Crary Michael A, Carnaby Giselle D
aSwallowing Research Laboratory, Department of Speech, Language, and Hearing Sciences bSwallowing Research Laboratory, Department of Behavioral Science and Community Health, University of Florida, Gainesville, Florida, USA.
Curr Opin Otolaryngol Head Neck Surg. 2014 Jun;22(3):172-80. doi: 10.1097/MOO.0000000000000055.
To review recent literature depicting a shift in dysphagia rehabilitation in adults. Distinguishing rehabilitation from compensation in dysphagia management, a review of basic exercise principles is followed by description of recent publications depicting exercise-based therapies. Subsequently, transcutaneous electrical stimulation (TES) is reviewed as it may contribute to exercise-based dysphagia rehabilitation in adults.
Surveys have documented extensive variability in the clinical application of dysphagia therapy techniques. Despite this variability, two trends are emerging in dysphagia rehabilitation research: documentation of physiologic and functional changes within the swallowing mechanism subsequent to therapy; and prophylactic exercise-based therapies. In addition, extensive efforts have emerged describing the potential application of TES in dysphagia rehabilitation. Though results of these efforts are conflicted, TES may serve a useful role as an adjunct to well developed exercise-based rehabilitation for dysphagia.
The focus of dysphagia rehabilitation in adults is changing. Current efforts indicate that exercise-based therapies should incorporate multiple principles of exercise physiology and document physiologic change within the impaired swallowing mechanism. TES may function as an adjunctive modality; however, current practices should be evaluated to develop additional parameters of stimulation that are focused toward specific dysphagia impairments.
回顾近期描述成人吞咽困难康复发生转变的文献。区分吞咽困难管理中康复与代偿的不同，在回顾基本运动原则之后，描述近期关于基于运动疗法的出版物。随后，对经皮电刺激（TES）进行综述，因为它可能有助于成人基于运动的吞咽困难康复。
调查记录了吞咽困难治疗技术临床应用中的广泛差异。尽管存在这种差异，但吞咽困难康复研究中出现了两种趋势：治疗后吞咽机制内生理和功能变化的记录；以及预防性的基于运动的疗法。此外，已经有大量研究描述了TES在吞咽困难康复中的潜在应用。尽管这些研究结果存在冲突，但TES作为成熟的基于运动的吞咽困难康复辅助手段可能会发挥有益作用。
成人吞咽困难康复的重点正在发生变化。目前的研究表明，基于运动的疗法应纳入运动生理学的多个原则，并记录受损吞咽机制内的生理变化。TES可能作为一种辅助手段发挥作用；然而，目前的做法应进行评估，以制定针对特定吞咽困难损伤的额外刺激参数。
