Cancelled: UCLP Centre for Neurorehabilitation seminar: Professor Maggie-Lee Huckabee

• The changing landscape of swallowing rehabilitation: Strength vs Skill Paradigms
• Please send enquiries to: cnr@ucl.ac.uk

Seminar topic:

In our early days of understanding swallowing neural control, we presumed this task to be a brainstem generated reflex, with little cortical contribution. In keeping with this thinking, the majority of our behavioural rehabilitation approaches have focused on increasing muscle strength - with the presumption that if we could not adapt the 'reflex', we may well be able to strengthen the muscles that execute the response. These approaches may well be very appropriate in many cases. But what if the patient is not weak? As we make advances in our understanding of cortical neural modulation of deglutition, we are more often viewing ingestive swallowing as a 'response' rather than reflex, representing an overlearned but adaptable motor behaviour. Although there continue to be many outstanding questions to a clear understanding of deglutitive neuromotor control, this shift in thinking opens a conceptual door for a variety of innovative options for rehabilitation. Recent research across a number of laboratories has focused attention on the refinement of swallowing 'skill'. Skill-based training focuses not on underlying strength (and indeed may exclude maximal strength tasks), but on aspects of coordination and control of timing and relative strength of swallowing. Several studies document very promising outcomes when using specific instrumental tools as biofeedback modalities, thus providing the important knowledge of performance and results necessary for adaptation of skill. Other studies have provided less specific feedback, suggesting that there may be some transference of skill with increased cortical engagement.

This presentation will address the conceptual shift in our understanding of swallowing neural control and subsequent rehabilitation practices. This will follow with a review of published rehabilitation approaches which address swallowing skill and will conclude with more questions than answers about what is left to discover in the rehabilitation of the dysphagic patient.