The pathogenesis of neurogenic dysphagias is not restricted to sensori
motor deficits of the oropharyngeal and laryngeal region but has to be
viewed in most cases in terms of a disturbed swallowing reflex, a red
uced elevation of the hyoid-larynx-complex, or a dysfunction of the up
per esophageal sphincter (UES). Videofluoroscopy with high spatial and
temporal resolution, radiomanometry (of the pharynx and the UES) and
endoscopy play a pivotal role in the diagnosis of dysphagia and the de
gree of aspirations. Invasive therapies are rarely indicated, because
swallowing rehabilitation is very effective. By means of indirect (cau
sal) methods (e.g. thermal stimulation) or direct (Compensatory) metho
ds such as swallowing maneuvers about two thirds of patients who are d
ependent on tube feeding on admission can be discharged as total oral
feeders after a therapy duration of about: three months. Time between
onset of disease and the beginning of swallowing therapy plays a minor
role in respect of functional outcome. Based on logistic-regression a
nalysis we found that the following admission variables were significa
ntly associated with a poor outcome: difficulty managing one's secreti
ons, low Barthel score, severely impaired oral feeding: higher age and
the frequency of pneumonias during hospital stay were also (but only
weakly) associated with a poor functional outcome. Among neuropsycholo
gical disturbances attentional deficits are the ones which cause most
problems during therapy. They correlate with a prolongation of therapy
duration and can in severe cases make swallowing therapy impossible.
The question whether EMC biofeedback training during rehabilitation is
superior to rehabilitation alone with regard to outcome or therapy du
ration is still unresolved. By use of new methods of three-dimensional
movement analysis the assessment of laryngeal kinematics is possible.
This allows measurement of degree of automaticity during motor learni
ng and thereby monitoring of the course of swallowing rehabilitation.