Applying Principles of Motor Learning in Dysphagia Rehabilitation

Abstract

Dysphagia or difficulty swallowing can be the consequence of numerous neurological and medical conditions. In mild forms individuals may be restricted in the types of foods and liquids they are able to consume, in its most severe form individuals are unable to consume any food or liquid orally and depend on direct nutrition to the stomach via a feeding tube. Dysphagia is associated with multiple adverse health outcomes including pulmonary complications, dehydration and malnutrition. Furthermore, the psychosocial impact of dysphagia is devastating. In most cultures, socializing with friends and family frequently involves enjoying a shared meal or drink and celebrations and holidays often have an accompanying feast.

Swallowing is complex movement involving both volitional and reflexive components. Our understanding of the neural underpinnings of swallowing continues to evolve. Alongside this, our understanding of the motor control of swallowing is augmented. A related concept to motor control, is motor learning which refers to the mechanism underlying the ability to develop skilled movements. The role of motor learning has primarily been studied in neurologically intact individuals. Its application to rehabilitation has gained traction across allied health disciplines. In speech pathology, it has been explored most thouroughly in Motor Speech Disorders. Emerging evidence is arising in the clinical practice area of voice. The role of motor control and motor learning for swallowing and dysphagia rehabilitation has been recognised. To date, no research prospectively designing an intervention program grounded in principles of motor learning is available.

The overarching goal of this doctoral research program was to evaluate the potential benefit of applying the Principles of Motor Learning to dysphagia rehabilitation. In achieving this, an important objective was to present a multifaceted perspective on the current status of dysphagia rehabilitation and draw together conceptual, empirical, clinical and patient perspectives. This research program is motivated in clinical practice so translational research findings are paramount to its inception, development, implementation and dissemination.

Review the status of motor control for complex movements like swallowing and the implications of motor learning in neurologically injured populations. (Chapter 1)

Present a clinically oriented evidence-based review of intervention options for severe dysphagia following brainstem stroke. This chapter reports an evidence based response to a case based scenario based on the first participant in this study. (Chapter 2)

Review the literature investigating behavioural intervention for post stroke dysphagia through the lens of motor learning.(Chapter 3)

Develop an intervention protocol grounded in the practice and feedback principles of motor learning. (Chapter 4)

Report on outcomes of the intervention protocol using single case experimental design methodology to evaluate efficacy. (Chapter 5)

Interview and thematically analyse the perspectives of stroke survivors with chronic dysphagia who have completed the research led intervention program. (Chapter 6)

From this multifaceted perspective future directions and clinical implications are recommended.