Dysphagia Associated with Neurological Disorders

Abstract

Neurogenic dysphagia is characterized by problems with neural control of swallowing caused by various neurological diseases: vascular diseases, traumatic diseases, neoplasms, infections, neuromuscular diseases, and others. In patients of intensive care units after long-term intubation and extubation may evolve “postextubation dysphagia”, characterized by the “learned non-use” phenomenon. Neurogenic dysphagia is a component of bulbar or pseudobulbar palsy, depending on the level of the neurological lesion. Diagnoses of neurogenic dysphagia include clinical examination (water swallow test), videofluoroscopy, upper gastrointestinal tract endoscopy and manometry, fiberoptic endoscopic evaluation of swallowing, a grade of Penetration-Aspiration Scale, and Fiberoptic Endoscopic Dysphagia Severity Scale. Dysphagia complications (malnutrition, dehydration, weight loss, aspiration, and respiratory tract obstruction) associated with bad functional recovery and life prognosis, so neurogenic dysphagia need a complex treatment: correct feeding pattern of caloric value and consistency, methods of oral cavity mucosa sensitivity stimulation, swallowing process stimulation, physiotherapeutic treatment methods (electrical stimulation of the larynx and tongue root), logopedic exercises therapy, surgical correction, lifestyle correction, and others. Sometimes it is a need for replacement therapy method by nasogastric tube and percutaneous endoscopic gastrostomy, parenteral feeding in several cases. Neurogenic dysphagia patient rehabilitation includes the “swallowing enhancement” method with optimal food consistency and training method after correct preparation of the oral cavity for swallowing. Neurogenic dysphagia patient oral feeding requires correct technique and contact with the patient for safety and efficient recovery.