of thermal tactile stimulation, electrical stimulation of suprahyoid or infrahyoid muscles, repetitive transcranial magnetic stimulation, and strengthening of the tongue or pharyngeal muscles involved in swallowing (Shaker's exercise and vocal cord adduction exercise). Oral hygiene, adequate hydration, and nutritional support are also crucial. Although the prognosis of dysphagia is favorable with proper rehabilitation, enteral feeding through percutaneous endoscopic gastrostomy or an oroesophageal tube would be helpful to patients who have unresolved dysphagia for some time. Further large-scale clinical studies will be needed to establish evidence on various training methods for dysphagia management. © Korean Medical Association.