Noninvasive Brain Stimulation for Treatment of Post-Stroke Dysphagia

Khedr, Eman M.; Abo-Elfetoh, Noha

doi:10.4303/ne/235663

Cited by 6 publications

(12 citation statements)

References 60 publications

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“…Dysphagia is a difficulty in swallowing that often occurs in neurological patients ( 1 ). Especially, dysphagia is a very common consequence of stroke, estimated to occur in up to 76% of patients with acute stroke ( 2 ). Dysphagia can have tremendous consequences, such as chest infection, malnutrition, prolonged hospital stay, slower rate of recovery, poorer rehabilitation potential, mortality, and reduced quality of life ( 3 , 4 ).…”

Section: Introductionmentioning

confidence: 99%

“…Acute focal brainstem infarct may produce dysphagia symptoms, especially affecting reflexive phases of the swallowing process, with little or no further neurocognitive deficit. About 62.5% of stroke patients with lesions in the brainstem, i.e., medulla oblongata or pons, aspirate ( 2 ). In contrast, volitional swallowing is represented in multiple regions of the cerebral cortex, such as the sensorimotor cortex, the lateral motor cortex, insula, the cerebellum, the superior temporal gyrus, middle and inferior frontal gyri, anterior cingulate cortex, and frontal operculum including the Broca’s area ( 21 , 25 , 38 – 40 ).…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, volitional swallowing is represented in multiple regions of the cerebral cortex, such as the sensorimotor cortex, the lateral motor cortex, insula, the cerebellum, the superior temporal gyrus, middle and inferior frontal gyri, anterior cingulate cortex, and frontal operculum including the Broca’s area ( 21 , 25 , 38 – 40 ). Lesions in these cerebral regions impair voluntary swallowing movements, which may lead to aspiration, too ( 2 , 41 ). On the basis of clinical and neuroimaging studies, especially unilateral hemispheric stroke can result in dysphagia ( 2 , 42 ).…”

Section: Introductionmentioning

confidence: 99%

“…Lesions in these cerebral regions impair voluntary swallowing movements, which may lead to aspiration, too ( 2 , 41 ). On the basis of clinical and neuroimaging studies, especially unilateral hemispheric stroke can result in dysphagia ( 2 , 42 ). A number of studies confirmed that about 40% of patients with unilateral hemispheric stroke may have swallowing difficulties ( 20 ).…”

Section: Introductionmentioning

confidence: 99%

“…Special emphasis lay on the question whether there are differences in brain activation patterns during swallowing movements between dysphagia patients with lesions in the cerebral cortex and dysphagia patients with lesions in the brainstem. Since there is evidence that lesions in cerebral regions impair voluntary swallowing movements whereas lesions in the brainstem impair more involuntary phases of the swallowing process, we expected differences in cerebral activation patterns during swallowing in dependence on lesion location ( 2 , 41 ). Furthermore, we wanted to determine the extent to which MI and ME of swallowing lead to comparable brain activation patterns in stroke patients, such as we have already observed in healthy young adults ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

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Hemodynamic Signal Changes Accompanying Execution and Imagery of Swallowing in Patients with Dysphagia: A Multiple Single-Case Near-Infrared Spectroscopy Study

Kober

Bauernfeind

Woller³

et al. 2015

Front. Neurol.

