Rethinking Rehab: Skill-Based Training for Swallowing Impairment

Abstract

Current rehabilitation approaches for swallowing impairment are limited by a general lack of specificity to associated pathophysiology, with many of our practices focusing on increasing strength of muscle activation. However, alternative rehabilitative options are emerging. One of these speculates on the concept of “skill training” for swallowing rehabilitation in neurogenic dysphagia. The presumed intent of this approach is to modulate neural substrates and refine motor planning for swallowing using intrinsically generated cortical modulation and adaptive practice. This manuscript provides a discussion of skill training in the context of physical rehabilitation, illustrating how this information may translate to the diagnosis and remediation of swallowing impairment. This information prompts the consideration of more diverse swallowing pathophysiologies, beyond peripheral muscle weakness. The focus on skill training approaches provides a pathway by which greater specificity of diagnosis and treatment can occur.