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In the present multiple case study, we examined hemodynamic changes in the brain in response to motor execution (ME) and motor imagery (MI) of swallowing in dysphagia patients compared to healthy matched controls using near-infrared spectroscopy (NIRS). Two stroke patients with cerebral lesions in the right hemisphere, two stroke patients with lesions in the brainstem, and two neurologically healthy control subjects actively swallowed saliva (ME) and mentally imagined to swallow saliva (MI) in a randomized order while changes in concentration of oxygenated hemoglobin (oxy-Hb) and deoxygenated hemoglobin (deoxy-Hb) were assessed. In line with recent findings in healthy young adults, MI and ME of swallowing led to the strongest NIRS signal change in the inferior frontal gyrus in stroke patients as well as in healthy elderly. We found differences in the topographical distribution and time course of the hemodynamic response in dependence on lesion location. Dysphagia patients with lesions in the brainstem showed bilateral hemodynamic signal changes in the inferior frontal gyrus during active swallowing comparable to healthy controls. In contrast, dysphagia patients with cerebral lesions in the right hemisphere showed more unilateral activation patterns during swallowing. Furthermore, patients with cerebral lesions showed a prolonged time course of the hemodynamic response during MI and ME of swallowing compared to healthy controls and patients with brainstem lesions. Brain activation patterns associated with ME and MI of swallowing were largely comparable, especially for changes in deoxy-Hb. Hence, the present results provide new evidence regarding timing and topographical distribution of the hemodynamic response during ME and MI of swallowing in dysphagia patients and may have practical impact on future dysphagia treatment.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Hemodynamic Signal Changes Accompanying Execution and Imagery of Swallowing in Patients with Dysphagia: A Multiple Single-Case Near-Infrared Spectroscopy Study

Kober

Bauernfeind

Woller³

et al. 2015

Front. Neurol.

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Effects of Motor Imagery and Visual Neurofeedback on Activation in the Swallowing Network: A Real-Time fMRI Study

2019

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Motor imagery of movements is used as mental strategy in neurofeedback applications to gain voluntary control over activity in motor areas of the brain. In the present functional magnetic resonance imaging (fMRI) study, we first addressed the question whether motor imagery and execution of swallowing activate comparable brain areas, which has been already proven for hand and foot movements. Prior near-infrared spectroscopy (NIRS) studies provide evidence that this is the case in the outer layer of the cortex. With the present fMRI study, we want to expand these prior NIRS findings to the whole brain. Second, we used motor imagery of swallowing as mental strategy during visual neurofeedback to investigate whether one can learn to modulate voluntarily activity in brain regions, which are associated with active swallowing, using real-time fMRI. Eleven healthy adults performed one offline session, in which they executed swallowing movements and imagined swallowing on command during fMRI scanning. Based on this functional localizer task, we identified brain areas active during both tasks and defined individually regions for feedback. During the second session, participants performed two real-time fMRI neurofeedback runs (each run comprised 10 motor imagery trials), in which they should increase voluntarily the activity in the left precentral gyrus by means of motor imagery of swallowing while receiving visual feedback (the visual feedback depicted one’s own fMRI signal changes in real-time). Motor execution and imagery of swallowing activated a comparable network of brain areas including the bilateral pre- and postcentral gyrus, inferior frontal gyrus, basal ganglia, insula, SMA, and the cerebellum compared to a resting condition. During neurofeedback training, participants were able to increase the activity in the feedback region (left lateral precentral gyrus) but also in other brain regions, which are generally active during swallowing, compared to the motor imagery offline task. Our results indicate that motor imagery of swallowing is an adequate mental strategy to activate the swallowing network of the whole brain, which might be useful for future treatments of swallowing disorders.

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Age-related differences in the within-session trainability of hemodynamic parameters: a near-infrared spectroscopy–based neurofeedback study

Kober

Spörk

Bauernfeind

et al. 2019

Neurobiology of Aging

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Noninvasive Brain Stimulation for Treatment of Post-Stroke Dysphagia

Cited by 6 publications

References 60 publications

Hemodynamic Signal Changes Accompanying Execution and Imagery of Swallowing in Patients with Dysphagia: A Multiple Single-Case Near-Infrared Spectroscopy Study

Hemodynamic Signal Changes Accompanying Execution and Imagery of Swallowing in Patients with Dysphagia: A Multiple Single-Case Near-Infrared Spectroscopy Study

Effects of Motor Imagery and Visual Neurofeedback on Activation in the Swallowing Network: A Real-Time fMRI Study

Age-related differences in the within-session trainability of hemodynamic parameters: a near-infrared spectroscopy–based neurofeedback study

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